WO2018225316A1 - Medical control device - Google Patents

Abstract

This medical control device comprises: an image input unit whereto are input a first image, obtained when light for illuminating a surface layer of a biological tissue is emitted at a site to be treated with a treatment instrument, and a second image, obtained when light capable of reaching a deep portion of the biological tissue is emitted at the site to be treated; a treatment instrument extraction processing unit for extracting the treatment instrument from the first image; a specific tissue extraction processing unit for extracting a specific tissue from the second image; a distance information acquisition unit for acquiring distance information indicating the distance between the treatment instrument and the specific tissue; and a control unit for performing control for displaying the first image and warning of the presence of the specific tissue on the basis of the distance indicated by the distance information and/or control for changing the state of supply of energy to the treatment instrument.

Description

Medical control device

The present invention relates to a medical control apparatus, and more particularly to a medical control apparatus used when performing a treatment on a living tissue under endoscopic observation.

In endoscopic observation in the medical field, for example, a subject such as a living tissue existing in a body cavity of a subject is irradiated with white light or RGB light to image the subject, and the subject is picked up with the naked eye. Conventionally, white light observation capable of displaying a white light image having substantially the same visibility as when viewed is performed.

Further, in endoscopic observation in the medical field, for example, light obtained by performing band limitation on a living tissue present in the body cavity of a subject according to the characteristics of a predetermined object included in the living tissue. Conventionally, special light observation has been performed that can display a special light image in which the visibility of the predetermined object is improved as compared to a white light image by irradiating special light and imaging the subject. .

For example, Japanese Patent Application Laid-Open No. 2014-226341 discloses a configuration for acquiring a white light image and a special light image as described above in an endoscope apparatus. Japanese Unexamined Patent Application Publication No. 2014-226341 discloses a configuration for acquiring an image obtained by imaging a deep blood vessel as a special light image.

Incidentally, when performing a treatment on a living tissue under endoscopic observation, it is desirable to avoid accidental damage to a specific tissue such as a deep blood vessel existing in the deep mucous membrane of the living tissue. Therefore, when performing treatment on a desired treatment target site under endoscopic observation, for example, a white light image suitable for confirming the structure of the mucosal surface in the desired treatment target site, and the desired treatment target site In some cases, it is necessary to perform a complicated operation to proceed with the treatment while switching between a special light image suitable for confirming the position of a specific tissue such as a deep blood vessel.

However, Japanese Patent Application Laid-Open No. 2014-226341 does not particularly disclose a method that can eliminate the complexity of operation in the above-described case. Therefore, according to the configuration disclosed in Japanese Patent Application Laid-Open No. 2014-226341, there is a problem that an excessive burden may be imposed on an operator who performs a treatment on a living tissue under endoscopic observation. Has occurred.

The present invention has been made in view of the above-described circumstances, and an object of the present invention is to provide a medical control device that can reduce the burden on an operator who performs a treatment on a living tissue under endoscopic observation.

In the medical control device according to one aspect of the present invention, light for illuminating the surface layer of the biological tissue in the subject is irradiated to the treatment target site to be treated by the treatment tool inserted in the subject. A first image obtained by imaging the treatment target site, and the treatment target site when the treatment target site is irradiated with light that can reach the deep part of the biological tissue in the subject. An image input unit that receives a second image obtained by imaging, and a treatment instrument extraction process configured to perform a process for extracting a region corresponding to the treatment instrument from the first image Unit, a specific tissue extraction processing unit configured to perform processing for extracting a region corresponding to the specific tissue existing in the subject from the second image, and processing of the treatment instrument extraction processing unit The treatment tool extracted by the method and the specific tissue extraction A distance information acquisition unit configured to acquire distance information, which is information indicating a distance between the specific tissue extracted by the processing of the physical unit, and the display device to display the first image In addition, control for notifying the presence of the specific tissue in the treatment target site according to the distance indicated by the distance information, and the treatment tool when performing the treatment of the treatment target site. And a control unit configured to perform at least one of the controls for changing the supply state of the energy supplied thereto.

The figure which shows the structure of the principal part of the medical system which concerns on embodiment. The figure for demonstrating an example of the specific structure of the endoscope system and treatment system which concern on embodiment. FIG. 3 is a diagram for explaining an example of a specific configuration of an image processing unit provided in the processor according to the embodiment. The figure which showed typically the white light image acquired by the endoscope system which concerns on embodiment. The figure which showed typically the fluorescence image acquired by the endoscope system which concerns on embodiment. The figure which shows an example of the image for distance calculation used when calculating the distance between a treatment tool and a deep blood vessel. The figure which shows an example of the image for distance calculation used when calculating the distance between a treatment tool and a deep blood vessel. The figure which showed typically the deep blood vessel emphasis image displayed on a display apparatus. The figure which showed typically the white light image acquired by the endoscope system which concerns on embodiment. The figure which showed typically the fluorescence image acquired by the endoscope system which concerns on embodiment. The figure which shows an example of the image for distance calculation used when calculating the distance between a treatment tool and a nerve. The figure which shows an example of the image for distance calculation used when calculating the distance between a treatment tool and a nerve. The figure which showed typically the nerve emphasis image displayed on a display apparatus.

Hereinafter, embodiments of the present invention will be described with reference to the drawings.

1 to 13 relate to the embodiment of the present invention.

As shown in FIG. 1, the medical system 1 includes an endoscope system 1A used for observing a desired subject such as a living tissue existing in a subject, and a desired treatment target site existing in the subject. And a treatment system 1B used for the treatment. In addition, the endoscope system 1A and the treatment system 1B are connected via a signal cable 30. Drawing 1 is a figure showing the composition of the principal part of the medical system concerning an embodiment.

As shown in FIG. 1, the endoscope system 1A is configured to be inserted into a subject and output an image obtained by imaging a subject such as a living tissue existing in the subject. A predetermined image with respect to the image output from the endoscope apparatus 2, the light source apparatus 3 configured to supply the light applied to the subject to the endoscope apparatus 2, and the endoscope apparatus 2. A processor 4 configured to generate and output a display image by performing processing, and a display device 5 configured to display a display image output from the processor 4 on a screen; Have. In addition, as shown in FIG. 1, the treatment system 1B is configured to be inserted into a subject and apply treatment to a living tissue of a treatment target site existing in the subject to perform treatment. And a treatment tool control device 62 configured to supply the treatment tool 61 with energy applied to the living tissue of the treatment target site.

The endoscope apparatus 2 includes an optical viewing tube 21 having an elongated insertion portion 6 and a camera unit 22 that can be attached to and detached from the eyepiece portion 7 of the optical viewing tube 21.

The optical viewing tube 21 includes an elongated insertion portion 6 that can be inserted into a subject, a gripping portion 8 provided at the proximal end portion of the insertion portion 6, and an eyepiece portion provided at the proximal end portion of the gripping portion 8. 7.

