Method and system for video documentation of a medical procedure

Abstract

Method for video documentation of a medical procedure, comprising the steps: - recording the medical procedure with at least one video camera (11,120) to obtain video data; - storing the video data recorded by the at least one video camera (11, 120) in a first temporary storage element (130); and - Setting a marker at at least one position of the video data corresponding to a relevant portion of the medical procedure; wherein after setting a marker, a section of the video data with a predetermined or predeterminable length and in a predetermined or predeterminable temporal relation to the position of the marker is copied and stored in a second, permanent storage element (200); characterized in that the setting of a marker is triggered automatically when - a predetermined or predeterminable medical instrument (21, 25) is activated or deactivated, or - operating parameters of a predetermined or predeterminable medical device (20, 30, 40) change or are changed, or - the achievement of a predetermined or predeterminable phase of the medical procedure is determined.

Description

[0001] The invention relates to a method for video documentation of a medical procedure, comprising the steps of: recording the medical procedure with at least one video camera to obtain video data; storing the video data recorded by the at least one video camera in a first, temporary storage element; and setting a marker at at least one position of the video data which corresponds to a relevant section of the medical procedure; wherein after setting a marker, a section of the video data with a predetermined or predeterminable length and in a predetermined or predeterminable temporal relationship to the position of the marker is copied and stored in a second, permanent storage element.

[0002] The invention further relates to a system for video documentation of a medical procedure, comprising: a video camera for recording the medical procedure and for generating video data, a first, temporary storage element for storing the video data, a second, permanent storage element for storing one or more sections of the video data, and a control device which is configured to set markers at positions of the video data which correspond to relevant sections of the medical procedure, and to copy sections of the video data with a predetermined or predeterminable length and in a predetermined or predeterminable temporal relationship to the position of the marker from the first, temporary storage element and to store them in the second, permanent storage element.

[0003] Corresponding methods and systems are known, for example, from patent US7231135B2. They are used to separate and permanently store relevant sections from the extensive video material generated during modern medical procedures.

[0004] Technical advances in video technology have made medicine better and safer. For example, many endoscopic procedures have only become possible thanks to the ability to observe the surgical site with video endoscopes and display the video image live on a monitor for the attending physician.

[0005] Video cameras are also used in open surgery to make the procedure visible to people who are not directly in contact with the patient, such as students or external experts.

[0006] The availability of video images from medical procedures is also of great importance for quality assurance in medicine. The video data generated during a procedure can be stored to document the proper course of the procedure.

[0007] However, this documentation generates immense amounts of data. For example, the data volume of a 2-hour video recording in HD quality is approximately 2.5 GB, and at 4K resolution, even 10 GB. In a small hospital with five operating rooms and six hours of recording per day, this can generate up to 8 TB of data per year.

[0008] Managing such volumes of data is no small feat. Conventional PACS (Picture Archiving and Communication Systems) systems for archiving medical image data are quickly overwhelmed.

[0009] To reduce the amount of data to be stored, generic procedures and systems were developed. Here, the attending physician can manually trigger the insertion of a marker into a video recording. After the procedure is completed, an automated process copies short excerpts from the video recording, each containing a marker, and transfers them to a permanent storage device, for example, an archiving system for image and video data.

[0010] This can significantly reduce the amount of data generated during video documentation. However, the existing systems and methods also have disadvantages.

[0011] Thus, the complete documentation of relevant procedural sections depends solely on the attending physician placing markers at the correct location in the video. This typically requires the activation of a finger or foot switch. If the physician forgets to place a marker at a relevant stage of the procedure, or fails to correctly press the finger or foot switch, which is normally operated blindly, no marker will be placed in the video, and the corresponding section of the procedure will not be included in the permanently stored documentation.

[0012] Furthermore, unexpected complications can arise during a procedure. In such cases, the attending physician is usually fully occupied with responding to the complication and cannot simultaneously initiate marker placement. At the same time, the relevant section of the video data would be of great importance for a subsequent investigation into the causes of the complications.

[0013] It is therefore the object of the invention to provide a method and a system for video documentation of a medical procedure, which is improved with regard to the described problem.

