Endoscope system and method for operating the endoscope system

Abstract

To provide an endoscope apparatus, an endoscope system, and an endoscope apparatus operation method which detect turbidity in perfusate and perform predetermined control to reduce burden on a patient and an operator.SOLUTION: An endoscope apparatus according to the present invention comprises: an endoscope which images a treatment target; and a first control device which converts imaging data obtained from the endoscope to image data. The first control device comprises: a storage which stores imaging data; a detection unit which obtains first imaging data from the endoscope, obtains second imaging data from the storage, calculates a variation in contrast between the first imaging data and the second imaging data, and detects information on turbidity in liquid resulting from treatment based on the variation; and a control unit which performs control based on a result of detection by the detection unit.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] The present invention relates to a surgical system, a control device, and a method for operating a surgical system. [Background technology]

[0002] Arthroscopic surgery involves opening a portal in the joint to be treated, inserting an arthroscope and treatment instruments into the joint through the portal, and performing the procedure while observing the inside of the joint cavity using the arthroscope under conditions where the joint cavity is filled with irrigation fluid.

[0003] International Publication No. 2018 / 078830 (Patent Document 1) discloses an arthroscopic surgery system for use in arthroscopic surgery. Patent Document 1 also discloses an ultrasonic treatment instrument for forming a hole in bone. This ultrasonic treatment instrument is configured so that the tip of the treatment instrument vibrates ultrasonically. When the surgeon brings the tip of the treatment instrument into contact with the bone and presses a switch that applies ultrasonic vibrations to the treatment instrument, the tip of the treatment instrument cuts the bone, forming a hole in the bone. When the tip of the treatment instrument cuts the bone, bone shavings (bone powder) are generated. [Prior art documents] [Patent documents]

[0004] [Patent Document 1] International Publication No. 2018 / 078830 Summary of the Invention [Problem to be solved by the invention]

[0005] However, bone powder generated during the cutting process temporarily disperses in the irrigation fluid, clouding the fluid and obstructing the arthroscope's view of the treated area. This can cause stress for both the surgeon and the patient, forcing them to stop working.

[0006] The present invention has been made in consideration of the above, and aims to provide a surgical system, a control device, and a method for operating a surgical system that detects turbidity in the perfusion fluid and performs predetermined control to reduce the burden on the patient and surgeon. [Means for solving the problem]

[0007] In order to solve the above-mentioned problems and achieve the objectives, the surgical system of the present invention is provided with a treatment device that treats biological tissue in a liquid, a detection unit that detects information related to turbidity in the liquid generated by the treatment device, and a control unit that controls the surgical system based on the detection results of the detection unit.

[0008] A control device according to the present invention is a control device for a surgical system that supplies a perfusion fluid to a treatment target and treats living tissue in the perfusion fluid, and includes a display device connectable to an endoscope device or a treatment instrument device, and at least one or more control devices, wherein the control device receives information from the endoscope device or the treatment instrument device via the display device, Based on the information, it is detected whether the perfusion fluid is turbid or not, and if the perfusion fluid is turbid, the control proceeds to the first control, and if the perfusion fluid is not turbid, the control proceeds to the second control.

[0009] Furthermore, the operating method of the surgical system according to the present invention is a method for operating a surgical system comprising an endoscopic device, a perfusion device that supplies perfusion fluid to a treatment target, and a treatment instrument device that treats biological tissue in the perfusion fluid in the treatment target, which detects whether the perfusion fluid is turbid, and if the perfusion fluid is turbid, transitions to a first control, and if the perfusion fluid is not turbid, transitions to a second control. [Effects of the Invention]

[0010] The surgical system, control device, and operation method according to the present invention can reduce the burden on the patient and surgeon. [Brief explanation of the drawings]

