JPH11318909A - Smoke removing system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To surely discharge smoke out of a peritoneal cavity by providing an aeroperitoneum means having a gas injecting means for injecting the gas into the peritoneal cavity to swell the peritoneal cavity and a sucking means for sucking the gas in the peritoneal cavity, and driving the aeroperitoneum means when a smoke generated by the cauterizing treatment of an affected tissue by a smoke detecting means. SOLUTION: In the medical treatment of the inner part of a peritoneal cavity under endoscopic observation, an aeroperitoneum device 8 is set, and CO2 gas is injected into the peritoneal cavity through a trocal 9 to expand the peritoneal cavity. A valve unit 27 is controlled by a control part 28 to regulate the temperature, flow rate or the like of the gas supplied from a bomb 26. When the internal pressure of the peritoneal cavity reaches a prescribed value, an endoscope 2 or a high frequency treatment tool 12 is inserted into the peritoneal cavity through trocals 9, 10, a high frequency cauterizing device 7 is started to cauterize the affected tissue in contact with the cauterizing electrode 29 of the high frequency treatment tool 12. When the smoke generated at this time is detected from the image projected on a TV monitor 17, a sucking pump 32 is operated to discharge the smoke out of the peritoneal cavity.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a smoke removal system used for performing a medical procedure in an abdominal cavity under endoscopic observation.

[0002]

2. Description of the Related Art Conventionally, medical treatment in the abdominal cavity under endoscopic observation has been widely performed. Especially recently,
Many medical procedures such as cholecystectomy under an endoscope are performed.

[0003] In such a medical procedure, an observation field required for performing work in the abdominal cavity is secured, and carbon dioxide is previously stored in the abdominal cavity to be treated in order to secure a space for operation of the endoscope. An operation of expanding gas by injecting gas into the abdominal cavity is performed.

[0004] After the expansion of the internal space of the abdominal cavity is completed, the affected tissue in the abdominal cavity expanded in an insufflation state is observed under endoscopic observation using a high-frequency ablation device or a cauterization device such as a medical laser device. The operation of performing the cauterization procedure is performed. During this cauterization procedure, smoke is generally generated. For this reason, as the cauterization procedure proceeds, smoke generated by the cauterization procedure may fill the abdominal cavity and obstruct the observation field of view of the endoscope.

In such a case, conventionally, the driving of the treatment device for performing cauterization is temporarily stopped. Then, after removing the endoscope introduced into the abdominal cavity and the treatment tool through the inner hole of the trocar from the trocar, the insufflation device injects carbon dioxide gas into the abdominal cavity while sending smoke filling the abdominal cavity. The trocar is naturally discharged out of the abdominal cavity through the inner hole of the trocar leading into the abdominal cavity.

[0006] Further, the applicant of the present invention discloses, in Japanese Patent No. 2544480, a system in which a smoke removing device is driven in accordance with a driving operation of a cauterizing device, and smoke generated by cauterizing treatment in the abdominal cavity is discharged out of the abdominal cavity by the smoke removing device. Has been proposed.

In this system, the operating time of the smoke removing device is set in advance. Then, after detecting the driving of the cauterization treatment, the smoke removing device is operated for a predetermined set time to remove the smoke in the abdominal cavity.

[0008]

However, when smoke generated by the cauterization treatment obstructs the observation field of view of the endoscope in the abdominal cavity, the drive of the treatment device for performing the cauterization is suspended and the endoscope is stopped. Also, in the method of removing the treatment tool from the trocar and then naturally discharging the abdominal smoke through the inner hole of the trocar to the outside of the abdominal cavity, it takes a certain period of time until the abdominal smoke is completely removed from the body. This increases the time required to resume the cauterization procedure once stopped. As a result, there is a problem that the whole treatment time becomes longer, which causes pain to the patient.

Further, it is conceivable to provide a suction device for sucking gas in the abdominal cavity to suck carbon dioxide gas in the abdominal cavity together with smoke. However, in this case, each operation for operating the suction device is necessary and complicated.

[0010] In the smoke removing apparatus disclosed in Japanese Patent No. 2544880, since the operation time of the smoke removing apparatus is set in advance, it is said that the smoke has not been completely exhausted from the abdominal cavity when the operation of the smoke removing apparatus is completed. There was a possibility.

The present invention has been made in view of the above circumstances, and an object of the present invention is to provide a smoke removing system capable of more reliably discharging smoke generated by cauterization in the abdominal cavity to the outside of the abdominal cavity. .

