Surgical assistance system

Abstract

Surgical assistance system comprising a group of devices (1, 101), a pathology unit and a bidirectional data link (69, 105) between a transmitting and receiving unit (72) of the pathology unit (70, 170) and a transmitting and receiving unit (60) of the group of devices (1, 101), wherein a) the group of devices (1, 101) includes at least: - an endomicroscope (4, 104) for acquiring cell-resolved image data from a surgical field (3, 103), - an operating microscope (2, 102) with at least one observation beam path for displaying an observation image for recording overview image data of the operating field (3, 103), wherein the endomicroscope (4, 104) and the operating microscope (2, 102) each contain at least one functional unit or are assigned at least one functional unit, wherein a functional control unit (65) for controlling the functional unit is assigned to the respective functional unit, and the transmitting and receiving unit (60) comprises a transmitting unit (63) for transmitting the acquired cellularly resolved image data and / or the acquired overview image data to the pathology unit (70, 170) and a data receiving unit (64) configured for receiving functional control data from the pathology unit (70, 170) and for forwarding the received functional control data to the respective functional control unit (65), b) which has at least one pathology unit (70, 170): - an input unit (77) for entering function control data for the at least one function control unit (65) of the group of devices (1, 101), - a display unit (76) for displaying received cellularly resolved image data and / or the received overview image data, wherein the transmitting and receiving unit (72) is equipped with a receiving unit (74) connected to the transmitting unit (63) of the group of devices (1, 101) for receiving the cellularly resolved image data and / or the overview image data and with a transmitting unit (73) for sending the function control data to the data receiving unit (64) of the group of devices (1, 101).

Description

[0001] The present invention relates to a surgical assistance system and in particular an assistance system for microsurgery.

[0002] During surgical procedures, and especially microsurgical procedures and tumor operations, tissue samples are taken intraoperatively and then analyzed by a pathologist using frozen section analysis. These analysis results are then transmitted to the treating surgeon by telephone and evaluated by them for further treatment planning. For such frozen section analysis, the intraoperatively obtained tissue samples are sent to a pathology laboratory, where the samples are analyzed. There, the tissue samples are frozen and sectioned before being analyzed by the pathologist. This process typically takes about 15 minutes for a single tissue sample. With multiple tissue samples, the time until the analysis results are available increases accordingly. In addition, there is the time required for transporting the tissue samples to the pathology laboratory.

[0003] Because the quality of sections obtained from frozen tissue samples is lower than that of formalin-fixed, paraffin-embedded tissue, and because the time available for analysis is very limited, the demands on the pathologist's skills are very high. However, even highly skilled pathologists can, due to the small number of tissue samples, the lower quality of the frozen sections, and the short analysis time, relatively frequently produce erroneous analyses, although experienced pathologists can achieve accuracy rates of 90% or more.

[0004] JP-H07-95556 A describes a system that allows a remotely positioned observer to view a magnified image of a sample on the stage of a microscope located in the operating room. Furthermore, a telephone connection exists between the operating room and the remotely positioned observer, enabling communication between the attending physician and the observer.

[0005] US 2005 / 0033556 A1 describes a diagnostic system comprising a device located in the operating room for capturing genetic data from patient tissue and a diagnostic device located in another room. The captured genetic data is sent to the diagnostic device, which searches for diagnostic information and displays the found information for verification by a pathologist. The verified diagnosis is then displayed on a screen located in the operating room. This can reduce the time required for diagnosis.

[0006] US Patent 2013 / 0324846 A1 describes a device and method for optical pathology. The method involves performing an optical examination of tissue in vivo. First, the tissue is stained with a fluorescent dye. Then, using confocal imaging, cell-resolved fluorescence images are acquired and displayed on a monitor. Based on these images, a pathological diagnosis of the tissue is made. The monitor can be located in a separate room from the operating room. An endoscope or a handheld microfiber probe can be used to deliver the radiation that stimulates fluorescence to the tissue under examination and to detect the fluorescence emitted by the tissue. The device also includes a CCD or CMOS camera, which provides a macroscopic overview of the tissue area of ​​interest.

[0007] With the devices described in the prior art, a pathological diagnosis can be made remotely without having to transfer tissue to a pathology laboratory. The pathological diagnosis can then be transmitted to the attending surgeon via a telephone line or a data connection and a display located in the operating room.

[0008] US 2011 / 0178395 A1 describes a system comprising an operating microscope and an endomicroscope, wherein the system enables the matching of an image taken with the endomicroscope to an image taken with the operating microscope.

[0009] German patent DE 10 2010 039 289 A1 describes a microscope system comprising an operating microscope and an endoscope, wherein the endoscope is equipped with a joystick for precise positioning. The operating microscope is aligned by means of a stand to which it is attached.

[0010] WO 2014 / 013412 A1 describes a reflective optical objective for an endomicroscope.

[0011] US 2014 / 0005555 A1 describes an optical arrangement with an operating microscope and a surgical device, whereby the position of the surgical device can be tracked.

[0012] US patent 2011 / 0280810 A1 discloses an optical surgical system for detecting brain tumors. The optical surgical system may include a surgical microscope and a confocal endomicroscope. Images obtained with the surgical microscope and the confocal endomicroscope can be displayed on a screen. The screen may also include an input device such as a mouse, keyboard, or touchscreen, allowing a user to select the displayed images.

[0013] US patent 2004 / 0070822 A1 describes a surgical microscope system in which real-time data acquired with an ultrasound sensor can be superimposed onto the image field of an operating microscope.

[0014] With reference to the prior art described above, the object of the present invention is to provide an advantageous surgical assistance system.

[0015] The aforementioned problem is solved by a surgical assistance system according to claim 1. The dependent claims contain advantageous embodiments of the invention.

[0016] A surgical assistance system according to the invention comprises a group of devices, a pathology unit, and a bidirectional data connection between the pathology unit and the group of devices. The group of devices includes at least one endomicroscope for acquiring cellularly resolved image data of a surgical field, an imaging device for acquiring overview image data of the surgical field, and a transmitting and receiving unit with a transmitting unit for transmitting the acquired cellularly resolved image data and / or the acquired overview image data. The imaging device for acquiring overview image data of the surgical field is preferably an operating microscope.

