Resectoscope apparatus, resectoscope, resectoscope system and imaging method

Abstract

The invention relates to a resection mirror device (10) comprising: an outer shaft (12) having a distal side (14) and a proximal side (16); a resection tool (18) extending through the outer rod (12) and movable relative to the outer rod (12); and an image acquisition unit (20) which is configured to capture an image of an imaging region (20a) located in the region of the distal side (14) of the outer rod (12), the image acquisition unit (20) being movable relative to the outer rod (12) and beyond the distal side (14) of the outer rod. The invention also relates to a resection mirror, a resection system and an imaging method.

Description

Technical Field

[0001] The present invention relates to a resection endoscope device, a resection endoscope having the resection endoscope device, a resection system having the resection endoscope, and an imaging method therefor. Background Technology

[0002] Resection refers to the surgical removal of tissue from an organ or tumor. Depending on the target and anatomical conditions, various types of resection can be performed. For inaccessible tissues, surgical removal can be performed endoscopically using a resection scope. This resection scope is used, for example, in transurethral resection, where diseased tissue is removed from the bladder or prostate. This procedure is performed endoscopically through the urethra without the need for an external incision.

[0003] For transurethral resection, resection scopes known to be implemented as backflushing resection scopes are described. This type of backflushing resection scope includes an inner rod and an outer rod, wherein the outer rod is introduced into the urethra during the procedure and remains there noninvasively. The outer rod includes channels for supplying fluid and other channels for aspirating fluid or tissue portions. The inner rod includes optics and a resection ring movable in the longitudinal direction of the inner rod for removing tissue; the optics are particularly formed by a light source and image acquisition unit, such as light-emitting diodes and cameras, or alternatively by, for example, rod-shaped lenses. During the procedure, irrigation fluid is continuously supplied via the resection scope configured as a backflushing endoscope and then aspirated in a controlled manner, thereby creating constant bladder distension to achieve a good field of view. Here, the resection ring can be used to remove or excise tissue, which can be observed from outside the outer rod using optics with an oblique line of sight. At the end of the procedure, the excised or removed tissue can be flushed out, and an irrigation catheter is inserted after thorough flushing.

[0004] For example, a known resection loop is a metal wire loop through which an electric current flows. This allows diseased tissue to be removed layer by layer. Any bleeding that occurs can be electrocoagulated. The physical principle here corresponds to, for example, HF surgery (high-frequency surgery).

[0005] Especially for the treatment of superficial bladder cancer, transurethral resection using a known resection scope can be used for intravesical resection. In this case, the inventors of the present invention have first discovered that bladder cancer located precisely at the bladder neck is difficult to see clearly because the optics arranged within the outer rod only obliquely observe the tissue to be removed from outside the outer rod, i.e., from the proximal side. This makes it difficult to remove the bladder cancer with a resection ring. The surgeon, i.e., the user of the resection scope, must first move the resection ring to the posterior side of the bladder cancer, i.e., the distal side, to establish a placement point for the resection ring, so that the bladder cancer can be removed when the resection ring is moved to the proximal side. If the placement point for the resection ring is not clearly visible, the surgeon can move the tissue to be removed into the camera's field of view by applying mechanical force from the outside and by significantly pivoting the inner rod. The inventors have recognized that, however, this is difficult for the surgeon to manipulate, and thus, especially since significant pivoting and compression of the inner rod can lead to invisible damage to muscles and tissues, which may subsequently result in urinary incontinence. Alternatively, surgeons may estimate placement points that are not clearly visible, which could lead to the removal of too much tissue or not removing all the tissue that forms part of the bladder cancer. Depending on the location of the bladder cancer, the problem with the resection endoscopy known in the prior art is that the placement points set for the resection cannot be clearly seen, or can only be clearly seen in situations that increase the risk of injury.

[0006] In transurethral resection of the prostate (TURP), the standard approach is to remove obstructions to urination caused by the prostate. Here, only the internal portion of the prostate facing the urethra is removed. Only the peripheral prostatic tissue and organ capsule are preserved. Furthermore, the verumontanum and urethral sphincter should not be damaged. Resection is most commonly used to treat benign prostatic hyperplasia, but it can also be used for other urinary obstructions, such as in cases of prostate cancer. Even in TURP, the placement point for the resection may be difficult to visualize. Furthermore, when removing multiple obstructions, a good overview is necessary for the surgeon. This prevents any obstruction from being overlooked. It also makes it easier to prevent the surgeon from unintentionally damaging or injuring, for example, tissue portions not intended for resection. This disclosure is primarily based on the finding that there is potential for improved imaging of the surgical subject available to the surgeon during the procedure.

[0007] Since the resectoscope must be introduced through the urethra during transurethral resection, the outer rod should also be as small as possible to minimize introduction resistance and thus avoid injury to the ureter or urethra. Because the outer rod houses the inner rod, which includes the optics, its dimensions are primarily determined by the dimensions of the inner rod. Therefore, the installation space is limited when designing the distal end of the inner rod, and optimal determination of the optics and their arrangement within the distal end is particularly crucial.

[0008] Endoscopes known from the prior art utilize digital technology for image generation and transmission, and according to the inventors' viewpoint, in principle, when necessary, can be fitted into the inner rod as part of a resection endoscope, particularly as an endoscope assembly, through some adaptation. This type of endoscope, also known as a video endoscope, has an image acquisition unit at its distal rod end according to a configuration, which can acquire images of tissue. The image acquisition unit can be powered by the endoscope rod, and the image signal can be transmitted from the image acquisition unit to the proximal end of the rod via a line. This eliminates the need for optical elements, such as lenses, especially rod lenses, or optical fibers for transmitting images through the rod. The image acquisition unit can be understood as a camera and includes, for example, incident optics and an image sensor. Compared to endoscopes with rod lens pairs, this allows for a high degree of design freedom in the arrangement of various components in the distal rod end. Summary of the Invention

[0009] The object of this invention is to provide good imaging of the tissue to be removed in a simple and / or inexpensive and / or user-friendly and / or reliable manner, especially in a manner that, for example, makes efficient use of installation space and / or is easy to operate during manufacturing, surgery or cleaning.

