WO2022181714A1 - 手術内容評価システム、手術内容評価方法及びコンピュータプログラム - Google Patents
手術内容評価システム、手術内容評価方法及びコンピュータプログラム Download PDFInfo
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Definitions
- the present invention relates to a surgical content evaluation method and a computer program for evaluating the content of a surgical operation performed by a surgeon.
- Patent Literature 1 describes a first process in which a simulated motion calculation device loads an educational scenario sequence from a storage device at the start of a surgical simulation and executes it; , a second step of storing the information of the simulation model data in the storage device; A surgical simulation using a computer simulator has been proposed, which consists of a third process of evaluation.
- a surgery content evaluation system for evaluating the content of a surgery performed by a surgeon, Acquisition means for acquiring a surgical image, which is an image of the body of a patient undergoing surgery by a surgeon; analysis means for analyzing physical information indicating the state of the body and/or instrument information indicating the state of instruments operated by the surgeon in the surgical image; and evaluation means for evaluating details of a surgery performed by the surgeon based on the physical information and/or the instrument information analyzed by the analysis means.
- the surgery content evaluation system includes acquisition means, analysis means, and evaluation means, and evaluates the content of the surgery performed by the surgeon.
- An acquisition means acquires a surgical image, which is an image of a patient's body being operated on by a surgeon.
- the analyzing means analyzes the physical information indicating the state of the body and/or the instrument information indicating the state of the instrument operated by the surgeon in the surgical image.
- the evaluation means evaluates the details of the operation performed by the surgeon based on the physical information and/or instrument information analyzed by the analysis means.
- the analysis means analyzes a specific region in the surgical image;
- a region that spreads when body fluid outflow or organ damage occurs is defined as a specific region, and it is determined whether or not this specific region exceeds a predetermined threshold.
- a predetermined threshold it is possible to objectively evaluate the outflow of body fluids and organ damage, which are important targets of evaluation, by evaluating that there has been outflow of body fluids and organ damage.
- the analyzing means analyzes the instrument information including information about the instrument;
- the surgery content evaluation system according to (1) or (2), wherein the evaluation means evaluates the operating mode of the instrument in the surgery based on the information about the instrument.
- the manner in which instruments are operated is important as an evaluation target for the details of surgery, considering the reduction of the burden on the body of the patient during surgery.
- the operation mode of the instrument by evaluating the operation mode of the instrument in the surgery based on the information about the instrument included in the instrument information, the operation mode of the instrument can be determined by the operator's sense, whether there is no organ damage, etc. It is possible to objectively evaluate not only from the results of
- the analysis means analyzing the body information, including information about the anatomy of the body; analyzing the body information and/or the instrument information including information regarding the position of the instrument relative to the anatomy; The evaluation means according to any one of (1) to (3), wherein the evaluation means evaluates the operating mode of the instrument with respect to the anatomical structure in surgery based on information regarding the position of the instrument with respect to the anatomical structure. Operation content evaluation system.
- an electric scalpel which is an example of an instrument
- the connective tissue which is an example of the anatomical structure connecting the affected area and other organs. If the position of the electric scalpel with respect to the connective tissue is not appropriate, the electric scalpel may come into contact with other organs and damage them. For this reason, the position of the instrument relative to the anatomy is important as an evaluation target for factors leading to errors in surgery.
- the operating mode of the instrument with respect to the anatomical structure in surgery based on the information on the position of the instrument with respect to the anatomical structure
- the operating mode of the instrument with respect to the anatomical structure is evaluated based on the operator's sense and organ damage. It is possible to objectively evaluate not only the results such as no failure, but also the possibility of causing mistakes such as organ damage.
- the analysis means analyzes each of the steps in the surgical image of the surgery consisting of a plurality of steps; further comprising timing means for measuring an inter-step time, which is the time from one said step to the next said step;
- the surgical content evaluation according to any one of (1) to (4), wherein the evaluation means evaluates the skill of the operation based on the inter-step time measured by the timing means for a given step. system.
- a surgery consists of multiple steps, and each step has a different degree of technical difficulty and a different impact on the patient's body, so it is necessary to evaluate the details of the surgery for each step. For this reason, the time between steps, which is the time from one step to the next step, is important as an evaluation target when examining the details of surgery for each step.
- the skill of the operation is evaluated based on the inter-step time, which is the time from one step to the next step. can be evaluated objectively.
- a method performed by a surgical performance evaluation system for evaluating surgical performance performed by a surgeon comprising: obtaining a surgical image, which is an image of the patient's body undergoing surgery by a surgeon; analyzing physical information indicating the state of the body and/or instrument information indicating the state of instruments being operated by the surgeon in the surgical image; and a step of evaluating details of a surgical operation being performed by the surgeon based on the physical information and/or the instrument information.
- a surgery content evaluation system for evaluating the content of surgery performed by a surgeon; Acquisition means for acquiring a surgical image, which is an image of the body of a patient undergoing surgery by a surgeon; Analysis means for analyzing physical information indicating the state of the body and/or instrument information indicating the state of instruments operated by the surgeon in the surgical image; A program functioning as evaluation means for evaluating the content of surgery performed by the surgeon based on the physical information and/or the instrument information analyzed by the analysis means.
- a surgery content evaluation system for evaluating the content of a surgery performed by a surgeon, Acquisition means for acquiring a surgical image, which is an image of the body of a patient undergoing surgery by a surgeon; analysis means for analyzing physical information indicating a physical condition in the surgical image; and evaluation means for evaluating details of a surgery performed by the surgeon based on the physical information analyzed by the analysis means.
- the details of the operation performed by the surgeon are evaluated based on the body information indicating the state of the body in the surgical image obtained by imaging the body of the patient undergoing the operation by the surgeon. Therefore, it is possible to objectively evaluate the contents of actual surgery. Therefore, it is possible to provide a surgery content evaluation system capable of objectively evaluating the content of an actual surgery.
- the analysis means calculates a recognition degree indicating the degree of recognition of the physical information in the surgical image;
- the surgery content evaluation system according to (8), wherein the evaluation means evaluates the content of the surgery performed by the surgeon according to the degree of recognition.
- the analysis means calculating a certainty factor indicating the certainty of the analysis result of the physical information;
- the analysis means can calculate the degree of recognition based on the degree of certainty that indicates the certainty of the analysis result of the physical information.
- the analysis means analyzes the trajectory of the tip position of the instrument being operated by the surgeon;
- the surgery content evaluation system according to any one of (8) to (12), wherein the evaluation means evaluates the operating mode of the instrument in surgery based on the trajectory.
- the analysis means analyzes the positional relationship between an action point, which is a portion of the instrument being operated by the surgeon that abuts against the anatomical structure, and a portion of the anatomical structure where the instrument abuts;
- the surgery content evaluation system according to any one of (8) to (13), wherein the evaluation means evaluates the operating mode of the instrument in surgery based on the positional relationship.
- the surgical instrument is determined. It is possible to evaluate the operation mode of
- the acquisition means continuously acquires the plurality of surgical images in time series, From (9), the evaluation means is characterized in that the analysis means specifies the surgical image for which the degree of recognition for information relating to a specific anatomical structure contained in the body information is determined to be equal to or greater than a specific threshold.
- the surgery content evaluation system according to any one of the items.
- a surgical image for which the degree of recognition of information related to a specific anatomical structure included in body information is determined to be equal to or higher than a specific threshold is specified. becomes possible.
- a method performed by a surgical evaluation system for evaluating surgical procedures performed by a surgeon comprising: obtaining a surgical image, which is an image of the patient's body undergoing surgery by a surgeon; a step of analyzing physical information indicating a physical condition in the surgical image; and a step of evaluating details of a surgical operation being performed by the surgeon based on the physical information analyzed by the analyzing means.
- a surgical content evaluation system for evaluating the content of surgery performed by a surgeon; Acquisition means for acquiring a surgical image, which is an image of the body of a patient undergoing surgery by a surgeon; Analysis means for analyzing physical information indicating the state of the body in the surgical image; A program that functions as evaluation means for evaluating the content of surgery performed by the surgeon based on the physical information analyzed by the analysis means.
- the present invention it is possible to provide a surgery content evaluation system, a surgery content evaluation method, and a computer program that can objectively evaluate the content of an actual surgery.
- FIG. 4(a) is a surgical image in a state in which bloodshed has not occurred.
- FIG. 4(b) is a surgical image in which bleeding has occurred. It is a figure explaining the process of the evaluation means in the surgery content evaluation system which concerns on embodiment of this invention.
- FIG. 6(a) shows a situation in which the instrument has not been properly manipulated relative to the anatomy.
- FIG. 6(b) shows the instrument properly manipulated relative to the anatomy.
- FIG. 7(a) shows a situation in which the instrument has not been properly manipulated relative to the anatomy.
- FIG. 7(b) shows the instrument properly manipulated relative to the anatomy. It is a figure which shows the surgery content evaluation processing flow which the surgery content evaluation system which concerns on embodiment of this invention performs.
- FIG. 10 is a diagram showing an example of evaluation criteria in the evaluation means of the surgery content evaluation system according to the application example of the embodiment of the present invention; It is a figure which shows an example of the evaluation information produced
- FIG. 16(a) is a surgical image of a lean patient.