As shown in FIG. 2, a light guide 11 for transmitting light supplied through a cable 13a is inserted into the insertion portion 6. FIG. 2 is a diagram for explaining an example of a specific configuration of the endoscope system and the treatment system according to the embodiment.

The exit end of the light guide 11 is disposed in the vicinity of the illumination lens 15 at the distal end of the insertion section 6 as shown in FIG. Further, the incident end portion of the light guide 11 is disposed in a light guide base 12 provided in the grip portion 8.

As shown in FIG. 2, a light guide 13 for transmitting light supplied from the light source device 3 is inserted into the cable 13a. A connection member (not shown) that can be attached to and detached from the light guide base 12 is provided at one end of the cable 13a. A light guide connector 14 that can be attached to and detached from the light source device 3 is provided at the other end of the cable 13a.

At the distal end of the insertion portion 6, there are an illumination lens 15 for emitting the light transmitted by the light guide 11 to the outside, and an objective lens 17 for obtaining an optical image corresponding to the light incident from the outside. Is provided. An illumination window (not shown) in which the illumination lens 15 is arranged and an observation window (not shown) in which the objective lens 17 is arranged are provided adjacent to each other on the distal end surface of the insertion portion 6. Yes.

2, a relay lens 18 including a plurality of lenses LE for transmitting an optical image obtained by the objective lens 17 to the eyepiece unit 7 is provided inside the insertion unit 6. That is, the relay lens 18 has a function as a transmission optical system that transmits light incident from the objective lens 17.

As shown in FIG. 2, an eyepiece lens 19 is provided inside the eyepiece unit 7 so that the optical image transmitted by the relay lens 18 can be observed with the naked eye.

The camera unit 22 includes an excitation light cut filter 23, a dichroic mirror 24, imaging elements 25A and 25B, and a signal processing circuit 26. The camera unit 22 is configured to be detachable from the processor 4 via a connector 29 provided at an end of the signal cable 28.

The excitation light cut filter 23 is configured as an optical filter that removes reflected light of excitation light from light emitted through the eyepiece lens 19. That is, the excitation light cut filter 23 has optical characteristics such that light in the wavelength band other than the IR light is transmitted while blocking light in the same wavelength band as IR light (described later) emitted from the light source device 3. Configured.

The dichroic mirror 24 transmits light in the visible range included in the output light emitted through the excitation light cut filter 23 to the image sensor 25A side, and transmits light in the near infrared region included in the output light to the image sensor 25B side. It is configured to have optical characteristics that reflect the light.

The image sensor 25A is configured to include an image sensor such as a color CCD or color CMOS having sensitivity in the visible range. The image sensor 25 </ b> A is configured to perform an imaging operation according to an image sensor drive signal output from the processor 4. The imaging element 25 </ b> A is configured to capture visible light that has passed through the dichroic mirror 24, generate an image corresponding to the captured visible light, and output the image to the signal processing circuit 26.

The image sensor 25B is configured to include an image sensor such as a monochrome CCD or monochrome CMOS having sensitivity in the near infrared region. In addition, the image sensor 25B is configured to perform an imaging operation in accordance with an image sensor drive signal output from the processor 4. The image sensor 25B is configured to image the infrared light reflected by the dichroic mirror 24, generate an image corresponding to the captured infrared light, and output the image to the signal processing circuit 26. .

The signal processing circuit 26 performs predetermined signal processing such as correlated double sampling processing, gain adjustment processing, and A / D conversion processing on the images output from the image sensors 25A and 25B, respectively. It is configured. Further, the signal processing circuit 26 is configured to output the image subjected to the predetermined signal processing described above to the processor 4 to which the signal cable 28 is connected.

The light source device 3 includes a light emitting unit 31, a multiplexer 32, a condenser lens 33, and a light source control unit 34.

The light emitting unit 31 includes a blue LED 311, a green LED 312, a red LED 313, an amber LED 314, and a near infrared LD (laser diode) 315.

The blue LED 311 is configured to emit B light which is light (narrow band) having intensity in the blue region. Specifically, the blue LED 311 is configured to emit B light having a center wavelength set to around 460 nm and a bandwidth set to about 20 nm, for example. Further, the blue LED 311 is configured to be switched between a lighting state and a light-off state according to the control of the light source control unit 34. Further, the blue LED 311 is configured to generate B light having an intensity according to the control of the light source control unit 34 in the lighting state. Note that the center wavelength of the B light may be set to a wavelength different from 460 nm as long as it is set in the blue region. In addition, the bandwidth of the B light may be set to a predetermined bandwidth corresponding to the center wavelength.

The green LED 312 is configured to emit G light which is light (narrow band) having intensity in the green region. Specifically, the green LED 312 is configured to emit G light whose center wavelength is set to around 540 nm and whose bandwidth is set to about 20 nm, for example. Further, the green LED 312 is configured to be switched between a lighting state and a light-off state according to the control of the light source control unit 34. Further, the green LED 312 is configured to generate G light having an intensity according to the control of the light source control unit 34 in the lighting state. The center wavelength of the G light may be set to a wavelength different from 540 nm as long as it is set in the green range. Moreover, the bandwidth of G light should just be set to the predetermined bandwidth according to the center wavelength.

The red LED 313 is configured to emit R light which is light (narrow band) having intensity in a red region. Specifically, the red LED 313 is configured to emit R light having a center wavelength set to around 630 nm and a bandwidth set to about 20 nm, for example. Further, the red LED 313 is configured to switch between a lighting state and a light-off state according to the control of the light source control unit 34. Further, the red LED 313 is configured to generate R light having an intensity according to the control of the light source control unit 34 in the lighting state. The center wavelength of the R light may be set to a wavelength different from 630 nm, for example, as long as it is set in the red region. Moreover, the bandwidth of R light should just be set to the predetermined bandwidth according to the center wavelength.

The amber LED 314 is configured to emit, for example, A light which is amber light (narrow band) whose center wavelength is set to around 600 nm. That is, the amber LED 314 is configured to emit A light that is light (special light) that can reach a deep blood vessel that is a deep blood vessel and a deep blood vessel that exists in the deep portion of the biological tissue. Further, the amber LED 314 is configured to switch between a lighting state and a light-off state according to the control of the light source control unit 34. Further, the amber LED 314 is configured to generate A light having an intensity according to the control of the light source control unit 34 in the lighting state.

