Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
  • A61B6/50—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications
  • A61B6/501—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications for diagnosis of the head, e.g. neuroimaging or craniography
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
  • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• • 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
  • A61B90/10—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 for stereotaxic surgery, e.g. frame-based stereotaxis
• • 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

Definitions

• the invention relates to a method and a device for reproducible optical representation of an intervention to be carried out with a surgical instrument according to the preamble of claim 1 and claim 9.
• the x-rays primarily show bony structures. It is therefore customary to take advantage of the more compressed information from computer tomograms for operation planning.
• the surgeon implements the X-ray findings in the operative procedure. This checks the exact position of the surgical instrument intraoperatively.
• the area of operation is also measured or examined.
• the latter is associated with all the disadvantages of conventional x-ray technology and higher radiation exposure for patient and surgeon.
• the spatial conditions in the area of the body to be operated on can only be displayed in a superimposed manner in the image that can be obtained thereby. An extremely extensive experience is required to draw at least approximately exact conclusions from this about the actual spatial conditions.
• Stereotactic surgery is a part of the
• Neurosurgery and relates to a class of operations in which probes, such as, for example, cannulas, needles, clamps or electrodes, are to be attached to brain locations or other concealed anatomical targets which are not visible from the outside.
• the stereotactic frame serves as a kind of "guiding device", which is used in human neurosurgery to guide an instrument to a specific point within the brain through a small opening in the cranium using radiographic or other visualization of reference points.
• the instrument should be brought to an exact predetermined point as precisely as possible. So if you attach the frame or device to the cranium, you can move the probe forward to a given topographic point within the skull.
• the exact point is then calculated from the determined distance and the direction between the perceived reference point and the desired target with respect to the coordinate system of the stereotactic device.
• a sample is then taken at the desired point, a local one Läsio ⁇ set or implanted radiation material.
• Punctual lesions can be set according to a plan obtained from CT images.
• These known methods and devices also require the use of a frame that is firmly adjusted on the head. It must also be borne in mind that an exact fit of the frame can only be achieved by at least three screws being screwed in firmly into the skull.
• Surgical microscope found.
• the previously stored computed tomography recordings can then be projected onto the focal plane of the surgical microscope in order to provide appropriate assistance during the operation.
• the present invention achieves significant advantages over the prior art. For the first time, it is possible to continuously display the operation area and its surroundings on a visualization system in the form of sections that can be freely selected by the surgeon, while at the same time continuously, the position of the operation instrument is also shown in the representation of the operation area, resulting in so-called overlay images.
• the position is continuously calculated from the coordinates of the instrument holder or the associated coordinate measuring device, a new x-ray is also unnecessary during the operation.
• the X-ray dose is also reduced compared to the prior art (intraoperative side fluoroscopy).
• other slice imaging methods such as magnetic resonance imaging, can also be used.
• the method according to the invention and the device according to the invention can be used particularly advantageously in the area of the facial skull (but not only there).
• Images can be represented by continuously producing photographic images from the overlay images visible on the output device. Another more expedient possibility of documentation takes place according to claim 3 in such a way that the image data of the overlay images are stored in a data memory of the data processing system, from which they can be called up again at any time and displayed again on the output device.
• the surgical instrument can be depicted in such a way that the position of the tip of the instrument is displayed on the screen as a point or crosshair.
• This type of representation is completely sufficient for performing the surgical intervention because the surgeon guides the surgical instrument manually and determines its spatial longitudinal extent.
• it can be expedient if not only the tip but at least a part of the entire instrument is depicted, so that the overlay image Longitudinal extension and the current orientation of the surgical instrument can be seen.
• FIG. 1 a schematic representation for the acquisition of a computed tomography
• FIG. 2 the slice image recordings made on the basis of computer tomography
• FIG. 3 a simplified diagrammatic illustration of a coordinate measuring device with inserted surgical instrument in connection with the body part of a patient to be treated;
• Figure 4 a computer with a graphics screen
• FIG. 5 a superimposed representation of the surgical instrument, processed according to the invention, with a slice image
• Figure 6 is a diagrammatic representation of the coordinate measuring device
• Figure 7 is a sectional view of one with a
• Coupler equipped with a code scanner for receiving an instrument carrier provided with a code symbol
• Figure 8 is a side view of the instrument carrier with code characters
• Figure 9 is a view of a partially shown articulated arm of a second embodiment 5 of a coordinate measuring device with a
• FIG. 10 a partially sectioned top view of the articulated arm 10 shown in the extended position according to FIG. 9.
• FIG. 3 shows a simplified coordinate measuring device (1), the structural design of which is shown in FIG. 6.
• the 15 coordinate measuring device (1) has an adjustable arm (3) on a rod (2).
• the boom (3) is connected via a joint (4) to an arm (5) which can be pivoted in the horizontal plane.
• a resolver (6) is arranged, which is one of the
• a support rod (11) is pivotably arranged by means of a joint (10), the pivoting of which is detected by a resolver (12).