- FIG. 16(b) is a surgical image of an obese patient.
- FIG. 10 is a diagram showing an example of evaluation criteria in the evaluation means of the surgery content evaluation system according to the application example of the embodiment of the present invention.
- FIG. 10 is a diagram for explaining processing in an image editing unit of the surgery content evaluation system according to an application example of the embodiment of the present invention
- FIG. 10 is a diagram for explaining processing in an image editing unit of the surgery content evaluation system according to an application example of the embodiment of the present invention
- FIG. 1 is a diagram for explaining an overview of a surgery content evaluation system according to an embodiment of the present invention.
- a surgery content evaluation system 1 evaluates the content of a surgery performed by a surgeon.
- the surgery content evaluation system 1 acquires a surgical image, which is an image of a surgical operation performed by a surgeon at a medical institution (for example, an institution such as a hospital where surgery is performed by a surgeon).
- Surgical images are images of the patient's body undergoing surgery and instruments operated by surgeons and assistants (e.g., forceps, electric scissors, electric scalpels, energy devices such as ultrasonic coagulation and incision devices, etc.). ) is captured.
- surgeons and assistants e.g., forceps, electric scissors, electric scalpels, energy devices such as ultrasonic coagulation and incision devices, etc.
- the surgical images may be moving images or, for example, still images captured continuously in time series.
- the surgical image is an image captured by a camera inserted through an access port in an endoscopic surgery.
- an image acquired by a surgical assistance robot or an image taken from above the patient may be used as long as the patient's body and the instruments operated by the surgeon or assistant are imaged.
- the surgery content evaluation system 1 uses AI (Artificial Intelligence) to analyze physical information indicating the state of the body and/or instrument information indicating the state of the instruments operated by the surgeon in the surgical image.
- AI Artificial Intelligence
- the surgery content evaluation system 1 evaluates the content of the surgery performed by the surgeon by AI based on the physical information and/or instrument information analyzed by the analysis means, and outputs evaluation information indicating the evaluation result, for example , the surgeon transmits the evaluation results to the terminal of the medical institution where the evaluation results can be confirmed.
- the surgery content evaluation system 1 physical information indicating the state of the body and/or the state of instruments operated by the surgeon can be obtained from the surgical image obtained by imaging the body of the patient undergoing surgery by the surgeon. Since the AI evaluates the details of the surgery performed by the surgeon based on the instrument information indicating the, it is possible to objectively evaluate the details of the actual surgery. Therefore, it is possible to objectively evaluate the details of the actual surgery.
- FIG. 2 is a diagram showing the functional configuration of the surgery content evaluation system according to the embodiment of the present invention.
- the surgery content evaluation system 1 is connected to a plurality of medical institution terminals 2 via a network, and includes acquisition means 11, analysis means 12, clocking means 13, evaluation means 14, transmission means 15, and storage. means 20;
- the medical institution terminal 2 may be a terminal managed by the medical institution, or may be installed in the medical institution and managed by the operator of the surgery content evaluation system 1, and is an imaging means (for example, , camera) to the surgical operation evaluation system 1 and receive evaluation information from the surgical operation evaluation system 1 .
- an imaging means for example, , camera
- the acquisition means 11 acquires a surgical image, which is an image of a patient's body undergoing surgery by a surgeon.
- the acquisition means 11 may receive the surgical image from the medical institution terminal 2, may receive the surgical image from another device (for example, a server that accumulates surgical images, etc.), or may store the surgical image in the storage means 20 in advance.
- the stored surgical images may be read out from the storage means 20 .
- the acquisition means 11 may receive voice data during surgery corresponding to the surgical image.
- the analysis results of surgical images based on such audio data, for example, the state of communication between the operator and the assistant, etc., the operator's independence, the operator's mental state such as impatience, and the operator's assistant You may evaluate the leadership for
- the acquisition means 11 acquires instrument information indicating the state of the instrument being operated by the surgeon (for example, position information detected in chronological order of surgery) by various sensors (for example, a gyro sensor, etc.) provided in the instrument. If detected, such instrument information may be acquired and stored in the storage means 20 in association with the corresponding surgical image.
- instrument information indicating the state of the instrument being operated by the surgeon (for example, position information detected in chronological order of surgery) by various sensors (for example, a gyro sensor, etc.) provided in the instrument. If detected, such instrument information may be acquired and stored in the storage means 20 in association with the corresponding surgical image.
- the storage means 20 stores surgical images, learned information for analysis used for analysis by the analysis means 12 described later, and learned information for evaluation used for evaluation by the evaluation means 14 described later.
- the learned information for analysis is generated by having AI learn multiple surgical images that have been performed in the past, and includes step recognition models for recognizing multiple steps that constitute surgery, and specific regions in surgical images. (e.g., areas identified as bodily fluids (e.g., red areas formed by blood outflow, yellow areas formed by bile outflow, etc.), areas of burnt organs, etc.)
- a specific area analysis model for anatomical analysis e.g., an anatomical structure identification model for identifying a patient's anatomical structure (organs, blood vessels, fat, connective tissue, etc.), and instruments used by surgeons (operators, assistants, etc.) (for example, forceps, energy devices such as electric scissors and electric scalpels, etc.).
- the learned information for analysis be able to change the detection threshold at the time of analysis.
- the learned information for evaluation is generated by having AI learn a plurality of surgical images that have been performed in the past.
- An anatomical structure/instrument state determination model for determining the state of the anatomical structure and the state of the instrument (instrument type, instrument position, instrument orientation, etc.) for each of a plurality of steps included.
- the learned information for analysis be able to change the detection threshold at the time of determination.
- the learned information for analysis and the learned information for evaluation are generated by any learning method such as known machine learning, deep learning, and reinforcement learning, and stored in the storage means 20 in advance. remembered. Also, the learned information for analysis and the learned information for evaluation may be generated by the surgery content evaluation system 1 or may be generated by an external device and stored in the storage means 20 .
- the analysis means 12 analyzes the physical information indicating the condition of the body and/or the instrument information indicating the condition of the instruments operated by the surgeon in the surgical image acquired by the acquisition means 11 .
- the analysis means 12 compares the surgical image acquired by the acquisition means 11 with the step recognition model stored in the storage means 20, and the state shown in the surgical image is a plurality of conditions constituting surgery. Analyze which step.
- the analyzing means 12 analyzes which step is for each frame in a moving image or for each of a plurality of continuous still images acquired in time series (hereinafter also referred to as “frames, etc.”).
- the analyzing means 12 may analyze after adjusting the fps (frames per second) of the moving image. For example, by suppressing the fps of the moving image, it is possible to suppress the processing load and processing time of the surgery content evaluation system 1 .
- the analysis means 12 compares the surgical image acquired by the acquisition means 11 with the specific region analysis model stored in the storage means 20, and analyzes the specific region in the surgical image.
- the analysis means 12 analyzes the specific region for each frame or the like.
- the specific region is a region formed by outflow of bodily fluid (for example, blood, bile, etc.) in the surgical image. yellow, white or black when organs are burnt, etc.) and the edge of the area (bodily fluids are more viscous than water and have distinctive edges). , are analyzed by the analysis means 12 .
- the analysis means 12 compares the surgical image acquired by the acquisition means 11 with the anatomical structure identification model stored in the storage means 20, and analyzes the anatomical structure imaged in the surgical image, which is an example of physical information. do.
- the analysis means 12 analyzes the anatomical structure for each frame or the like.
- the analysis means 12 compares the surgical image acquired by the acquisition means 11 with the instrument identification model stored in the storage means 20, and determines the state of the instrument captured in the surgical image, which is an example of instrument information (for example, , instrument type, and instrument orientation).
- the analyzing means 12 analyzes the state of the instrument being imaged for each frame or the like.
- the timing means 13 measures the inter-step time, which is the time from one step to the next step in a plurality of steps constituting the surgery captured in the surgical image acquired by the acquisition means 11 .
- FIG. 3 is a diagram for explaining the processing of the timing means in the surgery content evaluation system according to the embodiment of the present invention.
- the example shown in FIG. 3 is a surgical image of cholecystectomy. From the top in FIG. , the next step, step X+2 (excision of the gallbladder).
- the analyzing means 12 uses the step recognition model to detect step X, step X+1, and step X+2 among a plurality of continuous frames in a moving image or a plurality of continuous still images acquired in time series. Identify frames and still images.
- the timer 13 measures, for example, the step-to-step time TX+1, which is the time difference between the frame of step X specified by the analysis unit 12 and the frame of step X+1.
- the evaluation means 14 evaluates the content of the operation performed by the surgeon based on the physical information and/or instrument information analyzed by the analysis means 12.
- the evaluation means 14 evaluates the skill of surgery based on the inter-step time measured by the timer 13 between certain steps.
- the storage means 20 stores a determination table in which a time that serves as a reference for surgical skill is associated with each inter-step time. is compared with the inter-step time of each step measured by the timing means 13. For example, if the inter-step time is shorter than the reference time, the evaluation value for the skill of the operation is set to a higher value than the reference time. A longer time between steps gives a lower score for surgical performance.
- FIG. 4 is a diagram for explaining the processing of the evaluation means in the surgery content evaluation system according to the embodiment of the present invention.