[0011] [Figure 1] FIG. 1 is a diagram showing a schematic configuration of a surgical system according to an embodiment. [Figure 2] FIG. 2 is a diagram showing a procedure flow using the surgical system according to the embodiment. [Figure 3] FIG. 3 is a diagram showing a cutting procedure flow using the surgical system according to the embodiment. [Figure 4A] FIG. 4A is a diagram showing an example of a turbidity detection flow using the surgical system according to the embodiment. [Figure 4B] FIG. 4B is a diagram showing an example of a turbidity detection flow using the surgical system according to the embodiment. [Figure 5A] FIG. 5A is a diagram showing the relationship between the endoscopic field of view and the contrast value according to the first embodiment of turbidity detection. [Figure 5B] FIG. 5B is a diagram showing an example of a condition for turbidity detection according to the first embodiment of the turbidity detection. [Figure 5C] FIG. 5C is a diagram showing an example of a condition for turbidity detection according to the first embodiment of the turbidity detection. [Figure 6A] FIG. 6A is a diagram showing the relationship between the field of view of an endoscope and an edge according to a first modified example of the first embodiment of turbidity detection. [Figure 6B] FIG. 6B is a diagram showing an example of conditions for turbidity detection according to the first modified example of the first embodiment of turbidity detection. [Figure 6C] FIG. 6C is a diagram showing an example of conditions for turbidity detection according to a first modified example of the first embodiment of turbidity detection. [Figure 7A] FIG. 7A is a diagram showing the relationship between the luminance and the field of view of an endoscope according to a second modification of the first embodiment of turbidity detection. [Figure 7B] FIG. 7B is a diagram showing an example of conditions for turbidity detection according to the second modified example of the first embodiment of turbidity detection. [Figure 7C] FIG. 7C is a diagram showing an example of a condition for turbidity detection according to a second modified example of the first embodiment of turbidity detection. [Figure 8A] FIG. 8A is a diagram showing the relationship between the endoscopic field of view and the image difference according to the third modified example of the first embodiment of turbidity detection. [Figure 8B] FIG. 8B is a diagram showing an example of conditions for turbidity detection according to the third modified example of the first embodiment of turbidity detection. [Figure 9A] FIG. 9A is a diagram showing an example of a turbidity detection flow using a surgical system according to the second embodiment of the turbidity detection. [Figure 9B] FIG. 9B is a diagram showing an example of a turbidity detection flow using the surgical system according to the second embodiment of the turbidity detection. [Figure 9C] FIG. 9C is a diagram showing an example of a condition for turbidity detection according to the second embodiment of the turbidity detection. [Figure 9D] FIG. 9D is a diagram showing an example of a condition for turbidity detection according to the second embodiment of the turbidity detection. [Figure 10A] FIG. 10A is a diagram showing an example of conditions for turbidity detection according to the third embodiment of the turbidity detection. [Figure 10B] FIG. 10B is a diagram showing an example of a condition for turbidity detection according to the third embodiment of the turbidity detection. [Figure 11] FIG. 11 is a diagram showing an example of an endoscopic display according to the first embodiment of the turbidity response control. [Figure 12] FIG. 12 is a diagram showing a surgical system according to a third embodiment of turbidity response control. [Figure 13] FIG. 13 is a diagram showing a surgical system according to a first modified example of the third embodiment of the turbidity response control. [Figure 14] FIG. 14 is a diagram showing a surgical system according to a second modification of the third embodiment of the turbidity response control. DETAILED DESCRIPTION OF THE INVENTION

[0012] Hereinafter, a mode for carrying out the present invention (hereinafter referred to as an embodiment) will be described with reference to the drawings. Note that the present invention is not limited to the embodiment described below. Furthermore, in the description of the drawings, the same parts are given the same reference numerals.

[0013] [Surgical system overview] The surgical system 1 of the present embodiment includes a treatment tool device 3 (FIG. 1). Furthermore, the surgical system 1 includes an endoscope device 2, a treatment instrument device 3, and a perfusion device 6. Using the surgical system 1, a surgeon can perform anterior cruciate ligament reconstruction surgery.

[0014] The endoscope device 2 includes an endoscope 21, a first control device 22, and a display device 23 (FIG. 1). A part of the insertion section 211 of the endoscope 21 is inserted into the joint cavity C1 of the knee joint J1 through a first portal P1 that communicates between the inside of the joint cavity C1 and the outside of the skin. The endoscope 21 then irradiates the inside of the joint cavity C1 with light, captures the illumination light (subject image) reflected within the joint cavity C1, and captures the subject image. The first control device 22 is connected by wire or wirelessly to the endoscope 21 and the display device 23. The first control device 22 performs various image processing on the imaging data captured by the endoscope 21, and causes the display device 23 to display the captured image after the image processing.

[0015] The treatment tool device 3 includes a treatment tool 31, a second control device 32, and a foot switch 33 (FIG. 1). The treatment tool 31 includes a main body 311, an ultrasonic probe (not shown), and a sheath 313 (FIG. 1). The treatment tool 31 includes a second portal P2 that connects the inside of the joint cavity C1 of the knee joint J1 with the outside of the skin, and the sheath 313 and a portion of the ultrasonic probe are inserted into the joint cavity C1. The main body 311 is formed in a cylindrical shape and accommodates an ultrasonic transducer 311a therein, which is made up of a bolt-clamped Langevin-type transducer and generates ultrasonic vibrations in response to supplied driving power. The second control device 32 supplies the driving power to the ultrasonic transducer 311a in response to an operator's operation of a foot switch 33 or the like.

[0016] The perfusion device 6 comprises a liquid source 61, a liquid supply tube 62, a drain bottle 64, and a drain tube 65 (FIG. 1). The liquid source 61 contains an irrigation fluid. For example, this may be a sterile pack of physiological saline. One end of the liquid supply tube 62 is connected to the liquid source 61, and the other end is connected to the endoscope 21. Furthermore, by fixing the liquid source 61 at a location higher than the endoscope 21, the irrigation fluid is supplied into the joint cavity C1 through the liquid supply tube 62. This allows the joint cavity C1 to be filled with the irrigation fluid. On the other hand, there is a drainage tube 65 and a drainage bottle 64 for draining the perfusion fluid from the joint cavity C1. The drainage bottle 64 is connected to the drainage tube 65 and stores the perfusion fluid and the like from the joint cavity C1 that is drained through the drainage tube 65. Furthermore, by fixing the drainage bottle 64 at a location lower than the joint cavity C1, the perfusion fluid is drained out of the joint cavity C1 through the drainage tube 65.

[0017] The embodiment shown in FIG. 1 is composed of a first control device 22 and a second control device 32, but in another embodiment, the embodiment may be composed of a single control device that is connectable to the endoscope 21 and the treatment tool 31 and can control each of them.