[0012]

SUMMARY OF THE INVENTION The present invention provides a pneumoperitoneum having gas injecting means for injecting gas into the abdominal cavity of a patient to expand the abdominal cavity and suction means for sucking the gas in the abdominal cavity out of the abdominal cavity. Means, treatment means for performing cauterization and transpiration treatment of the affected tissue in the insufflated abdominal cavity, an endoscope inserted into the patient's body cavity, and imaging means for capturing an observation image of the endoscope,
Smoke detection means for detecting smoke generated in the abdominal cavity from an image obtained by the imaging means, and the insufflation means so as to remove the smoke in the abdominal cavity according to a detection result from the smoke detection means. And a pneumoperitoneum operation control means for performing driving control. When the observation field of view of the endoscope in the abdominal cavity was obstructed by the smoke generated by the cauterization treatment, the smoke was generated in the abdominal cavity by the smoke detection unit from the image obtained by the imaging unit of the observation image of the endoscope. Detect smoke. Further, by controlling the driving of the insufflation means to remove the smoke in the abdominal cavity by the insufflation operation control means in accordance with the detection result from the smoke detection means, the smoke generated by the cauterization treatment in the abdominal cavity is performed. Is more reliably discharged out of the abdominal cavity, and a better endoscope field of view can be obtained more reliably and quickly so that the operation can be smoothly performed.

[0013]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Hereinafter, a first embodiment of the present invention will be described with reference to FIGS. FIG. 1 shows a schematic configuration of the entire endoscope system 1 used in the smoke removal system of the present embodiment. An endoscope system 1 according to the present embodiment includes a rigid endoscope 2 inserted into an abdominal cavity of a patient.
A TV camera (imaging means) 4 for capturing an image of the inside of the body captured by the endoscope 2, a CCU (camera control unit) 5, and a light source device 6 for supplying illumination light to the endoscope 2.
And a high-frequency ablation device 7 for performing hemostasis at a treatment site or removing a living tissue, supplying an insufflation gas for inflating the abdominal cavity to secure a visual field and a treatment region, and for emitting smoke generated inside the abdominal cavity. Insufflation device (insufflation means)
8 mainly.

An endoscope 2 and two trocars 9 and 10, which are guide tubes having insertion holes for guiding surgical instruments into the abdominal cavity, are punctured in the abdomen of the patient. here,
One end of an insufflation tube 11 made of vinyl chloride or Teflon is detachably attached to one trocar 9 having an insertion hole 9a through which the endoscope 2 is inserted.

The insertion hole 10 of the other trocar 10
The high-frequency treatment instrument 12 is inserted through a. One end of an inhalation tube 24 made of the same material as the insufflation tube 11 is detachably attached to the high-frequency treatment instrument 12.

The endoscope 2 is provided with an elongated insertion portion 3 to be inserted into a patient's body and an eyepiece 3a connected to a base end of the insertion portion 3. Further, one end of a light guide cable 13 is connected to the base end of the insertion section 3 of the endoscope 2 near the eyepiece 3a. The other end of the light guide cable 13 is connected to the light source device 6.

Further, the light source lamp 1 is provided inside the light source device 6.
4 and a condenser lens 15 are provided. The light emitted from the lamp 14 in the light source device 6 is condensed by the lens 15 on the end face of the light guide cable 13. Further, the illumination light collected on the end face of the light guide cable 13 is transmitted to the distal end of the insertion section 3 of the endoscope 2 via a light guide fiber bundle (not shown) provided in the light guide cable 13. To illuminate the subject.

The illumination light emitted from the distal end of the insertion section 3 of the endoscope 2 is reflected by the subject, and an image of the subject is formed in the endoscope 2. further,
This subject image is supplied to an eyepiece unit 3 via an observation optical system (not shown).
a.

A TV camera 4 is detachably connected to the eyepiece 3a of the endoscope 2. The TV camera 4 has a built-in CCD (solid-state imaging device) not shown. The subject image transmitted to the eyepiece 3a of the endoscope 2 is captured by a CCD in the TV camera 4.

Further, a CCU 5 is connected to the TV camera 4 via a camera cable 16. This CCU5
Is connected to a TV monitor 17. And CCD
From the camera via the camera cable 16
The data is transmitted to U5. At this time, CCU
5 receives the transmitted signal and generates a video signal,
The data is output to the monitor 17. And TV
The monitor 17 displays the captured subject image. Further, the CCU 5 generates and outputs a control signal for controlling the insufflation device 8 based on the generated video signal.

