WO2004067053A2 - Systeme de technique medicale muni d'un dispositif oblong - Google Patents

Systeme de technique medicale muni d'un dispositif oblong Download PDF

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Publication number
WO2004067053A2
WO2004067053A2 PCT/EP2004/000465 EP2004000465W WO2004067053A2 WO 2004067053 A2 WO2004067053 A2 WO 2004067053A2 EP 2004000465 W EP2004000465 W EP 2004000465W WO 2004067053 A2 WO2004067053 A2 WO 2004067053A2
Authority
WO
WIPO (PCT)
Prior art keywords
elongated
sensor
elongated egg
actuator
force
Prior art date
Application number
PCT/EP2004/000465
Other languages
German (de)
English (en)
Other versions
WO2004067053A3 (fr
Inventor
Jörg Herrmann
Thorsten Kern
Original Assignee
Technische Universität Darmstadt
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Technische Universität Darmstadt filed Critical Technische Universität Darmstadt
Publication of WO2004067053A2 publication Critical patent/WO2004067053A2/fr
Publication of WO2004067053A3 publication Critical patent/WO2004067053A3/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
    • A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
    • A61B5/6885—Monitoring or controlling sensor contact pressure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • 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
    • A61B34/70—Manipulators specially adapted for use in surgery
    • 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
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A61B34/76—Manipulators having means for providing feel, e.g. force or tactile feedback
    • 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
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A61B34/77—Manipulators with motion or force scaling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/021—Measuring pressure in heart or blood vessels
    • A61B5/0215—Measuring pressure in heart or blood vessels by means inserted into the body
    • 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
    • A61B2017/00022—Sensing or detecting at the treatment site
    • 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
    • A61B2017/00207—Electrical control of surgical instruments with hand gesture control or hand gesture recognition
    • 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
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/064—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension

Definitions

  • the invention relates to a medical device with an elongated device for at least partially importing into an organism.
  • a device with an elongated device is to be understood as medical-technical instruments, such as a catheter, a catheter with a guide wire, a flexible endoscope, that is to say essentially instruments of minimally invasive surgery.
  • Such a device comprises an elongated device with a small thickness in relation to the length, in particular a small diameter in relation to the length.
  • One possible application of the device is to be able to display organs in an X-ray image with the addition of contrast media conveyed by the elongated device as a result of the absorption of X-rays.
  • the elongated device can also be used for surgical operations on the beating heart, for dilating vessels or for an intervention on blood-carrying vessels in the brain.
  • the elongated device In order to bring the elongated device to the desired location in the organism, it must be inserted into the respective organism at least partially via a natural or artificial body opening.
  • the elongated device can have equipment for manipulating the respective vessel at its end facing the organism, or can be designed to inject certain fluids into the corresponding location in the organism.
  • the placement, that is, insertion, of the elongated device onto the area to be examined or treated is carried out according to conventional practices by manually pushing the elongated device toward the treatment area.
  • the advancement harbors a source of injuries to the vessels, vessel walls and tissues of the organism, particularly through the tip of the elongated device, namely when the advancement takes place in an uncontrolled manner and edges of the tip enter the tissue of the organism cut in mus.
  • real-time X-ray contrast medium image recordings or video recordings can be used, for example, when examining venous or arterial blood vessels.
  • the doctor uses his knowledge of the particular course of the vessel to be cathetized. Less experienced doctors cannot fall back on such a wealth of experience.
  • the attending physician is assisted by the forces that can be felt on the actuating handle when manually pushing the elongated egg device onto the latter, which forces can tell the trained physician which course the vessel to be catheterized is taking.
  • a medical device with a sensor is known from US Pat. No. 6,221,023, which can measure the forces occurring at the tip of the elongated device when it is introduced into the organism.
  • the measurement results determined by the sensor are visually shown on a display.
  • the operation of the instrument requires a high level of attention from the operator, who must constantly closely monitor the displayed measurement results.
  • short shortcomings in concentration, eye fatigue, which is not uncommon when looking at the screen for a longer period of time, and brief wandering of the eyes from the screen can lead to decisive treatment errors by the doctor.
  • US-6,096,004 discloses a minimally invasive surgical arrangement that enables remote actuation of the minimally invasive instrument.
  • a main control device and a secondary control device are provided for this, the main control device electrically evaluating mechanically detected actuation movements of an operator and communicating them as electrical signals to the secondary control system by remote transmission.
  • the secondary control system transmits the signals to an actuator, which manipulates an elongated device on the basis of the operating movements of the operator.
  • the actuator of the secondary control system has sensors which can determine operating forces transmitted from the elongated device to the actuator.
  • the main control device and the secondary control device located elsewhere by the main control device communicate via remote signal transmission and the operator cannot establish direct physical contact with the patient, the operating forces determined on the secondary control system are transmitted to another actuator connected to the main control system, which gives the operator a haptic impression of the Mediate operational forces of the instrument.
  • the disadvantage of the local separation of operator and patient, if not eliminated, can be mitigated.
  • the operator becomes a sum of forces; such as " the frictional forces, the elastic deformation forces and the collision forces that may occur, the tip of the instrument against a tissue obstacle.
  • the forces on the actuating element are consequently filtered, or rather falsified, by a mechanical low-pass filter, the filter effect of which depends on the length of the miminal invasive instrument, depends on its mass, the friction on the vessel walls and many other parameters.
  • the medical device according to the invention has an elongated device, such as a catheter or a flexible endoscope, which is provided with at least one sensor.
  • the sensor on the elongate device detects a force or forces which, for example, attack or attack the regions of the elongate device to be turned towards the organism when the elongate device is pushed into the organism.
  • the operator is immediately tactile informed whether, for example, an obstacle, such as a vasoconstriction, hinders further advancement of the elongated device, because the direct measurement of the intracorpuscular forces gives the operator direct information about the force conditions at the potential danger point of the elongated device Egg seal.
  • the tactile feedback clearly communicates an obstacle to the operator, so that there is no need to injure the tissue even if the attending physician is unable to concentrate.
  • the device according to the invention can prevent an operator from causing injury to vessels of the organism by undosed feed movements. Forces or moments that could injure vessel walls can be recognized very early, namely felt. Since the forces are detected intracorpuscularly in the device according to the invention, the disturbing factors, such as the friction and the elasticity of the elongated device, which falsify the force measurement results determined outside the body, can be largely eliminated.
