Resectoscope device, resectoscope, resection system and imaging method

Abstract

The invention relates to a resectoscope device (10) comprising an outer shaft (12), which has a distal side (14) and a proximal side (16), a resection tool (18), which extends through the outer shaft (12) and which is movable relative to the outer shaft (12), and an image capturing unit (20), which is configured to record images of an imaging region (20a) situated in a region of the distal side (14) of the outer shaft (12), with the image capturing unit (20) being movable relative to the outer shaft (12) and beyond the distal side (14) of the latter. The invention also relates to a resectoscope, a resection system and an imaging method.

Description

[0001] Resectoscope device, resectoscope, resection system and imaging procedure

[0002] The present invention relates to a resectoscope device, a resectoscope having the same, a resection system having the same, and an imaging method therefor.

[0003] A resection is the surgical removal of tissue from an organ or tumor. Depending on the goal and anatomical conditions, several types of resection can be performed. For difficult-to-access tissue, surgical removal can be performed endoscopically using a resectoscope. Such a resectoscope is used, for example, in a transurethral resection, in which diseased tissue is removed from the bladder or prostate. The operation is performed endoscopically through the urethra without an external incision.

[0004] For transurethral resection, a resectoscope designed as a backwash resectoscope is known. Such a backwash resectoscope comprises an inner shaft and an outer shaft, with the outer shaft being inserted into a urethra during the operation and resting therein atraumatically. The outer shaft comprises a channel for supplying fluid and another channel for suctioning fluid or tissue. The inner shaft contains an optical system, which is formed in particular from a light source and an image capture unit, for example, from light-emitting diodes and a video camera, or alternatively, for example, from pairs of rod lenses, and a resection loop movable in the longitudinal direction of the inner shaft for removing tissue.During the operation, an irrigation fluid is continuously introduced through the resectoscope, which is designed as a backwash endoscope, and then suctioned out in a controlled manner, creating a constant bladder filling to allow for good visibility. The resection loop can be used to remove or resect tissue, while the telescope allows for an oblique view from the outer sheath. At the end of the operation, the resected or removed tissue can be rinsed out, and after sufficient irrigation, an irrigation catheter can be inserted.

[0005] A well-known resection loop, for example, is a wire loop through which an electric current flows. This allows diseased tissue to be removed layer by layer. Any bleeding that occurs can be electrically cauterized. The physical principle is similar to that of HF surgery (high-frequency surgery).

[0006] Transurethral resection with the known resectoscope can be used in particular to treat superficial bladder cancer for resection within a urinary bladder. The inventors of the present invention initially discovered that bladder cancer located at the bladder neck is difficult to visualize, as an optic arranged within the outer sheath only views the tissue to be removed at an angle from the outer sheath, i.e., from a proximal side. This makes removal of the bladder cancer with the resection loop difficult. A surgeon, i.e., a user of the resectoscope, must first extend the resection loop behind the bladder cancer, i.e., to a distal side, in order to establish an attachment point for the resection loop there, so that the bladder cancer can then be removed when the resection loop is retracted to a proximal side.If the starting point for the resection loop is not visible, the surgeon can bring the tissue to be removed into the field of view of the camera by applying mechanical force from an outside and by vigorously pivoting the inner shaft. The inventors have recognized, however, that this is difficult for the surgeon and that this can lead to hidden injuries to muscles and tissue, particularly due to the vigorous pivoting and pressing of the inner shaft, which can subsequently lead to urinary incontinence. Alternatively, the surgeon can estimate the hidden starting point, which may result in either too much tissue being removed or not all of the tissue forming the bladder cancer being removed. Depending on the location of the bladder cancer, it is common practice for resectoscopes known in the state of the art to make sure that the starting point for resection is not visible or only visible with an increased risk of injury.

[0007] During a transurethral resection of the prostate, a standard procedure is to remove obstructions to urine flow through the prostate. Only the inner part of the prostate, which faces the urethra, is removed. Only the peripheral prostate tissue and the organ capsule should remain. Furthermore, the seminal mound and urethral sphincter should be protected. While resection is usually used to treat benign prostatic hyperplasia, it can also be used for other outflow obstructions, such as prostate cancer. Even with a transurethral resection of the prostate, it can be difficult to identify a starting point for a resection. Furthermore, when removing multiple obstructions, the surgeon must be given a good overview. On the one hand, this can prevent any obstruction from being overlooked.On the other hand, this also makes it easier to prevent the surgeon from inadvertently damaging or injuring tissue parts that are not to be removed, for example, with the resection loop. The present disclosure is based, among other things, on the finding that an image of the object to be operated on, which is available to the surgeon during the operation, has potential for improvement.

[0008] Since the resectoscope is inserted through the urethra during transurethral resection, the outer sheath should also be as small as possible to minimize insertion resistance and thus avoid injury to the ureter or urethra. Since the outer sheath accommodates the inner sheath containing the optic, its dimensions are largely determined by the dimensions of the inner sheath. Therefore, when designing the distal end of the inner sheath, space is limited, and it is particularly important to optimally determine the optic and its arrangement within the distal end.

[0009] Endoscopes are known from the prior art that use digital technology for image generation and transmission and which, in the opinion of the inventors of the present invention, can in principle, with some adaptations if necessary, be installed within the inner shaft as part of a resectoscope, in particular as an endoscope assembly. Such endoscopes, which are also called video endoscopes, have, according to one design, an image acquisition unit at their distal shaft end that can capture an image of tissue. The image acquisition unit can be supplied with electrical energy through the shaft of the endoscope, and image signals can be transmitted via a cable from the image acquisition unit to the proximal end of the shaft. This eliminates the need for optical elements such as lenses, in particular rod lenses, or optical fibers for image transmission through the shaft.The image acquisition unit can be conceived as a video camera and includes, for example, an input lens and an image sensor. This allows for a high degree of design freedom in the arrangement of various elements in the distal shaft end compared to endoscopes with rod lens pairs. The present invention is based on the object of providing a good image of a tissue to be removed in a simple and / or inexpensive and / or user-friendly and / or reliable manner, in particular in a manner that is space-efficient and / or easy to handle, for example during manufacturing, surgery, or cleaning.

