JP4384285B2 - Surgical microscope - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a surgical microscope in which surgery is performed using an endoscope together.
[0002]
[Prior art]
In recent years, with the development and spread of microsurgery, which is a surgical operation on minute affected areas, microsurgery performed under the observation of a surgical microscope in various fields such as neurosurgery, otolaryngology, ophthalmology, etc. Became. In particular, in recent years, less invasive surgery has been performed in consideration of quick return to society after surgery. Among them, a surgical operation using a so-called endoscope that observes a portion (a blind spot) that cannot be seen with a conventional surgical microscope has attracted attention.
[0003]
When observing a surgical site with an endoscope in neurosurgery or the like, it must be easy for an operator to recognize the viewing direction of the endoscope.
In addition, there is a need for minimally invasiveness that minimizes the exclusion of tissue during the operation of an endoscope. Therefore, when an endoscope is used under observation with a surgical microscope, the operation must be performed while always confirming the insertion position of the endoscope.
[0004]
On the other hand, systems for merging and displaying an observation image of an endoscope in the field of view of a surgical microscope are disclosed in Japanese Patent Laid-Open Nos. 10-333047, 7-261094, and 62-166310, respectively. ing. Specifically, in the surgical microscope disclosed in Japanese Patent Laid-Open No. 10-333047, as shown in FIG. 3, an endoscopic image is simultaneously displayed in the upper region of the microscope observation image.
[0005]
By the way, in the endoscope used in such a conventional surgical microscope system, in order to illuminate an observation site by the endoscope or an imaging site by a solid-state imaging device, a dedicated light source device installed separately is used. Illumination light is supplied to the endoscope via a light guide fiber.
[0006]
On the other hand, as a surgical microscope used in ophthalmic surgery, as shown in Japanese Utility Model Laid-Open No. 4-83223, illumination light is supplied to an intraocular illumination probe from a light source provided on a gantry of the surgical microscope. The ones that are designed to be illuminated are known.
[0007]
[Problems to be solved by the invention]
The conventional systems disclosed in Japanese Patent Application Laid-Open Nos. 10-333047, 7-261994, and 62-166310 require a dedicated light source for an endoscope. It will be expensive. In addition, a mounting device such as a cart is required to install the light source in the operating room, which narrows the space in the operating room. Further, since the light source device cannot be sterilized, it is necessary to isolate the light source device at a position sufficiently away from the surgical site. Therefore, a long light guide fiber that connects the endoscope and the light source is required, and the weight and flexibility of the light guide fiber provide resistance during endoscope operation, and the endoscope cannot move smoothly during surgery. There was a problem.
[0008]
In the surgical microscope disclosed in Japanese Utility Model Laid-Open No. 4-83223, the illumination light is supplied from the surgical microscope light source to the intraocular probe. Since the light and the illumination light to the intraocular probe are supplied by switching the light of one light source lamp, it is not possible to illuminate both the surgical microscope and the intraocular probe at the same time, and as a result, it is possible to observe Can not.
[0009]
On the other hand, when operating deep from a small opening in neurosurgery or the like, it is very difficult to confirm the position of the endoscope tip without using a microscope, and where the endoscope is located in the skull, which is a complex tissue. It is not easy to judge whether you are watching. In addition, the operation of moving the endoscope visual field is performed by relying on the endoscopic image, and as a result, the opportunity for exclusion to the surrounding tissue by the endoscope increases.
[0010]
In addition, the illumination light is guided from the arm part of the surgical microscope to the surgical site, that is, into the eye by the light guide fiber. It was.
[0011]
The present invention has been made paying attention to such a problem, and the object of the present invention is to simultaneously illuminate both the operation microscope and the endoscope in the endoscopic operation, and to observe at the same time. It is possible to further improve the operability of the endoscope, provide a sufficient working space for the operator, secure enough space in the operating room, and perform endoscopic observation with an inexpensive system. There is in making it possible.