  • the device according to the invention can be provided with a plurality of sensors on the elongated device in order thereby to determine more precisely the direction of action of a force acting in the area of the sensors and to make it more precisely perceptible to the operator.
  • a more precise guidance of the elongated device by the organism is achieved, the risk of injury to the organism being virtually excluded.
  • the actuation area is mechanically and / or structurally coupled to the elongated device.
  • the actuator is structurally separated from the elongated device, the measurement results recorded on the sensor being transmitted telemetrically to the actuator, and mechanically coupled to the actuating component, the actuating component supply component a haptic impression corresponding to the forces detected on the elongated component can be conveyed.
  • the actuator which can carry out a translational and rotational movement of the elongated egg device, is accommodated in a sleeve.
  • the cuff can advantageously be attached extracorpuscularly or extracorporeally to a limb of the organism. In this way, a fixed reference point of the device with respect to the organism is defined.
  • a particularly simple embodiment of an actuation area which should be designed to be held in the hand of the operator, is realized by the shape of a syringe, which also allows fluid to be injected through the elongated device.
  • the device according to the invention comprises an egg device for controlling the actuator.
  • the control device controls the forces and moments to be generated by the actuator acting on the elongated egg device or the actuation area.
  • the forces or moments to be generated by the actuator depend, on the one hand, on the strength of the forces on the elongated device, which forces are detected by the at least one sensor.
  • the force output by the actuator depends on the standardizable operating conditions, which include the friction between the elongated device and the organism and the elasticity of the elongated device, the actuator, the actuation area, etc.
  • the friction increases with the increasing introduction of the elongated egg into the organism.
  • the operating forces are preferably superimposed with the forces determined, for example, at the tip of the elongated device.
  • the force to be overcome for advancing the elongated device can be represented in the following equation:
  • R frictional force to be overcome between elongated egg and organism
  • E force for elastic deformation of the elongated device
  • H the resistance force generated by the actuator, which corresponds to the force detected at the sensor.
  • the resistance force H generated by the actuator must be considerably greater than the sum of the frictional force R and the force E for the elastic deformation of the elongated device, which forces R, E the operator always has during the unobstructed advancement felt.
  • the actuator can be controlled in such a way that the operational resistance forces R, E are not overcome by the operator but essentially by the actuator itself. Consequently, the operator is only informed of the resistance forces H which are detected by the at least one sensor arranged at a desired location on the elongated egg device.
  • the actuator can thus move the elongated egg device in several directions.
  • the senor can be designed to determine, in addition to the force measurement, the position reached when the elongated egg device is introduced into the organism or the distance traveled in three-dimensional space.
  • a separate displacement or position sensor can be provided.
  • the position sensor is operationally connected to the actuator in such a way that small movements at the end of the elongated device, in particular a catheter, towards the organism result in haptic, representative movements or Changes in position on the operating area or control panel of the medical-technical device can be implemented scaled.
  • a reduction gear can be provided is arranged between the elongated device and the actuation area and ensures representative movements of greater amplitude than the actual path of the elongated egg device.
  • the elongated egg device When the path covered by the elongated egg device in an organism is scaled in representative movements at the actuation area, the elongated egg device is preferably decoupled from the actuation area.
  • the desired position or path scaling can also be realized by a control and / or regulation which processes determined position signals of the position sensor and generates movements which are clearly noticeable for the operator.
  • the force sensor signals and the position sensor signals are processed for joint evaluation and use in a control and / or regulating device in order to provide the operator with a force-scaled and path-scaled haptic size impression when inserting and moving an elongated egg device of a medical device To deliver organism.
  • the device according to the invention comprises a memory for securing the force and / or position signals.
  • a topography of the entry route to a vessel and / or the tissue stiffness of the organism along the entry route taken can be determined and optionally displayed visually.
  • the operator introduces the elongated device into the relevant area and selects a span and angular resolution.
  • the actuator can be controlled in such a way that the elongated device can be introduced into the organism automatically, in a manner that assists the operator or even without an operator being guided.
  • the device according to the invention with the “learned” movement sequences taking into account the forces that are determined in particular during the manual invasion, can easily be re-introduced with another elongated egg device as an additional control criterion
  • the learned insertion movements for pulling out the to use elongated egg seals from the organism, in particular for automatic removal without human assistance is the learned insertion movements for pulling out the to use elongated egg seals from the organism, in particular for automatic removal without human assistance.
  • an interruption mechanism which prevents the elongated egg device from being actuated.
  • This interruption mechanism can be activated if an amount of force is measured in the at least one sensor that has exceeded a predeterminable force threshold value.