- FIG. 4(a) is a surgical image in a state in which bloodshed has not occurred.
- FIG. 4(b) is a surgical image in which bleeding has occurred.
- the red component which is an example of the specific color, is increased in the entire image, and the image is darker than the image in FIG. 4(a).
- the evaluation means 14 compares the analysis result of the specific region of the surgical image by the analysis means 12 with the specific region threshold model indicating a predetermined threshold for the size of the specific region stored in the storage means 20, and compares the specific region threshold model in the surgical image. , it is determined whether or not the size of the specific region exceeds a predetermined threshold, and if the size of the specific region exceeds the predetermined threshold, it is evaluated that there has been an outflow of bodily fluid or organ damage.
- the evaluation unit 14 may evaluate the outflow of body fluids and organ damage step by step according to the size of the specific region regardless of the size of the specific region. For example, the evaluation means 14 may give a lower evaluation value for outflow of bodily fluid or organ damage as the specific region is larger.
- the evaluation means 14 determines whether or not the size of the specific region exceeds a predetermined threshold for each frame or the like.
- a predetermined threshold for each frame or the like.
- the elapsed time from the start of the moving image or the elapsed time from the start of surgery may be specified. By identifying such a time, it becomes easier to confirm the operation images before and after this time, and to easily identify the operation of the instrument that caused the bleeding or the location of the bleeding in the organ.
- the evaluation means 14 evaluates the operating mode of the instruments in surgery based on the information about the instruments included in the instrument information analyzed by the analysis means 12 .
- the evaluation means 14 compares the analysis result of the state of the instrument for each frame, etc., by the analysis means 12 with the anatomical structure/instrument state determination model stored in the storage means 20, and evaluates the operation of the instrument in surgery. Evaluate aspects.
- the evaluation means 14 compares such an anatomical structure/instrument state determination model with the analysis results by the analysis means 12 to determine, for example, whether an appropriate instrument has been selected or whether the instrument is being used appropriately. , Whether the ligation is properly performed, whether the suturing is properly performed, whether the blood vessel is properly processed, etc. are evaluated.
- FIG. 5 is a diagram explaining the processing of the evaluation means in the surgery content evaluation system according to the embodiment of the present invention.
- the forceps D1 operated by the operator's left hand (non-dominant hand) and the energy device D2 operated by the operator's right hand are imaged.
- the analysis means 12 analyzes the trajectory of the appliance (energy device D2 in the example shown in FIG. 5) that changes in time series by analyzing the state of the appliance being imaged for each frame.
- the position of the tip of the instrument in each frame is schematically indicated by a dot, and the trajectory of the instrument is indicated by a black line connecting these dots.
- the evaluation means 14 evaluates whether the trajectory analyzed by the analysis means 12 is straight or has no deviation, and evaluates whether the instrument is being used appropriately based on the total distance operated on the trajectory. The longer the total distance of such an instrument trajectory than the reference value (the standard defined in the anatomical structure/instrument condition determination model), the lower the evaluation value of whether the instrument is being used appropriately.
- the evaluation means 14 compares the trajectory analyzed by the analysis means 12 with the anatomical structure/instrument state determination model to determine the presence or absence of tremor during operation of the instrument, the consistency of the movement speed (low acceleration), the If the device is an energy device, it is possible to remain still while using it It is possible to evaluate whether separation and sharp separation are properly used, whether the separation line is linear, and the like.
- Such an evaluation can be used to evaluate the operator's mental state (deterioration in concentration) due to changes in the properties of the trajectory over time during the course of surgery.
- the evaluation means 14 evaluates the operating mode of the instruments with respect to the anatomical structures in the surgery based on the body information including the information on the anatomical structures of the body analyzed by the analyzing means 12 and the information on the positions of the instruments with respect to the anatomical structures contained in the instrument information. evaluate.
- Information about the position of the instrument with respect to the anatomical structure may be included not only in the instrument information but also in the body information and/or the instrument information.
- the evaluation means 14 compares the analysis result of the anatomical structure and the state of the instrument for each frame, etc., by the analysis means 12 with the anatomical structure/instrument state determination model stored in the storage means 20, and Evaluate instrument manipulation relative to anatomy.
- the anatomical structure for each of a plurality of steps composing a surgical operation, includes an appropriate exposed area of the connective tissue, an appropriate tension for the blood vessel and the connective tissue, and the surrounding area of the ligated blood vessel.
- Appropriate situations for example, situations in which unnecessary organs are not clinging around the blood vessel to be ligated
- the evaluation means 14 compares such an anatomical structure/instrument state determination model with the analysis result by the analysis means 12, so that the instrument can be positioned at an appropriate position with respect to the anatomical structure and with an appropriate amount of force. Evaluate whether it is being manipulated.
- the appropriate shape and color of each organ are specified in the anatomical structure/instrument state determination model.
- the evaluation means 14 compares the anatomical structure/instrument state determination model and the analysis result by the analysis means 12, and if there is any difference, it is possible to detect inappropriate operation of the instrument with respect to the organ. and evaluated. For example, if the color of the organ is different from the appropriate color, it is a burn mark caused by an instrument (such as an electric scalpel), and it is evaluated that there was an inappropriate operation of the instrument.
- FIG. 6 is a diagram explaining the processing of the evaluation means in the surgery content evaluation system according to the embodiment of the present invention.
- FIG. 6(a) shows a situation in which the instrument has not been properly manipulated relative to the anatomy.
- FIG. 6(b) shows the instrument properly manipulated relative to the anatomy.
- an instrument FIG. 6 ( In the example shown in a), the appropriate tension is not applied by the forceps D4), and the portion to be cut by the energy device D4 is close to another organ. May damage other organs.
- the evaluation means 14 lowers the evaluation value of the operation mode of the instrument with respect to the anatomical structure in surgery.
- the connective tissue (the part surrounded by the white circle in the figure), which is an example of the anatomical structure, is properly tensioned by the forceps D4, and cut by the energy device D4.
- the part is separated from other organs.
- the evaluation means 14 increases the evaluation value of the operating mode of the instrument with respect to the anatomical structure in surgery.
- the evaluation means 14 can give a higher evaluation value for the operation mode of the instrument for the anatomical structure in the operation, as the tension for the connective tissue defined in the anatomical structure/instrument condition determination model is approximated.
- FIG. 7 is a diagram explaining the processing of the evaluation means in the surgery content evaluation system according to the embodiment of the present invention.
- FIG. 7(a) shows a situation in which the instrument has not been properly manipulated relative to the anatomy.
- FIG. 7(b) shows the instrument properly manipulated relative to the anatomy.
- the fat which is an example of the anatomical structure
- an instrument forceps D5 in the example shown in FIG. 7(a) operated by the assistant.
- the evaluation means 14 lowers the evaluation value of the mode of operation of the instrument with respect to the anatomical structure in surgery and cooperation with the assistant.
- the upper part of the fat which is an example of the anatomical structure, is held straight by the forceps D5 operated by the assistant, and the lower part is held by the operator's left hand (non-dominant hand).
- the fat is grasped by the forceps D6 being operated, and an appropriate tension is applied to the fat, forming a triangular shape (white line portion in FIG. 7(b)) suitable for a cut portion in the fat.
- the evaluation means 14 increases the evaluation value of the mode of operation of the instrument with respect to the anatomical structure in surgery and cooperation with the assistant.
- the evaluation means 14 converts the analysis result into a shape corresponding to the fat cutting position defined in the anatomical structure/equipment state determination model (for example, a triangular shape stretched with appropriate tension, such as the sail of a yacht). The more similar the shape of the position is, the higher the evaluation value can be given to the operating mode of the instrument with respect to the anatomical structure in surgery and cooperation with the assistant.
- the evaluation means 14 associates the evaluation values determined according to the analysis results by the analysis means 12 with each item for evaluating the content of the surgery, and arranges them in an arbitrary form such as a table form, a graph form, or a radar form. , to generate evaluation information that can be displayed on the medical institution terminal 2 .
- the evaluation means 14 may extract proposal information that serves as a proposal for promoting technical improvement according to the evaluation value, or an ideal procedure image for each evaluation item according to the evaluation value.
- the surgery content evaluation system 1 stores, for example, proposal information and procedure images corresponding to evaluation values for each evaluation item in the storage means 20, and the evaluation means 14 refers to the storage means 20. , to extract proposal information and procedure images according to the determined evaluation value.
- the evaluation means 14 may determine a relative evaluation value of the analysis result with respect to the ideal surgical image.
- the surgery content evaluation system 1 may also include image editing means for generating a digest image of the surgical image acquired by the acquisition means 11 .
- the image editing means extracts from the surgical image acquired by the acquisition means 11, for example, a moving image of a predetermined time including the frame of each step in the operation specified by the analysis means 12 for each step, and synthesizes them. Generate a digest image.
- the image editing means extracts, from the surgical images acquired by the acquiring means 11, moving images of a predetermined time including frames evaluated by the evaluating means 14 as being lower than a preset reference value, and extracts these moving images.
- a digest version image may be generated by synthesizing.