Further, one end of an active cord 18 is connected to the high-frequency treatment instrument 12. The other end of the active cord 18 is connected to the high-frequency ablation device 7. The high-frequency ablation device 7 is provided with an active electrode 19 and a patient electrode 20. The high-frequency treatment device 12 is electrically connected to the active electrode 19 of the high-frequency cautery device 7 via the active cord 18.

One end of a patient cord 22 is connected to the patient electrode 20 of the high-frequency ablation device 7. The other end of the patient cord 22 has flexibility so as to be in close contact with the skin of a human body, and is connected to a patient plate 21 formed in a sheet shape.

Further, an HF output amplifier 23 for generating high-frequency power is provided inside the high-frequency ablation device 7. The active electrode 19 and the patient electrode 20 of the high-frequency ablation device 7 are connected to the HF output amplifier 23, respectively.

The insufflation device 8 includes a valve unit (gas injection means) 27 and a control unit (insufflation operation control means) 28.
And a suction pump (suction means) 32.
Here, one end of a high-pressure gas supply gas tube 25 is connected to the valve unit 27 of the insufflation device 8. The other end of the high-pressure gas supply tube 25 is connected to a gas supply gas cylinder 26 filled with liquefied carbon dioxide.

Further, the other end of the insufflation tube 11 is detachably connected to an air supply cap (not shown) of the insufflation device 8. This air supply base has a valve unit 2
7 is connected. The liquid carbon dioxide filled in the gas supply gas cylinder 26 is vaporized and reduced to a predetermined pressure through the valve unit 27 in the insufflation device 8, and then the trocar 9 is inserted from the insufflation tube 11. Hole 9
a into the abdominal cavity.

Further, a valve unit 27 and a suction pump 32 are electrically connected to a control unit 28 in the insufflation device 8. Then, the valve unit 27 controls the control unit 2.
8 to control the temperature and flow rate of the carbon dioxide gas supplied into the abdominal cavity.

FIG. 2 shows the distal end of the high-frequency treatment instrument 12.
As shown in FIG. Further, a suction hole 31 is formed inside the high-frequency treatment instrument 12. At the base end side of the suction hole 31, a suction base 3 is provided.
0 is formed.

One end of the suction tube 24 is detachably connected to the suction base 30. The other end of the suction tube 24 is connected to a suction pump 32 via a suction cap (not shown) of the insufflation device 8. The operation of the suction pump 32 is controlled by the control unit 28. By the operation of the suction pump 32, the air present in the abdominal cavity is discharged to the outside of the abdominal cavity through the suction hole 31 and the suction tube 24.

As shown in FIG. 3, the CCU 5 is provided with a video signal generation circuit 33, a motion detection circuit 34, a color extraction circuit 35, and a smoke generation determination circuit (smoke detection means) 36. . Here, an output signal from a CCD in the TV camera 4 is input to the video signal generation circuit 33. The output signal from the CCD of the TV camera 4 is converted by the video signal generation circuit 33 into a video signal such as NTSC. Further, the video signal generated here is output to the TV monitor 17 and also output to the motion detection circuit 34 and the color extraction circuit 35. Then, the motion of the video signal generated by the video signal generation circuit 33 is detected by the motion detection circuit 34, and at the same time, the color set by the color extraction circuit 35 is extracted.

Each output signal from the motion detection circuit 34 and the color extraction circuit 35 is input to a smoke generation determination circuit 36. Then, the smoke generation determination circuit 36
Then, the generation of smoke in the abdominal cavity of the patient is determined based on the output signals from the motion detection circuit 34 and the color extraction circuit 35, and the valve unit 27 and the suction pump 32 are connected to the control unit 28 in the insufflation device 8. A control signal for operating each is output.

Next, the operation of the above configuration will be described.
When using the endoscope system 1 of the present embodiment, the endoscope 2
In order to perform treatment in the abdominal cavity under the observation of, the insufflation device 8 injects carbon dioxide gas into the abdominal cavity in advance via the trocar 9 to expand the abdominal cavity.

At this time, the operation of the valve unit 27 is controlled by the control unit 28 so that the temperature, flow rate, and the like of the carbon dioxide gas supplied from the gas supply gas cylinder 26 are adjusted. Then, with the pressure in the abdominal cavity reaching a predetermined value, the endoscope 2 and the high-frequency treatment instrument 12 are inserted into the abdominal cavity via the trocars 9 and 10.