  • the interruption mechanism can be designed as a clamping device which clamps the elongated egg device with a stationary component in order to block the further feed.
  • the device according to the invention has an additional safety device which prevents severe injuries to the organism.
  • the clamping device can also be implemented dynamically by the actuator communicating to the actuating area a correspondingly large resistance force, as is exerted on the actuating area by the operator.
  • a filter device which filters the signals generated by the at least one sensor, in particular by high-frequency components.
  • a device can be provided for scaling the forces determined by the at least one sensor in order to realize a step-wise, approximately continuous or continuous haptic real-time reproduction of the detected forces at the actuation area.
  • the actuator can preferably operate according to a magnetorheological or electro-rheological function mode, so that a movement impressed on the operating area by the operator can be counteracted in a damping manner.
  • the actuator actively generates forces and moments at the actuation area in order to be able to represent the flexibility of the elongated egg device in this way.
  • the actuation area is designed to accommodate elongated egg devices of different widths.
  • the actuation area is preferably capable of being able to actuate catheters with different diameters.
  • the at least one sensor is provided in the region of the end to be turned towards the organism.
  • the at least one sensor on the tip of the elongated device which is to be turned towards the organism. In this way it is ensured that obstacles, such as vasoconstrictions, are detected directly at the collision site and that the operator is haptically informed in the actuation area.
  • the at least one sensor is preferably designed as a strain gauge or as a piezoelectric component. Both embodiments can be arranged on the surface of the elongated egg seal or embedded in the material of the elongated egg seal. Especially when using a strain gauge, it can be advantageous to design the attachment point of the at least one sensor to be reinforced or weakened. In this way, the measuring sensitivity of the strain gauge can be advantageously adjusted.
  • the at least one sensor is formed by a structural metallization layer, which is preferably arranged on the surface of the elongated egg seal or embedded in the material of the elongated egg seal.
  • the at least one sensor is particularly preferably designed as an envelope that at least partially surrounds the elongated egg seal. In this way, forces acting on the elongated egg device can be fully detected.
  • the elongated egg seal can be equipped with a certain functional mechanism.
  • This can be understood to mean surgical apparatus or other functional elements, such as a balloon catheter.
  • the at least one sensor can be arranged on the side of the functional mechanism facing away from the organism.
  • the functional mechanism can also be equipped with a sensor for force detection in order to also haptically represent the functional sequences of the functional mechanism on the actuation area.
  • the preferred device comprises a means for transmitting signals from the at least one sensor, in particular for control purposes.
  • the transmission means can be designed, for example, as an electrical line, in particular as a wire introduced into the elongated egg device. For a very compact sensor arrangement of the device according to the invention, this line can also be used to supply energy to the sensor or other electrical components adjacent to the sensor.
  • Another preferred means for transmitting signals from the at least one NEN sensor can be implemented by a wireless transmitter-receiver arrangement.
  • the transmitter can lie adjacent to the at least one sensor and can be operatively connected to it.
  • the at least one sensor and / or the transmitter preferably have an autonomous energy supply, for example by arranging a component for generating energy in the structural vicinity of the sensor and / or the transmitter.
  • a wireless energy transmission mechanism can be provided for the at least one sensor and / or the transmitter.
  • an ultrasonic transmitter is provided which either sends signals through the material of the elongated egg device or through a fluid to be conveyed in the elongated egg device.
  • the device according to the invention Because of the inexpensive and simple manufacturability of the device according to the invention, it is suitable as a disposable product. In this way, inexpensive and sterile use of the device according to the invention can be ensured.
  • FIG. 1 shows a schematic view of a device according to the invention
  • FIG. 2 shows a cross-sectional view of a partial region of an elongated egg seal in a first embodiment
  • FIG. 3 shows a side view of a partial area of the elongated egg seal in a second embodiment
  • FIG. 4 shows a side view of an end of a balloon catheter which is to be turned towards the organism
  • FIG. 5 shows a side view of an end of a guidewire for a catheter which is directed towards the organism
  • FIG. 6 is a perspective view of a device according to the invention, which is attached to an arm of a patient; 7 shows a schematic perspective illustration of a construction of an actuator of the device according to the invention;
  • FIG. 8 shows a schematic side view of a structure of the operating side of a medical device according to the invention, which has a position or path scaling device;
  • Fig. 9 is a schematic perspective view of a structure of the operating side of a further embodiment of a device according to the invention.
  • FIG. 1 schematically shows the device 1 according to the invention, which comprises an elongated egg device 3 and a sensor 4, not shown in FIG. 1, arranged at the tip of the elongated egg device 3.
  • the area of the tip to be turned towards the organism is inserted into a blood vessel 5.
  • the elongated egg seal 3 abuts at its end against the inner wall of the vessel 5, so that the sensor 4 arranged there is activated and generates a force signal K, measured in accordance with the contact pressure of the egg seal 3, which is sent to a transmitter 7.