[0014] This object is achieved according to one aspect of the invention by a method for video documentation of a medical procedure, comprising the steps of: recording the medical procedure with at least one video camera in order to obtain video data; storing the video data recorded by the at least one video camera in a first, temporary storage element; and setting a marker at at least one position of the video data which corresponds to a relevant section of the medical procedure; wherein after setting a marker, a section of the video data with a predetermined or predeterminable length and in a predetermined or predeterminable temporal relationship to the position of the marker is copied and stored in a second, permanent storage element;which method is further developed in that the setting of a marker is automatically triggered when a predetermined or predeterminable medical instrument is activated or deactivated, or when operating parameters of a predetermined or predeterminable medical device change or are changed, or when the reaching of a predetermined or predeterminable phase of the medical procedure is detected;

[0015] This ensures that potentially relevant sections of the procedure are marked in the video data with a marker, even without interaction from the attending physician, and that the corresponding video data is subsequently copied to the second, permanent storage element. This reliably prevents any corresponding video data from being inadvertently lost.

[0016] A video camera within the meaning of the invention can be a fixed or movable room camera or a boom-arm camera. Endoscopic cameras, video endoscopes, or video surgical microscopes are also considered. However, the term "video camera" within the meaning of the invention can also encompass non-optical imaging devices that provide a live image, such as ultrasound devices or fluoroscopes.

[0017] The marker can be set in different ways. A marker can be a predetermined data structure inserted directly into the video data, for example, between two frames. Alternatively, a marker can consist of one or more pixels of one or more frames that are manipulated in a predetermined manner. A marker can also be a predetermined data structure inserted into the metadata associated with the video data.

[0018] Activating a medical instrument can involve connecting the corresponding medical instrument to a power supply, such as an electrosurgical generator. The medical instrument can be identified by automatic instrument recognition. Deactivating a medical instrument can involve disconnecting the medical instrument from the power supply.

[0019] Alternatively, activating a medical instrument can involve placing it in a predetermined operating state, in which, for example, a specific function is performed by the medical instrument. This can involve the release of mechanical and / or electrical energy.

[0020] Operating parameters of a medical device can include, for example, the output pressure of an insufflator, the flow rate of a lavage pump, or similar operating parameters. Such operating parameters can be intentionally changed by a user. However, a change in operating parameters can also occur without the user's influence, for example, if the device malfunctions.

[0021] The detection of a predetermined or predeterminable phase of a medical procedure can be achieved in a variety of ways, using various data available during the procedure. For example, audio data recorded in an operating room can be evaluated using speech recognition to determine the respective phase of the procedure based on the use of certain key terms. Alternatively or additionally, automatic image analysis of the recorded video data can be used. For example, the complete exposure of the bile artery and bile duct during a cholecystectomy or the access to the cecum during a colonoscopy can be detected using image analysis of the video data, and appropriate markers can be set.

[0022] In a further development of a method according to the invention, the setting of additional markers can be triggered manually. Thus, the attending physician can set additional markers in addition to the automatically set markers to document sections of the procedure that he or she considers relevant.

[0023] Manually setting a marker can be triggered via familiar user interfaces, such as foot or finger switches or via a touch screen.

[0024] It may further be provided that the setting of additional markers occurs automatically at predetermined or predeterminable times during the procedure.

[0025] Various medical procedures, such as cholecystectomies or colonoscopies, are highly standardized, so that relevant parts of the procedure always take place at known times. In this case, additional markers can be automatically set at these times.

[0026] In a preferred embodiment of a method according to the invention, the first temporary storage element is a ring buffer or comprises such a ring buffer.

[0027] For the purposes of the invention, ring buffers refer to storage elements configured to overwrite older data when new data is recorded. For example, a ring buffer can be dimensioned to store approximately 30 minutes of video data. Video data older than 30 minutes is then overwritten by new video data, so that the ring buffer always contains the video data from the last 30 minutes.

[0028] A ring buffer can be integrated directly into the video camera, for example as part of a time-shift recording functionality.

[0029] The first, temporary storage element and the second, permanent storage element can be a physical storage element that is logically divided into two memory areas. The physical storage element should be large enough to simultaneously include a sufficiently large circular buffer as the logical first storage element and a logical second storage element on which the selected sections of the complete procedure can be stored.