The near-infrared LD 315 is configured to emit IR light, which is near-infrared light having a center wavelength set at 800 nm (narrow band), for example. That is, the near-infrared LD 315 is configured to emit IR light that is excitation light that can excite a predetermined fluorescent agent such as ICG (Indocyanine Green) administered to the subject to generate fluorescence. ing. In other words, the near-infrared LD 315 is configured to emit IR light that is light (special light) that can reach the deep part of the living tissue and nerves existing in the deep part of the living tissue. Further, the near-infrared LD 315 is configured to switch between a lighting state and a light-off state according to the control of the light source control unit 34. The near-infrared LD 315 is configured to generate IR light having an intensity according to the control of the light source control unit 34 in the lighting state.

The multiplexer 32 is configured to be able to multiplex each light emitted from the light emitting unit 31 so as to enter the condenser lens 33.

The condenser lens 33 is configured to collect the light incident through the multiplexer 32 and output it to the light guide 13.

The light source control unit 34 is configured to control each light source of the light emitting unit 31 based on a system control signal output from the processor 4.

The processor 4 has a function as a medical control device. In addition, the processor 4 includes an image sensor driving unit 41, an image input unit 42, an image processing unit 43, a display control unit 44, an input I / F (interface) 45, a sound generator 46, and a control unit 47. , And is configured. In the present embodiment, for example, the image sensor driving unit 41, the image input unit 42, the image processing unit 43, the display control unit 44, and the control unit 47 of the processor 4 are configured as individual electronic circuits. Alternatively, it may be configured as a circuit block in an integrated circuit such as an FPGA (Field Programmable Gate Array). In the present embodiment, for example, the processor 4 may include one or more CPUs.

The image sensor drive unit 41 is configured to generate and output an image sensor drive signal for driving the image sensors 25A and 25B in accordance with a system control signal output from the control unit 47.

The image input unit 42 receives an image obtained by the endoscope apparatus 2 and performs an operation for switching an output destination of the input image according to a system control signal output from the control unit 47. It is configured as follows.

The image processing unit 43 acquires distance information (described later) by performing predetermined image processing on the image output from the image input unit 42 in accordance with the system control signal output from the control unit 47, and acquires the information. This distance information is output to the display control unit 44 and the control unit 47, respectively. Further, for example, as illustrated in FIG. 3, the image processing unit 43 includes a treatment instrument extraction processing unit 431, a specific tissue extraction processing unit 432, and a distance information acquisition unit 433. FIG. 3 is a diagram for explaining an example of a specific configuration of the image processing unit provided in the processor according to the embodiment.

The treatment instrument extraction processing unit 431 is configured to perform a treatment instrument extraction process that is a process for extracting a region corresponding to the treatment instrument 61 from the entire image output via the image input unit 42. In addition, the treatment instrument extraction processing unit 431 is configured to generate a treatment instrument extraction image that is an image including only the treatment instrument 61 extracted by the above-described treatment instrument extraction process and output the treatment instrument extraction image to the distance information acquisition unit 433. .

The specific tissue extraction processing unit 432 is a process for extracting a region corresponding to the specific tissue according to the system control signal output from the control unit 47 from the entire image output via the image input unit 42. An extraction process is performed. In addition, the specific tissue extraction processing unit 432 is configured to generate a specific tissue extraction image that is an image including only the specific tissue extracted by the above-described specific tissue extraction processing and output the specific tissue extraction image to the distance information acquisition unit 433.

The distance information acquisition unit 433 includes a treatment tool included in the treatment tool extraction image output from the treatment tool extraction processing unit 431 and a specific tissue included in the specific tissue extraction image output from the specific tissue extraction processing unit 432. A distance calculation process, which is a process for calculating the distance between them, is performed. The distance information acquisition unit 433 acquires distance information that is information indicating the distance calculated by the above-described distance calculation processing, and outputs the acquired distance information to the display control unit 44 and the control unit 47, respectively. It is configured. That is, the distance information acquisition unit 433 is information indicating the distance between the treatment tool 61 extracted by the processing of the treatment tool extraction processing unit 431 and the specific tissue extracted by the processing of the specific tissue extraction processing unit 432. It is configured to acquire certain distance information.

The display control unit 44 generates a display image based on the image output from the image input unit 42, the distance information output from the image processing unit 43, and the system control signal output from the control unit 47. The generated display image is output to the display device 5.

The input I / F 45 is configured to include one or more switches and / or buttons capable of giving instructions according to the operation of the user such as the operator. Further, the input I / F 45 is configured to be able to issue an instruction to emit either the A light or the IR light from the light source device 3 in accordance with a user operation.

The sounding device 46 includes, for example, a speaker. The sound generator 46 is configured to emit a sound corresponding to a system control signal output from the control unit 47.

The control unit 47 is configured to generate and output a system control signal for performing an operation in accordance with an instruction made at the input I / F 44. The control unit 47 is configured to generate a system control signal for irradiating the subject with light emitted from the light emitting unit 31 in a time-sharing manner and output the system control signal to the light source control unit 34. The control unit 47 is configured to generate a system control signal for controlling the imaging operation of the imaging elements 25A and 25B and output the system control signal to the imaging element driving unit 41. In addition, the control unit 47 performs an operation related to switching of an output destination of an image obtained by the endoscope apparatus 2 according to an irradiation pattern when the subject is irradiated with light emitted from the light emitting unit 31 in a time division manner. The system control signal is generated and output to the image input unit 42. Further, the control unit 47 performs an operation according to the distance information output from the image processing unit 43 and the operation state information (described later) output from the treatment instrument control device 62 connected via the cable 30. Configured to do.

The display device 5 includes, for example, an LCD (liquid crystal display) and the like, and is configured to display a display image output from the processor 4.

As shown in FIG. 1, the treatment instrument 61 includes a handle portion 71, a shaft 72 having a proximal end attached to the handle portion 71, and a treatment portion 73 provided on the distal end side of the shaft 72. Has been. The treatment instrument 61 is connected to the treatment instrument control device 62 via a cable 63 extending from the handle portion 71. The treatment portion 73 is configured to have a pair of jaw members 73a and 73b that can be opened and closed.

The handle portion 71 includes, for example, a plurality of operation levers, and is configured to be able to change the open / close state of the jaw members 73a and 73b of the treatment portion 73 in accordance with the operation of the plurality of operation levers. In addition, the handle portion 71 is provided with a switch portion 74 having one or more switches for giving instructions to the treatment instrument control device 62 in accordance with an operation of a user such as an operator.

The shaft 72 is formed to have an elongated shape that can be inserted into the subject via a trocar placed on the body wall of the subject, such as a cylindrical shape.

The treatment section 73 is configured to be able to hold a living tissue between the jaw members 73a and 73b. In addition, the treatment unit 73 is configured to apply energy supplied from the treatment instrument control device 62 to the living tissue held between the jaw members 73a and 73b.

