DE102009042049A1 - Medical instrument system for use during e.g. laparoscopic surgery, has instruments transformable from transport state into working state to perform medical procedure in which components cooperate in system form - Google Patents

Abstract

The system (2) has an instrument (4a) designed in the form of a camera system, and another instrument (4b) designed in the form of a supporting structure. The former instrument includes components (12a-12c) in the form of cameras and lighting capsules. The latter instrument includes components (12d-12f). The components are individually insertable one after another into an interior (8) of a patient (6) in a transport state (T). The instruments are transformable from the transport state into a working state (A) to perform a medical procedure in which the components cooperate in a system form. An independent claim is also included for a method for introducing a medical instrument into an interior of a patient by a minimally invasive access.

Description

The invention relates to a medical instrument system and a method for introducing a medical instrument into the interior of a patient through a minimally invasive approach.

A medical intervention on a patient always includes the step of creating and keeping an access route to the appropriate place to be treated or examined inside the patient. Such access can z. B. a natural access path, z. As the esophagus, the intestine or the ureter of the patient. The access path can also be created artificially, z. B. a relatively small incision on the abdominal wall or on the knee of a patient. Both types of access in the context of the present invention should be referred to as minimally invasive access routes.

For all interventions, eg. For example, surgical procedures require minimizing the number and size of patients' natural access pathways to be created or augmented. Thus, the burden on the patient during and after the procedure should be reduced. Such gentle surgical procedures are referred to as minimally invasive surgery. The so-called endoscopic and laparoscopic surgery - also called buttonhole surgery - has already found widespread use. In this form of surgery are either a natural body opening, z. As the urethra, the esophagus or the rectum of the patient at endoscopy or small cuts on the patient's body, a camera with light source and instruments introduced. A monitor then performs the operation using the camera and light source.

The access path therefore requires instrument system to be introduced into the patient. This includes z. B. at least one visual path for the free view of the doctor on the relevant point inside the patient. Furthermore, a work path for equipment must be provided, ie. H. also an access path through the access, via which instruments introduced into the patient or z. B. tissue samples can be brought out of the patient.

It is known to use as an instrument system an endoscope on the access routes. The endoscope is an elongated, generally tubular unit, within which is provided both the visual path, the access path for the instrument and the working path for resources. This is realized by z. B. So control wires go through the endoscope to operate a biopsy forceps or to move the endoscopy tip. An optical fiber is used to transmit a camera image to the outside or to illuminate the patient's interior. A hose line for guiding medicaments or rinsing liquid can also be provided.

The problem is the still not optimal illumination and generally the visualization of the operating area. Due to the above-mentioned limitations, only restricted optics or their limited movement are possible given a small access path with a small cross section. In addition, laparoscopy always requires an additional opening, ie a corresponding access to the patient - usually in the form of a trocar - for the optics. This means an additional incision or wound for the patient. In endoscopy of cavities, the optics and working channels for instruments are contained in one device; H. in a tubular endoscope. Due to the relatively large cross section of the optical path, which runs in the endoscope, valuable space for instruments or their manipulation capability is lost during the actual operation. All optical systems of laparoscopy and endoscopy currently allow only the view, from a defined angle to Operatiosgebiet.

In other words, the thinness of the endoscopes is at the expense of the size of the available space in the access path, and hence the size and number or degrees of freedom for instruments, medications, optics, etc. available simultaneously in the patient.

It is known to use what are known as surgical robots in operations that provide the surgeon with the ability to have complex and frequently repeated manual maneuvers performed by a machine. Such aids are comparable in nature z. B. with the sewing machine of a cutter. From the DE 10 2007 030 747 A1 it is known at the beginning or during a minimally invasive procedure a, z. B. magnetically introduce in the patient contactless capsule into a body cavity of the patient and to proceed this beyond the actual target area for the treatment. During the following procedure, the capsule can be used to control a view from a different perspective than the surgical instrument.

From the WO 2006120179 A2 is a long-term used abdominal cavity camera known.

From the DE 10 2007 030 747 A1 it is also known in non-or difficult to access organs via a trocar - z. B. also magnetically mobile - to administer endoscopy capsule, to obtain additional visual information in the operating area or even an optical visual inspection, for. B. in contrast to pure X-ray control - to allow.