[0010] According to the present invention, this objective is achieved by resection endoscopes, resection endoscopes, resection systems, and imaging methods as described herein and defined in the claims.

[0011] The resection endoscope includes an outer rod having a distal side and a proximal side; a resection tool extending through the outer rod and movable relative to the outer rod; and an image acquisition unit configured to capture an image of an imaging region located in the region on the distal side of the outer rod, wherein the image acquisition unit is movable relative to the outer rod beyond its distal side.

[0012] A resection scope having a resection scope device according to the present invention may also be provided.

[0013] In addition, a resection system may be provided, which includes a resection endoscope device according to the present invention.

[0014] Alternatively, an imaging method may be provided in which at least one image is captured using the excisional endoscope device according to the invention.

[0015] The features of the invention allow for the provision of good imaging of the tissue to be removed in a simple and / or inexpensive and / or user-friendly and / or reliable manner. In particular, high space utilization and / or ease of operation can be achieved, for example, during manufacturing, surgery, or cleaning. The provided images can support the surgeon in setting appropriate placement points for tissue removal with the excision tool. In particular, it provides the surgeon with a good overview of the tissue to be removed and its adjacent tissue portions, thereby making it easier to prevent unintentional damage to tissue portions by the excision tool.

[0016] Resection devices can include endoscopic devices, particularly endoscopes. Resection devices can be implemented as backflushing resection endoscopes and / or configured as backflushing resection endoscopes. Resection devices can be implemented as cystoscopes. Resection devices can be implemented as rigid resection endoscopes. Resection devices can be implemented as flexible resection endoscopes. Resection devices can be implemented as video endoscopes.

[0017] "Resection endoscope device" should be understood in particular as a preferably functional component, especially a sub-component and / or structural and / or functional component of a resection endoscope. Preferably, the resection endoscope device can be constructed at least partially, preferably at least largely, and particularly preferably completely. For example, the resection endoscope device can be configured to be introduced at least partially and preferably at least largely into a cavity or, in particular, an artificial and / or natural cavity, especially a body cavity, more precisely, especially for the purpose of examining and altering, especially removing portions thereof. The resection endoscope device can be a medical resection endoscope device. Within the scope of this disclosure, "configured" can be understood in particular as specifically programmed, constructed, designed, and / or equipped. Within the scope of this disclosure, a component configured for a particular function can be understood in particular as the component realizing and / or performing that particular function in at least one application state and / or operating state.

[0018] "External rod" should be understood in particular as an elongated portion of a resection endoscope and / or resection endoscope device, which is configured, for example, to be introduced into a cavity or, in particular, an artificial and / or natural cavity, especially a body cavity.

[0019] The outer rod preferably extends from the proximal side to the distal side. The distal side should be particularly understood as the side that, during application, should be introduced into a cavity or space. The proximal side should be particularly understood as the side that, during application, remains outside the cavity or space. "Distal" should be particularly understood as being closer to the patient and / or farther from the operator and / or user during operation. In particular, the proximal side is the opposite of the distal side. "Proximal" should be particularly understood as being farther from the patient and / or closer to the operator and / or user during operation. "Elongated component" should be particularly understood as a member whose main extension is at least five times, preferably at least ten times, and particularly preferably at least twenty times larger than the maximum extension of the component perpendicular to its main extension, i.e., especially the diameter of the component. The "main extension" of the component should be particularly understood as the longest extension of the component along its main extension direction. The "primary extension direction" of a component should be understood in particular as a direction that extends parallel to the longest edge of the smallest imaginary cuboid that completely surrounds the component, and preferably extends through the geometric center and / or centroid of the component. The outer rod may have a longitudinal axis. The longitudinal axis may extend parallel to the primary extension direction of the outer rod.

[0020] The external rod can be configured to be inserted into the urethra. The external rod can be configured to remain in the urethra non-invasively during resection. The external rod may include a first channel for supplying fluid, particularly for supplying irrigation fluid. Alternatively or additionally, the external rod may include a second channel for aspirating fluid, particularly for aspirating irrigation fluid. The external rod can be configured to provide constant filling of the surgical cavity by allowing the supply and drainage of irrigation fluid. In particular, the second channel may also be configured to aspirate tissue portions.

[0021] The outer rod can be configured to receive a cutting tool and / or guide the cutting tool in one direction, particularly along the longitudinal direction of the outer rod. The outer rod can be configured to receive an image acquisition unit, particularly components forming the image acquisition unit. The outer rod can be configured to receive a rod of the component and / or guide a rod in one direction, particularly along the longitudinal direction of the outer rod.