The switch unit 74 generates energy from at least one of an ultrasonic wave used when incising the living tissue and a high-frequency current used when coagulating the living tissue from the treatment instrument control device 62 in accordance with a user operation. It is comprised so that the instruction | indication for supplying can be performed. In addition, the switch unit 74 is configured to be able to issue an instruction for setting the switching method of the energy supply state for the treatment instrument 61 to either manual switching or automatic switching in accordance with a user operation. .

The treatment instrument control device 62 includes, for example, a power supply circuit for generating energy to be supplied to the treatment instrument 61, a control circuit for controlling the treatment instrument 61, and the like. Further, as shown in FIGS. 1 and 2, the treatment instrument control device 62 is connected to the control unit 47 via the cable 30 and to the treatment instrument 61 via the cable 63. Further, the treatment instrument control device 62 can generate, for example, an ultrasonic wave and a high-frequency current as energy applied to the living tissue held in the treatment unit 73 and supply the generated energy to the treatment instrument 61. It is configured. The treatment instrument control device 62 is configured to change the output level of the ultrasonic wave by changing the frequency of the ultrasonic wave supplied to the treatment instrument 61, for example. In addition, the treatment instrument control device 62 generates operation state information indicating whether the energy supply state switching method for the treatment instrument 61 is set to manual switching or automatic switching in response to an instruction made in the switch unit 74. And output to the control unit 47. In addition, the treatment instrument control device 62 operates to supply energy to the treatment instrument 61 according to the instruction of the switch unit 74 when the switching method of the energy supply state for the treatment instrument 61 is set to manual switching. Is configured to do. In addition, the treatment instrument control device 62 supplies energy corresponding to the system control signal output from the control unit 47 to the treatment instrument 61 when the switching method of the energy supply state to the treatment instrument 61 is set to automatic switching. It is comprised so that the operation | movement for supplying may be performed.

Next, the operation of the medical system 1 of the present embodiment will be described.

For example, the user connects each part of the medical system 1 and turns on the power, and in a state where a plurality of trocars are installed on the abdominal wall of the subject, the user removes the subject from one trocar of the plurality of trocars. The insertion section 6 is inserted into the body cavity of the examiner, and the shaft 72 (and the treatment section 73) is inserted into the body cavity of the subject from the other one trocar among the plurality of trocars. Further, for example, the user operates the input I / F 44 after connecting each part of the medical system 1 and turning on the power, thereby giving an instruction to emit the A light from the light source device 3 and the switch. By operating the unit 74, the switching method of the energy supply state for the treatment instrument 61 is set to automatic switching. In response to such user operation, operation state information indicating that the method of switching the state of energy supply to the treatment instrument 61 is set to automatic switching is output from the treatment instrument control device 62 to the control unit 47. . In addition, for example, after the user gives an instruction to emit A light from the light source device 3, the insertion unit is inserted at a position where a biological tissue to be treated (hereinafter also referred to as a treatment target site) in the subject can be imaged. 6 is disposed, and the treatment portion 73 of the treatment instrument 61 is disposed in the vicinity of the biological tissue to be treated.

When the processor 4 is turned on, the light source device 3 is connected to the processor 4, and an instruction for emitting A light is given at the input I / F 44, A system control signal for alternately irradiating the subject with WL light, which is white light mixed with B light, and A light is generated and output to the light source control unit 34. That is, the control unit 47 illuminates the treatment target site to be treated by the treatment tool 61 inserted into the subject with WL light, which is light for illuminating the surface layer of the living tissue in the subject, A system control signal for alternately irradiating A light, which is light that can reach the deep part of the living tissue in the specimen, is generated and output to the light source control unit 34.

Based on the system control signal output from the processor 4, the light source control unit 34 controls to turn off the amber LED 314 and the near-infrared LD 315 while turning on the three LEDs of the blue LED 311, the green LED 312 and the red LED 313, Control for turning off the LEDs of the three colors and the near-infrared LD 315 while turning on the color LED 314 is alternately performed on the light emitting unit 31. Then, according to the operation of the light source control unit 34, WL light and A light are alternately irradiated onto the subject including the treatment target region, and the subject irradiated with the WL light is imaged by the imaging element 25A. The endoscope apparatus 2 outputs a white light image WLI obtained in this way and a fluorescent image ALI obtained by imaging the subject irradiated with the A light with the imaging device 25A.

For example, as shown in FIG. 4, the white light image WLI output from the endoscope apparatus 2 at the time of irradiation with the A light includes a deep blood vessel imaged in a state where the visibility is lower than that of the fluorescent image ALI, A structure other than deep blood vessels existing in or near the mucosal surface layer of a living tissue such as a capillary blood vessel and a treatment portion 73 provided at the distal end portion of the treatment instrument 61 are included. FIG. 4 is a diagram schematically illustrating a white light image acquired by the endoscope system according to the embodiment.

In the fluorescence image ALI, for example, as shown in FIG. 5, the location of the deep blood vessel in the subject is relatively dark, and the location other than the location of the deep blood vessel in the subject is relatively dark. Acquired as a bright image. Further, in the fluorescence image ALI, for example, as shown in FIG. 5, other than the deep blood vessels existing in the deep mucosa of the living tissue and the deep blood vessels imaged in a state where the visibility is lower than that of the white light image WLI. And a treatment portion 73 provided at the distal end portion of the treatment instrument 61 are included. FIG. 5 is a diagram schematically illustrating a fluorescent image acquired by the endoscope system according to the embodiment.

When the processor 4 is turned on and an instruction for irradiating the subject with A light is given at the input I / F 44, the control unit 47 outputs the white light image WLI output from the endoscope apparatus 2. Is output to the treatment instrument extraction processing unit 431 and the display control unit 44, and the system control signal for causing the specific tissue extraction processing unit 432 and the display control unit 44 to output the fluorescent image ALI output from the endoscope apparatus 2 Is output to the image input unit 42. That is, according to the operation of the control unit 47 as described above, the white light image WLI output from the endoscope apparatus 2 is input to the treatment instrument extraction processing unit 431 and the display control unit 44 via the image input unit 42. The fluorescent image ALI output from the endoscope apparatus 2 is input to the specific tissue extraction processing unit 432 and the display control unit 44 via the image input unit 42.

The treatment instrument extraction processing unit 431 performs a treatment instrument extraction process for extracting a region corresponding to the treatment instrument 61 from the entire area of the white light image WLI output via the image input unit 42.

Specifically, the treatment instrument extraction processing unit 431, for example, of the luminance value of the red component, the luminance value of the green component, and the luminance value of the blue component among the pixels included in the white light image WLI. In addition, a process for extracting a pixel group having a threshold value TPA or more as a region corresponding to the treatment instrument 61 is performed as the treatment instrument extraction process.

The treatment instrument extraction processing unit 431 generates a treatment instrument extraction image TRI including only the treatment instrument 61 extracted by the above-described treatment instrument extraction process, and outputs the treatment instrument extraction image TRI to the distance information acquisition unit 433.

