Surgical system and program

Abstract

To enable identification of a resection line of an affected area without relying on experience.SOLUTION: A surgical system for performing surgery under endoscopic observation, comprises: an endoscope that can be inserted into the patient's body and images an area including a surgical object site; a processor apparatus that processes a surgical field image captured by the endoscope and causes an image display apparatus to display the surgical field image; a storage device that holds resection site position data for identifying a position of a resection site including the patient's surgical object site; an in-body marking apparatus that can be inserted into the patient's body and marks a part of the area including the surgical object site; and an image generation apparatus that, during surgery on the patient, acquires a marking image obtained by imaging the area including the surgical object site marked by the in-body marking apparatus on the basis of the resection site position data using the endoscope, and generates resection site guide information indicating the resection site on the basis of the marking image. The image generation apparatus synthesizes the resection site guide information with a real-time surgical field image captured by the endoscope and displays it on the image display apparatus.SELECTED DRAWING: Figure 1

Description

Technical Field

[0001] The present disclosure relates to a surgical system and a program.

Background Art

[0002] In the medical field, various surgical support systems have been proposed and developed. For example, one of them is a system that utilizes a robot. However, since the robot does not have a sense of touch, it is difficult to identify small lung lesions or accurately determine the range of lung resection in a robotic surgical system. In addition, a technique (LATS) for performing lung resection (tumor resection) under the guidance of red light inserted from the bronchus has also been proposed, but the identification of the lung resection line depends importantly on the judgment based on the experience of the surgeon.

[0003] On the other hand, another type of system for assisting surgery has also been developed. For example, Patent Document 1 proposes a navigation system for medical instruments such as a bronchoscope. Specifically, during a medical procedure of inserting a bronchoscope or the like into a patient's body, the navigation system draws a model of an anatomical structure such as the patient's lung network created using an image obtained by a CT scan or the like in advance, and further draws the position and orientation of the bronchoscope detected by an electromagnetic coil of the bronchoscope or the like on the model, and also draws a target in a biopsy procedure.

Prior Art Documents

Patent Documents

[0004]

Patent Document 1

Summary of the Invention

Problems to be Solved by the Invention

[0005] However, in the navigation system according to Patent Document 1, only a model of the patient's pulmonary lumen network is drawn, and the surgical field image captured by the bronchoscope camera is not displayed. Therefore, it is insufficient as a means to assist the ongoing surgery, and a surgeon's rich experience is still required to accurately identify the pulmonary resection line. In view of such a situation, the present disclosure proposes a technique that enables identification of the resection line of the affected part without relying on experience.

Means for Solving the Problems

[0006] In order to solve the above problems, the present disclosure provides a surgical system for performing surgery under endoscopic observation, including an endoscope that can be inserted into a patient's body and captures an area including the surgical site, a processor device that processes the surgical field image captured by the endoscope and displays the surgical field image on an image display device, a storage device that holds resection site position data for specifying the position of the resection site including the patient's surgical site, a body marking device that can be inserted into the patient's body and marks a part of the area including the surgical site, an image generation device that, during the patient's surgery, acquires a marking image of the area including the surgically marked surgical site by the body marking device based on the resection site position data, and generates resection site guide information indicating the resection site based on the marking image, and the image generation device synthesizes the resection site guide information with the real-time surgical field image captured by the endoscope and displays it on the image display device, and proposes a surgical system.

[0007] Further features related to the present disclosure will become apparent from the description in this specification and the accompanying drawings. Also, aspects of the present disclosure are achieved and realized by elements and combinations of various elements and the aspects of the following detailed description and the appended claims. It should be understood that the description in this specification is merely a typical example and does not limit the claims or application examples in any sense.

Advantages of the Invention

[0008] According to the technology of the present disclosure, an operator can easily identify a resection line (resection site) of an affected part without relying on experience.

Brief Description of the Drawings

[0009]

Figure 1

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Figure 5B

Modes for Carrying Out the Invention

[0010] This embodiment discloses a technique for identifying a lung cutting surface by projecting a lung regional dissection surface by LED light onto the surgical field in the thoracic cavity using a technique (LATS) of performing lung resection under the guidance of red LED light inserted through the bronchus, and further combining it with a lung resection simulation (using CT scan images) in which the positional relationship between the tumor and the cutting surface was measured before the surgery.

