U.S. patent application number 10/662198 was filed with the patent office on 2004-04-15 for surgical microscopic system.
This patent application is currently assigned to OLYMPUS OPTICAL CO., LTD.. Invention is credited to Fukaya, Takashi, Kinukawa, Masahiko, Mizoguchi, Masakazu, Nakanishi, Kazuhito, Ohno, Wataru, Shimomura, Koji, Shinmura, Toru, Shioda, Keiji, Takayama, Masaki, Ueda, Masaaki, Yasunaga, Koji.
Application Number | 20040070822 10/662198 |
Document ID | / |
Family ID | 29716381 |
Filed Date | 2004-04-15 |
United States Patent
Application |
20040070822 |
Kind Code |
A1 |
Shioda, Keiji ; et
al. |
April 15, 2004 |
Surgical microscopic system
Abstract
Provided is a surgical observational system capable of
effectively displaying, in the field of an operating microscope, a
real-time image obtained by means of an ultrasonic probe, for
example, and a slice image obtained by a preoperative diagnosis on
the location of the distal end portion of the probe or a
three-dimensional image of an affected region, in association with
an actual observational image obtained by means of the microscope.
The surgical operation observational system is provided with two
monitors in the operating microscope for the observation of the
affected region to be operated. Images on the two monitors are
alternatively superposed on the optical path of the operating
microscope.
Inventors: |
Shioda, Keiji;
(Hachioji-shi, JP) ; Shimomura, Koji;
(Hachioji-shi, JP) ; Nakanishi, Kazuhito;
(Hachioji-shi, JP) ; Mizoguchi, Masakazu;
(Tsukui-gun, JP) ; Ueda, Masaaki; (Sagamihara-shi,
JP) ; Kinukawa, Masahiko; (Sagamihara-shi, JP)
; Ohno, Wataru; (Hachioji-shi, JP) ; Shinmura,
Toru; (Hachioji-shi, JP) ; Yasunaga, Koji;
(Hino-shi, JP) ; Fukaya, Takashi; (Tama-shi,
JP) ; Takayama, Masaki; (Hachioji-shi, JP) |
Correspondence
Address: |
FRISHAUF, HOLTZ, GOODMAN & CHICK, PC
767 THIRD AVENUE
25TH FLOOR
NEW YORK
NY
10017-2023
US
|
Assignee: |
OLYMPUS OPTICAL CO., LTD.
Tokyo
JP
|
Family ID: |
29716381 |
Appl. No.: |
10/662198 |
Filed: |
September 11, 2003 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10662198 |
Sep 11, 2003 |
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09663676 |
Sep 18, 2000 |
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6661571 |
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Current U.S.
Class: |
359/372 |
Current CPC
Class: |
A61B 34/70 20160201;
A61B 90/361 20160201; G02B 21/0012 20130101; A61B 90/36 20160201;
A61B 2090/378 20160201; A61B 90/50 20160201; A61B 2090/365
20160201; A61B 34/20 20160201; A61B 1/04 20130101; A61B 2034/2055
20160201; A61B 50/13 20160201; A61B 34/25 20160201; A61B 90/25
20160201; A61B 90/20 20160201; A61B 1/0005 20130101; A61B 2090/3784
20160201 |
Class at
Publication: |
359/372 |
International
Class: |
G02B 021/18 |
Foreign Application Data
Date |
Code |
Application Number |
Sep 21, 1999 |
JP |
11-266687 |
Oct 8, 1999 |
JP |
11-288328 |
Oct 20, 1999 |
JP |
11-298250 |
Nov 2, 1999 |
JP |
11-312443 |
Dec 13, 1999 |
JP |
11-353212 |
Dec 14, 1999 |
JP |
11-354414 |
Claims
What is claimed is:
1. An observation apparatus comprising: an optical microscope for
observing an optical image of an object in a field of view of the
optical microscope, the optical microscope including a first
optical system for forming the optical image of the object; a first
display capable of displaying a first image which is different from
the optical image; a second optical system for optically
transmitting the first image to display the first image in the
field of view of the optical microscope; a second display capable
of displaying a second image which is different from the optical
image and the first image, and a third optical system for optically
transmitting the second image to display the second image in the
field of view of the optical microscope.
2. The observation apparatus according to claim 1, wherein the
second optical system is configured to superpose the first image on
a part of the optical image.
3. The observation apparatus according to claim 2, wherein the
third optical system is configured to superpose the second image on
a part of the optical image.
4. The observation apparatus according to claim 1, wherein the
second optical system forms a projection optical system for
projecting the first image on a part of the optical image.
5. The observation apparatus according to claim 4, wherein the
third optical system forms a projection optical system for
projecting the second image on a part of the optical image.
6. The observation apparatus according to claim 1, further
comprising a computer electrically connected to the first display,
wherein the computer controls a size of the first image displayed
on the first display so as to change a size of the first image
displayed in the field of view in accordance with a magnification
of the optical image observed by the optical microscope.
7. The observation apparatus according to claim 1, wherein the
first image is an image obtained by one selected from the group
consisting of an endoscope, a rigid scope and an ultrasonic
diagnostic apparatus.
8. The observation apparatus according to claim 1, wherein: the
first image is an image of the object obtained by means of an
observation unit selected from the group consisting of an endoscope
and an ultrasonic probe; and the first image and the second image
include one of (i) a combination of the first image obtained by
means of the observation unit and an image indicative of an
observation position or direction of the observation unit and (ii)
a combination of a preoperative/mid-operative diagnostic image
selected from the group consisting of image-processed fluorescent
observational images obtained by means of the observation unit and
the image,indicative of the observational position or direction of
the observation unit and a tumor position display marker image.
9. The observation apparatus according to claim 1, wherein the
second image is a marker image.
10. An operating microscope apparatus comprising: an observational
optical system for forming an optical image of an object including
an affected region; observational means capable of observing the
optical image in a field of view of the observational optical
system; first display means for observably displaying a first image
different from the optical image in the field of view of the
observational means; and second display means for observably
displaying a second image different from the optical image and
first image in the field of view of the observational means.
11. The operating microscope apparatus according to claim 10,
wherein the first display means includes a display which displays
the first image and an image projection optical system which
projects the first image into the field of view.
12. The operating microscope apparatus according to claim 11,
wherein the image projection optical system projects a part of the
optical image and the first image.
13. The operating microscope apparatus according to claim 10,
wherein the second display means includes an image superposition
optical system which superposes an image on a part of the optical
image.
14. The operating microscope apparatus according to claim 10,
further comprising switching means which independently switches
display/non-display of the first and second images of the
object.
15. The operating microscope apparatus according to claim 10,
wherein: the first image is an image of the object obtained by
means of object observing means selected from the group consisting
of an endoscope and an ultrasonic probe; and the first and second
images include one of (i) a combination of the first image obtained
by means of the object observing means and an image indicative of
an observational position or direction of the object observing
means and (ii) a combination of a preoperative/mid-operative
diagnostic image selected from the group consisting of
image-processed fluorescent observational images and the image
indicative of the observational position or direction of the object
observing means and a tumor position display marker image.
16. A surgical observational system comprising: an observational
optical system for forming an optical image of an object including
an affected region; first observational means for observing the
optical image; a memory which stores a preoperative diagnostic
image of the object including the affected region; second
observational means which obtains an image showing a desired area
of the object, the desired area found in the optical image, the
second observational means being different from the first
observational means in at least one of observational direction and
observational method; detecting means which detects the relative
position of the first and second observational means in three
dimensions; first display means which displays the image showing
the desired area of the object obtained by the second observational
means on the optical image observed by the first observational
means in accordance, with the relative position of the first and
second observational means in three dimensions; and second display
means which reads out the preoperative diagnostic image including
the desired area from the memory and displays the preoperative
diagnostic image on the optical image observed by the first
observational means in accordance with the relative position of the
first and second observational means in three dimensions.
17. The surgical observational system according to claim 16,
wherein the second observational means is one selected from the
group consisting of an endoscope, rigid scope and ultrasonic
diagnostic apparatus.
18. A surgical observational system comprising: a first
observational apparatus including a first optical system which
forms an optical image of an object; a second observational
apparatus different from the first observational apparatus in at
least one of observational direction and observational method, the
second observational apparatus obtaining an image showing a desired
area of the object, the desired area found in the optical image; a
first display capable of displaying the image showing the desired
area of the object obtained by the second observational apparatus;
a second optical system optically coupled to the first optical
system, the image showing the desired area of the object displayed
on the first display entering into the second optical system, being
superposed on the optical image and observed by the first
observational apparatus; a memory which stores a preoperative
diagnostic image of the object; a second display capable of
displaying the preoperative diagnostic image; a third optical
system optically coupled to the first optical system, the image of
the preoperative diagnostic image displayed on the second display
entering into the third optical system, being superposed on the
optical image and observed by the first observational apparatus; a
detector capable of detecting the relative position of the first
and second observational apparatuses in three dimensions; and a
computer electrically connected to the first display, second
display and detector, the computer controlling the display position
of the image showing the desired area on the first display such
that the image showing the desired area obtained by the second
observational apparatus is superposed on the desired area of the
optical image observed by the first observational apparatus in
accordance with the result of the detection by the detector, and
the computer reading out the preoperative diagnostic image
including the desired area from the memory in accordance with the
result of the detection and displaying it on the second
display.
19. The surgical observational system according to claim 18,
wherein the second observational apparatus is one selected from the
group consisting of an endoscope, rigid scope and ultrasonic
diagnostic apparatus.
20. The surgical observational system according to claim 19,
wherein the computer is further capable of setting the size of the
image showing the desired area, the image showing the desired area
superposed on the desired area of the optical image and displayed
on the first display in accordance with a magnification of the
optical image observed by the first observational apparatus.
Description
[0001] This application is a division of application Ser. No.
09/663,676 filed on Sep. 18, 2000.
CROSS-REFERENCE TO RELATED APPLICATION
[0002] This application is based upon and claims the benefit of
priority from the prior Japanese Patent Applications No. 11-266687,
filed Sep. 21, 1999; No. 11-288328,filed Oct. 8, 1999; No.
11-298250, filed Oct. 20, 1999; No. 11-312443, filed Nov. 2, 1999;
No. 11-353212, filed Dec. 13, 1999; and No. 11-354414, filed Dec.
14, 1999, the entire contents of which are incorporated herein by
reference.
BACKGROUND OF THE INVENTION
[0003] The present invention relates to a surgical microscopic
system adapted for microsurgery carried out under microscopic
observation for neurosurgery, for example.
