WO2015030157A1 - Système de support de chirurgie et dispositif de support de chirurgie - Google Patents

Système de support de chirurgie et dispositif de support de chirurgie Download PDF

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Publication number
WO2015030157A1
WO2015030157A1 PCT/JP2014/072685 JP2014072685W WO2015030157A1 WO 2015030157 A1 WO2015030157 A1 WO 2015030157A1 JP 2014072685 W JP2014072685 W JP 2014072685W WO 2015030157 A1 WO2015030157 A1 WO 2015030157A1
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WO
WIPO (PCT)
Prior art keywords
identification information
tag
processing device
receiving antenna
signal
Prior art date
Application number
PCT/JP2014/072685
Other languages
English (en)
Japanese (ja)
Inventor
寿彦 佐藤
岡田　実
忠男 杉浦
裕美 高畑
Original Assignee
国立大学法人京都大学
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Application filed by 国立大学法人京都大学 filed Critical 国立大学法人京都大学
Publication of WO2015030157A1 publication Critical patent/WO2015030157A1/fr

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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
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • 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
    • A61B90/90—Identification means for patients or instruments, e.g. tags
    • 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
    • A61B90/90—Identification means for patients or instruments, e.g. tags
    • A61B90/98—Identification means for patients or instruments, e.g. tags using electromagnetic means, e.g. transponders
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00743—Type of operation; Specification of treatment sites
    • A61B2017/00809—Lung operations
    • 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
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0807—Indication means
    • 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
    • A61B2090/3904—Markers, e.g. radio-opaque or breast lesions markers specially adapted for marking specified tissue
    • 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
    • A61B2090/397—Markers, e.g. radio-opaque or breast lesions markers electromagnetic other than visible, e.g. microwave
    • A61B2090/3975—Markers, e.g. radio-opaque or breast lesions markers electromagnetic other than visible, e.g. microwave active

Definitions

  • the present invention relates to a surgery support system and a surgery support device, and more particularly to a technique for specifying the position of a lesion.
  • the tag device is placed in the body using a device that has a relatively low burden on the patient, such as an endoscope device.
  • a device that has a relatively low burden on the patient such as an endoscope device.
  • the antenna is scanned in the body of the patient, and the position of the tag device (the position of the lesion) is detected from the area where the signal transmitted from the tag device can be received. ) Is considered.
  • the present invention has been made in view of the above-described reasons, and an object thereof is to provide a surgical operation support system that allows an operator to easily grasp the position of a lesion.
  • a surgical operation support system includes a plurality of tag devices, an operation member, and a processing device.
  • the plurality of tag devices are placed inside the living body and hold different identification information.
  • the plurality of tag devices can transmit an identification signal including the identification information.
  • the operation member has a receiving antenna capable of receiving an identification signal.
  • the processing device performs a process of acquiring identification information included in an identification signal transmitted from a tag device placed in a communicable region in which communication via a receiving antenna is possible among a plurality of tag devices.
  • the operation member further includes a display unit whose display mode changes according to the identification information acquired by the processing device.
  • the processing device acquires the identification information included in the identification signal transmitted from the tag device placed in the communicable area. Further, the display mode of the display unit changes according to the identification information of the tag device acquired by the processing device. Therefore, if a plurality of tag devices are placed near the lesion, the surgeon can easily grasp the positional relationship between each of the plurality of tag devices and the lesion by confirming the display mode of the display unit. it can.
  • an operator uses an endoscopic device that places less burden on the patient before the operation and places a plurality of tag devices in the patient's body so as to surround the lesion.
  • the surgeon can easily identify the region surrounding the lesion by confirming the display mode of the display part of the operation member at the time of surgery, and therefore can easily identify the position of the lesion. . Therefore, since the time required for the surgeon to operate can be shortened, the burden on the patient can be reduced.
  • the display unit may include a plurality of light emitting units corresponding to identification information held by a plurality of tag devices. According to this configuration, by checking which of the plurality of light emitting units included in the display unit emits light, which of the plurality of tag devices is present in the communicable area, the operator Can be easily confirmed.
  • the display unit blinks the light emitting unit corresponding to the identification information, and the receiving antenna and the tag device.
  • the blinking frequency of the light emitting unit may be changed according to the distance between the two. According to this configuration, the surgeon can visually grasp the distance between the receiving antenna of the operation member and the tag device existing in the communicable region from the blinking frequency of the light emitting unit.
  • the processing device acquires the identification information
  • the light emitting unit corresponding to the identification information included in the display unit is turned on, and the receiving antenna and the tag device
  • the light emission intensity of the light emitting unit may be changed according to the distance between the two. According to this configuration, the surgeon can visually grasp the distance between the receiving antenna of the operation member and the tag device existing in the communicable region from the light emission intensity of the light emitting unit.
  • the operation member has a rod shape
  • the reception antenna is provided at one end in the longitudinal direction
  • a display unit is provided in the vicinity of the reception antenna in the longitudinal direction. It may be what is provided.
  • the display unit is provided in the vicinity of the receiving antenna provided at one end in the longitudinal direction of the rod-shaped operation member.
  • the operation member is rod-shaped
  • the receiving antenna is provided at one end in the longitudinal direction
  • a gripping part is provided at the other end in the longitudinal direction.
  • the display portion may be provided near the grip portion in the longitudinal direction.
  • the display part is provided in the vicinity of the grip part provided in the other end part in the longitudinal direction of the rod-shaped operation member.