[0011] Hereinafter, this embodiment will be described with reference to the accompanying drawings. In the accompanying drawings, functionally identical elements may sometimes be denoted by the same reference numerals, and overlapping descriptions will be omitted. Note that the accompanying drawings show specific embodiments and examples in accordance with the principles of the present disclosure, but these are for the purpose of understanding the present disclosure and are by no means used for limiting the interpretation of the present disclosure. In this embodiment, the technique of the present disclosure will be described by taking as an example the guidance of a cutting surface (resection site) for removing a tumor present in the lung, but the resection site is not limited to the lung and may be other sites.

[0012] Also, in this embodiment, although the description is made in sufficient detail for those skilled in the art to implement the present disclosure, it should be understood that other implementation forms are possible and that changes in configuration and structure and replacement of various elements can be made without departing from the scope and spirit of the technical idea of the present disclosure. Therefore, the following description should not be construed as being limited thereto.

[0013] <Configuration example of surgical system 100> FIG. 1 is a diagram showing a schematic configuration example of a surgical system 100 according to an embodiment of the present disclosure. The surgical system 100 includes a thoracoscopic scope 101, a thoracoscopic processor 102, a surgical simulation device 103, a thoracoscopic monitor (display device) 104, an image generation device 105, a generated image monitor (display device) 106, and an ultra-thin fiber (direct light probe) 107.

[0014] The thoracoscopic scope 101 is inserted into the patient's chest cavity during surgery to observe the inside of the patient's chest cavity (observing the lungs from the outside). When the thoracoscopic scope 101 is not used, the surgery is performed as an open-chest surgery, and instead of the thoracoscopic scope 101, a camera for imaging the lungs in the open-chested state may be used. Also, when the thoracoscopic scope 101 is not used, the thoracoscopic processor 102 is also unnecessary, and the above camera is directly connected to a monitor (a display device replacing the thoracoscopic monitor 104) and the surgical simulation device 103.

[0015] The thoracoscopic processor 102 is a device for processing the image data acquired by the thoracoscopic scope 101 and generating a video signal. This thoracoscopic processor 102 outputs the generated video signal to the thoracoscopic monitor 104 and provides it to the surgical simulation device 103. The thoracoscopic monitor 104 displays the external appearance image of the lungs imaged inside the chest cavity.

[0016] The surgical simulation device 103 acquires data on the position of a tumor visually identified by a surgeon or a person other than the surgeon (e.g., a doctor other than the one in charge of the surgery) using pre-acquired CT scan images (two-dimensional slice images) of the lungs (inflated lungs) of the patient (the subject of the surgery). At this time, the surgeon or the like identifies a plurality of bronchi located at positions that completely surround the tumor in the affected area, and inputs the position data thereof (e.g., represented by anatomically pre-determined segmental bronchus information such as B 6 a or B 3 b, etc.) and information on the distance from each bronchus to the tumor (measured from the CT scan image) to the surgical simulation device 103. If the distance between the bronchus and the tumor is equal to or less than a predetermined value, the bronchus may be considered inappropriate for use in determining the resection site, and the surgeon or the like may be prompted to identify an appropriate bronchus. At this time, the surgeon or the like may also provide the surgical simulation device 103 with the position data of the central (upstream) bronchus that serves as the base point of each bronchus. The position data of the upstream bronchus serving as this base point becomes the information on the apex of the resection site of the cone (conical body) described later.

[0017] The image generation device 105 includes a storage device 1051, a light source 1052 that outputs red light to an ultra-thin fiber (direct light probe: red light guiding) 107, and an image generation unit 1053 that determines and draws the resection site of a cone (circular cone) described later for the surgeon to refer to during the operation. Specifically, the image generation device 105 reads the position data of the tumor and the position data of each bronchus from the storage device 1051 that holds the position data of the tumor and the position data of each bronchus from the surgical simulation device 103, and displays, for example, the data on the generated image monitor 106. While looking at the display data, the surgeon sequentially inserts an ultra-thin fiber into each bronchus and illuminates the patient's lung with red light from inside the bronchus. The image at that time (operative field red light image: see Fig. 3A) is acquired by the thoracoscope 101 in the operative field, and a plurality of operative field red light images are sequentially transmitted to the image generation device 105 via the thoracoscope processor 102 and stored in the storage device 1051. The image generation unit 1053 reads a plurality of operative field red light images from the storage device 1051, synthesizes them to generate a synthesized operative field red light image (see Fig. 3B). Then, the image generation unit 1053 marks and displays (see Fig. 4A) on the synthesized operative field red light image the position of the bronchus that is the basis point of each bronchus, which is input by the surgeon or provided from the surgical simulation device 103. Further, the image generation unit 1053 determines a resection line in order to generate a cone (circular cone) having the marking display as the apex and the pleural surface including each red light irradiation point 301 to 304 in the synthesized operative field red light image as the base, draws the resection site of the cone including the resection line on the synthesized operative field red light image, and displays an image of the resection site on the screen of the generated image monitor 106 (see Fig. 3C).