[0010] This object is achieved according to the invention by a resectoscope device, a resectoscope, a resection system and an imaging method as described herein and defined in the claims.

[0011] The resectoscope device comprises an outer shaft having a distal side and a proximal side, a resection tool extending through the outer shaft and movable relative to the outer shaft, and an image acquisition unit configured to capture images of an imaging region located in a region of the distal side of the outer shaft, the image acquisition unit being movable relative to the outer shaft beyond its distal side.

[0012] Furthermore, a resectoscope with the resectoscope device according to the invention can be provided.

[0013] In addition, a resection system can be provided which comprises the resectoscope device according to the invention.

[0014] In addition, an imaging method can be provided, wherein at least one image is recorded by means of the resectoscope device according to the invention.

[0015] The features according to the invention make it possible to provide a good image of tissue to be removed in a simple and / or inexpensive and / or user-friendly and / or reliable manner. In particular, a high degree of space efficiency and / or ease of handling can be achieved, for example during manufacturing, surgery, or cleaning. The images provided can assist a surgeon in setting a suitable starting point for removing tissue with the resection tool. In particular, a surgeon can be provided with a good overview of the tissue to be removed and adjacent tissue parts, so that unintentional damage to tissue parts by the resection tool can be more easily prevented. The resectoscope device can comprise an endoscope device, in particular an endoscope.The resectoscope device can be designed for a backwash resectoscope and / or as a backwash resectoscope. The resectoscope device can be designed as a cystoscope. The resectoscope device can be designed for a rigid resectoscope. The resectoscope device can be designed for a flexible resectoscope. The resectoscope device can be designed for a video endoscope.

[0016] A “resectoscope device” should be understood in particular as a preferably functional component, in particular a subassembly and / or a structural and / or functional component of a resectoscope. Preferably, the resectoscope device can form the resectoscope at least partially, preferably at least to a large extent, and particularly preferably completely. For example, the resectoscope device can be configured to be inserted at least partially and preferably at least to a large extent into a hollow space or into a particularly artificial and / or natural cavity, in particular a body cavity, in particular in order to examine it and to modify parts thereof, in particular to remove them. The resectoscope device can be a medical resectoscope device.Within the scope of this disclosure, "configured" can be understood to mean, in particular, specifically programmed, designed, configured, and / or equipped. Within the scope of this disclosure, the fact that a component is configured for a specific function can be understood to mean, in particular, that the component fulfills and / or performs this specific function in at least one application and / or operating state.

[0017] An “outer shaft” is to be understood in particular as an elongated part of a resectoscope and / or a resectoscope device which is designed, for example, to be inserted into a hollow space or into a particularly artificial and / or natural cavity, in particular a body cavity.

[0018] The outer shaft preferably extends from the proximal side to the distal side. The distal side is to be understood in particular as a side that is to be introduced into a hollow space or cavity during use. The proximal side is to be understood in particular as a side that remains outside a hollow space or cavity during use. The term “distal” is to be understood in particular as facing towards a patient during operation and / or facing away from an operator and / or user. In particular, proximal is the opposite of distal. The term “proximal” is to be understood in particular as facing away from a patient during operation and / or facing towards an operator and / or user.An “elongated part” is to be understood in particular as a component whose main extension is at least a factor of five, preferably at least a factor of ten, and particularly preferably at least a factor of twenty greater than a greatest extension of the component perpendicular to its main extension, i.e. in particular a diameter of the component. A “main extension” of a component is to be understood in particular as its longest extension along its main extension direction. A “main extension direction” of a component is to be understood in particular as a direction which runs parallel to a longest edge of a smallest imaginary cuboid which just completely encloses the component and which preferably runs through a geometric center and / or through a center of mass of the component. The outer shaft can have a longitudinal axis.The longitudinal axis can run parallel to the main extension direction of the outer shaft.

[0019] The outer shaft can be configured to be insertable into a urethra. The outer shaft can be configured to rest atraumatically in a urethra during a resection. The outer shaft can comprise a first channel for supplying a fluid, in particular for supplying a rinsing fluid. Alternatively or additionally, the outer shaft can comprise a second channel for suctioning a fluid, in particular for suctioning a rinsing fluid. The outer shaft can be configured to provide a constant filling of an operating cavity by allowing the supply and removal of rinsing fluid. In particular, the second channel can also be configured for suctioning off tissue parts.