[0018] [Procedure flow] The procedure flow performed by the surgeon using the surgical system 1 will be described with reference to FIG. The surgeon forms a first portal P1 and a second portal P2 that connect the inside of the joint cavity C1 of the knee joint J1 with the outside of the skin (S1). Next, the surgeon inserts an endoscope 21 and a treatment tool 31 into the joint cavity C1 through the first portal P1 and the second portal P2, respectively (S2). In the above, it has been described that two portals are formed and then the endoscope 21 and treatment tool 31 are inserted, but it is also possible to form a first portal P1 and then insert the endoscope 21, and then form a second portal P2 and then insert the treatment tool 31.

[0019] Next, the surgeon brings the ultrasonic probe of the treatment tool 31 into contact with the treatment target while checking the state of the inside of the joint cavity C1 imaged by the endoscope 21 on the display device 23 (S3). After the treatment tool 31 is brought into contact with the treatment target, cutting treatment is performed (S4).

[0020] A bone hole is created into which the tendon graft can be inserted, and the tendon graft is inserted and fixed in place (S5).

[0021] Thereafter, the endoscope 21 and the treatment tool 31 are removed from the first portal P1 and the second portal P2, respectively (S6), and the first portal P1 and the second portal P2 are sutured together (S7), completing the treatment flow performed by the surgeon using the surgical system 1. Although the "operator" is explained as a single doctor, the role may be shared between a doctor and an assistant as appropriate.

[0022] [Cutting procedure flow] Next, a detailed flow of the cutting treatment (S4) will be described with reference to FIG. The second control device 32 reads the settings based on the ultrasonic probe attached to the main body 311 (S41). The timing for reading the settings may be at the beginning of the cutting procedure, or may be immediately after the main power of the second control device 32 is turned on and the ultrasonic probe is attached to the main body 311. The settings may also be input in advance by the surgeon or an assistant.

[0023] Next, normal control is started (S42). This normal control is the control of the surgical system that has been conventionally performed.

[0024] Next, the first control device 22 performs turbidity detection based on the information about turbidity (S43). The first control device 22 transmits the turbidity detection result to the second control device 32. If turbidity is detected ("turbidity detection = 1"), the second control device 32 proceeds to turbidity response control (S44), and if turbidity is not detected ("turbidity detection = 0"), normal control (S45) is performed. As an exception, if the surgeon or assistant selects turbidity response control even when turbidity is not detected, the process transitions to turbidity response control S44, just as when turbidity is detected ("turbidity detection" = 1). Specific details of turbidity detection and turbidity response control will be described later. Any combination of turbidity detection and turbidity response control described below may be used.

[0025] After the turbidity response control S44 and the normal control S45, it is confirmed whether the power of the treatment tool 31 is turned off (S46). If the power is not turned off ("No"), the process returns to the turbidity detection S43. If the power is turned off ("Yes"), the cutting treatment ends.

[0026] [Turbidity detection] Next, several methods for detecting turbidity based on specific information about turbidity will be described below. Here, the information about turbidity includes values ​​obtained from imaging data generated by the endoscope device 2, physical property values ​​of the perfusion fluid, impedance obtained from the treatment device 3, etc.

[0027] [First embodiment of turbidity detection: contrast] The first embodiment of turbidity detection is an embodiment in which turbidity is detected by obtaining information about turbidity from imaging data generated by the endoscope device 2. The embodiment is implemented by a first control device 22 that includes a storage (not shown) that stores imaging data generated by the endoscope device 2. The storage may be an external device. In the first embodiment of turbidity detection, a detection unit is provided in the first control device 22.

[0028] Next, a detection method of the first embodiment of turbidity detection will be specifically described. The first embodiment of turbidity detection is a method of detecting turbidity using the contrast of imaging data generated by the endoscope device 2.

[0029] An example of a method for detecting turbidity using contrast will be described with reference to FIG. 4A. The first control device 22 reads the first imaging data from the endoscope device 2 and stores it in a storage device provided in the first control device 22 (S431). The first control device 22 then calculates the contrast c0 (first value) of the first imaging data using a known technique (S432). Next, the detection unit provided in the first control device 22 reads the second imaging data output from the endoscope device 2 (S433) and calculates the contrast c1 (second value) of the second imaging data using a known technique (S434). Next, the detection unit provided in the first control device 22 compares the magnitudes of c0 and c1 (S435). If c1 is smaller, it is determined that turbidity has been detected, and turbidity detection is set to 1 (S436: see FIG. 5B). If c1 is equal to c0 or c1 is larger, it is determined that turbidity has not been detected, and turbidity detection is set to 0 (S437: see FIG. 5B). Once the detection result is obtained, the turbidity detection flow ends.

[0030] The first imaging data is imaging data captured several seconds or several frames before the second imaging data.

[0031] A method of detecting turbidity using conditions different from those in FIG. 5B will be described with reference to FIG. 4B. The detection unit provided in the first control device 22 reads a preset threshold value (S430). Thereafter, the detection unit provided in the first control device 22 performs S431 to S434 as described above. Thereafter, the detection unit provided in the first control device 22 calculates the amount of change by taking the difference between c0 and c1, and determines whether or not turbidity has occurred based on the calculated amount of change (S438: see FIG. 5C). Here, the threshold value may be a preset value, or may be calculated by collecting images with and without turbidity and performing machine learning.

[0032] The cause of turbidity is, for example, bone powder or emulsified cerebrospinal fluid. Therefore, the color of the turbidity itself is white. Therefore, when comparing the endoscopic field of view under normal conditions with that under turbidity, the contrast value is lower (see FIG. 5A). This makes it possible to detect turbidity regardless of the color of the illumination of the endoscope 21.