  • the transmitter 7 transmits the signal S to an amplifier 9, which comprises a control device, not shown.
  • the amplifier 9 with control device is arranged distally from the sensor 4.
  • the control device transmits a signal S V K to an actuator 11 which, in accordance with the measured force signal K, haptically influences an actuation area 13 of the elongated device.
  • the actuating area 13 is shown schematically in FIG. 1 only as part of the elongated egg seal, in order to clarify in this preferred embodiment that the elongated egg seal 3 can be structurally coupled to the actuation area.
  • the actuation area can also be designed as a separate actuation component, such as a syringe or a joy stick, to which the amplified, if necessary regulated, actuator signal S V KA can also be communicated wirelessly, which will be described in more detail later.
  • FIG. 2 shows the end of an elongated egg device 3 facing the organism, which is designed as a tubular catheter.
  • the elongated egg seal 3 comprises an inner channel 15 which is suitable for injecting a fluid, such as a contrast medium.
  • a circumferential recess 19 is provided on the outside of the elongated device 3 at a short distance d from the blunt end 17 of the elongated egg device 3.
  • the sensor 4 in the form of a Strain gauge 21 inserted such that its outer surface lies flat with the surrounding surface of the elongated device 3.
  • the 3 shows a further embodiment of the arrangement of a sensor 4 at the end region of an elongated device 3, the sensor 4 surrounding the elongated egg device along a distance 1 in this embodiment, the extent of which is greater than the diameter of the elongated egg device 3.
  • the sensor 4 can be formed by a piezoceramic film.
  • the senor 4 shows a balloon catheter 23 in the region of the end 22 of the elongated egg device 3 which is directed towards the organism and which can in particular be inflated with a contrast medium in order to widen a vasoconstriction.
  • the sensor 4 which is designed here as a strain gauge, is to be arranged on the side of the functional mechanism facing away from the organism. In this way it is ensured that the measurement results determined on the sensor 4 are not falsified by the operation of the functional mechanism.
  • the elongated egg seal 3 is designed as a guide wire 25, at the end of which facing the organism there is an adhesive layer 27 covering the flat tip region, to which a force sensor 4 is firmly attached.
  • the force sensor 4 as well as the force sensor attachment 27 and the guide wire 25 are enclosed for protection against wear with an insulating jacket which also serves as a return conductor for the force signal.
  • FIG. 6 A possible application of the device 1 according to the invention is shown schematically in FIG. 6.
  • the elongated egg seal 3 of the device 1 according to the invention is sterile inserted into the organism through a standard catheter lock 31. Before the catheter lock 31 is reached, the elongated egg seal 3 passes through one arm 33 of the patient attached cuff 35, in which the actuator (not visible) directs the elongated egg device 3 according to the forces of the sensor measured on the elongated egg device, pushes it back and forth or manipulates it in some other way.
  • FIG. 7 shows the implementation of an actuator system of an actuator 11 for generating the haptic forces on the elongated egg device 3.
  • Two cylindrical rollers 37, 39 are provided, the rotation of which (indicated by arrow A) produces the translatory advance of the elongated egg device.
  • the rotary motion actuator system is realized by the translational displacement (indicated by arrow B) of the cylindrical rollers 37, 39.
  • the cylindrical rollers 37, 39 are coupled to motors, in particular electric motors 41, 43, which ensure the drive of the cylindrical rollers 37, 39.
  • the device 1 shows in particular the structure of a medical device 1 on the operator side.
  • the device 1 is provided with a position sensor (not shown) at the end of the elongated egg device 3 facing the organism, which detects the displacement path of the elongated egg device 3 relative to the organism (not shown), in particular the vessel walls.
  • the actuator 11 is not only operatively connected to the force sensor (not shown in detail) but also to the position sensor.
  • the actuator 11 comprises an egg device (not shown in more detail) for scaling the feed path of the elongated egg device 3 determined by the position sensor.
  • the actuator 11 is designed to convert the scaled position measurement signals at the actuation area 13 into larger, noticeable movements.
  • the actuator 11 can have a reduction gear (not shown in more detail) which mechanically converts the movement of the elongated device 3, or process the position signal detected by the position sensor by means of a control device in order to generate a scaled movement corresponding to the feed path.
  • FIG. 9 shows an alternative embodiment of a medical device 101, the same reference numbers being used for identical and similar components, which are increased by 100.
  • the embodiment according to FIG. 9 essentially differs from the embodiment according to FIG. 1 in that the actuation area 113 is structurally decoupled from the elongated egg device 103.
  • the actuation area 113 is connected wirelessly, telemetrically or electrically directly to the actuator 111 (161).
  • the connection 161a serves to transmit force and / or position signals from the elongated egg device 103 to the actuation area 113.
  • the forces communicated to the operating area 113 by the operator's hand 153 and the actuating positions which are made are made via sensors, scaling devices, controls and / or controls (all accommodable at 113) provided on the operating side, essentially in a mirror-image arrangement to the organism side of the device 1, via the connection 161b is remotely communicated to the actuator 111, which in accordance with the force and position signals introduces the elongated egg device 103 to the desired vessel 163 of a patient.
  • This arrangement is particularly advantageous if, for example, the attending doctor is dangerous to health during an examination. Radiation could be exposed, for example in an X-ray examination, which is indicated schematically by a computer tomograph sheet 165.