[0020] The outer shaft can be configured to receive the resection tool and / or guide it along a direction, in particular along a longitudinal direction of the outer shaft. The outer shaft can be configured to receive an image acquisition unit, in particular an assembly forming the image acquisition unit. The outer shaft can be configured to receive a shaft of the assembly and / or guide it along a direction, in particular along a longitudinal direction of the outer shaft. The resection tool can be configured to remove tissue by cutting and / or by vaporization. The resection tool can comprise an electrically conductive material, in particular a wire, through which an electrical current can flow. The resection tool can be designed as an HF tool (high-frequency tool). The resection tool can comprise a resection loop.The resection tool can be loop-shaped, hook-shaped, or spherical. The resection tool can comprise two guide shafts and a resection loop suspended between the guide shafts. The resection tool can, in particular, have an HF loop (high-frequency loop). Alternatively or additionally, the resection tool can have a laser for cutting and / or vaporization. The laser can, in particular, be designed for holmium laser enucleation or KTP laser vaporization, or can be a continuous wave laser. These laser processes differ in the wavelength and energy of the laser light used, in particular in their energy effect in the tissue and their penetration depth. Alternatively or additionally, the resection tool can have a monopolar or bipolar HF tool (high-frequency tool).The monopolar HF tool can be designed as a hook electrode, ball electrode, or spatula electrode for cutting and / or vaporization. The bipolar HF tool can be designed, in particular, as bipolar forceps or pliers for cutting and / or vaporization. The resection tool can also be configured to perform contact coagulation on tissue. Depending on the application, a described embodiment of the resection tool may be particularly suitable.

[0021] The image acquisition unit and the resection tool can be movable relative to one another. The image acquisition unit, in particular an assembly comprising the image acquisition unit, can be configured to receive the resection tool and / or guide it in one direction, in particular in a longitudinal direction of the image acquisition unit or its assembly.

[0022] The image acquisition unit may comprise one image acquisition device. The image acquisition unit may comprise multiple image acquisition devices. The image acquisition unit may comprise multiple image acquisition devices directed in different viewing directions. The image acquisition unit may comprise at least two image acquisition devices directed in different viewing directions. The arrangement of multiple image acquisition devices with different viewing directions improves the image of a tissue to be removed available to a surgeon. The at least two image acquisition devices may, in particular, comprise a first image acquisition device and a second image acquisition device, wherein the first image acquisition device is directed in a distal viewing direction and wherein the second image acquisition device is directed in a proximal viewing direction.The viewing direction from two different sides further improves the image available to the surgeon by taking images from different perspectives, and in particular improves visibility when setting a starting point for tissue removal. The viewing direction can be directed in a proximal direction with respect to the outer shaft. The viewing direction can be directed in a distal direction with respect to the outer shaft. The viewing direction can be defined by a viewing angle with respect to a longitudinal direction of the outer shaft. A viewing angle of 0° to less than 90° can mean directed in a distal viewing direction and a viewing angle of more than 90° to 180° can mean directed in a proximal viewing direction.

[0023] The image acquisition unit can comprise at least three image acquisition devices directed in three different viewing directions. The arrangement of several image acquisition devices with different viewing directions improves the image of a tissue to be removed available to a surgeon. The at least three image acquisition devices can define three different, overlapping imaging regions. With overlapping imaging regions viewed from different viewing directions, the image of a tissue to be removed available to the surgeon is further improved. The several image acquisition devices can be arranged offset in a longitudinal direction and / or with respect to a longitudinal axis of the outer shaft, in particular arranged one behind the other.The plurality of image capture devices can be arranged offset in a transverse direction of the outer shaft, in particular arranged next to one another.

[0024] The one or more image capture devices can each be formed by camera modules, in particular camera modules with short lenses or so-called camera cubes with wafer-level optics. The one or more image capture devices or the camera modules can each be formed, in particular, by an input optics system and / or an image sensor for image generation, in particular a CCD chip or CMOS chip. The one or more image capture devices each have, in particular, a single viewing angle. The single viewing angle can be, for example, 60°, 65°, 70°, 75°, 80°, 85°, 90°, 95°, 100°, 105°, or 110°.

[0025] The viewing direction of an image capture device can be a main viewing direction of the respective image capture device. For example, the viewing direction can be a central axis of an input optics of the respective image capture device. The individual viewing angle can be an angle spanned with respect to the viewing direction. In particular, the central axis can be a bisector of the individual viewing angle. Depending on the design of the image capture device, these can each be defined by two individual viewing angles that are spanned perpendicular to one another. These can, for example, define a viewing angle with respect to a transverse axis or a viewing angle with respect to a vertical axis, each of which is perpendicular to the central axis and / or the viewing direction.In particular, in cases where an image capture device comprises a rectangular image sensor, both viewing angles belonging to the image capture device can be assigned to a short and a long side of the rectangular image sensor.

[0026] The specification of an individual viewing angle can also be understood as the largest viewing angle of the respective image capture device and / or as a viewing angle corresponding to a diagonal of the respective image sensor. An image capture device can also be described by a horizontal viewing angle, a vertical viewing angle, and a diagonal viewing angle. Specifications relating to a viewing angle can refer to any of these three dimensions and preferably refer to a diagonal viewing angle.

[0027] The image acquisition unit can comprise a distal assembly and a proximal assembly. The distal assembly and the proximal assembly can be spaced apart from one another. The distal assembly and the proximal assembly can be spaced apart from one another in a longitudinal direction of the outer shaft. The distal assembly and the proximal assembly can be jointly movable relative to the outer shaft. The distal assembly and the proximal assembly can be movable beyond the distal side of the outer shaft. The distal assembly and the proximal assembly can each have at least one image acquisition device. In particular, the distal assembly and the proximal assembly can be spaced apart from one another and jointly movable relative to the outer shaft and beyond its distal side, wherein the distal assembly and the proximal assembly each have at least one image acquisition device.With the intended distance between two assemblies, each with at least one image capture device, the surgeon can position the resectoscope device so that the tissue to be removed is located between them, allowing it to be imaged from two opposite sides. Imaging based on images taken from two opposite sides improves visibility of the working area of ​​the resection tool or a resection region, thus assisting the surgeon, particularly in locating a starting point for a resection. The surgeon can thus forgo mechanical manipulation of the tissue from the outside or by pivoting the resection device.In addition, the spaced assemblies, which define the working area of ​​the resection tool between them, can push tissue located on a surface opposite the tissue to be removed, in particular away from the working area of ​​the resection tool.