The object of the invention is to specify an improved medical instrument system and an improved method for introducing a medical instrument into the interior of a patient through a minimally invasive approach.

In other words, the object of the invention is to provide a device or technique or method with which a plurality of optics and / or instruments can be made available on the intervention area via only one slender natural or created path.

With regard to the medical instrument system, the object is achieved by an instrument system with an instrument. The instrument can be introduced into the interior of a patient through a minimally invasive approach. During this process, the instrument is in a transport state. In the transport state, the instrument has at least two components. The two components can be introduced one after the other into the interior of the patient. Inside the patient, the instrument is transformable in a working state. In the working state, the instrument is suitable for carrying out a medical procedure. In the working state, the components work together in the manner of a system.

In contrast to an implant, which is indeed introduced into a patient in the form of several parts and is composed there, the instrument can actively carry out a medical procedure in the patient. By carrying out a medical measure, this also means the support of such a measure. In general, the extent of the instrument in the transport state is many times smaller than those expansion of the instrument in the working state.

In other words, the invention is based on the idea of introducing optics, instruments or support structures that are folded, disassembled or in the manner of a synergetic system into the intervention area via an appropriate path, namely the access, and then put them together on site. The medical instrument system described allows this.

The invention allows accurate planning of a complex surgical procedure and supports this or the operation by auxiliary structures in front of the target area. In this way, in pathologies that today require open surgery or a minimally invasive, multiple approach, they can be replaced with a single-access, minimally invasive surgery. The manual requirements for the surgeon and the staff are lower than before. This saves costs.

In a first advantageous variant of the invention, the instrument in the working state comprises at least two autonomously operating components. Although the two components are not mechanically joined together in the patient, they work together as a system and condition each other. Thus, the two components work together autonomously as an instrument in working condition as an instrument. An example of this would be z. Example, a camera system of a plurality of individual cameras, which systematically capture together a surgical field from several directions.

In another embodiment, in the working state, the instrument consists of at least two assembled components. In contrast to the above, at least two components are combined in the transformation of the instrument into the working state to the actual instrument. This makes it possible to bring even large or bulky instruments through a very small access in the patient. The instrument is z. B. after the end of the medical procedure then dismantled again. In this case, the instrument may also be previously disassembled outside the patient or it may already be disassembled outside the patient for transformation into the transport state.

In an advantageous embodiment of the variant just mentioned, the components forming the instrument have coupling points which permit a defined joining of the components to the instrument. The coupling points can z. B. be mechanically stable magnetic coupling points. Since the surgeon's manipulation options are limited by the minimally invasive access, the assembly of the instrument in the patient is greatly simplified if the instrument can be assembled only in a specific, namely the defined manner. In a defined joining is then z. B. already the place or the angle under which individual components are assembled, given so that the surgeon can make no mistake here. In other words, this leads to a semi-automatic assembly. For example, support structures have magnetic coupling sites where they can be semi-automatically assembled and easily separated again. The support structures also have z. B. discrete coupling sites that allow coupling at different angles and distances. This creates a kind of modular system, eg. B. comparable to the Legosystem in toys.

In a further advantageous embodiment of the instrument system, at least two components are connected via a connection structure. The connection structure, z. As a multiple cameras as components supporting tripod is deployed during the transformation into the working state and / or inflatable. Within the patient during the transformation, the connecting structure is deployed and / or inflated. This represents an even more simplified variant of the transformation compared to the above-mentioned assembly of the components, since unfolding or inflation means even easier manipulation for the surgeon. After the end of the measure, the connection structure z. B. again collapsible or emptied. The inflation can z. B. by gas or liquid. In inflatable structures these z. B. made of a respect to the expansion coefficient anisotropic material. Some areas of the connection structure then expand a lot, others little.

In a further advantageous embodiment, location markers and / or license markers are attached to the component. The instruments or instrument parts thus bear markers that can be used with radiological procedures z. B. X-ray - the marker is then z. B. a silver inlay - or with the help of magnetic resonance - the marker is then z. As a mixture of water and the contrast agent GD-DTPA - can be displayed. In 3D image data recorded by the patient, the components or instruments can be automatically segmented or located. Thus, during and at the end of the intervention structural elements can be detected, located and segmented.

