Surgical support device

Abstract

To reduce labor and time of a nurse in instrument provision work.SOLUTION: A surgical operation supporting device according to an embodiment includes an acquisition unit and a creation unit. The acquisition unit acquires a procedure database that stipulates a procedure of a surgical operation to be performed, an instrument database in which a doctor's actions and surgical operation instruments required for the actions are associated, and a patient individual situation on a patient who undergoes the surgical operation. The creation unit estimates uncertainties that are contained in the procedure and result from the patient individual situation on the basis of the procedure database and the patient individual situation, and creates an individual surgical operation model that associates a surgical operation instrument with an action that may be taken for the uncertainties on the basis of the instrument database.SELECTED DRAWING: Figure 1

Description

Technical Field

[0001] The embodiments disclosed in this specification and the drawings relate to a surgical assistance device. in the position

Background Art

[0002] During the perioperative period, the instrument delivery work by operating room nurses (openers) is carried out. The instrument delivery work involves preparing surgical instruments before the surgery and handing them to the doctor during the surgery. The instrument delivery work is extremely important for the smooth progress of the surgery.

[0003] In recent years, a chronic and serious shortage of nurses in the operating room has become a problem. Especially in the instrument delivery work, since medical knowledge and experience are required, it is difficult to secure personnel. In addition, since it is necessary to assign such personnel exclusively to the instrument delivery work, it has led to an increase in surgical costs.

Prior Art Documents

Patent Documents

[0004]

Patent Document 1

Summary of the Invention

Problems to be Solved by the Invention

[0005] One of the problems to be solved by the embodiments disclosed in this specification and the drawings is to reduce the labor of operating room nurses in the instrument delivery work. However, the problems to be solved by the embodiments disclosed in this specification and the drawings are not limited to the above problems. The problems corresponding to the respective effects of each configuration shown in the embodiments described later can also be regarded as other problems.

Means for Solving the Problems

[0006] ​The surgical support device according to the embodiment includes an acquisition unit and a creation unit. The acquisition unit acquires a procedure database that defines the procedure of the surgery to be performed, an instrument database that associates the actions of the doctor with the surgical instruments required for the actions, and the individual circumstances of the patient who will undergo the surgery. The creation unit estimates the uncertain factors included in the procedure and caused by the individual circumstances of the patient based on the procedure database and the individual circumstances of the patient, and creates an individual surgical model that associates surgical instruments with the actions that can be taken for the uncertain factors based on the instrument database.

Brief Description of the Drawings

[0007]

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DETAILED DESCRIPTION OF THE INVENTION

[0008] Hereinafter, embodiments of the surgical support device and the surgical support system will be described in detail with reference to the drawings.

[0009] The surgical support device according to the present embodiment is a computer for assisting the instrument delivery work related to surgical instruments. The surgical support system is a computer network including the surgical support device and its peripheral devices. The surgical instruments according to the present embodiment include medical instruments such as forceps, scissors, tweezers, needle holders, hooks, retractors, orthopedic surgical instruments, and neurosurgical surgical instruments, as well as consumables such as gauze, threads, and rubber cords, and all articles that can be used in surgery such as drugs.

[0010] (First Embodiment) FIG. 1 is a diagram showing a configuration example of a surgical support system 100 and a surgical support device 1 according to the first embodiment. As shown in FIG. 1, the surgical support system 100 includes a surgical support device 1, a camera 21, and a microphone 22. The surgical support device 1 includes a processing circuit 11, an input device 12, a communication device 13, a display device 14, a storage device 15, and a connection device 16.

[0011] The processing circuit 11 includes processors such as a CPU (Central Processing Unit) and a GPU (Graphics Processing Unit). By executing a surgical support program, the processing circuit 11 realizes an acquisition function 111, a creation function 112, an estimation function 113, a determination function 114, an output control function 115, and the like. Note that each of the functions 111 to 115 is not limited to being realized by a single processing circuit. It is also possible to configure a processing circuit by combining a plurality of independent processors, and each processor executes a surgical support program to realize each of the functions 111 to 115. Further, the functions 111 to 115 may be modularized programs constituting the surgical support program, or may be individual programs. These programs are stored in the storage device 15.

[0012] By realizing the acquisition function 111, the processing circuit 11 acquires various information. As an example, the processing circuit 11 acquires a standard surgical model, a surgeon model, and a patient model. The standard surgical model includes a procedure database and an instrument database. The procedure database defines the standard procedure of the surgery. The instrument database associates the medical acts performed by the doctor with the surgical instruments required for the medical acts. That is, the standard surgical model is a database that associates the medical acts and surgical instruments required for the surgery to be performed. The surgeon model is a database that records the individual circumstances of the doctor (surgeon) in charge of performing the surgery to be performed. The patient model is a database that records various individual circumstances of the patient for whom the surgery is to be performed.

[0013] By implementing the creation function 112, the processing circuit 11 estimates the uncertain elements included in the procedure based on the procedure database and the individual circumstances of the patient defined by the patient model, and creates an individual surgical model that associates surgical instruments with actions that can be taken for the uncertain elements, based on the instrument database included in the standard surgical model. It can be said that the individual surgical model is a standard surgical model that reflects the individual circumstances of the patient scheduled for the operation. Specifically, the individual surgical model associates a series of medical actions in the operation to be performed with the surgical instruments required for the medical actions. Here, the medical actions defined in the individual surgical model include, in addition to the medical actions that are typically performed in the operation to be performed, medical actions that can be taken for uncertain elements that may occur due to the individual circumstances of the patient.

[0014] By implementing the estimation function 113, the processing circuit 11 estimates the current process and specific situation in the procedure of the operation based on the image information and / or audio information collected during the performance of the operation on the patient.