[0012]
[Means and Actions for Solving the Problems]
The present invention includes a microscope unit including a stereomicroscope optical system for observing a surgical site, an illumination optical system for transmitting illumination light to the surgical site, a light source device for illuminating the surgical site, and the above A light guide fiber having an emission end disposed in the microscope unit and transmitting illumination light from the light source device to the microscope unit ; the light guide fiber at the emission end of the light guide fiber; Illumination light from the light source device branches into two emission ends, a first emission end to which the system is connected and a second emission end on which a connecting portion for detachably connecting the light guide cable of the endoscope is arranged. Illumination light branching means for branching into illumination light supplied from the first emission end to the illumination optical system and illumination light supplied from the second emission end to the light guide cable of the endoscope surgical microscope, wherein A.
[0013]
With the configuration as described above, the illumination light emitted from one light source is guided to the microscope unit and branched, and supplied to the first illumination unit and the second illumination unit, respectively, and the respective surgical units (observation sites). Illuminate at the same time.
[0014]
DETAILED DESCRIPTION OF THE INVENTION
[ First Reference Example ]
A first reference example of the present invention will be described with reference to FIGS.
[0015]
(Constitution)
FIG. 1 schematically shows a configuration of a surgical microscope system combined with an endoscope. In FIG. 1, reference numeral 1 denotes a surgical microscope, and this apparatus includes a gantry unit 2 installed on a floor surface, an arm unit 4 connected to the gantry unit 2, and a microscope unit supported by the arm unit 4. The operation part is magnified and observed with this microscope part 3. The microscope unit 3 is supported by the arm unit 4 and can move and tilt three-dimensionally in the space. A light source device 5 is installed in the column of the gantry 2. The light source device 5 includes a lamp 5a and a condenser lens 5b, and makes illumination light incident on a flexible light guide fiber 14 (to be described later) disposed inside the gantry 2 and the arm 4. The illumination light incident on the light guide fiber 14 is guided to the microscope unit 3 through the light guide fiber 14.
[0016]
An endoscope 6 for observing a blind spot in visual field observation by the microscope unit 3 is connected to the surgical microscope 1. The endoscope 6 has an insertion portion 6a and a hand portion 6b, and an eyepiece portion 6c and a light guide cable 6d are provided on the hand portion 6b. A TV camera head 7 is connected to the eyepiece 6 c of the endoscope 6. The TV camera cable 7 a of the TV camera head 7 is guided to the inside of the arm portion 4 and the gantry 2 and connected to a camera control unit 7 b disposed in the gantry 2. The camera control unit 7b is connected to a monitor 8 and a small monitor 9 built in the microscope unit 3 as will be described later.
[0017]
A light guide fiber 6e is built in the light guide cable 6d of the endoscope 6, and the light guide cable 6d is connected to the lower surface portion of the microscope unit 3. The illumination light sent to the light guide fiber 6e is taken into the endoscope 6 and irradiated from the distal end of the insertion portion 6a toward the surgical site.
[0018]
In the gantry 2, a power source 11a for an electric scalpel and an ultrasonic suction device, which are surgical tools for treating the surgical site at the time of surgery, and a control unit 12a are housed, and a main body of the power source 11a and The cables led out from the main body of the control unit 12a are collected into one flexible integrated cable 15 and guided to the microscope unit 3. The microscope unit 3 is provided with a relay unit 13, and the general cable 15 is connected to the relay unit 13. An electric knife handpiece 11b and an ultrasonic suction device handpiece 12b are connected to the relay unit 13, and are electrically connected to the power source 11a and the control unit 12a.
[0019]
Next, a specific configuration of the microscope unit 3 will be described with reference to FIG. That is, one objective lens 20, a pair of zoom lenses 21a and 21b, and a pair of imaging lenses disposed in the interior of the microscope body of the microscope unit 3 in order from the surgical site P side, with a space perpendicular to the paper surface. 22a and 22b, a pair of prisms 23a and 23b, and a pair of eyepieces 24a and 24b, and two observation optical paths 25a and 25b are formed in a direction perpendicular to the paper surface for stereoscopic observation. Here, in the drawing, the observation light paths 25a and 25b are not shown with reference numerals with b regarding the reference numerals 21 to 25 described above.