[0022] The resection tool can be configured to remove tissue by cutting and / or by vaporization. The resection tool can have a conductive material, particularly a wire through which an electric current can flow. The resection tool can be constructed as an HF tool (high-frequency tool). The resection tool can have a resection ring. The resection tool can be annular, hook-shaped, or spherical. The resection tool may include two guide rods and a resection ring suspended between the guide rods. The resection tool can particularly have an HF ring (high-frequency ring). Alternatively or additionally, the resection tool can have a laser for cutting and / or for vaporization. This laser can particularly be constructed for holmium-laser-enukleation or KTP laser vaporization, or implemented as a continuous-wave (continuous-output) laser. These laser methods differ in the wavelength and energy of the laser light used, and therefore, in particular in their energy effect on tissue and their depth of penetration. Alternatively or additionally, the resection tool can be a monopolar or bipolar HF tool (high-frequency tool). Monopolar HF tools can be configured with hook-shaped, ball-shaped, or shovel-shaped electrodes for cutting and / or vaporization. Bipolar HF tools can be configured, in particular, as bipolar forceps or clamps for cutting and / or vaporization. Resection tools can also be configured to perform contact coagulation at the tissue site. The described design of the resection tool may be particularly suitable depending on the application.

[0023] The image acquisition unit and the cutting tool can move relative to each other. The image acquisition unit, and in particular the components including the image acquisition unit, can be configured to receive the cutting tool and / or guide the cutting tool in one direction, particularly in the longitudinal direction of the image acquisition unit or its components.

[0024] An image acquisition unit may include one image acquisition device. An image acquisition unit may include multiple image acquisition devices. An image acquisition unit may include multiple image acquisition devices pointing in different visual directions. An image acquisition unit may include at least two image acquisition devices pointing in different visual directions. The arrangement of multiple image acquisition devices with different visual directions improves the imaging of the tissue to be removed, which is available to the surgeon. The at least two image acquisition devices may in particular include a first image acquisition device and a second image acquisition device, wherein the first image acquisition device points in a distal visual direction, and wherein the second image acquisition device points in a proximal visual direction. Visual directions from two different sides further improve the imaging available to the surgeon by capturing images from different perspectives, and particularly improve visibility when setting the placement point for removing the tissue. The visual direction may be a proximal visual direction pointed to by a reference outer rod. The visual direction may be a distal visual direction pointed to by a reference outer rod. The visual direction may be defined by the viewing angle in the longitudinal direction of the reference outer rod. A viewing angle from 0° to less than 90° can be considered a distal visual direction, while a viewing angle greater than 90° to 180° can be considered a proximal visual direction.

[0025] The image acquisition unit may include at least three image acquisition devices pointing in three different viewing directions. The arrangement of multiple image acquisition devices with different viewing directions improves the imaging of the tissue to be removed, which is available to the surgeon. The at least three image acquisition devices can define three different, overlapping imaging regions. Imaging of the tissue to be removed, which is available to the surgeon, is further improved within the overlapping imaging regions viewed from different viewing directions. The multiple image acquisition devices may be arranged staggered, particularly sequentially, in the longitudinal direction of the outer rod and / or with reference to the longitudinal axis of the outer rod. The multiple image acquisition devices may also be arranged staggered, particularly side-by-side, in the transverse direction of the outer rod.

[0026] The one or more image acquisition devices may be formed from camera modules, particularly camera modules with short objectives, or so-called camera cubes with wafer-level optics. The one or more image acquisition devices or camera modules may be formed from incident optics and / or image sensors for image generation, particularly CCD chips or CMOS chips. The one or more image acquisition devices may each have a single field of view. The single field of view may be, for example, 60°, 65°, 70°, 75°, 80°, 85°, 90°, 95°, 100°, 105°, or 110°.

[0027] The line-of-sight direction of the image acquisition device can be the main line-of-sight direction of the corresponding image acquisition device. For example, the line-of-sight direction can be the central axis of the incident optics of the relevant image acquisition device. A single field of view can be an angle opened with reference to the line-of-sight direction. In particular, the central axis can be the angle bisector of a single field of view. Depending on the implementation of the image acquisition device, it can be defined by two corresponding single field of view angles that are perpendicular to each other. They can be defined, for example, by a field of view angle with reference to a horizontal axis and a field of view angle with reference to a vertical axis, which are perpendicular to the central axis and / or the line-of-sight direction, respectively. Especially when the image acquisition device includes a rectangular image sensor, the two field of view angles belonging to the image acquisition device can be associated with the short side and the long side of the rectangular image sensor.

[0028] The expression of a single field of view can also be understood as the maximum field of view of the associated image acquisition device, and / or as the field of view corresponding to the diagonal of the associated image sensor. The image acquisition device can also be described by a horizontal field of view, a vertical field of view, and a diagonal field of view. Expressions involving the field of view can refer to any of these three parameters, and preferably refer to the diagonal field of view.

[0029] The image acquisition unit may include a distal component and a proximal component. The distal and proximal components may be spaced apart from each other. Specifically, the distal and proximal components may be spaced apart from each other in the longitudinal direction of the outer rod. The distal and proximal components may move together relative to the outer rod. The distal and proximal components may move beyond the distal side of the outer rod. Each of the distal and proximal components may include at least one image acquisition device. In particular, the distal and proximal components may be spaced apart from each other and may move together relative to the outer rod and beyond their distal sides, wherein each of the distal and proximal components has at least one image acquisition device. Within a predetermined spacing between the two components, each having at least one image acquisition device, the surgeon can position the resection endoscope such that the tissue to be removed is located therebetween, and thus image can be captured from two opposite sides. Imaging based on images taken from two opposite sides improves the visibility of the resection area or the working area of ​​the resection tool, and thereby provides support to the surgeon, especially in finding the placement point for the resection. Therefore, the surgeon does not need to mechanically manipulate the tissue from the outside or via a pivoting resection device. Furthermore, the tissue opposite to the tissue to be removed, especially from the working area of ​​the cutting tool, can be pushed away by the spaced components that define the working area of ​​the cutting tool therebetween.