[0015] By implementing the decision function 114, the processing circuit 11 estimates the medical actions that can be taken later according to the current process and specific situation based on the current process and specific situation estimated by the estimation function 113 and the individual surgical model, and determines the candidates for surgical instruments (hereinafter referred to as surgical instrument candidates) associated with the estimated medical actions.

[0016] By implementing the output control function 115, the processing circuit 11 outputs various information. As an example, the processing circuit 11 outputs candidate information regarding the surgical instrument candidates determined using the individual surgical model according to the progress of the operation on the patient. The candidate information is output to the display device 14, for example.

[0017] The input device 12 receives various input operations from the operator, converts the received input operations into electrical signals, and outputs them to the processing circuit 11. Specifically, as the input device 12, a mouse, keyboard, trackball, switch, button, joystick, touch pad, touch panel display, etc. are used. Note that the input device 12 may be an input device provided in another computer connected via a network or the like.

[0018] The communication device 13 transmits and receives various information to and from other computers included in the hospital information system to which the surgical support system 100 belongs.

[0019] The display device 14 displays various information according to the output control function 115 of the processing circuit 11. As the display device 14, for example, a liquid crystal display (LCD), a CRT (Cathode Ray Tube) display, an organic EL display (OELD), a plasma display, or any other display can be appropriately used. Also, a projector may be used instead of or in combination with the display.

[0020] As the storage device 15, a ROM (Read Only Memory), RAM (Random Access Memory), HDD (Hard Disk Drive), SSD (Solid State Drive), integrated circuit storage device, etc. that store various information are used. The storage device 15 may also be a drive device that reads and writes various information to and from portable storage media such as CDs (Compact Discs), DVDs (Digital Versatile Discs), flash memories, etc., and semiconductor memory elements, etc., in addition to the above storage devices. Also, the storage device 15 may be in another computer connected via a network.

[0021] The connection device 16 is an interface for connecting to peripheral devices. The connection device 16 connects a camera 21 and a microphone 22 as peripheral devices.

[0022] The camera 21 is an optical imaging device provided in the operating room. The camera 21 optically captures the state of the operating room during the operation and collects image information. The camera 21 transmits the collected image information to the surgical support device 1. The image information may be a still image or a moving image.

[0023] The microphone 22 is a sound collection device provided in the operating room. The microphone 22 collects sound information by collecting the state of the operating room during the operation. The microphone 22 transmits the collected sound information to the surgical support device 1.

[0024] FIG. 2 is a diagram showing the flow of aspects of the support process for the instrument delivery operation according to the first embodiment. As shown in FIG. 2, the instrument delivery operation is divided into three aspects: pre-processing (step SA), pre-operation (step SB), and intra-operation (step SC). In the pre-processing aspect (step SA), an individual surgical model is created by the surgical support device 1. In the pre-operation aspect (step SB), surgical instruments that can be used in the operation are prepared. In the intra-operation aspect (step SC), instrument delivery support using the individual surgical model is performed. Hereinafter, the three aspects will be specifically described.

[0025] FIG. 3 is a diagram showing the flow of processing by the surgical support device 1 in the pre-processing aspect (step SA). As shown in FIG. 3, the processing circuit 11 first acquires a standard surgical model, a surgeon model, and a patient model by realizing the acquisition function 111 (step SA1). The standard surgical model, the surgeon model, and the patient model are managed in the hospital information system as surgical information associated with an electronic medical record or the like. The processing circuit 11 acquires a standard surgical model related to the operation scheduled to be performed, a surgeon model related to the surgeon scheduled to be in charge, and a patient model related to the patient of the operation scheduled to be performed from the hospital information system.

[0026] The surgery scheduled in this embodiment assumes a surgical operation in which an instrument removal operation is performed. However, the type of the surgical operation is not particularly limited, and any surgical operation can be applied as long as surgical instruments are used. Hereinafter, as the surgery scheduled to be performed, a trephination and irrigation for chronic subdural hematoma will be described as a specific example to explain the embodiment.

[0027] FIG. 4 is a diagram showing an overall flow of a trephination and irrigation for chronic subdural hematoma. As shown in FIG. 4, the trephination and irrigation for chronic subdural hematoma is divided into a step of shaving and skin incision, a step of securing the surgical field, a step of dura mater incision, and a step of washing the hematoma cavity and placing a drain.

[0028] FIG. 5 is a diagram illustrating the content of a standard surgical model. As shown in FIG. 5, the standard surgical model is a database associating the surgical steps scheduled to be performed with surgical instruments. The surgical steps correspond to the actions by a doctor in the surgical procedure. In FIG. 5, the surgical steps are arranged along the procedure, but they do not necessarily have to be arranged along the procedure and may be arranged disorderly. Identification information of surgical instruments that are standardly used in each surgical step is associated therewith. As the identification information, information that can identify the type of surgical instruments, such as the name or ID of the surgical instrument, may be used. In FIG. 5, the name of the surgical instrument is used as the identification information. For example, the surgical instrument "clipper" is associated with the surgical step "partial shaving". The number of surgical instruments associated with one surgical step is not limited to one, and may be two or more. For example, three surgical instruments, namely, "bipolar", "suction tube", and "perforator", are associated with the surgical step "setting".

[0029] It may be advisable to set derivative surgical acts (hereinafter referred to as derivative acts) for each surgical procedure. Derivative acts are surgical acts that can be taken against uncertain factors resulting from individual patient circumstances and / or individual physician circumstances. For example, as shown in FIG. 5, for the surgical procedure "partial shaving" (number "1"), the surgical procedure "partial shaving (long hair)" (number "1-1") is set as a derivative act. The surgical instruments "rubber cord" and "clipper" are associated with the surgical procedure "partial shaving (long hair)". Also, for the surgical procedure "local anesthesia" (number "5"), the surgical procedure "local anesthesia (consideration for bleeding: required)" (number "5-1") is set as a derivative act, and the surgical instrument "1% xylocaine with epinephrine" is associated with it.