[0030] The section of video data that is copied after a marker is set and stored in the second, permanent storage element can include a preceding section that was recorded before the marker was set. This makes it possible to identify the causes of the disturbance or complication in the video data, particularly in the event of disturbances or complications.

[0031] Alternatively or additionally, the section of video data may include a trailing section recorded after the marker was set. This is particularly useful if the marker is set automatically or manually at the beginning of a relevant procedural section.

[0032] The object is achieved according to a further aspect of the invention by a system for video documentation of a medical procedure, comprising: a video camera for recording the medical procedure and for generating video data, a first, temporary storage element for storing the video data, a second, permanent storage element for storing one or more sections of the video data, and a control device configured to set markers at positions of the video data that correspond to relevant sections of the medical procedure, as well as to copy sections of the video data with a predetermined or predeterminable length and in a predetermined or predeterminable temporal relationship to the position of the marker from the first, temporary storage element and store them in the second, permanent storage element, wherein the system is further developed in that the control device is further configured to set markers automatically,when a predetermined or predeterminable medical instrument is activated or deactivated, or when operating parameters of a predetermined or predeterminable medical device change or are changed, or the achievement of a predetermined or predeterminable phase of the medical procedure is detected.

[0033] Further preferred embodiments of a system according to the invention can be found in the corresponding subclaims, with reference being made to the above-mentioned with regard to the effects and advantages achieved.

[0034] The invention is explained in more detail below using some exemplary illustrations. They show: Fig. 1: A medical device system, Fig. 2: the course of a medical procedure, Fig. 3: a basic representation of the selection of video data.

[0035] Fig. 1 shows a medical device system 1. The medical device system 1 comprises several medical devices.

[0036] The medical device system 1 comprises an endoscope control unit 10 with a connected video endoscope 11. The video endoscope is equipped with finger switches 12, via which a user can control functions of the video endoscope 11, such as the viewing direction, focusing, or taking still images. Additional functions of the video endoscope 11 or the endoscope control unit can be controlled via a foot switch 13, which is connected to the endoscope control unit 10.

[0037] The medical device system 1 further comprises an electrosurgical generator 20 with a connected electrosurgical instrument 21. In the example shown, the electrosurgical instrument 21 is a forceps and also has finger switches 22, via which individual functions of the forceps can be controlled, such as gripping, coagulating, or severing tissue. The electrosurgical generator is further connected to a foot switch 23, via which functions of the electrosurgical generator 20 or the connected electrosurgical instrument 21 can be controlled.

[0038] Another electrosurgical instrument 25, in the example shown a J-hook dissecting hook, can be connected to the electrosurgical generator 20 via a connector 26. The electrosurgical instrument 25 also has finger switches 27.

[0039] Furthermore, the medical device system 1 comprises a rinsing pump 30 and an insufflator 40.

[0040] The medical devices 10, 20, 30, 40 are connected to a central control unit 100. A monitor 110, a video camera 120, and a temporary storage element 130 are also connected to the central control unit 100. The storage element 130 can be, for example, a digital video storage device. In addition, the central control unit 100 is connected via a network 150, for example, a hospital network, to a permanent storage element 200 in the form of a database. The database 200 is configured to store medical image data and can be part of a picture archiving and communication system (PACS).

[0041] In Fig. Figure 2 shows an example of a medical procedure, in this case a laparoscopic gallbladder resection.

[0042] In a first step 201, a patient is prepared and anesthetized. Then, in a step 202, the attending physician inserts a Verres needle through the patient's abdominal wall, which is connected to the insufflator 40. Subsequently, in a step 203, the insufflator 40 pumps a dilation gas, e.g., carbon dioxide, into the patient's abdominal cavity to expand it. Then, in a step 204, the attending physician makes incisions in the patient's abdominal wall, into which trocars are inserted.

[0043] During steps 201 to 204, the progress of the procedure is filmed by the video camera 120, and the video data generated is stored in the storage element 130. In fact, only a few sections of the video material obtained here are relevant for documenting the procedure, primarily the insertion of the Verres needle, the making of the incisions, and the placement of the trocars.