[0033] [First Modification of the First Embodiment of Turbidity Detection: Edge] Next, a first modified example of the first embodiment of turbidity detection will be described. The first modified example of the first embodiment of turbidity detection is a method in which a detection unit provided in the first control device 22 compares edges between the first imaging data and the second imaging data and detects turbidity based on the amount of change in the edges. Here, the first imaging data is imaging data captured several seconds or several frames before the second imaging data.

[0034] When turbidity occurs, biological tissue (e.g., bone) and the treatment tool 31 become invisible. In other words, the edges of biological tissue and the edges of the treatment tool 31 cannot be imaged (see FIG. 6A). Therefore, turbidity is detected by detecting a decrease in the number of edges. This makes it possible to detect turbidity independently of the color of the illumination of the endoscope.

[0035] The specific flow of turbidity detection is the same as that shown in Fig. 4A. Instead of calculating c0 in S432, the detection unit provided in the first control device 22 calculates an edge e0 from the first imaging data using a known technique. Thereafter, the conditions for turbidity detection will be explained using the edge e0 calculated in place of the determination of the turbidity detection condition (c0≦c1) used in S435, and the edge e1 calculated from the second imaging data using a known technique. If e1 is smaller than e0, it is determined that turbidity has occurred in the joint cavity C1, and turbidity is detected in the same manner as in S436 (see FIG. 6B). Conversely, if e1 is equal to or greater than e0, it is determined that turbidity has not occurred in the joint cavity C1 or has decreased, and turbidity is not detected in the same manner as in S437 (see FIG. 6B).

[0036] In the above description, the values ​​of e0 and e1 are simply compared, but a threshold may be set as shown in FIG. 4B, and turbidity may be detected by comparing the difference between e0 and e1 with the threshold (see FIG. 6C). Here, the threshold value may be a preset value, or may be calculated by collecting images with and without turbidity and performing machine learning.

[0037] [Second Modification of the First Embodiment of Turbidity Detection: Luminance] Next, a second modified example of the first embodiment of turbidity detection will be described. The second modified example of the first embodiment of turbidity detection is a method of comparing the brightness of the first imaging data with the brightness of the second imaging data and detecting turbidity based on the amount of change in brightness. Here, the first imaging data is imaging data captured several seconds or several frames before the second imaging data.

[0038] As mentioned above, turbidity is white. Therefore, the brightness is higher when turbidity occurs than when normal (see Figure 7A). This makes it possible to detect turbidity regardless of the color of the endoscope's illumination.

[0039] The specific flow of turbidity detection is the same as that shown in Fig. 4A. The detection unit provided in the first control device 22 calculates the luminance r0 from the first imaging data using a known technique instead of calculating c0 in S432. Thereafter, the turbidity detection conditions will be explained using the luminance r0 calculated instead of the turbidity detection condition (c0≦c1) used in S435, and the luminance r1 calculated from the second imaging data using a known technique. If r1 is greater than r0, it is determined that turbidity has occurred in the joint cavity C1, and turbidity is detected in the same manner as in S436. Conversely, if r1 is equal to or smaller than r0, it is determined that turbidity has not occurred or has decreased in the joint cavity C1, and turbidity is not detected in the same manner as in S437 (see FIG. 7B).

[0040] In the above description, the values ​​of r0 and r1 were simply compared, but a threshold may be set as shown in FIG. 4B, and turbidity may be detected by comparing the difference (amount of change) between r0 and r1 with the threshold (see FIG. 7C). Here, the threshold value may be a preset value, or may be calculated by collecting images with and without turbidity and performing machine learning.

[0041] [Third Modification of the First Embodiment of Turbidity Detection: Image Difference] Next, a third modified example of the first embodiment of turbidity detection will be described. The third modified example of the first embodiment of turbidity detection is a method of detecting turbidity by comparing pixels of the first imaging data and the second imaging data, calculating the amount of change in the pixels, and comparing the amount of change in the pixels with a threshold. Here, the first imaging data is imaging data captured several seconds or several frames before the second imaging data.

[0042] The specific flow of turbidity detection is the same as that shown in FIG. 4B except for steps S432 and S434. Instead of calculating c1 in step S432, the detection unit provided in the first control device 22 acquires pixels at the same coordinates in the first imaging data and the second imaging data, calculates the difference, and calculates the sum of absolute values ​​n of the change amounts of the pixels at each coordinate. The turbidity detection condition (c1-c0≧threshold) used in step S438 is then determined using the calculated sum of absolute values ​​n and the threshold value loaded in step S430. If n is greater than the threshold, it is determined that turbidity has occurred in the joint cavity C1, and turbidity is detected in the same way as in step S436. Conversely, if n is equal to the threshold value or smaller than the threshold value, it is determined that turbidity has not occurred in the joint cavity C1 or has decreased, and turbidity is not detected in the same way as in step S437 (see FIG. 8B).

[0043] When turbidity occurs, a change appears in the pixels of the image data (see Figure 8A). By detecting this change, turbidity can be detected.

[0044] [Second embodiment of turbidity detection: detecting turbidity from the pH of the perfusion fluid] The second embodiment is a means for detecting turbidity from the physical property values ​​of the perfusion fluid.