[0030] Optional surgical acts (hereinafter referred to as optional acts) may be set for each surgical procedure. Optional acts are surgical acts that are not included in the original essential surgical procedures but can be taken against sudden or accidental events during the surgical operation. For example, as shown in FIG. 5, as optional acts, the surgical procedure "hemostasis" (number "※1") is set, and the surgical instrument "vascular forceps" is associated with it, and the surgical procedure "suture" (number "※2") is set, and the surgical instruments "needle, suture thread, gauze" are associated with it.

[0031] FIG. 6 is a diagram illustrating the content of the surgeon model. As shown in FIG. 6, the surgeon model is a database that records the individual circumstances of the physician responsible for performing the planned surgery. As an example, the surgeon model has items such as basic information, surgical experience, and preferences as individual physician circumstances. As basic information, gender such as "male", age such as "30 years old", dominant hand such as "left", physical build such as "height: 180 cm" are recorded. As surgical experience, the number of planned surgeries (trephination and lavage) such as "3 times", the level of the surgery such as "low" are recorded. As preferences, for example, information useful for preparing surgical instruments such as "using a round blade knife during scalp incision" and "being prone to worrying about bleeding" are recorded.

[0032] FIG. 7 is a diagram illustrating the content of the patient model. As shown in FIG. 7, the patient model is a database that records the individual circumstances of the patient for whom the operation is scheduled. As the individual patient circumstances, circumstances that can be useful in assisting the instrument delivery operation are recorded. As an example, the patient model has items such as basic information, findings information, surgical history, and past history as individual patient circumstances. As the basic information, gender such as "female", age such as "75 years old", build such as "normal", etc. are recorded. As the findings information, disease names such as "chronic subdural hematoma" and lesions such as "large hematoma" are recorded. As the surgical history, the number of laparotomies such as "3 times" is recorded. As the past history, disease names such as "dementia" and complications such as "none" are recorded.

[0033] When step SA1 is performed, the processing circuit 11 creates an individual surgical model by realizing the creation function 112 (step SA2). In step SA2, the processing circuit 11 creates an individual surgical model based on the standard surgical model, the surgeon model, and the patient model acquired in step SA1. The processing circuit 11 searches for the presence or absence of uncertain elements for each surgical step along the standard surgical procedure recorded in the standard surgical model. For example, the processing circuit 11 searches for derivative actions related to individual patient circumstances and / or individual physician circumstances for the surgical step to be processed. If there is no derivative action, it is determined that there is no uncertain element. For a surgical step without an uncertain element, the surgical instrument associated with the surgical step in the standard surgical model is selected, and the combination of the surgical step and the surgical instrument is registered in the individual surgical model. On the other hand, if there is a derivative action, it is determined that there is an uncertain element. For a surgical step with an uncertain element, the derivative action is adopted instead of the surgical step to be processed. The surgical instrument associated with the derivative action in the standard surgical model is selected, and the combination of the derivative action and the surgical instrument is registered in the individual surgical model.

[0034] In this way, an individual surgical model is created by performing the presence or absence of uncertain elements and the selection of surgical instruments in order along the surgical procedure for the surgical steps to be processed. When it is assumed that an arbitrary action should be taken in the surgical procedure, the arbitrary action may be incorporated into the surgical procedure defined in the individual surgical model. Regarding the arbitrary action, it may be automatically selected by the processing circuit 11 or may be selected by an operator or the like.

[0035] Hereinafter, the processing of step SA2 will be specifically described with reference to FIGS. 8 to 11. FIG. 8 is a diagram showing the association of uncertain elements and surgical instruments with the surgical procedure from shaving to skin incision in the trephination and irrigation for chronic subdural hematoma. FIG. 9 is a diagram showing the association of uncertain elements and surgical instruments with the surgical procedure for securing the surgical field in the trephination and irrigation for chronic subdural hematoma. FIG. 10 is a diagram showing the association of uncertain elements and surgical instruments with the surgical procedure for dural incision in the trephination and irrigation for chronic subdural hematoma. FIG. 11 is a diagram showing the association of uncertain elements and surgical instruments with the surgical procedure from washing of the hematoma cavity to drainage placement in the trephination and irrigation for chronic subdural hematoma.

[0036] As shown in FIG. 8, in the stage from shaving to skin incision, first, the surgical procedure "partial shaving" is performed. In "partial shaving", the surgical instruments used vary according to the hair length. Typically, since "female" has long hair, when the patient-specific factor "gender" is "female", it is advisable to prepare the surgical instruments "rubber string" and "clipper" for the surgical procedure "partial shaving". Therefore, when the patient-specific factor "gender" is "female", the processing circuit 11 adopts the surgical procedure "partial shaving (long hair)" instead of the surgical procedure "partial shaving", and as the surgical instruments, it selects the "rubber string" and "clipper" associated with the surgical procedure "partial shaving (long hair)" in the standard model. On the other hand, when the patient-specific factor "gender" is "male", the processing circuit 11 adopts the standard surgical procedure "partial shaving", and as the surgical instrument, it selects the "clipper" associated with the surgical procedure "partial shaving" in the standard model. In addition, when "long hair" or "short hair" etc. is recorded as the patient-specific factor, regardless of the gender, the surgical procedure and surgical instruments may be selected according to "long hair" or "short hair".

[0037] As another example, in "local anesthesia", in preparation for bleeding during the subsequent "scalp incision", an anesthetic with a hemostatic effect may be injected. Therefore, for a surgeon who is prone to being concerned about bleeding, it is advisable to prepare the surgical instrument "1% xylocaine with epinephrine" for "local anesthesia". Therefore, when a tendency to be concerned about bleeding such as "prone to being concerned about bleeding" is recorded in the item "preference" of the doctor-specific factors, the processing circuit 11 adopts the surgical procedure "local anesthesia (consideration for bleeding: required)" instead of the surgical procedure "local anesthesia", and as the surgical instrument, it selects the "1% xylocaine with epinephrine" associated with the surgical procedure "local anesthesia (consideration for bleeding: required)" in the standard model. On the other hand, when a tendency to be concerned about bleeding such as "prone to being concerned about bleeding" is not recorded in the item "preference", the processing circuit 11 adopts the standard surgical procedure "local anesthesia", and as the surgical instrument, it selects the "1% xylocaine" associated with the surgical procedure "local anesthesia" in the standard model.

