WO2023170982A1 - Treatment system and operating method for treatment system - Google Patents

Abstract

A treatment system according to the present invention is equipped with: a treatment instrument for cutting biological tissue in a liquid; an irrigation device for controlling the irrigation of the liquid; a turbidity information storage unit for storing turbidity information in advance in order to determine a change in the turbidity of the liquid which is caused by cutting debris generated by cutting with the treatment instrument; a cutting data measurement unit for measuring data which expresses the cutting state brought about by the treatment instrument; and a control unit for controlling the drive conditions of the irrigation device on the basis of the measured cutting data and the stored turbidity information.

Description

Treatment systems and how they operate

The present invention relates to a treatment system and a method of operating the treatment system.

In arthroscopic surgery, a portal is formed in the joint to be treated, the arthroscope and treatment instruments are inserted through the portal into the joint to be treated, and the arthroscopy is performed with the joint cavity filled with irrigation fluid. This is a surgery in which the inside of the joint cavity is observed using a Arthroscopic surgery is performed using an arthroscopic surgery system (see, for example, Patent Document 1). Moreover, Patent Document 1 discloses an ultrasonic treatment tool for forming a hole in a bone. This ultrasonic treatment tool is configured so that the tip of the treatment tool vibrates ultrasonically. In arthroscopic surgery, the tip of a treatment instrument crushes (cuts) bone using ultrasonic vibrations, forming a hole in the bone. After this, the two bone holes are connected to form one bone hole.

International Publication No. 2018/078830

By the way, when a bone is cut with a treatment tool, bone shavings (bone powder) are generated. During arthroscopic surgery, bone powder to be treated is flushed away with irrigation fluid. However, bone powder may be dispersed in the irrigation fluid, making the irrigation fluid cloudy and obstructing the field of view of the arthroscope for observing the treatment target. In this case, the operator must stop and wait for the visual field to recover, which may place a burden on the patient and the operator, and may increase the time required for the surgery.

The present invention has been made in view of the above, and an object of the present invention is to provide a treatment system and a method for operating the treatment system that can suppress the influence on surgery caused by turbidity in the irrigation fluid.

In order to solve the above-mentioned problems and achieve the objects, a treatment system according to the present invention includes a treatment tool for cutting biological tissue in a liquid, a perfusion device for controlling perfusion of the liquid, and a treatment system for cutting biological tissue by the treatment tool. a turbidity information storage unit that stores in advance turbidity information for determining a change in turbidity of the liquid due to cutting dust generated by the cutting process, and a cutting data measurement unit that measures data indicating the state of cutting by the treatment instrument; A control unit that controls driving conditions of the perfusion device based on the measured cutting data and the stored turbidity information.

Moreover, in order to solve the above-mentioned problems and achieve the purpose, a method for operating a treatment system according to the present invention includes: a treatment tool that cuts biological tissue in a liquid; a perfusion device that controls perfusion of the liquid; A method of operating a treatment system comprising: a turbidity information storage unit that stores turbidity information in advance for determining a change in turbidity of the liquid due to cutting dust generated by cutting with the treatment tool; and the control unit. The cutting data measurement unit measures data indicating the cutting state by the treatment instrument, and the control unit controls the driving conditions of the perfusion device based on the measured cutting data and the stored turbidity information. Control.

According to the present invention, it is possible to suppress the influence on surgery caused by turbidity in the irrigation fluid.

FIG. 1 is a diagram showing a schematic configuration of a treatment system according to a first embodiment. FIG. 2 is a diagram showing how a bone hole is formed using an ultrasonic probe. FIG. 3A is a schematic diagram showing a schematic configuration of an ultrasound probe. FIG. 3B is a schematic diagram in the direction of arrow A in FIG. 3A. FIG. 4 is a block diagram showing an overview of the functional configuration of the treatment system according to the first embodiment. FIG. 5 is a block diagram showing the functional configuration of the endoscope device. FIG. 6A is a diagram schematically showing a state in which the endoscope has good visibility when forming a bone hole in the lateral condyle of the femur. FIG. 6B is a diagram schematically showing a state in which the visibility of the endoscope is not good when forming a bone hole in the lateral condyle of the femur. FIG. 7 is a block diagram showing the functional configuration of the treatment device. FIG. 8 is a block diagram showing the functional configuration of the perfusion device. FIG. 9 is a block diagram showing the functional configuration of the lighting device. FIG. 10 is a flowchart illustrating an overview of a treatment performed by an operator using the treatment system according to the first embodiment. FIG. 11 is a flowchart illustrating an overview of the cutting treatment in the treatment system according to the first embodiment. FIG. 12 is a diagram for explaining control of the perfusion device in a cutting treatment, and is a diagram for explaining the relationship between impedance and drive conditions of the perfusion device. FIG. 13 is a diagram for explaining the driving conditions of the perfusion device. FIG. 14 is a diagram for explaining the pulse waveform under the driving condition D1. FIG. 15 is a diagram for explaining the pulse waveform under driving condition D2. FIG. 16 is a diagram for explaining the pulse waveform under driving condition D3. FIG. 17 is a diagram for explaining the pulse waveform under the driving condition Ds. FIG. 18 is a block diagram showing the functional configuration of a treatment device included in the treatment system according to the second embodiment. FIG. 19 is a flowchart illustrating an overview of cutting treatment in the treatment system according to the second embodiment. FIG. 20 is a diagram for explaining the control of the perfusion device in the cutting treatment, and is a diagram for explaining the relationship between the cutting time and the driving conditions of the perfusion device.

Hereinafter, modes for carrying out the present invention (hereinafter referred to as embodiments) will be described with reference to the drawings. Note that the present invention is not limited to the embodiments described below. Furthermore, in the description of the drawings, the same parts are denoted by the same reference numerals.

(Embodiment 1)
[Schematic configuration of treatment system]
FIG. 1 is a diagram showing a schematic configuration of a treatment system 1 according to the first embodiment.
The treatment system 1 treats living tissues such as bones by applying ultrasonic vibrations to the living tissues. Here, the treatment means, for example, removal or cutting of living tissue such as bone. In addition, in FIG. 1, a treatment system for performing anterior cruciate ligament reconstruction is illustrated as the treatment system 1. This treatment system 1 includes an endoscope device 2, a treatment device 3, a guiding device 4, a perfusion device 5, and an illumination device 6.