- the transmission means 15 transmits the evaluation information generated by the evaluation means 14 to the medical institution terminal 2 . Further, the transmission unit 15 may transmit the proposal information extracted by the evaluation unit 14 , the ideal procedure image, and the digest version image to the medical institution terminal 2 . Note that the transmission means 15 may transmit to the medical institution terminal 2 of an evaluator (for example, a surgeon who can evaluate the contents of the surgery in the digest version image) who is different from the operator of the surgery in the digest version image. . In this case, the surgery content evaluation system 1 may receive, from the medical institution terminal 2, human evaluation information indicating an evaluator's evaluation based on the transmitted digest version image. Then, the transmission means 15 may transmit the human evaluation information to the medical institution terminal 2 together with the evaluation information generated by the evaluation means 14 .
- an evaluator for example, a surgeon who can evaluate the contents of the surgery in the digest version image
- the surgery content evaluation system 1 may receive, from the medical institution terminal 2, human evaluation information indicating an evaluator's evaluation based on the transmitted digest version
- each function processing unit is stored in a storage device (storage unit) such as ROM (Read Only Memory), flash memory, SSD (Solid State Drive), hard disk, etc. It is realized by a computer program executed by the CPU by reading out a computer program (for example, basic software or an application that causes the CPU to execute the various processes described above).
- ROM Read Only Memory
- SSD Solid State Drive
- hard disk etc.
- each functional processing unit may be configured with an FPGA (Field-Programmable Gate Array).
- each functional processing unit reads and writes necessary data such as a table from a database (DB; Data Base) stored in a storage device or a storage area on a memory, and depending on the case, the related hardware It is realized by controlling hardware (for example, GPU (Graphics Processing Unit), input/output device, display device, communication interface device).
- DB database
- the database (DB) in the embodiment of the present invention may be a commercial database, but it also means a simple collection of tables and files, and the internal structure itself of the database itself is not a concern.
- FIG. 8 is a diagram showing a surgery content evaluation processing flow executed by the surgery content evaluation system according to the embodiment of the present invention.
- step S1 the acquisition means 11 acquires from the medical institution terminal 2 or the storage means 20 a surgical image, which is an image of the patient's body being operated on by a surgeon.
- step S2 the analysis means 12 analyzes the physical information indicating the condition of the body and/or the instrument information indicating the condition of the instruments operated by the surgeon in the surgical image acquired by the acquisition means 11 in step S1. Also, in this step, the analysis means 12 analyzes the color component of a specific color (for example, red, which is the color of blood, and yellow, which is the color of bile) in the surgical image acquired by the acquisition means 11 in step S1. .
- a specific color for example, red, which is the color of blood, and yellow, which is the color of bile
- step S3 the timer 13 measures the inter-step time, which is the time from a certain step to the next step in a plurality of steps constituting the surgery imaged in the surgical image acquired by the acquisition unit 11 in step S1. Measure.
- step S4 the evaluation means 14 evaluates the skill of the surgery based on the inter-step time measured by the timing means 13 between certain steps. Further, in this step, the evaluation means 14 determines whether or not the specific color component has increased in the surgical image based on the analysis result of the specific color component of the surgical image by the analysis means 12 in step S2, When it is determined that the component of the specific color has increased, it is evaluated that there has been an outflow of body fluid. Also, in this step, the evaluation means 14 evaluates the operating mode of the instrument in the surgery based on the information regarding the instrument included in the instrument information analyzed by the analysis means 12 in step S2.
- the evaluation means 14 performs surgery based on the body information including the information on the anatomical structure of the body analyzed by the analysis means 12 in step S2 and the information on the position of the instrument with respect to the anatomical structure contained in the instrument information. Evaluate instrument manipulation relative to anatomy. Then, in this step, the evaluation means 14 generates evaluation information that can be displayed on the terminal 2 of the medical institution.
- step S5 the transmission means 15 transmits the evaluation information generated by the evaluation means 14 in step S4 to the medical institution terminal 2.
- a surgery content evaluation system physical information indicating the state of the body and/or the state of instruments operated by the surgeon can be displayed in a surgical image obtained by imaging the body of a patient undergoing surgery by the surgeon. Since the details of the surgery performed by the surgeon are evaluated based on the displayed instrument information, it is possible to objectively evaluate the details of the actual surgery. Therefore, it is possible to provide a surgery content evaluation system capable of objectively evaluating the content of an actual surgery.
- the surgery content evaluation system 1 by evaluating the operation mode of the instruments in the surgery based on the information about the instruments included in the instrument information, the operation mode of the instruments can be evaluated based on the operator's senses and whether there is no organ damage. It is possible to objectively evaluate not only from the results such as
- the surgery content evaluation system 1 by evaluating the operating mode of the instruments with respect to the anatomical structure in surgery based on the information about the position of the instruments with respect to the anatomical structure, the operating mode of the instruments with respect to the anatomical structure can be perceived by the operator's sense. In addition, it is possible to objectively evaluate not only the results such as no organ damage, but also the possibility of causing mistakes such as organ damage.
- the skill of surgery is evaluated based on the time between steps, which is the time from one step to the next step. It is possible to objectively evaluate the skill of
- the “recognition degree” refers to the number of pixels or area of which the degree of certainty indicating the certainty of the analysis result by the analysis means 12 for the surgical image is equal to or higher than a certain threshold, the total amount of certainty, or the speed or acceleration of their increase or decrease. , the degree of continuity (without interruption) of structures such as organs.
- FIG. 9 is a diagram showing an example of evaluation information generated by the surgery content evaluation system according to the application example of the embodiment of the present invention.
- the example shown in FIG. 9 is an example of evaluation information that is generated by the evaluation means 14 and can be displayed on the medical institution terminal 2, and the evaluation values determined according to the analysis results by the analysis means 12 are shown in a graph format.
- the graph on the right side of the figure shows the data transition during surgery
- the horizontal axis is the elapsed time in surgery (in the example shown in FIG. time is set to 100.)
- the vertical axis indicates the degree of each item.
- graphs showing changes in confidence, amount of device movement, amount of bleeding, operation time between steps, and relative positions of instruments/structures are superimposed on the same time axis.
- the evaluation information includes information indicating the transition of events during surgery (elapsed time of each event) in a pie chart, and the AI model used by the analysis means 12 and the evaluation means 14. Information indicating rate and information indicating surgery time may also be included.
- the analysis means 12 calculates a recognition degree indicating the degree of recognition of body information (for example, anatomical structure) in the surgical image. Specifically, the analysis means 12 calculates a degree of certainty indicating the certainty of the analysis result of the physical information, and calculates the degree of recognition based on the degree of certainty. Then, the evaluation means 14 evaluates the content of the operation performed by the surgeon according to this degree of recognition.
- FIG. 10 is a diagram explaining the processing of the evaluation means in the operation content evaluation system according to the application example of the embodiment of the present invention.
- FIG. 10 shows surgical images of the steps of ablating adipose tissue and exposing nerves. Nerve tissue is not exposed in the surgical image (upper panel) before adipose tissue ablation. Then, as the operation progresses, it can be confirmed that the nerve tissue is exposed in the surgical image (lower diagram) after the adipose tissue is removed, and that the nerve tissue is not disrupted and is continuous.
- the left side is the original image captured by the camera
- the right side is the original image
- the nerve tissue portion is specified by the analysis of the analysis means 12, Colored.
- the analysis means 12 analyzes the portion where the nerve tissue is displayed in the surgical image, and colors the portion where the degree of certainty exceeds a predetermined threshold among the analysis results.
- the exposure of the nerve tissue is less than that shown in the surgical image after the adipose tissue exfoliation in FIG.
- the area (the area of the portion where the certainty exceeds a predetermined threshold) is reduced.
- the contents of such an operation are considered to be low evaluation.
- the degree of recognition of the nerve tissue which is an example of the body information calculated by the analysis means 12, is lowered compared to the case where the nerve tissue is sufficiently exposed and the nerve tissue is not interrupted. Then, when the degree of recognition is lowered, the evaluation means 14 lowers the content of the operation performed by the surgeon accordingly.
- the analysis means 12 may calculate the exposed area of the target organ (the total number of pixels whose certainty factor exceeds the threshold), which is an example of the body information, as the recognition level, or may calculate the total amount of the certainty factor of the target organ. may be used as the recognition level, the recognition level may be calculated from the continuity of the target organ, or the recognition level may be calculated by combining these.
- the evaluation means 14 may evaluate the content of the operation performed by the surgeon according to the time-dependent change in the degree of recognition. Specifically, the evaluation means 14 may evaluate the details of the surgery according to the speed or acceleration of increase/decrease in the degree of recognition.
- the evaluation means 14 may evaluate that the surgery is progressing quickly if the rate of increase/decrease in the degree of recognition is fast, or that it is stable if the acceleration of increase/decrease in the degree of recognition is constant. You may assess that the surgery is progressing.
- the evaluation means 14 is a learning model that AI learns good evaluation examples (examples evaluated as good surgery) and bad evaluation examples (examples evaluated as bad surgery) reflecting the analysis results of the analysis means 12. may be generated and evaluated using this learning model.
- good surgery includes surgery that has no surgical complications, is performed by a skilled doctor, and is judged to be a good surgery by a skilled doctor.
- bad surgery includes surgery that has surgical complications, is performed by an inexperienced doctor, or is judged to be a bad surgery by a skilled doctor.
