Combination of surgical microscope and endoscope

Abstract

Combination (7) of a surgical microscope (1) with an endoscope (3), wherein the surgical microscope (1) has a light source (2) with a first color temperature and illuminates a first section of an operating field (6) and the endoscope (3) has an LED light source (4) with a second color temperature and illuminates a second section of the operating field (6), characterized in that the two color temperatures are adapted to one another in such a way that in an optical and / or digital image of the surgical microscope (1) and / or in an optical and / or digital image of the endoscope (3), no color differences occur in sections of the operating field (6) jointly illuminated and observed by the surgical microscope (1) and the endoscope (3).

Description

The invention relates to a combination of a surgical microscope and an endoscope, each of which is equipped with its own light source and is used jointly in a surgical procedure.Surgical microscopes are known, for example, from the product series "PENTERO" of the applicant. With a surgical microscope, a surgical field on a patient to be operated can be depicted in an enlarged manner by means of a monocular or preferably binocular observation beam path. For this purpose, the surgical microscope has eyepieces, lenses and magnification optics with, in particular, variable magnification, in order to image the surgical field in an enlarged manner to an attending physician. Surgical microscopes are arranged, for example, on a wall, ceiling or a stand and can preferably be moved and / or pivoted in all spatial directions in order to enable the respectively desired view onto the surgical field.Furthermore, an additional observation beam path can be provided on the surgical microscope, for example for an assistant and / or an image recording device and / or a data reflecting device and / or a device for optical coherence tomography and / or a mechanical or optical (LASER) treatment device.To illuminate the surgical field, a light source is assigned to the surgical microscope. Depending on the preference of the attending physician, this usually comprises a xenon or halogen light source, i.e. gas discharge lamps with the respective elements for generating light or meanwhile also an LED light source. It is known that xenon and halogen lamps each have different color temperatures, i.e. they cause different color impressions at least subjectively by the treatment physician through the observation beam paths of the surgical microscope.Furthermore, endoscopes are known, for example, for microinvasive interventions on a patient. These likewise have an observation beam path with, for example, eyepiece, lens and magnifying optics, and a light source for illuminating an operating field. Furthermore, mechanical means can be provided for a treatment or sample removal, for example, or also means for optical or electromagnetic manipulation, that is to say for example for an electrical waste or a heat treatment. So-called static endoscopes have an external light source, such as likewise a xenon light source.EP 0 928 981 A2 discloses a surgical microscope equipped with a xenon light source, which is used in combination with an endoscope equipped with a halogen light source, wherein, in the case that the distal end of the endoscope enters into the field of view of the surgical microscope, a light-dimming device of the surgical microscope dims the intensity of the surgical microscope light source in order to obtain an uncorrupted endoscope image.DE 10 2009 017 710 A1 discloses an optical observation device having an illumination device, an attenuator and a spectral filter, in which the illumination light provides an approximately identical illumination intensity at a first color temperature and a second color temperature.Particularly flexible endoscopes, manual endoscopes or endoscopes hand-held by a treating doctor are equipped with a light source with an LED (light emitting diode). Here too, the use of fibre optics is known in order to reduce the overall size. The light source is arranged in a handpiece of the endoscope. In particular in the case of such hand-held endoscopes, digital image acquisition takes place. This means that there is no eyepiece for viewing through, but rather the image of the operating field captured via the lens system of the endoscope is captured by a CCD chip, for example, and is displayed and / or recorded directly on a monitor.Finally, it is known that a treating doctor or together with an assistant uses both a surgical microscope and an endoscope as a combination during a surgical procedure. For example, in the case of a cerebral surgery procedure, the surgical field proper can be viewed by means of the surgical microscope. At the same time, the surgical field or surrounding tissue such as veins or a cavity can be viewed by means of the endoscope, so to speak from the side or from behind, in order to provide more information to the treating physician.In this case, the surgical microscope illuminates a first section of the surgical field with its light source, that is to say, for example, a xenon light source, and a second section of the surgical field is illuminated by means of the light source of the endoscope. These two sections can at least partially overlap. In this overlap region of the two sections, joint illumination is thus effected by the light source of the surgical microscope and by the light source of the endoscope. This overlap region is observed by the surgical microscope and by the endoscope or, for example, is imaged on a monitor in the case of the endoscope. However, the effect occurs here that the endoscope with LED light source can cause a change in the color impression when the surgical field is viewed with the surgical microscope, at least in the section of the surgical