[0017] The pathology unit comprises a transmitting and receiving unit with a receiving unit for receiving the cellularly resolved image data and / or the overview image data, and a display unit for displaying the received cellularly resolved image data and / or the received overview image data. The pathology unit is preferably located in a separate room from the group of devices and typically includes one or more computers. The transmitting and receiving unit of the group of devices is connected to the transmitting and receiving unit of the pathology unit via the bidirectional data link between the pathology unit and the group of devices.

[0018] In the surgical assistance system according to the invention, the imaging device contains at least one functional unit, or at least one functional unit is assigned to it. Additionally, the endomicroscope contains at least one functional unit, or at least one functional unit is assigned to it. Furthermore, each functional unit is assigned a functional control unit for controlling the functional unit. The functional control units can each be individual control units or subunits of a common central control unit that can control each of the functional units. The pathology unit also has an input unit for entering functional control data for the at least one functional unit, as well as a transmitting unit for sending the functional control data to a data receiving unit of the group of devices via the data connection.The data receiving unit of the group of devices is designed to forward the received function control data to at least one function control unit.

[0019] A functional unit may, in particular, include a motor-driven positioning and / or orientation device for positioning and / or orienting the imaging device and / or the endomicroscope. In this case, the functional control data includes position and / or orientation control data for the imaging device, preferably designed as a surgical microscope, and / or for the endomicroscope.

[0020] The imaging device is designed as an operating microscope, which includes at least one observation beam path for displaying an observation image.

[0021] The operating microscope may contain at least one of the following functional units: 1. An image superimposition device acting on the observation beam path for superimposing the observation image with a superimposed image.

[0022] In the case of the image overlay device, the functional control data includes image data for an overlay image. This design allows the pathologist to overlay information directly into the observation beam path of the operating microscope. Such data can, for example, include image data for a pointer with which the pathologist indicates the location where a cellularly resolved microscopic image is to be acquired with the endomicroscope. Furthermore, the pathologist can overlay image data, such as marking a tumor location, onto the overview image displayed in the pathology unit's display unit.For example, an inset image with boundary lines indicating the location of the tissue to be removed can be superimposed on the overview image obtained with the operating microscope, or certain areas of the overview image can be superimposed with an inset image in such a way that, for example, tissue to be removed is highlighted in color. 2. A focusing unit.

[0023] In the case of the focusing unit, the functional control data includes focusing control data. By accessing the focus of the operating microscope, the pathologist can focus the overview image on a tissue area of ​​interest for closer examination. Based on such an examination, a decision can then be made as to whether a cell-resolved microscopic image should be obtained in this tissue area. 3. A magnification change unit.

[0024] In the case of the magnification change unit, the functional control data includes magnification change control data. Access to the magnification changer of the operating microscope allows the pathologist to display a tissue area of ​​interest at a desired magnification. 4. A device for generating fluorescence excitation in the surgical field.

[0025] In this case, the functional control data includes control data for the device used to generate fluorescence excitation. This device can be, in particular, an illumination system that generates light with a wavelength of approximately 400 nm, for example, using a suitable light source or a spectral filter that can be swung into the illumination beam path. Such illumination makes it possible, for example, to acquire fluorescence data from the tissue under examination using an endomicroscope. The pathological diagnosis can then be based not only on a conventional cell-resolved image but also on a cell-resolved fluorescence image. 5. A device for recording fluorescence data.

[0026] In this case, the functional control data includes control data for the fluorescence data acquisition device. This device can, for example, be a spectral filter that can be swiveled into the observation beam path and filters out the excitation radiation. Specifically, the swiveling spectral filter can have a filter characteristic that not only filters out the excitation radiation from the illumination beam path but allows only the fluorescence radiation to pass through. This configuration enables the pathologist not only to acquire fluorescence data with the endomicroscope but also to gain an overview of the fluorescence in the surgical field. 6. A laser Doppler imaging facility.

[0027] In the case of the laser Doppler imaging system, the functional control data includes control data for operating the laser Doppler imaging system. Using the laser Doppler imaging system, the pathologist can, for example, obtain data about blood flow through the tissue under examination. 7. A device for laser speckle interferometry.

[0028] In the case of laser speckle interferometry, the functional control data includes control data for the laser speckle interferometry device. Laser speckle interferometry can be used to acquire motion data, such as data on blood flow within tissue. 8. An image recording device comprising a hyperspectral sensor.

[0029] In this case, the functional control data includes control data for controlling the image acquisition device with the hyperspectral sensor. Such a sensor enables the pathologist to perform a detailed spectral analysis of the light reflected by the tissue under examination.

[0030] If the imaging device has one or more of the aforementioned functional units, this significantly expands the information available to the pathologist for diagnosis. In particular, if several of these functional units are present, the pathologist has the opportunity to obtain a comprehensive picture of the tissue under examination. This can greatly reduce the risk of misdiagnosis.

[0031] In an advantageous embodiment of the surgical assistance system according to the invention, the group of devices also includes a device for acquiring position and / or orientation data of at least the distal end of the endomicroscope. This device can be either a navigation system or an image processing module of the operating microscope, in which the position and / or orientation data of the endomicroscope are determined based on at least one image acquired by the operating microscope and showing the distal end of the endomicroscope. The navigation system can "see" and thus acquire the distal end of a device inserted into the body. The OPMI can typically also see the proximal end and thus show its position relative to anatomical landmarks.Using the device for acquiring positional and / or orientation data, the pathologist can determine the position and orientation of the endomicroscope relative to the tissue under examination at any time. The pathologist can then communicate this positional and / or orientation data to the attending surgeon in the surgical field. This allows the pathologist to easily inform the surgeon how the endomicroscope must be positioned and / or oriented to acquire the cellularly resolved image required for pathological diagnosis. The surgeon can then use this positional and / or orientation data to position and / or orient the endomicroscope accordingly.

[0032] Furthermore, the group of devices of the surgical assistance system can include at least one surgical treatment device, wherein the position and orientation of at least one part of the surgical treatment device are detected by means of the device for acquiring position and / or orientation data. A positioning and orientation unit for positioning and orienting at least the part of the surgical treatment device is assigned to the surgical treatment device, wherein a position and orientation control unit for controlling the positioning and orientation of the part of the surgical treatment device is assigned to the positioning and orientation unit. The input unit of the pathology unit is then configured to input position and orientation data for the position and orientation control unit.Furthermore, the transmitter unit of the pathology unit is configured to send position and orientation data via the data connection to the data receiver unit of the group of devices. Finally, the data receiver unit of the group of devices is configured to forward the received position and orientation control data to the positioning and orientation unit. In this embodiment of the surgical assistance system according to the invention, the pathologist has the option of positioning and orienting the surgical treatment device as deemed appropriate based on the pathological diagnosis. The surgical treatment device can, in particular, be a suction device with a suction tip, wherein the suction tip forms the part of the surgical treatment device whose position and orientation are detected. However, other surgical treatment devices, such as surgical lasers, are also suitable.