- the evaluation means 14 learns the evaluation by AI by attaching information to these as correct data, and gives good evaluation and bad evaluation.
- FIG. 11 is a diagram showing an example of evaluation information generated by the surgery content evaluation system according to the application example of the embodiment of the present invention.
- FIG. 11 is an example of evaluation information generated by the evaluation means 14 and displayable on the medical institution terminal 2, and shows evaluation values determined according to analysis results by the analysis means 12 in a graph format.
- the example shown in FIG. 11 shows the transition of the degree of certainty of the resected organ in surgery for resecting an organ, and shows an example with a higher evaluation score of the evaluation means 14 and an example with a lower evaluation score.
- the evaluation means 14 has a higher maximum confidence value for the analysis result with the resected organ (well exposed, less camera shake and bleeding), and a confidence value of 0
- the evaluation index for the evaluation by the evaluation means 14 may be the amount of pixels with a certain degree of certainty or more, or the rate of increase/decrease of the amount of pixels (quick processing time), instead of the degree of certainty. good (there is no deviation in technique). In this way, the evaluation means 14 may evaluate the content of the operation performed by the surgeon according to the recognition level based on other factors, not limited to the recognition level based on the confidence level.
- FIG. 12 is a diagram showing an example of evaluation criteria in the evaluation means of the surgery content evaluation system according to the application example of the embodiment of the present invention.
- FIG. 12 shows temporal changes in the degree of recognition of resected organs and preserved organs in such cases.
- the evaluation means 14 recognizes the surgical scene (event recognition of resecting the resected organ from the preserved organ) based on the analysis result of the anatomical structure and the state of the instrument (type of instrument used, etc.) by the analysis means 12 .
- the evaluation means 14 evaluates the content of the operation performed by the surgeon based on the change in the degree of recognition of the resected organ (for example, connective tissue) and the change in the degree of recognition of the preserved organ (nerve) after event recognition. Evaluate. For example, the evaluation unit 14 gives a higher evaluation score if the degree of recognition of resected organs decreases and the degree of recognition of preserved organs increases after event recognition.
- FIG. 13 is a diagram showing an example of evaluation information generated by the surgery content evaluation system according to the application example of the embodiment of the present invention.
- FIG. 13 is an example of evaluation information that is generated by the evaluation means 14 and can be displayed on the medical institution terminal 2, and shows the amount of movement calculated according to the analysis result by the analysis means 12 in a graph format.
- the example shown in FIG. 13 shows the transition of the amount of movement in the trajectory of the distal end position of the instrument being operated by the surgeon.
- the evaluation means 14 gives a higher evaluation score because it can be estimated that the operation was performed more efficiently as the amount of movement of the instrument decreased.
- the analysis means 12 analyzes the trajectory of the tip position of the instrument (see FIG. 5), as in the present embodiment.
- the evaluation means 14 evaluates whether the trajectory analyzed by the analysis means 12 is straight or not blurred, and determines whether the instrument is used appropriately based on the total distance operated on the trajectory, as in the present embodiment. Evaluate whether Since the total distance and deviation in the trajectory of the tip position of the instrument increases in proportion to the useless movement in operating the instrument, it is a technical evaluation of the operator.
- the evaluation means 14 may evaluate whether the instrument is being used appropriately based on the frequency of opening and closing of the distal end portion.
- the evaluation means 14 evaluates the operating mode of the instrument in surgery based on the velocity calculated from the distance between the tip positions of the instrument between adjacent frames and the acceleration measured at the gyro center (forceps side). good too.
- the analysis means 12 analyzes the points of action (for example, the tip of forceps or cutting instruments), which are the parts of the instrument being operated by the surgeon that abut against the anatomical structure, and the parts of the anatomical structure where the instrument abuts ( For example, the positional relationship with a portion grasped with forceps or a portion cut with an excision instrument is analyzed. Specifically, the anatomical structure and the part where the tissue is grasped, including the instrument, are image-recognized.
- a good rating is a good surgical maneuver with a high degree of confidence in the grasping state.
- the evaluation means 14 evaluates the anatomical structure in surgery based on the body information including the information on the anatomical structure of the body analyzed by the analyzing means 12 and the information on the position of the instrument relative to the anatomical structure contained in the instrument information. Evaluate how the instrument operates. Furthermore, the evaluation means 14 provides information on the position of the anatomical structure of the body analyzed by the analysis means 12 and the instrument (for example, forceps, etc.) The positional relationship between the point of action and the site of the anatomical structure with which the instrument abuts) may be used to evaluate the details of the surgery. Specifically, the evaluation means 14 may evaluate whether the organ is grasped at an appropriate position by the forceps based on the anatomical structure and the positional information of the tip of the forceps.
- the evaluation means 14 determine the three-dimensional absolute position of the anatomy and the instrument, the two-dimensional absolute position of the anatomy and the instrument, the three-dimensional relative position of the anatomy and the instrument or the two-dimensional relative position of the anatomy and the instrument. Based on the location, the content of surgery can be evaluated.
- FIG. 14 is a diagram showing an example of evaluation information generated by the surgery content evaluation system according to the application example of the embodiment of the present invention.
- FIG. 14 shows an example of evaluation information generated by the evaluation means 14 and displayable on the medical institution terminal 2.
- the anatomical structure calculated according to the analysis result by the analysis means 12 and the position of the tip of the surgical instrument are shown in a graph. format.
- the example shown in FIG. 14 shows the transition between the three-dimensional absolute position of the center of gravity of the structure (anatomical structure) and the three-dimensional absolute position of the distal end position of the surgical instrument.
- the center of gravity of the structure is the position of the center of gravity (1/2 point, 1/3 point, etc.) of the area analyzed by the analysis means 12 as the target structure (for example, pancreas). Note that the position of the outline (upper edge, lower edge, left edge, right edge) of the part may be used instead of the center of gravity of the structure.
- FIG. 15 is a diagram showing an example of evaluation information generated by the surgery content evaluation system according to the application example of the embodiment of the present invention.
- FIG. 15 is an example of evaluation information generated by the evaluation means 14 and displayable on the medical institution terminal 2.
- the relative position between the anatomical structure and the tip of the surgical instrument calculated according to the analysis result by the analysis means 12 is shown in FIG. , shown in graphical form.
- the example shown in FIG. 15 shows transition of the relative position between the center of gravity of the structure (anatomical structure) and the tip of the surgical instrument.
- the relative x, y, z position transitions of the center of gravity of the structure and the tip of the surgical instrument are shown.
- the evaluation means 14 evaluates the content of the surgery from the transition of the positional relationship between the anatomical structure and the instruments according to the type of anatomical structure and the content of the surgery. For example, when the anatomical structure is a preserved organ, the evaluation means 14 evaluates the contents of the surgery more highly when the instrument used for the purpose of resection (excision instrument) is separated from the preserved organ. In addition, when the anatomical structure is a resected organ, the evaluation unit 14 evaluates the details of the surgery more highly when the resecting instrument is closer to the resected organ. Also, in this case, the evaluation unit 14 may evaluate the details of the surgery more highly when the speed at which the relative positions of the cutting instrument and the resected organ are closer to each other is high or when the acceleration is constant.
- the evaluation information as shown in FIGS. 14 and 15 is cumulatively recorded in the storage means 20, and this evaluation information is used for appropriate surgery (for example, surgery in which no adverse events of surgery occurred, experienced surgeons, etc.). Surgery performed by a surgeon, etc.) and unfamiliar surgery (surgery in which adverse events occurred, surgery performed by an inexperienced surgeon, etc.)
- a learning model for evaluating the content of surgery may be generated from the transition of the positional relationship between the anatomical structure and the instrument by learning the boundary point of the AI.
- the evaluation means 14 can evaluate the contents of the operation from the transition of the positional relationship between the anatomical structure and the instrument using such boundary points and learning models.
- the evaluation means 14 evaluates the degree of difficulty of surgery according to the information about the anatomical structure of the body included in the body information.
- FIG. 16 is a diagram explaining the processing of the evaluation means in the surgery content evaluation system according to the embodiment of the present invention.
- FIG. 16(a) is a surgical image of a lean patient.
- FIG. 16(b) is a surgical image of an obese patient.
- the evaluation means 14 evaluates the amount of area such as adhesions composed of fat, blood vessels, and connective tissue at the beginning of surgery, and evaluates the degree of surgical difficulty. Moreover, the evaluation means 14 may correct the final evaluation value of the details of the surgery based on the evaluation at the beginning of the surgery.
- the evaluation means 14 evaluates that the operation is of a high degree of difficulty at the beginning of such an operation, the evaluation means 14 transmits warning information indicating a warning/suggestion such as a high bleeding risk to the terminal of the medical institution. good too.
- FIG. 17 is a diagram for explaining the processing of the evaluation means in the surgery content evaluation system according to the embodiment of the present invention.
- the analysis means 12 compares the surgical image acquired by the acquisition means 11 with the specific region analysis model stored in the storage means 20, and analyzes the specific region (body fluid (eg, blood, Bile, intestinal fluid, etc.) is analyzed, and the specific region (in the example shown in FIG. 17, the part indicated as bleeding) and the outline of the specific region are colored.
- body fluid eg, blood, Bile, intestinal fluid, etc.