field illuminated jointly by both light sources. A color change can occur when the surgical field is viewed through, for example, the surgical microscope, since the color temperatures of the two light sources or the color rendering indices of the surgical microscope and endoscope differ. If, for example, the surgical microscope is equipped with a xenon light source which has a relatively uniform intensity distribution in the color spectrum over the range visible to the human eye, and the endoscope with a white light LED which has a typical peak in the blue spectral range, a color change occurs in the optical reproduction of the surgical microscope by the light source of the endoscope. The light of the endoscope is perceived as too cold with respect to the color temperature or the image perceived by the treating physician through the surgical microscope is perceived as reddish at least in sections. The adjective "reddish" is to be understood in such a way that at least subjectively a too warm color temperature or a different color is perceived or perceived in the CIE color space (from 1931). Objectively, a white balance of a camera, for example of the surgical microscope, shows a color deviation in the region of a surgical field which is illuminated jointly by endoscope and surgical microscope or their respective light sources and is correspondingly respectively observed. This changed perception can interfere with or impair an assessment of the attending physician, for example which regions of the surgical field have to be manipulated.Proceeding from this prior art, the problem addressed by the person skilled in the art is to improve a combination of surgical microscope and endoscope to the effect that observation of the actual surgical field, in particular without being affected by the color temperature, can be realized.This object is made possible by a combination with the features of claim 1.The core idea of the invention is that the light source of the surgical microscope and the LED light source of the endoscope are matched to one another in such a way that, in particular when the surgical field is viewed through the surgical microscope, no color change, or at least only a slight color change, in particular no longer perceptible by the human eye, occurs through the light source of the endoscope. In this case, a first section of the surgical field is illuminated by the light source of the surgical microscope and a second section of the surgical field is illuminated by the LED light source. This means that in that section of the surgical field which is illuminated jointly by both the light source of the surgical microscope and the light source of the endoscope, i.e. in which the above-mentioned first and second sections overlap, the light of the two light sources is superimposed, but due to the adaptation of the LED light source of the endoscope to the xenon light source of the surgical microscope, for example, no color change occurs when viewing the surgical field, in particular through the surgical microscope. This overlap region is observed by the surgical microscope as well as by the endoscope or is observed or viewed through the surgical microscope by a treating doctor and is imaged on a monitor, for example, by means of an endoscope. This is to be understood in particular as meaning that no color differences, which can be perceived at least subjectively by the treating physician, occur in the regions jointly illuminated and observed by the surgical microscope and endoscope. Objectively, a white balance of a camera, for example of the surgical microscope, shows no change in the color deviation in the region of a surgical field that is illuminated jointly by endoscope and surgical microscope or their respective light sources and is correspondingly respectively observed. In particular, an LED light source with a higher color temperature is provided for the endoscope, which is matched to the color spectrum, known per se, of a xenon light source of the surgical microscope. This prevents the colour impression of the operating field from being adulterated or altered. This means that a color or a color point in the CIE color space (of 1931) does not change due to the additional illumination of the endoscope, or this is not perceived by a human observer.It is understood that both the surgical microscope and the endoscope are each designed for optical and / or digital image acquisition. Digital image acquisition means that, for example, in an endoscope, no eyepiece is provided for direct observation, but an image is acquired, for example, by means of a CCD chip and is reproduced and / or recorded directly on a monitor for an attending physician.Corresponding LEDs with a color spectrum adapted to a xenon light source, or a color temperature, are known in the prior art. It is also evident that the respective brightness or intensity of the light sources can be adjusted in the desired manner.It is understood that the surgical microscope and the endoscope can be controlled jointly or independently of one another, for example with respect to the respective brightnesses of the light sources. For this purpose, use is made, inter alia, of hand switches or foot switches or a menu-guided control on a screen.It is also included within the scope of the invention that instead of a combination of surgical microscope and endoscope, a combination of surgical microscope and a per se arbitrary visualization system with its own light source is also used. For example, it can be a hyperspectral camera with its own light source.Advantageous embodiments of the invention are the subject matter of dependent claims.In a preferred embodiment, the surgical microscope is equipped with a xenon light source and the endoscope is equipped with an LED light source. In this case, the color temperature of the LED light source