  • the processing device further includes a display, and the position of the tag device holding the identification information acquired by the processing device in the living body is displayed on the display screen. It may be displayed above. According to this configuration, the surgeon can confirm the position in the patient's body of the tag device that holds the identification information acquired by the processing device by confirming the display content of the display.
  • the surgery assistance apparatus viewed from another viewpoint is provided with a receiving antenna capable of receiving an identification signal including identification information of a tag apparatus transmitted from a tag apparatus placed inside a living body. And a processing device that performs processing for obtaining identification information included in the identification signal received by the receiving antenna.
  • the operation member further includes a display unit whose display mode changes according to the identification information acquired by the processing device.
  • FIG. 1 is a schematic configuration diagram of a surgery support system according to an embodiment.
  • the surgery assistance system which concerns on embodiment (a) is a side view of a tag apparatus, (b) is a perspective view of a probe.
  • It is a block diagram of the surgery assistance system concerning an embodiment.
  • It is a block diagram of a tag device concerning an embodiment.
  • It is a figure which shows an example of arrangement
  • It is a figure which shows the usage example of the endoscope apparatus which concerns on embodiment.
  • the endoscope apparatus which concerns on embodiment is shown, (a) is a partial schematic block diagram, (b) is a figure for demonstrating the usage method. It is a schematic side view of the probe which concerns on a modification. It is a block diagram of the surgery assistance system which concerns on a modification. It is a block diagram of the signal preparation device concerning a modification. The operation
  • FIG. 1 shows a schematic configuration diagram of a surgery support system according to the present embodiment.
  • the surgery support system includes a processing device 1 and a plurality (three in FIG. 1) of tag devices 2A, 2B, and 2C.
  • the processing device 1 includes a probe (operation member) 12, a signal processing device 13, and a personal computer (hereinafter referred to as “PC”) 14.
  • the probe 12 is connected to the signal processing device 13 via wirings L1, L2, and L3.
  • the signal processing device 13 and the PC 14 are connected via a wiring L4.
  • the probe 12 is rod-shaped, and a receiving antenna 121 is provided at one end in the longitudinal direction.
  • An indicator (display unit 122) is provided in the vicinity of the receiving antenna 121 in the longitudinal direction of the probe 12.
  • “near” means that the indicator 122 is provided at a position separated from the receiving antenna 121 by 0 mm to 50 mm, for example.
  • the probe 12 further includes a transmission antenna 11 that transmits a scanning signal for scanning the tag device 2A (2B, 2C).
  • the receiving antenna 121 receives identification signals transmitted from the plurality of tag devices 2A, 2B, 2C.
  • the indicator 122 includes first, second, and third light emitting units 122A, 122B, and 122C, and is associated with each tag device 2A, 2B, and 2C. Each of the first, second, and third light emitting units 122A, 122B, and 122C may blink or be turned off according to the distance between the tag devices 2A, 2B, and 2C and the receiving antenna 121.
  • the plurality of tag devices 2A, 2B, 2C are placed in the lung B of the human body of the patient P, for example.
  • a method of placing the plurality of tag devices 2A, 2B, 2C in the human lung B will be described in detail in ⁇ 3>.
  • Each of the plurality of tag devices 2 ⁇ / b> A, 2 ⁇ / b> B, and 2 ⁇ / b> C transmits an identification signal including identification information of its own device to the processing device 1 when receiving the scanning signal transmitted from the processing device 1.
  • the processing device 1 causes each of the first, second, and third light emitting units 122A, 122B, and 122C constituting the indicator 122 to blink or extinguish based on the presence / absence of the identification signal and the reception intensity of the identification signal. To do.
  • the tag device 2A (2B, 2C) includes a housing 21, a hook 22, and a circuit module 23.
  • the housing 21 has a substantially spheroid shape and is made of an insulating material such as glass.
  • the insulating material may be, for example, a resin such as a silicone resin or a fluororesin.
  • the size of the housing 21 is set to, for example, a diameter of 2.2 mm and a length of 10.2 mm.
  • the shape of the housing 21 may be, for example, a spherical shape, a rectangular plate shape, or other shapes.
  • the hook 22 includes a spiral portion 22a wound around the outer peripheral surface of the housing 21, and a hook-like portion 22b continuous to both ends of the spiral portion 22a.
  • the hook 22 is made of a metal material such as stainless steel.
  • the circuit module 23 is housed inside the housing 21. Details of the circuit module 23 will be described later.
  • the tag device 2 ⁇ / b> A (2 ⁇ / b> B, 2 ⁇ / b> C) is placed in the lung B when the hook-like portion 22 b of the hook 22 is hooked on a part of a living tissue constituting the lung B in the lung B, for example.
  • the probe 12 includes an antenna that functions as both the transmitting antenna 11 and the receiving antenna 121, an indicator 122, an elongated bottomed cylindrical main body 123, a circuit, A substrate 125 and a grip portion 124 are provided.
  • the receiving antenna 121 is a coil antenna.
  • the receiving antenna 121 is made of, for example, copper wire, and the number of windings is set to 9 times, for example. Note that the receiving antenna 121 is not limited to a coil antenna, and may be, for example, a ceramic capacitor.
  • the main body 123 is formed in an elongated bottomed cylindrical shape.
  • Wirings L1, L2, and L3 derived from the signal processing device 13 are connected to the base end of the main body 123.
  • the wiring L1 is connected to the transmitting antenna 11.
  • the wiring L2 is connected to the receiving antenna.
  • the wiring L3 is connected to the circuit board 125.
  • a magnetic core portion 123 b around which the receiving antenna 121 is wound is provided at the distal end portion of the main body portion 123.