• the support rod (11) can also be rotated about its longitudinal axis via a joint (13). The rotational position of the support rod (11) is detected by a resolver (14).
• second support rod (16) is pivotally arranged, the pivot position of which is detected by a resolver (17).
• the support rod (16) can also be rotated about its longitudinal axis via a joint (18). The rotational position of the support rod (16) is detected by a resolver (19).
• the components (3) to (19) form an articulated arm (20) with six axes of rotation.
• the joints (4), (7), (10), (13), (15), (18) are designed so that they are self-locking, but can be moved with little effort.
• the resolvers (6), (9), (12), (14), (17), (19) are incremental resolvers with 4,000 pulses per revolution. This large number of pulses results in a very precise angle detection of the swivel and / or rotational position of the relevant members of the articulated arm (20).
• the resolvers (6), (9), (12), (14), (17), (19) are connected to a data processing system shown graphically in FIG.
• a flange (23) On the support rod (16) in the region of its free end a flange (23) is fixed, the U start side is covered by a sleeve (24).
• a pin (25) flattened on one side is formed on the support rod (16) in connection with the flange (23).
• a spring-loaded ball (27) is arranged in a transverse blind bore (26) of the pin (25) and is secured against falling out by a corresponding constriction (not shown) at the edge of the bore (26).
• An instrument carrier (28) is attached to the pin (25) and is associated with one of the balls (27) this has a recess (29) forming a locking mechanism.
• the carrier (28) contains a bore (30) designed to match the shape of the flattened pin (25), as a result of which the carrier (28) is secured against rotation.
• a surgical instrument (31) is detachably fastened in the carrier (28).
• the carrier (28) and the pin (25) thus form a coupling (32) for connecting the surgical instrument (31) to the articulated arm (20) of the coordinate measuring device (1), which thus also serves as a guiding and holding device for the instrument ( 31) forms.
• a plurality of circularly arranged blind bores (33) are provided on the end face of a flange part of the instrument carrier (28), in which three permanent magnets (34) are fastened.
• the arrangement of the permanent magnets (34) forms an identification code assigned to the instrument (31) used.
• a number of Hall generators (35) corresponding to the number of blind bores (33) are arranged in the flange (23), which are exactly opposite the bores (33) or the permanent magnets (34) used in them and form a code scanner (36).
• the permanent magnets (34) cause the Hallge ⁇ eratoren (35) assigned to them to generate a signal.
• the signals generated by the Hall generators (35) or the code scanner (36) are fed to the data processing system (21), whereby this is informed of the type and size of the surgical instrument (31) connected to the articulated arm (20).
• the coordinate measuring device (50) partially shown in FIG. 9 has one on one The rod (51), which is adjustable, is not shown.
• a transversely projecting support plate (54) is formed at the lower end of the articulated bolt (53).
• a transversely projecting hollow arm (56) is attached to the carrier plate (54). Attached to the arm (56) is a pin (57) which extends coaxially to the hinge pin (53) and which transmits the rotational position of the arm (56) to a resolver (58) which is secured against rotation by means of a holder (59) on the arm (51) is arranged.
• a hollow arm (61) which can be pivoted in the vertical plane, the angular position of which arm is via a hinge pin
• a hollow support rod (65) is pivotally mounted by means of a joint (64), the pivot position of which is arranged on one of the arm (61) via one of two joint pins (66) (FIG. 10) which are aligned with one another
• the resolver (67) is transmitted.
• a sleeve (68) is rotatably mounted on the support rod (65) and is connected in a rotationally fixed manner to a second support rod (69) (FIG. 10).
• the rotational position of the second carrier rod (69) relative to the first carrier rod (65) is transmitted via a shaft (70) to a resolver (71) arranged on the carrier rod (65).
• the components (51 to 71) are components of a gele ⁇ kar it (72), which is constructed similarly to the articulated arm (20) (FIG. 6) and thus, in addition to these components, has a further support rod, not shown, which can be rotated transversely and longitudinally.
• the articulated arm (72) thus has six axes of rotation like the articulated arm (20).
• a likewise not shown instrument carrier is connected to the carrier rod (not shown) via a coupling (not shown) corresponding to the coupling (32), which is constructed like the instrument carrier (28).
• the articulated arm (72) is provided with a weight balancing mechanism (73).
• This has a fork-shaped support (74) which is clamped onto the upper end of the hinge pin (53) and which contains a fixed pin (75) at its upper end.
• Two toothed belt wheels (76, 77) are freely rotatably mounted on the bolt (75).
• a rod (78) is fixedly connected to the front toothed belt wheel (76), at the end of which a compensating mass (79) is arranged.
• a longer rod (80) is firmly connected to the rear toothed belt wheel (77), at the end of which a compensating mass (81) is arranged.
• a pin (82) running parallel to the pin (75) is fixedly arranged in the arm (56), on which two independently rotating double toothed belt wheels (83, 84) are mounted.
• the rear toothed belt wheel (77) and the inner wheel of the rear double toothed belt wheel (84) are connected to one another by a toothed belt (85).
• the outer wheel of the rear double toothed belt wheel (84) is via a toothed belt e ⁇ (86) with a not shown Toothed belt wheel connected, which is arranged on the hinge pin (62) and rotatably connected to the arm (61).
• the front toothed belt wheel (76) and the inner wheel of the front double toothed belt wheel (83) are connected to one another by a toothed belt (87).
• the outer wheel of the front double toothed belt wheel (83) is connected via a toothed belt (88) to a wheel of a double toothed belt wheel (89) which is freely rotatable on the hinge pin (62).
• the other wheel of the double toothed belt wheel (89) is connected to a toothed belt wheel (91) via a toothed belt (90), which is arranged on the front hinge pin (66) and rotatably connected to the support rod (65).
• the toothed belts (90, 88 and 87) transmit the pivoting movements of the support rod (65) to the front toothed belt wheel (76), whereby the rod (78) is pivoted in the same direction of rotation with the compensating mass (79).
• the movement relationships between the support rod (65) and the balancing mass (79) are comparable to those described above