- the evaluation means 14 quantifies the number of times the specific region has been analyzed by the analysis means 12 (the number of times the body fluid has flowed out), and evaluates the content of the operation performed by the surgeon according to this number.
- the analysis means 12 may also determine the type of body fluid (blood, bile, intestinal fluid, etc.) that forms the specific region. In this case, the evaluation means 14 may evaluate the content of the operation performed by the surgeon according to the number of times for each type of body fluid forming the specific region. For example, when the analysis means 12 determines the type of body fluid to be blood, the evaluation means 14 gradually lowers the evaluation as the number of times increases, and the analysis means 12 determines the type of body fluid to be a specific body fluid (bile, intestinal fluid, etc.). If it is determined that the outflow of the specific body fluid is analyzed even once, the evaluation may be significantly lowered.
- the analysis means 12 analyzes, as instrument information, a bodily fluid treatment tool (for example, gauze used for wiping up bleeding) that treats the bodily fluid that has flowed out.
- the evaluation means 14 may evaluate the content of surgery performed by the surgeon according to the number of times the body fluid disposal tool is analyzed by the analysis means 12 and the movement distance (area per frame) of the body fluid disposal tool. . If the body fluid disposal device (eg, gauze, etc.) has been inserted many times or traveled many distances, there is a possibility that many treatments for bleeding have been performed. Therefore, the evaluation unit 14 may lower the evaluation as the number of times the body fluid treatment tool is analyzed or the moving distance of the body fluid treatment tool increases.
- a body fluid disposal tool eg, gauze, etc.
- the evaluation means 14 may use the anatomical structure of the body and the position information of the bodily fluid disposal device to correct the evaluation of the content of the surgery. For example, when the positions of the preserved tissue and the body fluid handling device are close to each other and the movement of the body fluid handling device is not analyzed (when it is estimated that the body fluid handling device is being used to gently suppress ), even if the body fluid treatment device is analyzed, the evaluation may not be lowered.
- FIG. 18 is a diagram showing an example of evaluation criteria in the evaluation means of the surgery content evaluation system according to the application example of the embodiment of the present invention.
- FIG. 18 shows temporal changes in the area of a specific region (eg, blood) and the movement distance of an instrument (eg, cutting instrument).
- a specific region eg, blood
- an instrument eg, cutting instrument
- the cutting instrument continues to move without reducing the area of the specific region (without reducing the amount of bleeding). In such a case, it is presumed that the operation is proceeding without hemostasis, and the evaluation means 14 lowers the evaluation.
- the surgery content evaluation system 1 may include image editing means for generating a digest image of the surgical image acquired by the acquisition means 11 .
- the image editing means extracts from the surgical image acquired by the acquisition means 11, for example, a moving image of a predetermined time including the frame of each step in the operation specified by the analysis means 12 for each step, and synthesizes them. Generate a digest image.
- the evaluation means 14 identifies surgical images (frames) for which the analysis means 12 has determined that the degree of recognition of information regarding a specific anatomical structure contained in the body information is equal to or greater than a specific threshold.
- FIG. 19 is a diagram for explaining processing in the image editing means of the surgery content evaluation system according to the application example of the embodiment of the present invention.
- FIG. 19 shows temporal changes in the degree of recognition of the target organ and the range of extracted moving images.
- the evaluation means 14 determines that the analysis means 12 determines that the degree of recognition of information regarding a specific anatomical structure (for example, a target organ such as nerve tissue) included in the body information is equal to or greater than a specific threshold (area of nerve tissue (pixel amount or certainty The surgical image (frame) determined to be the total amount of )) is set as the moving image extraction point. Then, the image editing means automatically extracts a predetermined period before and after the moving image extraction point, and edits the moving image. As the predetermined period, for example, after the anatomical structure is analyzed by the analysis means 12 (after the recognition degree of the anatomical structure is generated) until the anatomical structure is no longer analyzed (the recognition degree of the anatomical structure is 0). until ).
- a specific threshold area of nerve tissue (pixel amount or certainty
- the evaluation means 14 may specify surgical images (frames) with a certain degree of certainty or more for the target organ.
- the evaluation unit 14 may set moving image extraction points based on the relationship between the degree of certainty of the operating tool and the structure, or the relationship between the graph of the area of the structure.
- the image editing means extracts the trajectory of the instrument (for example, the resection line, etc.) presented by the AI model that has learned the resection line of each expert doctor when extracting a specific scene during surgery. You may display it in a moving image. Further, the image editing means may display the predicted surgical field and predicted structure after excision by GAN (Generative adversarial network) or the like in the extracted moving image.
- GAN Generative adversarial network
- FIG. 20 is a diagram for explaining processing in the image editing means of the surgery content evaluation system according to the application example of the embodiment of the present invention.
- FIG. 20 shows the transition of surgical images due to the operation of imaging means (for example, a camera) that captures surgical images.
- imaging means for example, a camera
- a camera for imaging the inside of the body is passed through a camera port that is inserted into the body from the outside.
- the upper part of FIG. 20 shows transition of surgical images when the camera placed inside the body is pulled out of the body.
- the lower part of FIG. 20 shows transition of surgical images when a camera is inserted into the body from outside the body.
- the evaluation means 14 may specify a first point at which the degree of certainty of the target organ becomes 0, and a second point at which the degree of certainty increases again thereafter.
- the analyzing means 12 may analyze a fixed structure outside the camera (eg, camera port) as the appliance information. In this case, the evaluation means 14 may specify the time when such a structure is analyzed after starting the analysis of the physical information as the first point. Based on the first point and the second point specified by the evaluation means 14 in this way, the image editing means may automatically delete the moving image between the first point and the second point.
- the surgery content evaluation system 1 it is possible to evaluate the content of the surgery performed by the surgeon according to the degree of recognition that indicates the degree of recognition of body information in the surgical image. .
- the target organ, etc. of the surgery is separated from other organs and exposed, the physical information of the target organ, etc. will be clear in the surgical image, and the degree of recognition of the physical information will be higher. Higher and more recognizable.
- the target organ, etc. for surgery cannot be clearly separated from other organs, the physical information of the target organ, etc. will be unclear in the surgical image, and the degree of recognition of the body information will be lower, and the degree of recognition will be lower. lower.
- the more exposed the target organ, etc. of the surgery the more smoothly the target organ is treated, and the less likely it is that other organs will be damaged. , it becomes a good surgery with less burden on the patient's body (the contents of the surgery are evaluated higher).
- the analysis means can calculate the degree of recognition based on the degree of certainty that indicates the certainty of the analysis result of the physical information. As a result, from a more objective point of view, it is possible to calculate the degree of recognition that indicates the degree of recognition of body information, and to evaluate the content of surgery performed by a surgeon according to such a degree of recognition. Therefore, it is possible to more objectively evaluate the contents of the actual surgery.
- the surgery content evaluation system 1 it is possible to evaluate the content of the surgery performed by the surgeon according to the change in recognition level over time.
- the target organ for surgery (physical information to be analyzed) is a preserved organ
- the faster the recognition rate increases the more skillfully the target organ will be exposed.
- the target organ of surgery (physical information to be analyzed) is a resected organ
- the more the recognition level changes at a relatively low value the more skillfully the target organ has been resected.
- the degree of recognition of a certain organ changes with time relatively little, it means that there is no deviation in the technique. In these cases, the surgery is good with less burden on the patient's body (evaluation of the content of the surgery is higher).
- the surgery content evaluation system 1 it is possible to evaluate the degree of difficulty of the surgery according to the information about the anatomical structure of the body included in the body information.
- the fat which is an example of an anatomical structure
- the blood vessels can be clearly seen through, which reduces the difficulty of the operation. Since the blood vessels are covered with fat, the blood vessels cannot be seen, and since there are adhesions, the fat cannot be sufficiently lifted, resulting in a poor visual field and increasing the difficulty of the operation.
- the surgery content evaluation system 1 it is possible to evaluate the operation mode of the instrument in surgery based on the trajectory of the tip position of the instrument being operated by the surgeon. This improves the analysis accuracy of the trajectory and eliminates the need to recognize all instruments, thereby reducing the load of analysis processing.
- the surgery content evaluation system 1 according to the application example, the positional relationship between the point of action, which is the portion of the instrument being operated by the surgeon that abuts against the anatomical structure, and the part of the anatomical structure with which the instrument abuts. Based on this, it becomes possible to evaluate the operation mode of instruments in surgery.
- the degree of recognition of information related to a specific anatomical structure included in body information among a plurality of consecutive surgical images in time series is determined to be greater than or equal to a specific threshold. It is possible to identify the surgical image that has been acquired. This makes it possible to specify the time point at which a specific anatomical structure is exposed in a moving image composed of a plurality of surgical images that are consecutively arranged in time series. For example, by adding a marker to the specified time point in a moving image, it is possible to quickly reproduce a scene in which a specific anatomical structure is exposed, or to edit the video based on the specified time point.