  • a window portion 123a made of a transparent material is provided in the vicinity of the magnetic core portion 123b in the longitudinal direction of the main body portion 123.
  • “near” means, for example, that the window portion 123a is provided at a position separated from the magnetic core portion 123b by 0 mm to 10 mm.
  • parts other than the magnetic core part 123b and the window part 123a in the main body part 123 are formed of, for example, a metal material or a resin material.
  • the magnetic core portion 123b is formed of a ferromagnetic material such as ferrite.
  • the magnetic core portion 123b is formed in a cylindrical shape having a diameter of 3.5 mm and a length of 10 mm, for example.
  • the window part 123a is formed from transparent resin, transparent glass, or the like.
  • Each of the first, second, and third light emitting units 122A, 122B, and 122C is formed of a light emitting element (for example, an LED (Ling Emitting Diode)).
  • a light emitting element for example, an LED (Ling Emitting Diode)
  • the first, second, and third light emitting units 122A, 122B, and 122C are not necessarily limited to those configured from LEDs, and may be configured from other light emitting elements.
  • the first, second, and third light emitting units 122A, 122B, and 122C are preferably composed of light emitting elements that emit light of different colors in order to clarify correspondence with the tag devices 2A, 2B, and 2C.
  • the first light emitting unit 122A is configured by an LED that emits blue light
  • the second light emitting unit 122B is configured by an LED that emits yellow light
  • the third light emitting unit 122C is an LED that emits red light. Consists of
  • the first, second, and third light emitting units 122A, 122B, and 122C are mounted on the circuit board 125.
  • the circuit board 125 is disposed at a position corresponding to the window portion 123 a inside the main body portion 123.
  • the circuit board 125 supplies the current input from the signal processing device 13 through the wiring L3 to the first, second, and third light emitting units 122A, 122B, and 122C, respectively, so that the first, second, and third light emitting units are provided.
  • 122A, 122B, and 122C are caused to emit light. Light emitted from the first, second, and third light emitting units 122A, 122B, and 122C is emitted to the outside of the main body 123 through the window 123a.
  • the indicator 122 is provided in the vicinity of the receiving antenna 121 provided at one end in the longitudinal direction of the rod-like probe 12.
  • the operator inserts the probe 12 through a hole formed in a body wall such as the abdominal wall or chest wall of the patient, and performs endoscopic surgery using a laparoscope or thoracoscope while the receiving antenna 121 is brought close to the lesion C.
  • the indicator 122 easily enters the surgical field of the surgeon projected on a monitor or the like, so that the surgeon can easily grasp the position of the lesion C.
  • the indicator 122 of the probe 12 inserted from an incision or a hole in the body wall can easily enter the surgical field of the operator, so that the operator can easily grasp the position of the lesion C. Become.
  • FIG. 3 is a block diagram of the surgery support system according to the present embodiment.
  • the signal processing device 13 includes a signal generator 131, a duplexer 132, a mixer 133, an amplifier 134, an analog-digital converter (hereinafter referred to as “ADC”) 136, and a digital-analog converter (hereinafter referred to as “ADC”). 137).
  • ADC analog-digital converter
  • ADC digital-analog converter
  • the PC 14 includes a CPU (Central Processing Unit), a memory, an I / O interface, and a bus that connects these components to each other.
  • the PC 14 implements an FFT unit 142, a bandpass filter 143, and a signal detection unit 144 by executing a predetermined computer program.
  • the display 145 displays an image based on information input from the signal detection unit 144.
  • the memory stores a table indicating the correspondence between the identification information of the tag devices 2A, 2B, and 2C and the light emitting units 122A, 122B, and 122C.
  • the signal generator 131 generates a scanning signal having a frequency of 13.56 MHz, for example, and inputs it to the duplexer 132.
  • the signal generator 131 generates a scanning signal based on control information acquired from a signal detection unit 144 described later.
  • the demultiplexer 132 divides the scanning signal into the transmission antenna 11 and the mixer 133 and inputs them.
  • the duplexer 132 divides the scanning signal so that, for example, the signal voltage of the scanning signal input to the transmitting antenna 11 is nine times the signal voltage of the scanning signal input to the mixer 133. Thereby, the scanning signal input to the transmission antenna 11 is transmitted from the transmission antenna 11 to the outside.
  • the reception signal received by the reception antenna 121 is input to the mixer 133.
  • This received signal includes an identification signal transmitted from the tag device 2A (2B, 2C) and a scanning signal transmitted from the transmitting antenna 11.
  • the carrier wave of the identification signal is set to a frequency (13.56 ⁇ 0.423 MHz) shifted by 423 kHz from the frequency of the scanning signal.
  • the tag device 2A placed in an area (hereinafter referred to as “communicable area”) capable of communicating with the processing device 1 via the receiving antenna 121.
  • the identification signal transmitted from (2B, 2C) is included in the received signal. That is, the mixer 133 receives the identification signal transmitted from the tag device 2A (2B, 2C) placed in the region where the identification signal reaches the receiving antenna 121 among the three tag devices 2A, 2B, 2C. Included in the signal.
  • the mixer 133 performs town conversion of the frequency of the received signal by mixing the scanning signal input from the duplexer 132 and the received signal input from the receiving antenna 121. Then, the mixer 133 inputs the received signal whose frequency is town converted to the amplifier 134. Note that a band cut filter for cutting a band in the vicinity of the frequency of the scanning signal may be interposed between the mixer 133 and the receiving antenna 121. In this case, the scanning signal component can be more effectively excluded from the received signal.
  • the amplifier 134 amplifies the reception signal input from the mixer 133 and inputs the amplified signal to the ADC 136.