deviates by at most 500° K from the color temperature of the xenon light source. Thus, a corruption of the color impression that a treating doctor perceives, for example, by the surgical microscope when a surgical field is also illuminated by the endoscope with its LED light source in addition to the illumination by the xenon light source is avoided. This means that the treating doctor does not perceive any color change despite the additional illumination. The same naturally also applies to digital image acquisition by means of, for example, the surgical microscope and / or endoscope. An even better result is achieved if the colour temperature of the LED light source deviates by at most 300° K from the colour temperature of the xenon light source, even more preferably at most 100° K and particularly preferably 50° K.It is evident that in principle a halogen light source or an LED light source can also be used for the endoscope and then a correspondingly designed LED is used for the endoscope.An important parameter for describing a lighting device is the color rendering index value and the R9 index value. The color rendering index value characterizes for each light source or lighting device how well it can reproduce the colors compared to sunlight. Only colors from the visible wavelength spectrum are taken into account in this case. The higher the color rendering index value of a light source or illumination device, the more natural the color rendering or the color impression of the object illuminated therewith. The lower the color rendering index value, the more the color impression of an object is distorted by the lighting device. The maximum one of the color rendering index values is 100.The colour rendering index value is calculated in accordance with DIN 6169. DIN 6169 defines 14 test colors with a standardized reflectance curve. These 14 test colors are R1: altreosa, R2: mustard yellow, R3: yellow green, R4: light green, R5: turquoise blue, R6: sky blue, R7: aster violet, R8: violet, R9: red saturated, R10: yellow saturated, R11: green saturated, R12: blue saturated, R13: pink (skin color), R14: leaf green. The R9 index value serves as a measure for the particular color rendering index value R9 to be "9" (saturated red). The maximum R9 index value is 100.If the five light emitting devices are selected in such a way that the five dominant wavelengths are in the wavelength ranges mentioned, white light having a very natural color impression can advantageously be generated. The color rendering index value has a value in a range of 87 to 100. The R9 index value has a value in a range of 45 to 100. The color rendering index value preferably has a value in a range from 90 to 100, particularly preferably a value in a range from 95 to 100. The R9 index value preferably has a value in a range from 60 to 100, more preferably in a range from 80 to 100, particularly preferably in a range from 87 to 100.The surgical microscope has a first color rendering index with its light source, xenon, halogen or LED, and the endoscope has a second color rendering index with its light source. If these two indices differ by at most the value five, then a treating physician can virtually not ascertain any color change or a change in the color impression in a section of the operating field that is illuminated jointly by both light sources. A maximum difference of four of the color rendering indices is particularly preferred, more preferably at most three or only two, in particular only one.It is proposed that the endoscope is a manually manageable endoscope, in particular the LED light source is integrated therein. By means of the manually manipulable endoscope, for example, the operating field can be viewed from the side or from the rear in order to view wires, cavities in the tissue or the like. In this case, the LED light source is arranged in particular in a hand grip or handle piece of the endoscope.A white light LED is particularly advantageously provided as the LED light source of the endoscope in order to obtain the greatest possible agreement with the color spectrum of the xenon light source of the surgical microscope. In principle, an RGB LED can also be used.In order to adapt the color spectrum or the color temperature of the light source of the endoscope to the light source of the surgical microscope, the endoscope light source can be designed as an RGB LED. This means that it is a combined LED that can emit red, green and blue light. It is understood that the respective light sources can be controlled with respect to their respective intensity in order to generate light overall with a desired intensity or brightness and a desired color spectrum or a desired spectral distribution or a desired color impression. RGB LED light sources could be extended by further LEDs with "additional colors" for special applications. For example, with additional edge peaks or intermediate peaks for more uniform spectral illumination for a higher CRI value or color rendering index value, or for example with deep blue (405 nm) wavelength or near infrared wavelength (800 nm) for exciting fluorescence.For further improvement of the optical and / or digital imaging of the surgical microscope and / or in the case of an optical and / or digital imaging of the endoscope, a white balance is provided. This is effected in particular automatically by means of correspondingly designed control hardware and / or software and thus a color temperature of an image of the operating field can be set to 4000Kelvin, for example. It is understood that a white balance can be carried out, for example, in a camera or recording device of the surgical microscope and / or of the endoscope. In principle, this can be done alternatively or additionally with respect to one of the light sources.Various light sources can also be provided for the surgical