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Abstract
Description
外科医によって手術が行われている患者の身体を撮像した画像である手術画像を取得する取得手段と、
前記手術画像において、身体の状態を示す身体情報及び/又は外科医に操作されている器具の状態を示す器具情報を解析する解析手段と、
前記解析手段が解析した前記身体情報及び/又は前記器具情報に基づき、当該外科医によって行われている手術の内容を評価する評価手段と、を備えることを特徴とする手術内容評価システム。
取得手段と、外科医によって手術が行われている患者の身体を撮像した画像である手術画像を取得する。
解析手段は、手術画像において、身体の状態を示す身体情報及び/又は外科医に操作されている器具の状態を示す器具情報を解析する。
評価手段は、解析手段が解析した身体情報及び/又は器具情報に基づき、当該外科医によって行われている手術の内容を評価する。
したがって、実際の手術の内容を客観的に評価することが可能な手術内容評価システムを提供できる。
前記評価手段は、前記手術画像における前記特定領域が所定の閾値を超えた場合には、体液の流出又は臓器損傷があったと評価することを特徴とする(1)に記載の手術内容評価システム。
前記評価手段は、前記器具に関する情報に基づき、手術における前記器具の操作態様を評価することを特徴とする(1)又は(2)に記載の手術内容評価システム。
身体の解剖構造に関する情報を含む前記身体情報を解析し、
前記解剖構造に対する前記器具の位置に関する情報を含む前記身体情報及び/又は前記器具情報を解析し、
前記評価手段は、前記解剖構造に対する前記器具の位置に関する情報に基づき、手術における前記解剖構造に対する前記器具の操作態様を評価することを特徴とする(1)から(3)のいずれかに記載の手術内容評価システム。
ある前記ステップから、次の前記ステップまでの時間であるステップ間時間を測定する計時手段を、更に備え、
前記評価手段は、ある前記ステップ間に対して、前記計時手段が測定した前記ステップ間時間に基づき、手術の手際を評価することを特徴とする(1)から(4)に記載の手術内容評価システム。
外科医によって手術が行われている患者の身体を撮像した画像である手術画像を取得するステップと、
前記手術画像において、身体の状態を示す身体情報及び/又は外科医に操作されている器具の状態を示す器具情報を解析するステップと、
前記身体情報及び/又は前記器具情報に基づき、当該外科医によって行われている手術の内容を評価するステップと、を含むことを特徴とする手術内容評価方法。
外科医によって手術が行われている患者の身体を撮像した画像である手術画像を取得する取得手段、
前記手術画像において、身体の状態を示す身体情報及び/又は外科医に操作されている器具の状態を示す器具情報を解析する解析手段、
前記解析手段が解析した前記身体情報及び/又は前記器具情報に基づき、当該外科医によって行われている手術の内容を評価する評価手段、として機能させるプログラム。
外科医によって手術が行われている患者の身体を撮像した画像である手術画像を取得する取得手段と、
前記手術画像において、身体の状態を示す身体情報を解析する解析手段と、
前記解析手段が解析した前記身体情報に基づき、当該外科医によって行われている手術の内容を評価する評価手段と、を備えることを特徴とする手術内容評価システム。
したがって、実際の手術の内容を客観的に評価することが可能な手術内容評価システムを提供できる。
前記評価手段は、前記認識度に応じて、外科医によって行われている手術の内容を評価することを特徴とする(8)に記載の手術内容評価システム。
前記身体情報の解析結果の確からしさを示す確信度を算出し、
前記認識度を、前記確信度に基づき算出することを特徴とする(9)に記載の手術内容評価システム。
前記評価手段は、前記軌道に基づき、手術における前記器具の操作態様を評価することを特徴とする(8)から(12)のいずれかに記載の手術内容評価システム。
前記評価手段は、前記位置関係に基づき、手術における前記器具の操作態様を評価することを特徴とする(8)から(13)のいずれかに記載の手術内容評価システム。
前記評価手段は、前記解析手段において、前記身体情報に含まれる特定の解剖構造に関する情報に対する前記認識度が、特定閾値以上と判定された前記手術画像を特定することを特徴とする(9)から(14)のいずれかに記載の手術内容評価システム。
外科医によって手術が行われている患者の身体を撮像した画像である手術画像を取得するステップと、
前記手術画像において、身体の状態を示す身体情報を解析するステップと、
前記解析手段が解析した前記身体情報に基づき、当該外科医によって行われている手術の内容を評価するステップと、を含むことを特徴とする手術内容評価方法。
外科医によって手術が行われている患者の身体を撮像した画像である手術画像を取得する取得手段、
前記手術画像において、身体の状態を示す身体情報を解析する解析手段、
前記解析手段が解析した前記身体情報に基づき、当該外科医によって行われている手術の内容を評価する評価手段、として機能させるプログラム。
図1は、本発明の実施形態に係る手術内容評価システムの概要を説明する図である。
手術内容評価システム1は、外科医によって行われた手術の内容を評価する。
したがって、実際の手術の内容を客観的に評価することが可能となる。
図2は、本発明の実施形態に係る手術内容評価システムの機能構成を示す図である。
手術内容評価システム1は、複数の医療機関端末2と、ネットワークを介して接続されており、取得手段11と、解析手段12と、計時手段13と、評価手段14と、送信手段15と、記憶手段20と、を備える。
図3に示す例は、胆嚢摘出手術の手術画像であり、図3中上から胆嚢摘出手術におけるステップX(胆嚢の表出)と、次のステップであるステップX+1(胆嚢管の切離)と、次のステップであるステップX+2(胆嚢の摘出)を示している。
図4は、本発明の実施形態に係る手術内容評価システムにおける評価手段の処理を説明する図である。図4(a)は、流血が発生していない状態の手術画像である。図4(b)は、流血が発生した状態の手術画像である。図4(b)に示す例では、画像全般に特定色の一例である赤色の成分が増大しており、図4(a)に比べて、暗い画像となっている。
図8は、本発明の実施形態に係る手術内容評価システムが実行する手術内容評価処理フローを示す図である。
したがって、実際の手術の内容を客観的に評価することが可能な手術内容評価システムを提供できる。
次に、本発明の実施形態の応用例について説明する。以下の説明において、本実施形態と同様の構成には、同一の符号を付し、その説明を省略又は簡略する。
応用例に係る手術内容評価システム1は、本実施形態の構成に加え、主に、解析手段12(図2参照)が、身体情報の認識の程度を示す認識度を算出し、評価手段14(図2参照)が、この認識度に応じて、外科医によって行われている手術の内容を評価する。
図9に示す例は、評価手段14により生成され、医療機関端末2で表示可能な評価情報の一例であり、解析手段12による解析結果に応じて決定した評価値が、グラフ形式で示されている。
解析手段12は、手術画像における身体情報(例えば、解剖構造)の認識の程度を示す認識度を算出する。詳細には、解析手段12は、身体情報の解析結果の確からしさを示す確信度を算出し、認識度を、確信度に基づき算出する。
そして、評価手段14は、この認識度に応じて、外科医によって行われている手術の内容を評価する。
このような場合、神経組織が十分に露出しており、神経組織が途絶していない場合に比べ、解析手段12に算出される身体情報の一例である神経組織の認識度が低下する。そして、評価手段14は、認識度が低下した場合、これに応じて、外科医によって行われている手術の内容を低く評価する。
このような評価基準を踏まえ、評価手段14は、認識度の経時変化に応じて、外科医によって行われている手術の内容を評価してもよい。具体的には、評価手段14は、認識度の増減の速度や加速度に応じて、手術の内容を評価してもよい。例えば、評価手段14は、認識度の増減の速度が早ければ、速やかに手術が進行しているとの評価をしてもよいし、認識度の増減の加速度が一定であれば、安定して手術が進行しているとの評価をしてもよい。
具体的には、良い手術とは、手術合併症がない、熟練の医師が行っている、熟練の医師が良い手術と判断した手術などである。また、悪い手術とは、手術合併症があった、不慣れな医師が行っている、熟練の医師が良くない手術と判断した手術などである。
評価手段14は、これらを、正解データとして情報付けすることによって、AIにより評価を学習し、良い評価、悪い評価をする。
図11は、評価手段14により生成され、医療機関端末2で表示可能な評価情報の一例であり、解析手段12による解析結果に応じて決定した評価値が、グラフ形式で示されている。図11に示す例は、臓器を切除する手術における切除臓器の確信度の推移を示しており、評価手段14の評価点がより高い例と、より低い例とを重ねて示している。
ここで、手術では、切除する切除臓器と、温存する温存臓器とが混在する。図12は、このような場合における切除臓器と温存臓器の認識度の時間的変化を示している。
図13は、本発明の実施形態の応用例に係る手術内容評価システムで生成される評価情報の一例を示す図である。
図13は、評価手段14により生成され、医療機関端末2で表示可能な評価情報の一例であり、解析手段12による解析結果に応じて算出された移動量が、グラフ形式で示されている。図13に示す例は、外科医に操作されている器具の先端位置の軌道における移動量の推移を示しており、評価手段14の評価点がより高い例と、より低い例とを重ねて示している。