  • the ADC 136 converts a reception signal composed of an analog signal into a digital signal and inputs the digital signal to the PC 14.
  • the FFT unit 142 performs a Fourier transform on the received signal input from the ADC 136.
  • the FFT unit 142 performs Fourier transform after correcting the received signal by the Hanning window function. Thereby, the noise component which arises with the Fourier-transform process by the FFT part 142 can be reduced. Then, the FFT unit 142 inputs a signal obtained by Fourier transforming the received signal to the band pass filter 143.
  • the band pass filter 143 has a center frequency of 423 kHz.
  • the band pass filter 143 removes the scanning signal component from the received signal by passing only the band of the identification signal.
  • the identification signal that has passed through the bandpass filter 143 is input to the signal detection unit 144.
  • the signal detection unit 144 measures the strength of the identification signal, decodes the identification information included in the identification signal, and acquires the identification information.
  • the signal detection unit 144 transmits a voltage signal in the form of a pulse train to the indicator 122 of the probe 12 via the DAC 137 based on the acquired identification information.
  • the light emitting unit 122A blinks at the pulse period of the voltage signal.
  • the signal detection unit 144 can distinguish between the position of the tag device (for example, the tag device 2A) placed in the communicable area and the position of the other tag devices (for example, the tag devices 2B and 2C). It is displayed on the screen of the display 145.
  • FIG. 4 is a block diagram of the tag device 2A (2B, 2C) according to the present embodiment.
  • the tag device 2 ⁇ / b> A (2 ⁇ / b> B, 2 ⁇ / b> C) is a passive type tag device, and includes an antenna 231, a communication unit 232, a signal processing unit 233, and a storage unit 234.
  • the antenna 231 is composed of, for example, a coil antenna.
  • the antenna 231 functions as both a receiving antenna and a transmitting antenna.
  • the storage unit 234 is composed of a memory such as an EEPROM, for example, and identification information (for example, “ID1 (ID2, ID3)” in FIG. 4) corresponding to the tag device 2A (2B, 2C) in which the device itself is built.
  • ID1 ID2, ID3
  • the communication unit 232 is configured by, for example, a dedicated integrated circuit.
  • the communication unit 232 activates the signal processing unit 233.
  • the communication unit 232 transmits a signal including the identification information to the processing device 1 through the antenna 231.
  • the signal transmitted from the antenna may be a sinusoidal signal having a frequency of 423 kHz, for example.
  • the signal processing unit 233 is configured by a dedicated integrated circuit, for example. When activated by the communication unit 232, the signal processing unit 233 inputs the identification information ID 1 (ID 2, ID 3) stored in the storage unit 234 to the communication unit 232.
  • the processing device 1 transmits a signal having a frequency of 13.56 MHz to the tag devices 2A, 2B, and 2C.
  • the identification signals transmitted from the tag devices 2B and 2C do not reach the reception antenna 121 of the processing device 1. Therefore, the processing device 1 cannot receive the identification signal transmitted from the tag devices 2B and 2C.
  • the tag device 2 ⁇ / b> A exists in the communicable area of the processing device 1, the identification signal transmitted from the tag device 2 ⁇ / b> A reaches the receiving antenna 121 of the processing device 1. Therefore, the processing device 1 can receive the identification signal transmitted from the tag device 2A.
  • the signal detection unit 144 measures the strength of the identification signal transmitted from the tag device 2A, decodes the identification information ID1 included in the identification signal, and acquires the identification information. To do.
  • the decoded identification information ID1 is held by the tag device 2A placed in the communicable area.
  • the signal detection unit 144 transmits a voltage signal in the form of a pulse train to the light emitting unit 122A (122B, 122C) corresponding to the acquired identification information ID1 (ID2, ID3).
  • the signal detection unit 144 selects a transmission destination of the voltage signal with reference to a table indicating a correspondence relationship between the identification information ID1, ID2, and ID3 and the light emitting units 122A, 122B, and 122C. In this way, when the processing apparatus 1 acquires the identification information ID1 (ID2, ID3), the light emitting unit 122A (122B, 122C) corresponding to the acquired identification information ID1 (ID2, ID3) included in the indicator 122 blinks.
  • the signal detection unit 144 changes the pulse interval of the voltage signal in a pulse train according to the intensity of the identification signal. Specifically, the signal detection unit 144 decreases the pulse interval and increases the blinking frequency of the light emitting unit 122A (122B, 122C) as the strength of the identification signal increases. On the other hand, the signal detection unit 144 increases the pulse interval and decreases the blinking frequency of the light emitting unit 122A (122B, 122C) as the strength of the identification signal is smaller.
  • the greater the strength of the identification signal the shorter the distance between the receiving antenna 121 and the tag device 2A (2B, 2C) placed in the communicable area.
  • the smaller the intensity of the identification signal the longer the distance between the receiving antenna 121 and the tag device 2A (2B, 2C) placed in the communicable area.
  • the processing device 1 increases the blinking frequency of the light emitting unit 122A (122B, 122C) as the distance between the receiving antenna 121 and the tag device 2A (2B, 2C) is shorter.
  • the processing device 1 decreases the blinking frequency of the light emitting unit 122A (122B, 122C) as the distance between the receiving antenna 121 and the tag device 2A (2B, 2C) is longer.
  • the relationship between the distance between the receiving antenna 121 and the tag device 2A (2B, 2C) and the blinking frequency of the light emitting unit 122A (122B, 122C) may be reversed.
  • the processing device 1 reduces the blinking frequency of the light emitting unit 122A (122B, 122C), and the receiving antenna 121 and the tag.