[0030] In particular, at least one image acquisition device of the distal component can be pointed towards the proximal line of sight, and at least one image acquisition device of the proximal component can be pointed towards the distal line of sight. This orientation enables imaging based on images simultaneously captured from two opposite sides without component movement. Specifically, the distal and proximal components can be spaced apart from each other, defining a resection area or a working area for the resection tool therebetween. This spacing enables simultaneous imaging from two opposite sides without component movement during the resection. The size of the gap between the distal and proximal components depends on the size of the tissue to be removed and / or the size of the resection tool. Specifically, the distal and proximal components can be spaced apart from each other such that the gap is at least a few millimeters, particularly, for example, 5 mm, and at most a few centimeters, particularly, for example, 5 cm or 10 cm. At least one image acquisition device of the distal component and at least one image acquisition device of the proximal component can be pointed towards the working area of ​​the resection tool from different sides, respectively. In this arrangement, after a disposable positioning resection endoscope, the surgeon can perform the resection while simultaneously imaging the tissue from two opposite sides without further component movement.

[0031] The resection endoscope may also include an illumination unit. The illumination unit is movable relative to the resection tool. The illumination unit is movable relative to an outer rod. The illumination unit can be configured to illuminate the imaging area. Illuminating the imaging area supports image acquisition by the image acquisition unit, and thus particularly improves the image quality available to the surgeon. The illumination unit may include multiple light-emitting elements, particularly pointing in different illumination directions. Each light-emitting element may be formed of a light-emitting diode and / or a laser diode and / or a light conductor. Particularly in embodiments where the light-emitting elements include light conductors, the resection endoscope or its endoscopic assembly may have an optical interface on the proximal side and / or nearby, which is configured to connect to the illumination unit. Endoscopic device: The image acquisition unit and the illumination unit are preferably constructed as an integral unit, especially in pairs. This integral construction improves the efficient use of available installation space.

[0032] Alternatively or additionally, the resection device includes an endoscope assembly comprising an image acquisition unit, wherein the endoscope assembly includes an endoscope rod and an imaging head mounted on the endoscope rod, in which at least one image acquisition device of the image acquisition unit is arranged. The arrangement of at least one image acquisition device in the imaging head supports a modular structure of the resection device. The imaging head can, in particular, extend radially with reference to the longitudinal axis of the endoscope rod. Therefore, the at least one image acquisition device arranged in the imaging head can also extend radially with reference to the longitudinal axis of the endoscope rod. Due to the radial extension, the imaging area including the endoscope rod can be easily imaged using an image acquisition device pointing proximally, especially in a proximal line of sight. The resection tool may include two guide rods and a resection ring suspended between the guide rods, wherein the endoscope assembly is arranged between the guide rods. This arrangement enables a particularly compact arrangement of the resection tool and the endoscope assembly including the image acquisition unit. The resection tool and the endoscope assembly can be configured such that they can be freely displaced relative to each other along the longitudinal direction of the outer rod. The resection tool and endoscope assembly can occupy installation spaces that do not overlap with other installation spaces when viewed along the longitudinal direction of the outer rod.

[0033] The resection endoscope may have a transport mechanism for the relative movement of the imaging unit and / or the resection tool relative to an outer rod. The resection endoscope may include a coupling mechanism configured to selectively engage and / or selectively prevent relative movement between the endoscope assembly and the resection tool. Depending on the circumstances, it may be helpful for the surgeon to obtain a better overview during the resection by appropriately co-moving or fixing the imaging area provided by the imaging unit with the resection tool. For example, after placing the resection tool at the placement point, the surgeon may cause the imaging image, displayed to them based on the image acquisition unit, to co-move with the resection tool. The coupling between the endoscope assembly and the resection tool may be designed to be direct. Alternatively, the coupling between the endoscope assembly and the resection tool may be designed to have a selectively determined transmission ratio. Thus, when needed, the imaging displayed to the surgeon may move faster than the resection tool or move over and with the resection tool.

[0034] The endoscope assembly may include an illumination unit. At least one light-emitting element of the illumination unit may be arranged in the imaging head. The arrangement of the light-emitting element in the imaging head enables efficient use of the available installation space.

[0035] The endoscope stem of the endoscope assembly may also include a heat-conducting section designed to transfer heat from the distal side of the endoscope stem to the proximal side. The heat-conducting section may be formed of a heat pipe, which can transfer heat via evaporation and condensation loops. The heat-conducting section can reduce the heat input to tissues caused by the image acquisition unit and / or illumination unit.

[0036] The resection system may also include a control device configured to process images acquired by the image acquisition unit and generate illustrations for the user or surgeon. The resection system may also include a supply unit. The control device may also be located within the supply unit. Alternatively, the control device may be constructed in other units, such as the proximal segment of the resection endoscope, and / or constructed as multiple separate control units distributed across different units of the resection system.

[0037] The control device can be configured to create an illustration for a user or surgeon from different images captured by an image acquisition unit, each showing a different image region. This illustration shows at least one object that is occluded in at least one image and visible in at least one other image. The illustration can be a superposition or overlay of different images, wherein at least one of the images is modified, particularly appropriately mirrored and / or appropriately distorted. The control device can also be configured to create an illustration for a user or surgeon from different images, showing a segment, particularly the outline, of a resection tool that is initially occluded in one of the captured images. In particular, the illustration can be a superposition or overlay of a modified, particularly appropriately mirrored and / or appropriately distorted image of the resection tool, particularly the outline, on other images in which the resection tool is not shown. The control device can be configured to create an illustration for a user or surgeon from images acquired by an image acquisition unit, showing a top view of the working area of ​​the resection tool. Multiple acquired images can be modified, particularly appropriately mirrored and / or appropriately distorted, and overlaid to create a top view. This top-down view can provide the surgeon with an improved overview during resection, depending on the situation. The control device can be configured to generate stereoscopic images from different images acquired by the image acquisition unit. Stereoscopic images can be generated based on different images of the imaging area, and the surgeon can use these stereoscopic images for better orientation. Therefore, by using appropriately arranged and oriented image acquisition devices, a wide range of functions can be achieved within a compact arrangement of components. In particular, stereoscopic endoscopy can be performed within a selected angular range. For this purpose, the overlap of the various imaging areas of the relevant image acquisition devices is appropriately selected. For example, the overlap used to generate stereoscopic images can be at least 10°, at least 20°, at least 30°, or even at least 40°, and in some cases, at least 50° or at least 60°.