[0004] In order to ensure higher accuracy for a neurosurgical
operation that uses an operating microscope, for example, treatment
based on an endoscope, ultrasonic diagnostic apparatus, or any
other diagnostic technique without the use of visible light is
expected to be carried out for the tissues of regions that are not
accessible to the operating microscope, such as the back or inside
of an affected region, accompanied by real-time observation and
diagnosis. Various surgical microscopic systems have been developed
to meet this requirement.
[0005] Described in Jpn. Pat. Appln. KOKAI Publications Nos.
62-166310, 3-105305, 7-261094 are surgical observational systems in
which an endoscope or the like is used to observe regions that
correspond to dead angles of an operating microscope, and optical
images of the observational regions are projected in the field of
the microscope.
[0006] According to these conventional surgical observational
systems, however, an observational image obtained by means of the
endoscope or the like is only projected on the microscopic field,
so that it is difficult for an operator to identify the endoscopic
image that is actually observed through the field of the
microscope. In the case where this technique is applied to a
diagnostic apparatus, such as an ultrasonic diagnostic apparatus,
which uses no visible light, the operator can hardly grasp an
actually diagnosed part of a patient's body according to an image
in the observational field only. Thus, the operator can
discriminate the diagnosed region by the image only if s/he ideally
superposes the characteristic features of the diagnostic image and
the actual observational image, based on his or her experience.
[0007] Described in Jpn. Pat. Appln. KOKAI Publication No. 9-56669,
moreover, is a surgical microscopic system with improved
operativity, in which an endoscopic image or the like is displayed
as a sub-picture in some other part of the microscopic field than
the field portion where a main observational image is displayed. If
the operator uses the system in combination with an endoscope or
ultrasonic observer in this case, however, s/he is not provided
with any means for grasping the region that is observed actually.
Therefore, the operator can grasp the observational region only by
randomly swinging the endoscope or ultrasonic probe in all
directions and ideally superposing the characteristic features in
comparison with a microscopic image.
[0008] Further, a method for guiding second observational means,
such as an ultrasonic probe, into the field of an operating
microscope is described in Jpn. Pat. Appln. KOKAI Publication No.
6-209953. According to this conventional technique, however, there
is provided no method for effectively displaying the observational
image of the second observational means in the microscopic field,
so that the operator can correlate the microscopic optical image
and the image of the second observational means only ideally.
[0009] Proposed in Jpn. Pat. Appln. No. 11-132688 filed by the
assignee of the present invention ( , 1999, not published),
furthermore, is a surgical microscopic system in which the
direction of the observational field of an endoscope is indicated
by an arrow or the like displayed in the field of a microscope.
However, the microscopic optical image and the endoscopic image
cannot be satisfactorily correlated by only indicating the
observational direction in this manner. Thus, the operator can
correlate these images only ideally in consideration of differences
in rotation, magnification, etc. between them. If an ultrasonic
observer is used as auxiliary observational means, moreover, the
observational direction is not fixed, covering the circumferential
angle of 360.degree., for example, so that it is hard to align
observational image and an actual affected region.
[0010] Described in Jpn. Pat. Appln. KOKAI Publication No.
6-205793, moreover, is a display system that displays a
preoperative diagnostic image by superposition on an image of an
affected region by means of a half-mirror. Since the preoperative
diagnostic image is superposed on the whole affected region image
in this case, however, the microscopic field is too obscure to
ensure a satisfactory actual surgical operation. Therefore, this
system can only determine a preoperative position for craniotomy,
and cannot accurately grasp information on the inner tissue in
association with the affected region on a real-time basis during
the surgical operation.
[0011] Described in Jpn. Pat. Appln. KOKAI Publication No. 9-24052,
furthermore, is a method that uses fluorescent observation for the
recognition of the position of a cerebral tumor, in order to
extract the tumor securely under surgical microscopic observation.
Although the observational tumor position can be securely
recognized by this method, however, the obtained information is
related only to the exposed surface of the tumor on the plane of
observation at that time (during the extraction). Accordingly,
information on the entire tumor (including information on
inaccessible depths) inevitably depends on preoperative
information.
[0012] Further, a navigation apparatus is proposed in Jpn. Pat.
Appln. No. 10-248672 (filed , 1998, not published). This navigation
apparatus forms three-dimensional image data on the basis of image
information from a CT scanner or MRI that is operated for a
preoperative diagnosis, establishes a spatial correlation between a
patient's head and the observational position of a microscope
during a surgical operation, and supports the surgical operation in
accordance with the three-dimensional image data. According to this
navigation apparatus, the image of the entire tumor is obtained as
slice image information for the observational point concerned
during the surgical operation. However, only the slice image
information for a focal position can be obtained on a
three-dimensional observational plane of the operating microscope.
Therefore, the operator must identify the position of the tumor by
the slice image information with the progress of the operation.
[0013] With the recent development and spread of microsurgery, a
technique for surgical operations for minute affected regions,
moreover, operating microscopes have started to be extensively used
for microsurgery in a wide variety of fields including
ophthalmology, neurosurgery, otolaryngology, etc. Naturally,
therefore, the operating microscopes are being improved to meet
various requirements that depend on operators' surgical maneuvers.
Recently, surgical operations have been changed into less invasive
ones in consideration of earlier rehabilitation of operated
patients, so that there is a demand for the way of observation of
affected regions in finer tubules. For improved accuracy and safety
of surgical operations in the depths of the body cavity,
furthermore, hidden regions that are inaccessible to microscopic
observation are expected to made observable.
[0014] As a technique to meet these requirements, a stereoscopic
operating microscope described in Jpn. Pat. Appln. KOKAI
Publication No. 62-166310, for example, is designed so that the
inside of a tubule can be observed by means of first and second
stereoscopic optical systems with different base line intervals.
Since the two stereoscopic optical systems shares a finder optical
system, moreover, an operator can alternatively observe images from
the two optical systems. This stereoscopic operating microscope is
provided with the stereoscopic optical system that includes the
finder optical system and a pair of variable-magnification optical
systems, left and right, having the same optical axis. An auxiliary
stereoscopic optical system that is located near the main
stereoscopic optical system includes image restoring means for
reproducing an image from a solid-state image-pickup device for
picking up an image of an observed object and image projecting
means for guiding the image to the finder optical system of the
stereoscopic optical system.
[0015] An optical device described in Jpn. Pat. Appln. KOKAI
Publications No. 3-105305 is designed so that one or both of images
from two observational means of a stereoscopic operating microscope
can be alternatively observed and that the operator can select the
images by means of a footswitch or the like without using his or
her hand.
[0016] A system described in Jpn. Pat. Appln. KOKAI Publication No.
6-175033, moreover, is provided with position specifying means for
specifying a position in or near the observational field. In this
system, the relation between a reference position of an operating
microscope and the position specified by means of the position
specifying means is computed, and the body of the microscope is
moved to the specified position.
[0017] Described in Jpn. Pat. Appln. No. 10-319190 filed by the
assignee of the present invention ( , 1998, not published),
furthermore, is a system provided with drive means that causes an
operating microscope and a robot manipulator to move to target
positions in accordance with a preoperative diagnostic image or
slice image information, thereby correlating the preoperative image
and the operative field.
[0018] If the operator uses an auxiliary optical system for tubule
observation to observe dead-angle regions that are inaccessible to
microscopic observation, e.g., the back side of the an aneurysm,
nerves cleared of a tumor, peripheral tissues, etc., as in the
prior art case mentioned before, a video image picked up by means
of an endoscope or other auxiliary optical system is displayed in
the microscopic field. In this case, the operator's mate sometimes
may observe a similar image as s/he aspirates the marrow or blood
to secure the operator's field of vision.
[0019] FIG. 74 shows an example of the system of an operating
microscope a of this type. A body b of the microscope a is provided
with an operator eyepiece unit c1 and a mate eyepiece unit c2. An
in-field monitor (not shown) is located in a part of the field of
each of the eyepiece units c1 and c2. As shown in FIGS. 75A and
75B, indexes and sub-images e1 and e2 that are different from main
images d1 and d2 of the operating microscope a are projected in the
main images d1 and d2.
[0020] An LCD driver f is connected to each in-field monitor.
Further, a CCTV unit q is connected to the LCD driver f. A camera
head i is connected to the CCTV unit g. An endoscopic image
observed by means of an endoscope h is displayed on the respective
in-field monitors of the operator and mate eyepiece units c1 and
c2.
[0021] When a conventional operating microscope apparatus is used,
moreover, an operative field j as an object of a surgical operation
is observed at different angles by means of the microscope body b
and the endoscope h. An optical video image then caught by the
endoscope h is photoelectrically converted by means of a
image-pickup device (not shown) in the TV camera head i and applied
as an electrical signal to the TV camera head i to be processed
therein, whereupon a TV signal is outputted. This TV signal is
converted into a display mode signal of a liquid crystal display
device (not shown) by means of the LCD driver f. This signal is
delivered to liquid crystal image display devices (not shown) of
the respective in-field monitors of the operator and mate eyepiece
units c1 and c2 of the microscope a. Thereupon, endoscopic images
are partially displayed as the sub-images e1 and e2 on the main
images d1 and d2 of the microscope a in the microscopic field, as
shown in FIGS. 75A and 75B. More specifically, in the operator
eyepiece unit c1 of this operating microscope apparatus, the
sub-image e1, an endoscopic image, is inserted into the main image
d1 in the field of the microscope a by means of the liquid crystal
image display device (not shown), as shown in FIG. 75A. Likewise,
in the mate eyepiece unit c2, the sub-image e2, an endoscopic
image, is inserted into the main image d2 in the field of the
microscope a by means of the liquid crystal image display device
(not shown), as shown in FIG. 75B.
[0022] According to this operating microscope apparatus, however,
the operator and the mate have their respective observational
directions. Therefore, the relation between the display position of
the main image d1 in the field of the operator eyepiece unit c1 of
the microscope a and the display position of the sub-image e1 in
the same field is different from the relation between the display
position of the main image d2 in the field of the mate eyepiece
unit c2 of the microscope a and the display position of the
sub-image e2 in the same field. Since the field direction of the
mate is different from that of the operator, the position in the
mate-side observational optical system where the in-field display
image appears is inevitably different from the corresponding
position in the operator-side observational optical system.
Possibly, therefore, a region that can be observed through the
operator-side optical system may not be able to be observed through
the mate-side optical system.