The endoscope device 2 includes an endoscope 201, an endoscope control device 202, and a display device 203.
In the endoscope 201, the distal end portion of the insertion portion 211 is inserted into the joint cavity C1 of the knee joint J1 through a first portal P1 that communicates the inside of the joint cavity C1 with the outside of the skin. The endoscope 201 then irradiates the inside of the joint cavity C1, captures the illumination light (subject image) reflected within the joint cavity C1, and captures the subject image.
The endoscope control device 202 performs various image processing on the captured image captured by the endoscope 201, and causes the display device 203 to display the captured image after the image processing. The endoscope control device 202 is connected to the endoscope 201 and the display device 203 by wire or wirelessly.
The display device 203 receives data, image data, audio data, etc. transmitted from each device of the treatment system via the endoscope control device, and displays/announces the data. The display device 203 is configured using a display panel made of liquid crystal or organic EL (Electro-Luminescence).

The treatment device 3 includes a treatment tool 301, a treatment tool control device 302, and a foot switch 303.
The treatment tool 301 includes a treatment tool main body 311, an ultrasonic probe 312 (see FIG. 2), and a sheath 313.
The treatment instrument main body 311 is formed into a cylindrical shape. Inside the treatment instrument main body 311, an ultrasonic transducer 311a (constituted by a bolt-clamped Langevin-type transducer) that generates ultrasonic vibrations in accordance with the supplied driving power. Figure 1) is stored.
The treatment instrument control device 302 supplies the driving power to the ultrasonic transducer 311a in response to the operator's operation of the foot switch 303. Note that the supply of the driving power is not limited to the operation on the foot switch 303, and may be performed, for example, in response to the operation on an operation section (not shown) provided on the treatment instrument 301.
The foot switch 303 is an input interface used by the surgeon to operate the ultrasound probe 312 with his/her foot.
The guiding device 4, perfusion device 5, and lighting device 6 will be described later.

FIG. 2 is a diagram showing how the bone hole 101 is formed using the ultrasonic probe 312. FIG. 3A is a schematic diagram showing a schematic configuration of the ultrasound probe 312. FIG. 3B is a schematic diagram in the direction of arrow A in FIG. 3A.
The ultrasonic probe 312 is made of, for example, a titanium alloy, and has a substantially cylindrical shape. A proximal end portion of the ultrasonic probe 312 is connected to an ultrasonic transducer 311a within the treatment instrument main body 311. The ultrasonic probe 312 transmits ultrasonic vibrations generated by the ultrasonic transducer 311a from the base end to the distal end. In the first embodiment, the ultrasonic vibration is longitudinal vibration along the longitudinal direction of the ultrasonic probe 312 (vertical direction in FIG. 2). Furthermore, as shown in FIG. 2, a distal treatment section 312a is provided at the distal end of the ultrasonic probe 312.

The sheath 313 is formed into a cylindrical shape that is more elongated than the treatment instrument main body 311, and covers a part of the outer periphery of the ultrasound probe 312 from the treatment instrument main body 311 to an arbitrary length.

The tip of the ultrasonic probe 312 in the treatment instrument 301 described above is guided by the guiding device 4 inserted into the joint cavity C1 through the second portal P2 that communicates the inside of the joint cavity C1 with the outside of the skin. , is inserted into the joint cavity C1.
When ultrasonic vibration is generated with the distal treatment section 312a in contact with the bone treatment target site 100, the portion of the bone that mechanically collided with the distal treatment section 312a is finely damaged by the hammering action. It is ground into fine particles (see Figure 2). When the distal treatment section 312a is pushed into the treatment target site 100 by the operator, the distal treatment section 312a enters the inside of the treatment target site 100 while crushing the bone. As a result, a bone hole 101 is formed in the treatment target site 100.

At the base end of the treatment instrument main body 311, an annular circuit board 317 on which a posture detection section 314, a CPU (Central Processing Unit) 315, and a memory 316 are mounted is provided. (See Figures 3A and 3B). Posture detection unit 314 includes a sensor that detects rotation and movement of treatment instrument 301. The posture detection unit 314 detects movement in three mutually orthogonal axial directions, including an axis parallel to the longitudinal axis of the ultrasound probe 312, and rotation around each axis. The posture detection unit 314 includes, for example, a three-axis angular velocity sensor (gyro sensor), an acceleration sensor, and the like. The treatment instrument control device 302 determines that the treatment instrument 301 is stationary if the detection result of the posture detection unit 314 does not change for a certain period of time. The CPU 315 corresponds to a control unit that controls the operation of the posture detection unit 314 and transmits and receives information to and from the treatment instrument control device 302.

In FIG. 1, the guiding device 4 is inserted into the joint cavity C1 through the second portal P2, and guides the insertion of the tip portion of the ultrasound probe 312 of the treatment tool 301 into the joint cavity C1.
The guiding device 4 includes a guide body 401, a handle portion 402, and a drain portion 403 with a cock.

The guide body 401 has a cylindrical shape with a through hole through which the ultrasound probe 312 is inserted (see FIG. 1). The guide body 401 guides the movement of the ultrasound probe 312 by restricting the movement of the ultrasound probe 312 inserted through the through hole in a certain direction. In this embodiment, the cross-sectional shapes of the outer circumferential surface and the inner circumferential surface of the guide main body 401 perpendicular to the central axis are approximately circular.
This guide body 401 becomes thinner toward the tip. That is, the distal end surface of the guide body 401 includes an opening formed by a slope diagonally intersecting the central axis.

The drain part 403 with a cock is provided on the outer peripheral surface of the guide body 401 and has a cylindrical shape that communicates with the inside of the guide body 401. One end of the drain tube 505 of the perfusion device 5 is connected to the drain portion 403 with a cock, and serves as a flow path that communicates the guide main body 401 and the drain tube 505 of the perfusion device 5 . This flow path is configured to be openable and closable by operating a cock (not shown) provided in the drain portion 403 with a cock.

The perfusion device 5 delivers a sterilized irrigation fluid such as physiological saline into the joint cavity C1, and also discharges the irrigation fluid outside the joint cavity C1. The perfusion device 5 includes a liquid source 501, a liquid feeding tube 502, a liquid feeding pump 503, a drainage bottle 504, a drainage tube 505, and a drainage pump 506 (see FIG. 1).