[0028] In particular, the at least one image capture device of the distal assembly can be directed in a proximal viewing direction, and the at least one image capture device of the proximal assembly can be directed in a distal viewing direction. This orientation enables imaging based on images captured from two opposite sides simultaneously and without movement of the assemblies. The distal assembly and the proximal assembly can, in particular, be spaced apart from one another such that a working area of ​​the resection tool or a resection area is defined between them. Such spacing enables imaging from two opposite sides simultaneously and without movement of the assemblies during a resection. A dimension of the spacing between the distal assembly and the proximal assembly depends on a size of tissue to be removed and / or a dimension of a resection tool.In particular, the distal assembly and the proximal assembly can be spaced apart such that the spacing is at least a few millimeters, in particular, for example, 5 mm, and at most a few centimeters, in particular, for example, 5 cm or 10 cm. The at least one image capture device of the distal assembly and the at least one image capture device of the proximal assembly can each be directed from different sides onto a working area of ​​the resection tool. With this arrangement, after positioning the resectoscope device once, the surgeon can perform a resection with simultaneous imaging of the tissue from two opposite sides and without further movement of the assemblies.

[0029] The resectoscope device can further comprise a lighting unit. The lighting unit can be movable relative to the resection tool. The lighting unit can be movable relative to the outer shaft. The lighting unit can be configured to illuminate the imaging region. Illumination of the imaging region supports the recording of an image thereof with the image acquisition unit and thus, in particular, increases the image quality of an image provided to the surgeon. The lighting unit can comprise a plurality of lighting elements, which are in particular directed in different illumination directions. The individual lighting elements can be formed by light-emitting diodes and / or laser diodes and / or light guides. In particular in embodiments in which the lighting element comprises a light guide, the resectoscope device orAn endoscope assembly of the resectoscope device may have an optical connector on a proximal side and / or in its vicinity, which is configured for connection to a lighting unit. The image acquisition unit and the lighting unit are preferably formed integrally, in particular in pairs. This integral design increases the efficient use of available installation space.

[0030] Alternatively or additionally, the resectoscope device comprises an endoscope assembly comprising the image acquisition unit, wherein the endoscope assembly comprises an endoscope shaft and an imaging head attached to the endoscope shaft, in which at least one image acquisition device of the image acquisition unit is arranged. The arrangement of the at least one image acquisition device in the imaging head supports a modular design of the resectoscope device. The imaging head can, in particular, protrude radially with respect to a longitudinal axis of the endoscope shaft. The at least one image acquisition device arranged in the imaging head can therefore also protrude radially with respect to the longitudinal axis of the endoscope shaft.Due to the radial protrusion, an imaging area containing the endoscope shaft can be easily captured using an image capture device directed toward a proximal side, in particular one directed in the proximal viewing direction. The resection tool can comprise two guide shafts and a resection loop suspended between the guide shafts, with the endoscope assembly arranged between the guide shafts. This arrangement enables a particularly compact arrangement of the resection tool and the endoscope assembly comprising the image capture unit. The resection tool and the endoscope assembly can be configured to be freely displaceable relative to one another along a longitudinal direction of the outer shaft.In particular, the resection tool and endoscope assembly can each occupy a space which, when viewed in a longitudinal direction of the outer shaft, does not overlap with the other space.

[0031] The resectoscope device can have a conveyor for the relative movement of the imaging unit and / or the resection tool relative to the outer shaft. The resectoscope device can comprise a coupling mechanism configured to selectively couple and / or selectively prevent relative movement between the endoscope assembly and the resection tool. Depending on the situation, it can be helpful for a surgeon during a resection to suitably move or fix the imaging area provided by the imaging unit together with the resection tool for a better overview. For example, after positioning the resection tool at an application point, a surgeon can move the image displayed to him along with the resection tool based on the images from the imaging unit. The coupling between the endoscope assembly and the resection tool can be designed to be direct.Alternatively, the coupling between the endoscope assembly and the resection tool can be configured with a selectively adjustable translation. The image displayed to the surgeon can therefore move faster than the resection tool, or even move over it, if necessary.

[0032] The endoscope assembly may include the illumination unit. At least one light element of the illumination unit may be arranged in the imaging head. The arrangement of light elements in the imaging head enables efficient use of the available installation space.

[0033] The endoscope shaft of the endoscope assembly may further include a heat sink configured to transfer heat from a distal side of the endoscope shaft to a proximal side of the endoscope shaft. The heat sink may be formed by a heat pipe that can transfer heat via an evaporation and condensation circuit. The heat sink may reduce heat input to tissue caused by the image acquisition units and / or illumination unit.

[0034] The resection system may further comprise a control device configured to process the images acquired by the image acquisition unit and generate a display for a user or surgeon. The resection system may further comprise a supply unit. The control device may also be arranged in the supply unit. Alternatively, the control device may be configured in another unit, for example, at a proximal portion of the resectoscope device, and / or distributed as a plurality of individual control units in different units of the resection system.

