JP2002253480A - Device for assisting medical treatment - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical treatment assisting device for easily grasping a site to the treated in a medical treatment and smoothly performing the medical treatment. SOLUTION: The medical treatment assisting device is provided with an endoscope having a first inserting part which consists of an observing part (22) for obtaining the observation image signal of a subject and of a first position detecting means (23) for detecting at least the position of a tip, a first inserting tool which consists of a second inserting part and of a second position detecting means (24) for detecting the inserting position of the second inserting part, a first arithmetic means (29) for obtaining position relation between the tip of the endoscope and the first inserting part based on position information from the first and second position detecting means and a synthesizing means (33) for synthesizing an endoscope image obtained based on the observation image signal with the inserting position of the second inserting part as an image based on the arithmetic result of the first arithmetic means and displaying and outputting it.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a medical treatment assisting device, and more particularly to a medical treatment assisting device for assisting a medical treatment based on image data of a subject.

[0002]

2. Description of the Related Art Conventionally, as a technique for displaying, on the same screen, the position of a medical instrument for surgery and an image of a patient who is a subject taken before surgery, a technique disclosed in Japanese Patent Application Laid-Open No. H11-318937 has been proposed. is there. This is for assisting a surgical operation or the like, and displays a related image recorded in advance according to the movement of a medical instrument operated by a surgeon or the like. In particular, the device described in Japanese Patent Application Laid-Open No. H11-318937 discloses an accurate medical device by fixing a reference unit for specifying a position to a patient without displacing the position of a medical device even when the patient moves. It is intended to be able to display the position of the device.

[0003] The device includes a field generator for generating a magnetic field or the like in multiple directions, for example, three-dimensional directions, for detecting its position, and a sensor for detecting the magnetic field. Then, by performing predetermined arithmetic processing based on multi-directional magnetic field data detected by the sensor, the device calculates three-dimensional coordinate positions (X, Y, Z) of the medical device, and Enables accurate position display.

[0004]

However, in the apparatus, images from multiple directions are displayed on a monitor in order to show a doctor a three-dimensional positional relationship between a medical instrument and a patient as a subject. indicate. Specifically, in accordance with the calculated coordinate position of the medical device, previously recorded image data in the front, lateral, and axial directions of the patient are respectively displayed on the monitor. However, it is not easy for an operator such as a surgeon to three-dimensionally understand the position of the medical device with respect to the target position by looking at such image data from multiple directions. Furthermore, whether or not treatment is possible during surgery depends on the experience of the surgeon,
Many aspects were left to intuition, and the surgeon required skilled skills.

[0005]

SUMMARY OF THE INVENTION The present invention has been made to solve the above-mentioned problems, and in a medical treatment, a medical treatment assisting device capable of easily grasping a position of a treatment target and smoothly performing a medical treatment. The purpose is to provide.

Another object of the present invention is to provide a medical treatment assisting device for controlling a medical treatment using an energy treatment tool so that the medical treatment can be appropriately performed.

[0007]

Therefore, a medical treatment assisting apparatus according to the present invention comprises an observation section for obtaining an observation image signal of a subject and at least a first position detection means for detecting a position of a tip. An endoscope having a first insertion portion provided with:
A first insertion tool having a second insertion portion and a second position detection means for detecting an insertion position of the second insertion portion; and first and second position detection means A first calculating means for obtaining a positional relationship between the tip of the endoscope and the second insertion portion based on the positional information from the first endoscope, and a first calculating means for adding an endoscope image obtained based on the observation image signal to the first calculating means. Based on the calculation result of
And a synthesizing means for synthesizing an image of the insertion position of the insertion portion as an image and outputting the image.

Further, the medical treatment assisting device of the present invention has an insertion portion having an energy treatment device, and an insertion device provided with a position detecting means for detecting an insertion position of the insertion portion, and a preset insertion device. Control means for controlling energy supply to the energy treatment device based on the obtained three-dimensional data and position information from the position detection means.

[0009]

Embodiments of the present invention will be described below with reference to the drawings.

FIG. 1 to FIG. 4 are diagrams showing a first embodiment of the present invention.

FIG. 1 is an explanatory diagram for explaining an example of an operation performed using the medical treatment assisting apparatus according to the present invention. FIG. 2 is a block diagram showing an example of the medical treatment assistance device according to the present invention. FIG. 3 and FIG. 4 are diagrams showing screen display examples displayed on the monitor of the medical treatment assisting device.

First, an example of an operation, which is a medical treatment performed using the medical treatment assistance device, will be described with reference to FIG.

FIG. 1 is a diagram showing an example in which a patient as a subject is undergoing a hysterectomy operation. In a hysterectomy operation, it is necessary to perform a resection operation while confirming the position of the organ so as not to damage the surrounding organs.

In this operation, an endoscope 2 whose tip is inserted into a body cavity, two forceps 3 and 4 inserted into the same lumen as the endoscope 2, and a ureter. A probe 5 having a bifurcated tip is used.