Fluid source 501 contains irrigation fluid.
The liquid feeding tube 502 has one end connected to the liquid source 501 and the other end connected to the endoscope 201.
The liquid sending pump 503 sends the irrigation liquid from the liquid source 501 toward the endoscope 201 through the liquid sending tube 502 . The irrigation fluid sent to the endoscope 201 is then sent into the joint cavity C1 from the liquid delivery hole formed at the distal end portion of the insertion section 211.

Drainage bottle 504 contains the irrigation fluid drained out of joint cavity C1.
The drain tube 505 has one end connected to the guiding device 4 and the other end connected to the drain bottle 504.
The drainage pump 506 follows the flow path of the drainage tube 505 from the guiding device 4 inserted into the joint cavity C1, and discharges the irrigation fluid in the joint cavity C1 to the drainage bottle 504. In addition, although this Embodiment 1 demonstrates using the drainage pump 506, it does not restrict to this and may use the suction device with which the facility was equipped.

The illumination device 6 has two light sources that each emit two illumination lights with different wavelength bands. The two illumination lights are, for example, white light and special light. Illumination light from the illumination device 6 is propagated to the endoscope 201 via the light guide, and is irradiated from the tip of the endoscope 201.

[Functional configuration of the entire treatment system]
FIG. 4 is a block diagram showing an overview of the functional configuration of the entire treatment system. The treatment system 1 further includes a network control device 7 that controls communication throughout the system, and a network server 8 that stores various data.
The network control device 7 is communicably connected to the endoscope device 2, treatment device 3, perfusion device 5, lighting device 6, and network server 8. Although FIG. 4 illustrates a case where the devices are connected wirelessly, they may be connected by wire. The detailed functional configurations of the endoscope device 2, treatment device 3, perfusion device 5, and illumination device 6 will be described below.

[Functional configuration of endoscope device]
The endoscope device 2 includes an endoscope control device 202, a display device 203, an imaging section 204, and an operation input section 205 (see FIGS. 4 and 5).

The endoscope control device 202 includes an image processing unit 221, an image processing unit 222, a turbidity detection unit 223, an input unit 226, a CPU (Central Processing Unit) 227, a memory 228, a wireless communication unit 229, a distance sensor drive circuit 230, and a distance sensor drive circuit 230. It includes a data memory 231 and a communication interface 232.

The imaging processing unit 221 is provided in an imaging device drive control circuit 221a that controls the driving of the imaging device 241 included in the imaging unit 204, and in a patient circuit 202b that is electrically insulated from the primary circuit 202a, and processes signals from the imaging device 224a. It has an image sensor signal control circuit 221b that performs control. The image sensor drive control circuit 221a is provided in the primary circuit 202a. Further, the image sensor signal control circuit 221b is provided in the patient circuit 202b which is electrically insulated from the primary circuit 202a.
The image processing unit 222 includes a first image processing circuit 222a that performs image processing and a second image processing circuit 222b that performs image editing processing.
The turbidity detection unit 223 detects turbidity based on information regarding turbidity within the endoscope device 2 . Here, the information regarding turbidity is, for example, a value obtained from imaging data generated by the endoscope 201, a physical property value of the perfusate, an impedance or pH obtained from the treatment device 3, and the like. Here, FIGS. 6A and 6B are diagrams showing a state in which the field of view of the endoscope 201 is good and a state in which it is poor, respectively, when the operator forms a bone hole in the lateral femoral condyle 900. FIG. 3 is a diagram schematically showing a field of view. Of these, FIG. 6B schematically shows a state in which the field of vision is clouded due to bones crushed into fine particles by the driving of the ultrasonic probe 312. Note that in FIG. 6B, minute bones are represented by dots. The fine bones are white, and the perfusate becomes cloudy due to the white particles containing these bones.

In FIG. 5, the input unit 226 receives the signal input by the operation input unit 205.
The CPU 227 centrally controls the operation of the endoscope control device 202. The CPU 227 corresponds to a control unit that executes a program stored in the memory 228 and controls the operation of each part of the endoscope control device 202.
The memory 228 stores various information necessary for the operation of the endoscope control device 202, image data captured by the imaging unit 204, and the like.
The wireless communication unit 229 is an interface for wireless communication with other devices.
The distance sensor drive circuit 230 drives a distance sensor that measures the distance to a predetermined object in the image captured by the imaging unit 204.
The distance data memory 231 stores distance data detected by the distance sensor.
The communication interface 232 is an interface for communicating with the imaging unit 204.
Of the configuration described above, components other than the image sensor signal control circuit 221b are provided in the primary circuit 202a, and are interconnected by bus wiring.

The imaging unit 204 includes an imaging element 241, a CPU 242, and a memory 243.
The image sensor 241 is configured using a CCD (Charge Coupled Device) or a CMOS (Complementary Metal Oxide Semiconductor).
The CPU 242 centrally controls the operation of the imaging unit 204. The CPU 242 corresponds to a control unit that executes a program stored in the memory 243 and controls the operation of each part of the imaging unit 204.
The memory 243 stores various information, image data, etc. necessary for the operation of the imaging unit 204.

In FIG. 4, the operation input unit 205 is configured using an input interface such as a mouse, keyboard, touch panel, microphone, etc., and accepts operation input of the endoscope apparatus 2 by the operator.

[Functional configuration of treatment device]
The treatment device 3 includes a treatment tool 301, a treatment tool control device 302, and an input/output section 304 (see FIGS. 4 and 7).

The treatment tool 301 includes an ultrasonic transducer 311a, a posture detection section 314, a CPU 315, and a memory 316 (see FIG. 7).
The posture detection unit 314 includes an acceleration sensor and/or an angular velocity sensor, and detects the posture of the treatment instrument 301.
The CPU 315 centrally controls the operation of the treatment instrument 301 including the ultrasonic transducer 311a. The CPU 315 corresponds to a control unit that executes a program stored in the memory 316 to control the operation of each part of the treatment instrument 301.
The memory 316 stores various information necessary for the operation of the treatment instrument 301.

The treatment instrument control device 302 includes a primary circuit 321, a patient circuit 322, a transformer 323, a first power source 324, a second power source 325, a CPU 326, a memory 327, a wireless communication section 328, a communication interface 329, and an impedance measurement section 330.