本実施形態と同様に、評価手段14は、解析手段12が解析した身体の解剖構造に関する情報を含む身体情報及び器具情報に含まれる解剖構造に対する器具の位置に関する情報に基づき、手術における解剖構造に対する器具の操作態様を評価する。さらに、評価手段14は、解析手段12が解析した身体の解剖構造と器具(例えば、鉗子等)の位置情報(例えば、上述の外科医に操作されている器具の解剖構造に当接した部分である作用点と、解剖構造の当該器具が当接した部位との位置関係)を用いて、手術の内容を評価してもよい。具体的には、評価手段14は、解剖構造と鉗子の先端の位置情報に基づき、鉗子で臓器を適切な位置で把持されているかを評価してもよい。
図14は、評価手段14により生成され、医療機関端末2で表示可能な評価情報の一例であり、解析手段12による解析結果に応じて算出された解剖構造と術器具の先端の位置が、グラフ形式で示されている。図14に示す例は、構造物(解剖構造)の重心の三次元の絶対位置と、手術器具の先端位置の三次元の絶対位置との推移を示している。詳細には、構造物の重心のx,y,z方向のそれぞれの位置、術器具の先端位置のx,y,z方向のそれぞれの位置の推移が示されている。構造物の重心とは、解析手段12により対象構造物(例えば、膵臓等)と解析された部分の面積の重心位置(1/2点や1/3点等)である。なお、構造物の重心の代わりに、当該部分の輪郭(上縁、下縁、左縁、右縁)の位置を用いてもよい。
図15は、評価手段14により生成され、医療機関端末2で表示可能な評価情報の一例であり、解析手段12による解析結果に応じて算出された解剖構造と術器具の先端との相対位置が、グラフ形式で示されている。図15に示す例は、構造物(解剖構造)の重心と手術器具の先端との相対位置の推移を示している。詳細には、構造物の重心と手術器具の先端との相対的なx,y,z方向のそれぞれの位置の推移が示されている。
評価手段14は、身体情報に含まれる身体の解剖構造に関する情報に応じて、手術の難易度を評価する。
評価手段14は、脂肪や血管、結合組織で構成される癒着などの面積量を手術の序盤で評価し、手術難易度を評価する。また、評価手段14は、このような手術の序盤における評価に基づき、手術の内容の最終評価値の補正をしてもよい。また、評価手段14は、このような手術の序盤において、高難易度の手術との評価をした場合、出血リスクが高い等の警告・示唆を示す警告情報を、医療機関の端末に送信してもよい。
図17は、本発明の実施形態に係る手術内容評価システムにおける評価手段の処理を説明する図である。
本実施形態と同様に、解析手段12は、取得手段11が取得した手術画像と、記憶手段20に記憶された特定領域解析モデルとを対比し、手術画像における特定領域(体液(例えば、血液、胆汁、腸液等)の流出によりできた領域)を解析し、特定領域(図17に示す例では、出血と差し示した部分)や特定領域の輪郭を着色する。
本実施形態と同様に、手術内容評価システム1は、取得手段11が取得した手術画像のダイジェスト版画像を生成する画像編集手段を備えてもよい。画像編集手段は、取得手段11が取得した手術画像から、例えば、解析手段12が特定した手術における各ステップのフレームを含む所定時間の動画を、ステップ毎に抽出し、これらを合成することで、ダイジェスト版画像を生成する。
図20の上段は、体内に配置されたカメラを体外に引き出した場合の手術画像の推移を示している。図20の下段は、体外から体内にカメラを挿入した場合の手術画像の推移を示している。
そして、当然に、手術の対象臓器等が、他の臓器から切り離されて露わにされているほど、対象臓器への施術がスムーズに行われ、他の臓器に損傷を与える可能性が低減し、患者の身体への負担が少ない良い手術となる(手術の内容の評価がより高くなる。)。
2 医療機関端末
11 取得手段
12 解析手段
13 計時手段
14 評価手段
15 送信手段
20 記憶手段
Claims (17)
- 外科医によって行われた手術の内容を評価する手術内容評価システムであって、
外科医によって手術が行われている患者の身体を撮像した画像である手術画像を取得する取得手段と、
前記手術画像において、身体の状態を示す身体情報及び/又は外科医に操作されている器具の状態を示す器具情報を解析する解析手段と、
前記解析手段が解析した前記身体情報及び/又は前記器具情報に基づき、当該外科医によって行われている手術の内容を評価する評価手段と、を備えることを特徴とする手術内容評価システム。 - 前記解析手段は、前記手術画像における特定領域を解析し、
前記評価手段は、前記手術画像における前記特定領域が所定の閾値を超えた場合には、体液の流出又は臓器損傷があったと評価することを特徴とする請求項1に記載の手術内容評価システム。 - 前記解析手段は、前記器具に関する情報を含む前記器具情報を解析し、
前記評価手段は、前記器具に関する情報に基づき、手術における前記器具の操作態様を評価することを特徴とする請求項1又は2に記載の手術内容評価システム。 - 前記解析手段は、
身体の解剖構造に関する情報を含む前記身体情報を解析し、
前記解剖構造に対する前記器具の位置に関する情報を含む前記身体情報及び/又は前記器具情報を解析し、
前記評価手段は、前記解剖構造に対する前記器具の位置に関する情報に基づき、手術における前記解剖構造に対する前記器具の操作態様を評価することを特徴とする請求項1から3のいずれかに記載の手術内容評価システム。 - 前記解析手段は、複数のステップからなる手術の前記手術画像において、前記ステップをそれぞれ解析し、
ある前記ステップから、次の前記ステップまでの時間であるステップ間時間を測定する計時手段を、更に備え、
前記評価手段は、ある前記ステップ間に対して、前記計時手段が測定した前記ステップ間時間に基づき、手術の手際を評価することを特徴とする請求項1から4のいずれかに記載の手術内容評価システム。 - 外科医によって行われた手術の内容を評価する手術内容評価システムが実行する方法であって、
外科医によって手術が行われている患者の身体を撮像した画像である手術画像を取得するステップと、
前記手術画像において、身体の状態を示す身体情報及び/又は外科医に操作されている器具の状態を示す器具情報を解析するステップと、
前記身体情報及び/又は前記器具情報に基づき、当該外科医によって行われている手術の内容を評価するステップと、を含むことを特徴とする手術内容評価方法。 - 外科医によって行われた手術の内容を評価する手術内容評価システムを、
外科医によって手術が行われている患者の身体を撮像した画像である手術画像を取得する取得手段、
前記手術画像において、身体の状態を示す身体情報及び/又は外科医に操作されている器具の状態を示す器具情報を解析する解析手段、
前記解析手段が解析した前記身体情報及び/又は前記器具情報に基づき、当該外科医によって行われている手術の内容を評価する評価手段、として機能させるプログラム。 - 外科医によって行われた手術の内容を評価する手術内容評価システムであって、
外科医によって手術が行われている患者の身体を撮像した画像である手術画像を取得する取得手段と、
前記手術画像において、身体の状態を示す身体情報を解析する解析手段と、
前記解析手段が解析した前記身体情報に基づき、当該外科医によって行われている手術の内容を評価する評価手段と、を備えることを特徴とする手術内容評価システム。 - 前記解析手段は、前記手術画像における前記身体情報の認識の程度を示す認識度を算出し、
前記評価手段は、前記認識度に応じて、外科医によって行われている手術の内容を評価することを特徴とする請求項8に記載の手術内容評価システム。 - 前記解析手段は、
前記身体情報の解析結果の確からしさを示す確信度を算出し、
前記認識度を、前記確信度に基づき算出することを特徴とする請求項9に記載の手術内容評価システム。 - 前記評価手段は、前記認識度の経時変化に応じて、外科医によって行われている手術の内容を評価することを特徴とする請求項9又は10のいずれかに記載の手術内容評価システム。
- 前記評価手段は、前記身体情報に含まれる身体の解剖構造に関する情報に応じて、手術の難易度を評価することを特徴とする請求項8から11のいずれかに記載の手術内容評価システム。
- 前記解析手段は、外科医に操作されている器具の先端位置の軌道を解析し、
前記評価手段は、前記軌道に基づき、手術における前記器具の操作態様を評価することを特徴とする請求項8から12のいずれかに記載の手術内容評価システム。 - 前記解析手段は、外科医に操作されている器具の解剖構造に当接した部分である作用点と、解剖構造の前記器具が当接した部位との位置関係を解析し、
前記評価手段は、前記位置関係に基づき、手術における前記器具の操作態様を評価することを特徴とする請求項8から13のいずれかに記載の手術内容評価システム。 - 前記取得手段は、時系列で連続的に複数の前記手術画像を取得し、
前記評価手段は、前記解析手段において、前記身体情報に含まれる特定の解剖構造に関する情報に対する前記認識度が、特定閾値以上と判定された前記手術画像を特定することを特徴とする請求項9から14のいずれかに記載の手術内容評価システム。 - 外科医によって行われた手術の内容を評価する手術内容評価システムが実行する方法であって、
外科医によって手術が行われている患者の身体を撮像した画像である手術画像を取得するステップと、
前記手術画像において、身体の状態を示す身体情報を解析するステップと、
前記解析手段が解析した前記身体情報に基づき、当該外科医によって行われている手術の内容を評価するステップと、を含むことを特徴とする手術内容評価方法。 - 外科医によって行われた手術の内容を評価する手術内容評価システムを、
外科医によって手術が行われている患者の身体を撮像した画像である手術画像を取得する取得手段、
前記手術画像において、身体の状態を示す身体情報を解析する解析手段、
前記解析手段が解析した前記身体情報に基づき、当該外科医によって行われている手術の内容を評価する評価手段、として機能させるプログラム。
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