During the operation, the surgeon performs the operation while viewing the observation image of the operation site from the observation section of the endoscope 2. The endoscope 2 has a CCD which is a solid-state imaging device
A (Charge Coupled Device) element is provided to capture an image from the observation unit at the distal end of the insertion unit 6. The endoscope 2 is connected to an endoscope image processing device 7 by a cable 9, and the endoscope image processing device 7 is connected to a monitor device 8. Data of an observation image signal from an imaging device of the endoscope 2 and probe image data described later are processed by an endoscope image processing device 7 having a central processing unit (hereinafter, referred to as a CPU) and an image is displayed on a monitor device 8. Is displayed. The endoscope may be of a fiberscope type without a CCD element at the tip.

In the resection operation, scissors forceps are used as a treatment tool. Here, two forceps 3, 4 are shown.

The endoscope 2, one forceps 3 and the probe 5 each have at least a position detecting sensor (not shown) for detecting the tip position or the shape of the insertion portion. One is built-in. The forceps 4 may be provided with a position detection sensor. However, since the cutting operation is performed by the forceps 3, the position detection sensor is provided only on the forceps 3.

In particular, in order to more accurately detect the positions and shapes of the insertion portions 10 and 11 of the probe 5, a plurality of sensors are provided along the length direction of the insertion portions 10 and 11 so that the shapes can be grasped. It is preferred to provide. In addition, the insertion portions 10, 1
Even if only one position detection sensor is provided at each of the distal ends, the shape of the insertion portion of the probe, which is the shape of the ureter, can be specified from the trajectory of the distal end at the time of insertion.

An output signal of the position detecting sensor of the endoscope 2 is transmitted via a cable 12 to an arithmetic unit 13 including a CPU.
It is connected to the. The output signal of the probe for detecting the position of the probe 5 is connected to the arithmetic unit 13 by the probe 5 line. The output signal of the position detecting sensor of the forceps 3 is connected to the calculating means 13 via the cable 14.

The output signals of the position detecting sensors of the endoscope 2, forceps 3 and the insertion sections 10 and 11 of the probe 5 are connected to a calculation device 13 for calculating the respective positions and the mutual positional relationship. Further, the arithmetic unit 13 sets the probe 5
The shapes of the insertion sections 10 and 11 are calculated based on the output signals of the position detection sensors of the insertion sections 10 and 11.

The arithmetic unit 13 is connected by a cable 15 to an endoscope image processing unit 7 for processing image data picked up by the endoscope 2 and converts the calculated position and shape data to an endoscope image processing unit. 7

Each position detecting sensor detects a magnetic field generated by a magnetic field generator provided at a location (not shown). The arithmetic unit 13 performs a predetermined arithmetic process based on the multi-directional magnetic field signals detected by the position detection sensors, so that the three-dimensional coordinate position (X, Y,
Z) is calculated.

Although an example using a magnetic field will be described as an example of means for detecting each position, other means may be used.

Instead of providing a magnetic field generator or the like outside, a magnetic field generator or the like is provided at the tip of an endoscope, forceps, probe, or the like, and a magnetic field is generated by a sensor such as a detection coil provided outside. May be detected to calculate the position of each tip. The same applies to the second and third embodiments. Therefore, a magnetic field detector may be provided for a target whose position is to be detected, or a magnetic field generator may be provided.

Accordingly, hereinafter, the position detecting sensor or the position detecting energy generator will be referred to as a position detecting means, but in the following description, an example of the position detecting sensor will be described. The same applies to the second and third embodiments.

FIG. 2 is a block diagram showing a configuration example of the medical treatment assisting device.

Reference numeral 21 shown by a two-dot chain line is the arithmetic unit shown in FIG. Reference numeral 22 denotes an image detection unit of the imaging device of the endoscope. Reference numeral 23 denotes a position detection sensor provided at the distal end of the endoscope. Numeral 24 denotes a position detection sensor provided on the probe. Although only one sensor is shown here, a plurality of sensors may be provided to more accurately detect the shape as described above. Reference numeral 25 denotes a position detection sensor provided at the tip of the forceps. The output signals of these position detecting sensors are converted into digital data by an analog-to-digital converter (not shown) and provided to each of the arithmetic units described below.

The calculating device 21 includes a tip position calculating section 26,
A tip position and shape calculation unit 27, a tip position calculation unit 28, a relative position calculation unit 29, a relative position calculation unit 30, and a display format determination unit 31 are included. The distal end position calculating unit 26 calculates a distal end position by receiving a signal from the position detecting sensor 23 provided at the distal end of the endoscope. The tip position and shape calculation unit 27 includes a position detection sensor 24 provided in the probe.
, The tip position of the probe is calculated, and the shape data of the probe is created. This shape data is three-dimensional data. The distal end position calculating section 28 receives the signal of the position detecting sensor 25 provided at the distal end of the forceps and calculates the distal end position.