[0023] Basically, moreover, the field direction on the mate side is
different from the operator-side field direction. Although the
microscope images are located in correct relative positions,
therefore, the positional relation between the images obtained by
means of the auxiliary optical system cannot be displayed
correctly. Since the mate-side observational optical system is
rotatable with respect to the operator-side system, furthermore,
the positional relation between the images of the auxiliary optical
system goes wrong if the mate-side system is rotated. If bleeding
or the like occurs in any region corresponding to a dead angle of
the image of the auxiliary optical system in the mate-side field,
therefore, the display position of the auxiliary optical system
must be controlled manually.
[0024] In carrying out a surgical operation with reference to a
diagnostic image, furthermore, a preoperative diagnostic image,
such as MRI or X-ray CT, sometimes may be display as each of the
sub-images e1 and e2 on the video images in the main images d1 and
d2 in the field of the microscope a. In this case, these
sub-images, unlike the aforesaid video image of the auxiliary
optical system, should never fail to be erect images, and the
images that are accessible to the operator and the mate,
individually, must be of the same type.
[0025] In the case where the operating microscope apparatus is used
in combination with a position information detector or the like,
moreover, a position information detection image and a marker for
the detector must be overlaid on a microscopic image. A
conventional microscopic apparatus with in-field display means
requires use of one combination of an optical system and a display
device for the display of an image in the microscopic field and
another for the display of a marker. If the image and the marker
are needed simultaneously, therefore, the display device must be
changed during use or one of the devices must be replaced with an
alternative device.
[0026] Conventionally, furthermore, the operator is expected to
confirm the marker display of the position information detector and
manually move the microscope body to the marker position.
Accordingly, highly complicated maneuvers are required by a
technique that uses the position information detector in
combination with an auxiliary optical system such as an
endoscope.
[0027] In order to make a microsurgical operation less invasive,
moreover, various pieces of image information are used during the
operation. The image information may be obtained by means of an
endoscope for observing regions that are inaccessible to the
operating microscope or an ultrasonic observer for obtaining a
slice image of the inside of tissue. Further, it may be obtained by
means of a diagnostic device such as a so-called nerve monitor
device for measuring the potential of nerves of a patient under the
operation. To attain this, an operating microscope for the
observation of an endoscopic image or the like is described in Jpn.
Pat. Appln. KOKAI Publication No. 10-333047, as in Jpn. Pat. Appln.
KOKAI Publication No. 62-166310.
[0028] A microscope requires visibility adjustment or adjustment of
differences in eyesight (refractive force) between observers. A
technique for this visibility adjustment is described in Jpn. Pat.
Appln. KOKAI Publication No. 7-281103. An operating microscope is
also subjected to the visibility adjustment with every surgical
operation. On the other hand, a method for measuring the refractive
force of an eye is described in Jpn. Pat. Appln. KOKAI Publication
No. 3-200914. In this method, however, the refractive force of an
eye of a patient, not an observer, is measured by projecting an
index on the eyeground and detecting light reflected by the
eyeground.
[0029] The operating microscope described in Jpn. Pat. Appln. KOKAI
Publication No. 10-333047 can perform microscopic observation and
endoscopic observation in one and the same field. When an endoscope
is moved in an affected region, however, its distal end must be
checked for the location on a microscopic image lest it damage
tissue as an endoscopic image is observed. It is to be desired,
therefore, that the endoscopic image should not intercept the
microscopic field or should be displayed small on the microscopic
image.
[0030] When the endoscopic image is watched as a treatment or the
like is carried out, on the other hand, it is expected to be wide
enough. Observation based on the microscopic image is also needed
to check an instrument for insertion or watch a wide range of the
affected region. Thus, it is advisable to display the endoscopic
image large on the microscopic image.
[0031] In each of the operating microscopes described in Jpn. Pat.
Appln. KOKAI Publications Nos. 62-166310 and 10-333047, however,
the endoscopic image is displayed in a fixed position and within a
fixed range in the microscopic field. Therefore, a surgical
operation using the endoscope cannot easily meet the demand for
both the movement of the endoscope and the treatment with reference
to the endoscopic image, and the endoscopic image may be
obstructive or too small for smooth treatment.
[0032] Thus, it is hard for an operator to concentrate his or her
attention on the surgical operation, so that the operator's fatigue
increases, and the operation time extends. An ultrasonic diagnostic
apparatus is subject to the same problems when its probe is moved
or when ultrasonic observation or treatment under ultrasonic
observation is carried out. Since the endoscope used under surgical
microscopic observation is designed for the observation of regions
corresponding to dead angles of the microscope, moreover, it should
be of a squint type for observation in directions different from
the direction of its insertion. If the squint-type endoscope is
rotated around the direction of insertion, it ceases to be able to
identify the direction of view with respect to the microscopic
field. Accordingly, the operator must judge the observational
direction by a tissue form displayed in the endoscopic image. Thus,
it is hard for the operator to be devoted to the surgical
operation, so that the operator's fatigue increases, and the
operation time extends. Even when the operator is concentrating his
or her attention on the observational image of the operating
microscope, furthermore, s/he must also pay attention to the state
of some other equipment to detect a change in the nerve monitor
device, so that his or her fatigue is increased.
[0033] On the other hand, the conventional visibility adjustment
operation described in Jpn. Pat. Appln. KOKAI Publication No.
7-281103 is troublesome and lengthens the setup time before the
start of operation of the operating microscope. If the operator
changes during a surgical operation, moreover, the visibility must
be readjusted. Usually, it is difficult to adjust the visibility
with a drape for sterilization on the microscope. If the microscope
is used with wrong visibility, the surgical operation is performed
with the right or left eye of the operator out of focus, so that
the operator is fatigued much. Further, a TV camera or 35-mm camera
that is connected to the operating microscope may fail to be in
focus. In this case, the refractive index of the operator's eye may
be able to be measured automatically to correct the visibility by
the method described in Jpn. Pat. Appln. KOKAI Publication No.
3-200914. According to this method, however, an optical system must
be provided with an index projection optical system for detection
and its mating light receiving optical system, so that a
large-sized apparatus is required, constituting a hindrance to the
surgical operation. Even if projected light has a wavelength in an
invisible zone, its influence upon the observational performance of
the microscope cannot be removed thoroughly, so that the efficiency
of the surgical operation is lowered, and the operator is fatigued
inevitably.
[0034] A rigid scope may be used for the observation of regions
corresponding to dead angles of the operating microscope in
microsurgery. In this case, the observation of the dead-angle
regions requires use of a so-called squint-type rigid scope for
oblique observation at a fixed angle (e.g., 30.degree., 70.degree.
or 110.degree.) to the observational optical axis of its eyepiece.
In this rigid scope, a TV camera (image-pickup device) is connected
to the eyepiece to display its observational image on a monitor
screen. The rigid scope is also connected with a light guide, which
is connected to a light source unit to guide illumination light to
an affected region. In order to observe a region corresponding to a
dead angle of the operating microscope, the rigid scope of this
type is used in a very narrow space (normally about 300 mm) between
the body of the microscope and the observational region. To change
its squint angle, moreover, the rigid scope can be rotated
throughout the angular range of 360.degree. with respect to the
direction of its insertion during a surgical operation. Thus, the
operator can observe his or her desired position.
[0035] In a rigid scope described in Jpn. UM Appln. KOKAI
Publication No. 5-78201, a TV camera is connected optically to the
imaging point of its eyepiece. A light guide that constitutes an
illumination optical system in the rigid scope and a light guide
one end of which is connected to a light source unit are connected
optically to each other in a position near the eyepiece. Since the
TV camera itself projects in the direction of insertion of the
rigid scope, however, it may possibly interfere with the operating
microscope body, depending on the direction of insertion of the
scope into the body cavity, so that the operator's desired
observational position is restricted inevitably. Further, the light
guide that is connected to the light source unit projects
substantially at right angles to the direction of insertion into
the body cavity. If the operator rotates the rigid scope around the
direction of insertion to change the observational direction,
therefore, the light guide may get deep into the field of the
microscope depending on its direction, thereby hindering the
microscopic observation.
[0036] In a rigid scope described in U.S. Pat. No. 5,168,863,
moreover, cables of a TV camera that is connected to an eyepiece
are guided in a direction at about 45.degree. to its longitudinal
direction (direction of insertion into the body cavity). In this
case, the TV camera can somewhat be prevented from interfering with
the body of an operating microscope. Nevertheless, the TV camera
itself still causes interference, and the light guide extensively
intercepts the microscopic field as the rigid scope rotates.
[0037] In a rigid scope described in Jpn. UM Appln. KOKAI
Publication No. 56-176703, furthermore, a reflective member for
bending the observational optical axis is disposed on an
observational optical system therein so that the optical axis of an
eyepiece is inclined at a fixed angle to the longitudinal direction
of the scope (direction of insertion into the body cavity). Since
the a part of the eyepiece portion of this rigid scope is inclined
at the fixed angle to the direction of insertion of the scope, a TV
camera can avoid interfering with the body of an operating
microscope. Since the direction of projection of a light guide is
coincident with the direction of insertion into the body cavity,
however, the light guide and the microscope body inevitably
interfere with each other.
[0038] A rigid scope described in Jpn. Pat. Appln. KOKAI
Publication No. 11-155798, like the one described in Jpn. UM Appln.
KOKAI Publication No. 56-176703, is designed so that the
observational optical axis of an eyepiece is inclined at a fixed
angle to its longitudinal direction (direction of insertion into
the body cavity), and a light guide, which is connected to a light
source unit, is connectable near the eyepiece. In either of the
rigid scopes described in Jpn. UM Appln. KOKAI Publication No.
56-176703 and Jpn. Pat. Appln. KOKAI Publication No. 11-155798,
however, the eyepiece and the TV cam attached thereto project long
within a plane at about 90.degree. to the direction of insertion of
the rigid scope into the body cavity (i.e., region for the
operator's surgical operation), so that they inevitably intercept
the space for the surgical operation, thereby hindering the
operation. When the operator rotates the rigid scope around the
direction of insertion into the body cavity to change the
observational direction, in particular, the scope moves in an arc
of a circle having a radius that is equal to the sum of the
respective overall lengths of the eyepiece, TV camera, cables,
etc., thus constituting a great hindrance to the operation.
Depending on the observational direction, moreover, the TV camera
and the light guide may interfere with the operator's hand or body,
so that they may possibly lower the efficiency of the surgical
operation.
BRIEF SUMMARY OF THE INVENTION
[0039] The present invention has been contrived in consideration of
these circumstances.