The primary circuit 321 generates power to be supplied to the treatment instrument 301.
Patient circuit 322 is electrically insulated from primary circuit 321.
Transformer 323 electromagnetically connects primary circuit 321 and patient circuit 322.
The first power source 324 is a high voltage power source that supplies driving power for the treatment instrument 301.
The second power source 325 is a low voltage power source that supplies driving power for a control circuit within the treatment instrument control device 302.
The CPU 326 centrally controls the operation of the treatment instrument control device 302. The CPU 326 corresponds to a control section that executes a program stored in the memory 327 to control the operation of each section of the treatment instrument control device 302.
The memory 327 stores various information necessary for the operation of the treatment instrument control device 302. The memory 327 is a turbidity information storage unit that stores in advance turbidity information for determining a change in turbidity of the liquid, which corresponds to cutting dust generated by cutting with the treatment tool 301. The wireless communication unit 328 is an interface for wireless communication with other devices.
The communication interface 329 is an interface for communicating with the treatment instrument 301.
The impedance measurement unit 330 supplies power to the treatment instrument 301 and measures the impedance in the treatment region. For example, a pair of electric wires is provided at the tip of the treatment tool 301, and a voltage or current is applied to the treatment region to obtain a signal (voltage and current). The impedance measuring section 330 measures impedance based on the ratio of the obtained signals. This impedance changes depending on the degree of clouding caused by bone powder during treatment.

The input/output unit 304 is configured using input interfaces such as a mouse, keyboard, touch panel, microphone, etc., and output interfaces such as a monitor, speakers, etc., and receives operation input from the surgeon for the endoscope device 2 and notifies the surgeon. Various information is output (see Figure 4).

[Functional configuration of perfusion device]
The perfusion device 5 includes a liquid feeding pump 503, a drainage pump 506, a liquid feeding control section 507, a liquid drainage control section 508, an input section 509, a CPU 510, a memory 511, a wireless communication section 512, a communication interface 513, a pump internal CPU 514, and An internal pump memory 515 is provided (see FIGS. 4 and 8).

The liquid feeding control unit 507 includes a first drive control unit 571, a first driving power generation unit 572, a first transformer 573, and a liquid feeding pump drive circuit 574 (see FIG. 8).
The first drive control section 571 controls the driving of the first drive power generation section 572 and the liquid pump drive circuit 574.
The first driving power generation unit 572 generates driving power for the liquid feeding pump 503.
The first transformer 573 electromagnetically connects the first drive power generation section 572 and the liquid pump drive circuit 574.
The first drive control section 571, the first drive power generation section 572, and the first transformer 573 are provided in the primary circuit 5a. Further, the liquid pump drive circuit 574 is provided in the patient circuit 5b which is electrically insulated from the primary circuit 5a.

The drain control section 508 includes a second drive control section 581, a second drive power generation section 582, a second transformer 583, and a drain pump drive circuit 584.
The second drive control section 581 controls the driving of the second drive power generation section 582 and the drainage pump drive circuit 584.
The second drive power generation unit 582 generates drive power for the drainage pump 506.
The second transformer 583 electromagnetically connects the second drive power generation section 582 and the drain pump drive circuit 584.
The second drive control section 581, the second drive power generation section 582, and the second transformer 583 are provided in the primary circuit 5a. Further, a drainage pump drive circuit 584 is provided in the patient circuit 5b.

The input unit 509 receives input of various signals such as operation input (not shown).
The CPU 510 and the pump CPU 514 work together to centrally control the operation of the perfusion device 5. The CPU 510 corresponds to a control unit that executes a program stored in the memory 511 and controls the operation of each part of the perfusion device 5 via the BUS line.
The memory 511 stores various information necessary for the operation of the perfusion device 5.
The wireless communication unit 512 is an interface for wireless communication with other devices.
The communication interface 513 is an interface for communicating with the pump CPU 514.
The internal pump memory 515 stores various information necessary for the operation of the liquid feeding pump 503 and the liquid draining pump 506.
The input section 509, CPU 510, memory 511, wireless communication section 512, and communication interface 513 are provided in the primary circuit 5a.
An in-pump CPU 514 and an in-pump memory 515 are provided in the pump 5c. The in-pump CPU 514 and the in-pump memory 515 may be provided around the liquid feeding pump 503 or around the drainage pump 506.

[Functional configuration of lighting device]
The lighting device 6 includes a first lighting control section 601, a second lighting control section 602, a first lighting 603, a second lighting 604, an input section 605, a CPU 606, a memory 607, a wireless communication section 608, a communication interface 609, and a lighting circuit. It includes a CPU 610 and a lighting circuit internal memory 61A (see FIGS. 4 and 9).

The first lighting control section 601 includes a first drive control section 611 , a first drive power generation section 612 , a first controller 613 , and a first drive circuit 614 .
The first drive control section 611 controls the driving of the first drive power generation section 612 , the first controller 613 , and the first drive circuit 614 .
The first drive power generation unit 612 generates drive power for the first lighting 603.
The first controller 613 controls the light output of the first illumination 603.
The first drive circuit 614 drives the first illumination 603 to output illumination light.
The first drive control section 611, the first drive power generation section 612, and the first controller 613 are provided in the primary circuit 6a. Further, the first drive circuit 614 is provided in the patient circuit 6b which is electrically insulated from the primary circuit 6a.

The second lighting control section 602 includes a second drive control section 621 , a second drive power generation section 622 , a second controller 623 , and a second drive circuit 624 .
The second drive control section 621 controls the driving of the second drive power generation section 622, the second controller 623, and the second drive circuit 624.
The second drive power generation unit 622 generates drive power for the second lighting 604.
The second controller 623 controls the light output of the second illumination 604.
The second drive circuit 624 drives the second illumination 604 to output illumination light.
The second drive control section 621, the second drive power generation section 622, and the second controller 623 are provided in the primary circuit 6a. Further, the second drive circuit 624 is provided in the patient circuit 6b.

The input unit 605 receives input of various signals such as operation input (not shown).
The CPU 606 and the lighting circuit CPU 610 work together to centrally control the operation of the lighting device 6. The CPU 606 corresponds to a control unit that executes a program stored in the memory 607 to control the operation of each part of the lighting device 6.
The memory 607 stores various information necessary for the operation of the lighting device 6.
The wireless communication unit 608 is an interface for wireless communication with other devices.
The communication interface 609 is an interface for communicating with the lighting circuit 6c.
The lighting circuit memory 61A stores various information necessary for the operation of the first lighting 603 and the second lighting 604.
The input section 605, CPU 606, memory 607, wireless communication section 608, and communication interface 609 are provided in the primary circuit 6a.
The lighting circuit CPU 610 and the lighting circuit memory 61A are provided in the lighting circuit 6c.