  • the blinking frequency of the light emitting unit 122A (122B, 122C) may be increased as the distance from the device 2A (2B, 2C) is longer.
  • the surgeon can use the tag device 2A (2B, 2C) existing in the communication area AR1 (AR2, AR3) with the receiving antenna 121 of the probe 12 from the blinking frequency of the light emitting unit 122A (122B, 122C). Can be visually grasped.
  • FIG. 5 is a diagram illustrating an example of the arrangement of the tag devices 2A, 2B, and 2C in the surgery support system according to the present embodiment.
  • AR1, AR2, and AR3 in FIG. 5 indicate the communicable areas of the tag devices 2A, 2B, and 2C, respectively.
  • the tag devices 2A, 2B, 2C are arranged so as to surround the lesion C inside the lung B. Specifically, the tag device 2A is disposed above the lesion C, the tag device 2B is disposed on the left side of the lesion C, and the tag device 2C is disposed below the lesion C.
  • the lesion C is located in an area surrounded by the three communicable areas AR1, AR2, AR3.
  • FIG. 6 is a diagram illustrating an example of use of the surgery support system according to the present embodiment. It is assumed that the operator scans the probe 12 over the entire lung B. In this case, in the communicable area AR1, the first light emitting unit 122A of the probe 12 blinks. In the communicable area AR2, the second light emitting unit 122B of the probe 12 blinks. Then, in the communicable area AR3, the third light emitting unit 122C of the probe 12 blinks. Thereby, the surgeon can grasp the positions of the communicable areas AR1, AR2, AR3. Then, the surgeon can relatively easily recognize that the lesion C exists in the area surrounded by the three communicable areas AR1, AR2, and AR3 in the lung B. Therefore, the operator can easily identify the position of the lesion C and perform an operation for removing the lesion C.
  • the processing device 1 positions the tag device 2A (2B, 2C) holding the acquired identification information ID1 (ID2, ID3) in the patient P (for example, in the lung B). And a display mode corresponding to the identification information ID1 (ID2, ID3) of the indicator 122 is displayed on the screen of the display 145.
  • the PC 14 displays on the screen of the display 145 a graphics image of an organ to be operated (for example, lung B) and a graphics image indicating the positions of the tag devices 2A, 2B, 2C (for example, circles). Image).
  • identification information for example, “ID1”, “ID2”, “ID3” of each tag device 2A, 2B, 2C is also displayed on the screen of the display 145.
  • FIG. 7 is a diagram illustrating a usage example of the surgery support system according to the present embodiment.
  • a portion corresponding to the position of the tag device 2A in the image of the lung B on the screen of the display 145 The portion where the identification information ID1 of the tag device 2A is displayed blinks.
  • the portion corresponding to the position of the tag device 2A is also blue on the screen of the display 145.
  • the portion where the identification information ID1 is displayed may be blinked in blue.
  • the portion corresponding to the position of the tag device 2A (2B, 2C) and the portion where the identification information ID1 (ID2, ID3) is displayed are the emission colors of the light emitting units 122A, 122B, 122C. Just make it blink in the same color.
  • the operator confirms the display content of the display 145, whereby the tag device 2A (2B, 2C) holding the identification information ID1 (ID2, ID3) acquired by the processing device 1 is inside the patient P (for example, The position in lung B) can be confirmed.
  • the surgeon registers the portions corresponding to the positions of the tag devices 2A, 2B, 2C on the screen of the display 145 in advance. Specifically, first, the operator uses the endoscope device before the operation to place the tag devices 2A, 2B, 2C in the patient's body using the endoscope device 2A, The position information of 2B and 2C is grasped. Then, the surgeon may register the portion corresponding to the position of the tag devices 2A, 2B, 2C on the screen of the display 145 based on the grasped position information of the tag devices 2A, 2B, 2C.
  • FIG. 8 is a diagram illustrating a usage example of the endoscope apparatus 3 according to the embodiment.
  • the endoscope device 3 includes a device main body 32 and a tube portion 31.
  • the distal end portion of the tube portion 31 can be inserted into the lung B through the bronchus from the mouth of the patient P.
  • FIG. 9 shows the endoscope apparatus 3 according to the embodiment, in which (a) is a partial schematic configuration diagram, and (b) is a diagram for explaining a method of use.
  • an image sensor 313 and a color filter 313 b are disposed at the distal end portion of the tube portion 31.
  • An observation window 313a and an illumination window 314a are provided on the distal end surface of the tube portion 31.
  • An objective lens (not shown) is fitted in the observation window 313a.
  • a tube 311 for tag device that can accommodate the tag device 2A (2B, 2C) extends from the distal end surface of the tube portion 31 therein.
  • a thin wire 312 is disposed inside the tag device tube 311, and the position of the tip of the thin wire 312 can be changed on the device main body 32 side (see the broken line portion in FIG. 9).
  • a cable 315 connected to the image sensor 313 and an optical fiber 314 are disposed inside the pipe portion 31. Then, the image formed on the image sensor 313 through the observation window 313 a is converted into an electrical signal by the image sensor 313 and transmitted to the apparatus main body 32 via the cable 315.
  • the apparatus main body 32 is provided with a monitor 32a.
  • the electrical signal transmitted from the image sensor 313 to the apparatus main body 32 is converted into an image and displayed on the monitor 32a.
  • the distal end portion of the tube portion 31 is inserted into the bronchus T of the lung B. Thereafter, when the distal end portion of the tube portion 31 is disposed at a desired position, the tag device 2A (2B, 2C) is moved to the tag device tube 311 by changing the position of the distal end portion of the thin wire 312 on the device main body 32 side. Extrude outside.