microscope, for example a xenon and a halogen light source or an LED. These can then be selected by an attending physician depending on the desired color impression of the operating field. In this case, a configuration of the light source of the endoscope as an RGB LED is then preferred in order to obtain a corresponding color temperature in a simple manner.In principle, it is also possible that, during image processing of the surgical microscope and / or of the endoscope, consideration is given to the color temperature or the color spectrum of the respective other light source. This means that if, for example, the surgical field is illuminated and viewed by means of a xenon light source of the surgical microscope and at the same time an endoscope illuminates the surgical field with a light source of a different color temperature, this is taken into account, for example, when the surgical field is displayed via the surgical microscope by means of a correspondingly designed software or electronics, and a corrected color reproduction is imaged.To improve a view of the surgical field, both light sources of the surgical microscope and of the endoscope can preferably be changed in their respective color spectrum or their color temperature. Thus, the respective light sources can be matched to each other and the color-true reproduction of the operation field can be improved. For example, RGB LEDs are used in each case for this purpose.Additionally or alternatively, the light sources of the surgical microscope and / or endoscope can each be assigned colour filters which can be pivoted out and into an illumination beam path, for example. A color temperature or a color spectrum can thus be adapted in the desired manner.It is understood that the features mentioned above and those still to be explained below can be used not only in the respectively specified combination, but also in other combinations or alone, without departing from the scope of the present invention.An exemplary embodiment of the invention is illustrated in the drawing and is explained in more detail in the following description. It shows: FIG. 1 shows a combination of surgical microscope and endoscope in schematic representation, FIG. 2 is a reddish image of an operation field, FIG. 3 shows the spectrum of a white light LED light source of an endoscope, FIG. 4 shows the spectrum of a xenon light source of a surgical microscope, and FIG. 5 shows the spectrum of an LED light source with a higher color temperature.The embodiment shown in FIG. 1 is a schematic representation of a combination 7 of surgical microscope 1 and endoscope 3. the surgical microscope 1 is, for example, a model from the series "PENTERO" of the applicant and is equipped with a xenon light source 2, the spectrum of which is shown in FIG. 4. The surgical microscope 1 is equipped in a manner known per se with eyepieces, objectives or lenses and preferably variable magnification optics in order to display a surgical field 6 such as a brain region of a patient to be treated in an enlarged manner to an attending physician 5. The treating doctor 5 sees the operating field 6 via an observation beam path 8, which can also be binocular. Furthermore, a further observation beam path for an assistant and / or devices for image acquisition and / or data reflection and / or for optical coherence tomography can be provided on the surgical microscope 1.The endoscope 3 is, for example, the model FSC200 from Scholly Fiberoptic GmbH, Robert Bosch Straβe 1-3, 79211 Denzlingen, Germany and has an LED light source 4, the spectrum of which is depicted in FIG. 3. This is a white light LED light source. The surgical field 6 can also be viewed via the observation beam path 9 by means of the endoscope 3 using a magnifying optical system and, if appropriate, eyepieces, lenses or objectives. The endoscope 3 can also only record the operating field 6 digitally and reproduce an image on a monitor, for example. For example, the surgical field 6 can be viewed with the surgical microscope 1 so to speak from above and the surgical field 6 can be viewed by means of the endoscope 3, for example, from the side, in order, inter alia, to look into cavities or behind a blood vessel. The endoscope 3 is preferably a hand-held endoscope 3, wherein the LED light source 3 is preferably arranged in a handle piece, that is to say outside a patient's body.It is understood that the surgical microscope 1 and / or the endoscope 3 are designed for the optical and / or digital detection of the surgical field 6. This means that the operating field 6 can be observed either directly optically through inter alia eyepiece and lens and / or cameras are provided for digital image acquisition.The surgical microscope 1 with its light source 2 illuminates a first section of the surgical field 6 and the endoscope 3 with its LED light source 4 illuminates a second section of the surgical field. At least in a portion of the surgical field 6 illuminated jointly and observed by surgical microscope 1 and endoscope 3, the two illuminations overlap, so that, for example, a changed color perception or a changed color impression can occur through the surgical microscope 1.Since the respective color spectra or color temperatures of the light sources 2 and 4 differ, the xenon light source 2 of the surgical microscope 1 has a color spectrum as depicted in FIG. 4, and the LED light source 4 of the endoscope 3 has a color spectrum as depicted in FIG. 3, a reddish tinge occurs in the color impression as it is communicated to the treating physician 5 by the surgical microscope 1 from the surgical field 6, which is depicted only schematically shaded in FIG. 2. This means that a color change takes place at least partially as a result of the additional illumination by the LED light source 4 of the endoscope 3. This may result in the surgical field 