Surgery – Endoscope – Having imaging and illumination means
Reexamination Certificate
2001-10-01
2003-11-18
Leubecker, John P. (Department: 3739)
Surgery
Endoscope
Having imaging and illumination means
C600S106000, C600S104000
Reexamination Certificate
active
06648816
ABSTRACT:
BACKGROUND OF THE INVENTION
The present invention relates to a device for intracorporal, minimal-invasive treatment of a patient, comprising a working instrument that can be introduced into a body cavity of the patient for carrying out a treatment step, wherein a distal end of the introduced working instrument defines an intracorporal working area, and at least one image pick-up unit for picking up an image of the intracorporal working area, further comprising positioning means for orienting an optical axis of the image pick-up unit in dependency on a spatial position of the intracorporal working area, wherein the positioning means comprise a guide shaft, in which the working instrument is guided, and wherein the image pick-up unit is pivotably fixed at an intracorporal portion of the guide shaft.
Such a device is known from U.S. Pat. No. 5,166,787.
In the minimal-invasive, surgical treatment of patients, working instruments are brought to the location to be treated in the body of the patient merely through one or several small incisions. The visual control of the working steps to be carried out in the body of the patient is done endoscopically. An example for a minimal-invasive standard operation is the laparoscopical colecystectomy. In this procedure, three small openings are cut into the abdominal area of the patient. One of the openings serves for introducing an endoscope with a video camera, the image of which can be seen on a monitor by the treating physician. Working instruments, like e.g. scissors, forceps or the like, are introduced through the other two openings.
When the operation is carried out, the endoscope is, today, usually handled by an assistant physician, who tracks the endoscope to changes and displacements of the working area so far that the treating physician always has the working instruments in his visual field. Such camera assistance requires, however, a very good coordination between the treating physician and the assistant physician, what often is problematic in practice. Moreover, the necessary camera assistance requires more staff in carrying out the operation, which has a negative effect on the costs.
In DE 195 29 950 C1, a device was, thus, suggested, in which the camera assistant is replaced by an automatically controlled robot that is arranged outside the body of the patient. For the control of the robot, the image picked up by the endoscope camera is evaluated with reference to the position of working instrument or instruments appearing in the image picked up. The working instruments are marked with colors to this end, so that they can be identified by means of the proposed image treatment algorithm.
It is true that such a robot control can generally replace the assistant physician required as in the past, it is, however, expensive from the technical point of view and has, moreover, further disadvantages. In particular, the robot system requires a very large mechanical holder, which takes a relatively large space over the patient. This limits the freedom of movement for the treating physician over the patient. Apart from that, the sterilization of the relatively large robot device is difficult. The assembly and disassembly of such a device also requires relatively much time, what has a negative effect on the costs and the efficiency particularly in standard operations.
From U.S. Pat. No. 5,166,787 mentioned at the outset, an endoscope with a video camera arranged on its distal end is known, wherein the video camera is movable as a whole with respect to the distal end of the endoscope shaft after being introduced into the body cavity to be examined of the patient. The video camera can be pivoted about an axis running parallel with respect to the longitudinal axis of the shaft, which forms a body-own axis of the video camera, in a plane transverse to the longitudinal direction of the shaft out of the longitudinal axis of the shaft. The viewing direction of the video camera remains, in this procedure, in every pivot position of the video camera parallel with respect to the longitudinal center axis of the shaft. In another embodiment, the video camera is additionally pivotable, about a pivot axis running transversely with respect to the longitudinal direction of the shaft, again, about a video camera-own axis. In this procedure, the viewing angle of the video camera is changed with respect to the longitudinal axis of the shaft, however, only such viewing directions are created, which form a very acute angle with the longitudinal axis of the shaft, or such viewing directions, which are facing away from the longitudinal center axis of the shaft and are, thus, not useful for the endoscope when used in an operation. In other words, it is not possible to reach the same or at least similar perspective observation conditions with this known endoscope as with an endoscope that was introduced into the body cavity via an additional access.
Neither the known endoscope nor the video camera, moreover, have positioning means by which the viewing direction and/or the image field of the video camera can automatically be tracked to certain displacements or shiftings of the intracorporal working area. Thus, also for this known device a manual positioning with the disadvantages already mentioned is necessary.
It is, thus, an object of the present invention to provide a device of the type mentioned at the outset, by which at least similar perspective viewing conditions can be reached like with an endoscope that is introduced into the body cavity via an additional access.
SUMMARY OF THE INVENTION
According to the invention, the object underlying the invention is achieved by a device for intracorporal, minimal-invasive treatment of a patient, comprising:
a working instrument that can be introduced into a body cavity of said patient for carrying out a treatment step, said working instrument having a distal end defining an intracorporal working area when said working instrument is introduced in said body cavity;
at least one image pick-up unit for picking up an image of said intracorporal working area, said image pick-up unit having an optical axis; and
positioning means for orienting said optical axis of said image pick-up unit in dependency on a spatial position of said intracorporal working area, said positioning means further comprising:
a guide shaft in which said working instrument is guided, said guide shaft having an intracorporal portion, and
a holder pivotably fixed to said intracorporal portion of said guide shaft, wherein said image pick-up unit is arranged at said holder in a distance from a location where said holder is linked to said guide shaft, such that said image pick-up unit is intracorporally pivotable into a working position, in which said optical axis runs angularly to a longitudinal center axis of said guide shaft and points to said longitudinal center axis.
The device according to the invention differs from the known device in particular by the fact that the image pick-up unit is fixed at the guide shaft via a holder, and, due to the pivotability of the holder, can be pivoted away from the guide shaft, i.e. can be spaced apart from the guide shaft. In that way, the viewing direction can be positioned under a larger angle with respect to the longitudinal axis of the guide shaft, which corresponds to the perspective viewing conditions of an endoscope being introduced through an additional opening into the body cavity, what is welcomed by the physician. By the coupling of the image pick-up unit with the intracorporal portion of the guide shaft, it is moreover possible, as is in the following described in more detail, that the image pick-up unit can automatically follow at least a part of the movements of the working instrument, without a robot or a corresponding device outside of the body cavity being necessary. It is therefore practically a seeing working instrument. The device according to the invention is consequently considerably smaller and more space saving and less cost-expensive than common devices with an extracorporal positioning device.
Irion Klaus M.
Kocher Mark
Schwarz Peter
Karl Storz GmbH & Co. KG
Leubecker John P.
St. Onge Steward Johnston & Reens LLC
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