In response to the system control signal output from the control unit 47, the specific tissue extraction processing unit 432 performs a deep portion from the entire region of the fluorescent image ALI output via the image input unit 42 when the subject is irradiated with the A light. Processing for extracting a region corresponding to a blood vessel is performed as specific tissue extraction processing.

Specifically, the specific tissue extraction processing unit 432 sets, for example, a pixel group having a luminance value equal to or lower than the threshold value TPA different from the threshold value TPA among the pixels included in the fluorescent image ALI as a region corresponding to the deep blood vessel. Processing to extract is performed as specific tissue extraction processing.

The specific tissue extraction processing unit 432 generates a deep blood vessel extraction image DVI that is an image including only the deep blood vessels extracted by the specific tissue extraction processing described above, and outputs the deep blood vessel extraction image DVI to the distance information acquisition unit 433.

The distance information acquisition unit 433 includes a treatment tool 61 included in the treatment tool extraction image TRI output from the treatment tool extraction processing unit 431 and a deep blood vessel included in the deep blood vessel extraction image DVI output from the specific tissue extraction processing unit 432. And a distance calculation process for calculating the distance between.

Specifically, the distance information acquisition unit 433 synthesizes, for example, the treatment tool extraction image TRI output from the treatment tool extraction processing unit 431 and the deep blood vessel extraction image DVI output from the specific tissue extraction processing unit 432. The distance calculation processing is performed by generating a distance calculation image and calculating a distance DMNA corresponding to the shortest distance between the distal end of the treatment unit 73 and the deep blood vessel included in the generated distance calculation image. Do as.

That is, according to the operation of the distance information acquisition unit 433 as described above, for example, when the distance between the distal end of the treatment unit 73 and the deep blood vessel is far, the distance calculation image as shown in FIG. A DCIA is generated. Further, according to the operation of the distance information acquisition unit 433 as described above, for example, when the distance between the distal end of the treatment unit 73 and the deep blood vessel is short, the image for distance calculation as shown in FIG. A DCIB is generated. 6 and 7 are diagrams illustrating an example of a distance calculation image used when calculating the distance between the treatment tool and the deep blood vessel.

The distance information acquisition unit 433 acquires distance information that is information indicating the distance DMNA calculated by the above-described distance calculation processing, and outputs the acquired distance information to the display control unit 44 and the control unit 47, respectively. The distance information acquisition unit 433, for example, displays control when it is not possible to obtain at least one of the treatment instrument extraction image TRI and the deep blood vessel extraction image DVI, that is, when the distance DMNA cannot be calculated. The distance information is not output to the unit 44 and the control unit 47.

Based on the operation state information output from the treatment instrument control device 62 connected via the cable 30, the control unit 47 confirms that the energy supply state switching method for the treatment instrument 61 is set to automatic switching. If detected, a system control signal for controlling the display control unit 44, the treatment instrument control device 62, and the like is generated and output according to the distance information output from the image processing unit 43.

Specifically, for example, the control unit 47 detects that the distance DMNA indicated by the distance information output from the distance information acquisition unit 433 is larger than the threshold value TDA, or the distance information is received from the distance information acquisition unit 433. If not output, a system control signal for displaying the white light image WLI on the display device 5 is generated and output to the display control unit 44, and energy corresponding to the instruction of the switch unit 74 is supplied to the treatment instrument 61. A system control signal for generating the control signal is generated and output to the treatment instrument control device 62. That is, according to the operation of the control unit 47, when the distance DMNA is larger than the threshold value TDA or when the distance information is not output from the distance information acquisition unit 433, the energy supply state to the treatment instrument 61 is changed to the switch unit. Manual switching at 74 is possible.

For example, when the control unit 47 detects that the distance DMNA indicated by the distance information output from the distance information acquisition unit 433 is equal to or smaller than the threshold value TDA and larger than the threshold value TDB (<TDA), A system control signal for generating a predetermined sound such as a beep sound by generating a system control signal for causing the display device 5 to display the value of the distance DMNA together with the white light image WLI and outputting it to the display control unit 44. Is generated and output to the sound generator 46, and a system control signal for supplying the treatment instrument 61 with the ultrasonic wave of the output level PLC is generated and output to the treatment instrument controller 62.

For example, when the control unit 47 detects that the distance DMNA indicated by the distance information output from the distance information acquisition unit 433 is equal to or smaller than the threshold TDB, the control unit 47 sets the value of the distance DMNA to the fluorescent image ALI. In addition, a system control signal to be displayed on the display device 5 is generated and output to the display control unit 44, and a system control signal for generating a predetermined sound such as a beep sound is generated and output to the sound generation device 46. Then, a system control signal for causing the treatment instrument 61 to supply ultrasonic waves with an output level PLD lower than the output level PLC is generated and output to the treatment instrument controller 62. That is, when the distance DMNA is equal to or less than the threshold value TDB, the control unit 47 controls the system 61 to supply the treatment instrument 61 with ultrasonic waves that suppress the incision ability of the living tissue more than when the distance DMNA is larger than the threshold value TDB. A signal is generated and output to the treatment instrument control device 62. In addition, the control part 47 of this embodiment stops the supply of the ultrasonic wave for reducing the output level PLD to 0, ie, the treatment tool 61, when detecting that the distance DMNA is below the threshold value TDB. A system control signal may be generated and output to the treatment instrument control device 62.

That is, according to the operation of the control unit 47 at the time of irradiation of A light as described above, when the distance DMNA is equal to or less than the threshold value TDA, the value of the distance DMNA is displayed on the display device 5, and A predetermined sound such as a beep sound is emitted from the sound generation device 46. Further, according to the operation of the control unit 47 at the time of irradiation with the A light as described above, when the distance DMNA is equal to or smaller than the threshold value TDA and larger than the threshold value TDB, the treatment held by the treatment unit 73 is performed. An ultrasonic wave is applied to the target biological tissue, and a white light image WLI is displayed on the display device 5 as a display image. Further, according to the operation of the control unit 47 at the time of irradiation with the A light as described above, when the distance DMNA is equal to or less than the threshold value TDB, the output level with respect to the living tissue held by the treatment unit 73 An ultrasonic wave having an output level PLD lower than that of the PLC can be applied, and the fluorescent image ALI is displayed on the display device 5 as a display image instead of the white light image WLI. Therefore, according to the operation of the control unit 47 at the time of irradiation with the A light as described above, for example, a treatment is performed on a living tissue while supplying an ultrasonic wave to the treatment instrument 61 (cutting the living tissue). ), The risk of accidentally damaging deep blood vessels located in the vicinity of the living tissue by the treatment unit 73 can be reduced.