[0044] To make these sections easier to locate in the video material, they are marked with markers in the video data. A first marker is automatically inserted into the video data by the central control unit 100 when the insufflator 40 is activated. Since this occurs immediately after the insertion of the Verres needle, a section of the video data documenting the insertion of the Verres needle can be located using the corresponding marker.

[0045] Another marker is automatically inserted into the video data by the central control unit 100 when the insufflator 40 reaches its set target pressure, thus completing the abdominal distension. The incisions for placing the trocars are made immediately afterward, so that this section of the video data can also be easily located using the marker.

[0046] Next, in step 205, the attending physician inserts the endoscope 11 through a trocar into the patient's abdominal cavity and activates it so that the interior of the abdominal cavity can be observed on the monitor 110. The video data from the video endoscope 11 is now stored on the storage element 130, and the recording of the video signals from the video camera 120 is terminated.

[0047] In step 206, the electrosurgical instrument 21 is then inserted through another trocar; this step is monitored by the video endoscope 11. To document the corresponding section of the procedure, the attending physician can manually insert a marker into the video data of the video endoscope 11 using a finger switch 12 on the video endoscope 11.

[0048] To remove the gallbladder, the blood vessels supplying it and the bile duct must be sealed and severed in step 207. This is performed under observation through the video endoscope 11 using the electrosurgical instrument 21. To do so, the vessel to be treated is grasped and pressed shut using the forceps. The vessel is then sealed using high-frequency energy provided by the electrosurgical generator 20. To do so, the attending physician actuates one of the finger switches 22 or the foot switch 23. Subsequently, the respective vessel is severed mechanically or with high-frequency current. To do so, the attending physician again actuates one of the finger switches 22.

[0049] When the high-frequency current is activated via the finger switch 22 or the foot switch 23, a marker is automatically inserted into the video data of the video endoscope 11. This ensures that this crucial phase of the medical procedure is permanently documented. Alternatively, the successful exposure of, for example, the bile artery and bile duct can be detected by automatic image recognition in the video image of the video endoscope 11. Alternatively, corresponding communication between the operating surgeon and other operating room personnel can be detected using voice recognition.

[0050] After the vessels of the gallbladder have been severed, the gallbladder must be separated from the surrounding liver and fascia tissue. To do this, the electrosurgical instrument 21 is first removed from the abdominal cavity and separated from the electrosurgical generator 20. For this purpose, the additional electrosurgical instrument 25 is connected to the electrosurgical generator 20 and inserted into the abdominal cavity. The instrument exchange is shown as step 208. When the electrosurgical instrument 25 is connected to the electrosurgical generator 20, the generator recognizes the instrument type via a chip built into the electrosurgical instrument 25 and automatically sets operating parameters such as voltage, current, and waveform. At the same time, when a new instrument is detected, a marker is inserted into the video data of the video endoscope 11.

[0051] In the next step 209, the gallbladder is then detached from the surrounding tissue using the electrosurgical instrument 25 and removed from the abdominal cavity through one of the trocars. A mechanical forceps (not shown) can be used for this purpose.

[0052] In a step 210, the physician then checks the surgical site using the video endoscope 11 to ensure that no hidden bleeding is present. At this point, the physician can manually insert a marker into the video data by pressing a finger switch 12 or the foot switch 13 to document this final inspection.

[0053] Finally, in a step 211, the video endoscope 11 and the trocars are removed from the abdominal cavity, and the punctures are sutured. This step is again documented by the video camera 120. When the video endoscope 11 is deactivated, the video sources can be automatically switched, and another marker can be inserted into the video data.

[0054] If disturbances occur during the procedure, such as a pressure drop at the insufflator 40, a corresponding marker is also inserted into the video data. A marker can also be inserted if the operating parameters of the electrosurgical generator 10 are manually adjusted during the procedure.

[0055] The described procedure can, for example, last approximately 2 hours, resulting in video data with a recording time of 2 hours. This data is stored in temporary storage element 130.

[0056] During the procedure, in the example shown, seven markers are set. After the procedure is completed, the central control unit 100 separates the sections of the video data that have a specific temporal relationship to the markers, for example, a 5-minute section arranged symmetrically around the marker. These sections of the video data are then transferred via the network 150 to the permanent storage element 200, where they are available for later analysis.