The components, eg. B. in the form of support structures are made of magnetic resonance compatible material, ie z. B. non-ferromagnetic, not electrically conductive, with small tan Δ and very short MR relaxation times. A suitable material is for example Teflon.

The location markers thus allow a highly accurate location of an instrument in the patient. The place marker can z. B. RF transmitter of a high frequency, which allow a phase detection in the free stomach height.

The coupling points can act as described above between individual components, but can also z. B. docking points for other auxiliary equipment such as cameras or Hauteaken be with the help of which z. B. components are fixed in the patient.

In medical technology, for safety reasons and business model reasons (pay-per-use), the number of use cases for materials is limited. The corresponding is z. B. from the US 2003/110260 known. If the components carry license markers, z. B. a detection of license markers. Depending on the detection, a function is then enabled on a medical device. The medical device may in this case belong to the instrument system or be an external medical device.

In a further preferred embodiment, the instrument is an optically delivering an image of the patient's interior when working. Since the optics several self-sufficient individual components, eg. B. includes the above single cameras or even in the form of a combined instrument allows a much more complex or complex optics, the imaging of the intervention area compared to a conventional endoscope is significantly improved.

In a particularly preferred embodiment, the instrument thus comprises a camera system which can be installed in the patient and has at least two cameras as components. This embodiment of the invention is based on the recognition, in the free volume before the intervention target, a number of at least two -. B. independently working - to install cameras. The cameras can simultaneously deliver images from different directions and at different distances to the target area. Nevertheless, only one way, namely the access route, has to be used for the intervention. This is - if necessary - by extending a natural path, for. B. the urinary tract bladder or surgically created. About this way so z. B. brought with a flexible endoscope or magnetic navigation wireless cameras with radio transmitter in the volume in front of the intervention area and z. B. anchored there, z. B. by clips or magnetically by means of counter magnet on the outside of the patient.

In such a camera system, for example, in an advantageous embodiment. B. the position of the fields of view of the cameras are determined and the fields of view are combined to form an at least partial 3D visual image. For example, with a 3D imaging method - e.g. B. a 3D X-ray C-arm - recorded at the end of the positioning of all cameras 3D image data of the target area and automatically segmented in the cameras. Then, the field of view of the respective camera, in the knowledge of the imaging properties, is virtually projected onto a rendered 3D surface virtually. Due to the stitched image or the projection of the camera images onto a rendered surface, the so-called at least partially 3D visual image is produced.

This results in the advantage that the viewer can now in principle take any virtual observation location. In this case, the viewer is shown in real time a gestitchtes image from the respective frames of each camera. Alternatively, the position of the cameras or their fields of view can also be defined or determined by fixing them to a foldable tripod as mentioned above. In the unfolded state of the status then the relative location and angle relationships of the individual cameras are known to each other. However, to detect the position of the cameras or their fields of view, the cameras can also be equipped, as mentioned above, with location markers, which enable position determination with the aid of a magnetic navigation system.

The cameras are then already attached to a multicamera tripod prior to insertion into the surgical cavity. This is folded when introduced through the trocar and deployed in the surgical cavity. Alternatively, it is possible to introduce the cameras and a tripod successively over the trocar in the surgical cavity and put together there.

In the camera system z. B. at least one component to be a lighting component. This is an alternative to cameras, which themselves - z. B. pulsed - contain lighting. The control of the lighting is hereby possible independently of the image acquisition in order to optimize the illumination for each individual camera. Optionally, a pure illumination capsule thus assumes the illumination function, which is specially optimized for this purpose.

At the end of an intervention z. B. all camera or lighting capsules removed. The successful removal can z. B. be checked using an X-ray. It is also conceivable to leave one or more capsules in the patient to z. B. according to one of the WO 2006 120 179 A2 known method to observe or cure postoperative adhesions.

In an alternative embodiment, the instrument can also be a support structure that can be placed in the patient and holds a cavity open. Since the support structure is assembled from several individual components, a particularly patient-friendly, z. B. the patient over a large area supporting structure can be selected. This can, for. B. work alone by touching, so without the use of skin hooks or the like patient friendly.

In the context of the invention, the components or structural components of the instrument z. B. stored in a library. The user of the instrument, for. B. the surgeon can plan the use of components based on this library and the data of the patient to be operated and this targeted and individually as a set z. B. order from the manufacturer or from a warehouse.