[0020]
On the other hand, the light combining prism 16 is disposed between the prism 23a and the eyepiece lens 24a in the observation optical path 25a, thereby forming the in-field display optical path 17. An imaging lens 18 and the small monitor 9 are arranged on the in-field display optical path 17 in this order from the prism 16 side. The small monitor 9 is connected to the camera control unit 7b described above.
[0021]
Further, the microscope section 3 is provided with an exit end 14a of the flexible light guide fiber 14, and in order from the exit end 14a side, a condenser lens 26, an illumination zoom lens 27, an illumination prism 28, and An illumination optical path 29 for the microscope reaching the objective lens 20 is configured. The illumination zoom lens 27 is interlocked with the zoom lens 21a of the observation optical path 25a, and the illumination range by the illumination optical system changes according to the size of the observation field.
[0022]
A half mirror 30 is disposed in the middle of the microscope illumination optical path 29, and an endoscope illumination optical path 31 branched from the microscope illumination optical path 29 is formed by the half mirror 30. Illumination light branching means for dividing the illumination light of the microscope illumination light path 29 by the half mirror 30 at a predetermined brightness ratio, branching part of the illumination light and introducing it to the endoscope illumination light path 31 Configure. A condensing lens 32 is disposed on the endoscope illumination optical path 31, and the branched illumination light is incident on the incident end 6f of the light guide fiber 6e which is a flexible light transmission means in the light guide cable 6d of the endoscope 6. It is made to inject into.
[0023]
A connector 6g having a screw (not shown) formed on the outer periphery is provided at the incident end of the light guide cable 6d of the endoscope 6, and the light guide cable 6d of the endoscope 6 is connected to the microscope unit 3 using this connector 6g. On the other hand, it is detachably connected.
[0024]
(Function)
Illumination light emitted from the light source device 5 in the gantry 2 of the surgical microscope 1 is guided to the emission end 14a located in the microscope unit 3 through the light guide fiber 14, and the condenser lens 26 is emitted from the emission end 14a. Then, it is guided to the surgical site P through the illumination zoom lens 27, the illumination prism 28, and the objective lens 20. The light reflected by the surgical part P is transmitted to the surgeon by the objective lens 20, the pair of zoom lenses 21a and 21b, the pair of imaging lenses 22a and 22b, the pair of prisms 23a and 23b, and the pair of eyepieces 24a and 24b. Guided to the eyes, the surgical site P is observed three-dimensionally.
[0025]
On the other hand, the illumination light of the microscope illumination optical path 29 is partly divided into a part of the illumination light reflected by the half mirror 30 at a certain ratio, and the divided light is guided to the endoscope illumination optical path 31. The light is guided to the light guide fiber 6 e of the endoscope 6 by the condenser lens 32 of the endoscope illumination optical path 31.
[0026]
Thereby, the surgical site P, that is, the observation site of the endoscope 6 is illuminated from the distal end of the endoscope 6. The observation image of the endoscope 6 is guided to the TV camera head 7, the TV camera cable 7 a, and the camera control unit 7 b and displayed on the monitor 8 and the small monitor 9 in the microscope unit 3. The display image of the small monitor 9 is inserted into the microscope observation optical paths 25a and 25b through the in-field display optical path 17 and guided to the eyes of the surgeon, and as shown in FIG. An endoscopic image 41 is displayed on the screen.
[0027]
(effect)
According to this reference example , since the light guide cable 6d of the endoscope 6 is connected to the lower surface portion of the microscope unit 3, the light guide cable 6d can be configured to be the shortest and does not interfere. Further, since the endoscope light guide cable 6d can be attached to and detached from the microscope section 3, it can be removed when the endoscope 6 is not used. Furthermore, it is easy to exchange the type of the endoscope 6 according to the surgical technique.
[0028]
In this reference example , the power source 11a and the control unit 12a, which are the main body of the surgical instrument for treating the affected part at the time of surgery, are housed in the gantry 2 of the surgical microscope 1. It is also possible to install the relay unit at the lower part of the operating table 2 through a single integrated cable that is installed in a single unit and connect the handpiece of the surgical tool to the relay unit. Further, the optical path dividing means may be a beam splitter instead of a half mirror.
[0029]
[ Second Reference Example ]
A second reference example will be described with reference to FIG.