[0057] By means of the described method, the memory requirement in the permanent storage element 200 can be reduced by a factor of approximately 4.

[0058] The selection of video data is in Fig.3. Axis 300 represents the recording time of the corresponding video data, while arrows 301, 302, 303, 304, 305, 306, and 307 symbolize the respective markers. The sections of the video data copied for permanent storage are marked by the hatched blocks 311, 312, 313, 314, 315, 316, and 317.

[0059] The set markers can also contain additional information. For example, a distinction can be made between automatically set and manually set markers. In this case, the alignment of the video data sections to be copied to the respective marker can also vary for different types of markers. For example, with a manually set marker, a section can be copied that begins with the marker and has a specified duration. With an automatically set marker that indicates a fault, however, a section can be copied that begins a certain time before the marker and ends shortly after it.

[0060] The temporary storage element 130 can be dimensioned so large that it can store all the video data of a complete procedure. Alternatively, the temporary storage element can also be dimensioned smaller, so that it can store, for example, only a few minutes of video data. In this case, the temporary storage element can be implemented as a ring buffer in which old video data is automatically overwritten by new video data after, for example, 30 minutes.

[0061] With a correspondingly designed temporary storage element 130, the copying of a section of the video data marked by a marker from the temporary storage element 130 to the permanent storage element 200 preferably takes place immediately after the respective marker has been set, or when a predetermined trailing section has been completely recorded after the marker has been set.

[0062] The examples presented here serve only to better understand the invention and should in no way be understood as limiting the invention to these specific examples.

Claims

[1] A method for video documentation of a medical procedure, comprising the steps: - recording the medical procedure with at least one video camera (11,120) to obtain video data; - storing the video data recorded by the at least one video camera (11, 120) in a first temporary storage element (130); and - Setting a marker at at least one position of the video data corresponding to a relevant portion of the medical procedure; wherein after setting a marker, a section of the video data with a predetermined or predeterminable length and in a predetermined or predeterminable temporal relation to the position of the marker is copied and stored in a second, permanent storage element (200); characterized by that setting a marker is triggered automatically when - a predetermined or predeterminable medical instrument (21, 25) is activated or deactivated, or - operating parameters of a predetermined or predeterminable medical device (20, 30, 40) change or are changed, or - the achievement of a predetermined or predeterminable phase of the medical procedure is determined. [2] Method according to claim 1, characterized by that the setting of additional markers is triggered manually. [3] Method according to one of claims 1 to 2, characterized by that the setting of additional markers occurs automatically at predetermined or predeterminable times during the procedure. [4] Method according to one of claims 1 to 3, characterized by that the first temporary storage element (130) is a ring buffer or comprises a ring buffer. [5] Method according to one of the preceding claims, characterized bythat the section of video data includes a leading section which was recorded before the marker was set. [6] Method according to one of the preceding claims, characterized by that the section of video data includes a trailing section recorded after the marker was set. [7] System for video documentation of a medical procedure, comprising: - a video camera (11,120) for recording the medical procedure and for generating video data, - a first temporary storage element (130) for storing the video data, - a second, permanent storage element (200) for storing one or more sections of the video data, and - a control device (100) which is configured to set markers at positions of the video data which correspond to relevant sections of the medical procedure, as well as to copy sections of the video data with a predetermined or predeterminable length and in a predetermined or predeterminable temporal relation to the position of the marker from the first, temporary storage element (130) and to store them in the second, permanent storage element (200), characterized by that the control device (100) is further configured to set markers automatically when - a predetermined or predeterminable medical instrument (21, 25) is activated or deactivated, or - operating parameters of a predetermined or predeterminable medical device (20, 30, 40) change or are changed, or - the achievement of a predetermined or predeterminable phase of the medical procedure is determined. [8] System according to claim 7, characterized by that the control device (100) is further configured to set further markers at predetermined or predeterminable times during the procedure. [9] System according to claim 7 or 8, characterized by that the control device (100) further comprises input means (110,12,13,22,23) via which the setting of additional markers can be triggered manually. [10] System according to one of claims 7 to 9, characterized by that the first temporary storage element (130) is a ring buffer.

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