The components can also be available as radiological objects in a database. After recording a 2D or preferably a 3D X-ray image, the structure blocks currently installed in the patient can be segmented using this library. Also, a logical 3D model of the current operation situation can be displayed or superimposed into existing image material.

With regard to the method, the object is achieved by a method for introducing a medical instrument into the interior of a patient through a minimally invasive approach. The instrument comprises at least two components in a transport state, and the components are introduced one at a time through access into the patient. The instrument is transformed in the patient into a working state for performing a medical procedure, in which the components are combined to form a system.

A medical instrument is thus introduced in the transport state element by element one by one into the interior of a patient through a minimally invasive approach. Only in the patient, the instrument for the implementation of a medical procedure is transformed into the working state, in which the components are combined to form a system.

The method has already been explained above together with its embodiments.

For a further description of the invention reference is made to the embodiments of the drawing. It shows in a schematic outline sketch:

1 a medical instrument system when used on a patient.

1 shows a medical instrument system 2 , This includes a first instrument 4a in the form of a camera system and a second instrument 4b in the form of a support structure. As a third instrument 4c is a conventional endoscope included.

1 also shows a patient 6 in whose interior 8th in the form of the abdominal cavity a minimally invasive procedure is to be carried out. For this purpose in the abdominal cavity is an artificial minimally invasive approach 10 in the form of an abdominal incision brought in. The instrument 4a comprises in a first embodiment, three components 12a In the form of two cameras and a lighting capsule, which in a second embodiment via a foldable connection structure 14 connected in the form of a state (shown in dashed lines). The second instrument 4b is also in the form of three components 12d -F, which each represent individual struts of the joinable support structure.

In 1 are the instruments 4a , b outside the patient 6 initially shown in a transport state T. In the case of the instrument 4a This means that the three components 12a -C individually in an uncoordinated way in a storage box or the tripod is folded up. In the case of the instrument 4b the individual parts of the supporting structure are stored in disassembled form.

A first step is to prepare for the actual procedure on the patient 6 , The instrument 4c is not in the patient yet 6 introduced. Access 10 so free. In this first step, the components are now first 12a -C in its transport state T one behind the other with the help of the instrument 4c in the patient 6 brought in. Now they are placed in the positions shown and thus transformed into their working state A. The components 12a , b in the form of the cameras are here using unillustrated clips or one outside the patient 6 held, not shown magnets attached to the inner wall of the abdominal cavity, as well as the component 12c in the form of the illumination capsule.

With the process just described become the components 12a -C so controlled inside 8th , So the abdominal cavity placed so that they work together in their working state A in the manner of a system, ie, the two cameras each have a viewing cone 16a , b, which shows the abdominal cavity from different angles. The illumination capsule provides light to illuminate the abdominal cavity.

In the alternative embodiment, the transformation into the working state A takes place by unfolding the connection structure 14 in their predetermined position. The relative position of the components 12a Thus, c is in the unfolded state of the connection structure 14 fixed.

Subsequently, the components are successively 12d -F in the transport state T through the access 10 in the interior 8th brought in. The corresponding support parts in this case have coupling points 18a -C on. These can only be explained in a very specific way as you are in 1 is shown, join together, so that a total of a support structure of the shown manner in the interior 8th results, which spans this or the abdominal cavity as a large cavity. Now that's the instrument too 4b transformed into the working state A.

The individual components 12a -F also carry place markers 20a f. These work together with a navigation system, not shown, which always the exact location of the respective location marker 20a -F can determine. So, within the patient 6 be controlled, whether the instruments 4a , b are placed correctly or in which direction the view cone 16a , b show the two cameras.

The connection structure 14 also carries a license marker 22 , The license marker 22 is from a license detector 24 in the patient 6 detected. Only with successful detection becomes a medical device 26 activated in the form of an image system. This process image information from the two view cones 16a , b and puts them on a monitor 28 in panorama representation (so-called stitching) represents.

One in the patient 6 located body structure 30 , of which the two cameras only record one part at a time, can thus be regarded as an almost complete 3D virtual model on the monitor 28 being represented. This creates an at least partial 3D visual image 32 the entire body structure 30 ,

The surgeon can now use the instrument 4c Insert in the usual way in the abdominal cavity and there manipulation of the body structure 30 under full visual control.

