JP2008188115A - Stabilizer - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a stabilizer monitoring bleeding in an organ caused by the contact of the organ with a contact part supporting part inserted into a living body. <P>SOLUTION: The stabilizer 10 to be brought into contact with the target organ 12 to restrain the movement of the target organ 12 comprises the contact part 14 to be brought into contact with the target organ 12, the contact part supporting part 16 to support the contact part 14, and a plurality of miniature cameras 26 as observing parts disposed along the longitudinal direction of the contact part supporting part 16. <P>COPYRIGHT: (C)2008,JPO&INPIT

Description

  The present invention relates to a stabilizer that contacts an organ such as the heart and suppresses the movement of the organ.

  In conventional cardiac surgery, the sternum is incised (median sternotomy) to allow access to the thoracic cavity. In this case, the retractor is placed in the chest incision and the retractor expands the sternum and tissue to form a large opening. A surgical instrument is then placed through the opening and a cardiac surgery is performed.

  One of the most common cardiac surgeries is Coronary Artery Bypass Grafting (CABG). In this CABG, an occlusion in one or more coronary arteries is bypassed by connecting a graft vessel (graft) to the coronary artery downstream of the occlusion. The technique of connecting a graft to a coronary artery is known as anastomosis. For example, the thoracic artery incised from the chest wall is used for the graft. In this case, the upstream end of the thoracic artery is left intact, and the downstream end of the thoracic artery is connected to the coronary artery. . The graft may also use arteries or veins from any part of the patient's body. Furthermore, an artificial blood vessel graft can also be used, in which case the upstream end of the graft is connected to an artery such as the aorta and the downstream end is connected to the coronary artery. In this way, occlusion of multiple coronary arteries at various locations on the front, side and back of the heart is bypassed using multiple grafts.

  Conventionally, since CABG is performed with the patient's heart stopped, the patient's blood is circulated using an oxygenator.

  However, CABG may be performed while the heart is beating by a technique known as "Off-pump coronary artery bypass (OPCAB)", thereby avoiding the use of a heart-lung machine.

  In this OPCAB, while the heart is beating, the surface of the heart near the anastomosis site of the coronary artery is fixed using a special instrument called a stabilizer. This local fixation by the stabilizer keeps the anastomosis site as stationary as possible while the graft is connected to the coronary artery.

The stabilizer as described above includes, for example, a contact portion that comes into contact with an organ and a contact portion support portion that has flexibility to support the contact portion as disclosed in Patent Document 1. The contact portion support portion is formed by a plurality of joined bodies so that the contact portion support portion can be bent or deformed, and an elongated cable such as a wire extends through the inside of the joined body. Then, by appropriately adjusting the tension of this cable, while bending or deforming the contact part support part, the contact part support part is inserted into the chest cavity, and the contact part is brought into contact with a desired part of the heart, The movement is suppressed by pressing or adsorbing the heart.
Japanese translation of PCT publication No. 2003-521296

  In the above-described median sternotomy and thoracotomy, since the sternum and tissue are expanded by the retractor to form a large opening, a doctor can directly observe the state of the stabilizer.

  On the other hand, in recent years, as a minimally invasive one that does not require a large incision, a hole is made in a body wall such as an abdominal wall, and various treatments are performed in the body cavity by inserting an endoscope or a treatment instrument into the body cavity through the hole. Endoscopic surgery has also been performed in the CABG. In such a case, an operation is performed while observing the surgical site by inserting an observation camera at a position in the body cavity corresponding to a diseased site based on a CT image or the like taken before surgery.

  In such an endoscopic operation, if the stabilizer has a redundant degree of freedom to reach the back of the organ, the stabilizer and the organ may come into contact with each other and bleed. The contact part of the stabilizer is set in the operative field within the field of view of the observation camera, so it can be monitored by the observation camera, but it could not be monitored for bleeding by the contact part support part other than the operative field. .