  • the pushed tag device 2A (2B, 2C) is placed in the lung B when the hook-like portion 22b of the hook 22 is caught in a part of the living tissue constituting the lung B in the lung B.
  • the operator inserts the probe (operation member) 12 into the body through the hole formed in the body wall of the patient P, and the indicator If the (display unit) 122 is held close to the lesion C, the surgeon can perform an operation while confirming the display mode of the indicator 122 in the surgical field by the endoscope. Further, in the operation by laparotomy or thoracotomy, if the probe 12 is inserted through an incision or a hole in the body wall and the indicator 122 is held close to the lesion C, the operator can perform the indicator 122 in the operative field by direct vision. Surgery can be performed while confirming the display mode.
  • the processing device 1 acquires identification information ID1 (ID2, ID3) included in the identification signal transmitted from the tag device 2A (2B, 2C) placed in the communicable area.
  • the indicator 122 changes in display mode according to the identification information ID1 (ID2, ID3) of the tag device 2A (2B, 2C) acquired by the processing device 1. Therefore, if the three tag devices 2A, 2B, 2C are placed near the lesion C, the surgeon confirms the display mode of the indicator 122, so that each of the three tag devices 2A, 2B, 2C and the lesion The positional relationship with C can be easily grasped.
  • the operator uses the endoscope apparatus 3 that places little burden on the patient P before the operation, and places three tag devices 2A, 2B, and 2C in the body of the patient P (lung B) so as to surround the lesion C. ).
  • the operator easily identifies the communicable areas AR1, AR2, AR3 of the tag devices 2A, 2B, 2C surrounding the lesion C by confirming the display mode of the indicator 122 of the probe 12 during the operation. Therefore, the position of the lesion C can be easily specified. Accordingly, the time required for the surgeon to perform the operation can be shortened, so that the burden on the patient P can be reduced.
  • the three tag devices 2A, 2A, and 3B are confirmed by checking which one of the first, second, and third light emitting units 122A, 122B, and 122C included in the indicator 122 emits light. The surgeon can easily confirm which of 2B and 2C exists in the communicable area.
  • the processing apparatus 1 acquires the identification information ID1 (ID2, ID3)
  • the light emitting unit 122A (122B, 122C) corresponding to the acquired identification information ID1 (ID2, ID3) included in the indicator 122 is turned on. There may be.
  • the signal detection unit 144 transmits a constant voltage signal to the light emitting unit 122A (122B, 122C) corresponding to the identification information ID1 (ID2, ID3).
  • the processing device 1 may change the light emission intensity of the light emitting unit 122A (122B, 122C) in accordance with the distance between the receiving antenna 121 and the tag device 2A (2B, 2C).
  • the signal detection unit 144 changes the voltage value of the voltage signal according to the strength of the identification signal. For example, the signal detection unit 144 increases the voltage value of the voltage signal and increases the emission intensity of the light emitting unit 122A (122B, 122C) as the identification signal intensity increases. On the other hand, the signal detection unit 144 decreases the voltage value of the voltage signal and decreases the emission intensity of the light emitting unit 122A (122B, 122C) as the identification signal intensity decreases.
  • the surgeon can visually grasp the distance between the receiving antenna of the operation member and the tag device existing in the communicable region from the light emission intensity of the light emitting unit.
  • FIG. 10 is a schematic side view of probes 512 and 612 according to this modification.
  • the probe 512 is rod-shaped.
  • the probe 512 is provided with a receiving antenna 121 at one end in the longitudinal direction and a grip 124 at the other end in the longitudinal direction.
  • An indicator 122 is provided in the vicinity of the grip portion 124 in the longitudinal direction of the probe 512.
  • “near” means being provided at a position separated from the grip portion 124 by 0 mm to 10 mm, for example.
  • the indicator 122 is provided in the vicinity of the grip 124 provided at the other end opposite to the one end provided with the receiving antenna 121 in the longitudinal direction of the rod-like probe 512. .
  • the surgeon can grasp the position of the lesion C from the position of the receiving antenna 121 in the surgical field by checking the indicator 122 of the probe 512 inserted into the body outside the body of the patient P.
  • the indicator 122 may be provided at a substantially central portion in a portion other than the magnetic core portion 123 b and the grip portion 124 of the probe 612.
  • the operator confirms the position of the lesion C from the position of the receiving antenna 121 in the operative field by checking the indicator 122 of the probe 612 inserted in the body outside or inside the body of the patient P (operative field). I can grasp it.
  • the indicator 122 of the probes 512 and 612 inserted from the hole formed in the incision or the body wall in the operation by open abdomen or thoracotomy or the like is outside the patient P's body.
  • the position of the lesion C can be grasped by checking in the body.
  • FIG. 11 is a block diagram of a surgery support system according to this modification. As shown in FIG. 11, in the surgery support system, the configuration of the signal processing device 413 is different from that of the embodiment.
  • the signal processing device 413 includes first and second duplexers 432 and 438.
  • the probe 412 includes a transmission / reception antenna 421 that functions as both transmission and reception.
  • Second demultiplexer 438 divides the signal input from first demultiplexer 432 into antenna 421 and mixer 133 for input.
  • the second demultiplexer 438 divides the signal input from the antenna 421 into the first demultiplexer 432 and the mixer 133 for input.
  • the configuration of the processing device 401 can be simplified.
  • each of the plurality of tag devices 2A, 2B, 2C receives a signal transmitted from the transmission antenna 11 of the operation member 12, an example of transmitting identification information held by the own device has been described.