[0040] An object of the present invention is to improve the
efficiency of a surgical operation by simultaneously displaying a
plurality of pieces of information required by an operator in the
field of a microscope during microsurgery so that the operator can
be fed with necessary information as required.
[0041] Another object of the invention is to display a real-time
observational image of second observational means effectively in
association with an observational image of first observational
means in the field of the first observational means in a microscope
body.
[0042] Still another object of the invention is to provide a
surgical microscopic system designed so that an operator can easily
grasp the progress of an surgical operation during the operation,
whereby the operation can be carried out more securely and
safely.
[0043] A further object of the invention is to provide a surgical
microscopic system designed so that necessary in-field information
can be appropriately offered to an operator or his or her mate, and
that a required microscopic field can be easily secured during a
surgical operation.
[0044] An additional object of the invention is to provide a
surgical microscopic system designed so that an operator can be
devoted to a surgical operation, his or her fatigue can be eased,
and the operation time can be shortened.
[0045] Furthermore, the invention is intended to improve a rigid
scope that can be inserted into the body cavity under surgical
microscopic observation, thereby enabling observation at a fixed
angle to the direction of insertion, to prevent the rigid scope and
a TV camera or light guides connected thereto from hindering the
microscopic observation or surgical treatment, and to enable an
operator to observe a desired position with ease.
[0046] In order to achieve the above objects, according to an
aspect of the invention, there is provided an operating microscope
apparatus comprising: at least one microscope body defining an
observational field for observing an affected region; first image
display means for displaying a first image in the observational
field; second image display means for displaying a second image in
the observational field; and image display control means for
displaying independent images on the first and second image display
means, individually.
[0047] The microscope body may include an optical image displayed
in the observational field. In this case, the operating microscope
apparatus may comprise second observational means different from an
operating microscope and selected from a group including an
endoscope and an ultrasonic probe. Further, the second image
display means may include an image superposition optical system for
superposing an image on the optical image in the observational
field. Preferably, the image display control means includes means
for independently switching on and off the first and second image
display means.
[0048] In the case where the operating microscope apparatus
comprises second observational means different from an operating
microscope and selected from a group including an endoscope and an
ultrasonic probe, the first and second images preferably include
(i) a combination of an observational image obtained by means of
the second observational means and an image (navigation image)
indicative of the observational position or direction of the second
observational means or (ii) a combination of a tumor position
display marker image and a preoperative/mid-operative diagnostic
image selected from a group including image-processed fluorescent
observational images and the image (navigation image) indicative of
the observational position or direction of the second observational
means.
[0049] According to another aspect of the invention, there is
provided a surgical observational system including first
observational means for observing an affected region and second
observational means different from the first observational means at
least in the observational direction or observational method. This
system comprises detecting means for detecting the respective
observational positions and directions of the first and second
observational means relative to the position of the affected
region; and display means for displaying an observational image of
the second observational means in a given part of an observational
image of the first observational means in visual correlation based
on the relative positions detected by means of the detecting means.
According to this surgical observational system, the image of the
second observational means is correlatively displayed in a part of
the observational image of the first observational means. Thus, the
respective observational positions of the first and second
observational means are detected on the basis of the affected
region by means of an optical position detector, for example. The
observational image of a corresponding portion of the second
observational means can be cut out into a given position of the
observational image of the first observational means to adjust the
image size for display.
[0050] Alternatively, the surgical observational system may
comprise detecting means for previously storing a preoperative
diagnostic image and detecting the observational position of the
second observational means relative to the preoperative diagnostic
image; and display means for simultaneously displaying the
preoperative diagnostic image concurrent with the observational
position of the second observational means and the observational
image of the second observational means in the field of the first
observational means in accordance with the relative positions
detected by means of the detecting means. In this case, the
observational position of the second observational means is
detected on the basis of the affected region by means of an optical
position detector, for example. The observational image of the
second observational means is displayed in the field of the
observational image of the first observational means, and at the
same time, a part of the preoperative diagnostic image
corresponding to the observational position of the second
observational means is displayed in the observational field of the
first observational means.
[0051] According to this surgical observational system, at least a
part of the observational image of the second observational means
is displayed in the observational field of the first observational
means for the observation of the affected region in a manner such
that its position, size, etc. are associated with those of the
observational field of the first observational means. Accordingly,
the states of dead angle portions and the inside of tissue that
cannot be observed by means of the first observational means can be
recognized easily and securely, so that the reliability and
efficiency of the surgical operation can be improved
considerably.
[0052] On the other hand, the surgical observational system may
comprise detecting means for detecting the respective observational
positions and directions of the first and second observational
means relative to the position of the affected region; an indicator
indicative of an optional position in the observational field of
the first observational means; and display means capable of
following the indicator and displaying an observational image for a
given range in the observational field of the first observational
means by superposition. According to this surgical observational
system, as in the case of the system described above, the image of
the second observational means can be correlatively displayed in a
part of the observational image of the first observational means.
An operator can operate the indicator to set an optional position
in the observational field of the first observational means. The
observational image of the second observational means is displayed
in a given range of the indicator after is cut out and subjected to
size adjustment. Thus, the affected region in the peripheral
portion and the observational image of the second observational
means can be correlated with ease, and treatment can be carried out
smoothly, so that the efficiency of the surgical operation can be
improved.
[0053] According to still another aspect of the invention, there is
provided an operating microscope apparatus for subjecting an
affected region to a surgical operation, comprising: a microscope
body including a stereoscopic optical system and used to observe a
desired region; position computing means for detecting the position
of the observational region observed through the stereoscopic
optical system and computing the positional relation between the
observational region and a diagnostic image of the affected region;
fluorescent shooting means for shooting fluorescent images of the
observational region, thereby obtaining fluorescent observational
images; and display means for displaying, by superposition, the
diagnostic image corresponding to the position of the observational
region detected. by means of the position computing means and the
fluorescent observational images obtained by means of the
fluorescent shooting means.
[0054] This operating microscope apparatus may comprise storage
means for storing the fluorescent observational images. In this
case, the display means displays the diagnostic image corresponding
to the observational position detected by means of the position
computing means and the fluorescent observational images stored in
the storage means, by superposition on the observational image of
the affected region. Further, the operating microscope apparatus
may comprise display mode setting means capable of setting an
optional display mode. In this case, the display means displays the
diagnostic image corresponding to the observational position
detected by means of the position computing means and the
fluorescent observational images stored in the storage means, by
superposition on the observational image of the affected region, in
accordance with the setup state of the display mode setting
means.
[0055] According to this operating microscope apparatus, the
fluorescent observational images shot by means of the fluorescent
shooting means and the diagnostic image selected according to the
observational position detected by means of the position computing
means are displayed by superposition, so that the operator can
accurately recognize the conditions of a tumor to be extracted.
Thus, the operator can carry out extraction more accurately and be
devoted to the extracting operation. Further, only the tumor
portion can be extracted securely, so that the object for minimally
invasive surgery can be achieved.
[0056] According to the present invention, moreover, there is
provided an operating microscope apparatus for subjecting an
affected region to a surgical operation, comprising: a microscope
body including a stereoscopic optical system and used to observe a
desired region; position computing means for detecting the position
of the observational region observed through the stereoscopic
optical system and computing the positional relation between the
observational region and a diagnostic image of the affected region;
fluorescent shooting means for stereoscopically shooting
fluorescent images of the observational region, thereby obtaining
fluorescent observational images; storage means for storing the
fluorescent observational images; image dividing means for dividing
the diagnostic image corresponding to the observational position
detected by means of the position computing means into two image
signals having a lateral parallax; and display means for displaying
the individual stored fluorescent observational images and the
laterally divided diagnostic images by superposition on the
observational image of the affected region.
[0057] Likewise, there is provided an operating microscope
apparatus for subjecting an affected region to a surgical
operation, comprising: a microscope body including a stereoscopic
optical system and used to observe a desired region; position
computing means for detecting the position of the observational
region observed through the stereoscopic optical system and
computing the positional relation between the observational region
and a diagnostic image of the affected region; fluorescent shooting
means for stereoscopically shooting fluorescent images of the
microscopic observational region, thereby obtaining fluorescent
observational images; storage means for storing the fluorescent
observational images; display mode setting means capable of setting
an optional display mode; image dividing means for dividing the
diagnostic image corresponding to the observational position
detected by means of the position computing means into two image
signals having a lateral parallax; superposing means for
superposing the individual stored fluorescent observational images
and the laterally divided diagnostic images on the observational
image of the affected region in accordance with the setup state of
the display mode setting means; and a lens tube portion having a
monitor portion for displaying the individual images.
[0058] The fluorescent shooting means may be designed for
stereoscopic shooting of the fluorescent images of the
observational region. In this case, the operating microscope
apparatus comprises image dividing means for dividing the
diagnostic image corresponding to the observational position
detected by means of the position computing means into two image
signals having a lateral parallax. The display means can display
the individual stored fluorescent observational images and the
laterally divided diagnostic images by superposition on the
observational image of the affected region.
[0059] Further, the operating microscope apparatus may comprise a
lens tube portion having a monitor portion for displaying the
individual images.
[0060] Furthermore, the display means may be designed to display,
by superposition, the slice image corresponding to the
observational position detected by means of the position computing
means and the fluorescent observational images obtained by means of
the fluorescent shooting means. This operating microscope apparatus
may comprise display mode setting means capable of setting an
optional display mode. In this case, the display means displays the
slice image corresponding to the observational position detected by
means of the position computing means and the fluorescent
observational images stored in the storage means, by superposition
on the observational image of the affected region, in accordance
with the setup state of the display mode setting means.
[0061] According to a further aspect of the invention, there is
provided an operating microscope apparatus including a plurality of
eyepiece units capable of relative movement and individually having
fields capable of displaying one and the same region as a main
image and in-field monitors provided individually for the eyepiece
units and each adapted to project an index and/or a sub-image
different from the main image on a part of the field, comprising:
input means for applying observation conditions to one of the
eyepiece units; and observational state changing means for changing
the observational state of the other eyepiece unit according to the
conditions. Thus, necessary in-field information can be
appropriately offered to the operator or his or her mate, and a
target microscopic field can be easily secured during a surgical
operation.