[Summary of treatment]
FIG. 10 is a flowchart illustrating an overview of the treatment performed by the surgeon using the treatment system 1. Note that the number of surgeons who perform the treatment may be one doctor, or two or more including a doctor and an assistant.

First, the operator forms a first portal P1 and a second portal P2 that communicate the inside of the joint cavity C1 of the knee joint J1 and the outside of the skin, respectively (step S1).

Next, the operator inserts the endoscope 201 into the joint cavity C1 from the first portal P1, inserts the guiding device 4 into the joint cavity C1 from the second portal P2, and guides the guiding device 4. The treatment instrument 301 is inserted into the joint cavity C1 (step S2). Note that although the case where two portals are formed and the endoscope 201 and the treatment instrument 301 are inserted into the joint cavity C1 from each portal has been described here, the first portal P1 is formed and the endoscope 201 is inserted into the joint cavity C1. After inserting into the joint cavity C1, the second portal P2 may be formed and the guiding device 4 and the treatment instrument 301 may be inserted into the joint cavity C1.

Thereafter, the operator brings the ultrasound probe 312 into contact with the bone to be treated while visually checking the endoscopic image of the joint cavity C1 displayed on the display device 203 (step S3).

Subsequently, the operator performs a cutting treatment using the treatment tool 301 (step S4). At this time, the operator turns on the output of the treatment tool 301 and causes the ultrasonic probe 312 to vibrate ultrasonically to perform the treatment. For example, bone is crushed to form a bone hole.

After that, the display device 203 performs a display/notification process of displaying the inside of the joint cavity C1 and information regarding the state after the cutting procedure (step S5). For example, after the display/notification process, the endoscope control device 202 stops the display/notification after a predetermined period of time.

Next, the cutting treatment of the first embodiment will be explained with reference to FIGS. 11 to 17. FIG. 11 is a flowchart illustrating an overview of the cutting treatment in the treatment system according to the first embodiment. FIG. 12 is a diagram for explaining control of the perfusion device in a cutting treatment, and is a diagram for explaining the relationship between impedance and drive conditions of the perfusion device. In the first embodiment, each process will be described as being executed under the control of the CPU 326 of the treatment instrument control device 302, but for example, any one of the control devices such as the network control device 7 may execute the process. The process may be executed, or the CPU of each control device may partially execute the process. FIG. 11 describes an example in which a bone hole is formed by crushing a bone.

First, when a signal is input by an operation for turning on the output of the treatment instrument 301, such as pressing down the foot switch 303, the CPU 326 turns on the output of the treatment instrument 301 (step S101). When the output of the treatment instrument 301 is turned on, the ultrasonic probe 312 vibrates ultrasonically. At this time, the CPU 326 sets the operation mode to cutting mode.

The CPU 326 sets the driving condition of the perfusion device 5 to condition D1 (step S102). The CPU 326 outputs a signal to the CPU 510 of the perfusion device 5 indicating that the perfusion device 5 is to be driven under the condition D1. For example, the first drive control unit 571 drives the liquid pump 503 according to the condition D1. Note that the driving conditions will be described later.

After that, the CPU 326 causes the impedance measurement unit 330 to measure the impedance during treatment (step S103). The impedance measurement unit 330 measures impedance Z by acquiring a signal from the power supplied to the treatment tool 301. At this time, the impedance Z changes depending on the contact/non-contact state between the ultrasound probe 312 and the bone, or the properties of the crushed bone tissue of the bone.
That is, the impedance measuring section 330 is configured as a cutting data measuring section that measures the state of cutting by the treatment tool 301.

The CPU 326 determines whether the impedance Z measured in step S103 satisfies Z≧Z1 (step S104). Here, Z1 is a threshold value for determining the cutting state, and the minimum value of impedance for determining whether cortical bone is being crushed is set (see FIG. 12). Each piece of state information showing changes in turbidity and a look-up table showing the relationship with driving conditions shown in FIG. 12 are stored in advance in the memory 327 as turbidity information for determining changes in turbidity. That is, the memory 327 is configured as a turbidity information storage section.
Returning to FIG. 11, when the CPU 326 determines that Z≧Z1 (step S104: Yes), the process proceeds to step S105. Further, when the CPU 326 determines that Z≧Z1 is not satisfied (Z<Z1) (step S104: No), the process returns to step S103 and remeasures the impedance. Note that the impedance measurement may be performed immediately or after a predetermined period of time has passed since the previous measurement time.
At this time, if the impedance Z is Z<Z1, it can be assumed that cutting has just started, or that the ultrasonic probe 312 is in a non-contact state with the bone, or in a state other than cutting bone tissue.

In step S105, the CPU 326 determines whether impedance Z satisfies Z≧Z2. Here, Z2 is a threshold value for determining the cutting state, and is set as the minimum value of impedance for determining whether or not cancellous bone is being crushed. When the CPU 326 determines that Z≧Z2 is not satisfied (Z<Z2) (step S105: No), the process proceeds to step S106. Further, when the CPU 326 determines that Z≧Z2 (step S105: Yes), the process proceeds to step S107.
At this time, when it is determined that Z<Z2, the cortical bone is crushed. Further, in a state where it is determined that Z≧Z2, cancellous bone is crushed, and the amount of bone powder increases compared to when cortical bone is crushed.

In step S106, the CPU 326 sets the drive condition of the perfusion device 5 to condition D2. The CPU 326 outputs a signal to the CPU 510 indicating that it is to be driven under condition D2. For example, the first drive control unit 571 drives the liquid pump 503 according to condition D2.

Furthermore, in step S107, the CPU 326 determines whether the output of the treatment instrument 301 is off. If the CPU 326 determines that the output of the treatment instrument 301 is turned off by detecting an operation to turn off the output of the treatment instrument 301 due to the operator's foot leaving the foot switch 303 or the like (step S107: Yes), the process proceeds to step S109. Further, when the CPU 326 determines that the output of the treatment tool 301 is not turned off (step S107: No), the process proceeds to step S108.

In step S108, the CPU 326 sets the drive condition of the perfusion device 5 to condition D3. The CPU 326 outputs a signal to the CPU 510 indicating that it is to be driven under condition D3. For example, the first drive control unit 571 drives the liquid pump 503 according to condition D3.