[0038] When information suggesting the possibility of blood pressure increase or vasoconstriction due to individual patient circumstances is recorded, it may be determined to add the surgical procedure "hemostasis operation" to the operation procedure. In this case, the processing circuit 11 selects the "bipolar" associated with the surgical procedure "hemostasis operation" as the surgical instrument.

[0039] When step SA2 is performed, the processing circuit 11 stores the individual surgical model created in step SA2 in the storage device 15 by realizing the output control function 115 (step SA3). The individual surgical model is stored in the storage device 15 in association with the identification number of the surgery to be performed, the patient number of the patient, etc.

[0040] Thus, the preprocessing phase by the surgical support device 1 ends.

[0041] After the end of the preprocessing phase, as shown in FIG. 2, preparation of surgical instruments is performed (step SB). In step SB, a nurse or the like prepares in advance the surgical instruments necessary for the surgery to be performed. At this time, the processing circuit 11 of the surgical support device 1 may display the individual surgical model on the display device 14 by realizing the output control function 115. As the content of the individual surgical model, the surgical procedure in the surgery to be performed, each surgical step (essential surgical step, derivative action, and optional action) constituting the surgical procedure, and information on the surgical instrument associated with the surgical step may be displayed. Information on the surgical instrument includes the name, image, storage location, etc. of the surgical instrument. As described above, the individual surgical model not only records the surgical instruments that are standardly necessary but also the surgical instruments necessary for derivative actions that can be taken against uncertain factors caused by individual patient circumstances, etc. Therefore, a nurse or the like can prepare sufficient surgical instruments in advance without requiring proficiency. At this time, a nurse or the like may perform a sterilization process on the surgical instruments using an autoclave or the like as necessary.

[0042] In step SB, the processing circuit 11 may display the details of the patient's individual circumstances included in the patient model. For example, if information that can predict adhesions or a large amount of bleeding, such as "a patient who has had laparotomy for the second time" is registered as the patient's individual circumstances, it becomes possible to prepare more gauze and hemostatic agents than usual. Further, the processing circuit 11 may display the details of the doctor's individual circumstances included in the operating doctor model. For example, if a preference for using a circular blade knife when making a scalp incision is registered as the doctor's individual circumstances, it becomes possible to prepare a circular blade knife.

[0043] If a surgical act is not performed, it may not be known whether it is appropriate or inappropriate. For such uncertain factors, it is advisable to prepare all possible surgical instruments in advance. As an example, assuming that hemostasis is not successful, it is advisable to have a Surgicel (hemostatic agent) prepared. As another example, when the cutting range is not determined as wide or narrow, both a circular blade knife for use in a wide range and a pointed blade knife for use in a narrow range should be prepared.

[0044] It is advisable to prepare surgical instruments in advance according to the patient's individual information. As an example, if "dementia" is registered as the past history among the patient's individual information, in order to relieve anxiety and tension and calm the mood, it is advisable to prepare a drug called "Celsin" as a surgical instrument. As another example, when the gender among the patient's individual information is "female" and "long hair", as surgical instruments, not only a "hair clipper" but also a "rubber band" for tying up the hair should be prepared.

[0045] It is advisable to prepare surgical instruments in advance according to the assumed uncertain factors of the surgical content. As an example, when performing a procedure to expose the skull, since there is a possibility of bone bleeding, it is advisable to prepare a drug called "bone wax", a surgical instrument for hemostasis.

[0046] When the surgical instruments are prepared, the surgery is started. As shown in Figure 2, during the surgery (intraoperatively), instrument delivery support using the individual surgical model is performed (step SC).

[0047] FIG. 12 is a plan view schematically showing the environment of the operating room during the operation according to the first embodiment. As shown in FIG. 12, a patient is placed on the operating table, and medical staff such as a surgeon, a nurse, an assistant to the surgeon, and an anesthesiologist are positioned so as to surround the operating table. A lighting fixture 34 is arranged above the operating table. The lighting fixture 34 is arranged so as to illuminate the surgical site of the patient and the like. A camera 21 and a microphone 22 are attached to the lighting fixture 34. The camera 21 is provided for optically photographing the state of the operating room. The object to be photographed by the camera 21 is preferably a part where the specific situation during the operation can be grasped, such as the surgical site of the patient or the hands of the surgeon. The microphone 22 is provided for collecting sound of the operating room. The object to be collected by the microphone 22 is preferably a person from whom the specific situation during the operation can be grasped, such as the voices emitted by medical staff such as a surgeon, a nurse, an anesthesiologist, and an assistant, or the voice emitted by the patient. The camera 21 and the microphone 22 are provided on the lighting fixture 34 via joints (not shown), and are preferably provided so that the directions of the camera 21 and the microphone 22 can be adjusted manually or electrically via a processing circuit 11.

[0048] As shown in FIG. 12, a placement table 31 is placed near the surgeon and the nurse. Surgical instruments 33 prepared in the preparation stage (step SB) are arranged on the top plate of the placement table 31. The placement table 31 is provided with wheels and is configured to be movable to an arbitrary place so as not to obstruct medical staff. Also, a Mayo table 32 is provided near the operating table. The top plate of the Mayo table 32 protrudes so as to cover a part of the upper part of the operating table. Surgical instruments after being used by the surgeon and the like are placed on the top plate of the Mayo table 32. Also, a monitor is installed at an arbitrary place in the operating room. Vital signs such as the electrocardiogram waveform and blood pressure value of the patient are displayed on the monitor. Also, candidates for surgical instruments are displayed in a predetermined layout on the monitor by realizing the output control function 115. The monitor is an example of the display device 14 of the surgical support device 1.