In addition, the control part 47 can also be made to supply both the ultrasonic wave and the high frequency current to the treatment tool 61 by performing the following operation | movement at the time of irradiation of A light.

Specifically, for example, when the control unit 47 detects that the distance DMNA indicated by the distance information output from the distance information acquisition unit 433 is equal to or less than the threshold value TDA and greater than the threshold value TDB, the output level PLE The system control signal for causing the treatment instrument 61 to supply the ultrasonic wave and the high-frequency current of the output level PLF is generated and output to the treatment instrument controller 62. In such a case, the control unit 47 may generate a system control signal for reducing the output level PLF to 0 and output it to the treatment instrument control device 62.

For example, when the control unit 47 detects that the distance DMNA indicated by the distance information output from the distance information acquisition unit 433 is equal to or less than the threshold value TDB, the ultrasonic wave having an output level PLG lower than the output level PLE is used. Then, a system control signal for causing the treatment instrument 61 to supply a high-frequency current having an output level PLH higher than the output level PLF is generated and output to the treatment instrument controller 62.

According to the operation of the control unit 47 as described above, for example, when performing a treatment on a living tissue while simultaneously supplying ultrasonic waves and high-frequency current to the treatment instrument 61, the living tissue to be treated It is possible to improve the coagulation performance of the treatment target living tissue while reducing the risk of accidentally damaging deep blood vessels located in the vicinity of the treatment vessel 73.

In addition, by appropriately modifying the configuration of each unit of the present embodiment, when the distance DMNA is equal to or less than the threshold value TDB, information indicating the deep blood vessel extracted by the processing of the specific tissue extraction processing unit 432 is added to the white light image WLI. In addition, the control unit 47 may perform control for displaying on the display device 5. Specifically, when the distance DMNA is equal to or smaller than the threshold TDB, for example, the display device 5 generates an enhanced image in which the deep blood vessels extracted by the processing of the specific tissue extraction processing unit 432 are emphasized in the white light image WLI. The control unit 47 may be configured to perform control for displaying on the screen. According to such control of the control unit 47, for example, the pixel value of the red component of the deep blood vessel region included in the white light image WLI, as schematically shown in FIG. 8, is added to the deep blood vessel extraction image DVI. A deep blood vessel emphasized image DEI corresponding to the image replaced with the pixel value of the included deep blood vessel region is displayed on the display device 5 as a display image instead of the fluorescent image ALI. FIG. 8 is a diagram schematically showing a deep blood vessel emphasis image displayed on the display device.

Further, in the present embodiment, when the distance DMNA is equal to or less than the threshold value TDA, control for displaying the value of the distance DMNA on the display device 5 and control for generating a predetermined sound from the sound generation device 46. It is sufficient that at least one of the controls is performed by the control unit 47.

For example, the user operates the input I / F 44 in a state where a fluorescent agent FLP that is excited by IR light and generates FL light that is near-infrared fluorescence having a longer wavelength than the IR light is administered to the subject. Thus, an instruction for irradiating the subject with IR light is issued. In addition, for example, after giving an instruction for emitting IR light from the light source device 3, the user arranges the distal end portion of the insertion portion 6 at a position where the treatment target living tissue in the subject can be imaged. The treatment portion 73 of the treatment tool 61 is disposed in the vicinity of the biological tissue to be treated. In this embodiment, the fluorescent drug FLP administered to the subject is a drug that includes, for example, a target molecule that specifically binds to a nerve and a fluorescent dye such as indocyanine green.

The controller 47 turns on the WL light and the IR light when the power of the processor 4 is turned on, the light source device 3 is connected to the processor 4 and an instruction for emitting IR light is given at the input I / F 44. And a system control signal for alternately irradiating the subject to the light source controller 34 and outputting the system control signal to the light source controller 34. That is, the control unit 47 illuminates the treatment target site to be treated by the treatment tool 61 inserted into the subject with WL light, which is light for illuminating the surface layer of the living tissue in the subject, A system control signal for alternately irradiating IR light, which is light that can reach the deep part of the biological tissue in the specimen, is generated and output to the light source control unit 34.

Based on the system control signal output from the processor 4, the light source control unit 34 performs control to turn off the amber LED 314 and the near infrared LD 315 while turning on the three LEDs of the blue LED 311, the green LED 312 and the red LED 313. Control for turning off the three-color LED and the amber LED 314 while turning on the infrared LD 315 is alternately performed on the light emitting unit 31. Then, according to the operation of the light source control unit 34, WL light and IR light are alternately irradiated onto the subject including the treatment target region, and the subject irradiated with the WL light is imaged by the imaging element 25A. The endoscope apparatus 2 outputs a white light image WLI obtained in this way and a fluorescent image FLI obtained by imaging the FL light emitted from the subject irradiated with the IR light with the imaging device 25B.

In the white light image WLI output from the endoscope apparatus 2 at the time of irradiation with IR light, for example, as shown in FIG. 9, nerves and capillaries that are imaged in a state where visibility is lower than that of the fluorescence image FLI. A structure other than nerves existing in or near the mucous membrane surface layer of a living tissue such as the above, and a treatment portion 73 provided at the distal end portion of the treatment tool 61 are included. In addition, although not shown, the white light image WLI output from the endoscope apparatus 2 at the time of irradiation with IR light includes biological tissue to be treated in the subject. FIG. 9 is a diagram schematically illustrating a white light image acquired by the endoscope system according to the embodiment.

For example, as shown in FIG. 10, the fluorescence image FLI is such that the location of the nerve in the subject becomes relatively bright and the location other than the location of the nerve in the subject becomes relatively dark. Acquired as a simple image. Further, for example, as shown in FIG. 10, the fluorescence image FLI includes nerves existing in the deep mucosa of the living tissue and a treatment portion 73 provided at the distal end portion of the treatment instrument 61. FIG. 10 is a diagram schematically illustrating a fluorescence image acquired by the endoscope system according to the embodiment.

When the processor 4 is turned on and an instruction for irradiating the subject with IR light is given at the input I / F 44, the control unit 47 outputs the white light image WLI output from the endoscope apparatus 2. Is output to the treatment instrument extraction processing unit 431 and the display control unit 44, and a system control signal for causing the specific tissue extraction processing unit 432 and the display control unit 44 to output the fluorescent image FLI output from the endoscope apparatus 2 is provided. Generate and output to the image input unit 42. That is, according to the operation of the control unit 47 as described above, the white light image WLI output from the endoscope apparatus 2 is input to the treatment instrument extraction processing unit 431 and the display control unit 44 via the image input unit 42. The fluorescence image FLI output from the endoscope apparatus 2 is input to the specific tissue extraction processing unit 432 and the display control unit 44 via the image input unit 42.