Furthermore, in step S109, the CPU 326 determines whether the elapsed time Toff since the output of the treatment tool 301 is turned off satisfies Toff>Ts. Here, Ts is a time set in advance as a period for transitioning to standby mode after the output is turned off. When the CPU 326 determines that Toff>Ts (step S109: Yes), the process proceeds to step S111. Further, when the CPU 326 determines that Toff>Ts is not satisfied (Toff≦Ts) (step S109: No), the process proceeds to step S110.

In step S110, the CPU 326 sets the drive condition of the perfusion device 5 to condition Ds. The CPU 326 outputs a signal to the CPU 510 indicating that it is to be driven under the condition Ds. For example, the first drive control unit 571 drives the liquid pump 503 according to the condition Ds.
Note that at this time, the CPU 326 sets the operation mode to standby mode.

Further, in step S111, the CPU 326 sets the operation mode of the perfusion device 5 to the stop mode, and outputs a signal to turn off the driving power of the perfusion device 5 (at least the driving power of the pump, the same applies hereinafter). After that, the CPU 326 moves to step S5 shown in FIG.
Note that at this time, the CPU 326 sets the operation mode to the stop mode.

FIG. 13 is a diagram for explaining the driving conditions of the perfusion device 5. In the first embodiment, the driving conditions of the perfusion device 5 are set by combining the power amplitude (voltage V) and the power frequency. The power frequency is set by setting a cycle and a pulse width in the cycle. The look-up table in FIG. 13 is stored in advance in the memory 511 of the perfusion device 5, and the CPU of each control device reads the data via communication and uses it as a driving condition.

As for the driving condition D1, the voltage is set to V1 and the power frequency is set to FP1. FIG. 14 is a diagram for explaining the power pulse waveform under driving condition D1. Under drive condition D1, the voltage is set to V1, and a pattern (power frequency FP1) with continuously different pulse widths and cycles is repeated.

As for the driving condition D2, the voltage is set to V2 and the power frequency is set to FP2. FIG. 15 is a diagram for explaining the pulse waveform under driving condition D2. Under drive condition D2, the voltage is set to V2 (>V1), and a pattern (power frequency FP2) with continuously different pulse widths and cycles is repeated. The period of this pattern (power frequency FP2) is shorter than the period of the pattern (power frequency FP1) of driving condition D1.

As for the driving condition D3, the voltage is set to V3 and the power frequency is set to FP3. FIG. 16 is a diagram for explaining the pulse waveform under driving condition D3. Under drive condition D3, the voltage is set to V3 (>V2), and a pattern (power frequency FP3) with continuously different pulse widths and cycles is repeated. The period of this pattern (power frequency FP3) is shorter than the period of the pattern (power frequency FP2) of driving condition D2.
As the driving conditions change from D1 to D2 and from D2 to D3, the amount of water fed by the pump (water feeding intensity) increases, and the irrigation fluid is fed continuously over a short period of time.

As for the driving conditions Ds, the voltage is set to Vs and the power frequency is set to FPs. FIG. 17 is a diagram for explaining the pulse waveform under the driving condition Ds. Under drive condition D3, the voltage is set to Vs (<V1), and a pattern (power frequency FPs) with continuously different pulse widths and cycles is repeated. The period of this pattern (power frequency FPs) is longer than the period of the pattern (power frequency FP1) of driving condition D1. Under the driving condition Ds, a low-pressure irrigation fluid is supplied for a predetermined period of time in order to remove bone powder (see FIG. 12) remaining in the fluid after the treatment.

In the first embodiment described above, the impedance of the treatment environment, which is state information, is measured, and the water supply conditions of the perfusion device 5 are set based on this impedance. According to the first embodiment, the amount of bone powder generated by the treatment is estimated from the impedance and the amount of water supplied by the perfusion device 5 is automatically controlled, thereby suppressing the influence on the surgery caused by turbidity in the perfusate. Can be done.

(Embodiment 2)
Next, a second embodiment will be described with reference to FIGS. 18 to 20. FIG. 18 is a block diagram showing the functional configuration of a treatment device included in the treatment system according to the second embodiment. The treatment system according to the second embodiment includes a treatment instrument control device 302A in place of the treatment instrument control device 302 of the treatment system 1 according to the first embodiment. This treatment tool control device 302A has the same configuration as the treatment tool control device 302 except that it does not include the impedance measuring section 330. Further, since the other configurations are the same as those in Embodiment 1, the explanation will be omitted.

In the second embodiment, treatment is performed according to the flow shown in FIG. 10. The cutting treatment according to the second embodiment will be explained below. FIG. 19 is a flowchart illustrating an overview of cutting treatment in the treatment system according to the second embodiment. FIG. 20 is a diagram for explaining the control of the perfusion device in the cutting treatment, and is a diagram for explaining the relationship between the cutting time and the driving conditions of the perfusion device. The look-up table showing the relationship among the total amount of bone powder, cutting time, and driving conditions showing changes in turbidity shown in FIG. 20 is stored in advance in the memory 327 as turbidity information for determining changes in turbidity. That is, the memory 327 is configured as a turbidity information storage section. In the second embodiment, when the treatment tool 301 is pressed with a predetermined pressing force and the bone tissue is cut by vibrations of a predetermined amplitude and frequency, the amount of cutting per unit time, that is, the amount of bone powder depending on the tissue properties of the bone. Take appropriate measures to accommodate different conditions. As for bone tissue properties, control will be described when cutting soft tissue up to the surface layer of cortical bone, cortical bone, and cancellous bone in this order.

First, when a signal is input by an operation for turning on the output of the treatment instrument 301, such as pressing down the foot switch 303, the CPU 326 turns on the output of the treatment instrument 301 (step S201). At this time, the CPU 326 sets the operation mode to cutting mode.

The CPU 326 sets the cutting time T at the time when the output is turned on to T=0 (step S202).
The CPU 326 measures the cutting time T from the time when cutting is started by the treatment tool 301 as cutting data, and is configured as a cutting data measurement unit that measures the state of cutting by the treatment tool 301.

The CPU 326 sets the driving condition of the perfusion device 5 to condition D1 (step S203). The CPU 326 outputs a signal to the CPU 510 indicating that it is to be driven under the condition D1. For example, the first drive control unit 571 drives the liquid pump 503 according to the condition D1. Note that although the condition D1 will be described as being the same as that in FIG. 13, it is not limited thereto.