[0033] However, when positioning and / or orienting the endomicroscope, operating microscope or surgical treatment device by the pathologist, it must be ensured that positioning and / or orientation can only take place if it has been approved by the treating surgeon on site and that the positioning and / or orientation can be aborted by the surgeon at any time in order to prevent damage to tissue in a timely manner.

[0034] Within the scope of the invention, the surgical assistance system can also be designed to generate an automated diagnosis. In this case, the pathology unit comprises a diagnostic database containing a number of stored diagnoses and a number of stored image information sets, in which at least one image information set characteristic of the respective diagnosis is assigned to each stored diagnosis. Furthermore, the pathology unit then comprises an image evaluation unit for extracting specific image information from the received cellularly resolved image data and / or the received overview image data, as well as a diagnostic unit that is connected to the image evaluation unit for receiving the extracted image information and to the diagnostic database for receiving the stored image information.Based on a comparison of the extracted image information with the received and stored image information, the diagnostic unit selects a diagnosis and displays it as a diagnostic suggestion on the display unit. This allows the pathologist to quickly receive an initial diagnostic suggestion. If the comparison reveals that the specific image information matches the characteristic image information of several diagnoses, the pathologist can be offered a preselection of possible diagnoses. The pathologist can then, as a first step, review the suggested diagnoses and either confirm or reject them. This preselection of possible diagnoses reduces the time required to establish a pathological diagnosis.

[0035] The surgical assistance system according to the invention offers the pathologist a wealth of possibilities with which to influence data acquisition and / or to provide information to the treating surgeon. Compared to diagnostic systems known from the prior art, the surgical assistance system according to the invention expands the possibilities for collaboration between the pathologist and the treating surgeon.

[0036] It should be noted that the image data acquired with the surgical assistance system can also be sent to the pathology system for purposes other than generating a pathological diagnosis. For example, instead of or in addition to a pathologist, another physician, such as a specialist for a particular treatment, may be present in the room housing the pathology unit to assist the surgeon in the operating room with that specific procedure. Similarly, an experienced surgeon can remotely support a less experienced surgeon, for instance, by drawing boundaries on the observation image of an operating microscope, indicating the limits within which the treating surgeon may incise. Pointing out peculiarities in the surgical field can also be done remotely without any problems.In this sense, the term "pathology system" in the surgical assistance system is merely a label that does not necessarily imply that a pathological diagnosis is made using the pathology system. Rather, the term "pathology system" should be understood as providing a physician outside the operating room with image information about the surgical field, enabling them to obtain useful additional information for the attending surgeon, which they can then transmit to the surgeon.

[0037] Further features, properties and advantages of the present invention will become apparent from the following description of exemplary embodiments with reference to the accompanying figures. Fig. Figure 1 shows a surgical assistance system according to the invention in a schematic representation. Fig. Figure 2 shows the typical structure of an operating microscope in a schematic representation. Fig. Figure 3 shows an objective lens for a surgical microscope, which replaces the one in Fig. The lens shown in section 2 can be used. Fig. Figure 4 shows a second embodiment of the surgical assistance system according to the invention. Fig. Figure 5 shows a stand with a microscope holder and an operating microscope attached to it. Fig. Figure 6 shows the degrees of freedom that the tripod and the mount have. Fig. 5 will be made available.

[0038] A first embodiment of the surgical assistance system according to the invention is described below with reference to Fig. 1 described. The figure schematically shows a group of devices 1 located in the operating room, as well as a pathology unit 70, which may be located outside the operating room. Typically, the pathology unit 70 is located away from the operating room in another room of the same building. However, it could also be located in a different building or even in a different city or country.

[0039] The group of devices 1 comprises an operating microscope 2, with which an operating field 3 can be viewed. The operating microscope 2 essentially provides an overview image of the operating field 3. Furthermore, the group of devices 1 includes an endomicroscope 4, with which cellularly resolved image data can be acquired at selected locations within the operating field 3. Both the operating microscope 2 and the endomicroscope 4 each have at least one electronic image acquisition unit, with which the acquired optical images can be converted into electronic images. This unit is connected to a transmitter 60, also belonging to the group of devices 1, which has a transmitter 63 and a receiver 64.

[0040] The pathology unit 70, located remotely from the group of devices 1, comprises a transmitter and receiver unit 72 with a transmitter 73 and a receiver 74, as well as a computer 75 equipped with a screen 76 as a display unit for image data and a keyboard 77 for data input. Of course, other devices for data input may also be present, but these are not shown here. In particular, interfaces for transferring data from external devices to the computer 57 are suitable. For example, a USB interface could be provided, allowing a USB flash drive containing data to be connected to the computer. However, drives such as CD-ROM drives or DVD drives can also be used to input data stored on data carriers.An expert will readily recognize other ways of entering data into the computer 75.

[0041] The transmitting and receiving unit 72 of the pathology unit 70 is connected to the transmitting and receiving unit 60 of the group of devices 1 via a bidirectional data line.

[0042] The following refers to the Fig. 2. The basic structure of the operating microscope is explained.

[0043] The in Fig. The surgical microscope 2 shown in Figure 2 comprises as essential components an objective 5 directed towards an object field 3, which can be designed, in particular, as an achromatic or apochromatic objective. In the present embodiment, the objective 5 consists of two cemented partial lenses forming an achromatic objective. The object field 3 is arranged in the focal plane of the objective 5 so that it is imaged to infinity by the objective 5. In other words, a divergent beam of light 7 emanating from the object field 3 is transformed into a parallel beam of light 9 as it passes through the objective 5.

[0044] On the observer side of the objective 5, a magnification changer 11 is arranged, which can be configured either as a zoom system for stepless changes in the magnification factor, as in the illustrated embodiment, or as a so-called Galilean changer for stepwise changes in the magnification factor. In a zoom system, which, for example, consists of a lens combination with three lenses, the two object-side lenses can be moved to vary the magnification factor. In fact, the zoom system can also have more than three lenses, for example, four or more lenses, in which case the outer lenses can also be fixed. In contrast, a Galilean changer has several fixed lens combinations that represent different magnification factors and can be alternately inserted into the beam path.Both a zoom system and a Galilean changer convert an object-side parallel beam of light into an observer-side parallel beam of light with a different beam diameter. In the present embodiment, the magnification changer 11 is already part of the binocular beam path of the operating microscope 1, i.e., it has its own lens combination for each stereoscopic partial beam path 9A, 9B of the operating microscope 1. In the present embodiment, the magnification factor is set using the magnification changer 11 via a motor-driven actuator, which, together with the magnification changer 11, forms part of a magnification changer unit for setting the magnification factor.