• Hinge pin (66) can be moved with a largely uniform, low force.
• a two-part closed housing (92) is clamped onto the adjusting ring (55) and surrounds the movement paths of the compensating masses (79, 81).
• the six resolvers are housed together in a housing comparable to the housing (92), the individual resolvers being connected to the individual links of the joint arm via respective toothed belt or gear drives.
• the articulated arm is not only lower in mass and therefore easier to handle, but also slimmer, which reduces the risk of collisions.
• a person to be treated (as shown in FIG. 1) is pushed into a suitable layer image recording device (40) in order to take several layer images.
• computer tomography recordings or, for example, magnetic resonance imaging can be produced here.
• FIG. 2 shows schematically the layer receptacles (41) recorded according to FIG. 1.
• three measuring points (42) are marked, fastened, esse ⁇ or fixed in the area of interest of a person to be operated, two of which are located in the area of the ears, while the third is formed, for example, by the gap between the two upper incisors that runs out below can be.
• Ceramic particles are particularly suitable because they do not cause any reflection in the corresponding images.
• the measurement points (42) mentioned are on the slice recordings (41) shown in FIG relevant position or location and included in the data.
• the layer image data provided with the data of the measuring points, which in their entirety reflect a spatial structure of the body part to be treated, are stored in a corresponding memory of the data processing system.
• the patient is kept lying on an operating table and adjusted.
• the position of the three measuring points (42) attached and fastened or fixed to the patient is first determined using the coordinate measuring device (1) mentioned. This is done in such a way that the surgical instrument (31) or a button used instead is brought into contact with the measuring points (42), the instrument or button being raised, lowered, inclined completely unimpeded due to the articulation of the articulated arm (20) , can be adjusted and advanced at an angle. Every movement and position of the individual links of the articulated arm (20) is exactly recorded via the resolvers (6), (9), (12), (14), (17), (19) and transmitted to the data processing system (21). The position data of the measuring points (42) obtained in this way are compared with the image data of the
• Measuring points (42) checked in the data memory (7) By means of a corresponding calculation by the computer, the measuring points (42) determined in their position on the operating table are brought into agreement with the stored image data of the measuring points (42) such that an exact assignment of the stored ones is now made
• Layer recording data with the specific spatial position of the patient and especially the surgical instrument (31) is made.
• the computer retrieves the characteristic values assigned to the corresponding surgical instrument (31) and stored in the data memory via the size and the distance of the instrument tip from the instrument carrier (28), which means that any of the various instruments can be used for any one Position of the instrument holder (28) is calculated by the computer, the exact position of the instrument tip.
• the operation can be started, so that with a movement and a corresponding intervention, the tip or the effective area of the surgical instrument can now be detected via the coordinate measuring device (1) with every movement, however small, and / or angular movement and determined by means of the computer.
• This detected movement of the surgical instrument is then displayed on the computer (22), together with the current slice image recording, which creates a superimposed image (43).
• the image data of the overlay images (43) are stored in the data memory for documentation of the course of the surgical intervention, from which they can be called up again at any time and displayed again on the screen (22).
• the slice image into which the instrument tip now moves is automatically displayed instead of this image. This provides the surgeon with the maximum information about the exact area in which he is during the operation.
• Another measure for better information about the spatial position of the instrument tip within the operating area can be achieved by simultaneously displaying overlay images which were formed by longitudinal, transverse and horizontal slice images in different windows of the screen (22).
• the help provided by the device described can be further increased by, for example, one of the next lower ones depending on requirements
• Layers can be displayed in advance on the screen (22) in order to consider beforehand in which direction the surgical instrument (31) is to be moved further. This also significantly improves security compared to conventional methods and devices.
• the coordinate measuring device (1) described does not only serve for the position detection of the surgical instrument carrier
• This offers the further advantage that it can also be checked at any time during the operation whether the exact position of the patient has been maintained. All you have to do is Using an instrument, the three measuring points (42) are also traversed during the operation and the corresponding position data are each input into the computer. If a slight change in the position of the part of the body to be treated has been determined, this change in position can immediately be calculated and the image displayed on the screen (22) can be corrected.
• the surgical instrument of the coordinate measuring device (1) is detachably attached to the articulated arm (20) or connected to it. It is also possible, however, that the surgical instrument is continuously monitored contactlessly via a "locating device", that is to say a coordinate measuring device, and as a result the exact position coordinates of the tip or the effective area of the instrument are determined and forwarded to the computer. This can be done using, for example, three spatially arranged probes and three detectors.
• the position coordinates are determined on the basis of an acoustic or optical or electromagnetic path (e.g. above or below the light wave range).
• the data thus obtained can be transferred to the patient during the operation by traversing the resulting cavities in the form of an envelope
• Data storage is entered and the layer image data obtained before the operation are modified accordingly.
• the current conditions which have changed during the operation can thus be displayed on the screen (22).
• the so obtained Post-operative slice images are also stored in the data memory for documentation of the result of the operation.