The CPU 326 determines whether the cutting time T is T>T1 (step S204). Here, T1 is a threshold value for determining the cutting state, and for example, the minimum value of the time for determining whether the cutting time (elapsed time) has reached the cortical bone surface layer is set. . When the CPU 326 determines that T>T1 (step S204: Yes), the process proceeds to step S205. Further, when the CPU 326 determines that T>T1 is not satisfied (T≦T1) (step S204: No), the CPU 326 repeats confirmation of the elapsed time.
At this time, if the cutting time T is T≦T1, it can be assumed that the ultrasound probe 312 and the bone are in a substantially non-contact state. The total amount of bone powder during the period T≦T1 is aT, where a (mm ³ /sec) is the amount of bone fragments reaching the cortical bone surface layer.

In step S205, the CPU 326 determines whether the cutting time T is T≧T2. Here, T2 is a threshold value for determining the cutting state, and, for example, the maximum value of the time for determining whether the cutting time (elapsed time) is at which cortical bone is being crushed is set. Ru. That is, when the cutting time exceeds T2, the bone crushing position changes from cortical bone to cancellous bone. When the CPU 326 determines that T≧T2 (step S205: Yes), the process proceeds to step S207. Further, when the CPU 326 determines that T≧T2 is not satisfied (T<T2) (step S205: No), the process proceeds to step S206.
At this time, when it is determined that (T1≦)T≦T2, the cortical bone is crushed. The total amount of bone powder during the period of T1≦T≦T2 is aT1+b (T−T1), where b (mm ³ /sec) is the amount of crushed bone in cortical bone.

In step S206, the CPU 326 sets the drive condition of the perfusion device 5 to condition D2. The CPU 326 outputs a signal to the CPU 510 indicating that it is to be driven under condition D2. For example, the first drive control unit 571 drives the liquid pump 503 according to condition D2.

Further, in step S207, the CPU 326 determines whether the cutting time T is T≧T3. Here, T3 is a threshold value for determining the cutting state, and for example, the maximum value of the time for determining whether or not the cutting time (elapsed time) is at which the cancellous bone is crushed is set. Ru. When the CPU 326 determines that T≧T3 (step S207: Yes), the process proceeds to step S209. Further, when the CPU 326 determines that T≧T3 is not satisfied (T<T3) (step S207: No), the process proceeds to step S208.
At this time, when it is determined that (T2<)T≦T3, the cancellous bone is crushed. The total amount of bone powder during the period of T2<T≦T3 is aT1+b(T2-T1)+c(T-T2), where c (mm ³ /sec) is the amount of broken bone in the cancellous bone.

In step S208, the CPU 326 sets the driving condition of the perfusion device 5 to condition D3. The CPU 326 outputs a signal to the CPU 510 indicating that it is to be driven under condition D3. For example, the first drive control unit 571 drives the liquid pump 503 according to condition D3.

Furthermore, in step S209, the CPU 326 determines whether the cutting time T is T>T4. Here, T4 is a preset time period from the start of cutting until the transition to the standby mode after completing the crushing of the cancellous bone. When the CPU 326 determines that T>T4 (step S209: Yes), the process proceeds to step S211. Further, when the CPU 326 determines that T>T4 is not satisfied (T≦T4) (step S209: No), the process proceeds to step S210.

In step S210, the CPU 326 sets the drive condition of the perfusion device 5 to condition Ds. The CPU 326 outputs a signal to the CPU 510 indicating that it is to be driven under the condition Ds. For example, the first drive control unit 571 drives the liquid pump 503 according to the condition Ds.
Note that at this time, the CPU 326 sets the operation mode to standby mode.

Further, in step S211, the CPU 326 sets the operation mode of the perfusion device 5 to stop mode, and outputs a signal to turn off the driving power of the perfusion device 5 (at least the driving power of the pump). After that, the CPU 326 moves to step S5 shown in FIG.
Note that at this time, the CPU 326 sets the operation mode to the stop mode.

In the second embodiment described above, the water supply conditions of the perfusion device 5 are set based on the elapsed time from the start of cutting, which is state information. According to the second embodiment, the amount of bone powder generated by the treatment is estimated from the elapsed time and the amount of water supplied by the perfusion device 5 is automatically controlled, thereby suppressing the influence on the surgery caused by turbidity in the perfusate. be able to.

(Other embodiments)
Various inventions can be formed by appropriately combining the plurality of components disclosed in the first and second embodiments described above. For example, some components may be deleted from all the components described in the first and second embodiments.

Furthermore, in Embodiments 1 and 2, the description has been made assuming that power and power frequency are set as drive conditions, but it is also possible to set only either power or power frequency.

Furthermore, in Embodiments 1 and 2, an example was explained in which conditions on the liquid sending side are set as drive conditions, but conditions on the liquid draining side may be set, or conditions on the liquid sending side and liquid draining side. may also be set.

Furthermore, in Embodiments 1 and 2, an example has been described in which the treatment instrument control devices 302 and 302A have the function of a control section that sets and controls the driving conditions of the perfusion device 5, but the CPU 510 of the perfusion device 5 The configuration may have a function of a control section for setting and controlling the driving conditions of No. 5. At this time, the CPU 510 may acquire impedance from the treatment instrument control device 302, or may acquire measured raw data (voltage value and current value) and calculate the impedance in the perfusion device 5. .

Further, in the first embodiment, the amount of turbidity is estimated by determining the bone tissue based on the impedance of the electric power supplied to the treatment instrument 301, but the amount of turbidity is estimated by determining the bone tissue based on other parameters. It may also be a configuration. In addition, in the second embodiment, the amount of turbidity was estimated from the amount of bone powder depending on the tissue properties of bone produced by cutting, but the amount of bone powder calculated by simulation from a diffusion model in liquid of each tissue, experimental values, and treatment A configuration that generates turbidity information to judge turbidity changes and estimates the turbidity amount from bone powder amount calculation using a high-order polynomial that approximates various factors such as the cross-sectional area for crushing bone tissue due to the shape of the tool. You can also use it as

Further, in Embodiments 1 and 2, an example in which white turbidity is caused by white bone powder generated by crushing bones has been described, but the present invention can be applied to treatments in which white turbidity is caused by white particles other than bone powder.

Furthermore, in Embodiments 1 and 2, a configuration was described in which the control units that control each device such as the endoscope 201 and the treatment instrument 301 are individually provided as control devices, but one control unit (control device) It is also possible to adopt a configuration in which each device is controlled collectively.