[0018] <Procedure for determining the lung resection site> FIG. 2 is a flowchart for explaining the procedure of the lung resection site determination process according to the present embodiment. The main operating entity of the process is mainly the image generation unit 1053 of the image generation device 105, but the image generation device 105 can be configured by a computer. At this time, a CPU, MPU, etc. of the computer (hereinafter, "processor (a component different from the processor device 102 of the endoscope)") reads a program for realizing the process shown in the flowchart of FIG. 2 from the storage device 1051 and expands it in the internal memory to configure the image generation unit 1053. Therefore, it is also possible to use the processor as the operating entity.

[0019] (i) Step S201 The image generation unit 1053 acquires the position data of the tumor in the affected area and the position data of a plurality of bronchi (including the position data of the bronchi on the central side of each bronchus) from the storage device 1051 and displays them on the screen of the generated image monitor 106. When the image generation device 105 has a display device, it may be displayed on the screen of the display device. Further, the position data of the tumor and the position data of the bronchi (including the position data of the bronchi located on the central side of each bronchus (the position data of the bronchus that becomes the apex of the cone constituting the resection part)) are the data identified and input in advance by the surgeon or the like based on the CT scan image in the surgical simulation device 103 as described above.

[0020] (ii) Step S202 While referring to the thoracoscopic image captured by the thoracoscopic scope 101 and the position data of the tumor and the position data of the bronchi displayed on the screen of the generated image monitor 106, the surgeon identifies a plurality of bronchi (for example, four bronchi) into which the ultra-thin fiber 107 is to be inserted and the central bronchus that is the base point of these plurality of bronchi. Then, the image generation unit 1053 receives an input (bronchus identification completion notification: input by the surgeon) indicating that a plurality of bronchi into which the ultra-thin fiber 107 is to be inserted have been identified.

[0021] (iii) Step S203 The operator inserts the ultra-thin fiber into one of the bronchi identified in step S202 and irradiates the obliterated pulmonary pleural region (red light irradiation point 301) with red light. Then, an image of the obliterated pulmonary pleural region is acquired from the pulmonary field with the thoracoscopic scope 101 (operative field red light image: see FIG. 3A), displayed on the thoracoscopic monitor 104, and the image data is transmitted to the image generation device 105. The image generation device 105 stores the image (FIG. 3A) in the storage device 1051. The operative field red light images (red light irradiation points 301, 302, 303, and 304) are acquired for each bronchus identified in step S202, transmitted to the image generation device 105, and sequentially stored in the storage device 1051.

[0022] When the operative field red light images for all the bronchi are acquired, the image generation unit 1053 generates a composite operative field red light image (see FIG. 3B) by synthesizing them and stores it in the storage device 1051.

[0023] (iv) Step S204 The image generation unit 1053 acquires the position data of the plurality of bronchi identified in step S202 and the position data of the bronchus located on the central side (the most upstream side) of the plurality of bronchi from the storage device 1051. Then, the image generation unit 1053 sets the central bronchus as the apex of the cone of the resection site.

[0024] (v) Step S205 As shown in FIG. 3C, the image generation unit 1053 draws the resection lines 307 and 308 from the bronchus of the apex (the central bronchus) to the bottom surface 305 of the obliterated pulmonary pleural region so that a cone (circular cone) is formed by the apex 306 set in step S204 and the bottom surface 305 including each point (red light irradiation point) 301 to 304 of the obliterated pulmonary pleural region obtained by introducing the ultra-thin fiber into each identified bronchus, and synthesizes the resection site image with the operative field image (see FIGS. 3C, 4A, and 4B).

[0025] The image generation unit 1053 generates a resection site composite image (Fig. 3C) obtained by superimposing the resection site image on the surgical field image, transmits it to the generated image monitor 106, and instructs it to be displayed on the screen. While looking at the resection site composite image displayed on the screen of the generated image monitor 106, the surgeon can resect the lung affected part including the patient's tumor.