[0035] The control device can be configured to create a representation for a user or surgeon from different images that were recorded by means of the image acquisition unit and that show different image areas, in which representation at least one object is shown that is concealed in at least one of the images and visible in at least one other of the images. The representation can be a blending or superimposition of the different images, wherein at least one of the images is processed, in particular suitably mirrored and / or suitably distorted. The control device can further be configured to create a representation for a user or surgeon from the different images, in which representation a section, in particular a contour, of the resection tool is shown that is initially concealed in one of the recorded images.In particular, the representation can be a blending or superimposition of a revised, in particular suitably mirrored and / or suitably distorted, image of the resection tool, in particular a contour, onto the other image in which the resection tool is not shown. The control device can be configured to create a representation for a user or surgeon from images acquired by means of the image acquisition unit, which representation represents a top view of a working area of ​​the resection tool. The multiple acquired images can be revised, in particular suitably mirrored and / or suitably distorted, and superimposed in such a way as to create a top view. Such a top view can offer a surgeon an improved overview depending on the situation during a resection.The control device can be configured to generate a stereo image from different images acquired by the image acquisition unit. A stereo image can be generated using different images of an imaging region, and a surgeon can use this for better orientation. By using suitably arranged and oriented image acquisition devices, a wide range of functions can be achieved with a compact arrangement of the components. In particular, stereoendoscopy can be performed within a selected angular range. For this purpose, an overlap of individual imaging regions of the respective image acquisition devices is suitably selected. For example, the overlap for generating a stereo image can be at least 10°, at least 20°, at least 30°, or even at least 40°, in some cases even at least 50° or at least 60°.

[0036] The imaging method performed with the resectoscope device and / or with the resectoscope and / or with the resection system comprises the steps of moving the image acquisition unit into a first position relative to the outer shaft, capturing at least one image with the image acquisition unit in the first position, moving the image acquisition unit into a second position relative to the outer shaft that is different from the first position, and capturing at least one image using the image acquisition unit in the second position. The relative mobility of the image acquisition unit and the outer shaft is utilized to provide a surgeon with a view from different positions and thus from different perspectives.

[0037] The imaging method can be performed partially or completely manually. In other embodiments, the method can be performed partially or completely automatically, in particular by means of fly-by-wire control with respect to a haptic, wherein a movement input from a surgeon can be reversely implemented and / or displayed.

[0038] The devices according to the invention and the methods according to the invention are not intended to be limited to the application and embodiments described above. In particular, they may have a number of individual elements, components and units as well as method steps that differs from the number stated herein in order to fulfill a function described herein. Furthermore, within the value ranges specified in this disclosure, values ​​​​that lie within the stated limits are also to be considered disclosed and can be used arbitrarily. It is particularly pointed out that all features and properties described with regard to a device, as well as methods, can be transferred mutatis mutandis to methods and can be used within the meaning of the invention and are considered to be co-disclosed. The same applies in the reverse direction.This means that structural features mentioned in relation to methods, i.e. features related to the device, can also be taken into account, claimed and also counted as part of the disclosure within the scope of the device claims.

[0039] The present invention is described below by way of example with reference to the accompanying figures. The drawings, the description, and the claims contain numerous features in combination. Those skilled in the art will expediently consider the features individually and use them in meaningful combination within the scope of the claims.

[0040] If there is more than one instance of a particular object, only one of them is provided with a reference symbol in the figures and in the description. The description of this instance can be transferred accordingly to the other instances of the object. If objects are named using numerical terms, such as first, second, third object, etc., these serve to name and / or assign objects. Accordingly, a first object and a third object, but not a second object, can be included. However, a number and / or sequence of objects can also be derived using numerical terms.

[0041] They show schematically:

[0042] Fig. 1 is a side view of a resectoscope device in a first position according to an embodiment;

[0043] Fig. 2 is a side view of the resectoscope device in a second position according to the embodiment;

[0044] Fig. 3 is a side view of the resectoscope device in the second position according to the embodiment in a reduced representation;

[0045] Fig. 4 shows a side view of a resectoscope device in a first position according to a further embodiment; Fig. 5 shows a side view of the resectoscope device in a second position according to the further embodiment;

[0046] Fig. 6 is a perspective view of a resection system with a resectoscope according to the embodiment; and

[0047] Fig. 7 is a flowchart of an imaging method according to an embodiment.

[0048] Fig. 1 shows a side view of a resectoscope device 10 in a first position according to one embodiment. Fig. 2 shows a side view of the endoscope device 10 in a second position according to the embodiment. Fig. 3 shows a side view of the resectoscope device 10 in the second position according to the embodiment in a reduced representation.

[0049] The resectoscope device 10 comprises an outer shaft 12 having a distal side 14 and a proximal side 16, a resection tool 18 extending through the outer shaft 12 and movable relative to the outer shaft 12, and an image acquisition unit 20 configured to capture images of an imaging region 20a located in a region of the distal side 14 of the outer shaft 12, the image acquisition unit 20 being movable relative to the outer shaft 12 beyond its distal side 14.

[0050] The resectoscope device 10 can provide a user or surgeon with a clear image of a tissue 19, in particular of a tissue 19a to be removed, through the images recorded from various positions by means of the image acquisition unit 20, which is movable relative to the outer shaft 12. By moving the image acquisition unit 20, the surgeon can, in particular, view various perspectives before applying the resection tool 18 to an application point 19b for removing the tissue 19a to be removed. In the first position shown in Fig. 1, the application point 19b is not within the imaging area 20a of the image acquisition unit 20, whereas in the second position shown in Fig. 2, the application point 19b is within the imaging area 20a of the acquisition unit 20.

[0051] The first position of the image acquisition unit 20 shown in Fig. 1 can, for example, initially be used to detect the tissue 19a to be removed, such as a tumor, and then to move the resection tool 18 to a distal side of the tissue 19a to be removed relative to the outer shaft 12, i.e., to extend the resection tool 18 and bring it behind the tissue 19a to be removed. By a relative movement of the image acquisition unit 20 with respect to the outer shaft 12, the first position of the image acquisition unit 20 shown in Fig. 1 can be transferred to the second position of the image acquisition unit 20 shown in Fig. 2. The image acquisition unit 20 can therefore be extended with respect to the outer shaft 12.