The relative position calculator 29 is provided with a tip position calculator 2
6 and the position data and the shape data from the tip position and shape calculation unit 27, the distance between the endoscope and the probe is calculated. The relative position calculation unit 30 includes a tip position and shape calculation unit 2
7 and the position data and the shape data from the distal end position calculation unit 28, the distance between the probe and the forceps is calculated. The display format determination unit 31 receives the distance data from the relative position calculation unit 30 and, based on the calculated relative positional relationship between the probes 10 and 11 and the forceps 3, that is, the distance between the probes 10, 1
The display format of the shape 1 is determined.

As described above, in each arithmetic unit, the position is calculated by detecting the magnetic field generated by a magnetic field generator provided at a location (not shown) by each position detecting sensor and detecting the detected position. By performing a predetermined calculation process based on the magnetic field signal in the direction, the three-dimensional coordinate position (X, Y, Z) of each position detection sensor is calculated.

In order to calculate the shape of the probe, the data of the trajectory of the probe tip position when the probe is inserted into an organ to be protected from damage and the data of the form (thickness etc.) of the probe stored in advance are used. Based on the above, it is possible to construct the shape data of the probe by performing the coordinate complement operation and the synthesis operation. Alternatively, a plurality of position detection sensors may be provided not only at the tip of the probe but also in the middle of the probe, and the shape may be calculated by coordinate complement calculation to construct the shape data.

The relative position calculator 29 and the relative position calculator 30 receive the coordinate position data of the tip, which is the calculation result of each tip position calculator, and the position data and shape data from the tip position and shape calculator 27. , The relative positional relationship, that is, the distance between them is calculated. The distance is calculated based on three-dimensional coordinate data.

The display format determining section 31 determines the display format of the probes 10 and 11 according to the calculation result of the calculated relative positional relationship between the insertion sections 10 and 11 of the probe 5 and the forceps 3. The relative position calculation unit 30 calculates the distance using the coordinate data of the point closest to the forceps 3 among the shape data of the insertion units 10 and 11, and supplies the distance data to the display format determination unit 31. The display format refers to, for example, a line type such as a solid line or a dotted line, a line color, a thickness, and the like, and is calculated based on a relative positional relationship calculated as described later.
Is to determine how to display the probe displayed in. In the display format determination unit 31, a distance threshold for determining whether to change the display format is set in advance. Then, the distance data from the relative position calculator 30 is compared with the threshold value, and display format data is output based on the comparison result.

Reference numeral 32 denotes the endoscope image processing apparatus in FIG. The endoscope image processing device 32 includes an image synthesis unit 33 and a probe shape processing unit 34. The image synthesizing unit 33 is an arithmetic processing unit for generating a synthetic image in which the shape data of the probe from the relative position calculating unit 29 is superimposed on image data from the endoscope on a monitor. The screen composition unit 33
CCD which is an imaging device calculated by the relative position calculation unit 29
The position where the probe exists in the image data of the CCD camera is calculated based on the position data of the distal end portion of the endoscope with the camera and the shape data of the probe, and the position of the calculated data in the CCD camera image is calculated. Are superimposed on the probe image based on the shape data and combined. The image data generated by the image synthesis unit 33 includes the image data of the endoscope and the generated image data of the probe, and is supplied to the probe shape processing unit 34.

The image synthesizing section 33 displays the probe shape, which is three-dimensional data, at the position projected on the endoscopic image plane (two-dimensional). Therefore, the image synthesizing unit 33 is provided with a plurality of position detection sensors at the end of the endoscope, and assumes a viewpoint position of the endoscope image and an endoscope image plane from the direction, that is, the line of sight. Then, on the assumed image plane,
Image synthesis is performed by projecting the probe shape. Note that even if there is only one position detection sensor provided at the distal end of the endoscope, images can be synthesized if the insertion direction and position of the endoscope are determined in advance.

The probe shape processing unit 34 processes the probe image data from the image synthesizing unit 33 based on the display format data determined by the display format determining unit 31, and synthesizes the image data with the endoscope image data. And output display data to the monitor.

Next, the operation of the medical processing assisting device will be described with reference to an example of display of an image when performing an operation. 3 and 4
FIG. 7 is a diagram showing a screen display example displayed on a monitor of the medical treatment assisting device.

FIG. 3 shows an endoscopic image 42 on a screen 41 of the monitor 8 in which the shapes of the probes 10 and 11 inserted into the ureter at the time of a hysterectomy operation are indicated by dotted lines 43 and 44. 45 and 46 are forceps. 47 is a uterus,
48 and 49 are ovaries.

The operator performs a surgical operation on the uterus 47 on the endoscope image 42 displayed on the screen 41 of the monitor 8.
The operation is performed while viewing the forceps 45 and 46 operated by the operator. The surgeon must be careful not to damage or accidentally cut the ureter other than the one to be operated on. Image 4
In 2, probe shape images calculated by the arithmetic device 21 and calculated by the endoscope image processing device 32 are displayed by dotted lines 43 and 44.