The treatment tool extraction processing unit 431 performs a treatment tool extraction process for extracting a region corresponding to the treatment tool 61 from the entire area of the white light image WLI output through the image input unit 42, and the treatment tool extraction process A treatment instrument extraction image TRI including only the extracted treatment instrument 61 is generated and output to the distance information acquisition unit 433.

In response to the system control signal output from the control unit 47, the specific tissue extraction processing unit 432 transmits nerves from the entire fluorescent image FLI output via the image input unit 42 when IR light is irradiated on the subject. Processing for extracting the corresponding region is performed as specific tissue extraction processing.

Specifically, for example, the specific tissue extraction processing unit 432 specifies a process of extracting a pixel group having a luminance value equal to or higher than the threshold value TPC among the pixels included in the fluorescent image FLI as a region corresponding to a nerve. Performed as a tissue extraction process.

The specific tissue extraction processing unit 432 generates a nerve extraction image NRI that is an image including only the nerve extracted by the above-described specific tissue extraction processing, and outputs it to the distance information acquisition unit 433.

The distance information acquisition unit 433 includes a treatment tool 61 included in the treatment tool extraction image TRI output from the treatment tool extraction processing unit 431, a nerve included in the nerve extraction image NRI output from the specific tissue extraction processing unit 432, A distance calculation process for calculating the distance between the two is performed.

Specifically, the distance information acquisition unit 433 synthesizes, for example, the treatment tool extraction image TRI output from the treatment tool extraction processing unit 431 and the nerve extraction image NRI output from the specific tissue extraction processing unit 432. Thus, a distance calculation image is generated, and a process for calculating the distance DMNB corresponding to the shortest distance between the distal end of the treatment unit 73 and the nerve included in the generated distance calculation image is performed as the distance calculation process. .

That is, according to the operation of the distance information acquisition unit 433 as described above, for example, when the distance between the distal end of the treatment unit 73 and the nerve is far, the distance calculation image DCIC as shown in FIG. Is generated. Further, according to the operation of the distance information acquisition unit 433 as described above, for example, when the distance between the distal end of the treatment unit 73 and the nerve is short, the distance calculation image DCID as shown in FIG. Is generated. 11 and 12 are diagrams illustrating an example of a distance calculation image used when calculating the distance between the treatment tool and the nerve.

The distance information acquisition unit 433 acquires distance information that is information indicating the distance DMNB calculated by the above-described distance calculation process, and outputs the acquired distance information to the display control unit 44 and the control unit 47, respectively. The distance information acquisition unit 433, for example, when it is not possible to obtain at least one of the treatment instrument extraction image TRI and the nerve extraction image NRI, that is, when the distance DMNB cannot be calculated, 44 and the distance information to the control unit 47 is not output.

Based on the operation state information output from the treatment instrument control device 62 connected via the cable 30, the control unit 47 confirms that the energy supply state switching method for the treatment instrument 61 is set to automatic switching. If detected, a system control signal for controlling the display control unit 44, the treatment instrument control device 62, and the like is generated and output according to the distance information output from the image processing unit 43.

Specifically, for example, when the control unit 47 detects that the distance DMNB indicated by the distance information output from the distance information acquisition unit 433 is larger than the threshold TDC, or the distance information is received from the distance information acquisition unit 433. If not output, a system control signal for displaying the white light image WLI on the display device 5 is generated and output to the display control unit 44, and energy corresponding to the instruction of the switch unit 74 is supplied to the treatment instrument 61. A system control signal for generating the control signal is generated and output to the treatment instrument control device 62. That is, according to the operation of the control unit 47 as described above, when the distance DMNB is larger than the threshold value TDC or when the distance information is not output from the distance information acquisition unit 433, the energy supply state to the treatment instrument 61 is switched to the switch unit. Manual switching at 74 is possible.

For example, when the control unit 47 detects that the distance DMNB indicated by the distance information output from the distance information acquisition unit 433 is equal to or smaller than the threshold TDC and larger than the threshold TDD (<TDC), A system control signal for generating a predetermined sound such as a beep sound by generating a system control signal for causing the display device 5 to display the value of the distance DMNB together with the white light image WLI and outputting it to the display control unit 44. Is generated and output to the sound generator 46, and a system control signal for supplying the treatment instrument 61 with the ultrasonic wave of the output level PLA and the high-frequency current of the output level PLI is generated and output to the treatment instrument controller 62. To do.

For example, when the control unit 47 detects that the distance DMNB indicated by the distance information output from the distance information acquisition unit 433 is equal to or less than the threshold value TDD, the control unit 47 combines the value of the distance DMNB with the fluorescence image FLI. A system control signal for display on the display device 5 is generated and output to the display control unit 44, a system control signal for generating a predetermined sound such as a beep sound is generated and output to the sound generation device 46, A system control signal for causing the treatment instrument 61 to supply ultrasonic waves having an output level PLB lower than the output level PLA and a high-frequency current having an output level PLJ lower than the output level PLI is generated and output to the treatment instrument controller 62. To do. In addition, the control part 47 of this embodiment stops supply of the high frequency current for reducing the output level PLJ to 0, ie, the treatment tool 61, when detecting that the distance DMNB is below the threshold value TDD. A system control signal may be generated and output to the treatment instrument control device 62.

That is, according to the operation of the control unit 47 at the time of IR light irradiation as described above, when the distance DMNB is equal to or less than the threshold TDC, the value of the distance DMNB is displayed on the display device 5, and A predetermined sound such as a beep sound is emitted from the sound generation device 46. Further, according to the operation of the control unit 47 at the time of irradiation with IR light as described above, the treatment held by the treatment unit 73 when the distance DMNB is equal to or smaller than the threshold TDC and larger than the threshold TDD. The ultrasonic wave of the output level PLA is applied to the target living tissue, and the white light image WLI is displayed on the display device 5 as a display image. Further, according to the operation of the control unit 47 at the time of irradiation with the A light as described above, when the distance DMNB is equal to or less than the threshold value TDD, the output level with respect to the living tissue sandwiched by the treatment unit 73. While the PLB ultrasonic waves are applied, the fluorescent image FLI is displayed on the display device 5 as a display image instead of the white light image WLI.

In addition, when the distance DMNB is equal to or smaller than the threshold value TDD, information indicating the nerve extracted by the processing of the specific tissue extraction processing unit 432 is combined with the white light image WLI by appropriately modifying the configuration of each unit of the present embodiment. Then, the control for displaying on the display device 5 may be performed by the control unit 47. Specifically, when the distance DMNB is equal to or less than the threshold value TDD, for example, an enhanced image in which the nerve extracted by the processing of the specific tissue extraction processing unit 432 is enhanced in the white light image WLI is generated and displayed on the display device 5. Control for display may be performed by the control unit 47. Then, according to such control of the control unit 47, for example, as shown schematically in FIG. 13, the nerve extracted image NRI is converted to the pixel value of the green component of the nerve region included in the white light image WLI. A nerve-enhanced image NEI corresponding to an image obtained by adding the pixel values of the included nerve area is displayed on the display device 5 as a display image instead of the fluorescent image FLI. FIG. 13 is a diagram schematically illustrating a nerve-enhanced image displayed on the display device.