[0049] Next, a processing example of instrument delivery support in the intraoperative phase (step SC) will be described.

[0050] FIG. 13 is a diagram showing the flow of processing by the surgical support device 1 in the intraoperative situation (step SC). As shown in FIG. 13, the processing circuit 11 of the surgical support device 1 reads an individual surgical model stored in the storage device 15 (step SC01). The individual surgical model read in step SC01 is the individual surgical model regarding the patient for the surgery scheduled to be performed, which was generated in step SA.

[0051] When step SC01 is performed, the processing circuit 11 acquires intraoperative image information and audio information by realizing the acquisition function 111 (step SC02). In step S02, image information is acquired from the camera 21 and audio information is acquired from the microphone 22 via the connected device 16. The image information and the audio information may be continuously acquired during the surgery, may be acquired at regular intervals such as 1 second or 5 seconds, or may be acquired at the time instructed via the input device 12 by medical staff or the like. Also, it is not necessary to acquire both the image information and the audio information, and only one of the image information or the audio information may be acquired. Hereinafter, it is assumed that the image information and the audio information are acquired in step SC02.

[0052] When step SC02 is performed, the processing circuit 11 estimates the current process and the specific situation based on the image information and the audio information acquired in step SC02 by realizing the estimation function 113 (step SC03). In step SC03, the processing circuit 11 first performs image processing on the image information to extract the feature information of the image information. For example, the feature information may be extracted from the image information using a machine learning model that performs feature extraction such as an encoder. Next, the processing circuit 11 estimates the current process from among a plurality of surgical steps defined in the individual surgical model based on the feature information. For example, the class corresponding to the current process may be estimated from the feature information using a machine learning model whose learning parameters are trained to input the feature information and output the class of the surgical step to which the feature information belongs. For example, when the image information shows the head at the time of incision, "scalp incision" is estimated as the current process.

[0053] In addition, the current process may be estimated by performing speech recognition on the voice information. The voice of a person to be recognized, such as the surgeon, may be registered in the surgeon model, and only the voice of the person to be recognized may be processed. Further, the current process may be estimated using both the image information and the voice information.

[0054] In parallel with the estimation of the current process, the processing circuit 11 estimates the current specific situation. For example, the processing circuit 11 performs speech recognition on the voice information to analyze the meaning of the utterance corresponding to the voice information, and estimates the current specific situation based on the meaning. Further, the processing circuit 11 may acquire voice information of various keywords of the surgeon in advance, and generate a machine learning model in which the learning parameters are trained to input the voice information and output a label of the specific situation corresponding to the voice information. In this case, the processing circuit 11 applies the voice information acquired in step SC02 to the machine learning model to generate a label of the specific situation corresponding to the voice information. For example, when voice information such as "This blood vessel is a bit deep. I wonder if there's anything we can do about it" is acquired, a specific situation where an attempt is being made to cut a blood vessel at a deep position is estimated. In addition, when silent voice information is acquired, it is estimated that there is no change in the situation. In this case, it is synonymous with the fact that the specific situation has not been estimated.

[0055] In addition, the processing circuit 11 may estimate the current specific situation from the image information. Further, the current specific situation may be estimated using both the image information and the voice information.

[0056] When step SC03 is performed, the processing circuit 11 determines candidates for the next necessary surgical instruments based on the current process and specific situation estimated in step SC03 by realizing the determination function 114 (step SC04). In step SC04, the processing circuit 11 determines, as candidates, the surgical instruments associated with the process after the current process, for example, the process one step later, in the individual surgical model. When the current process is estimated to be "fascia suture", as shown in FIG. 11, the surgical instruments "3-0 nylon angle needle" and "stapler" associated with the next process "skin suture" are determined as candidates.

[0057] When an uncertainty factor is associated with the next process, the surgical instruments associated with the actions that can be taken for the uncertainty factor in the individual surgical model are determined as candidates. For example, when the current process is estimated to be "scraping out bone chips", as shown in FIG. 10, the next process is "hemostasis", but the uncertainty factor "hemostasis condition" is associated. In this case, the surgical instrument "Surgicel" associated with the surgical process (derived action) "hemostasis: difficult" that can be taken for the uncertainty factor "hemostasis condition" and the surgical instrument "bipolar" associated with the surgical process (normal action) "hemostasis: normal" are determined as candidates. When there are two or more candidates, the processing circuit 11 may assign priorities to these candidates based on the current specific situation. For example, when massive bleeding is expected from the current specific situation, the surgical instrument "Surgicel" associated with the surgical process (derived action) "hemostasis: difficult" that suits the situation may be set as the first candidate, and the surgical instrument "bipolar" associated with the surgical process (normal action) "hemostasis: normal" with a relatively lower degree of suitability for the situation may be set as the second candidate.

[0058] On the other hand, when the current specific situation is estimated in step SC03, the processing circuit 11 may estimate an arbitrary action to be performed next from the current specific situation, and determine, as candidates, the surgical instruments associated with the arbitrary action in the individual surgery model. For example, when voice information such as "This blood vessel is a bit deep. I wonder if I can do something about it" is acquired, a specific situation where an attempt is being made to cut a blood vessel at a deep position is estimated. In this case, since it is estimated that some treatment for bleeding will be performed, surgical actions such as "hemostasis" and "suturing" are estimated as arbitrary actions, and the surgical instrument "vascular forceps" associated with the arbitrary action "hemostasis" and the surgical instruments "needle", "suture thread", and "gauze" associated with the arbitrary action "suturing" are determined as candidates. Further, when there is information such as patient individual information "second laparotomy" and image information "during resection, bleeding is relatively heavy", if "hemostasis" is more likely than "suturing" as the next possible action, the surgical instrument "vascular forceps" may be set as the first candidate and the surgical instruments "needle", "suture thread", and "gauze" may be set as the second candidates.