[0052] The second position of the image acquisition unit 20 shown in Fig. 2 can be used, for example, by the surgeon to display the imaging area 20a in which the starting point 19b for the resection tool 18 is located. These images provided to the surgeon can assist the surgeon in optimally setting the starting point 19b for removing or resecting a tissue 19a to be removed with the resection tool 18. The surgeon can then cut off the tissue 19a to be removed by retracting the resection tool 18. The image acquisition unit 20 can in turn be moved accordingly to provide the surgeon with a good image of the tissue 19a to be removed or also of the resection tool 18 during the retraction of the resection tool 18.In particular, the movable image acquisition unit 20 provides the surgeon with a good overview when using the resection tool 18, so that, for example, unintentional damage to adjacent tissue parts of the tissue 19 can be more easily prevented. In particular, as shown here by way of example, the image acquisition unit 20 and the resection tool 18 are movable relative to one another, so that the surgeon can select the imaging area independently of the position of the resection tool 18.

[0053] The outer shaft 12 is an elongated part and is designed to be inserted into a natural cavity 17 shown in Fig. 3. The outer shaft 12 extends from the proximal side 16 to the distal side 14, wherein the distal side is inserted into cavity 17 during use. The natural cavity 17 shown in Fig. 3 is a urinary bladder, wherein the outer shaft 12 is designed to be insertable into a urethra in order to penetrate the cavity 17. The resectoscope device 10 is designed as a backwash resectoscope, wherein the supply and removal of rinsing fluid takes place in a known manner via channels of the outer shaft 12. The resection tool 18 is designed to remove tissue by cutting. As shown by way of example, the resection tool 18 is an HF loop (high frequency loop) comprising two guide shafts 46 and a resection loop 48 suspended between the guide shafts 46.

[0054] The resectoscope device 10 shown in Fig. 1 to Fig. 3 has an image acquisition unit 20, which has a first image acquisition device 21 with a first viewing direction 21a and a second image acquisition device 22 with a second viewing direction 21a. The image acquisition devices 21, 22 are arranged one behind the other in a longitudinal direction of the outer shaft 12, wherein alternatively or additionally, an offset arrangement in a transverse direction of the outer shaft 12 is also possible. The two image acquisition devices 21, 22 are directed in different viewing directions 21a, 22a. The image acquisition device 21 is directed in a distal viewing direction, and the second image acquisition device 22 is directed in a proximal viewing direction. This orientation offers the surgeon, in particular, an image based on images of the tissue 19a to be removed, which were taken from two opposite sides.This allows the attachment point 19b to be particularly clearly viewed without the need to manipulate the tissue 19 from the outside or pivot an image acquisition unit. The viewing direction 21a of the first image acquisition device 21 is arranged at a viewing angle of approximately 40°, and the viewing direction 22a of the second image acquisition device 22 is arranged at a viewing angle of approximately 130°, each with respect to a longitudinal axis of the outer shaft 12. The image acquisition devices 21, 22 shown as examples are each formed by camera modules with input optics and an image sensor. The individual viewing angles of the image acquisition devices 21, 22 are each approximately 70°.

[0055] The resectoscope device 10 shown in Fig. 1 to Fig. 3 comprises an endoscope assembly 40 comprising the image acquisition unit 20. The endoscope assembly 40 comprises an endoscope shaft 42 and an imaging head 44 attached to the endoscope shaft 42, in which the first image acquisition device 21 and the second image acquisition device 22 of the image acquisition unit 20 are arranged. The imaging head 44 protrudes radially with respect to a longitudinal axis 42a of the endoscope shaft 42. The endoscope assembly 40 is arranged with respect to the resection tool 18 such that it lies between the guide shafts 46 so that they do not interfere with each other during a relative movement in a longitudinal direction of the outer shaft 12. The endoscope assembly 40 further comprises an illumination unit 30 comprising a first lighting element 31 and a second lighting element 32, which are arranged in the imaging head 44.The illumination unit 30 further comprises a third lighting element 33 arranged on the endoscope shaft 42. The illumination unit 30, together with the endoscope assembly 40, is movable relative to the outer shaft 12 and is configured to illuminate the imaging area 20a. The individual lighting elements 31, 32, 33 are formed, for example, by light-emitting diodes in the present case. Alternatively, a design with laser diodes or light guides would also be possible.

[0056] The endoscope shaft 42 of the endoscope assembly 44 further includes a heat dissipation 28 configured to transfer heat from a distal side of the endoscope shaft 42 to a proximal side of the endoscope shaft 42. The heat dissipation 28 is implemented, for example, by an evaporation and condensation circuit.

[0057] Fig. 4 shows a side view of a resectoscope device 10' in a first position according to a further embodiment. Fig. 5 shows a side view of the resectoscope device 10' in a second position according to the further embodiment. The further resectoscope device 10' shown as an example is an alternative embodiment of the resectoscope device 10 described above. The resectoscope device 10' according to the further embodiment largely corresponds to the resectoscope device 10 according to the previously described embodiment and the illustrations in Fig. 1 to Fig. 3, wherein, however, the image capture unit 20', unlike the image capture unit 20, comprises a distal assembly 24 and a proximal assembly 26. In addition, the illumination unit 30' is adapted compared to the previously described illumination unit 30. The other individual features of the resectoscope device 10 are therefore already present in the embodiment shown in Fig. 1 to Fig.3 and can be transferred accordingly. A further description of the individual features is therefore omitted.