Further, in this state, by turning on a foot switch (not shown) for turning on the output of the high frequency ablation device 7 or a hand switch (not shown) provided on the high frequency treatment device 12, the cauterizing electrode of the high frequency treatment device 12 is turned on. A high-frequency current flows through 29 and the affected tissue in contact with the cautery electrode 29 is cauterized.

During the cauterization procedure, smoke is generated. Then, smoke generated in the abdominal cavity by this cauterization treatment is detected and removed by the following processing. That is, an endoscope image including smoke generated by the cauterization treatment by the cauterization electrode 29 is captured by the CCD in the TV camera 4.

At this time, the imaging signal is transmitted from the CCD in the TV camera 4 to the CCU 5. In the CCU 5, a video signal is generated by the video signal generation circuit 33.
The video signal generated here is output to the TV monitor 17, and an endoscope image is displayed on the TV monitor 17.

At the same time, this video signal is
And the color extraction circuit 35. The motion detection circuit 34 detects the presence or absence of a motion in the captured image and the position of the detected motion in the image by image processing such as detection of a difference between the captured images and detection of a motion vector.

Further, the color extraction circuit 35 is preset so as to extract a high-brightness signal (white) when smoke is picked up. Then, a white portion in the captured image is extracted by the color extraction circuit 35.

The smoke generation judging circuit 36 receives the output signals from the motion detecting circuit 34 and the color extracting circuit 35, and calculates the position of the motion detected by the motion detecting circuit 34 and the white position detected by the color extracting circuit 35. If they match, it is determined that smoke is generated. At this time, a control signal for operating the suction pump 32 of the insufflation apparatus 8 is output from the smoke generation determination circuit 36. Then, the suction pump 32 of the insufflation device 8 receives this signal and sucks air in the abdominal cavity, thereby removing smoke generated in the abdominal cavity.

Therefore, the above configuration has the following effects. In other words, in the present embodiment, when the observation field of view of the endoscope 2 in the abdominal cavity is obstructed by smoke generated by the high-frequency treatment device 12, C in the TV camera 4
The smoke generated in the abdominal cavity is detected by the smoke generation determination circuit 36 in the CCU 5 from the image obtained by the CD. When the smoke is detected, the smoke generation determination circuit 36 outputs a control signal to the control unit 28 in the insufflation device 8 so that the smoke in the abdominal cavity is removed and the valve unit 27 and the suction pump are removed. 32 is operated to control each of them. Therefore, in the present embodiment, the generation of smoke in the abdominal cavity is detected by image processing, and the smoke is exhausted based on the information, so that a good surgical field can be obtained quickly and reliably.

A medical laser apparatus using YAG, CO ₂ , semiconductor or the like as a laser light source is used instead of the high-frequency ablation apparatus 7 used in the present embodiment having the above configuration, and the high-frequency treatment instrument 12 is used instead of the high-frequency treatment tool 12. A laser probe may be used.

FIG. 4 shows a modification of the CCU 5 in the endoscope system 1 according to the first embodiment (see FIGS. 1 to 3). In this modification, as shown in FIG. 4, a band pass filter 37 and a high frequency ablation apparatus output noise detection circuit 38 are provided inside the CCU 5 of the first embodiment.

Next, the operation of the above configuration will be described.
In general, a high-frequency cautery device 7 outputs a high-frequency / high-current high-frequency signal in order to perform treatment on the affected tissue.
At the time of this output, unnecessary radiation waves are generated. In order to prevent noise from being superimposed on a captured image from the CCD in the TV camera 4 due to this effect, measures such as applying an electromagnetic shield to the TV monitor 17 and the camera cable 16 are taken. Mixing is suppressed.

In this modification, the noise mixed in the picked-up image due to the influence of the unnecessary radiation generated when the high-frequency ablation device 7 outputs the high-frequency signal is converted into the band-pass filter 37 in the CCU 5 and the high-frequency ablation device output noise detection circuit. 38, the high-frequency ablation device 7
, The suction pump 32 of the insufflation device 8 is operated to remove the smoke generated in the abdominal cavity.

The detection of the noise is performed by separating a signal having a frequency near the high-frequency signal output from the high-frequency ablation apparatus 7 by the band-pass filter 37 from the video signal output from the video signal generation circuit 33 of the CCU 5. .
Here, the high frequency ablation device output noise detection circuit 38 recognizes the signal level of the separated signal, and when a signal exceeding the set level is input, the valve unit 27 of the insufflation device 8 and the suction pump 32 is output.

Therefore, the above configuration has the following effects. That is, in this modification, the high-frequency ablation device 7
Can be detected without providing a configuration for the high-frequency ablation device 7 on the side of the high-frequency ablation device 7, and there is an effect that the configuration of the high-frequency ablation device 7 can be prevented from becoming complicated.