[0062] Preferably, the observational state changing means includes
detecting means for detecting the position of the one eyepiece unit
relative to the other eyepiece unit, an in-field display control
means for controlling the display position of the in-field monitor
of at least the one eyepiece unit to change the observational
region in accordance with the result of detection by the detecting
means, shielding means for selectively intercepting the optical
image of the eyepiece units, and image rotating means for rotating
the image of the in-field monitor in response to the output of the
position detecting means. In this case, an optimum image display
method can be provided even for a fixed-direction image, such as a
preoperative image, and overlay display of the index by means of a
position information detector and the operation of the detector can
be carried out with ease. Further, the display method can secure a
satisfactory degree of freedom for the operator and the mate.
[0063] The sub-image may be a diagnostic image. Preferably, in this
case, the operating microscope apparatus comprises index
manipulating means for changing the in-field index position on the
diagnostic image and a position information computing unit for
computing the three-dimensional position of an actual affected
region relative to the position of the index displayed by means of
the index manipulating means, and the position information
computing unit and the in-field display control means drive the
observational region of the operating microscope to the
three-dimensional position.
[0064] Preferably, the operating microscope apparatus further
comprises an image processing unit for image map conversion,
adapted synchronously to rotate the image of the in-field monitor
and the shielding means formed of the liquid crystal device in
response to the output of the relative position detecting
means.
[0065] According to an additional aspect of the invention, there is
provided an operating microscope comprising: a first observational
optical system for optically enlarging an affected region; a second
observational optical system for observing optional image
information from an external apparatus; and an eyepiece optical
system for simultaneously observing observational images of the
first and second observational optical systems, the second optical
system including display state changing means capable of changing
the display state of the image information from the external
apparatus in accordance with operation information from the
external apparatus. The first and second observational optical
systems are different from each other.
[0066] According to this operating microscope, if the operating
state of the external apparatus is changed when the observational
images of the first and second observational optical systems are
simultaneously displayed, the image observed by means of the second
observational means is automatically changed into a suitable state
for a surgical operation. A small endoscopic image is displayed
when an endoscope is moved in the affected region, for example. The
displayed endoscopic image is large enough when it is watched as
treatment or the like is carried out. Thus, according to this
operating microscope, the display state of the display image in the
microscopic field can be automatically changed in accordance with
the operating state of the external apparatus, so that the operator
can be devoted to the surgical operation, his or her fatigue can be
eased, and the operation time can be shortened. This microscope is
particularly serviceable if it is used with an ultrasonic observer
for obtaining a slice image of the inside of tissue or a so-called
nerve monitor device for measuring the potential of nerves of a
patient under the operation, as well as the endoscope for observing
regions that are inaccessible to the operating microscope.
[0067] Further, there is provided an operating microscope
comprising: a first observational optical system for enlarged-scale
optical observation of an affected region; a second observational
optical system for observing optional image information from an
external apparatus, the second observational optical system being
different from the first observational optical system, and an
eyepiece optical system for simultaneously observing observational
images of the first and second observational optical systems. The
second optical system includes fixed-view image display means for
an observer's close observation, an index projection optical system
for the eyeground, and an image receiving optical system for
receiving reflected light from the eyeground. The operating
microscope further comprises detecting means for computing
refractive force in accordance with information from the image
receiving optical system and visibility adjustment drive control
means for driving a visibility adjustment mechanism in accordance
with information from the detecting means. According to this
operating microscope, the sight or refractive force of an observing
eye is measured through the second observational optical system.
Based on this refractive force, the visibility adjustment drive
control means automatically carries out visibility adjustment.
Thus, the operating microscope can be reduced in size without
lowering its observational performance, and the operator can
concentrate his or her attention on the operation without
fatigue.
[0068] The display state changing means may include operation input
portion for inputting the operation information from the external
apparatus, optical changing means capable of optically changing the
display state of the image information of the second observational
optical system compared to the observational image of the first
observational optical system, and control means for actuating the
optical changing means in accordance with input information from
the operation input portion. Preferably, the optical changing means
includes magnification changing means capable of changing the
magnification of the second observational optical system. According
to this operating microscope, the size of each endoscopic image in
the microscopic field can be changed in accordance with the
movement and observational state of the endoscope. Thus, when the
endoscope is moved, a small endoscopic image is displayed such that
the distal end of the endoscope can be satisfactorily observed
through the microscope. During endoscopic observation, on the other
hand, a large image is displayed to facilitate treatment. If a
squint-type endoscope for observation in directions different from
the direction of insertion is used and rotated around the direction
of insertion to observe regions corresponding to dead angles of the
microscope, therefore, the observational direction of the endoscope
compared to the microscopic field can be identified with ease.
[0069] Preferably, the optical changing means includes
magnification changing means capable of changing the magnification
of the second observational optical system or display position
changing means capable of changing the position of the second
observational optical system relative to the first observational
optical system. The magnification changing means may be lens moving
means for moving a variable-magnification optical system
constituting the second observational optical system. Thus, there
is provided an operating microscope in which the observational
direction of an endoscope compared to the microscopic image can be
recognized with ease.
[0070] The display position changing means may include rotating
means for rotating the second observational means around the
optical axis of the first observational means. Even when the
operator is concentrating his or her attention on the observational
image of the operating microscope, in this case, s/he can readily
notice a change in the nerve monitor device. Thus, the operator can
be devoted to the surgical operation, and his or her fatigue can be
eased.
[0071] Additional objects and advantages of the invention will be
set forth in the description which follows, and in part will be
obvious from the description, or may be learned by practice of the
invention. The objects and advantages of the invention may be
realized and obtained by means of the instrumentalities and
combinations particularly pointed out hereinafter.
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING
[0072] The accompanying drawings, which are incorporated in and
constitute a part of the specification, illustrate presently
preferred embodiments of the invention, and together with the
general description given above and the detailed description of the
preferred embodiments given below, serve to explain the principles
of the invention.
[0073] FIG. 1 is a view showing an outline of an operating
microscope for use as first observational means of a surgical
observational system according to a first embodiment;
[0074] FIG. 2 is a block diagram of the surgical observational
system according to the first embodiment;
[0075] FIG. 3 is a detailed view for illustrating a microscope body
portion of the operating microscope;
[0076] FIGS. 4A and 4B are views showing a state in which the whole
surface of a first liquid crystal shutter is transmittable and a
state in which a partial shading portion is provided in the
shutter, respectively;
[0077] FIGS. 5A and 5B are views showing a state in which the whole
surface of a second liquid crystal shutter is interceptive and a
state in which a partial transparent portion is provided in the
shutter, respectively;
[0078] FIGS. 6A and 6B are views individually showing images
observed by an operator, in which FIG. 6A shows only an optical
image obtained when the whole surface of the first liquid crystal
shutter is transmittable, and FIG. 6B shows a state in which an
image obtained by means of an ultrasonic probe is displayed in a
microscopic field;
[0079] FIG. 7A is a view showing an image obtained by means of the
ultrasonic probe and displayed on a monitor;
[0080] FIG. 7B is a view showing a state in which the image
obtained by means of the ultrasonic probe is reduced to a given
size;
[0081] FIG. 8 is a block diagram of a surgical observational system
according to a second embodiment;
[0082] FIG. 9 is a detailed view for illustrating a microscope body
portion of an operating microscope;
[0083] FIGS. 10A to 10C are views individually showing various
states of an image in the microscopic field observed by the
operator, in which FIG. 10A shows an ultrasonic image obtained by
means of the ultrasonic probe, FIG. 10B shows a preoperative
diagnostic image, and FIG. 10C shows the preoperative diagnostic
image and the ultrasonic diagnostic image in association with an
actual affected region;
[0084] FIGS. 11A and 11B are views individually showing
observational images according to the second embodiment, in which
FIG. 11A shows the ultrasonic probe having its central portion
extracted by means of a mixer, and FIG. 11B shows an image actually
observed by the operator;
[0085] FIG. 12 is a general block diagram of a surgical
observational system according to a third embodiment;
[0086] FIG. 13 is a view showing the way an observational image of
a rigid scope for use as second observational means according to
the third embodiment is displayed on a monitor;
[0087] FIGS. 14A to 14F illustrate the respective operations of
first and second liquid crystal shutters according to the third
embodiment, in which FIGS. 14A and 14B are views showing the
relation between a shading portion and a transparent portion, FIG.
14C is a view showing a state of display on a monitor, and FIGS.
14D to 14F are views similar to FIGS. 14A to 14C, showing the
shading portion and the transparent portion shifted in
position;
[0088] FIGS. 15A to 15D show images observed by the operator
according to the third embodiment and illustrate various positional
relations between the image obtained by means of the rigid scope
and an optical image obtained by means of the microscope;
[0089] FIG. 16 is a view showing a configuration of an operating
microscope according to a fourth embodiment of the invention;
[0090] FIG. 17 is a view showing a configuration of an illumination
system of the operating microscope;
[0091] FIG. 18 is a view showing a configuration of an
observational optical system of the operating microscope;
[0092] FIG. 19 is a general functional block diagram of the
operating microscope;
[0093] FIG. 20 is a chart for illustrating the operation of the
invention;
[0094] FIG. 21 is a view for illustrating the way of synthesizing a
fluorescent observational image and a two-dimensional preoperative
slice image;
[0095] FIG. 22 is a view showing a configuration of an
observational optical system according to a fifth embodiment of the
invention;
[0096] FIG. 23 is a general functional block diagram of an
operating microscope;
[0097] FIG. 24 is a general functional block diagram of an
operating microscope according to a sixth embodiment of the
invention;
[0098] FIG. 25 is a three-dimensional exterior view of a tumor;
[0099] FIG. 26 is a view for illustrating the effect of the sixth
embodiment of the invention;
[0100] FIG. 27 is a side view showing the general external
appearance of an operating microscope apparatus according to a
seventh embodiment of the invention;
[0101] FIG. 28 is a side view showing a configuration of a
microscope body of the operating microscope apparatus according to
the seventh embodiment;
[0102] FIG. 29 is a schematic view of an optical system of the
operating microscope apparatus according to the seventh
embodiment;
[0103] FIG. 30 is a block diagram of an electric circuit of the
operating microscope apparatus according to the seventh
embodiment;
[0104] FIG. 31A is a plan view showing a state in which a mask
portion is inserted in a microscopic image of an operator-side
optical system of the operating microscope apparatus according to
the seventh embodiment;
[0105] FIG. 31B is a plan view showing plan view showing a state in
which an endoscopic image is partially displayed on an in-field
image;
[0106] FIGS. 31C and 31D are plan views showing images obtained by
rotating the images of FIGS. 31A and 31B, respectively;
[0107] FIGS. 32A and 32B show in-field images in a state such that
endoscopic images are inserted individually in operator- and
mate-side microscopic images of the operating microscope apparatus
according to the seventh embodiment;
[0108] FIGS. 33A and 33B are plan views showing operatorand
mate-use microscopic images, respectively, in the operating
microscope apparatus according to the seventh embodiment;
[0109] FIGS. 34A and 34B are plan views showing a mask image and a
in-field display image, respectively, obtained when an index is
overlaid on each microscopic image in the operating microscope
apparatus according to the seventh embodiment;
[0110] FIGS. 35A and 35B are plan views showing indexes superposed
individually on the operator- and mate-use microscopic images,
respectively, in the operating microscope apparatus according to
the seventh embodiment;
[0111] FIG. 36 is a schematic view of a mate-side optical system of
an operating microscope apparatus according to an eighth embodiment
of the invention;
[0112] FIG. 37 is a plan view showing an outline of a drive
mechanism for a microscopic image mask LCD of the operating
microscope apparatus according to the eighth embodiment;
[0113] FIG. 38A is a plan view showing an outline of a drive
mechanism for a microscopic image mask LCD of an operating
microscope apparatus according to a ninth embodiment of the
invention;
[0114] FIG. 38B is a plan view showing an outline of a drive
mechanism for a microscopic image mask LCD of an operating
microscope apparatus according to a tenth embodiment of the
invention;
[0115] FIG. 39 is a general schematic view of an operating
microscope apparatus according to an eleventh embodiment of the
invention;
[0116] FIG. 40A is a plan view showing a microscopic image in an
operating microscope apparatus according to the eleventh
embodiment;
[0117] FIG. 40B is a perspective view showing an index/in-field
display controller;
[0118] FIG. 41A is a plan view showing a state in which a
microscopic image mask as large as an in-field display image is
displayed on a microscopic image mask LCD of the operating
microscope apparatus according to the eleventh embodiment;
[0119] FIG. 41B is a plan view showing a state in which an index
and a marker are displayed on the in-field display image;
[0120] FIG. 42A is a plan view showing a microscopic image in the
operating microscope apparatus according to the eleventh
embodiment;
[0121] FIG. 42B is a plan view showing a state in which an index
and a marker are displayed on the microscopic image by
superposition;
[0122] FIG. 43 is a view schematically showing an outline of an
operating microscope and an endoscopic apparatus according to a
twelfth embodiment;
[0123] FIG. 44 is a schematic view showing an endoscopic system
along with a scope holder for supporting an endoscope shown in FIG.