  The present invention has been made in view of the above points, and an object of the present invention is to provide a stabilizer capable of monitoring bleeding due to contact between a contact portion support portion inserted into a living body and an organ.

One aspect of the stabilizer of the present invention is a stabilizer that suppresses the movement of an organ in contact with the organ,
A contact part support part for supporting a contact part in contact with an organ;
A plurality of observation parts provided along the length direction of the contact part support part;
It is characterized by comprising.

  According to the present invention, since a plurality of observation parts are provided along the length direction of the contact part support part, it is possible to monitor bleeding due to contact between the contact part support part inserted into the living body and the organ. A stabilizer can be provided.

  The best mode for carrying out the present invention will be described below with reference to the drawings.

[First Embodiment]
FIG. 1A is a diagram showing a configuration of a stabilizer 10 according to the first embodiment of the present invention.

  The stabilizer 10 includes a contact portion 14 that comes into contact with the target organ 12 and a contact portion support portion 16 that has flexibility to support the contact portion 14. The contact portion support portion 16 is formed by a plurality of joined bodies 18 so that the contact portion support portion 16 can be bent or deformed. Although not shown, a wire or the like passes through the inside of the joined body 18. An elongated cable extends. The stabilizer 10 is positioned by a stabilizer support arm 20, and a hole (not shown) formed in a body wall (not shown) while bending or deforming the contact portion support portion 16 by appropriately adjusting the tension of the cable. (Not shown) is inserted into the chest cavity 24 through the ribs 22 and the contact part 14 is brought into contact with a desired part of the target organ 12 to suppress the movement of the target organ 12.

  In the present embodiment, a plurality of small cameras 26 are provided along the length direction of the contact portion support portion 16. As this small camera 26, for example, a capsule endoscope can be used. Preferably, the direction of the visual field can be adjusted from the outside.

  Therefore, when the contact portion support portion 16 comes into contact with the target organ 12 or another organ and bleeding occurs, the bleeding can be monitored by the small camera 26.

  FIG. 2 is a diagram illustrating a configuration of a surgical system using the stabilizer 10 having such a configuration, and FIG. 3 is a block diagram illustrating an electrical configuration of the surgical system.

  That is, this surgery system includes, for example, a master unit 30 that is a remote operation device and a control unit 34 that controls the slave main body 32 based on remote operation information from the master unit 30.

  Here, the slave body 32 includes a stabilizer slave unit 36, a manipulator slave unit 38, and an observation camera unit 40.

  The stabilizer slave unit 36 includes the stabilizer 10, the stabilizer support arm 20, a motor 42 that drives each drive mechanism (not shown) in the stabilizer 10, and each drive mechanism in the stabilizer support arm 20. A motor 44 for driving a unit (not shown) and the plurality of small cameras 26.

  The manipulator slave unit 38 includes a manipulator 46 that performs a treatment on an in-vivo region, a manipulator support arm 48 that supports the manipulator 46 and positions the manipulator 46, and each drive mechanism unit in the manipulator 46 ( A motor 50 that drives a motor (not shown) and a motor 52 that drives each drive mechanism (not shown) in the manipulator support arm 48 are configured. The details of the manipulator 46 are disclosed in, for example, Japanese Patent Application Laid-Open No. 7-136173, and the description thereof is omitted here.

  The observation camera unit 40 includes an observation camera 54 for observing a part in a living body, an observation camera support arm 56 for supporting the observation camera 54 and positioning it with respect to an operation part, and an inside of the observation camera support arm 56. And a motor 58 for driving each drive mechanism (not shown).