[0058] The image capture unit 20' comprises the distal assembly 24 and the proximal assembly 26, which are spaced apart from one another in a longitudinal direction of the outer shaft 12. The distal assembly 24 and the proximal assembly 26 are jointly movable relative to the outer shaft 12 and, in particular, are movable beyond its distal side 14. The distal assembly 24 is configured correspondingly to the previously described imaging head 44 according to the previously described embodiment, with an illumination unit 30' being adapted. The proximal assembly 26 of the image capture unit 20' comprises a third image capture device 23 with a viewing direction 23a. The third image capture device 23 is directed in a distal viewing direction, wherein the viewing direction 23a has a viewing angle of approximately 40° with respect to a longitudinal direction of the outer shaft 12.

[0059] The distal assembly 24 and the proximal assembly 26 are spaced apart from one another such that a working area of ​​the resection tool 18, or rather a resection area, is defined between them. Within this working area, the resection tool 18 can be displaced relative to the outer shaft 12 and the image acquisition unit 20, and simultaneously, in particular without moving the image acquisition unit 20, the imaging area 20a can be imaged, which completely encloses the tissue 19a to be removed. Thus, the resection tool 18 can be viewed by the surgeon from opposite sides during both extension and retraction, without the need to move the image acquisition unit 20.

[0060] The lighting unit 30' shown in Fig. 4 and Fig. 5 comprises four lighting elements, each constructed in a manner similar to the lighting elements 31, 32, 33 according to the previously described embodiment. Unlike the previously described embodiment, three lighting elements are distributed on the endoscope shaft 42 between the distal assembly 24 and the proximal assembly 26, and only one lighting element is arranged on the imaging head 44. This arrangement enables particularly good illumination of the working area of ​​the resection tool 18.

[0061] Fig. 6 shows a perspective view of a resection system 100 with a resectoscope 50 having a resectoscope device 10.

[0062] The resection system 100 illustrated by way of example comprises a control device 102, the resectoscope 50 with the resectoscope device 10 and with a handle 104, a connecting cable 106, and a supply unit 108 connected to the resectoscope device 10 via the connecting cable 106. The resection system 100 and / or the resectoscope device 10 and the supply unit 108 can be part of a medical system. The supply unit 108 can be used with a display (not shown). Furthermore, the supply unit 108 can be configured to forward and / or process image data received from the resectoscope device 10. The control device 102 does not have to be arranged in the supply unit 108, but can also be arranged in another unit, for example, at a proximal portion of the resectoscope device 10, or distributed as several individual control units in different units.

[0063] The control device 102 is configured to process the images captured by the image capture unit 20 and generate a display for a user or surgeon. When using, for example, the image capture device 22 directed in the proximal viewing direction, the surgeon is placed in the patient's position from his or her perspective. For orientation, the surgeon must align movements made from a proximal position with the opposite image. A movement in the direction of a vertical axis also remains in the correct direction for the image capture device 22. For movements in a transverse axis, an image from the image capture device 22 can be mirrored horizontally. With modern sensors, this can be done directly on the image sensor of the image capture device 22 or in the control device 102.

[0064] For example, the control device 102 is configured to create a representation for a user or surgeon from different images captured by the image capture unit 20, 20' and showing different image areas, in which representation at least one object is depicted that is concealed in at least one further image and visible in at least one further image. This is particularly advantageous in the image capture unit 20' with the spaced-apart assemblies 24, 26. For example, an image can be captured simultaneously with the image capture device 22 and a different image can be captured simultaneously with the image capture device 23 from opposite sides.The control device 102 can, for example, horizontally mirror the image of the image capture device 22 and overlay it with the image of the control device 23 so that the surgeon can view a tissue 19a to be removed from two sides simultaneously.

[0065] Fig. 7 shows an exemplary flow diagram of an imaging method according to an embodiment. The imaging method can be carried out with the resectoscope device 10, 10' or with the resectoscope 50 or with the resection system 100. The imaging method comprises a first step S1 of moving the image acquisition unit 20, 20' into a first position relative to the outer shaft 12, a second step S2 of recording at least one image with the image acquisition unit 20, 20' in the first position, a third step S3 of moving the image acquisition unit 20, 20' into a second position different from the first position relative to the

[0066] Outer shaft 12, and a third step S4 of capturing at least one image using the image acquisition unit 20, 20' in the second position. The imaging method can be performed manually by the surgeon, for example. The surgeon moves the image acquisition unit 20, 20' accordingly relative to the outer shaft 12 and initiates the capturing of an image at the corresponding positions.

[0067] List of reference symbols

[0068] 10 Resectoscope device

[0069] 12 Outer shaft

[0070] 14 distal side

[0071] 16 proximal side

[0072] 17 Cavity

[0073] 18 Resection tool

[0074] 19 tissues

[0075] 19a Tissue to be removed

[0076] 19b Starting point

[0077] 20 image acquisition unit

[0078] 20a Imaging area

[0079] 21 first image capture device

[0080] 21a Viewing direction of the first image capture device

[0081] 22 second image capture device

[0082] 22a Viewing direction of the second image capture device

[0083] 23 third image capture device

[0084] 23a Viewing direction of the third image capture device

[0085] 24 distal assembly

[0086] 26 proximal assembly

[0087] 28 Heat dissipation

[0088] 30 lighting units

[0089] 31 first light element

[0090] 32 second light element

[0091] 33 third light element

[0092] 40 Endoscope assembly

[0093] 42 Endoscope shaft

[0094] 42a Longitudinal axis of the endoscope shaft

[0095] 44 imaging head

[0096] 46 Leadership

[0097] 48 Resection loop

[0098] 50 Resectoscope

[0099] 100 resection system

[0100] 102 Control device

[0101] 104 Grab handle

[0102] 106 connecting cables

Claims

Claims 1. A resectoscope device (10), comprising: an outer shaft (12) having a distal side (14) and a proximal side (16); a resection tool (18) extending through the outer shaft (12) and movable relative to the outer shaft (12); and an image acquisition unit (20) configured to capture images of an imaging region (20a) located in a region of the distal side (14) of the outer shaft (12), wherein the image acquisition unit (20) is movable relative to the outer shaft (12) and beyond its distal side (14).