As described above, since the shapes of the probes 10 and 11 are displayed so as to be superimposed on the endoscopic image, it is not necessary to confirm the position of the ureter again. Therefore, the operation is performed smoothly.

FIG. 4 shows an image changed as a result of the operator moving the forceps 46 from the state shown in FIG. When the forceps 46 are moved and the forceps 46 provided with the position detection sensor approach the ureter 44 into which the probe has been inserted by a predetermined distance or more, the above-described display format determination unit 3
1 changes the display format. As a result, in the probe shape processing unit 34, the shape of the ureter 44 into which the probe was inserted was changed from the dotted line display to the solid line display in the image generated by the image synthesis unit 33. For example, the display format determination unit 31 changes the display format to a solid line when the distance from the tip of the forceps 46 for performing a process such as excision to the ureter 44 that does not want to be damaged approaches within 5 mm [mm]. Is set in advance. Then, the distance is calculated by the relative position calculation unit 30, and the distance between the forceps and the probe is set to the set value.
[Mm], the display format determination unit 31
The display format data is output in such a manner that the display of No. 4 is changed to a solid line as shown in FIG. 4 instead of the dotted line as shown in FIG.

Thus, the operator knows that the forceps 46 are close to the ureter, and knows that the forceps 46 must be handled with care. Further, when the forceps 46 are separated by more than a predetermined distance, the shape of the ureter is changed from a solid line to a dotted line.

As described above, based on the position information obtained by using the position detecting means, the distance between the organ to be operated into which the probe is inserted and the forceps, which is a surgical instrument, is obtained. Since the display on the screen is changed, the surgeon can very easily know whether or not the surgical instrument is at a distance to which attention should be paid.

In the above example, the display format is changed according to the relative relationship. However, the present invention is not limited to this. The color or thickness of the line is changed according to the relative relationship. You may let it.

As another modified example, there is no display on the image, and the sound from a separately provided speaker (not shown) is changed (the pitch, the volume, etc.) according to the relative relationship. The operator may be notified, notified, or alerted audiovisually.

As described above, the position of an organ or the like hidden in the peritoneum, which does not appear in a mere endoscopic image, is synthesized with the endoscopic image and displayed, and it can be easily confirmed that the user has approached further. It is not necessary to confirm the position again so as not to damage other organs or the like as in the related art, and the operator can perform the operation in a short time and smoothly.

Furthermore, since the positional relationship between the target organ and the like and the surgical instrument can be grasped three-dimensionally, the mutual positional relationship can be recognized more accurately, so that the operator can perform the operation more smoothly. it can.

Next, a second embodiment will be described.

In the second embodiment, when the uterus of the subject is removed transvaginally using an endoscope and a transvaginal probe,
It is an example when the medical treatment assistance device according to the present invention is applied. A second embodiment will be described with reference to FIGS.

FIG. 5 is an explanatory diagram for explaining an example of a hysterectomy operation performed using the medical treatment assisting apparatus according to the present invention. In FIG. 5, reference numeral 51 denotes an endoscope insertion portion. 52 and 53 are forceps. A transvaginal probe 54 is a surgical instrument. 55 is the uterus, 56 is the vagina, and 57 is the vaginal stump. The operator uses the monitor 8 shown in FIG.
Perform surgery while looking at.

The difference from the first embodiment is that the sensor 24 shown in FIG. 2 is provided at the distal end of the transvaginal probe 54, and a plurality of positions are provided on the cut end of the transvaginal probe 54 on the circumference. The point is that a detection sensor is provided. And
The difference is that the position calculation and shape calculation unit 27 calculates and calculates the position and shape of the stump of the transvaginal probe 54 based on signals from a plurality of position detection sensors. Other points are the same, the position of the endoscope and the position of the forceps are calculated, and when approaching a predetermined distance or more from the relative positional relationship,
The display format is changed. Here, the display format is changed in the display format of the stump shape of the transvaginal probe. As in the first embodiment, the operator may be notified, notified, and alerted audiovisually.

FIG. 6 is an endoscope image displayed on the monitor 8.

In the endoscopic image 62 on the screen 61 of the monitor 8, the shape of the stump of the transvaginal probe 54 applied to the stump of the vagina during the operation of hysterectomy is superimposed and indicated by a dotted line 63.
64 and 65 are forceps. 66 is a uterus, 67
And 68 are ovaries.

During the operation, the operator performs the operation while viewing the uterus 66 to be operated and the forceps 64 and 65 operated by the operator on the endoscope image 62 displayed on the screen 61 of the monitor 8. . When transvaginally removing the uterus, along the stump image of the transvaginal probe 54 displayed on the endoscopic image,
A circular incision is made and the uterus is removed. At this time, the operator calculates the position and the shape of the stump probe 54 in the endoscope image processing device 32 by calculating the stump image of the transvaginal probe 54 that cannot be seen with the endoscope. The displayed probe shape image is displayed by a dotted line 63. Therefore, the operator can specify the position and shape of the vaginal stump from the abdominal cavity side.