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• Health & Medical Sciences (AREA)
• Life Sciences & Earth Sciences (AREA)
• Surgery (AREA)
• Engineering & Computer Science (AREA)
• Medical Informatics (AREA)
• Veterinary Medicine (AREA)
• Biomedical Technology (AREA)
• Heart & Thoracic Surgery (AREA)
• Molecular Biology (AREA)
• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
• Public Health (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Pathology (AREA)
• Oral & Maxillofacial Surgery (AREA)
• Neurology (AREA)
• Robotics (AREA)
• Neurosurgery (AREA)
• Dentistry (AREA)
• Physics & Mathematics (AREA)
• Biophysics (AREA)
• High Energy & Nuclear Physics (AREA)
• Optics & Photonics (AREA)
• Radiology & Medical Imaging (AREA)
• Apparatus For Radiation Diagnosis (AREA)
• Image Processing (AREA)
• Microscoopes, Condenser (AREA)
• Length Measuring Devices With Unspecified Measuring Means (AREA)

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Cited By (87)

Families Citing this family (143)

Citations (6)

Family Cites Families (7)

• 1987
  • 1987-05-27 DE DE3717871A patent/DE3717871C3/de not_active Expired - Fee Related
• 1988
  • 1988-05-21 WO PCT/EP1988/000457 patent/WO1988009151A1/de not_active Ceased
  • 1988-05-21 EP EP88904956A patent/EP0359773B2/de not_active Expired - Lifetime
  • 1988-05-21 AU AU18056/88A patent/AU621053B2/en not_active Ceased
• 1990
  • 1990-01-29 US US07/445,838 patent/US5186174A/en not_active Expired - Lifetime

Patent Citations (6)

Non-Patent Citations (1)

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