[0045] The drainage bottle 64 or the insertion section 211 of the endoscope 21 is equipped with a pH sensor (not shown) that detects the pH of the perfusion fluid. This storage may be an external device. The pH sensor provided in the drainage bottle 64 or the insertion section 211 of the endoscope 21 is disposed in a position where it can come into contact with the perfusion fluid. The first control device 22, which is provided with a detection unit, is connected to the pH sensor by wire or wirelessly so as to be able to receive the detection value from the pH sensor provided in the drainage bottle 64 or the insertion section 211 of the endoscope 21.

[0046] The turbidity is caused by, for example, bone or cerebrospinal fluid generated by treatment with the treatment tool 31. Therefore, the pH of the perfusion fluid changes when comparing a state where no turbidity occurs with a state where turbidity occurs. By detecting this change in the pH of the perfusion fluid, turbidity caused by bone or cerebrospinal fluid can be detected.

[0047] An example of a specific flow of turbidity detection will be described with reference to FIG. 9A. First, the detection unit provided in the first control device 22 reads a preset first pHw0 (S4310). Next, the detection unit provided in the first control device 22 receives a second pHw1 detected from a pH sensor provided in the drainage bottle 64 or the insertion portion 211 of the endoscope 21 (S4311). Thereafter, the first pHw0 stored in the detection unit provided in the first control device 22 is compared with the pHw1 acquired from the pH sensor provided in the drainage bottle 64 or the insertion portion 211 of the endoscope 21 (S4312). If w1 is greater than w0 ("No"), it is determined that turbidity has occurred in the joint cavity C1, and turbidity is detected (S4313: see FIG. 9C). Conversely, if w1 is equal to or less than w0 ("Yes"), it is determined that turbidity has not occurred in the joint cavity C1 or has decreased, and turbidity is not detected (S4314).

[0048] A method of detecting turbidity using conditions different from those in FIG. 9A will be described with reference to FIG. 9B. The detection unit provided in the first control device 22 reads a preset threshold value (S439). Thereafter, as described above, the detection unit provided in the first control device 22 performs S4310 to S4311. Thereafter, the detection unit provided in the first control device 22 calculates the amount of change by taking the difference between w0 and w1, and determines whether or not turbidity has occurred based on the calculated amount of change (S4315: see FIG. 9D). Here, the threshold value may be a preset value, or may be calculated by performing machine learning on the perfusion fluid pH when turbidity occurs and the perfusion fluid pH under normal conditions.

[0049] [Third embodiment of turbidity detection: turbidity detection from the impedance (viscosity) of the treatment tool] The third embodiment of the turbidity detection is a method for detecting turbidity based on impedance acquired from the treatment tool 31. The method is implemented by a second control device 32 having a storage (not shown), and a detection unit is provided in the second control device 32. The storage may be an external device.

[0050] The third embodiment of turbidity detection is a method in which a detection unit (not shown) provided in the second control device 32 calculates impedance based on the current and voltage supplied to the treatment tool 31 to perform constant voltage control or constant current control, and detects turbidity from the calculated impedance.

[0051] Turbidity is caused by, for example, bone or cerebrospinal fluid generated by treatment with the treatment tool 31. When biological tissue such as bone or cerebrospinal fluid mixes with the perfusion fluid, the viscosity of the perfusion fluid changes. When the viscosity of the perfusion fluid changes, the impedance of the treatment tool 31 changes. Therefore, when a state in which turbidity does not occur is compared to a state in which turbidity occurs, the impedance obtained from the treatment tool 31 changes. This makes it possible to predict viscosity from the change in impedance and detect turbidity.

[0052] The specific flow of turbidity detection is the same as that shown in FIG. 9A. The detection unit provided in the second control device 32 reads a preset first impedance i0 in place of w0 in S4310. Thereafter, the second impedance i1, which is calculated at any timing, is calculated in place of w1 in S4311. Instead of turbidity detection (w0≧w1) in S4312, the conditions for turbidity detection will be explained using the read first impedance i0 and the calculated second impedance i1. If i1 is greater than i0 ("No"), it is determined that turbidity has occurred in the joint cavity C1, and turbidity is detected in the same manner as in S4313 ("turbidity detection" = 1: see FIG. 10A). Conversely, if i1 is equal to or smaller than i0 ("Yes"), it is determined that turbidity has not occurred or has decreased in the joint cavity C1, and turbidity is not detected ("turbidity detection" = 0) in the same manner as in S4314.

[0053] In the above description, the values ​​of i0 and i1 are simply compared, but a threshold may be set as shown in FIG. 9B, and turbidity may be detected by comparing the difference between i0 and i1 with the threshold (see FIG. 10B). Here, the threshold value may be a preset value, or may be calculated by performing machine learning on the impedance when turbidity occurs and the impedance under normal conditions.

[0054] [Other applications of turbidity detection] The above-described methods of detecting turbidity may be used in combination. When using two turbidity detection methods in combination, if turbidity is detected by both detection methods, turbidity detection can be set to 1. In this case, even if one of them detects turbidity due to a malfunction, turbidity detection will not be set to 1 unless both detect turbidity, so turbidity detection can be performed carefully. Also, when either one of the detection methods detects turbidity, turbidity detection may be set to 1. In this case, even a small change in turbidity can be detected.

[0055] When a plurality of turbidity detection methods are used in combination, turbidity detection may be performed after weighting each detection method.