[0030]
(Constitution)
The second reference example is a modification of the surgical microscope according to the first reference example in the case where a transparent sterilized bag called a drape is put on the surgical microscope 1 for use.
[0031]
In this case, the connecting portion provided in the microscope unit 3 for connecting the light guide cable 6d of the endoscope 6 is configured as shown in FIG. That is, a substantially cylindrical connecting tube 45 is fixedly attached to the lower surface portion of the microscope unit 3, and the sterilized condensing lens 32 of the endoscope illumination optical path 31 is installed inside the connecting tube 45. Has been. The connecting tube 45 is provided so as to protrude from the lower surface of the microscope unit 3, and a drape mounting hole 46 is formed at the protruding end of the connecting tube 45. A sterilized connection port 48 of the drape 47 is inserted into and attached to the drape mounting hole 46.
[0032]
The drape 47 is formed of a transparent thin-film bag that can cover the microscope section 3, and a connection port 48 formed in a substantially cylindrical shape is provided at a portion corresponding to the connection cylinder 45. The connection port 48 is formed of an elastic material in a substantially cylindrical shape, passes through a part of the drape 47 and is hermetically fixed to the drape 47.
[0033]
Further, an edge flange 48 a is formed at the insertion side end (inner end) of the connection port 48. When the connection port 48 is inserted into the drape mounting hole 46, the edge flange 48 a is engaged with a step 45 a formed at the inner end of the drape mounting hole 46 of the connection tube 45 and is inserted into the drape mounting hole 46. The connection port 48 is prevented from falling off.
[0034]
A screw 48b is formed on the inner diameter portion of the connection port 48, and this screw 48b is screwed with a screw portion (not shown) formed on the connector 6g of the endoscope light guide cable 6d.
[0035]
Further, a sterilized optical member 49 that can transmit illumination light is bonded and airtightly fixed to the inner end of the connection port 47. The optical member 49 is made of a synthetic resin or glass member.
[0036]
Therefore, when the drape 47 is mounted on the microscope unit 3, the sterilized state of the microscope unit 3 is ensured. In general, the light guide cable 6d of the endoscope 6 is sterilized by high-pressure steam and is attached to the microscope unit 3 through the sterilized connection port 48, so that the sterilized state of the microscope unit 3 is ensured. . Further, even if the light guide cable 6d of the endoscope 6 is removed, since the microscope unit 3 is isolated from the outside by the optical member 49, no filth is dropped on the operation site.
[0037]
[ Embodiment ]
Referring to FIG. 5 will be described embodiments of the present invention.
[0038]
(Constitution)
This embodiment differs from the first reference example only in the configuration of the parts of the microscope illumination optical path 29 and the endoscope illumination optical path 31, and the other parts are the same as those in the first reference example. explain.
[0039]
FIG. 5 shows the configuration of the microscope unit 3 and its peripheral devices. In the figure, reference numeral 50 denotes a light guide cable in which a two-part light guide fiber 51 is built. The light guide fibers 51 are bundled at the same incident side. The incident end 51a collected in this single bundle is connected to the light source device 5 as in the first reference example .
[0040]
Further, the exit side portion of the light guide fiber 51 is bifurcated, and the two exit ends 51b and 51c are both detachably connected to the microscope unit 3. The one incident end 51b is connected to the microscope illumination optical path 29 of the microscope unit 3 as in the first reference example . That is, the condensing lens 26, the illumination zoom lens 27, the illumination prism 28, and the objective lens 20 of the microscope illumination optical path 29 are arranged in this order from the emission end 51b side. That is, the illumination light branching unit here is constituted by a divided light guide fiber.
[0041]
Here, the other emission end 51 c is connected to a connecting portion 52 formed to protrude from the lower portion of the microscope portion 3. A connector 6g of a light guide cable 6d of the endoscope 6 is detachably connected to the connecting portion 52. Then, the exit end 51d of the light guide fiber 51 is disposed in the connecting portion 52 so as to directly face and face the incident end 6f of the light guide fiber 6e in the light guide cable 6d.
[0042]
(Function)
Illumination light emitted from the light source device 5 is divided into two by the light guide fiber 51 and guided to the illumination light path 29 for the microscope and the light guide fiber 6e of the endoscope 6, respectively. Illuminate the site simultaneously.