[0045] On the observer side, an interface arrangement 13A, 13B is connected to the magnification changer 11, via which external devices can be connected to the operating microscope 1 and which, in the present embodiment, comprises beam splitter prisms 15A, 15B. However, other types of beam splitters can also be used, e.g., partially reflective mirrors. In the present embodiment, the interfaces 13A, 13B serve to couple a beam of light out of the beam path of the operating microscope 2 (beam splitter prism 15B) or to couple a beam of light into the beam path of the operating microscope 2 (beam splitter prism 15A).

[0046] In the present embodiment, the beam splitter prism 15A in the partial beam path 9A serves to reflect information or data for a viewer into the partial beam path 9A of the operating microscope 1 via the beam splitter prism 15A, using a display 37, e.g., a digital mirror device (DMD) or an LCD display, and associated optics 39. In the other partial beam path 9B, a camera adapter 19 with an attached camera 21 is arranged at the interface 13B. The camera 21 is equipped with an electronic image sensor 23, e.g., a CCD sensor or a CMOS sensor. An electronic, and in particular a digital, image of the tissue area 3 can be captured using the camera 21. A hyperspectral sensor can also be used as the image sensor, in which not only three spectral channels (e.g., red, green, and blue) but a plurality of spectral channels are present.

[0047] A binocular tube 27 is connected to the interface 13 on the observer side. This tube has two objective lenses 29A, 29B, which focus the respective parallel beams of light 9A, 9B onto an intermediate image plane 31, thus imaging the observed object 3 onto the respective intermediate image planes 31A, 31B. The intermediate images located in the intermediate image planes 31A, 31B are then imaged to infinity by eyepiece lenses 35A, 35B, so that the observer can view the intermediate image with relaxed eyes. Furthermore, the distance between the two partial beams of light 9A, 9B is increased within the binocular tube by means of a mirror system or prisms 33A, 33B, in order to adapt it to the interpupillary distance of the observer. The mirror system or prisms 33A, 33B also erect the image.

[0048] The operating microscope 2 is also equipped with an illumination device that illuminates the object field 3 with broadband light. In this exemplary embodiment, the illumination device comprises a white light source 41, such as a halogen incandescent lamp or a gas discharge lamp. The light emitted from the white light source 41 is directed towards the object field 3 via a deflecting mirror 43 or a deflecting prism to illuminate it. The illumination device also includes an illumination optic 45, which ensures uniform illumination of the entire observed object field 3.

[0049] It should be noted that the in Fig. The lighting beam path shown in Figure 2 is highly schematic and does not necessarily represent the actual path of the lighting beam. In principle, the lighting beam path can be designed as so-called oblique lighting, which corresponds to the schematic representation in Figure 2. Fig. 2 comes closest. In such oblique illumination, the beam path runs at a relatively large angle (6° or more) to the optical axis of the lens 5 and can, as in Fig. As shown in Figure 1, the illumination beam can run entirely outside the lens. Alternatively, the oblique illumination beam can also pass through an edge region of the lens 5. Another possible arrangement of the illumination beam is the so-called 0° illumination, in which the illumination beam passes through the lens 5 and is coupled into the lens between the two partial beam paths 9A and 9B, along the optical axis of the lens 5 in the direction of the object field 3. Finally, the illumination beam can also be implemented as a so-called coaxial illumination, in which a first and a second partial illumination beam path are present.The partial beam paths are coupled into the operating microscope via one or more beam splitters parallel to the optical axes of the observation partial beam paths 9A, 9B, so that the illumination runs coaxially to the two observation partial beam paths.

[0050] In the Fig. In the operating microscope shown in Figure 2, the illumination can be controlled. For example, a filter 47 can be inserted into the illumination beam path, which allows only a narrow spectral range from the broad spectrum of the white light source 41 to pass through, e.g., a spectral range with which the fluorescence of a fluorescent dye located in the object field 3 can be excited. To observe the fluorescence, filters 37A and 37B can be inserted into the observation beam paths, which filter out the spectral range used for fluorescence excitation in order to observe the fluorescence.

[0051] The lighting device can also be equipped with a unit for changing the light source. This is in Fig. 2 is indicated by a system for replacing the white light source 41 with a laser 49. Using a laser as a light source, in particular an infrared laser, in conjunction with a suitable image sensor 23, enables, for example, laser Doppler imaging or laser speckle imaging. In the present embodiment, the unit for changing the illumination light source is motor-driven and can be controlled by the pathology unit 70 using suitable control data.

[0052] In the Fig. In the embodiment of the operating microscope 2 shown in Figure 2, the objective 5 consists solely of an achromatic lens. However, an objective lens system consisting of several lenses can also be used, in particular a so-called variable-angle objective, with which the working distance of the operating microscope 2, i.e., the distance of the object-side focal plane from the vertex of the first object-side lens surface of the objective 5, also called the focal length, can be varied. The object field 3, arranged in the focal plane, is also imaged to infinity by the variable-angle objective 50, so that a parallel beam of light is present on the observer side.

[0053] An example of a varifocal lens is shown schematically in Fig. Figure 3 shows the Vario lens 50 comprising a positive element 51, i.e., an optical element with positive refractive power, which is in Fig. 3 is schematically represented as a convex lens. Furthermore, the Vario lens 50 includes a negative element 52, i.e., an optical element with negative refractive power, which is in Fig. Figure 3 schematically depicts a concave lens. The negative element 52 is located between the positive element 51 and the object field 3. In the depicted varifocal lens 50, the negative element 52 is fixed, whereas the positive element 51, as indicated by the double arrow 53, is displaceable along the optical axis OA. When the positive element 51 is in the Fig. When the position shown in dashed lines is moved, the cutting distance increases, so that the working distance of the operating microscope 2 from the object field 3 changes.