[0038] An imaging method performed using a resection endoscope and / or a resection endoscope and / or a resection system includes the following steps: moving an image acquisition unit relative to an outer rod to a first position; capturing at least one image using the image acquisition unit in the first position; moving the image acquisition unit relative to the outer rod to a second position different from the first position; and capturing at least one image using the image acquisition unit in the second position. In this case, the relative mobility of the image acquisition unit and the outer rod provides the surgeon with views from different positions and thus from different perspectives.

[0039] The imaging method can be performed manually, either partially or entirely. In other embodiments, the method can be performed automatically, either partially or entirely, particularly by means of tactile electrotransmission control, wherein the surgeon's motion input can be practiced and / or displayed in reverse.

[0040] The apparatus and method according to the invention should not be limited to the applications and embodiments described above. In particular, to achieve the working methods described herein, they may have quantities different from those mentioned herein for the various elements, components, units, and method steps. Furthermore, the numerical ranges given in this disclosure, as well as values ​​within the mentioned limits, should be considered as public and freely usable.

[0041] In particular, it is noted that all features and characteristics described regarding the device, but also including methodological approaches, are adaptably transferred to the method and are applicable within the scope of this invention and are considered simultaneously disclosed. The reverse also applies. This means that structural features mentioned regarding the method, i.e., features according to the device, can also be considered, claimed, and are equally disclosed within the scope of the device claims.

[0042] The invention is described exemplarily below with reference to the accompanying drawings. The drawings, description, and claims comprise a large number of features in combination. Those skilled in the art will also find it appropriate to observe these features individually and to combine them reasonably within the scope of the claims.

[0043] If there are more than one instance of a particular object, then only one instance may be given a reference numeral in the figures and description, if necessary. The description of that instance can be correspondingly applied to the other instances of the object. If the object is named, in particular, by ordinal numbers (e.g., first, second, third object, etc.), then these are used for naming and / or associating the objects. Thus, for example, first and third objects may be included, but second objects may not be included. However, additionally, the number and / or order of objects can also be inferred from the ordinal numbers. Attached Figure Description

[0044] The diagram illustrates the following:

[0045] Figure 1 A side view of a resection endoscope device in a first posture according to an embodiment is shown;

[0046] Figure 2 A side view of the resection endoscope device in a second posture according to an embodiment is shown;

[0047] Figure 3 A side view of the resection endoscope device in a second posture according to an embodiment is shown in a reduced view.

[0048] Figure 4 A side view of a resection endoscope device in a first posture according to another embodiment is shown;

[0049] Figure 5 A side view of a resection endoscope device in a second posture according to another embodiment is shown;

[0050] Figure 6 A perspective view of a resection system with a resection scope according to an embodiment is shown; and

[0051] Figure 7 A flowchart of an imaging method according to an embodiment is shown. Detailed Implementation

[0052] Figure 1 A side view of the resection endoscope device 10 in a first posture according to an embodiment is shown. Figure 2 A side view of the endoscope device 10 in a second posture according to an embodiment is shown. Figure 3 A side view of the resection endoscope 10 in a second posture according to the embodiment is shown in a reduced view.

[0053] The resection endoscope device 10 includes: an outer rod 12 having a distal side 14 and a proximal side 16; a resection tool 18 extending through the outer rod 12 and movable relative to the outer rod 12; and an image acquisition unit 20 configured to capture an image of an imaging region 20a located in the region of the distal side 14 of the outer rod 12, wherein the image acquisition unit 20 is movable relative to the outer rod 12 beyond its distal side 14.

[0054] The resection endoscope 10 provides the user or surgeon with excellent imaging of the tissue 19, especially the tissue 19a to be removed, through images captured from different positions via an image acquisition unit 20 that is movable relative to the outer rod 12. The movement of the image acquisition unit 20 allows the surgeon to observe different perspectives, particularly before placing the resection tool 18 at the placement point 19b to remove the tissue 19a. Figure 1In the first pose shown, the placement point 19b is not within the imaging area 20a of the image acquisition unit 20, but... Figure 2 In the second pose shown, the placement point 19b is within the imaging area 20a of the acquisition unit 20.

[0055] Image acquisition unit 20 Figure 1 The first posture shown can be used, for example, to first identify the tissue 19a to be removed, such as a tumor, and then the resection tool 18 is moved relative to the outer rod 12 to the distal side of the tissue 19a to be removed, that is, the resection tool 18 is moved out and brought behind the tissue 19a to be removed. Through the relative movement of the image acquisition unit 20 relative to the outer rod 12, the image acquisition unit 20... Figure 1 The first pose shown can be switched to the image acquisition unit 20. Figure 2 The second posture is shown. Therefore, the image acquisition unit 20 can be moved out relative to the outer rod 12.