  • the tag device 2A (2B, 2C) receives a signal including identification information transmitted from the processing device 1, and compares the identification information received from the processing device 1 with the identification information held by itself. There may be.
  • FIG. 12 is a block diagram of the signal generator 131 according to this modification.
  • the signal generator 131 includes an interface 131a, a signal generation unit 131b, a storage unit 131c, and a communication unit 131d.
  • the interface 131a is composed of an RS232C connector, for example.
  • the storage unit 131c is configured by a memory such as an EEPROM, for example, and stores identification information (for example, “ID1”, “ID2”, and “ID3” in FIG. 12) of the tag devices 2A, 2B, and 2C. .
  • the signal generation unit 131b reads identification information from the storage unit 131c based on the control information acquired from the signal detection unit 144 through the interface 131a, and generates a scanning signal including the read identification information.
  • the tag device 2A (2B, 2C) has the same configuration as that of FIG. 4 and includes an antenna 231, a communication unit 232, a signal processing unit 233, and a storage unit 234.
  • the processing performed by the communication unit 232 and the signal processing unit 233 is different from the embodiment.
  • the communication unit 232 demodulates the scanning signal transmitted from the processing device 1 and received by the antenna 231 and inputs the demodulated signal to the signal processing unit 233. Further, the communication unit 232 transmits the response signal input from the signal processing unit 233 to the processing device 1 through the antenna 231.
  • the signal processing unit 233 decodes the identification information included in the scanning signal input from the communication unit 232. Then, the signal processing unit 233 compares the identification information obtained by decoding with the identification information stored in the storage unit 234. If the two match, the signal processing unit 233 generates a response signal and generates the communication unit 232. To enter.
  • FIG. 13 is an operation explanatory diagram of the surgery support system according to the embodiment, (a) is a sequence diagram, and (b) is a time chart showing the operation of the processing apparatus.
  • the processing device 1 broadcasts identification information (ID1) of the tag device 2A to the tag devices 2A, 2B, and 2C (steps S1, S2, and S3).
  • the tag devices 2B and 2C compare the identification information (ID1) transmitted from the processing device 1 with the identification information (ID2, ID3) held by the own device, and the identification information transmitted from the processing device 1. And the identification information held by the own device are determined not to match.
  • the tag devices 2B and 2C do not transmit a response signal.
  • the tag device 2A compares the identification information (ID1) transmitted from the processing device 1 with the identification information (ID1) held by the own device, and holds the identification information transmitted from the processing device 1 and the own device. It is determined that the information matches. Then, the tag device 2A transmits a response signal ACK to the processing device 1 (step S4).
  • the processing device 1 broadcasts the identification information (ID2) of the tag device 2B to the tag devices 2A, 2B, 2C (steps S5, S6, S7).
  • the tag devices 2A and 2C determine that the identification information (ID2) transmitted from the processing device 1 and the identification information (ID1, ID3) held by the own device do not match in the same manner as described above. In this case, the tag devices 2A and 2C do not transmit a response signal.
  • the tag device 2B determines that the identification information (ID2) transmitted from the processing device 1 matches the identification information (ID2) held by itself. Then, the tag device 2B transmits a response signal ACK to the processing device 1 (step S8).
  • the processing device 1 broadcasts the identification information (ID3) of the tag device 2C to the tag devices 2A, 2B, 2C (steps S9, S10, S11).
  • the tag devices 2A and 2B determine that the command information transmitted from the processing device 1 is not information corresponding to the own device in the same manner as described above. In this case, the tag devices 2A and 2B do not transmit a response signal.
  • the tag device 2C determines that the identification information (ID3) transmitted from the processing device 1 matches the identification information (ID3) held by itself. Then, the tag device 2C transmits a response signal ACK to the processing device 1 (step S12).
  • the processing device 1 and the tag devices 2A, 2B, and 2C repeatedly perform the above-described processing of step S1 to step S12.
  • the processing device 1 broadcasts, for example, three types of identification information in a time-sharing manner.
  • FIG. 14 is a diagram illustrating a usage example of the surgery support system according to the present modification.
  • the communicable area AR21 of the tag device 2A and the communicable area AR22 of the tag device 2B interfere with each other.
  • the communicable area AR2 of the tag device 2B and the communicable area AR3 of the tag device 2C interfere with each other.
  • the receiving antenna 121 of the probe 12 is located in an area that does not interfere with the communicable area AR22 in the communicable area AR21, only the light emitting unit 122A corresponding to the tag device 2A blinks.
  • the reception antenna 121 of the probe 12 when the reception antenna 121 of the probe 12 is located in an area that interferes with the communicable area AR22 in the communicable area AR21, the first and second light emitting units 122A and 122B corresponding to the tag devices 2A and 2B, respectively. Both flash. Furthermore, when the receiving antenna 121 of the probe 12 is located in an area that interferes with the communicable area AR23 in the communicable area AR22, both the light emitting units 122B and 122C corresponding to the tag devices 2B and 2C blink.
  • the processing device 1 can distinguish and recognize the three tag devices 2A, 2B, and 2C. Therefore, even when the three tag devices 2A, 2B, and 2C are arranged close to each other to such an extent that the communicable areas AR1, AR2, and AR3 interfere with each other, the positions of the three tag devices 2A, 2B, and 2C Can be easily identified.
  • the light emitting unit 122A (122B, 122C) is also used according to the distance between the receiving antenna 121 and the tag device 2A (2B, 2C).
  • Blinking frequency and emission intensity may be changed.