6 being impaired by the attending physician 5. The phrase "reddish tinge" is to be understood here such that at least subjectively a color temperature that is too warm is perceived or perceived. Objectively, a white balance of a camera, for example of the surgical microscope 1, shows a color deviation in the region of a surgical field 6, which is illuminated jointly by endoscope 3 and surgical microscope 1 or their respective light sources 2, 4 and is correspondingly respectively observed. In particular, the light sources 2, 4 are matched to one another in such a way that the color or the color point in the CIE color space (of 1931) is substantially not changed by the additional illumination of the operating field 6 by the light source 4 of the endoscope 3.In the case of the color spectra of various light sources 2, 4 illustrated in FIGS. 3 to 5, the wavelength is in nanometers in each case indicated on the x-axes and the intensity is in milliwatts per square centimeter and nanometers in FIGS. 4 and 5 and in watts per square meter and nanometers in FIG. 3 and an intensity in percent on the y-axis.It is clearly evident from the illustration in FIGS. 3 and 4 that the light source 2 of the endoscope 1, see FIG. 3, has a substantially broader, uniformly distributed spectrum than an LED light source 4 of an endoscope 3 from FIG. 4.If an LED light source 4 with a color spectrum corresponding to FIG. 5 is now used as the LED light source 4 of the endoscope 3, the red tinge or white balance of a camera, see above, is substantially minimized. As a result of the increased white light fraction, the color impression through the surgical microscope 1 on the surgical field 6 is only changed in a practically indistinguishable manner. Such an LED light source has a higher color temperature and can be selected depending on the light source 2 used for the surgical microscope 1.In principle, it is also possible to change a color temperature or intensity distribution of the LED light source 4 in the desired manner by using RGB LEDs. An RGB LED can emit red, green and blue light in the desired intensity. In principle, the light source 2 of the surgical microscope can also comprise an LED.Finally, color filters can also be provided in illumination and / or observation beam paths 8, 9 of surgical microscope 1 and / or endoscope in order to avoid false color impression.List of reference numbers:1 Surgical microscope 2 Light source of 1 3 Endoscope 4 Light source of 2 5 Treating doctor 6 Surgical field 7 Combination of 1 and 3 8 Observation beam path of 1 9 Observation beam path of 3 10 hatching to illustrate a reddish tinge

Claims

Combination (7) of a surgical microscope (1) with an endoscope (3), wherein the surgical microscope (1) has a light source (2) with a first colour temperature and illuminates a first section of a surgical field (6) and the endoscope (3) has an LED light source (4) with a second colour temperature and illuminates a second section of the surgical field (6), characterized in that the two colour temperatures are matched to one another in such a way that no colour differences occur in sections of the surgical field (6) illuminated and observed jointly by the surgical microscope (1) and endoscope (3) in an optical and / or digital image of the surgical microscope (1) and / or in an optical and / or digital image of the endoscope (3).Combination (7) according to claim 1, characterised in that the surgical microscope (1) has a xenon light source (2) and the endoscope (3) is equipped with an LED light source (4) whose colour temperature deviates at most 500°K from the colour temperature of the xenon light source (2) of the surgical microscope (1), in particular only 300°K.Combination (7) according to Claim 1, characterized in that the surgical microscope (1) has a xenon light source (2) and the endoscope (3) is equipped with an LED light source (4), wherein the surgical microscope (1) has a first colour rendering index with its light source (2) and the endoscope (3) has a second colour rendering index with its LED light source (4) and the two colour rendering indices differ by at most five, in particular only by the value four, preferably only by the value three, particularly preferably only by the value two and in particular only by the value one.Combination (7) according to one of Claims 1 to 3, characterized in that the endoscope (3) is a hand-held endoscope, in particular the LED light source (4) is integrated therein.Combination (7) according to one of claims 1 to 4, characterised in that the LED light source (4) of the endoscope (3) is a white light LED.Combination (7) according to one of claims 1 to 4, characterised in that the LED light source (4) of the endoscope (3) is an RGB LED.Combination (7) according to one of Claims 1 to 6, characterized in that white balancing of a camera and / or a light source (2, 4) can be carried out in the case of the optical and / or digital imaging of the surgical microscope (1) and / or in the case of an optical and / or digital imaging of the endoscope (2).Combination (7) according to one of Claims 1 to 7, characterized in that the surgical microscope (1) has different light sources (2).Combination (7) according to one of Claims 1 to 8, characterized in that, in an optical and / or digital imaging of the surgical microscope (1) and / or of the endoscope (3), an adaptation with respect to the colour temperature of the respective other light source (2, 4) can be carried out by means of image processing.Combination (7) according to one of Claims 1 to 9, characterized in that the colour temperatures of the two light sources (2, 4) can be changed.Combination (7) according to one of Claims 1 to 10, characterized in that either individually or both colour filters are assigned to the light sources (2, 4).

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