[0056] [Turbidity control] Next, a specific example of the turbidity response control S44 will be shown in Fig. 3. The embodiment of the turbidity response control described below can be combined with the above-mentioned turbidity detection. Here, the control unit is provided in at least one of the first control device 22 or the second control device 32, and is configured to be able to transmit and receive the detection results of the detection unit wirelessly or via a wire. The control unit performs turbidity response control based on the acquired detection results. In this way, by configuring the detection results of the detection unit to be transmitted to the control unit, it is possible for the control unit to perform turbidity response control regardless of the location of the detection unit.

[0057] [First embodiment of turbidity control: edge-overlapped image display] First, a first embodiment of turbidity response control will be described. In the first embodiment of turbidity response control, when a turbidity detection result of 1 is received from a detection unit provided in at least one of the first control device 22 or the second control device 32, an image in which the edges of the treatment tool 31 and biological tissue are emphasized is superimposed on the video of the endoscopic field of view output to the display device 23 (see FIG. 11). In this embodiment, the control unit is provided in the first control device 22. On the other hand, normal control in this embodiment performs control to output to the display device 23 an image of the endoscope field of view without an edge-enhanced image superimposed thereon.

[0058] By superimposing an image in which the edges of the treatment tool 31 and biological tissue are emphasized on the video of the endoscopic field of view output to the display device 23, the position of the treatment tool 31 and the location of the biological tissue can be seen even in cloudy conditions, allowing the surgeon to continue the procedure.

[0059] Next, the flow of the turbidity response control according to the first embodiment will be described in detail. When a detection unit provided in at least one of the first control device 22 or the second control device 32 sends a signal detecting turbidity to a control unit provided in the first control device 22, the control unit provided in the first control device 22 acquires the imaging data and extracts edges using a known method. Thereafter, the control unit provided in the first control device 22 superimposes the edge-enhanced image data generated by extracting the edges on normal image data generated from the imaging data, and displays the superimposed image on the display device 23.

[0060] [Second embodiment of turbidity response control: adjustment of driving power of treatment tool 31] Next, a second embodiment of the turbidity response control will be described. In the second embodiment of the turbidity response control, when the control unit receives a turbidity detection result of 1 from a detection unit provided in at least one of the first control device 22 or the second control device 32, the drive power of the treatment tool 31 is reduced to the second drive power. In this embodiment, the control unit is provided in the second control device 32. On the other hand, the normal control in this embodiment is a control for driving the treatment tool 31 with the first driving power, which is greater than the second driving power.

[0061] The flow of the second embodiment of the turbidity response control will now be described in detail. When a signal detecting turbidity is sent from a detector provided in at least one of the first control device 22 or the second control device 32 to a controller provided in the second control device 32, the controller provided in the second control device 32 adjusts the drive power supplied to the treatment tool 31. As a result, the treatment tool 31 generates ultrasonic vibrations at a second drive power lower than the first drive power.

[0062] By reducing the drive power of the treatment tool 31, the cutting speed can be reduced, and the amount of biological tissue generated by cutting can be reduced. As a result, the perfusion speed does not change when turbidity occurs and when normal, so turbidity in the endoscopic field of view is reduced. This allows the operator to continue the procedure without interrupting it, without stopping the ultrasonic vibration of the treatment tool 31.

[0063] [First Modification of the Second Embodiment of Turbidity Control: Adjustment of Driving Power of the Treatment Tool 31] Next, a first modified example of the second embodiment of the turbidity response control will be described. The first modified example of the second embodiment of the turbidity response control is turbidity response control in which, when turbidity is detected, the treatment tool 31 is driven with a third drive power that is greater than the first drive power. Moreover, the normal control in this modification of the present embodiment is a control in which the treatment tool 31 is driven with the first driving power, which is lower than the third driving power.

[0064] A first modified example of the second embodiment of the turbidity response control will be described below. When a signal detecting turbidity is sent from a detector provided in at least one of the first control device 22 or the second control device 32 to a controller provided in the second control device 32, the controller provided in the second control device 32 adjusts the drive power supplied to the treatment tool 31. As a result, the treatment tool 31 generates ultrasonic vibrations at a third drive power greater than the first drive power.

[0065] Increasing the drive power of the cutting tool increases the cutting speed, allowing for a shorter treatment time. This method also generates more bone powder, so setting a faster irrigation rate is more effective.

[0066] [Second Modification of the Second Embodiment of Turbidity Control: Adjustment of Driving Power of the Treatment Tool 31] Next, a second modified example of the second embodiment of the turbidity response control will be described. The second modified example of the second embodiment of the turbidity response control is turbidity response control in which, when turbidity is detected, the driving of the treatment tool 31 is repeatedly stopped and started. Moreover, the normal control in this modification of the present embodiment is a control for driving the treatment tool 31 intermittently.

[0067] The flow of the second modification of the second embodiment of the turbidity response control will be specifically described. When a signal detecting turbidity is sent from a detection unit provided in at least one of the first control device 22 or the second control device 32 to a control unit provided in the second control device 32, the control unit provided in the second control device 32 controls the supply of driving power to the treatment tool 31 to be repeatedly stopped and supplied.

[0068] By repeatedly starting and stopping the treatment tool 31, the amount of bone powder produced during cutting is reduced compared to when the tool is continuously oscillated. This eliminates the cloudiness of the endoscopic field of view, allowing the surgeon to continue the procedure.

[0069] [Third embodiment of turbidity control: perfusion control] Next, a third embodiment of turbidity response control will be described. The third embodiment of turbidity response control is a response control in which the amount of water fed by the perfusion device 6 is increased (the water feed rate is increased) when turbidity is detected.