FIG. 5 shows a second embodiment of the present invention. In the present embodiment, the configuration of the endoscope system 1 of the first embodiment (see FIGS. 1 to 3) is changed as follows.

That is, in the present embodiment, as shown in FIG. 5, a smoke detection sensor 39 is provided at the tip of the trocar 9 of the first embodiment. Further, a smoke detection circuit 40 connected to the smoke detection sensor 39 is provided. This smoke detection circuit 40 is connected to the control unit 28 of the insufflation device 8.

The smoke detection sensor 39 is constituted by an ultrasonic sensor. Further, the smoke detection circuit 40 is provided with a drive circuit for driving the smoke detection sensor 39 of the ultrasonic sensor and a frequency detection circuit (neither is shown) for detecting a change in the drive frequency. The CCU 5 is provided with only the video signal generation circuit 33.

The smoke generated by the cauterization treatment is detected by a smoke detection sensor 39 provided at the tip of the trocar 9. The detection signal of the smoke detection sensor 39 is received by the smoke detection circuit 40 and outputs a control signal to the control unit 28 of the insufflation device 8.

Next, the operation of detecting smoke by the smoke detection sensor 39 will be described. Here, an adsorption layer for adsorbing moisture is formed on the surface of the ultrasonic sensor constituting the smoke detection sensor 39. And the smoke generated by the cauterization procedure
Water vapor generated when the living tissue is cauterized is contained, and this water vapor is adsorbed on the adsorption layer on the surface of the ultrasonic sensor. At this time, the oscillation frequency of the ultrasonic sensor changes due to the adsorption of water vapor. Then, the change in the oscillation frequency of the ultrasonic sensor is detected by the frequency detection circuit of the smoke detection circuit 40.

When this change is detected by the frequency detection circuit of the smoke detection circuit 40, the frequency detection circuit outputs a signal for operating the valve unit 27 of the insufflation device 8 and the suction pump 32. Thereby, smoke generated in the abdominal cavity can be removed.

Therefore, in the present embodiment, smoke generated in the abdominal cavity can be directly detected by the smoke detection sensor 39 provided at the tip of the trocar 9, so that the smoke can be more reliably removed.

FIGS. 6 and 7 show a third embodiment of the present invention. In the present embodiment, the configuration of the endoscope system 1 of the first embodiment (see FIGS. 1 to 3) is changed as follows.

That is, in this embodiment, as shown in FIG. 6, a medical laser device 42 having a laser light source 41 of YAG, CO ₂ , semiconductor or the like instead of the high-frequency ablation device 7 of the first embodiment. And a high-frequency treatment instrument 1
Instead of 2, a laser probe 43 is provided.

Further, a light guide fiber 44 is provided between the medical laser device 42 and the laser probe 43. Further, the laser probe 43 is inserted into the trocar 10.

Further, inside the TV camera 4, as shown in FIG. 7, a prism 45 for distributing the optical image from the endoscope 2 and one of the optical images distributed by the prism 45 (the prism 45). A laser cut filter 46 for cutting the wavelength of the laser beam from the incident optical image, a CCD 47 for capturing the formed image, and the other optical image (right-angled reflected by the prism 45) distributed by the prism 45 And a photodiode 48 on which an optical image is incident.

The CCU 5 is provided with a video signal generation circuit 33 to which a signal from the CCD 47 is input and a laser light detection circuit 49 to which a signal from the photodiode 48 is input.

Next, the operation of the above configuration will be described.
In this embodiment, the laser light source 41 generates laser light by turning on a foot switch (not shown) for turning on the output of the medical laser device 42 or a hand switch (not shown) provided on the laser probe 43.
The laser light passes through the inside of the light guide fiber 44, is guided to the laser probe 43, and is emitted from the tip of the laser probe 43 toward a target living tissue in the abdominal cavity of the patient, and the living tissue evaporates. It is.

At the time of laser emission, a high-brightness optical image such that highlighting occurs during imaging by the CCD is incident on the endoscope 2. The optical image from the endoscope 2 is split by the prism 45 into two optical images (optical paths). here,
One optical image (prism 45) distributed by the prism 45
After the wavelength of the laser beam is cut by the laser cut filter 46, the optical image is formed on the CCD 47.

At this time, when a laser beam is picked up by a normal CCD, that portion is highlighted. In order to avoid this, in the present embodiment, a laser cut filter 46 is provided in front of the CCD 47 that captures an image displayed on the TV monitor 17.