[0026] <Position relationship between tumor and resection line> Fig. 5A is a diagram showing the positional relationship between the tumor 501 in the lung, and the resection lines 504 and 505. Fig. 5B is a diagram showing a state in which only the tumor 501, and the resection lines 504 and 505 are taken out.

[0027] From Fig. 5A, it can be seen that by determining the resection site (cone) by the above-described procedure, resection lines (straight lines L and M) 504 and 505 having sufficient distances 502 and 503 from the tumor (able to completely remove the tumor) can be set. Also, from Fig. 5B, it can be seen that the side surface of the cone becomes the entire resection surface, and the resection surface becomes a surface formed from the bottom surface 305 on the pulmonary pleura including points A, B, C, and D (corresponding to the red light irradiation points) toward the apex 306.

[0028] <Summary> (i) As described above, this embodiment discloses a surgical system 100 for performing surgery under the observation of an endoscope (thoracoscopic scope 101). More specifically, the surgical system 100 includes an endoscope (thoracoscopic scope 101) that can be inserted into a patient's body and captures an image of a region including the surgical site, a processor device (thoracoscopic processor 102) that processes the intraoperative field image captured by the endoscope and displays the intraoperative field image on an image display device, a storage device 1051 that holds resection site position data (position data of a plurality of bronchi) for specifying the position of a resection site including the surgical site of the patient, a body marking device (ultra-thin fiber 107) that can be inserted into the patient's body and marks a part of the region including the surgical site, an image generation device that, during the patient's surgery (in real time), acquires a marking image (FIGS. 3A and 3B) of the region including the surgical site marked by the body marking device based on the resection site position data (bronchus position data) and generates resection site guide information (FIG. 3C) indicating the resection site based on the marking image. This image generation device synthesizes the resection site guide information with the real-time intraoperative field image captured by the endoscope (thoracoscopic scope 101) and displays it on an image display device (generated image monitor 106).

[0029] The above surgical system 100 further includes a surgical simulation device 103. The surgical simulation device 103 displays a CT scan image of a region including a patient's tumor (lesion) acquired before the surgery on a display screen. Then, the user determines a plurality of bronchi that serve as a reference for determining an excision line (separation plane) indicating the excision site with reference to the CT scan image, and inputs the position data of the plurality of bronchi and the position data of the bronchi on the central side of the plurality of bronchi to the surgical simulation device 103. The surgical simulation device 103 transmits the acquired data to the image generation device 105, and the image generation device 105 stores the received data in the storage device 1051. The position data of the plurality of bronchi are the position data of a plurality of bronchi that are located at a predetermined distance from the lesion (tumor) and surround the lesion. The marking image is an image obtained by sequentially inserting an in-vivo marking device (ultra-thin fiber 107) into the identified plurality of bronchi and photographing a region (pulmonary pleural region) including the surgically-targeted site in the marked state (the state illuminated by red light) from the surgical field with the thoracoscopic scope 101.

[0030] Based on the position data of the bronchi on the central side of the position data of the plurality of bronchi, the image generation device 105 generates excision site guide information (FIG. 3C) by drawing a line connecting from the bottom surface to the apex based on a cone (circular cone or pyramid) having the bronchi on the central side as the apex and a figure including the marking image as the bottom surface. That is, the excision site guide information is information including information indicating a separation plane to be excised by a treatment tool for treating the surgically-targeted site and information indicating the distance between the separation plane and the tumor.

[0031] (ii) The functions of this embodiment can also be realized by software program codes. In this case, a storage medium storing the program codes is provided to a system or device, and a computer (or CPU or MPU) of the system or device reads the program codes stored in the storage medium. In this case, the program codes themselves read from the storage medium realize the functions of the foregoing embodiment, and the program codes themselves and the storage medium storing them constitute this disclosure. As the storage medium for supplying such program codes, for example, a flexible disk, CD-ROM, DVD-ROM, hard disk, optical disk, magneto-optical disk, CD-R, magnetic tape, non-volatile memory card, ROM, etc. are used.

[0032] Also, based on the instructions of the program codes, an OS (operating system) running on the computer, etc. may perform part or all of the actual processing so that the functions of the foregoing embodiment are realized by such processing. Further, after the program codes read from the storage medium are written into the memory on the computer, based on the instructions of the program codes, a CPU of the computer, etc. may perform part or all of the actual processing so that the functions of the foregoing embodiment are realized by such processing.