[0054] Although in Fig. Since the positive element 51 is designed to be movable, it is also possible, in principle, to arrange the negative element 52 to be movable along the optical axis OA instead of the positive element 51. However, the negative element 52 often forms the end lens of the varifocal objective 50. A fixed negative element 52 therefore offers the advantage that the interior of the operating microscope 2 can be more easily sealed against external influences. Furthermore, it should be noted that, although the positive element 51 and the negative element 52 are in Fig. 3 are shown only as individual lenses, each of these elements can also be realized as a lens group or cemented element instead of as a single lens, e.g. to make the varifocal lens achromatic or apochromatic.

[0055] The operating microscope 2 is connected to a functional control unit 65. This unit has a number of functional control subunits through which functions of the operating microscope 2 can be controlled. For example, the position of the zoom system 11 for setting the magnification factor of the operating microscope, the position of the filters 37A, 37B, and 47 for enabling fluorescence observation, the type of light source used 41, 49 for enabling laser Doppler imaging or laser speckle imaging, etc., can be set via the functional control subunits. If the operating microscope 2 is equipped with a varioscope objective, the working distance of the operating microscope from the object field 3 can also be set using a functional control subunit of the functional control unit 65.

[0056] The surgical assistance system according to the invention enables images acquired with the operating microscope 2 and the endomicroscope 4 to be transmitted to the pathology unit 70 by means of the transmitter unit 63 of the transmitter and receiver unit 60 of the group of devices 1. There, the transmitted image data is received by the receiver unit 74 and forwarded to the computer 57 for display on the monitor 76. A pathologist can then view the images on the monitor and make a pathological diagnosis. Because a bidirectional data connection 69 exists between the transmitter and receiver unit 60 of the group of devices 1 and the transmitter and receiver unit 72 of the pathology system 70, the pathologist can send instructions, data, and information to the group of devices 1.These can include, for example, functional control data that acts on the display 37 of the operating microscope 2 to overlay instructions, data, or information onto the observation beam path of the operating microscope 2. Such instructions, data, or information can be, for example, text data that can be used to send instructions to the surgeon, such as for positioning the operating microscope or the endomicroscope. However, instead of text (or in addition to text), the instructions or information can also be provided as a pointer that indicates the position in the observation image where further images should be obtained using the endomicroscope. The treating surgeon can then position the endomicroscope with pinpoint accuracy. This can be important, for example, if the pathologist needs further images of specific tissue areas to make a pathological diagnosis.If the pathologist has already made a pathological diagnosis, it is also possible to mark, for example, the tissue areas that need to be surgically removed by appropriately superimposing them into the observation beam path. This can be done, for instance, by defining the outline of the tissue to be removed based on the overview image displayed on monitor 76 and then sending these outlines, in the form of functional control data containing information about the outlines, to the functional control unit 65. The functional control unit then controls the display on screen 37 based on the received data. Instead of using outlines, the pathologist can also mark the tissue to be removed by overlaying color images onto the corresponding areas of the overview image, thus color-coding the tissue to be removed.Accordingly, the function control data sent to the function control unit 65 would then contain image data of the color overlay images. Of course, it is also possible, in addition to or as an alternative to displaying the data in the observation beam path of the operating microscope, to display the data sent by the pathologist on a monitor in the operating room.

[0057] In addition to transmitting information to the treating surgeon via image data, it is also possible to transmit audio data to the group of devices 1, provided they include a speaker. In this case, it is advantageous if the group of devices 1 also includes a microphone, so that the treating surgeon and the pathologist can speak directly to each other.

[0058] In the event that the pathologist requires further image data for their diagnosis, in addition to giving instructions to the surgeon, the pathologist can also remotely access functions of, for example, operating microscope 2, to change the magnification of the overview image or to switch various observation modes, such as fluorescence spectroscopy, laser Doppler imaging, or laser speckle imaging, on and off. The pathologist can also remotely adjust the working distance of operating microscope 2.

[0059] With the aid of the surgical assistance system, the pathologist can very quickly make a pathological diagnosis based on intraoperatively acquired images, especially since the endomicroscope 4 enables the acquisition of cellularly resolved images. The pathologist can orient themselves within the surgical field 3 using the overview image obtained with the operating microscope 2. In this way, the pathologist is not only able to establish a pathological diagnosis of a specific tissue, but also to consider the location of the diagnosed tissue within the surgical field 3. Furthermore, the acquisition of additional data, such as fluorescence data, laser Doppler data, laser speckle data, etc., provides a more comprehensive dataset than with frozen section analysis or the previously described state-of-the-art systems. This also allows for the involvement of other specialists, such as radiologists, neurologists, etc.to assess the tissue. The surgical assistance system thus enables real-time consultation between a treating surgeon and a pathologist and / or specialists located at a remote location, with essentially the same image information available to all participating physicians. Furthermore, through controlling interventions, the participating physicians can each obtain the image data required for their diagnosis.

[0060] A second embodiment of a surgical assistance system according to the invention is described in Fig. 4 shown.

[0061] The second embodiment of the surgical assistance system differs from the first embodiment primarily in that the number of devices in the group of devices is increased and that the transmitting and receiving unit of the group of devices, as well as the transmitting and receiving unit in the pathology unit, are each integrated into a computer 160 or 175, respectively. The two computers 160 and 175 are connected to each other via a bidirectional data line 105. Furthermore, in the second embodiment, the pathology unit is also enhanced with additional functionalities.

[0062] The group of devices 101 of the second embodiment comprises, in addition to an operating microscope 102 and an endomicroscope 104 for obtaining an overview image or a cell-resolved image of an object field 103, a surgical aspirator 107 and a navigation system 109. The navigation system 109 can determine the position data and, if applicable, the orientation data of the operating microscope 102, the tip of the endomicroscope 104, and the tip 108 of the aspirator 107 with respect to the object field 103. The image data acquired by the endomicroscope 104 or the operating microscope 102 can then be assigned coordinates, from which a position and, if applicable, an orientation with respect to the object field 103 can be determined. This data is combined with the overview image or cell-resolved image obtained with the operating microscope 102.The cell-resolved image acquired with the endomicroscope 104 is transmitted to the pathology unit 170, where it can be superimposed onto the respective image. This makes it possible to display the coordinates of the tip of the endomicroscope 104 in the overview image, thus marking the location of the cell-resolved images. Furthermore, it is possible to transmit new positions, for example, at which cell-resolved images should be acquired, to the treating surgeon in the form of navigation data.