  On the other hand, the control unit 34 includes the motor driving unit 60 that drives the motors 42, 44, 50, 52, and 58 of the slave main body 32, and the plurality of small units provided in the contact unit support unit 16 of the stabilizer 10. Based on the remote operation information from the master unit 30 and the camera display control unit 64 for controlling the operation of the camera 26 and the observation camera 54 and controlling the display of the display unit 62 connected to the control unit 34. 10, a signal for controlling the movement amount and operation of the manipulator 46 and the observation camera 54 is generated and supplied to the motor drive unit 60 and the camera display control unit 64, so that the stabilizer 10, the manipulator 46, and the observation camera 54 are controlled. The calculation unit 66 is configured to move and operate, and the power supply unit 68 supplies power to each unit.

  Therefore, the surgeon observes the image of the surgical part displayed on the display unit 62 by the observation camera 54 and the images of the plurality of small cameras 26 attached to the contact part support part 16 of the stabilizer 10. By operating the master unit 30, the stabilizer 10 is inserted into the chest cavity 24, and the contact part 14 of the stabilizer 10 is brought into contact with a desired site of the target organ 12, thereby suppressing the movement. Thereafter, the master unit 30 is operated, and the manipulator 46 performs a treatment on the affected part of the target organ 12.

  Further, by appropriately adjusting the orientation of the plurality of small cameras 26 by operating the master unit 30, it is determined whether or not bleeding due to contact between the contact unit support unit 16 of the stabilizer 10 and the target organ 12 or another organ has occurred. Can be confirmed.

[Second Embodiment]
FIG. 1B is a diagram showing a configuration of a stabilizer 10 according to the second embodiment of the present invention.

  In the present embodiment, a magnetic coil 70 is further provided along the length direction of the contact portion support portion 16 as a position index portion whose position is detected from the outside of the living body. In this case, each magnetic coil 70 is provided corresponding to each of the plurality of small cameras 26. Here, each magnetic coil 70 is built in the contact portion support portion 16 by being fixed to the contact portion support portion 16 with an adhesive so that the coil shape is not deformed.

  These magnetic coils 70 generate electromagnetic waves when a drive signal is applied. Therefore, as disclosed in the above Japanese Patent Laid-Open No. 8-542, for example, the magnetic field of the electromagnetic wave generated by the magnetic coil 70 by the magnetic detector 72 placed at a known position in the corner of the bed on which the patient is placed. By detecting a signal proportional to the intensity, the position of each magnetic coil 70 can be accurately detected based on the detection signal.

  Such a magnetic coil 70 is attached to several locations of the ribs 22. Since the position of the diseased part of the target organ 12 with respect to the rib 22 is determined by a CT image or the like taken before the operation, for example, by adopting a technique as disclosed in Japanese Patent Application Laid-Open No. 2000-308646, for example, Using the position of the rib 22 detected by the magnetic coil 70 attached to the rib 22 as a reference, the position of each magnetic coil 70 provided in the contact portion support portion 16 of the stabilizer 10 and the target organ 12 and its diseased site are relative to each other. Can be identified. Therefore, it is possible to easily determine which part of the target organ 12 each small camera 26 corresponding to each magnetic coil 70 provided on the contact support 16 is imaging.

  Although not particularly illustrated, in the surgical system using the stabilizer 10 according to the second embodiment, the magnetic coil 70 and the magnetic detector 72 are connected to the control unit 34, and the magnetic detection is performed by the control unit 34. The position of the contact portion support portion 16 is detected from the position of each magnetic coil 70 detected by the machine 72, and the detection result is displayed on the display portion 62 as an image.

  Although the present invention has been described above based on the embodiments, the present invention is not limited to the above-described embodiments, and various modifications and applications are naturally possible within the scope of the gist of the present invention.

  For example, the small camera 26 is not limited to a capsule endoscope.

  Further, although the magnetic coil 70 is used as the position index portion, it may be anything as long as the position can be detected from the outside of the living body by another method such as X-ray.

  Further, by attaching the magnetic coil 70 in a state where the relative positional relationship is fixed with respect to the observation field of view of the corresponding small camera 26, when the orientation of the small camera 26 is adjusted, which direction is observed. It is also possible to determine whether or not

(Appendix)
The invention having the following configuration can be extracted from the specific embodiment.