[0070] The configuration of a surgical system 1A of this embodiment is shown in FIG. Only the differences from the surgical system 1 will be described. The perfusion device 6 is provided with a water pump 63. In this embodiment, the control unit is provided in the water pump 63 or the first control device 22. When the control unit is provided in the first control device 22, the first control device 22 and the water pump 63 are configured to be able to send and receive signals wirelessly or via wire. Based on the acquired detection results, the control unit provided in the water supply pump 63 or the first control device 22 generates a signal to increase the amount of perfusion fluid flowing from the liquid source 61 toward the endoscope 21 to a second water supply amount, and controls the water supply pump 63. On the other hand, the normal control in this embodiment is a control in which water is fed at a first water feed rate that is smaller than the second water feed rate.

[0071] The flow of the turbidity response control in the third embodiment will now be described in detail. When a detection unit provided in at least one of the first control device 22 or the second control device 32 sends a signal indicating turbidity to the water supply pump 63 or the control unit provided in the first control device 22, the water supply pump 63 or the control unit of the first control device 22 controls the perfusion fluid to be supplied at a second water supply rate that is greater than the first water supply rate.

[0072] By supplying the perfusion fluid at a second water supply rate greater than the first water supply rate, biological tissues such as bone and cerebrospinal fluid, which are examples of causes of turbidity, are easily discharged from the joint cavity C1 through the drainage tube 65 and into the drainage bottle 64. This eliminates turbidity in the endoscopic field of view, allowing the surgeon to continue the procedure.

[0073] [First Modification of the Third Embodiment of Turbidity Control: Perfusion Control] Next, a first modified example of the third embodiment of the turbidity response control will be described. The first modified example of the third embodiment of the turbidity response control is a response control in which the amount of perfusion fluid suctioned by the perfusion device 6 is increased when turbidity is detected.

[0074] The configuration of a surgical system 1B according to this modified example of the present embodiment is shown in Figure 13. Only the differences from the surgical system 1 will be described. A suction pump 66 is provided in the perfusion device 6. The suction pump 66 controls the suction volume for discharging the perfusion fluid from the joint cavity C1 through the flow path of the drainage tube 65 into the drainage bottle 64, increasing the suction volume to a second suction volume greater than the first suction volume. In this modification of the embodiment, the control unit is provided in the suction pump 66 or the first control device 22. When the control unit is provided in the first control device 22, the first control device 22 and the suction pump 66 are configured to be able to send and receive signals wirelessly or via wire. Based on the acquired detection results, the control unit provided in the suction pump 66 or the first control device 22 generates a signal to increase the suction volume for discharging the perfusion fluid in the joint cavity C1 into the drainage bottle 64 to a second suction volume, and controls the suction pump 66. On the other hand, the normal control in this modification of the present embodiment is a control in which suction is performed at a first suction amount that is smaller than the second suction amount.

[0075] The flow of the third embodiment of the turbidity response control will now be described in detail. When a signal indicating turbidity is sent from a detector provided in at least one of the first control device 22 or the second control device 32 to the suction pump 66 or the control unit provided in the first control device 22, the control unit provided in the suction pump 66 or the first control device 22 controls the suction amount of the perfusion fluid to increase to the second suction amount.

[0076] By increasing the suction volume of the perfusion fluid to the second suction volume, biological tissues such as bone and cerebrospinal fluid, which are examples of causes of turbidity, are easily discharged from the joint cavity C1 through the drainage tube 65 and into the drainage bottle 64. This eliminates the turbidity in the endoscopic field of view, allowing the surgeon to continue the procedure.

[0077] [Second Modification of the Third Embodiment of Turbidity Control: Perfusion Control] Next, a second modified example of the third embodiment of the turbidity response control will be described. The second modified example of the third embodiment of the turbidity response control is a response control in which the amount of suction and the amount of water supply of the perfusion fluid of the perfusion device 6 are increased when turbidity is detected.

[0078] The configuration of a surgical system 1C according to this modification of the present embodiment is shown in Fig. 14. Only the differences from the surgical system 1 will be explained. A water pump 63 and a suction pump 66 are provided in the perfusion device 6. In this embodiment, the control unit is provided in both the water pump 63 and the suction pump 66 or in the first control device 22. When the control unit is provided in the first control device 22, the first control device 22, the water pump 63, and the suction pump 66 are configured to be able to send and receive signals wirelessly or via wires. A control unit provided in both the water supply pump 63 and the suction pump 66 or in the first control device 22 generates a signal to increase the amount of perfusion fluid flowing from the liquid source 61 toward the endoscope 21 to a second water supply amount based on the acquired detection results, and controls the water supply pump 63. Also, a control unit generates a signal to increase the suction amount for discharging the perfusion fluid in the joint cavity C1 into the drainage bottle 64 to a second suction amount, and controls the suction pump 66.

[0079] The flow of the third embodiment of the turbidity response control will now be described in detail. When a detection unit provided in at least one of the first control device 22 or the second control device 32 sends a signal detecting turbidity to both the water supply pump 63 and the suction pump 66 or to a control unit provided in the first control device 22, both the water supply pump 63 and the suction pump 66 or to a control unit provided in the first control device 22 controls the water supply rate of the perfusion fluid to increase to a second water supply rate, and further controls the suction rate of the perfusion fluid to increase to a second suction rate. Furthermore, the normal control in this modification of the present embodiment is a control in which water is fed at a first water feed rate that is smaller than the second water feed rate, and a control in which suction is performed at a first suction rate that is smaller than the second suction rate.