[0033] Furthermore, by distributing the software program codes that realize the functions of the embodiment and each example via a network, they are stored in storage means such as a hard disk or memory of a system or device or a storage medium such as a CD-RW or CD-R, and when in use, a computer (or CPU or MPU) of the system or device reads and executes the program codes stored in the storage means or the storage medium.

[0034] The processes and techniques described herein are not inherently related to any particular apparatus and can be implemented by a combination of each component. Also, various types of devices for general purposes can be added. To execute the functions of the present embodiment and each example, a dedicated apparatus may be constructed. Further, various functions can be formed by appropriately combining a plurality of components disclosed in the present embodiment and each example. For example, some components may be deleted from all the components shown in the embodiment and each example, or components from different examples may be appropriately combined.

[0035] In the present disclosure, specific examples are described, but these are for explanation (understanding of the technology of the present disclosure) rather than limitation in all aspects. Those having ordinary knowledge in the relevant technical field can understand that there are numerous combinations of hardware, software, and firmware suitable for implementing the technology of the present disclosure. For example, the described software can be implemented in a wide range of programming or scripting languages such as assembler, C / C++, perl, Shell, PHP, Java (registered trademark), etc.

[0036] Furthermore, in the above-described embodiment, control lines and information lines are shown as those considered necessary for explanation, and not all control lines and information lines are necessarily shown on the product. All components may be interconnected.

[0037] In addition, those having ordinary knowledge in the relevant technical field can clarify other implementations of the present disclosure from the considerations of the present embodiment and each example. The specification and specific examples are merely typical, and the scope and spirit of the technology of the present disclosure are shown in the subsequent claims.

Description of Reference Numerals

[0038] 100 Surgical system 101 Thoracoscopic scope 102 Thoracoscopic processor 103 Surgical simulation device 104 Thoracoscope monitor 105 Image generation device 1051 Memory device 1052 Light source 1053 Image generation unit 106 Generated image monitor 107 Ultra-thin fiber 301, 302, 303, 304 Red light irradiation points 305 Bottom surface (erased pulmonary pleural area) 306 Vertex (central bronchus) 307, 308, 504, 505 Cutting lines 501 Tumor 502, 503 Distance between tumor and cutting line

Claims

1. A surgical system for performing surgery under endoscopic observation, comprising: an endoscope that can be inserted into a patient's body and captures an area including the surgical site; a processor device that processes the intraoperative field image captured by the endoscope and displays the intraoperative field image on an image display device; a storage device that holds resection site position data for identifying the position of a resection site including the surgical site of the patient; a body marking device that can be inserted into the patient's body and marks a part of the area including the surgical site; an image generation device that, during the patient's surgery, acquires a marking image of an area including the surgical site marked by the body marking device based on the resection site position data, and generates resection site guide information indicating the resection site based on the marking image; The image generation device synthesizes the resection site guide information with a real-time intraoperative field image captured by the endoscope and displays it on an image display device. A surgical system.

2. In Claim 1, further comprising a surgical simulation device that displays a CT scan image of an area including the surgical site of the patient, acquired before performing the surgery, on a display screen, generates the resection site position data based on an input instruction of a user who refers to the CT scan image, and stores the data in the storage device. A surgical system.

3. In Claim 1, the resection site includes a lesion present in the patient's lung, the resection site position data is position data of a plurality of bronchi that are located at a predetermined distance from the lesion and surround the lesion, the marking image is an image obtained by inserting the body marking device into the plurality of bronchi and capturing, with the endoscope, an area including the surgical site in the marked state from the intraoperative field. A surgical system.

4. In Claim 3, the image generation device generates the resection site guide information by drawing a line connecting from the bottom surface to the apex based on a cone having, as its apex, the position data of the central bronchus among the position data of the plurality of bronchi and having, as its bottom surface, a figure including the marking image. A surgical system.

5. In Claim 4, The surgical system, wherein the resection site guide information is information that can be inserted into the patient's body and indicates a separation plane to be resected by a treatment instrument for treating the surgical site, and information indicating the distance between the separation plane and the lesion.

6. In claim 1, The surgical system, wherein the in-vivo marking device is composed of a direct light probe that propagates red light from a light source.

7. In claim 1, The surgical system, wherein the endoscope is a thoracoscope.

8. A program for causing a computer to function as the image generation device in the surgical system according to claim 1.

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