43;
[0124] FIG. 45 is a view showing an outline of a binocular tube of
the operating microscope of FIG. 43;
[0125] FIG. 46 is a view showing an observational state of the
operating microscope for the case where an endoscopic image is
mainly observed as a surgical operation is carried out;
[0126] FIG. 47 is a view similar to FIG. 46, showing an
observational state of the operating microscope for the case where
the observational position of the endoscope is moved;
[0127] FIG. 48 is a view similar to FIG. 43, schematically showing
an outline of an operating microscope and an endoscopic system
according to a thirteenth embodiment;
[0128] FIG. 49 is a view showing an outline of a binocular tube of
the operating microscope of FIG. 48;
[0129] FIGS. 50A and 50B are views individually showing states of
observation through an eyepiece optical system of the binocular
tube shown in FIG. 49;
[0130] FIG. 51 is a view illustrating a binocular tube optical
system of an operating microscope according to a fourteenth
embodiment;
[0131] FIG. 52 is a view showing an outline of a in-field display
controller of an operating microscope according to a fifteenth
embodiment;
[0132] FIGS. 53A and 53B are views individually showing display
states in the field of an operating microscope according to a
sixteenth embodiment;
[0133] FIG. 54 is a general view of a surgical system using a rigid
scope in combination with an operating microscope according to a
seventeenth embodiment;
[0134] FIG. 55 is a detailed sectional view showing the
construction of the rigid scope shown in FIG. 54;
[0135] FIG. 56 is a general view of a surgical system using a rigid
scope in combination with an operating microscope according to an
eighteenth embodiment;
[0136] FIG. 57 is a detailed sectional view showing the
construction of the rigid scope shown in FIG. 56;
[0137] FIG. 58 is a view showing the configuration of the upper
surface portion of a coupling portion of the rigid scope shown in
FIG. 54;
[0138] FIG. 59 is a general view of a surgical system using a rigid
scope in combination with an operating microscope according to a
ninth embodiment;
[0139] FIG. 60 is a detailed sectional view showing the
construction of the rigid scope shown in FIG. 59;
[0140] FIG. 61 is a view taken in the direction of arrow X of FIG.
60;
[0141] FIG. 62 is a perspective view of an endoscopic surgical
system according to a twentieth embodiment of the invention;
[0142] FIG. 63 is a sectional view of an instrument constituting
the endoscopic surgical system of FIG. 62;
[0143] FIG. 64 is a conceptual diagram for illustrating wire-type
transmission means of the instrument;
[0144] FIG. 65 is a perspective view showing a first operation mode
of the endoscopic surgical system of FIG. 62;
[0145] FIG. 66 is a perspective view showing a second operation
mode of the endoscopic surgical system of FIG. 62;
[0146] FIG. 67 is a perspective view showing a modification of the
endoscopic surgical system of FIG. 62;
[0147] FIG. 68 is a perspective view of an endoscopic surgical
system according to a twenty-first embodiment of the invention;
[0148] FIG. 69 is a sectional view of an instrument connecting
member of the endoscopic surgical system of FIG. 68;
[0149] FIG. 70 is a block diagram of an electric control system for
the endoscopic surgical system of FIG. 68;
[0150] FIG. 71 is a perspective view of an endoscopic surgical
system according to a twenty-second embodiment of the
invention;
[0151] FIGS. 72 and 73 are views showing a prior art endoscopic
surgical system;
[0152] FIG. 74 is a schematic view showing a configuration of the
principal part of a conventional operating microscope apparatus;
and
[0153] FIGS. 75A and 75B are plan views individually showing
in-field images displayed in operator and mate eyepiece units,
respectively, of an operating microscope of the conventional
operating microscope apparatus.
DETAILED DESCRIPTION OF THE INVENTION
FIRST EMBODIMENT
[0154] A first embodiment of the present invention will now be
described in detail with reference to the accompanying
drawings.
[0155] FIG. 1 shows an outline of an operating microscope for use
as first observational means of a surgical observational system
according to the present embodiment. FIG. 2 is a block diagram
according to the present embodiment, and FIG. 3 shows a microscope
body portion of the operating microscope in detail. Further, FIGS.
4A, 4B, 5A and 5B show the respective operations of first and
second liquid crystal shutters, and FIGS. 6A and 6B individually
show images observed by an operator. FIGS. 7A and 7B show an
example of a display image on monitors 40 and 14.
[0156] The surgical observational system according to the first
embodiment will be described first.
[0157] The operating microscope of the surgical observational
system according to the present embodiment is provided with a stand
21, which includes a base 21a movable on a floor surface and a
support post 21b set up on the base 21a. One end of a first arm 22,
which has a light source for illumination (not shown) therein, is
mounted on the upper end portion of the post 21b so as to be
rotatable around an axis Oa.
[0158] One end of a second arm 23 is attached to the other end of
the first arm 22, which is distant from the support post 21b, so as
to be rotatable around an axis Ob. The second arm 23 is a
pantograph arm that is formed of a link mechanism and a balancing
gas spring. The other end of the arm 23 that is off the first arm
22 can be moved vertically. A third arm 24 is attached to the other
end of the second arm 23 so as to be rotatable around an axis Oc.
Further, the third arm 24 is provided with a swing arm 25 that
enables a microscope body 1 to swing in the anteroposterior
direction along the direction of the operator's observation around
an axis Od and swing in the lateral direction of the operator's
body around an axis Oe. The microscope body 1, an observational
portion 2, and a handle 26 are mounted on the distal end portion of
the arm 25.
[0159] In order to allow the microscope body 1 to be freely
positioned in a three-dimensional space, moreover, each of the
individual rocking portions that are rotatable around the axes Oa
to Oe is provided with a electromagnetic brake. Each rocking
portion can be locked and unlocked by means of a switch (not shown)
that is provided on the handle 26. Preferably, a power source unit
for the electromagnetic brakes should be incorporated in the
support post 21b.
[0160] As shown in FIG. 2, the microscope body 1 is situated over
an affected region P which is a portion or an area to be operated,
and an index 3 for optical position detection is attached to a
predetermined face of the microscope body 1. The index 3 is fitted
with a plurality of infrared LED's of the time-sharing emission
type, which will not be described in detail.
[0161] Although the microscope body 1 has therein two observational
optical systems for supplying luminous fluxes individually to the
two eyes of the operator, only one of them will be described for
simplicity.
[0162] As shown in FIG. 3, an observational optical system 10 is
composed of an objective lens 4, first imaging lens 6, lens 7,
second imaging lens 8, and eyepiece 9, which are arranged
successively from the side of the affected region P. A half-mirror
11 is interposed between the lenses 7 and 8 of the optical system
10. The half-mirror 11 is oriented so that it can reflect a
luminous flux from a direction perpendicular to the optical axis of
the observational optical system 10 toward the eyepiece 9. A
projection optical system 15 is composed of a lens 12, third
imaging lens 13, and monitor 14, which are arranged successively on
an optical axis that extends at right angles to the optical axis of
the optical system 10.
[0163] Further, a first liquid crystal shutter 16 is located on the
imaging point of the first imaging lens 6 of the observational
optical system 10, and a second liquid crystal shutter 17 on the
imaging point of the third imaging lens 13 of the projection
optical system 15.
[0164] As previously described with reference to FIG. 2, the
microscope body 1 is fitted with the index 3 for optical position
detection. An optical position detecting member 30 (hereinafter
referred to as digitizer 30) is provided in a required position in
an operating room where it can shoot the index 3.
[0165] The digitizer 30 includes a plurality of infrared cameras,
which are mounted at given spaces. The digitizer 30 is connected to
a position detector 31. The detector 31 is connected to a computing
unit 32, which is connected with a mixer 33 and a liquid crystal
driver 34. Further, the unit 32 is connected with input means 35
and a footswitch 36. The switch 36 is provided with an image on-off
switch (not shown).
[0166] As shown in FIG. 3, the liquid crystal driver 34 is
connected to the first and second liquid crystal shutters 16 and 17
in the microscope body 1. The mixer 33 is connected to the monitor
14 in the microscope body 1.