[0056] Image acquisition unit 20 Figure 2 The second posture shown can be used by a surgeon, for example, to display an imaging region 20a in which the placement point 19b for the resection tool 18 is located. The imaging provided to the surgeon can here support the surgeon in optimally setting the placement point 19b for removing or cutting the tissue 19a to be removed with the resection tool 18. The surgeon can then cut the tissue 19a to be removed by moving the resection tool 18. Here, the image acquisition unit 20 can again move accordingly to provide the surgeon with a good image of the tissue 19a to be removed and the resection tool 18 during the movement of the resection tool 18. In particular, the movable image acquisition unit 20 allows the surgeon to have a good overview when using the resection tool 18, thereby making it easier, for example, to prevent unintentional damage to adjacent tissue portions of the tissue 19. In particular, as shown in the present example, the image acquisition unit 20 and the resection tool 18 can move relative to each other, allowing the surgeon to select the imaging region independently of the posture of the resection tool 18.

[0057] The outer rod 12 is an elongated component and is configured to introduce... Figure 3 The natural cavity 17 is shown. The outer rod 12 extends from the proximal side 16 to the distal side 14, wherein the distal side is introduced into the cavity 17 during application. Figure 3 The natural cavity 17 shown is the bladder, wherein the outer rod 12 is configured to be inserted into the urethra for access into the cavity 17. The resection endoscope device 10 is implemented as a backflushing resection endoscope, wherein the supply and discharge of flushing fluid are achieved in a known manner via the channel of the outer rod 12.

[0058] The excision tool 18 is configured to remove tissue by cutting. As exemplarily shown, the excision tool 18 is an HF ring (high-frequency ring) which includes two guide rods 46 and an excision ring 48 suspended between the guide rods 46.

[0059] Figures 1 to 3 The illustrated resection endoscope 10 has an image acquisition unit 20, which includes a first image acquisition device 21 having a first viewing direction 21a and a second image acquisition device 22 having a second viewing direction 21a. These image acquisition devices 21 and 22 are arranged sequentially in the longitudinal direction of the outer rod 12, and alternatively or additionally, may be arranged staggered in the transverse direction of the outer rod 12. The two image acquisition devices 21 and 22 point to different viewing directions 21a and 22a. Image acquisition device 21 points to the distal viewing direction, and the second image acquisition device 22 points to the proximal viewing direction. This orientation provides the surgeon with imaging based on images of the tissue 19a to be removed taken from two opposite sides. This allows for particularly good observation of the placement point 19b without external manipulation of the tissue 19 or pivoting of the image acquisition unit. The first image acquisition device 21 has a viewing direction 21a arranged at an angle of approximately 40° relative to the longitudinal axis of the outer rod 12, and the second image acquisition device 22 has a viewing direction 22a arranged at an angle of approximately 130° relative to the longitudinal axis of the outer rod 12. The exemplary image acquisition devices 21 and 22 are each formed by a camera module having incident optics and an image sensor. The individual field of view of the image acquisition devices 21 and 22 is approximately 70°.

[0060] Figures 1 to 3 The illustrated resection endoscope device 10 includes an endoscope assembly 40, which includes an image acquisition unit 20. The endoscope assembly 40 includes an endoscope stem 42 and an imaging head 44 mounted on the endoscope stem 42, in which a first image acquisition device 21 and a second image acquisition device 22 of the image acquisition unit 20 are arranged. The imaging head 44 extends radially relative to the longitudinal axis 42a of the endoscope stem 42. The endoscope assembly 40 is arranged with reference to the resection tool 18 such that the resection tool is located between guide rods 46, so that the guide rods do not interfere with each other during relative movement along the longitudinal direction of the outer rod 12.

[0061] The endoscope assembly 40 also includes an illumination unit 30, which includes a first light-emitting element 31 and a second light-emitting element 32, disposed within the imaging head 44. The illumination unit 30 also includes a third light-emitting element 33 disposed at the endoscope stem 42. The illumination unit 30, together with the endoscope assembly 40, is movable relative to the outer stem 12 and is configured to illuminate the imaging area 20a. The light-emitting elements 31, 32, and 33 are currently formed, for example, by light-emitting diodes. Alternatively, embodiments with laser diodes or photoconductors are also possible.

[0062] The endoscope stem 42 of the endoscope assembly 44 also includes a heat-conducting section 28, which is designed to transfer heat from the distal side of the endoscope stem 42 to the proximal side of the endoscope stem 42. The heat-conducting section 28 is currently implemented, for example, through an evaporation and condensation circuit.

[0063] Figure 4 A side view of the resection endoscope device 10' in a first posture according to another embodiment is shown. Figure 5 A side view of a resection endoscope device 10' in a second posture according to another embodiment is shown. Other exemplary resection endoscope devices 10' shown are alternative embodiments of the resection endoscope device 10 described above. The resection endoscope device 10' according to other embodiments largely corresponds to the embodiments described previously. Figures 1 to 3 The illustrated resection endoscope device 10, however, differs from the image acquisition unit 20 in that the image acquisition unit 20' includes a distal component 24 and a proximal component 26. Furthermore, the illumination unit 30' is adapted relative to the previously described illumination unit 30. Therefore, in Figures 1 to 3 The remaining features of the resection endoscope 10 shown have already been described and can be applied accordingly. Therefore, further descriptions of each feature are omitted.

[0064] The image acquisition unit 20' includes a distal component 24 and a proximal component 26, which are spaced apart from each other in the longitudinal direction of the outer rod 12. The distal component 24 and the proximal component 26 can move together relative to the outer rod 12, and in particular can move beyond their distal side 14. The distal component 24 is designed in a manner corresponding to the previously described imaging head 44 according to the previously described embodiment, wherein the illumination unit 30' is adapted. The proximal component 26 of the image acquisition unit 20' includes a third image acquisition device 23 having a viewing direction 23a. The third image acquisition device 23 points to the distal viewing direction, wherein the viewing direction 23a has a viewing angle of approximately 40° relative to the longitudinal direction of the outer rod 12.