In the present embodiment, the optical image from the endoscope 2 from which the wavelength of the laser light has been cut by the laser cut filter 46 is formed on the CCD 47. Furthermore, this C
The optical image picked up by the CD 47 is converted into an electric signal and output.

The output signal from the CCD 47 is C
It is input to the video signal generation circuit 33 in the CU 5. Then, the video signal generated by the video signal generation circuit 33 is output to the TV monitor 17.

As for the other optical image distributed by the prism 45 (the optical image reflected at right angles by the prism 45), the image distributed by the prism 45 enters the photodiode 48 as it is. The output signal from the photodiode 48 is input to a laser light detection circuit 49 in the CCU 5. At this time, if the output signal from the photodiode 48 is equal to or higher than the level at the time of laser emission, a signal for operating the suction pump 32 of the insufflation device 8 is output.

In the above configuration, the prism 45 for distributing the optical image from the endoscope 2 into the TV camera 4 and the optical image distributed by the prism 45 (the prism 45 reflects the optical image at right angles). And a photodiode 48 on which the received optical image is incident. If the output signal from the photodiode 48 is equal to or higher than the level at the time of laser emission, the laser light detection circuit 49 operates the suction pump 32 of the insufflation device 8. Since the signal is output, the detection of the laser beam can be detected with a simpler configuration without using image processing.

Further, a laser cut filter 46 for cutting the wavelength of laser light from one optical image (optical image incident on the prism 45) distributed by the prism 45 is provided.
The optical image from the endoscope 2 whose laser light wavelength has been cut by the laser cut filter 46 is formed on the CCD 47, and the optical image picked up by the CCD 47 is displayed on the TV monitor 1.
7 so that even when emitting laser, CC
It is possible to prevent a highlight from occurring at the time of imaging in D47.

FIG. 8 shows a schematic configuration of the entire medical system 51 for performing medical treatment in the abdominal cavity under endoscopic observation. In FIG. 8, reference numerals 52 and 53 denote trocars punctured into the abdominal cavity of a patient.

Here, one end of an air supply tube 54 is connected to one trocar 52. The other end of the air supply tube 54 is connected to an insufflator 55. The insufflation gas sent from the insufflator 55 reaches the abdominal cavity via the air supply tube 54 and the trocar 52 to perform insufflation.

One end of an exhaust tube 56 is connected to the other trocar 53. The other end of the exhaust tube 56 is connected to a suction device 57. Further, an automatic ventilator 58 for automatically ventilating the abdominal cavity of a patient performing insufflation is provided in the middle of the exhaust tube 56.
Is interposed. As shown in FIG. 9, the automatic ventilator 58 has an exhaust pipe 59 connected to a middle portion of the exhaust tube 56, and a valve 60 capable of opening and closing the exhaust pipe 59.
And a valve control circuit 61 for controlling the opening / closing operation of the valve 60. Here, the valve 60 is controlled by a valve control circuit 61 in the automatic ventilator 58 so as to repeat the opening and closing operation at fixed time intervals. For example, after opening for 1 second, the operation of closing for 3 seconds is repeated.

When the medical system 51 having the above configuration is used, the valve 60 is controlled by the valve control circuit 61 in the automatic ventilator 58 so as to repeat the opening and closing operation at regular time intervals. The opening and closing operation of the valve 60 opens and closes the exhaust tube 56, and ventilates insufflation gas in the abdominal cavity at regular time intervals. For example, smoke generated in the abdominal cavity due to the use of an electric scalpel or the like in the abdominal cavity is intermittently discharged to the outside of the abdominal cavity through the exhaust tube 56 by opening and closing the valve 60. Can be kept good.

Therefore, the above configuration has the following effects. That is, in the automatic ventilator 58 having the above configuration, the insufflation gas in the abdominal cavity can be exhausted at regular time intervals without receiving a signal from an electric scalpel or an insufflation device. Therefore, in order to perform an interlocking operation, such as a device that opens and closes a suction tube in conjunction with a conventional electric knife and a device that interlocks with an insufflation operation of an insufflation machine, an electric knife or an insufflation device is provided inside the device. A control function for operating the opening / closing operation in response to a signal from the controller is not required, and it is not necessary to use in combination with an electric scalpel or an insufflation device capable of transmitting a control signal. As a result, the configuration of the entire system can be simplified as compared with the related art, and the cost can be reduced.