[0059] When step SC04 is performed, the processing circuit 11 displays the candidates determined in step SC04 (step SC05) by realizing the output control function 115. The candidates may be displayed on a monitor (display device 14) arranged at a position easily visible to the nurse.

[0060] FIG. 14 is a diagram showing an example of display of surgical instrument candidates. As shown in FIG. 14, N surgical instrument candidates are displayed on the display screen I1. The number N of the displayed surgical instrument candidates may be the number of all candidates determined in step SC04 or a predetermined number set in advance. In FIG. 14, three surgical instrument candidates are displayed. The N surgical instrument candidates may be displayed with priorities assigned. The name of the next process and the name of the surgical instrument are displayed for each candidate. For example, when the voice information is "It's a bit deep, this blood vessel, can't we do something about it?", the patient individual information is "Second laparotomy", and the image information is "During resection, bleeding is a bit much", as candidate 1, the next process is "Hemostasis" and the surgical instrument is "Vascular forceps", as candidate 2, the next process is "Vascular forceps" and the surgical instruments are "Needle", "Suture (thick)", "Gauze (a lot)", as candidate 3, the next process is "Vascular forceps" and the surgical instruments are "Needle", "Suture (standard)", "Gauze (a lot)", etc. are determined and displayed.

[0061] By displaying the surgical instrument candidates determined using the individual surgical model, the nurse can easily identify the surgical instruments that will be needed next. If the surgical instrument is on the instrument table, the nurse will pick it up and hand it to the surgeon. If the surgical instrument is not on the instrument table, the nurse will go to its storage location, pick it up, and hand it to the surgeon. According to the present embodiment, since surgical instrument candidates with relatively high usage possibilities are presented, even a nurse who is not familiar with the instrument delivery task can perform the instrument delivery simply and accurately. Since the task of handing over to the surgeon can be assigned to a nurse who is not skilled in it, the range of allocation of nurses can be increased. Also, since an unexpected situation can be recognized and the next medical act can be accurately predicted and responded to, a part of the instrument delivery task can be replaced by the surgical support device 1 and the surgical support system 100, which can contribute to the improvement of the chronic and serious shortage of nurses. Furthermore, for the patient, it reduces the burden associated with the smooth progress of the surgery, and since it is possible to employ a nurse who is not skilled in the surgery, there is an advantage of reducing the surgical cost.

[0062] When step SC05 ends, the processing by the surgical support device 1 in the intraoperative situation ends. Note that the above steps SC02 to SC05 are repeated every time image information and / or audio information is acquired, or at regular time intervals. By repeating the processing in this way, the presented surgical instrument candidates will be changed moment by moment according to the progress of the surgery. Therefore, the optimal surgical instrument candidate at the current time will be presented.

[0063] Note that the processing by the above surgical support device 1 is an example, and the present embodiment is not limited to this, and various specific examples, application examples, and modification examples are possible. Hereinafter, various specific examples, application examples, and modification examples will be described.

[0064] In the above embodiment, the name of the surgical instrument is displayed as the surgical instrument candidate, but an image of the surgical instrument or the storage location may be displayed. This enables a nurse who is not familiar with the instrument delivery work to easily find the surgical instrument.

[0065] Among the surgical instrument candidates, sterilization treatment is required, but there may be a case where the sterilization treatment is incomplete at the stage presented in step SC05. In this case, a message or mark indicating that the sterilization treatment is incomplete may be displayed together with the name of the surgical instrument candidate or the like. Also, when the time when the sterilization treatment is completed is known, the completion time or the remaining time until completion may be displayed. Further, when the sterilization treatment has not been performed yet, a message or mark indicating that the sterilization treatment has not been performed may be displayed together with the name of the surgical instrument candidate or the like. Alternatively, if there is a surgical instrument among the pre-prepared surgical instruments for which the sterilization treatment has not been performed yet, a message or mark indicating that the sterilization treatment has not been performed may be displayed together with the name of the surgical instrument or the like.

[0066] In the above embodiment, the surgical instrument candidate is displayed on the display device 14. However, the present embodiment is not limited to this. For example, a voice or the like that reads out the name of the surgical instrument candidate may be emitted via a speaker or the like.

[0067] As described above, the surgical support device 1 according to the first embodiment has a processing circuit 11. The processing circuit 11 acquires a procedure database that defines the procedure of the surgery to be performed, an instrument database that associates the actions of the doctor with the surgical instruments required for the actions, and the individual circumstances of the patient who will undergo the surgery. The processing circuit 11 estimates the uncertain factors included in the procedure and caused by the individual circumstances of the patient based on the procedure database and the individual circumstances of the patient, and creates an individual surgical model that associates surgical instruments with the actions that can be taken for the uncertain factors based on the instrument database.

[0068] According to the above configuration, it becomes possible to identify uncertain factors in advance before the surgery and create an individual surgical model that associates surgical instruments with the actions that can be taken for the uncertain factors. By referring to the individual surgical model, it becomes possible to prepare surgical instruments assuming not only the surgical procedure but also the uncertain factors caused by the individual circumstances of the patient before the surgery is performed.

[0069] (Second Embodiment) The surgical support system according to the first embodiment presents surgical instrument candidates. The surgical support system according to the second embodiment delivers surgical instruments to the surgeon by a machine such as a robot. Hereinafter, the second embodiment will be described. In the following description, components having substantially the same functions as those in the first embodiment are denoted by the same reference numerals, and redundant descriptions will be given only when necessary.