[0043]
(effect)
In the present embodiment, the microscope illumination optical path 29 has a general configuration, and the illumination light is divided into the endoscope 6 only by the light guide fiber 51, so that the configuration of the microscope unit 3 is greatly simplified. And can be miniaturized.
[0044]
[ Third reference example ]
A third reference example will be described with reference to FIG.
[0045]
(Constitution)
This embodiment is different from the first reference example only in the configuration of the microscope illumination optical path 29 and the endoscope illumination optical path 31, and the other parts are the same as in the first reference example. Explained.
[0046]
FIG. 6 shows the configuration of the microscope unit 3 and its peripheral devices. In the figure, reference numeral 60 denotes a prism as an optical optical path dividing means disposed in the microscope illumination optical path 29. This prism 60 deflects a part of the illumination light in the microscope illumination optical path 29 to create a new internal view. A mirror illumination optical path 61 is formed.
[0047]
Similar to the first reference example , the condenser lens 62 and the entrance end 6f of the endoscope light guide fiber 6d are disposed on the endoscope illumination optical path 61. Here, the prism 60, the condensing lens 62, and the incident end 6f of the endoscope light guide fiber 6d are integrally disposed in the housing 63. The housing 63 is configured to be movable in the axial direction of the endoscope illumination optical path 61 with respect to the microscope unit 3 by a gear transmission mechanism 65 using a rack and pinion by rotating a knob 64. That is, the amount of insertion of the prism 60 into the microscope illumination optical path 29 is variable, and the amount of light branched to the endoscope illumination optical path 61 is made variable by adjusting the amount of insertion.
[0048]
(Function)
A part of the illumination light emitted from the light guide exit end 14 a is split by the prism 60 from the microscope illumination optical path 29 and guided to the light guide fiber 6 d of the endoscope 6 through the condenser lens 62. Thereby, the surgical site P, that is, the observation site of the endoscope 6 is illuminated from the distal end of the endoscope 6.
[0049]
In an actual operation, when attempting to brighten the illumination on the endoscope 6 side during endoscopic observation, the knob 64 is used to increase the ratio of the amount of light that divides the illumination light from the microscope illumination light path 29 into the endoscope illumination light path 61. Is rotated, the housing 63 is slid via the gear transmission mechanism 65, the prism 60 is inserted in a wide range in the microscope illumination optical path 29, and the division ratio of the illumination light quantity is increased.
[0050]
Naturally, when the endoscope 6 is not used only by the surgical microscope 1, bright illumination can be supplied to the surgical microscope side by retracting the prism 60 from the microscope illumination optical path 29.
[0051]
(effect)
In this reference example , since the ratio of the brightness of the illumination light of the microscope and the illumination light of the endoscope is made variable, the operation can be performed with the optimum brightness in each operation.
[0052]
[ Fourth Reference Example ]
A fourth reference example will be described with reference to FIG.
[0053]
(Configuration and action)
In the present embodiment , the illumination light transmission method from the light source device of the first reference example and the third reference example to the microscope unit 3 by the light guide fiber is changed, and a lamp is directly incorporated in the microscope unit 3 . A reference example will be described in a modified form. The difference from the first reference example is that a lamp 70 with a reflecting mirror is arranged on the microscope illumination optical path 29 instead of the light guide exit end. The lamp 70 is driven to emit light by a power source (not shown) in the gantry 2. Other configurations are the same, and a description thereof will be omitted.
[0054]
The light emitted from the lamp 70 is transmitted to the surgical site P by the same action as in the first reference example .
[0055]
(effect)
By arranging the lamp 70 directly in the microscope section 3, there is little loss of brightness due to the passage of the light guide fiber, and efficient illumination is possible.
[0056]
The present invention is not limited to those implementation embodiments described above, also has the above-described embodiments and reference examples matters listed in at least the following, according to the description and the matters any combination of the above can get.
[0057]
<Appendix>
1. A microscope unit having a first observation means composed of a stereomicroscope optical system for observing the surgical part, a light source device for illuminating the surgical part, and for transmitting illumination light from the light source device to the surgical part A surgical microscope having a first illumination optical system and a second observation means having a second illumination optical system to which the second observation means can be connected.