[0063] In the present embodiment, the operating microscope 102 is also mounted on a motor-driven stand 201. By inputting navigation data, the operating microscope 102 can therefore be automatically adjusted in its orientation and position, making it possible to position or orient the operating microscope 102 remotely so that a specific section of the object field 103 is optimally displayed. For this purpose, a functional control unit 111 is assigned to the stand 201, which uses suitable actuators to position or orient the operating microscope 102 based on received position and / or orientation control data. The functional control unit 111 can receive position and / or orientation data either from the computer 160 located in the operating room 160 or from the pathology unit 170.The following section describes the stand 201 and the degrees of freedom enabled by the stand for the operating microscope 102 based on the . Fig. 5 and Fig. 6 described in more detail.

[0064] In the Fig. In the example shown for a tripod 201, the tripod rests on a tripod base 205, on the underside of which are rollers 206 that allow the tripod 201 to be moved. To prevent unintentional movement of the tripod 201, the tripod base 205 also has a foot brake 207.

[0065] The actual stand 201 comprises, as stand components, a height-adjustable stand column 208, a support arm 209, a spring arm 210, and a microscope suspension 211, which in turn includes a connecting element 213, a swivel arm 215, and a holding arm 214. The degrees of freedom that the stand components provide for positioning the operating microscope 102 are in Fig.Figure 6 shows that the support arm 209 is rotatably connected at one end to the stand column 208 about an axis A. At the other end of the support arm 209, one end of the spring arm 210 is rotatably attached about an axis B parallel to axis A, so that the support arm 209 and the spring arm 210 form an articulated arm. The other end of the spring arm 210 is formed by a tilting mechanism (not shown) to which the microscope suspension 211 is attached, allowing the microscope suspension 211 to tilt about axis C.

[0066] The microscope suspension 211 has a rotation axis D, a pivot axis E, and a tilt axis F about which the microscope 102 can be rotated, pivoted, or tilted. The microscope suspension 211 is rotatably attached to the outer end of the spring arm 210 about the rotation axis D by a connecting element 213. The rotation axis D extends along the connecting element 213. A pivot arm 215 is attached to the connecting element 213, and the microscope 102, or more precisely, a support arm 214 attached to the pivot arm 215, to which the microscope 102 is attached by means of a microscope holder (not shown), can be pivoted about the pivot axis E. The pivot axis E extends through the pivot arm 215. The angle between the pivot arm 215 and the connecting element 213, i.e., the angle between the pivot axis E and the rotation axis D, can be varied by means of an adjustment mechanism arranged between the connecting element 213 and the pivot arm 215.

[0067] The tilting axis F runs perpendicular to the plane of representation through the support arm 214, allowing the operating microscope 102 to be tilted. The operating microscope 102 is attached to the support arm 214 by means of a microscope mount (not shown).

[0068] The degrees of freedom of the microscope suspension 211 and the adjustment options of the operating microscope 102, e.g., focus, sharpness, magnification, etc., can be adjusted via an adjustment device 202, which in this embodiment is shown as a foot control panel. However, it can also be implemented as a hand control element or as a combination of both. Furthermore, remote control via the pathology unit is possible.

[0069] To prevent unintentional movement of the microscope 102 from a selected position, the stand sections or the joints between the stand sections are equipped with brakes (not shown) which are locked after the microscope 102 has been positioned. Both manually and electrically operated brakes are suitable.

[0070] Although the stand 201 has been described using a specific example, a person skilled in the art will recognize that other types of stands can also be used. Likewise, it is possible to mount the endomicroscope 104 and / or the suction unit 107 on a motorized stand, enabling positioning and / or orientation of the respective device based on position control data and / or orientation control data.

[0071] In the present embodiment, the endomicroscope 104 is associated with a functional control unit 113, which allows functions of the endomicroscope 104, such as the type of illumination, to be set using suitable functional control parameters. If the endomicroscope 104 is mounted on a motorized, movable stand, the functional control unit can also be used to position and / or orient the distal end of the endomicroscope 104 relative to the object field 103 using position and / or orientation data. However, it must be ensured that no damage to the tissue in the object field 103 occurs during powered positioning. Therefore, positioning should only be possible with the authorization of the treating surgeon and should be monitored by the surgeon.The surgeon must always have the option to override remotely controlled positioning initiated by the pathology unit 170, so that he can cancel the automatic positioning at any time if necessary.

[0072] According to the second embodiment, the group of devices 101 of the surgical assistance system also includes a surgical suction device 107, for example, for tumor removal. The position of the suction tip 108 of the suction device 107 can be tracked using the navigation system 109. Furthermore, it is possible to control the position of the suction tip 108 from the pathology system 170 using position and / or orientation data. This data is then transmitted to a functional control unit 115, which enables the positioning and / or orientation of the suction tip 108 relative to the object field 103 by means of a suitable motor-driven stand.

[0073] As mentioned above, in the present embodiment, the transmitting and receiving unit of the group of devices 101 is located in a computer 160 situated in the operating field, which can also transmit functional control data from the operating room to the respective functional control units or functional control subunits. Furthermore, the presence of the computer 160 in the operating room allows it to display on its monitor precisely the image that the pathologist sees on the monitor 176 of the computer 175 in the pathology department.

[0074] In the present embodiment, the transmitting and receiving unit of the pathology system 170 is also located in a computer 175. Furthermore, the pathology unit 170 of this embodiment includes a diagnostic database 117, an image evaluation unit 119, and a diagnostic unit 121. The image evaluation unit 119 is connected to the receiving unit of the pathology system 170 for receiving the cellularly resolved image data and the overview image data. It serves to extract specific image information from the received cellularly resolved image data and / or the received overview image data. For example, if the cellularly resolved image data and / or the overview image data contain fluorescence images, the image evaluation unit 119 can be used, for instance, to locate areas with characteristic fluorescence radiation.Another possibility is to extract certain spectral characteristics when using a hyperspectral sensor to capture the images.