(1) A stabilizer that touches an organ and suppresses the movement of the organ,
A contact part support part for supporting a contact part in contact with an organ;
A plurality of observation parts provided along the length direction of the contact part support part;
The stabilizer characterized by comprising.

(Corresponding embodiment)
The first and second embodiments correspond to the stabilizer described in (1). In these embodiments, the stabilizer 10 is the stabilizer, the target organ 12 is the organ, the contact part 14 is the contact part, the contact part support part 16 is the contact part support part, and the small camera 26 is the observation part. Respectively.

(Function and effect)
According to the stabilizer described in (1), since the plurality of observation parts are provided along the length direction of the contact part support part, bleeding due to contact between the contact part support part inserted into the living body and the organ is prevented. Can be monitored.

  (2) The stabilizer according to (1), wherein the observation unit is a small camera.

(Corresponding embodiment)
The first and second embodiments correspond to the stabilizer described in (2).

(Function and effect)
According to the stabilizer described in (2), the observation unit is a small camera so that it does not interfere with the insertion of the stabilizer into the thoracic cavity through the ribs from the hole formed in the body wall. The observation unit can reduce the possibility of contact with an organ.

  (3) The stabilizer according to (1), further including a plurality of position indicator portions that are provided along a length direction of the contact portion support portion and whose positions are detected from outside the living body.

(Corresponding embodiment)
The second embodiment corresponds to the stabilizer described in (3). In the embodiment, the magnetic coil 70 corresponds to the position indicator portion.

(Function and effect)
According to the stabilizer described in (3), it is possible to know from the outside how the contact portion support portion is inserted in the living body.

  (4) The stabilizer according to (3), wherein the plurality of position index units are provided corresponding to the plurality of observation units.

(Corresponding embodiment)
The embodiment relating to the stabilizer described in (4) corresponds to the second embodiment.

(Function and effect)
According to the stabilizer described in (4), it is possible to easily know where the observation unit is observing.

FIG. 1A is a diagram illustrating a configuration of a stabilizer according to the first embodiment of the present invention, and FIG. 1B is a diagram illustrating a configuration of the stabilizer according to the second embodiment of the present invention. FIG. 2 is a diagram showing a configuration of a surgical system using the stabilizer according to the first embodiment. FIG. 3 is a block diagram showing an electrical configuration of the surgical system using the stabilizer according to the first embodiment.

Explanation of symbols

    DESCRIPTION OF SYMBOLS 10 ... Stabilizer, 12 ... Target organ, 14 ... Contact part, 16 ... Contact part support part, 18 ... Conjugate, 20 ... Stabilizer support arm, 22 ... Rib, 24 ... Chest cavity, 26 ... Small camera, 30 ... Master part, 32 ... Slave body, 34 ... Control unit, 36 ... Stabilizer slave unit, 38 ... Manipulator slave unit, 40 ... Observation camera unit, 42, 44, 50, 52, 58 ... Motor, 46 ... Manipulator, 48 ... Manipulator support arm, 54 ... Observation camera 56 ... Observation camera support arm 60 ... Motor drive unit 62 ... Display unit 64 ... Camera display control unit 66 ... Calculation unit 68 ... Power supply unit 70 ... Magnetic coil 72 ... Magnetic detector .

Claims (4)

A stabilizer that touches the organ and suppresses the movement of the organ,
A contact part support part for supporting a contact part in contact with an organ;
A plurality of observation parts provided along the length direction of the contact part support part;
The stabilizer characterized by comprising.   The stabilizer according to claim 1, wherein the observation unit is a small camera.   The stabilizer according to claim 1, further comprising a plurality of position indicator portions that are provided along a length direction of the contact portion support portion and whose positions are detected from outside the living body.   The stabilizer according to claim 3, wherein the plurality of position index units are provided corresponding to the plurality of observation units.

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