In the calculation device 21, the position calculation and shape calculation unit 27 calculates and calculates the position and shape of the stump of the transvaginal probe 54 based on the output data of the sensor 24 in FIG. Further, the distance between the forceps 64, 65 and the stump probe 54 is calculated by the relative position calculation unit 30, and when the distance is smaller than a predetermined value in the display format determination unit 31, the vaginal stump is determined. Is changed from a dotted line to a solid line. Therefore, when the distance from the forceps to the vaginal stump is within a predetermined distance, the display format is changed, so that the operator can grasp the positional relationship between the vagina stump and the forceps, and easily perform an operation. be able to.

Therefore, since the incision at the vaginal stump for removing the uterus can be easily specified, the operation can be performed smoothly and in a short time.

As described above, based on the position information obtained by using the position detecting means, the position and the shape of the appliance which does not appear in the mere endoscope image are synthesized with the endoscope image and displayed.
Further, since the approach can be easily confirmed, it is not necessary to confirm the position of the device again as in the related art, and the operator can perform the operation in a short time and smoothly.

Next, a third embodiment will be described.

The third embodiment will be described with reference to FIG. Here, an example of an operation of exfoliating or resecting a tissue in a patient body of a subject is described.

FIG. 7 is an explanatory diagram for explaining an example of an operation performed using the medical treatment assisting apparatus according to the present invention. In FIG. 7, reference numeral 71 denotes a medical treatment assisting device according to the present invention. Reference numeral 72 denotes an endoscope to be inserted into a patient's body, and a position detecting sensor is provided at a distal end of the insertion portion 73. Numeral 74 denotes forceps as a treatment tool for performing resection, and a position detecting sensor is similarly provided at the tip thereof. Further, an energy treatment tool is provided at the tip of the forceps, and electric energy is supplied from a power supply unit 75 as an energy supply source via an energy supply cable 76. By inserting the forceps 74 into the patient, the tissue in the patient is separated and excised. 77
Is a switch connected to the power supply unit 75 for setting whether or not to output electric energy. This switch 77
Is turned on and off by the surgeon.

Reference numeral 78 denotes an arithmetic unit. The arithmetic unit 78 stores three-dimensional image data of a lesion, which is a surgical site of a patient, before surgery. The three-dimensional image data is three-dimensional image data obtained by using a tomography technique such as ultrasound, magnetic resonance, and CT.

The arithmetic unit 78 receives the output signal of the position detecting sensor provided at the distal end of the forceps 74 via a signal line 79, and calculates the position of the distal end of the forceps 74. Further, the arithmetic unit 78 further transmits a control signal for controlling the output of electric energy to the power supply unit 75 to a signal line 80.
Feed through. An endoscope display device 81 receives an image signal from the endoscope 72 via a signal line 82 and displays an image on a screen of a monitor device 83.

Next, how the medical treatment assisting device of the present invention is used when exfoliating and resecting tissue in a patient will be described with reference to an example of resection of a mammary gland.

When the mammary gland portion is resected due to the discovery of an early cancer, the resection is performed including a portion corresponding to a so-called surgical margin. In general, when a malignant tumor is resected, the resection is performed with a margin to a normal part around the malignant part so that there is no leftover. The surgical margin indicates such a margin range. Conventionally, the surgical margin has been marked by injecting a dye into the boundary portion of the surgical margin, and the surgeon has performed resection along the marking. However, the excision may not be performed clearly along the surgical margin due to the diffusion of the dye. Therefore, in the present embodiment, a method for appropriately performing excision along a surgical margin will be described.

As described above, the arithmetic unit 78 stores three-dimensional image data of a lesioned part of a patient, which is photographed by a CT scanner before an operation.

The three-dimensional image data is stored in the arithmetic unit 78 to calculate the position of the lesion and construct a three-dimensional model. Specifically, three-dimensional data (X,
Y, Z) and a three-dimensional model is obtained based on the calculated data. A three-dimensional model of an ablation range obtained by adding a surgical margin to the constructed three-dimensional model is further constructed.

FIG. 8 is an explanatory diagram for explaining the relationship between the surgical margin and the cutting. FIG. 8 is a view showing a state in which a lesion 9 is cut on the YZ plane in the figure when the lesion 91 is resected.
A case is shown in which a margin from 1 to D [mm] and a surgical margin with a margin of L [mm] up and down in the X direction are cut off. Therefore, the range shown by the dotted line 92 is
It is a surgical margin. If the energy treatment section 93 at the tip of the forceps is cut inside the surgical margin, it will not be cut properly.

FIGS. 9 and 10 are explanatory views for explaining the positional relationship between the treatment tool and the surgical margin.