The instrument 4c can be equipped here on its full cross-section only for manipulation and job execution, since it requires no internal supply for lighting and imaging. Besides, the abdominal cavity of the patient is 6 through the instrument 4b sufficiently stretched so that the surgeon has enough space to carry out the medical procedure.

Upon completion of the procedure, the surgeon removes the instrument 4c , Subsequently, the components 12a -F separated from each other or the connection structure 14 folded again and all the components one after the other through the access 10 from the inside 8th away.

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• DE 102007030747 A1 [0008, 0010]
• WO 2006120179 A2 [0009, 0032]
• US 2003/110260 [0025]

Claims (17)

Medical Instrument System ( 2 ) with an instrument ( 4a -B), which in a transport state (T) through a minimally invasive approach ( 10 ) into the interior ( 8th ) of a patient ( 6 ), the instrument ( 4a B) in the transport state (T) at least two components which can be introduced one after the other ( 12a -F), and where the instrument ( 4a B) in the patient can be transformed into a working condition (A) for carrying out a medical procedure, in which the components ( 12a -F) work together like a system. Instrument system ( 2 ) according to claim 1, with a working state (A) at least two self-sufficient working components ( 12a -F) comprehensive instrument ( 4a -b). Instrument system ( 2 ) according to claim 1 or 2, with one in the working state (A) of at least two components ( 12a -F) instrument ( 4a - b ). Instrument system ( 2 ) according to claim 3, in which the instrument ( 4a B) forming components ( 12a -F) coupling points ( 18a C) which define a defined assembly of the components ( 12a -F). Instrument system ( 2 ) according to one of the preceding claims, in which at least two components ( 12a F) via a during the transformation into the working state (A) deployable and / or inflatable connection structure ( 14 ) are connected. Instrument system ( 2 ) according to one of the preceding claims, with one at the component ( 12a -F) attached location markers ( 20a -F) and / or license markers ( 22 ). Instrument system ( 2 ) according to one of the preceding claims, in which the instrument ( 4a -B) one in working condition (A) a picture of the interior (A) 8th ) of the patient ( 6 ) supplying optics. Instrument system ( 2 ) according to claim 7, in which the instrument ( 4a -B) in the patient ( 6 ) installable camera system with at least two cameras as components ( 12a -F) is. Instrument system ( 2 ) according to one of claims 7 to 8, wherein at least one component ( 12a -F) is a lighting component. Instrument system ( 2 ) according to one of the preceding claims, in which the instrument ( 4a B) is a patient-placed, cavity-retaining support structure. Method for introducing a medical instrument ( 4a -B) inside ( 8th ) of a patient ( 6 ) through a minimally invasive approach ( 10 ), in which: - the instrument ( 4a B) in a transport state (T) at least two components ( 12a -F) and the components ( 12a -F) one by one through the access ( 10 ) in the patient ( 6 ), - the instrument ( 4a -B) in the patient ( 6 ) is transformed into a working state (A) for carrying out a medical procedure, by the components ( 12a -F) are combined to form a system. Method according to claim 11, wherein at least two components ( 12a -F) in working condition (A) self-sufficient as an instrument ( 4a -B) work together. Method according to claim 11, wherein at least two components ( 12a -F) when transforming into working condition (A) into an instrument ( 4a -B) are joined together. Method according to claim 13, in which the components ( 12a -F) via coupling points ( 18a -C) defined as an instrument ( 4a -B) are joined together. Method according to one of claims 11 to 14, wherein at least two components ( 12a -F) via a connection structure ( 14 ) during which it is unfolded and / or inflated during the transformation into the working state (A). Method according to one of claims 11 to 15, wherein on the component ( 12a -F) a license marker ( 22 ) in which, in the working state (A), a detection of the license marker ( 22 ) and depending on the detection a function on a medical device ( 26 ) is unlocked. Method according to one of claims 11 to 16, wherein the instrument ( 12a -F) in the patient ( 6 ) installable camera system with at least two cameras as components ( 12a -F), in which a position of the fields of view ( 16a , b) the cameras is detected, and the fields of view ( 16a , b) to an at least partial 3D visual image ( 32 ) be combined.

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