[0070] FIG. 15 is a diagram showing a configuration example of the surgical support system 200 and the surgical support device 2 according to the second embodiment. As shown in FIG. 15, the surgical support system 200 includes a surgical support device 2, a camera 21, a microphone 22, and an instrument delivery device 23. The processing circuit 11 of the surgical support device 2 realizes an acquisition function 111, a creation function 112, an estimation function 113, a determination function 114, an output control function 115, and a device control function 116 by executing a surgical support program. Note that each of the functions 111 to 116 is not limited to being realized by a single processing circuit. It is also possible to configure a processing circuit by combining a plurality of independent processors, and each processor executes a surgical support program to realize each of the functions 111 to 116. Further, the functions 111 to 116 may each be a modularized program constituting the surgical support program, or may be individual programs. These programs are stored in the storage device 15.

[0071] The device control function 116 controls the instrument delivery device 23 via the connection device 16 so as to hand over the surgical instrument determined by the determination function 114 to the surgeon.

[0072] The instrument delivery device 23 is a robot having a multi-joint arm and a gripping part capable of handing over a surgical instrument to medical staff such as a surgeon or a nurse. The instrument delivery device 23 operates according to the control by the device control function 116, and hands over the surgical instrument candidate determined by the determination function 114 to the medical staff via the multi-joint arm and the gripping part. In the following examples, it is assumed that the handover destination by the instrument delivery device 23 is the surgeon.

[0073] FIG. 16 is a plan view schematically showing the environment of the operating room during the operation according to the second embodiment. As shown in FIG. 16, an instrument delivery device 23 is arranged near the surgeon. The instrument delivery device 23 has a body portion 231 and two articulated arms 232 and 234 connected to the body portion 231. A placement table 233 is provided at the tip of the articulated arm 232. Surgical instruments 33 and the like determined by the determination function 114 are placed on the placement table 233. A gripping portion 235 capable of gripping the surgical instrument 33 is provided at the tip of the articulated arm 234. The gripping portion 235 is provided so as to be tiltable and rotatable in an arbitrary direction with respect to the articulated arm 234. The instrument delivery device 23 is provided with wheels and is configured to be movable to an arbitrary place so as not to interfere with medical staff such as the surgeon.

[0074] Next, an example of the processing of instrument delivery support in the intraoperative phase (step SC) according to the second embodiment will be described. In the second embodiment as well, it is assumed that the creation of the individual surgical model in the pretreatment phase (step SA) and the preparation of the surgical instruments in the preoperative phase (step SB) are performed by the same processing as in the first embodiment.

[0075] FIG. 17 is a diagram showing the flow of processing by the surgical support system 200 in the intraoperative phase (step SC). Since steps SC11 to SC14 are the same as steps SC01 to SC04 in FIG. 13, the description thereof will be omitted. In step SC14, it is assumed that finally one surgical instrument has been determined. When a plurality of surgical instrument candidates are determined by the determination function 114, it is assumed that one surgical instrument has been selected by the surgeon or the like.

[0076] As shown in FIG. 17, when step SC14 is performed, the processing circuit 11 activates the instrument delivery device 23 by realizing the device control function 116 to provide the surgeon with the surgical instrument determined in step SC14 (step SC15). Specifically, the instrument delivery device 23 grips the surgical instrument determined in step SC14 from among the surgical instruments arranged on the placement table 233 via the multi-joint arm 234 and the gripping portion 235. The processing circuit 11 reads the surgeon model, confirms the dominant hand of the surgeon and the preference for the way of receiving, and determines the optimal handover angle and timing. The instrument delivery device 23 operates the multi-joint arm 234 and the gripping portion 235 according to the determined handover angle and timing to hand over the surgical instrument to the surgeon. At this time, the processing circuit 11 may determine the angles of the multi-joint arm 234 and the gripping portion 235 when handing over the surgical instrument 33 based on the measurement information of the actions at the surgeon's hand. As the measurement information, measurement information by motion capture or image information by the camera 21 is appropriate. Thereby, it is possible to hand over hemostatic forceps, needles and threads, etc. at an optimal angle for each surgeon. Further, the processing circuit 11 may grasp the time position (timing) of the next process in the surgical procedure and determine the timing for handing over the surgical instrument 33. For example, when handing over the surgical instrument "needle and thread" for the next process "suturing", the movement of the surgeon is analyzed by the image information from the camera 21, and the needle and thread can be handed over just before the surgeon starts suturing.

[0077] The handover angle of the surgical instrument 33 by the multi-joint arm 234 and the gripping portion 235 can be learned by machine learning. For example, when the hand of the surgeon at the time of handover is photographed by the camera 21 and it is determined by image recognition or the like that the surgeon has changed the holding of the surgical instrument 33, the processing circuit 11 learns that the current handover angle is an inappropriate angle. That is, the processing circuit 11 corrects the next handover angle based on the current handover angle. The correction algorithm may be corrected by any algorithm such as reinforcement learning. Thereby, it is possible to hand over the surgical instrument 33 to the surgeon at an appropriate angle.

[0078] The handover timing of the surgical instrument 33 by the multi-joint arm 234 and the gripping part 235 can also be learned by machine learning. For example, the actions when the surgeon requests the surgical instrument 33 are learned. Specifically, the movement of turning the palm when the surgeon requests the surgical instrument 33 is photographed by the camera 21, and the image information of the movement is registered as the requested action when the surgical instrument is requested. Alternatively, the voice information of the utterance "scalpel" when the surgeon requests the surgical instrument 33 is registered as the requested action when the surgical instrument is requested. During the surgery, the processing circuit 11 analyzes the image information from the camera 21 and / or the voice information from the microphone 22 to detect in real time that the requested action has been performed, and at the timing when it is detected that the requested action has been performed, the surgical instrument 33 is handed over via the multi-joint arm 234 and the gripping part 235. Thereby, it is possible to hand over the surgical instrument 33 to the surgeon at an appropriate timing.