FIG. 9 shows a case where the treatment tool 93 is outside the range of the surgical margin. FIG.
3 shows a case in which the value falls within the range of the surgical margin. The operator performs an excision operation with the treatment tool 93 while watching the image on the monitor device 83. In the state of FIG.
When the treatment tool is turned on, resection can be performed including the surgical margin. However, in the state of FIG. 10, when the treatment tool is turned on and cut is performed, the cut is performed within the range of the surgical margin. Therefore, the range including the planned surgical margin cannot be completely cut. I will.

Therefore, in the arithmetic unit 78, control processing of energy output to the surgical instrument is performed. FIG. 11 is a flowchart showing the flow of the energy output control process.

First, step (hereinafter abbreviated as S) 10
In step 1, the switch (S) determines whether or not the operator has issued an instruction to output energy to the surgical instrument 93.
W) Judgment is made based on the state of 77. If NO in S101, the switch 77 is in the off state, and nothing is performed. When the switch 77 is turned on by the operator, YE is determined in S101.
The result is S, and it is determined whether the surgical tool 93 is within the surgical margin (S102). If there is a surgical tool within the surgical margin, YES is determined in S102,
The energy output is stopped (S103). N in S102
In the case of O, since it is not within the surgical margin, an energy output is output according to the operator's instruction (S104).

As described above, the arithmetic unit 78 performs an excision operation in a range where excision should not be performed from the tip position of the energy treatment instrument 93 and the three-dimensional model data constructed based on the image data stored in advance. Try to
No energy is output.

In the above description, when the switch of the treatment tool is turned on, the energy output is controlled based on the judgment as to whether or not it is within the resection range. When the position is within the ablation range (FIG. 10) and outside the ablation range (FIG. 9), the output of energy is stopped irrespective of the state of the output SW 25, and energy is supplied to the treatment tool only near the boundary of the surgical margin. You may do so.

Therefore, when the surgeon performs an operation while looking at the image from the observation section of the endoscope, the surgeon can ensure the surgical margin by reliably recognizing that the treatment tool has reached the resection range. It is possible to surely avoid the leftover.

In FIG. 7, the three-dimensional position data is transmitted from the arithmetic unit 78 to the endoscope image processing unit 81 via a signal line 83.
May be displayed on the monitor 81 such that the positional relationship between the surgical margin and the treatment tool can be understood.

For example, FIG. 12 shows a screen display example displayed on the monitor of the medical treatment assisting device. As shown in FIG. 12, an image of the forceps 113 is displayed on the endoscope image 112 projected on the screen 111 of the monitor device 83. In addition, a small display image 11
4, 115 appear. The display images 114 and 115
Shows the positional relationship between the lesion, the surgical margin, and the forceps from the arithmetic unit 78. The upper right image shows the three positional relationships when viewed from the horizontal direction (the Z-axis direction in the above example). Reference numeral 118 denotes a lesion, 120 denotes a surgical margin, and 116 denotes a position of a forceps. The lower right image includes these three images when viewed from the vertical direction (the X-axis direction in the above example).
Two positional relationships are shown. 119 is a lesion, 121
Indicates a surgical margin, and 117 indicates the position of the forceps.

It should be noted that the distance between the forceps and the surgical margin may be simply displayed on the display screens 114 and 115 together or independently. Furthermore, according to the distance, change the color of a specific part of the display screen, change the pitch and volume of the sound, etc., and output audiovisually to notify, notify, and alert the surgeon Is also good.

Therefore, the surgeon can obtain the endoscope image 112 and
Based on the position information obtained by the position detecting means,
The resection operation can be performed while confirming the positional relationship between the surgical margin and the position of the lesion and the treatment tool by looking at these two display images, and the operation can be performed smoothly.

Next, a fourth embodiment will be described.

The fourth embodiment relates to the processing of artificial bone to replace a partially defective bone with a bone.

Conventionally, when a part of a patient's bone is defective, artificial bone is replaced in the defective part. The artificial bone to be replenished is processed according to the shape of the defect,
Since precision was required for the processing, it was processed by hand. However, in such a method, a long processing time was required to increase the accuracy.

Therefore, as shown in FIG. 13, it is a flow chart showing a rough procedure of the processing for processing the bone at the defective portion. As shown in FIG. 13, the image processing device 132 constructs three-dimensional model data based on image data on a bone defect of a patient obtained by a tomography function of an image diagnostic device 131 such as a CT scanner. The shape of the artificial bone to be added to the defect is determined. The determined shape data is transferred from the image processing device 132 to the processing device 133. On the basis of the shape data of the defective portion from the image processing device 132, a processing device 133 such as a machining center manufactures artificial bones, that is, performs processing.

That is, based on the patient data obtained by the image diagnostic apparatus, the image processing means 132 constructs three-dimensional data in the vicinity of the bone defect. Further, the image processing device 132
Then, based on the constructed three-dimensional data, the shape data of the artificial bone to be replenished to the defective part is constructed. An artificial bone is manufactured based on the constructed shape data of the artificial bone.