[0065] The distal assembly 24 and the proximal assembly 26 are spaced apart from each other, defining a working area or resection area for the resection tool 18 between them. Within this working area, the resection tool 18 can be displaced relative to the outer rod 12 and relative to the image acquisition unit 20, and simultaneously, particularly without movement of the image acquisition unit 20, can image an imaging area 20a that completely surrounds the tissue 19a to be removed. Therefore, the resection tool 18 can be observed by the surgeon from the opposite side during removal and insertion without requiring movement of the image acquisition unit 20.

[0066] Figure 4 and Figure 5The illumination unit 30' shown includes four light-emitting elements, which are constructed in a manner corresponding to light-emitting elements 31, 32, and 33 according to the previously described embodiment. Unlike the previously described embodiment, three light-emitting elements are arranged at the endoscope stem 42 between the distal assembly 24 and the proximal assembly 26, and only one light-emitting element is arranged at the imaging head 44. This arrangement allows for particularly good illumination of the working area of ​​the excision tool 18.

[0067] Figure 6 A perspective view of a resection system 100 having a resection scope 50, which has a resection scope device 10, is shown.

[0068] The exemplary resection system 100 includes a control device 102, a resection scope 50 having a resection scope device 10 and a grip 104, a connecting cable 106, and a supply unit 108 connected to the resection scope device 10 via the connecting cable 106. The resection system 100 and / or the resection scope device 10 and the supply unit 108 may be part of a medical system. The supply unit 108 may be used with a display not shown.

[0069] Furthermore, the supply unit 108 may be configured to transmit and / or process image data obtained from the resection endoscope device 10. The control device 102 need not be arranged in the supply unit 108, but may be arranged in other units, such as in the proximal section of the resection endoscope device 10, or configured as multiple separate control units distributed in different units.

[0070] The control device 102 is configured to process the images acquired by the image acquisition unit 20 and generate illustrations for the user or surgeon. When using the image acquisition device 22, for example, oriented in the proximal line of sight, the surgeon is positioned inside the patient from their perspective. For orientation, the surgeon needs to coordinate movements from the proximal position with the opposite image. For the image acquisition device 22, movements along the vertical axis remain in the correct direction. For movements along the lateral axis, the image from the image acquisition device 22 can be horizontally mirrored. With modern sensors, this can be achieved directly on the image sensor of the image acquisition device 22 or within the control device 102.

[0071] For example, control device 102 is configured to create illustrations for a user or surgeon based on different images captured by image acquisition units 20, 20' that show different image regions, in which at least one object is shown that is occluded in at least one other image and is visible in at least one other image. This is particularly advantageous in the case of image acquisition units 20' having spaced-out components 24, 26. In this case, for example, images can be captured simultaneously with image acquisition device 22 and images captured from the opposite side by image acquisition device 23 that are different from them. Control device 102 can, for example, horizontally mirror the image of image acquisition device 22 and overlay it with the image of control device 23, so that the surgeon can simultaneously observe the tissue 19a to be removed from both sides.

[0072] Figure 7 An exemplary flowchart of an imaging method according to an embodiment is shown. The imaging method can be performed using resection endoscopes 10, 10', resection endoscope 50, or resection system 100. The imaging method includes: a first step S1 of moving image acquisition units 20, 20' relative to the outer rod 12 to a first position; a second step S2 of capturing at least one image using the image acquisition units 20, 20' in the first position; a third step S3 of moving the image acquisition units 20, 20' relative to the outer rod 12 to a second position different from the first position; and a third step S4 of capturing at least one image using the image acquisition units 20, 20' in the second position. For example, the imaging method can be performed manually by a surgeon. In this case, the surgeon moves the image acquisition units 20, 20' correspondingly relative to the outer rod 12 and captures images at the corresponding positions.

[0073] Explanation of reference numerals in the attached figures

[0074] 10 resection endoscopes

[0075] 12 outer rods

[0076] 14 distal side

[0077] 16 Proximal side

[0078] 17 chambers

[0079] 18 Resection Tools

[0080] 19 organizations

[0081] 19a Tissue to be removed

[0082] 19b placement point

[0083] 20 image acquisition units

[0084] 20a imaging area

[0085] 21 First Image Acquisition Device

[0086] 21a Line of sight of the first image acquisition device

[0087] 22 Second Image Acquisition Device

[0088] 22a Line of sight of the second image acquisition device

[0089] 23 Third Image Acquisition Device

[0090] 23a The line of sight of the third image acquisition device

[0091] 24 distal components

[0092] 26 proximal components

[0093] 28 Thermal Conductive Parts

[0094] 30 lighting units

[0095] 31 First light-emitting element

[0096] 32 Second light-emitting element

[0097] 33 Third light-emitting element

[0098] 40 Endoscope Components

[0099] 42 Endoscope rod

[0100] Longitudinal axis of 42a endoscope rod

[0101] 44 imaging head

[0102] 46 guide rods

[0103] 48-ring resection

[0104] 50 resection scope

[0105] 100 resection system

[0106] 102 Control Equipment

[0107] 104 grip section

[0108] 106 connecting cable

Claims

1. A resection endoscope (10), comprising: Outer rod (12), the outer rod having a distal side (14) and a proximal side (16); A cutting tool (18) extends through the outer rod (12) and is movable relative to the outer rod (12); as well as An image acquisition unit (20) is configured to capture an image of an imaging region (20a) located in the region of the distal side (14) of the outer rod (12), wherein the image acquisition unit (20) is movable relative to the outer rod (12) and moves beyond the distal side (14) of the outer rod.