In the present embodiment, when the distance DMNB is equal to or smaller than the threshold TDC, control for displaying the value of the distance DMNB on the display device 5 and control for generating a predetermined sound from the sound generation device 46. It is sufficient that at least one of the controls is performed by the control unit 47.

That is, the control unit 47 performs control for displaying the white light image WLI on the display device 5, and is further inserted into the subject according to the distance indicated by the distance information output from the distance information acquisition unit 433. Control for notifying the presence of deep blood vessels or nerves in the treatment target site to be treated by the treatment tool 61 and the supply state of energy supplied to the treatment tool 61 when performing the treatment of the treatment target site It is comprised so that at least any one control of the control for changing may be performed.

As described above, according to the present embodiment, the display image displayed on the display device 5 is displayed as the white light image WLI or 琥珀 according to the distance DMNA calculated by the distance information acquisition unit 433 when the A light is irradiated. While being able to switch to either of the optical images ALI, the energy supplied to the treatment tool 61 can be switched to either ultrasonic waves or high-frequency currents. Therefore, according to the present embodiment, for example, the procedure for switching the display image displayed on the display device 5 and the operation for switching the type of energy supplied to the treatment instrument 61 can be performed without performing the procedure. Since it is possible to proceed with the treatment of the living tissue while confirming the position of the deep blood vessel existing in the deep mucous membrane of the target living tissue, the burden on the operator who performs the treatment of the living tissue under endoscopic observation is reduced. be able to.

Further, as described above, according to the present embodiment, the display image displayed on the display device 5 is displayed as the white light image WLI according to the distance DMNB calculated by the distance information acquisition unit 433 at the time of irradiation with IR light. Alternatively, it is possible to switch to one of the fluorescent images FLI, and to switch the output level of the ultrasonic wave supplied to the treatment instrument 61 to either PLA or PLB. Therefore, according to the present embodiment, for example, without performing an operation related to switching of a display image displayed on the display device 5 and an operation related to switching of an output level of energy supplied to the treatment instrument 61, Since the treatment of the living tissue can be performed while confirming the position of the nerve existing in the deep mucosa of the living tissue to be treated, the burden on the operator who performs the treatment on the living tissue under endoscopic observation is reduced. be able to.

Note that, according to the present embodiment, for example, when the subject is irradiated with R light, G light, and B light in a time division manner, the image is an image obtained by imaging the subject irradiated with the R light. Any one of RLI, an image GLI which is an image obtained by imaging the subject irradiated with the G light, and an image BLI which is an image obtained by imaging the subject irradiated with the B light The treatment tool extraction processing unit 431 may perform a treatment tool extraction process for extracting a region corresponding to the treatment tool from the entire area of the image.

It should be noted that the present invention is not limited to the above-described embodiment, and various changes and applications can be made without departing from the spirit of the invention.

This application is filed on the basis of the priority claim of Japanese Patent Application No. 2017-110959 filed in Japan on June 5, 2017. Shall be quoted.

Claims (7)

1. Obtained by imaging the treatment target site when the treatment target site to be treated by the treatment tool inserted in the subject is irradiated with light for illuminating the surface layer of the biological tissue in the subject. A first image, and a second image obtained by imaging the treatment target site when light capable of reaching a deep portion of a living tissue in the subject is irradiated on the treatment target site. An input image input unit;
   A treatment instrument extraction processing unit configured to perform processing for extracting a region corresponding to the treatment instrument from the first image;
   A specific tissue extraction processing unit configured to perform processing for extracting a region corresponding to the specific tissue existing in the subject from the second image;
   Distance information that is information indicating a distance between the treatment tool extracted by the processing of the treatment tool extraction processing unit and the specific tissue extracted by the processing of the specific tissue extraction processing unit is acquired. A configured distance information acquisition unit;
   Control for displaying the first image on a display device, control for notifying the presence of the specific tissue in the treatment target site according to the distance indicated by the distance information, and the treatment A control unit configured to perform control of at least one of control for changing a supply state of energy supplied to the treatment instrument when performing treatment of a target site; and
   A medical control device comprising:
2. The control unit is configured to display the second image on the display device instead of the first image when the distance indicated by the distance information is equal to or less than a first threshold, or The control for causing the display device to display information indicating the specific tissue extracted by the processing of the specific tissue extraction processing unit together with the first image is performed. Medical control device.
3. The control unit emphasizes the specific tissue extracted by the processing of the specific tissue extraction processing unit in the first image when the distance indicated by the distance information is equal to or less than the first threshold. The medical control device according to claim 2, wherein control for generating an image and displaying the image on the display device is performed.
4. The control unit is configured to display a value of the distance indicated by the distance information on the display device when a distance indicated by the distance information is equal to or less than a second threshold value that is larger than the first threshold value; The medical control device according to claim 2, wherein one of control for generating a predetermined sound from the sound generation device is performed.
5. The specific tissue extraction processing unit extracts, as the specific tissue, a deep blood vessel that exists in a deep portion of the biological tissue in the subject,
   The control unit performs control for supplying the treatment tool with the first energy used when the living tissue is incised when the distance indicated by the distance information is larger than a predetermined threshold, When the distance indicated by the distance information is less than or equal to the predetermined threshold, the energy to be supplied to the processing tool is reduced from the first energy to the incision ability of the living tissue more than the first energy. The medical control apparatus according to claim 1, wherein control is performed to switch to energy of 2 or to stop the supply of the first energy to the treatment tool.
6. The control unit performs control for supplying ultrasonic energy having a first output level as the first energy, and outputs ultrasonic energy having an output level lower than the first output level to the second energy. In addition, when the distance indicated by the distance information is larger than the predetermined threshold, the control is performed to supply the high-frequency energy of the second output level to the treatment instrument. When the distance indicated by the distance information is equal to or less than the predetermined threshold value, control is performed to supply the treatment tool with high-frequency energy having an output level higher than the second output level. The medical control device according to claim 5.
7. The specific tissue extraction processing unit extracts nerves existing in a deep portion of the biological tissue in the subject as the specific tissue,
   When the distance indicated by the distance information is larger than a predetermined threshold, the control unit performs control for supplying the predetermined energy at the first output level to the treatment tool, and indicates the distance information. Performing control for supplying the predetermined energy of the second output level lower than the first output level to the treatment instrument when the distance to be transmitted is equal to or less than the predetermined threshold. The medical control device according to claim 1.

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