An operating microscope comprising illumination light branching means for branching illumination light from the first illumination optical system and supplying the branched illumination light to the second illumination optical system.
2. The surgical microscope according to claim 1, wherein the illumination light branching unit is disposed in the microscope unit.
[0058]
3. The surgical microscope according to any one of Items 1 and 2, wherein the illumination light branching means is an optical path dividing means inserted on an illumination optical path of the first illumination optical system.
4). The surgical microscope according to any one of Items 1 and 2, wherein the illumination light branching means is an optical reflecting means inserted in a part of the illumination optical path of the first illumination optical system.
[0059]
5. The surgical microscope according to any one of Items 1 and 2, wherein the illumination light branching means is a flexible light transmission means branched from the first illumination optical system.
6). The surgical light branching means according to any one of claims 1 and 4, wherein the illumination light branching means includes a light amount varying means for varying a branched light amount to the first illumination optical system and the second illumination optical system. microscope.
[0060]
7). 4. The surgical microscope according to item 3, wherein the optical optical path dividing means is a half mirror.
8). 4. The surgical microscope according to item 3, wherein the optical optical path dividing means is a beam splitter.
[0061]
9. 5. The surgical microscope according to item 4, wherein the optical light path reflecting means is a prism.
10. The surgical microscope according to item 4, wherein the optical optical path reflecting means is a mirror.
9. The surgical microscope according to item 5, wherein the flexible light transmission means is a divided light guide fiber.
[0062]
【The invention's effect】
As described above, according to the surgical microscope of the present invention, it is possible to illuminate both the surgical microscope and the endoscope at the same time in the endoscope combined operation. That is, it is possible to observe each visual field simultaneously with both a surgical microscope and an endoscope. Further, since illumination light is supplied from the microscope unit to the endoscope, a dedicated light source device for the endoscope is not necessary, so that the configuration can be simplified and an inexpensive device can be provided. . Further, a cart or the like for installing the light source device in the operating room is unnecessary, and the space in the operating room can be kept wide. Furthermore, since the light guide means only connects the endoscope and the microscope section and can be shortened, the light guide means does not impair the operability of the endoscope due to its own weight and flexibility. It is possible to provide a sufficient working space without disturbing the person.
[Brief description of the drawings]
FIG. 1 is an explanatory diagram schematically showing a configuration of a surgical microscope according to a first reference example .
FIG. 2 is an explanatory diagram schematically showing a configuration around a microscope portion of a surgical microscope according to a first reference example .
FIG. 3 is an explanatory diagram showing a microscope field of view of a surgical microscope according to a first reference example .
FIG. 4 is an explanatory diagram schematically showing a configuration of a surgical microscope according to a second reference example .
FIG. 5 is an explanatory diagram schematically showing the configuration of a surgical microscope according to an embodiment of the present invention .
FIG. 6 is an explanatory diagram schematically showing a configuration of a surgical microscope according to a third reference example .
FIG. 7 is an explanatory diagram schematically showing a configuration of a surgical microscope according to a fourth reference example .
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 ... Surgical microscope 2 ... Mount part 3 ... Microscope part 4 ... Arm part 5 ... Light source device 6 ... Endoscope 14 ... Light guide fiber 30 ... Half mirror

Claims (1)

A microscope unit equipped with a stereomicroscope optical system for observing the surgical site and an illumination optical system for transmitting illumination light to the surgical site;
A light source device for illuminating the surgical site;
A light guide fiber having an emission end disposed in the microscope unit, and transmitting illumination light from the light source device to the microscope unit ;
The light guide fiber is arranged at the emission end of the light guide fiber, the first emission end to which the illumination optical system is connected, and the second emission in which a connecting portion for detachably connecting the light guide cable of the endoscope is arranged. Branching into two exit ends, the illumination light supplied from the light source device to the illumination optical system from the first exit end, and the light guide cable of the endoscope from the second exit end Illumination light branching means for branching into illumination light to be supplied;
A surgical microscope characterized by comprising:

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