[0079] When step SC15 ends, the processing by the surgical support system 200 in the intraoperative situation ends. Note that the above steps SC12 to SC15 are repeated every time image information and / or voice information is acquired, or at regular time intervals. By repeating the processing in this way, the surgical instrument will be handed over moment by moment according to the progress of the surgery.

[0080] Note that the processing by the above surgical support system 200 is an example, and the present embodiment is not limited to this, and various specific examples, application examples, and modification examples are possible. Hereinafter, various specific examples, application examples, and modification examples will be described.

[0081] In the above embodiment, the instrument delivery device 23 is configured to hand over the surgical instrument to the surgeon. However, the present embodiment is not limited to this. The instrument delivery device 23 may hand over the surgical instrument to the nurse. The nurse will hand over the received surgical instrument to the surgeon.

[0082] It is assumed that the surgical instrument determined in step SC14 is not placed on the placement table 233 of the instrument delivery device 23. In this case, the instrument delivery device 23 may automatically move to the storage location of the surgical instrument, operate the articulated arm 234 and the gripping portion 235, and grip the surgical instrument. Also, surgical instruments may be prepared inside the body portion 231. In this case, it is possible to grip a desired surgical instrument only by operating the articulated arm 234 and the gripping portion 235 without the instrument delivery device 23 moving.

[0083] As described above, the surgical support system 200 according to the second embodiment includes a storage device 15, a processing circuit 11, and an instrument delivery device 23. The storage device 15 stores an individual surgical model that associates a surgical instrument with an action that can be taken with respect to an uncertain element included in the surgical procedure for a patient and resulting from the individual circumstances of the patient related to the patient. The processing circuit 11 determines a specific surgical instrument to be used in a step later than the current step based on the image information and / or audio information at the time of performing the surgery and the individual surgical model. The instrument delivery device 23 provides the specific surgical instrument to the medical staff.

[0084] According to the above configuration, it is possible for the surgical support system 200 to perform all operations from the selection to the handover of the surgical instrument. Therefore, it is possible to stably perform instrument delivery similar to that of an experienced nurse without a nurse.

[0085] According to at least one of the embodiments described above, it is possible to reduce the labor of the nurse in the instrument delivery task.

[0086] The term "processor" used in the above description means, for example, a CPU, a GPU, or a circuit such as an application specific integrated circuit (ASIC), a programmable logic device (e.g., a simple programmable logic device (SPLD), a complex programmable logic device (CPLD), and a field programmable gate array (FPGA)). The processor realizes its functions by reading and executing a program stored in a storage circuit. Instead of storing a program in the storage circuit, it may be configured to directly incorporate the program into the circuit of the processor. In this case, the processor realizes its functions by reading and executing the program incorporated into the circuit. Also, instead of executing a program, the functions corresponding to the program may be realized by a combination of logic circuits. Note that each processor of the present embodiment is not limited to being configured as a single circuit for each processor, and a plurality of independent circuits may be combined to be configured as one processor to realize its functions. Further, a plurality of components in FIGS. 1 and 15 may be integrated into one processor to realize its functions.

[0087] Although some embodiments have been described, these embodiments are presented as examples and are not intended to limit the scope of the invention. These embodiments can be implemented in various other forms, and various omissions, replacements, changes, and combinations of embodiments can be made without departing from the gist of the invention. These embodiments and their modifications are included in the scope and gist of the invention, and are also included in the invention described in the claims and its equivalent scope.

Description of Reference Numerals

[0088] 1 Surgical support device 2 Surgical support device 11 Processing circuit 12 Input device 13 Communication device 14 Display device 15 Memory device 16 Connection device 21 Camera 22 Microphone 23 Instrument delivery device 31 Placement table 32 Mayo stand 33 Surgical instrument 34 Lighting fixture 100 Surgical support system 111 Acquisition function 112 Creation function 113 Estimation function 114 Decision function 115 Output control function 116 Device control function 200 Surgical support system 231 Trunk part 232 Multi-joint arm 233 Placement table 234 Multi-joint arm 235 Gripping part

Claims

1. A procedure database that defines the procedure of a planned surgery, an instrument database that associates a doctor's actions with the surgical instruments required for the actions, and an acquisition unit that acquires patient-specific circumstances regarding the patient who will undergo the surgery, a creation unit that creates an individual surgical model that associates a surgical action in the planned surgery and the surgical instruments required for the surgical action, reflecting the patient-specific circumstances, based on the procedure database, the patient-specific circumstances, and the instrument database, comprising: the creation unit: searches for derivative actions related to the patient-specific circumstances for the surgical actions in the planned surgery, if there are no such derivative actions, selects the surgical instruments associated in the instrument database for the surgical action, and associates the selected surgical instruments with the surgical action, if there are such derivative actions, determines the adoption of the derivative actions according to the patient-specific circumstances, selects the surgical instruments associated in the instrument database for the derivative actions, and associates the selected surgical instruments with the derivative actions, a surgical support device.

2. an estimation unit that estimates the current process and specific situation in the procedure based on the image information and / or audio information collected during the surgery, a determination unit that determines candidates for surgical instruments associated with possible surgical actions for the current process and specific situation based on the current process and specific situation and the individual surgical model, and an output unit that outputs candidate information regarding the candidates, further comprising the surgical support device according to Claim 1.

3. The surgical support device according to Claim 2, wherein the output unit displays the candidate information on a display device.

4. The surgical support device according to Claim 2, wherein the output unit outputs the candidate information according to the priority order.

5. The surgical support device according to Claim 2, wherein the output unit outputs, as the candidate information, the name, image, and / or storage location of the candidates.

6. The surgical support device according to Claim 1, further comprising a display unit that displays information regarding the surgical instruments recorded in the individual surgical model.

7. the acquisition unit acquires doctor-specific circumstances regarding the doctor who will perform the surgery, and the creation unit further determines the surgical instruments based on the doctor-specific circumstances, the surgical support device according to Claim 1. ​

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