[0080] By increasing the amount of perfusion fluid supplied and aspirated, biological tissues such as bone and cerebrospinal fluid, which are examples of turbidity, can be easily discharged from the joint cavity C1 through the drainage tube 65 and into the drainage bottle 64. This eliminates the turbidity in the endoscopic field of view, allowing the surgeon to continue the procedure.

[0081] The amount of irrigation fluid supplied and the amount of suctioned may be controlled to be equal, thereby keeping the amount of irrigation fluid in the joint cavity C1 constant and reducing the burden on the patient.

[0082] The timing of increasing the perfusion fluid supply rate and the suction rate may be staggered so that the perfusion fluid supply rate is increased to the second supply rate and then the suction rate is increased to the second suction rate, thereby preventing a temporary decrease in the amount of perfusion fluid in the joint cavity C1 and facilitating the continuation of the procedure.

[0083] The timing of increasing the suction amount of perfusion fluid may be shifted so that the supply amount of perfusion fluid is increased to the second supply amount after the suction amount of perfusion fluid is increased to the second suction amount, thereby preventing the amount of perfusion fluid in the joint cavity C1 from temporarily increasing, thereby reducing the burden on the patient.

[0084] [Other application examples of turbidity control] The above-described turbidity response controls can also be used in combination with other turbidity response controls, which makes it more difficult for the surgeon to interrupt the process. [Industrial Applicability]

[0085] As described above, the surgical system, control device, and operating method of the surgical system according to the present invention are useful for reducing the burden on patients and surgeons by detecting turbidity in the perfusion fluid and performing predetermined control. [Explanation of symbols]

[0086] 1. 1A~1C Surgical System 2 Endoscopic devices 3 Treatment device 6 Perfusion device 21 Endoscopy 22 First control device 23 Display device 31 Treatment tools 32 Second control device 33 Footswitch 61 Liquid Source 62 Liquid transfer tube 63 Water pump 64 Drainage bottle 65 Drainage tube 66 Suction pump 211 Insertion part 311 Main Unit 311a Ultrasonic transducer 313 Sheath C1 joint cavity J1 Knee joint P1 First Portal P2 Second Portal

Claims

1. an endoscope device; a perfusion device for supplying a liquid to a treatment target; An endoscope system comprising: The endoscope device includes: an endoscope for capturing an image of a treatment target; a first control device that converts imaging data obtained from the endoscope into image data; and The first control device a storage device that stores the imaging data; a detection unit that acquires first imaging data from the endoscope and second imaging data from the storage, calculates a change in contrast between the first imaging data and the second imaging data, and detects information related to turbidity in the liquid caused by the treatment based on the change; a control unit that performs control based on the detection result of the detection unit; Equipped with The information about the turbidity relates to the color of the turbidity, which is white; The control unit sends a signal to the perfusion fluid device to increase the water supply rate of the fluid based on the detection result of the detection unit. Endoscopy system.

2. The information about turbidity is a value that increases or decreases in correlation with the occurrence of turbidity. The endoscope system according to claim 1 .

3. The information regarding turbidity is information resulting from biological tissue. The endoscope system according to claim 1 .

4. The detection unit calculating a change in pixel value at the same coordinate between the first imaging data and the second imaging data; detecting the turbidity according to the amount of change in the contrast and the amount of change in the pixel value; The endoscope system according to claim 1 .

5. The detection unit calculating an amount of change in an edge between the first imaging data and the second imaging data; The turbidity is detected based on the amount of change in the contrast and the amount of change in the edge. The endoscope system according to claim 1 .

6. The detection unit calculating a change in luminance between the first imaging data and the second imaging data; The turbidity is detected based on the amount of change in the contrast and the amount of change in the luminance. The endoscope system according to claim 1 .

7. The detection unit detects information related to the turbidity from the amount of change in the contrast and the liquid. The endoscope system according to claim 1 .

8. the detection unit has a sensor that detects the pH of the liquid, detecting the turbidity based on the pH value acquired from the sensor and the amount of change in the contrast; The endoscope system according to claim 7 .

9. The perfusion fluid device aspirates the fluid, the control unit sends a signal to the perfusion fluid device to increase the amount of the fluid being aspirated based on the detection result of the detection unit. The endoscope system according to claim 1 .

10. The perfusion fluid device supplies and draws the fluid, the control unit sends a signal to the perfusion fluid device to increase the amount of the fluid to be fed based on the detection result of the detection unit; the control unit sends a signal to the perfusion fluid device to increase the amount of the fluid being aspirated based on the detection result of the detection unit. The endoscope system according to claim 1 .

11. The information about turbidity relates to physical property values ​​of the liquid. The endoscope system according to claim 1 .

12. An operation method for an endoscope system including an endoscope device having an endoscope that captures an image of a treatment target, a first control device that converts image data obtained from the endoscope into image data, and a perfusion device that supplies a liquid to the treatment target, comprising: The first control device acquiring first imaging data from the endoscope and second imaging data from a storage that stores the imaging data; calculating a change in contrast between the first imaging data and the second imaging data; Based on the amount of change, information regarding turbidity in the liquid caused by the treatment is detected, the information being that the color of the turbidity is white; Based on the detection result, a signal to increase the speed of the fluid is sent to the perfusion fluid device. A method for operating an endoscope system.

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