[0167] In FIG. 2, numeral 37 denotes an ultrasonic probe that is
inserted in the affected region P. The probe 37 is fitted with an
index 38 that resembles the one on the microscope body 1. The index
38 is also fitted with a plurality of infrared LED'S of the
time-sharing emission type, which will not be described in detail.
However, the time-sharing emission patterns of the infrared LED's
that are attached to the index 38 are different from those of the
ones attached to the index 3. The position detector 31 can detect
the respective positions of the patterns separately.
[0168] The ultrasonic probe 37 is connected to an ultrasonic
observer 39. A video output (not shown) from the observer 39 is
connected to the monitor 40 and the mixer 33.
[0169] Referring now to FIGS. 1 to 7B, there will be described the
operation of the surgical observational system according to the
first embodiment.
[0170] A luminous flux emitted from the light source (not shown) in
the first arm 22 is applied to the affected region P of a patient's
body through an optical fiber (not shown) and an illumination
optical system (not shown). As shown in FIG. 3, the luminous flux
reflected by the affected region P lands on the objective lens 4 of
the microscope body 1, is focused through the first imaging lens 6,
first liquid crystal shutter 16, lens 7, half-mirror 11, and second
imaging lens 8, and is subjected to enlarged-scale observation
through the eyepiece 9 by the operator. In this state, the whole
surface of the first liquid crystal shutter 16 is transmittable, as
shown in FIG. 4A. FIG. 6A shows the image that is observed by the
operator in this state. This process will be mentioned later.
[0171] On the other hand, the ultrasonic probe 37 to be inserted
into the affected region P may be formed of a conventional
ultrasonic probe that emits an ultrasound from a rotating portion
(not shown) on its distal end. The ultrasound reflected by the
affected region P is received by a sensor (not shown), and a signal
from the sensor is transmitted to the ultrasonic observer 39. The
observer 39 analyzes the signal from the ultrasonic probe 37 and
generates an image-processed video signal that is indicative of the
internal structure of the tissue in accordance with the attenuation
or phase of the ultrasound based on the rotational angle of the
rotating portion (not shown). Then, the video signal is delivered
to the monitor 40 to be displayed thereon. FIG. 7A shows the image
then displayed on the monitor 40. The same video signal that is
delivered to the monitor 40 is also delivered to the mixer 33.
[0172] Further, the index 3 that is attached to the microscope body
1 causes the infrared LED's (not shown) to glow in a given
time-sharing pattern. Likewise, the index 38 that is attached to
the ultrasonic probe 37 causes the infrared LED's (not shown) to
glow in a time-sharing pattern different from the pattern for the
index 3.
[0173] The respective states of light emission of the indexes 3 and
38 are-shot by means of the infrared cameras (not shown) of the
digitizer 30. The information obtained by means of the digitizer 30
is analyzed by means of the position detector 31, whereupon the
respective positions and attitudes of the microscope body 1 and the
ultrasonic probe 37 in the three-dimensional space are detected. A
conventional suitable technique can be used for this optical
position detection system.
[0174] Since the affected region P is also positioned in the
three-dimensional space, moreover, the position detector 31 can
detect the relative positions of the affected region P, microscope
body 1 (observational position of the operating microscope), and
ultrasonic probe 37 (plane for ultrasonic observation).
[0175] As shown in FIG. 2, the position information detected by
means of the position detector 31 is delivered to the computing
unit 32.
[0176] If the image on-off switch (not shown) of the footswitch 36
is then off, the computing unit 32 delivers an image-off signal to
the mixer 33 and the liquid crystal driver 34. The mixer 33 outputs
no image when it receives the image-off signal from the computing
unit 32. Therefore, no image is displayed on the monitor 14 that is
connected to the mixer 33. On receiving the image-off signal from
the computing unit 32, moreover, the liquid crystal driver 34
delivers given outputs to the first and second liquid crystal
shutters 16 and 17. Thereupon, the whole surface of the first
liquid crystal shutter 16 becomes transmittable, as shown in FIG.
4A. Further, the second liquid crystal shutter 17 is rendered
entirely interceptive, as shown in FIG. 5A. Thus, the operator can
obtain no image from the monitor 1, only observing the optical
image of the affected region P. FIG. 6A shows this state of
observation.
[0177] If the operator then turns on the image on-off switch of the
footswitch 36, an image-on signal is delivered to the computing
unit 32. In this state, the computing unit 32 computes the position
of the distal end of the ultrasonic probe 37 in the field of
observation of the operating microscope on the basis of the
detected information from the position detector 31. Further, the
respective positions of the monitor 14 and the first and second
liquid crystal shutters 16 and 17 corresponding to the distal end
position are computed.
[0178] Then, the computing unit 32 calculates a signal from the
input means 35 and settles the size of an image in the microscopic
field. The operator can freely change the image size by operating
the input means 35.
[0179] Based on the result of the aforesaid computation and the
signal from the input means 35, the computing unit 32 delivers a
control signal to the mixer 33. The mixer 33 converts the output
image of the ultrasonic observer 39 into an image that has its
center in a position corresponding to the distal end position of
the ultrasonic probe 37 of the monitor 14, and further generates an
image signal of a reduced size set by means of the input means 35.
FIG. 7B shows this image signal.
[0180] Then, the computing unit 32 delivers a control signal to the
liquid crystal driver 34. The driver 34 generates, on the first and
second liquid crystal shutters 16 and 17, a shielding portion 41
(first liquid crystal shutter 16) and a transparent portion 42
(second liquid crystal shutter 17) that have positions and sizes
corresponding to the range of the reduced image that is generated
by means of the mixer 33. This state is shown in FIG. 4B (for the
first liquid crystal shutter 16) and FIG. 5B (for the second liquid
crystal shutter 17).
[0181] In this arrangement, only that portion of the optical
observational image from the objective lens 4 which corresponds to
the shielding portion 41 is intercepted by means of the first
liquid crystal shutter 16, and only the reduced image portion of
the monitor 14 is transmitted to the side of the half-mirror 11
through the transparent portion 42 of the second liquid crystal
shutter 17.
[0182] Thus, the operator can observe superposed ultrasonic images
on the monitor 14 in a predetermined range centering around the
distal end of the ultrasonic probe 37, among other microscopic
images. If the operator moves the probe 37 within the microscopic
field, the ultrasonic images also move correspondingly in the
field. FIG. 6B shows this state of observation.
[0183] If the operator operates again the image on-off switch (not
shown) of the footswitch 36, the ultrasonic images disappear in a
moment, and the state of observation shown in FIG. 6A is
restored.
[0184] Thus, the surgical observational system according to the
first embodiment can produce the following effects.
[0185] According to the first embodiment, the operator can observe
the optical observational image and ultrasonic diagnostic images in
a superposed manner, and the optical observational image is
superposed only partially. Therefore, the diagnostic images and the
affected region can be easily correlated, and transfer to each
treatment can be effected smoothly. Since the images follow the
ultrasonic probe, moreover, the operator can observe a desired
region without delay. In consequence, the operation time can be
shortened, and the operator's fatigue can be eased.
SECOND EMBODIMENT
[0186] A second embodiment of the present invention will now be
described with reference to FIGS. 8 to 10C. In these drawings, like
reference numerals refer to the same portions of the first
embodiment, and a description of those portions is omitted.
[0187] FIG. 8 is a block diagram according to the present
embodiment, FIG. 9 shows the body of the operating microscope in
detail, and FIGS. 10A to 10C individually show varied states of
images the operator observes.
[0188] A surgical observational system according to the second
embodiment will be described first.
[0189] In the second embodiment, as shown in FIG. 9, a
variable-scale optical system 50 is interposed between an objective
lens 4 and a first imaging lens 6 of a microscope body 1. A lens
drive section (not shown) of the optical system 50 is provided with
a sensor (not shown), which is connected to magnification detecting
means 56. As shown in FIG. 8, the detecting means 56 is connected
to a computing unit 55.
[0190] A changeover switch (not shown) of a footswitch 57, which is
connected to the computing unit 55, is connected to a position
detector 54. As in the case of the first embodiment, the output of
a digitizer 30 is connected to the position detector 54. The
position detector 54 includes an image forming section (not shown),
the image output of which is connected to a monitor 53 in the
microscope body 1. A fourth imaging lens 52 and a mirror 51 are
arranged successively on the emission side of the monitor 53. The
imaging position of the fourth imaging lens 52 is substantially
aligned with the reflective surface of the mirror 51 and the
imaging plane of a second imaging lens 8. Accordingly, the operator
can simultaneously observe, through an eyepiece 9, a microscopic
optical image formed by means of the first imaging lens 6 and an
image on the monitor 53 formed by means of the fourth imaging lens
52.
[0191] The following is a description of the operation of the
surgical observational system according to the second
embodiment.
[0192] As in the case of the first embodiment, the position
detector 54 can detect the respective positions of the point of
microscope observation and the distal end of an ultrasonic probe 37
relative to the affected region P. Further, the detector 54 stores
preoperative diagnostic images (e.g., slice images of an X-ray CT
apparatus; normally, slice images in a given direction and a
three-dimensional CG image constructed by joining the slice images)
in its storage section (not shown). In starting observation of the
ultrasonic images in the microscopic field, the operator turns on
an image on-off switch (not shown) of the footswitch 57. As this is
done, a signal from the sensor (not shown) of the variable-scale
optical system 50 is transmitted to the magnification detecting
means 56. The detecting means 56 calculates the observation
magnification of the microscope and delivers it to the computing
unit 55.
[0193] Based on data from the magnification detecting means 56, the
computing unit 55 sets the display size of an ultrasonic image to
be projected in the microscopic field. FIG. 10A shows the state of
the image the operator then observes.
[0194] If the operator operates the changeover switch (not shown)
of the footswitch 57 in this state, moreover, the position detector
54 reads a preoperative diagnostic slice image corresponding to the
position of the distal end portion of the ultrasonic probe 37 from
the storage section (not shown). Then, the detector 54 superposes a
marker on a region where the ultrasonic probe 37 is situated, and
delivers the resulting image to the monitor 53. As this is done,
the mirror 51 moves from an evacuation position (not shown) to an
observational position shown in FIG. 9, whereupon the operator can
observe the image on the monitor 53 along with a microscopic image
through the mirror 51.
[0195] When the operator depresses the changeover switch (not
shown) once, a preoperative diagnostic slice image, such as the one
shown in FIG. 10B, is displayed. In this state, the operator can
observe the actual affected region and the ultrasonic diagnostic
image in association with the preoperative diagnostic slice image
(with the display of the ultrasonic probe position).