Abstract

L'invention concerne un système médical muni d'un dispositif oblong, déterminé pour être introduit, au moins en partie, dans un organisme, par une incision pratiquée dans le corps, et qui comprend au moins un capteur qui détecte une force ou des forces agissant de manière intracorpusculaire au niveau du dispositif oblong. Il est prévu un actionneur qui produit, en fonction de la force ou des forces détectées, une impression haptique au niveau d'une zone d'actionnement du dispositif oblong.
PCT/EP2004/000465 2003-01-28 2004-01-21 Systeme de technique medicale muni d'un dispositif oblong WO2004067053A2 (fr)

Applications Claiming Priority (2)

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DE10303270A DE10303270A1 (de) 2003-01-28 2003-01-28 Medizintechnische Vorrichtung mit einer langgestreckten Einrichtung
DE10303270.3 2003-01-28

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WO2004067053A2 true WO2004067053A2 (fr) 2004-08-12
WO2004067053A3 WO2004067053A3 (fr) 2009-03-12

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WO2009009220A3 (fr) * 2007-07-09 2009-03-12 Immersion Corp Outils chirurgicaux à invasivité minimale dotés d'un retour haptique
US8845667B2 (en) 2011-07-18 2014-09-30 Immersion Corporation Surgical tool having a programmable rotary module for providing haptic feedback
US8853385B2 (en) 2008-01-17 2014-10-07 Mitsubishi Tanabe Pharma Corporation Combination therapy comprising SGLT inhibitors and DPP4 inhibitors
US9358072B2 (en) 2010-01-15 2016-06-07 Immersion Corporation Systems and methods for minimally invasive surgical tools with haptic feedback
US9579143B2 (en) 2010-08-12 2017-02-28 Immersion Corporation Electrosurgical tool having tactile feedback

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WO2005084542A1 (fr) * 2004-03-04 2005-09-15 Agency For Science, Technology And Research Appareil pour actes medicaux et ou simulation
DE102005003171A1 (de) * 2005-01-19 2006-08-03 Biotronik Crm Patent Ag Katheter mit drahtloser Datenübertragung
DE102006030407A1 (de) 2006-06-29 2008-01-03 Werthschützky, Roland, Prof. Dr.-Ing. Kraftsensor mit asymmetrischem Grundkörper zum Erfassen mindestens einer Kraftkomponente
DE102006031635A1 (de) 2006-07-06 2008-01-17 Werthschützky, Roland, Prof. Dr.-Ing. Minaturisierbarer Kraftsensor zum Erfassen eines Kraftvektors
DE102012104961A1 (de) * 2012-06-08 2013-12-12 Acandis Gmbh & Co. Kg Vorrichtung zur Betätigung eines medizinischen Führungs- oder Transportdrahtes
DE102020211999A1 (de) 2020-09-24 2022-03-24 Siemens Healthcare Gmbh Vorrichtung zum Bewegen eines medizinischen Objekts und Verfahren zum Bereitstellen eines Signals

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EP1559361A3 (fr) * 2004-01-30 2005-09-21 Fujinon Corporation Applicateur pour l'endoscope et endoscope
US7909755B2 (en) 2004-01-30 2011-03-22 Fujifilm Corporation Endoscope applicator and endoscope apparatus
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CN101730506A (zh) * 2007-07-09 2010-06-09 英默森公司 带有触觉反馈的微创外科工具
US8853385B2 (en) 2008-01-17 2014-10-07 Mitsubishi Tanabe Pharma Corporation Combination therapy comprising SGLT inhibitors and DPP4 inhibitors
US9358072B2 (en) 2010-01-15 2016-06-07 Immersion Corporation Systems and methods for minimally invasive surgical tools with haptic feedback
US9579143B2 (en) 2010-08-12 2017-02-28 Immersion Corporation Electrosurgical tool having tactile feedback
US8845667B2 (en) 2011-07-18 2014-09-30 Immersion Corporation Surgical tool having a programmable rotary module for providing haptic feedback

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