2. The resection endoscope device (10) according to claim 1. The image acquisition unit (20) and the excision tool (18) are movable relative to each other.

3. The resection endoscope device (10) according to claim 1 or 2. The image acquisition unit (20) includes at least two image acquisition devices (21, 22), which are pointed in different line-of-sight directions (21a, 22a).

4. The resection endoscope device (10) according to claim 3. The at least two image acquisition devices (21, 22) include a first image acquisition device (21) and a second image acquisition device (22), wherein the first image acquisition device (21) points to the far-side line of sight, and wherein the second image acquisition device (22) points to the near-side line of sight.

5. The resection endoscope device (10) according to claim 3 or 4. The image acquisition unit (20) includes at least three image acquisition devices (21, 22, 23), which point to three different line-of-sight directions.

6. The resection endoscope device (10) according to claim 5. The at least three image acquisition devices (21, 22, 23) define three different, overlapping imaging regions.

7. The resection endoscope device (10) according to any one of the preceding claims. The image acquisition unit (20) includes a distal component (24) and a proximal component (26), the distal component and the proximal component being spaced apart from each other and capable of moving together relative to the outer rod (12) and moving beyond the distal side (14) of the outer rod, wherein the distal component (24) and the proximal component (26) each have at least one image acquisition device (21; 22; 23).

8. The resection endoscope device (10) according to claim 7. The at least one image acquisition device (21; 22; 23) of the distal component (24) is directed toward the proximal line of sight, and the at least one image acquisition device (21; 22; 23) of the proximal component (26) is directed toward the distal line of sight.

9. The resection endoscope device (10) according to claim 7 or 8. The distal component (24) and the proximal component (26) are spaced apart from each other such that the working area of ​​the cutting tool (18) is defined between the distal component and the proximal component.

10. The resection endoscope device (10) according to any one of claims 7 to 9. The at least one image acquisition device (21; 22; 23) of the distal component (24) and the at least one image acquisition device (21; 22; 23) of the proximal component (26) are respectively pointed from different sides to the working area of ​​the excision tool (18).

11. The resection endoscope device (10) according to any one of the preceding claims. It also includes an illumination unit (28) that is movable relative to the cutting tool (18) and relative to the outer rod (12) and is configured to illuminate the imaging area (20a).

12. The resection endoscope device (10) according to claim 11. The lighting unit (30) includes multiple light-emitting elements (31, 32, 33) that point in different lighting directions.

13. The resection endoscope device (10) according to claim 11 or 12. The image acquisition unit (20) and the illumination unit (30) are constructed as a single unit.

14. The resection endoscope device (10) according to any one of the preceding claims. The endoscope assembly (40) includes an image acquisition unit (20), wherein the endoscope assembly (40) includes an endoscope rod (42) and an imaging head (44) mounted on the endoscope rod (42), and at least one image acquisition device (21; 22; 23) of the image acquisition unit (20) is arranged in the imaging head.

15. The resection endoscope device (10) according to claim 14. The imaging head (44) extends radially with reference to the longitudinal axis (42a) of the endoscope rod (42).

16. The resection endoscope device (10) according to claim 14 or 15. The resection tool (18) includes two guide rods (46) and a resection ring (48) suspended between the guide rods (46), and the endoscope assembly (40) is arranged between the guide rods (46).

17. The resection endoscope device (10) according to any one of claims 14 to 16. It also includes a coupling mechanism configured to selectively engage and / or selectively prevent relative movement between the endoscope assembly (40) and the resection tool (18).

18. The resection endoscope device (10) according to any one of claims 14 to 17. The endoscope assembly (40) includes an illumination unit (30), and at least one light-emitting element (31; 32; 33) of the illumination unit (30) is arranged in the imaging head (44).

19. A resection scope (50) having a resection scope device (10) according to any one of the preceding claims.

20. Resection system (100), including The resection endoscope device (10) according to any one of claims 1 to 18 and / or the resection endoscope (50) according to claim 19; and A control device (102) is configured to process images acquired by the image acquisition unit (20) and generate illustrations for the user.

21. The resection system (100) according to claim 20. The control device (102) is configured to create illustrations for the user from different images captured by the image acquisition unit (20) and showing different image regions, wherein at least one object is shown in the illustrations, the at least one object being occluded in at least one image of the images and visible in at least one other image of the images.

22. The resection system (100) according to claim 21. The control device (102) is configured to create illustrations for the user from different images, in which a segment of the cutting tool (18) is shown, the segment being obscured in one of the captured images.

23. The resection system (100) according to any one of claims 20 to 22. The control device (102) is configured to create an illustration for the user from an image acquired by the image acquisition unit (20), the illustration showing a top view of the working area of ​​the cutting tool (18).

24. The resection system (100) according to any one of claims 20 to 23. The control device (102) is configured to generate stereoscopic images from different images acquired by the image acquisition unit (20).

25. An imaging method, said imaging method being performed using a resection endoscope device (10) and / or a resection endoscope (50) and / or a resection system (100) according to any one of the preceding claims, comprising the following steps: Move the image acquisition unit (20) relative to the outer rod (12) to the first position; At least one image is captured using the image acquisition unit (20) located in the first position; Move the image acquisition unit (20) relative to the outer rod (12) to a second position different from the first position; as well as At least one image is captured using the image acquisition unit (20) located in the second position.

Images