In the automatic ventilation device 58 having the above configuration,
Since there is no need to exchange signals when used in combination with an electric scalpel or insufflation device, it is possible to perform intraperitoneal ventilation regardless of the type of electric scalpel or laser ablation device used in combination .

FIG. 10 shows a modification of the automatic ventilation device 58 shown in FIGS. This modification is shown in FIG.
In addition, a suction function is added to the automatic ventilation device 58 of FIG. 8 and 9 as in this modification.
By adding a suction function to the automatic ventilation device 58, automatic ventilation can be performed without preparing a suction device.

Further, the present invention is not limited to the above-described embodiment, and it goes without saying that various modifications can be made without departing from the spirit of the present invention. Next, other characteristic technical matters of the present application will be additionally described as follows. (Appendix 1) Insufflation means having means for injecting gas into the abdominal cavity to expand the abdominal cavity, means for aspirating gas inside the abdominal cavity to the outside of the abdominal cavity, and affected tissue in the insufflated abdominal cavity Treatment means for performing cauterization and transpiration treatment, an endoscope inserted into a body cavity of a patient, and imaging means for capturing an observation image of the endoscope,
A smoke removal system comprising: smoke detection means for detecting smoke generated in the abdominal cavity and controlling the insufflation means according to the detection result.

(Additional Item 2) The smoke removing system according to Additional Item 1, wherein the smoke detection means is a smoke detection image processing circuit for detecting smoke in the image from the image obtained by the imaging means.

(Additional Item 3) In the additional item 1, the smoke detection means is a smoke sensor inserted into the abdominal cavity and a smoke sensor input circuit receiving a signal from the smoke sensor.

(Additional Item 4) The smoke removing system according to additional items 1 to 3, wherein the treatment means is an induction cautery device. (Additional Item 5) The smoke removing system according to Additional Items 1 to 3, wherein the treatment means is a medical laser device.

(Additional Item 6) An endoscope inserted into a body cavity of a patient, imaging means for capturing an observation image of the endoscope, means for injecting gas into the abdominal cavity to expand the abdominal cavity, Insufflation means having means for sucking gas in the abdominal cavity out of the abdominal cavity,
A treatment means for performing treatment on the affected tissue in the insufflated abdominal cavity, and a control means for detecting an operation state of the treatment means and controlling the insufflation means in accordance with a result of the detection. Smoke removal system.

(Additional Item 7) In the additional item 6, the treatment means is a high-frequency ablation device, and the control means includes a noise detection means provided in the imaging means for detecting noise generated by the high-frequency ablation device. Smoke removal system characterized by the above.

(Additional Item 8) The smoke removing system according to additional item 6, wherein the treatment means is a medical laser device, and the control means includes laser light detecting means provided in the imaging means.

(Conventional Techniques of Additional Items 1 to 8) Conventionally, medical treatment in the abdominal cavity under endoscopic observation has been widely performed. Particularly recently, many medical procedures for performing cholecystectomy or the like under an endoscope have been performed. In such a medical procedure, a pneumo-abdominal device injects carbon dioxide gas into the abdominal cavity to be treated in order to secure an observation field of view necessary for performing work in the abdominal cavity and to secure space for operation of the endoscope. The interior space of the abdominal cavity is enlarged.

Further, when the affected tissue in the abdominal cavity expanded in the pneumoperitoneum state is cauterized using an ablation device such as a high-frequency ablation device or a medical laser device under endoscopic observation, the ablation is caused by this procedure. Smoke may fill the abdominal cavity and obstruct the viewing field of the endoscope.

In such a case, conventionally, the driving of the treatment apparatus for performing cauterization is stopped and the endoscope and the treatment tool introduced into the abdominal cavity through the inner hole of the trocar are removed from the trocar. While the apparatus is supplying carbon dioxide gas into the abdominal cavity, smoke filled in the abdominal cavity is naturally discharged to the outside of the abdominal cavity through the inner hole of the trocar communicating into the abdominal cavity. In this method, it takes a certain amount of time until the smoke is completely exhausted, so that the time required for restarting the cauterization procedure which has been stopped is increased, and the entire procedure time is increased, thereby causing pain to the patient. Will be. Also,
In the case where a suction device is provided to suck carbon dioxide gas in the abdominal cavity together with smoke, an operation for operating the suction device is required, which is complicated.

In order to solve this problem, the present applicant has filed Japanese Patent Application No.
No. 114483 proposes a system in which a smoke removing device is driven in response to a driving operation of the cauterizing device, and smoke generated by the cauterizing treatment generated in the abdominal cavity is discharged outside the abdominal cavity.