[0075] The diagnostic unit 121 is connected to the image evaluation unit 119 to receive the extracted image information. It is also connected to the diagnostic database 117, which contains a number of stored diagnoses and a number of stored image data points. Each diagnosis is assigned at least one stored image data point in the diagnostic database 117 that is characteristic of the respective diagnosis. The diagnostic unit 121 then compares the characteristic image data points in the diagnostic database 117 with the image data extracted from the image data. If the comparison of the extracted image data results in a match with characteristic image data from the diagnostic database 117, the diagnostic unit 121 displays the diagnosis assigned to the characteristic image data points as a diagnostic suggestion on the screen 176. The pathologist then has the option of verifying or rejecting this diagnosis.If the diagnosis is rejected, the pathologist establishes a new diagnosis based on the cell-resolved images and the overview image. If necessary, the real-time connection between the operating room and the room housing the pathology system allows the surgeon and pathologist to collaboratively determine the site for a conventional tissue sample. Thus, if a pathological diagnosis is not possible based on the cell-resolved image in conjunction with the overview image, the pathologist can at least use the overview image to indicate where a sample should be taken. This increases the likelihood of establishing an accurate diagnosis based on a frozen section. If the room housing the pathology system is located not too far from the operating room, the sampled tissue can be sent to the pathologist.For further tissue examination, it is advantageous if the pathology system 170 has connections for additional devices, such as a conventional light microscope 123 or a conventional laser scanning microscope 125 as in-vitro diagnostic systems. Alternatively, such in-vitro diagnostic systems can be set up in a room adjacent to the operating room, and the image data acquired can be transmitted to the pathology system via the data line. In this case, the transport time for the tissue is eliminated, as it does not need to be transported to the pathologist.

[0076] In the surgical assistance system according to the second embodiment, the pathologist can, for example, send navigation data to the functional control unit 115 of the surgical aspirator 107, reflecting the identified tumor locations. These locations can then be approached using a motorized stand. Alternatively, they can be approached manually, with the current position then displayed, for example, by the collimation device of the operating microscope 102 in the observation beam path. The surgeon can then position the suction tip 108 of the surgical aspirator 107 so that its position corresponds to the displayed coordinates. Additionally or alternatively, instead of coordinates, it is also possible to display a graphic representation of the position and orientation of the suction tip 107, as it is to be positioned and oriented for aspirating the tumor cells, in the observation beam path.The surgeon can then position the suction tip 108 by aligning it with the superimposed image.

[0077] If preoperative data are available and the intraoperative data differ from the preoperative data, for example due to tissue movements such as brain shift, the tumor locations determined by the pathologist can also be used to update the preoperative data, i.e. to correct a displacement of tissue occurring during the operation (e.g. brain shift).

[0078] Furthermore, the pathologist may remotely select suitable illumination to enhance the visibility of tumor sites. For example, fluorescence excitation could be considered if the tumor emits fluorescent light at a different intensity than healthy tissue.

[0079] The pathology system 170 can also include a portable computer or tablet 127 on which the received cellular image data and / or the received overview data can be displayed. The pathologist does not necessarily need to be at the location of the pathology system 170 if, for example, it is connected to the portable computer or tablet 127 via a wireless connection. In particular, it is also possible for the pathology system 170 to consist solely of the portable computer or tablet 127 as a monitor and input unit. Other functions of the pathology unit 170, such as the transmitting and receiving units, and optionally the diagnostic database 117, the image evaluation unit 119, and the diagnostic unit 121, can then be housed on a server.Furthermore, it is possible to consult a dispersed team of doctors if the pathology system 170 includes several tablets 127, to which the pathology system 170 server provides the image information requested by the respective doctor.

[0080] The present invention has been explained using two exemplary embodiments for illustrative purposes. However, it is clear to a person skilled in the art that deviations from these embodiments are possible. For example, the diagnosis can, in principle, also be performed solely using the diagnostic database, the image evaluation unit, and the diagnostic unit. In this case, the pathology system can also be located within the operating room. Furthermore, the operating microscope can have more than one image display device. Here, for example, it is desirable that not only one of the two stereo channels is equipped with an image display device, but both stereo channels. This makes it possible to couple stereoscopic image data into the observation beam path, which can be particularly advantageous if such image data is to be used for positioning a surgical instrument or the endomicroscope.If, for example, an image of the device in the position and orientation to which it is to be placed is superimposed into the observation beam path as a positioning aid, and the positioning is achieved by aligning the real device with the superimposed image, then stereoscopic superimposition of the image is advantageous. It is also possible to extract an image for the pathologist not only from one stereoscopic partial beam path, but from both stereoscopic partial beam paths. The pathologist can then obtain a stereoscopic image of the object field. A head-mounted display, for example, can be used as the display on which the image is shown. This allows the pathologist to be presented with exactly the same image as the surgeon sees when looking through the operating microscope. Furthermore, it is also possible to design the operating microscope to be fully digital, i.e.,Instead of an optical view into the operating microscope, two image sensors can be provided, and the image can be displayed to the surgeon via an electronic viewer or a head-mounted display. In this case, a beam extraction for generating the overview image for the pathologist can be omitted, as this can be generated using the image sensors that capture the image for the surgeon. The optical device for data overlay can also be dispensed with, since data transmitted by the pathologist can be electronically superimposed onto the image presented to the surgeon. Furthermore, the group of devices can additionally or alternatively include other devices not shown in the exemplary embodiments. For example, the group of devices could include, in addition to or as an alternative to the suction tip, a treatment laser for tissue coagulation or for making incisions.Furthermore, it is possible to dispense with the navigation system and determine the location of, for example, the tip of the endomicroscope or the suction tip using the image data acquired by the operating microscope. A suitable system for this is described, for example, in US 2011 / 0178395 A1, the content of which is referenced with regard to determining the positional data from the image data of the operating microscope. The present invention is therefore not limited to combinations of features of the described embodiments, but only to the content of the appended claims. Reference symbol list 1 group of devices 2 Operating microscopes 3. Operational field 4 Endomicroscope 5 lens 7 divergent beam 9 beams 9A, 9B stereoscopic partial beam path 11 magnification changers 13A, 13B Interface Arrangement 15A, 15B beam splitter prism 19 camera adapters 21 camera 23 Image sensor 27 Binocular tube 29A, 29B Tube objective 31A, 31B Intermediate image plane 33A, 33B Prism 35A, 35B eyepiece lens 37 Display 39 Optics 40A,40B spectral filters 41 White light source 43 Deflection mirrors 45 Lighting optics 47 spectral filters 49 lasers 50 Vario lens 51 positive term 52 negative term 53 Displacement path 60 Transmitting and receiving units 63 transmitting units 64 receiver units 65 Function control unit 69 Data connection 70 Pathology Unit 72 Transmitting and receiving unit 73 transmitting unit 74 receiving unit 75 computers 76" Monitor 77 keyboard 101 group of devices 102 Operating microscope 103 object field 104 Endomicroscope 105 Bidirectional data line 107 Surgical suction device 108 Suction tip 109 Navigation system 111 Functional control unit 113 Functional control unit 115 Function control unit 117 Diagnostic Database 119 Image evaluation unit 121 Diagnostic Unit 123 Light microscope 125 Laser Scanning Microscope 127 Tablet 201 Tripod 202 Foot switch 205 Tripod foot 206 roll 207 Foot brake 208 Tripod column 209 Support arm 210 spring arm 211 Microscope suspension 213 Connecting element 214 Holding arm 215 Swivel arm