2. Resectoscope device (10) according to claim 1, wherein the image acquisition unit (20) and the resection tool (18) are movable relative to each other.

3. Resectoscope device (10) according to claim 1 or 2, wherein the image acquisition unit (20) comprises at least two image acquisition devices (21, 22) directed in different viewing directions (21a, 22a).

4. Resectoscope device (10) according to claim 3, wherein the at least two image capture devices (21, 22) comprise a first image capture device (21) and a second image capture device (22), wherein the first image capture device (21) is directed in a distal viewing direction, and wherein the second image capture device (22) is directed in a proximal viewing direction.

5. Resectoscope device (10) according to claim 3 or 4, wherein the image acquisition unit (20) comprises at least three image acquisition devices (21, 22, 23) directed in three different viewing directions.

6. Resectoscope device (10) according to claim 5, wherein the at least three image capture devices (21, 22, 23) define three different imaging areas that overlap.

7. Resectoscope device (10) according to one of the preceding claims, wherein the image capture unit (20) comprises a distal assembly (24) and a proximal assembly (26) which are spaced apart from one another and are movable together relative to the outer shaft (12) and beyond its distal side (14), wherein the distal assembly (24) and the proximal assembly (26) each have at least one image capture device (21; 22; 23).

8. Resectoscope device (10) according to claim 7, wherein the at least one image capture device (21; 22; 23) of the distal assembly (24) is directed in a proximal viewing direction, and wherein the at least one image capture device (21; 22; 23) of the proximal assembly (26) is directed in a distal viewing direction.

9. Resectoscope device (10) according to claim 7 or 8, wherein the distal assembly (24) and the proximal assembly (26) are spaced apart from one another such that a working area of the resection tool (18) is defined between them.

10. Resectoscope device (10) according to one of claims 7 to 9, wherein the at least one image capture device (21; 22; 23) of the distal assembly (24) and the at least one image capture device (21; 22; 23) of the proximal assembly (26) are each directed from different sides onto a working area of the resection tool (18).

11. Resectoscope device (10) according to one of the preceding claims, further comprising an illumination unit (28) which is movable relative to the Resection tool (18) and is movable relative to the outer shaft (12) and which is adapted to illuminate the imaging area (20a).

12. Resectoscope device (10) according to claim 11, wherein the illumination unit (30) comprises a plurality of lighting elements (31, 32, 33) directed in different illumination directions.

13. Resectoscope device (10) according to claim 11 or 12, wherein the image acquisition unit (20) and the illumination unit (30) are integrally formed.

14. Resectoscope device (10) according to one of the preceding claims, comprising an endoscope assembly (40) which comprises the image acquisition unit (20), wherein the endoscope assembly (40) comprises an endoscope shaft (42) and an imaging head (44) attached to the endoscope shaft (42), in which at least one image capture device (21; 22; 23) of the image capture unit (20) is arranged.

15. Resectoscope device (10) according to claim 14, wherein the imaging head (44) projects radially with respect to a longitudinal axis (42a) of the endoscope shaft (42).

16. Resectoscope device (10) according to claim 14 or 15, wherein the resection tool (18) comprises two guide shafts (46) and a resection loop (48) suspended between the guide shafts (46), and wherein the endoscope assembly (40) is arranged between the guide shafts (46).

17. Resectoscope device (10) according to one of claims 14 to 16, further comprising a coupling mechanism configured to selectively couple and / or selectively prevent relative movement between the endoscope assembly (40) and the resection tool (18).

18. Resectoscope device (10) according to one of claims 14 to 17, wherein the endoscope assembly (40) comprises the illumination unit (30), and wherein at least one luminous element (31; 32; 33) of the illumination unit (30) is arranged in the imaging head (44).

19. Resectoscope (50) with a resectoscope device (10) according to one of the preceding claims.

20. A resection system (100) comprising a resectoscope device (10) according to any one of claims 1 to 18 and / or a resectoscope (50) according to claim 19; and a control device (102) configured to process images acquired by the image acquisition unit (20) and generate a display for a user.

21. Resection system (100) according to claim 20, wherein the control device (102) is configured to create a representation for a user from different images which were recorded by means of the image acquisition unit (20) and which show different image areas, in which representation at least one object is shown which is hidden in at least one of the images and can be seen in at least one further image.

22. Resection system (100) according to claim 21, wherein the control device (102) is configured to create a representation for a user from the different images, in which representation a portion of the resection tool (18) is shown which is hidden in at least one of the recorded images.

23. Resection system (100) according to one of claims 20 to 22, wherein the control device (102) is configured to create a representation for a user from images acquired by means of the image acquisition unit (20), which representation represents a plan view of a working area of the resection tool (18).

24. Resection system (100) according to one of claims 20 to 23, wherein the control device (102) is configured to generate a stereo image from different images acquired by means of the image acquisition unit (20).

25. Imaging method performed with a resectoscope device (10) and / or with a resectoscope (50) and / or with a resection system (100) according to one of the preceding claims, comprising the steps: Moving the image acquisition unit (20) into a first position relative to the outer shaft (12); Capturing at least one image by means of the image capture unit (20) in the first position; Moving the image acquisition unit (20) into a second position different from the first position relative to the outer shaft (12); and Capturing at least one image by means of the image capture unit (20) in the second position.

Images