(Problems to be Solved by Additional Items 1 to 5)
This system does not operate the smoke removing device by detecting the driving of the cauterizing device, but detects smoke in the abdominal cavity and removes the smoke. Since the operation time of the smoke removing device is set in advance, there is a possibility that the smoke has not yet been exhausted from the abdominal cavity when the operation of the smoke removing device is completed.

(Purpose of Supplementary Items 1 to 5) Provided is a smoke removing system capable of more reliably discharging smoke generated by cauterization in the abdominal cavity to the outside of the abdominal cavity. (Problems to be solved by the additional items 6 to 8) On the side of the high-frequency ablation device or the laser device for treating the affected tissue, means for outputting the operation state of the device to the smoke removal device is required, and the smoke removal is required. There is a restriction that the system can be constituted only by a device having the above means.

(Purpose of Supplementary Items 6 to 8) Provided is a smoke removing system which does not have the above-mentioned means and which can be constituted by an apparatus for treating a patient. (Effects of Additional Items 1 to 8) By detecting smoke generated in the abdominal cavity, the pneumoperitoneum device is controlled to remove the smoke, so that a good endoscope field of view can be obtained more reliably and quickly. The operation can proceed smoothly.

[0087]

According to the present invention, the smoke generated in the abdominal cavity is detected from the endoscope image to control the insufflation device to remove the smoke. The smoke generated by the above can be more reliably discharged outside the abdominal cavity. Therefore, a favorable endoscope visual field can be obtained more reliably and promptly, and the operation can be smoothly performed.

[Brief description of the drawings]

FIG. 1 is a schematic configuration diagram of an entire endoscope system according to a first embodiment of the present invention.

FIG. 2 is a vertical cross-sectional view showing a configuration of a main part inside the high-frequency treatment tool in the endoscope system according to the first embodiment.

FIG. 3 is a schematic configuration diagram of a main part showing an internal configuration of a CCU in the endoscope system according to the first embodiment;

FIG. 4 is a schematic configuration diagram of a main part showing a modification of the CCU in the endoscope system according to the first embodiment;

FIG. 5 is a schematic configuration diagram of an entire endoscope system according to a second embodiment of the present invention.

FIG. 6 is a schematic configuration diagram of an entire endoscope system according to a third embodiment of the present invention.

FIG. 7 is a schematic configuration diagram of a main part showing an internal configuration of a TV camera in an endoscope system according to a third embodiment.

FIG. 8 is a schematic configuration diagram of the entire medical system that performs medical treatment in the abdominal cavity under endoscopic observation.

FIG. 9 is a schematic configuration diagram of an automatic ventilation device in the medical system of FIG. 8;

FIG. 10 is a schematic configuration diagram of a main part showing a modification of the automatic ventilation device of FIGS. 8 and 9;

[Explanation of symbols]

 2 rigid endoscope 4 TV camera (imaging means) 8 insufflation device (insufflation means) 27 valve unit (gas injection means) 28 control unit (insufflation operation control means) 32 suction pump (suction means) 36 smoke generation judgment Circuit (smoke detection means)

 ──────────────────────────────────────────────────の Continued on the front page (72) Inventor Takao Tabata 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Industrial Co., Ltd. (72) Inventor Hiroshi Takahashi 2-43-2 Hatagaya, Shibuya-ku, Tokyo Within Olympus Optical Co., Ltd. (72) Yoshinao Daimei 2-43-2, Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Co., Ltd. (72) Takeaki Nakamura 2-43-2, Hatagaya, Shibuya-ku, Tokyo No. Olympus Optical Co., Ltd. (72) Shinji Hatta 2-43-2 Hatagaya, Shibuya-ku, Tokyo In-house Olympus Optical Co., Ltd. (72) Yoshitaka Honda 2-43-2 Hatagaya, Shibuya-ku, Tokyo No. Olympus Optical Co., Ltd.

Claims (1)

[Claims] Insufflation means having gas injecting means for injecting gas into the abdominal cavity of a patient to expand the abdominal cavity and suction means for sucking the gas in the abdominal cavity out of the abdominal cavity; Treatment means for performing cauterization / transpiration treatment of the affected tissue in the abdominal cavity, an endoscope inserted into the body cavity of the patient, imaging means for capturing an observation image of the endoscope, and the imaging means Smoke detection means for detecting smoke generated in the abdominal cavity from an image, and insufflation control for controlling the insufflation means to remove the smoke in the abdominal cavity according to the detection result from the smoke detection means What is claimed is: 1. A smoke removal system comprising: an operation control unit.