FIG. 14 is an explanatory diagram for explaining the processing of the artificial bone corresponding to the defective portion with respect to the lost bone. In FIG. 14A, reference numeral 141 denotes the originally missing bone. Reference numeral 142 denotes a missing portion.
In (B), a dotted line 143 indicates a bone in a state where there is no defect with respect to the lost bone 141. In (C), the dotted line at 144 indicates the opposite bone of the bone 143 without defects. The images shown in FIGS. 14A, 14B, and 14C can be displayed on a display device of a computer (not shown).

A bone having a defect is subjected to a CT scan, and three-dimensional image data, that is, three-dimensional data is obtained based on the scanned image data. According to the three-dimensional data, FIG.
As shown in (A), a defective bone is displayed on the screen.

The operator of the computer generates, on the computer, shape data of the bone having no defect, ie, the bone in the original state, in the displayed image. In the generation method, shape data is generated by specifying a shape while specifying the positions of a plurality of points using a pointing device such as a mouse on a screen. The generated shape is shown in FIG.
As shown in (B), it is indicated by the dotted line 143.

Next, the shape data of the bone corresponding to the defective portion, that is, the opposite bone is generated and superimposed and displayed on the screen. In FIG. 14C, it is indicated by a dotted line 144. In addition, the shape data of the opposing bone may be obtained by a CT scan or the like, as in the case of generating three-dimensional data of a bone having a defect.

Therefore, the shape of the artificial bone to be replenished to the defect part of the patient can be quickly processed with high accuracy.

The above processing will be described with reference to FIG. FIG. 15 is a flowchart showing a flow of processing until output of processing data for manufacturing an artificial bone at a defective portion of a defective bone.

First, in S151, the image diagnostic apparatus generates three-dimensional data of the lost bone and displays it on the screen (FIG. 14A). Subsequently, in S152, the operator of the computer generates image data of the ideal bone before the loss, and superimposes the image data on the screen (FIG. 14B). Further, subsequently, in S153, image data of a bone facing, that is, connected to, the lost bone is generated and is superimposed and displayed on the screen (FIG. 14C).

The operator checks the connection between the opposing bone and the bone supplemented with the defective part, that is, judges the quality of the defective part. If the connection is not good, the result of S154 is NO, the process returns to S153, and the process of generating the image data of the bone before the loss is performed again to optimize the shape of the lost portion. S15
If YES in step 4, image data of the missing portion is generated (S155). This can be generated by taking the difference between the image data before the loss and the image data of the lost bone. Then, the generated image data of the defective portion is
The data is stored in various memories as processing data for the processing apparatus, or output for transmission via a communication line (S
156).

As described above, medical treatment can be assisted in that an artificial bone can be easily processed based on three-dimensional image data obtained from a patient.

As described above, according to the medical treatment assisting apparatus of the present invention, the position of the treatment target can be easily grasped, and therefore, it can be applied to various medical treatments. In particular, since the position of a treatment target and the like are clearly shown in an operation or the like, the device can be used as a device for navigating the operation.

The configuration according to the embodiment described above is characterized by the configuration shown in the following appendix.

[Supplementary Notes] (1) A first insertion section provided with an observation section for obtaining an observation image signal of the subject and at least a first position detection means for detecting the position of the distal end is provided. An endoscope, a first insertion tool having a second insertion portion, and a second insertion position detection means for detecting an insertion position of the second insertion portion; First calculating means for obtaining a positional relationship between the distal end of the endoscope and the second insertion portion based on position information from a second position detecting means; and an inner part obtained based on the observation image signal. Synthesizing means for synthesizing an insertion position of the second insertion portion as an image based on an operation result of the first operation means with an endoscope image, and displaying and outputting the image. apparatus.

(2) A second insertion tool having a third insertion portion and having third position detecting means for detecting the insertion position of the third insertion portion, And second calculating means for calculating a positional relationship between the second insertion portion and the third insertion portion based on position information from the third position detecting means, and the combining means includes: The medical treatment assistance device according to claim 1, wherein a display state of the second insertion portion is changed based on a calculation result of the second calculation unit.

(3) An insertion device having an insertion portion having an energy treatment device, and a position detection means for detecting the insertion position of the insertion portion, three-dimensional data set in advance, A medical treatment assisting device, comprising: control means for controlling energy supply to the energy treatment device based on position information from position detection means.

(4) An endoscope inserted into the body having at least one first position detecting means, a probe inserted into the body having at least one second position detecting means, and at least one third position An instrument which has a detecting means and is inserted into the visual field of the endoscope; a first calculating means for calculating a positional relationship between the first and second position detecting means; and a position of the probe based on the first calculation result Means for synthesizing and displaying the endoscope image on the endoscope image, second calculating means for calculating the mutual positional relationship from the second and third position detecting means, and A navigation system comprising means for changing the display content of a probe image.

(5) An instrument having means for detecting the tip position, means for constructing the tip position of the instrument at the first coordinates,
Means for constructing and storing the treatment range of the subject at the second coordinates based on image diagnosis performed in advance, and calling the second coordinates;
A navigation system comprising: means for calculating a relative position with respect to first coordinates; and means for notifying an operator of the calculation result.