  • the processing device 1 broadcasts three types of identification information in a time division manner.
  • the signal detection unit 144 may calculate the intensity of the identification signal input from the bandpass filter 143 using the relational expression (1) below.
  • I (t) is the intensity of the identification signal input to the signal detector 144 at time t
  • I1ave, I2ave, and I3ave are average values of the intensity of the identification signals corresponding to the tag devices 2A, 2B, and 2C
  • K represents a parameter reflecting a period in which the signal detection unit 144 calculates the strength of the identification signal.
  • the signal detection unit 144 calculates the average intensity value of the identification signals corresponding to the tag devices 2A, 2B, and 2C using the above equation (1). That is, the signal detection unit 144 performs an operation of dividing the integrated intensity value by the time for each time assigned to the tag devices 2A, 2B, and 2C for the identification signal input from the bandpass filter 143.
  • the first, second The relative positions of the receiving antenna 121 of the probe 12 with respect to the tag devices 2A, 2B, and 2C can be grasped relatively easily from the difference in the blinking frequency and emission intensity of the three light emitting units 122A, 122B, and 122C.
  • the identification of the communicable areas AR1, AR2, AR3 where the receiving antenna 121 is located is based on which of the first, second, and third light emitting units 122A, 122B, 122C emits light. The example to do was demonstrated. However, identification of the communicable areas AR1, AR2, AR3 where the reception antenna 121 is located, that is, identification of the tag devices 2A, 2B, 2C closest to the reception antenna 121 is not limited to this method.
  • the probe 12 may include a display unit that displays identification numbers corresponding to the communicable areas AR1, AR2, and AR3.
  • the surgeon can recognize the tag device 2A (2B, 2C) located closest to the receiving antenna 121 of the probe 12 by confirming the identification number displayed on the display unit of the probe 12. it can. Further, an identification number corresponding to the communicable area AR1 (AR2, AR3) of the tag device 2A (2B, 2C) may be displayed on the screen of the display 145.
  • the surgeon confirms the display content of the probe 12 and the display content of the display 145 to thereby confirm the tag device 2A (2B, 2B, 2D) that holds the identification information ID1 (ID2, ID3) acquired by the processing device 1. 2C) can be confirmed. Further, even if the number of tag devices increases, there is an advantage that the probe 12 does not need to be provided with light emitting portions having different emission colors corresponding to the respective tag devices. Furthermore, since the identification number can be displayed in a single color, there is an advantage that a plurality of types of light emitting units having different emission colors are not required.
  • strength was demonstrated.
  • the index indicating the distance between the receiving antenna 121 and the tag devices 2A, 2B, and 2C is limited to the blinking frequency and light emission intensity of the first, second, and third light emitting units 122A, 122B, and 122C. It is not a thing.
  • the light emission color of each light emitting unit changes according to the distance between the receiving antenna 121 and the tag devices 2A, 2B, 2C. It may be.
  • the receiving antenna 121 when the receiving antenna 121 is located in the peripheral part of the communicable areas AR1, AR2, AR3, the light emitting unit emits purple light, and the receiving antenna 121 is connected to the tag devices 2A, 2A, AR3 in the communicable areas AR1, AR2, AR3. You may make it light-emit in red, green, and yellow, so that 2B and 2C vicinity is approached.
  • the first, second, and third light emitting units 122A, 122B, and 122C may have two types of light emitting elements having different emission colors.
  • the first light emitting unit 122A has a light emitting element that emits red light and a light emitting element that emits purple light
  • the second light emitting unit 122B emits a light emitting element that emits green light and purple light. It is sufficient to have a light emitting element that can be used.
  • the third light emitting unit 122C may have a light emitting element that emits yellow light and a light emitting element that emits purple light. And in 1st, 2nd, 3rd light emission part 122A, 122B, 122C, according to the distance between the receiving antenna 121 and tag apparatus 2A, 2B, 2C, the ratio of the emitted light intensity of two types of light emitting elements Can be changed. Alternatively, the two types of light emitting elements may be configured to alternately emit light, and the ratio of the light emission time of each light emitting element may be changed.
  • the surgeon grasps the distance between the receiving antenna 121 and each tag device 2A, 2B, 2C based on the emission colors of the first, second, and third light emitting units 122A, 122B, 122C. can do.
  • the surgery support system according to the present invention is suitable for cancer surgery and the like. It can also be applied to robotic surgery and navigation surgery.

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Abstract

L'invention concerne un système de support de chirurgie permettant à un chirurgien de localiser facilement la position d'une lésion. Le système de support de chirurgie comprend: une pluralité de dispositifs d'étiquette (2A, 2B, 2C) qui sont implantés in-vivo, chacun prenant en charge des informations d'identification différentes et pouvant émettre des signaux d'identification contenant lesdites informations d'identification; un élément d'actionnement (12) comprenant des antennes de réception (121) pouvant recevoir les signaux d'identification; et un dispositif de traitement (1) qui réalise un procédé d'acquisition des informations d'identification contenues dans le signal d'identification émis depuis un dispositif d'étiquette (2A, 2B, 2C) parmi la pluralité de dispositifs d'étiquettes (2A, 2B, 2C), qui est implanté dans une région communicable dans laquelle une communication via les antennes de réception (121) est possible. L'élément d'actionnement (12) comprend en outre une unité d'affichage (122) dans laquelle le mode d'affichage est modifié en réponse aux informations d'identification acquises du dispositif de traitement (1).
PCT/JP2014/072685 2013-08-29 2014-08-29 Système de support de chirurgie et dispositif de support de chirurgie WO2015030157A1 (fr)

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