Surgery – Endoscope – With means for indicating position – depth or condition of...
Reexamination Certificate
2000-09-26
2002-10-22
Mulcahy, John (Department: 3739)
Surgery
Endoscope
With means for indicating position, depth or condition of...
C600S112000, C600S138000, C606S130000
Reexamination Certificate
active
06468202
ABSTRACT:
BACKGROUND OF THE INVENTION
The invention relates to an apparatus comprising a transmitter unit with which the position of a medical instrument can be determined with the aid of a CAS system. The apparatus comprises the transmitter unit at a fixed location and the apparatus can be attached to the medical instrument.
Such an apparatus is disclosed in the article by Cinquin, P. et al.: “Computer Assisted Medical Intervention”, IEEE Engineering in Medicine and Biology, May/June 1995, pages 256 to 263.
So-called CAS systems (computer assisted surgery) are increasingly used in various operations, for example in neurosurgery, spinal surgery and surgery relating to the throat, nose and ears. Such systems are also indicated with the abbreviation CAMI=computer assisted medical intervention. These CAS systems consist at least of a position sensor unit which detects the position and/or the direction of an instrument, for example an endoscope, and transmits this information to an image processing unit in which data in the form of CT, MR and/or ultrasound images of the body region to the be treated are present in three dimensionals. After reference markings are correlated with three dimensional image data corresponding to the original position data, a correct position determination of instruments is possible in the image data set. The operator thus has the possibility to orient himself during an operation on the basis of image data reproduced on a monitor. A prerequisite for precise localization, apart from the accuracy of the position detection, is especially the geometric invariance of the body structure from the time the image data is taken until the time of the operation. Thus this method is especially suitable for operations in which rigid body structures are involved and the shifting capability of soft tissue is small, i.e. for operations on the skull, on the spine or the sinuses.
The position detection in the above-mentioned apparatus is effected by means of several radiating diode or position elements, whose signals can be detected from remote cameras and supplied to a computer.
The position of the diodes and thus the position of the instrument connected directly thereto is determined with the triangulation method in the computer. The transmitter unit must be connected at a fixed position with the instrument, for example an endoscope whose position is to be determined. This connection must remain invariable during the operation. In the abovementioned apparatus, a total of six diodes are arranged on an approximately T-shaped or sword-shaped bulky and voluminous component, which is attached in the region of a shaft of the respective instrument, namely either on the shaft of an endoscope or on the shaft of a borer. The apparatus can be positioned along the shaft and its position fixed by screws employing a sleeve covering the shaft.
A disadvantage of the known apparatus is that the mounting procedure and the change of the transmitter unit to another instrument, for example to another endoscope, are very time consuming and complicated. Such a change is only possible with considerable effort, especially under clinical conditions during an operation and under the requirements on sterility.
Several instruments are often employed in certain operations and in the course of an operation it is necessary to re-use an instrument employed at the beginning, which in the meantime has been set aside. For example, if the instrument is an endoscope with a so-called straight view, then this endoscope can be used at the beginning of the operation to approach an operation site by inserting along the endoscope axis, for example through the nose to a site in the sinus cavity. Should an operation then be carried out on a tumor located to the side of the operation site, the endoscope with the straight view is replaced with an endoscope having a side view.
Should the operation area be inspected again for remaining objects at the end of the operation, the initial endoscope with the straight view is required again. In addition, the change from or to a passive instrument is also frequently necessary, for example when a trocar with an obturator is to be inserted, i.e. without viewing.
Each instrument must be provided with numerous, at least three, transmitters in order to be able to determine the position of the respective instrument. This is complicated and expensive. Consequently, numerous coupling and decoupling procedures of the components of the medical instruments must be made during an operation. The components coupled to an endoscope are mainly cameras, which are connected to a processor unit and a monitor with cables. The problem of contamination of the sterile instruments arises due to the non-sterile components, such as cameras or the like.
The object of the present invention is therefore to provide an improved apparatus of the above-mentioned type, where the position detection of the respective instrument is carried out precisely and with little effort and where the coupling and decoupling between parts of the medical instruments and the CAS system are carried out in simple, rapid and reliable manner under sterile conditions.
SUMMARY OF THE INVENTION
According to the present invention, the apparatus is configured as an adapter comprising a reception coupling on a first side, with which it can simply be coupled to a predetermined connecting location on the medical instrument in releasable, but mechanically fixed manner.
It is no longer necessary to provide a transmitter unit on each instrument, but only necessary to couple the adapter to the instrument to be detected, which can be accomplished by a simple procedure. The adapter need only be placed upon the corresponding connecting location present on the instrument and coupled thereto, which can be performed in a clip-on manner. The adapter can be coupled to the most different types of instrument, where these only require the corresponding connecting locations for the adapter. Various instruments can now be coupled to an adapter during an operation or decoupled therefrom, which is very simple, does not require great concentration and is also very fast. Should the position of the distal end be detected, then the only necessary information when changing the instrument is how far the tip is removed from the adapter, which can be determined by the CAS system itself through corresponding input data and memory data in the processor unit or through corresponding instrument specifications.
The provision of this adapter now opens the possibility of separating at a defined location sterile portions of the medical instrument system, for example an endoscope, from non-sterile portions, for example a camera with connecting cables to monitors in the operating room. One only needs to adjust the adapter with its transmitter unit to the detection system of the CAS system, and then any properly configured instruments can be coupled to the adapter.
This considerably increases the flexibility in such operations and at the same time simplifies the operation of the CAS system with the corresponding array of instruments.
In a preferred embodiment of the invention, the adapter comprises at least one further reception coupling, with which it can be coupled to a further medical instrument. The feature has the advantage that the adapter including the transmitter unit can be employed at a favorable, intermediate position within the instrument system. Favorable means that the position is favorable for detection of the transmitter location of the transmitter unit and/or a favorable ergonomic arrangement without disturbing the operator.
In a further embodiment of the invention, the adapter is configured such that on a first side, it can be coupled to a proximal end of an instrument whose position is to be detected through the transmitter unit. The feature has the advantage that the adapter is coupled at an easily accessible location, where the instrument is not disturbed in its handling capabilities. To exchange the instrument, the connection is simply released and another
Irion Klaus M.
Rebholz Clemens
Karl Storz GmbH & Co. KG
Mulcahy John
St. Onge Steward Johnston & Reens LLC
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