(6) An energy supply means connected to the appliance, the energy supply means having means for taking in the above-mentioned operation result, and means for controlling the supply of energy according to the operation result taken in The navigation system according to item (5), including a supply unit.

(7) A step of constructing a missing part of a partially lost bone with three-dimensional data, a step of constructing three-dimensional data of a bone part facing a defect part, and a step of combining the two three-dimensional data described above. An artificial bone processing method comprising: a step of superimposing and optimizing data of a defective portion; and a step of processing an artificial bone based on the optimized data.

[0102]

As described above, according to the medical treatment assisting apparatus of the present invention, the position of the treatment target can be easily grasped in the medical treatment, and the medical treatment can be smoothly performed.

[Brief description of the drawings]

FIG. 1 is an explanatory diagram for explaining an example of an operation performed using the medical treatment assisting device according to the present invention.

FIG. 2 is a block diagram showing an example of a medical treatment assistance device according to the present invention.

FIG. 3 is a diagram showing a screen display example displayed on a monitor of the medical treatment assisting device.

FIG. 4 is a diagram showing a screen display example displayed on a monitor of the medical treatment assisting device.

FIG. 5 is an explanatory diagram for explaining an example of an operation performed using the medical treatment assisting device according to the present invention.

FIG. 6 is a diagram showing a screen display example displayed on a monitor of the medical treatment assisting device.

FIG. 7 is an explanatory diagram for explaining an example of an operation performed using the medical treatment assisting device according to the present invention.

FIG. 8 is an explanatory diagram for explaining a relationship between a surgical margin and resection.

FIG. 9 is an explanatory diagram for explaining a positional relationship between a treatment tool and a surgical margin.

FIG. 10 is an explanatory diagram for explaining a positional relationship between a treatment tool and a surgical margin.

FIG. 11 is a flowchart showing a flow of a control process of an energy output to the treatment tool.

FIG. 12 shows a screen display example displayed on a monitor of the medical treatment assisting device.

FIG. 13 is a flowchart showing a flow of a rough treatment for processing a bone at a defective portion.

FIG. 14 is an explanatory diagram for explaining processing of artificial bone corresponding to a defective portion.

FIG. 15 is a flowchart showing the flow of a specific treatment for processing a bone at a defect.

[Explanation of symbols]

1, 71: Medical treatment assistance device 2, 72: Endoscope 3, 4, 45, 46, 52, 53, 74, 93, 113
... forceps 5 ... probe 10, 11, 43, 44 ... probe insertion part 7, 32, 81 ... endoscope image processing apparatus 13, 21, 78 ... arithmetic unit 51 ... Endoscope insertion section 54 Transvaginal probe 75 Power supply 77 Switch

 ──────────────────────────────────────────────────続 き Continued on the front page (72) Kunihide Kaji, 2-34-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Co., Ltd. (72) Hiroaki Kagawa 2-43-2, Hatagaya, Shibuya-ku, Tokyo No. Olympus Optical Co., Ltd. (72) Shuichi Kimura, Inventor 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd. (72) Hiroshi Takahashi, 2-43-2 Hatagaya, Shibuya-ku, Tokyo No. Olympus Optical Co., Ltd. (72) Inventor Takechiyo Nakamitsu 2-43-2 Hatagaya, Shibuya-ku, Tokyo In-line Olympus Optical Co., Ltd. (72) Takeaki Nakamura 2-chome, Hatagaya, Shibuya-ku, Tokyo 43-2 F-term in Olympus Optical Co., Ltd. (reference) 4C061 AA00 BB00 CC00 DD00 FF50 GG11 HH51 LL02

Claims (3)

[Claims] 1. An endoscope having a first insertion section including an observation section for obtaining an observation image signal of a subject and at least a first position detection means for detecting a position of a tip, A first insertion tool having a second insertion portion and having second position detection means for detecting an insertion position of the second insertion portion; and the first and second position detections. First calculating means for obtaining a positional relationship between the distal end of the endoscope and the second insertion portion based on position information from the use means, and an endoscope image obtained based on the observation image signal, Synthesizing means for synthesizing and displaying an insertion position of the second insertion portion as an image based on a calculation result of the first calculating means, and outputting the image. A second insertion tool having a third insertion portion and a third position detecting means for detecting an insertion position of the third insertion portion; A second calculating unit that obtains a positional relationship between the second insertion unit and the third insertion unit based on position information from a third position detection unit. The medical treatment assistance device according to claim 1, wherein a display state of the second insertion portion is changed based on a calculation result of the second calculation unit. 3. An insertion section having an energy treatment device,
An insertion tool provided with a position detecting means for detecting an insertion position of the insertion portion; three-dimensional data set in advance; and position information from the position detecting means, to the energy treatment tool. A medical treatment assisting device comprising: a control unit for controlling energy supply of the medical treatment.