Furthermore, in Embodiments 1 and 2, the above-mentioned "apparatus", "unit", and "circuit" can be read as "means", "circuit", "unit", etc. For example, the control device can be read as a control unit or a control circuit.

Furthermore, the program to be executed by each device according to Embodiments 1 and 2 is file data in an installable or executable format and can be stored on a CD-ROM, a flexible disk (FD), a CD-R, or a DVD (Digital Versatile Disk). ), USB media, flash memory, and other computer-readable recording media.

Furthermore, the programs to be executed by each device according to Embodiments 1 and 2 may be stored on a computer connected to a network such as the Internet, and may be provided by being downloaded via the network. Furthermore, the program to be executed by the information processing apparatus according to Embodiments 1 and 2 may be provided or distributed via a network such as the Internet.

Furthermore, in Embodiments 1 and 2, signals were transmitted and received by wireless communication, but for example, signals were transmitted from various devices via transmission cables without the need for wireless communication. Good too.

Note that in the description of the flowcharts in this specification, the order of processing necessary to implement the present invention is not uniquely determined by the expressions shown in the flowcharts. That is, the order of processing in the flowcharts described in this specification can be changed within a consistent range.

Some of the embodiments of the present application have been described above in detail based on the drawings, but these are merely examples, and various embodiments including the embodiments described in the disclosure section of the present invention can be used based on the knowledge of those skilled in the art. It is possible to implement the present invention in other forms with modifications and improvements.

As described above, the treatment system and the method of operating the treatment system according to the present invention are useful for suppressing the influence on surgery caused by turbidity in the perfusate.

1 Treatment system 2 Endoscope device 3 Treatment device 4 Guiding device 5 Perfusion device 5a, 6a, 202a, 321 Primary circuit 5b, 6b, 202b, 322 Patient circuit 5c Pump 6 Lighting device 6c Lighting circuit 7 Network control device 8 Network server 61A Memory in illumination circuit 100 Treatment target site 101 Bone hole 201 Endoscope 202 Endoscope control device 203 Display device 204 Imaging section 205 Operation input section 211 Insertion section 221 Imaging processing section 221a Imaging element drive control circuit 221b Imaging element Signal control circuit 222 Image processing section 222a First image processing circuit 222b Second image processing circuit 223 Turbidity detection section 224a Image sensor 226, 509, 605 Input section 227, 242, 315, 326, 510, 606 CPU
228, 243, 316, 327, 511, 607 Memory 229, 328, 512, 608 Wireless communication unit 230 Distance sensor drive circuit 231 Memory for distance data 232, 329, 513, 609 Communication interface 241 Image sensor 301 Treatment instrument 302, 302A Treatment instrument control device 303 Foot switch 304 Input/output section 311 Treatment instrument body 311a Ultrasonic transducer 312 Ultrasonic probe 312a Tip treatment section 313 Sheath 314 Posture detection section 317 Circuit board 323 Transformer 324 First power source 325 Second power source 330 Impedance measurement Section 401 Guide body 402 Handle section 403 Drainage section with cock 501 Liquid source 502 Liquid feeding tube 503 Liquid feeding pump 504 Drainage bottle 505 Drainage tube 506 Drainage pump 507 Liquid feeding control section 508 Drainage control section 514 CPU in pump
515 Internal pump memory 571 First drive control unit 572 First drive power generation unit 573 First transformer 574 Liquid pump drive circuit 581 Second drive control unit 582 Second drive power generation unit 583 Second transformer 584 Drainage pump drive circuit 610 CPU in lighting circuit
900 Lateral condyle of femur C1 Joint cavity J1 Knee joint P1 First portal P2 Second portal

Claims (13)

1. A treatment tool that cuts biological tissue in liquid;
   a perfusion device that controls perfusion of the liquid;
   a turbidity information storage unit that stores in advance turbidity information for determining a change in turbidity of the liquid due to cutting dust generated by cutting with the treatment instrument;
   a cutting data measurement unit that measures data indicating a cutting state by the treatment instrument;
   a control unit that controls driving conditions of the perfusion device based on the measured cutting data and the stored turbidity information;
   A treatment system comprising:
2. The cutting data measuring unit measures impedance measured based on electric power supplied to the treatment instrument.
   The treatment system according to claim 1.
3. The cutting data measurement unit measures an elapsed time from a cutting time when cutting was started by the treatment instrument.
   The treatment system according to claim 1.
4. The control unit sets the operation mode of the perfusion device to one of a cutting mode, a standby mode, and a stop mode, based on the measured cutting data and the stored turbidity information.
   The treatment system according to claim 1.
5. In the cutting mode, the control unit sets, as a drive condition of the perfusion device, one of a plurality of drive conditions in which at least one of a power amplitude and a power frequency is different from each other, based on the state information. do,
   The treatment system according to claim 4.
6. a treatment tool control device that controls the treatment tool;
   Equipped with
   The control unit is provided in the treatment instrument control device,
   outputting the driving conditions to the perfusion device by wired or wireless communication;
   The treatment system according to claim 1.
7. The control unit is provided in the perfusion device,
   setting driving conditions for the perfusion device based on the cutting data acquired through the treatment tool and the turbidity information;
   The treatment system according to claim 1.
8. The control unit includes:
   In the standby mode, after the cutting of the biological tissue is completed, driving conditions are set to continue perfusion for a preset time;
   The treatment system according to claim 4.
9. The treatment tool is an ultrasonic treatment tool,
   The treatment system according to claim 1.
10. The turbidity of the liquid is caused by bone powder generated when the bone is cut by hammering using ultrasonic vibration.
    The treatment system according to claim 1.
11. The turbidity of the liquid is due to white particles,
    The treatment system according to claim 1.
12. an endoscope control device that controls an imaging unit that observes the cutting treatment performed by the treatment tool;
    a lighting device that illuminates the observation position;
    The treatment system according to claim 1, further comprising:
13. A treatment tool that cuts biological tissue in a liquid, a perfusion device that controls perfusion of the liquid, and turbidity information for determining changes in turbidity of the liquid due to cutting dust generated by cutting with the treatment tool. A method of operating a treatment system comprising: a turbidity information storage section that stores in advance a turbidity information storage section; and the control section:
    a cutting data measuring unit measures data indicating a cutting state by the treatment tool,
    The control unit controls driving conditions of the perfusion device based on the measured cutting data and the stored turbidity information.
    How the treatment system works.

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