Claims

[1] Surgical assistance system comprising a group of devices (1, 101), a pathology unit and a bidirectional data link (69, 105) between a transmitting and receiving unit (72) of the pathology unit (70, 170) and a transmitting and receiving unit (60) of the group of devices (1, 101), wherein a) the group of devices (1, 101) includes at least: - an endomicroscope (4, 104) for acquiring cell-resolved image data from a surgical field (3, 103), - an operating microscope (2, 102) with at least one observation beam path for displaying an observation image for recording overview image data of the operating field (3, 103), wherein the endomicroscope (4, 104) and the operating microscope (2, 102) each contain at least one functional unit or are assigned at least one functional unit, wherein a functional control unit (65) for controlling the functional unit is assigned to the respective functional unit, and the transmitting and receiving unit (60) comprises a transmitting unit (63) for transmitting the acquired cellularly resolved image data and / or the acquired overview image data to the pathology unit (70, 170) and a data receiving unit (64) configured for receiving functional control data from the pathology unit (70, 170) and for forwarding the received functional control data to the respective functional control unit (65), b) which has at least one pathology unit (70, 170): - an input unit (77) for entering function control data for the at least one function control unit (65) of the group of devices (1, 101), - a display unit (76) for displaying received cellularly resolved image data and / or the received overview image data, wherein the transmitting and receiving unit (72) is equipped with a receiving unit (74) connected to the transmitting unit (63) of the group of devices (1, 101) for receiving the cellularly resolved image data and / or the overview image data and with a transmitting unit (73) for sending the function control data to the data receiving unit (64) of the group of devices (1, 101). [2] Surgical assistance system according to claim 1, characterized by, that a motor-driven positioning and / or orientation device (201) for positioning and / or orienting the imaging device (102) and / or the endomicroscope (104) is provided as a functional unit and the functional control data include position and / or orientation control data for the imaging device (102) and / or the endomicroscope (104). [3] Surgical assistance system according to claim 1 or claim 2, characterized by , that as a functional unit, an image superimposition device (37) acting on the observation beam path for superimposing the observation image with a superimposition image, and that the functional control data contain image data of a superimposition image. [4] Surgical assistance system according to one of claims 1 to 3, characterized by , that the operating microscope (2, 102) is assigned a focusing unit (50) as a functional unit and the functional control data includes focusing control data. [5] Surgical assistance system according to any one of claims 1 to 4, characterized by , that the operating microscope (2, 102) is assigned a magnification change unit (11) as a functional unit and the functional control data includes magnification change control data. [6] Surgical assistance system according to any one of claims 1 to 5, characterized by , that the operating microscope (2) as a functional unit includes a device for generating a fluorescence excitation (47) in the operating field (3) and that the functional control data include control data for controlling the device for generating a fluorescence excitation (47). [7] Surgical assistance system according to any one of claims 1 to 6, characterized by, that the operating microscope (2) as a functional unit includes a device for recording fluorescence data (40A, 40B) and the functional control data includes control data for controlling the device for recording fluorescence data (40A, 40B). [8] Surgical assistance system according to any one of claims 1 to 7, characterized by , that the operating microscope (2, 102) comprises as a functional unit a laser Doppler imaging device and / or as a functional unit a laser speckle interferometry device and / or as a functional unit an image acquisition device having a hyperspectral sensor, and that the functional control data includes control data for controlling the laser Doppler imaging device and / or control data for controlling the laser speckle interferometry device and / or control data for controlling the image acquisition device having a hyperspectral sensor. [9] Surgical assistance system according to any one of claims 1 to 8, characterized by , that the group of devices (101) also includes a device for recording position and / or orientation data (109) of at least the distal end of the endomicroscope (104). [10] Surgical assistance system according to claim 9, characterized by , that the device for acquiring position and / or orientation data of the distal end of the endomicroscope (104) is a navigation system (109). [11] Surgical assistance system according to one of claims 1 to 8 and claim 9, characterized by , that the device for capturing position and / or orientation data is an image processing module of the operating microscope in which the position data and / or orientation data (109) of the endomicroscope (104) are determined on the basis of at least one image taken by means of the operating microscope (102) and including the distal end of the endomicroscope (104). [12] Surgical assistance system according to any one of claims 9 to 11, characterized by , that - the group of devices (101) includes at least one surgical treatment device (107), - the position and orientation of at least one part (108) of the surgical treatment device (107) are recorded by means of the device for recording position and / or orientation data (109), - a positioning and orientation unit for positioning and orienting at least part (108) of the surgical treatment device (107) is associated with the surgical treatment device (107), wherein a position and orientation control unit for controlling the positioning and orientation of part (108) of the surgical treatment device (107) is associated with the positioning and orientation unit, - the input unit of the pathology unit (170) is designed to input position and orientation control data for the position and orientation control unit, - the transmitting unit of the pathology unit (170) is designed to transmit the position and orientation control data via the data link (105) to the data receiving unit of the group of devices (101) and - the data receiving unit of the group of devices (101) is designed to transmit the received position and orientation control data to the positioning and orientation unit. [13] Surgical assistance system according to claim 12, characterized by , that the surgical treatment device is a suction device (107) with a suction tip (108) which forms the part of the surgical treatment device whose position and orientation are detected. [14] Surgical assistance system according to any one of claims 1 to 13, characterized by, that the pathology unit (170) comprises: - a diagnostic database (117) containing a number of stored diagnoses as well as a number of stored image information, in which each of the stored diagnoses is assigned at least one image information characteristic of the respective diagnosis from the number of stored image information, - an image evaluation unit (119) for extracting specific image information from the received cellularly resolved image data and / or the received overview image data and - a diagnostic unit (121) connected to the image evaluation unit (119) for receiving the extracted image information and to the diagnostic database (117) for receiving the stored image information and the associated stored diagnoses, which selects a diagnosis based on a comparison of the extracted image information with the received stored image information and displays this as a diagnostic suggestion on the display unit.

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