[0196] If the operator depresses the changeover switch once again,
the position detector 54 reads the three-dimensional image of the
affected region P from the storage section (not shown), and carries
out rotation processing (image processing) of the three-dimensional
image so that the image is aligned with the direction of actual
insertion of the ultrasonic probe 37 into the affected region.
Then, the detector 54 superposes the marker on the region and along
the direction in which the probe 37 is situated, and delivers the
resulting image to the monitor 53. FIG. 10C shows the image the
operator then observes. In this state, the operator can observe the
actual affected region and the ultrasonic diagnostic image in
association with the three-dimensional preoperative diagnostic
image (with the display of the ultrasonic probe position and
direction).
[0197] If the operator depresses the changeover switch once again,
the mirror 51 moves to the aforesaid evacuation position (not
shown), whereupon the operator can observes the image shown in FIG.
10A.
[0198] The surgical observational system according to the second
embodiment can produce the following effects.
[0199] According to the second embodiment, which enjoys the same
effects of the first embodiment, the display size of the ultrasonic
image can be set automatically according to the observation
magnification of the operating microscope. Therefore, the operator
can be saved the trouble of setting the image size, so that the
efficiency of surgical operations can be improved. Further, the
operator can observe the preoperative diagnostic image
simultaneously with the optical observational image and ultrasonic
diagnostic image. Accordingly, the approximate position of the
whole patient's body in the position for ultrasonic observation can
be recognized with ease. Besides, the deviation between the actual
affected region and the preoperative diagnostic image, which is
attributable to change of the intracranial pressure after
craniotomy or exclusion of tissue, can be recognized easily. Thus,
accurate surgical operations can be carried out, and the results of
operations can be improved.
[0200] Although the ultrasonic diagnostic image is displayed
substantially in a circular form on the monitor 14 according to the
second embodiment, its shape may be changed in the following
manner.
[0201] In the case of an ultrasonic probe of the same radial-scan
type (in which the periphery of the probe is scanned in a circle)
as in the foregoing embodiment, as shown in FIG. 11A, the central
portion of the ultrasonic probe 37 may be extracted by means of the
mixer 33 as it is displayed. The range of extraction is restricted
to a radius that ranges from the distal end of the ultrasonic probe
to the inner wall of the tissue of the affected region that is
located closest to the probe. This range can be settled by
analyzing the ultrasonic image or by means of an optical position
detector. FIG. 11B shows an actual image then observed by the
operator.
[0202] According to this arrangement, a microscopic optical image
is displayed in a range without any object of diagnosis, extending
from the ultrasonic probe to the inner wall of the tissue of the
affected region, and the region to be diagnosed can be displayed
securely. Accordingly, the diagnosis can be carried out in the same
manner as in the second embodiment, and the distal end of the
ultrasonic probe never fails to be recognized on the optical
observational image. Thus, the operator can move the ultrasonic
probe without switching off the display of the ultrasonic image, so
that the efficiency of surgical operations can be improved.
THIRD EMBODIMENT
[0203] A third embodiment of the present invention will now be
described with reference to FIGS. 12 to 15D. In these drawings,
like reference numerals refer to the same portions of the first and
second embodiments, and a description of those portions is
omitted.
[0204] FIG. 12 is a general block diagram illustrating the present
embodiment, and FIG. 13 shows an observational image of a rigid
scope for use as second observational means according to the
present embodiment. FIGS. 14A to 14F illustrate the respective
operations of first and second liquid crystal shutters according to
the present embodiment, and FIGS. 15A to 15D show images observed
by the operator according to the present embodiment.
[0205] A surgical observational system according to the third
embodiment will be described first.
[0206] Numeral 1 denotes a body of an operating microscope that
resembles the one according to the first embodiment. The microscope
body 1, like the one according to the first embodiment, is fitted
with an index 3. As in the case of the second embodiment, a
variable-scale optical system (not shown) of the microscope body 1
is provided with a sensor (not shown), which is connected to
magnification detecting means 56. As in the cases of the first and
second embodiments, moreover, the microscope body 1 is provided
with first and second liquid crystal shutters (not shown), which
are connected to a liquid crystal driver 34. The microscope body 1
is provided with a monitor (not shown) that resembles the one
according to the first embodiment. The monitor is connected to a
mixer 33. Thus, the optical system in the microscope body 1 of the
present embodiment is constructed substantially in the same manner
as the one according to the first embodiment.
[0207] Numeral 90 denotes a 90.degree.-squint rigid scope for use
as second observational means according to the present embodiment.
The rigid scope 90 is connected with one end of a light guide 91,
the other end of which is connected to a light source 92. The rigid
scope 90 is fitted with a camera head 93 for picking up its
observational image. The camera head 93 is connected to a camera
control unit 94 (hereinafter referred to simply as CCU 94). A first
video output section (not shown) of the CCU 94 is connected to a
monitor 95. A second video output section (not shown) of the CCU 94
is connected to the mixer 33. Further, an index 96 for position
detection is attached to given position on the camera head 93.
[0208] A digitizer 30 is located in a position such that it can
shoot both the indexes 3 and 96 that are attached to the microscope
body 1 and the camera head 93, respectively. The digitizer 30 is
connected to a position detector 31. The detector 31 is connected
to a computing unit 97. Further, the magnification detecting means
56 and a footswitch 81 are connected to the computing unit 97.
[0209] Furthermore, the computing unit 97 is connected to the mixer
33 and the liquid crystal driver 34.
[0210] The following is a description of the operation of the third
embodiment.
[0211] As in the case of the first embodiment, the operator
subjects the affected region P to enlarged-scale stereoscopic
optical observation by using the microscope body 1. Further, the
operator uses the rigid scope 90 to observe outside portions as
viewed through the microscope body 1 for the optical observation.
More specifically, a luminous flux for observation emitted from the
light source 92 is landed on the light guide 91. The light guide 91
transmits the incident luminous flux to the rigid scope 90 that is
connected to the other end thereof. This luminous flux is applied
to the affected region P through an illumination optical system
(not shown) in the rigid scope 90. The luminous flux reflected by
the affected region P is landed on an objective lens (not shown) of
the rigid scope 90 and focused on an image-pickup device (not
shown) of the camera head 93 that is connected to the rear end of
the scope 90. The camera head 93 converts the luminous flux,
focused on the image-pickup device, into an electrical signal, and
delivers it to the CCU 94. The CCU 94 converts the electrical
signal into a standardized video signal, and delivers it through
its first and second video output sections (not shown).
[0212] Thus, the image shot by means of the rigid scope 90 is
displayed on the monitor 95 that is connected to the first video
output section of the CCU 94, as shown in FIG. 13. The same video
signal is delivered from the second video output section of the CCU
94 to the mixer 33 in like manner.
[0213] Infrared cameras (not shown) of the digitizer 30 are used to
shoot infrared LED's (not shown) of the indexes 3 and 96 that are
attached to the microscope body 1 and the camera head 93 of the
rigid scope 90, respectively. As in the case of the first
embodiment, the information obtained by means of the digitizer 30
is analyzed by means of the position detector 31, whereupon the
respective positions and attitudes of the microscope body 1 and the
rigid scope 90 in the three-dimensional space are detected. Since
the affected region P is also positioned in the three-dimensional
space, moreover, the position detector 31 can detect the position
of the affected region P relatively to the respective observational
positions and directions of the microscope body 1 and the rigid
scope 90.
[0214] The position information detected by means of the position
detector 31 is delivered to the computing unit 97.
[0215] FIG. 15A shows an image then observed by the operator. The
operator observes only an optical image that is obtained by means
of the body 1 of the operating microscope. In this state, the first
liquid crystal shutter (not shown) in the microscope body 1 is
fully transmittable, while the second liquid crystal shutter (not
shown) is entirely interceptive. An image then obtained by means of
the rigid scope 90 is displayed on the monitor 95.
[0216] In starting observation of the image obtained by means of
the rigid scope 90 in the microscopic field, the operator turns on
an image on-off switch (not shown) of the footswitch 81. The
resulting signal is transmitted to the computing unit 97. On
receiving an image-on signal from the footswitch 81, the computing
unit 97 first carries out computation to display the image in a
given position in the microscopic field (upper left portion of the
microscopic field according to the present embodiment) and delivers
command signals to the liquid crystal driver 34 and the mixer 33.
More specifically, a signal is delivered to the liquid crystal
driver 34 such that it controls the first and second liquid crystal
shutters for the states shown in FIGS. 14A and 14B, respectively.
Further, a signal is delivered to the mixer 33 such that the video
signal from the CCU 94 is reduced at a suitable scale factor
computed on the basis of a signal from the magnification detecting
means 56 and that the image is moved to a region corresponding to a
shielding portion of the second liquid crystal shutter and
displayed on the monitor (not shown) in the microscope body 1 in
the manner shown in FIG. 14C. FIG. 15B shows the state of the image
then observed by the operator. In this state, the operator roughly
positions the rigid scope 90 while comparing the distal end of the
rigid scope 90 and the affected region.
[0217] Then, in displaying the microscopic field and the field of
the rigid scope 90 in association with each other, the operator
turns on an image shift switch (not shown) of the footswitch 81.
The resulting signal is applied to the computing unit 97. On
receiving this signal, the computing unit 97 computes the position
of display of the image of the rigid scope 90 in the microscopic
field in accordance with position information from the position
detector 31 and magnification information on the microscope body 1
from the magnification detecting means 56. Thus, the range of the
microscopic field is calculated from the position and magnification
of the body 1 of the microscope, while the distal end position and
observational direction of the rigid scope 90 in the microscopic
field is calculated from the position information of the scope 90.
Based on the results of these calculations, the computing unit 97
delivers a command signal to display the image of the rigid scope
90 in a circular range that has its center on the
observational-direction side of the rigid scope 90 with its distal
end on a point on the diameter of the circle. More specifically,
the first and second liquid crystal shutters are set for the states
shown in FIGS. 14D and 14E, respectively, and the monitor (not
shown) in the microscope body 1 displays the image shown in FIG.
14F. Thus, the operator can obtain the field shown in FIG. 15B in
the microscopic field.
[0218] Since the rigid scope 90 is 90.degree.-squint, moreover, the
observational direction changes if it is rotated for 90.degree. in
its axial direction, for example. In this state also, the image of
the rigid scope 90 is displayed in a circular range that has its
center on the observational-direction side of the rigid scope 90
with its distal end on a point on the diameter of the circle, so
that the field shown in FIG. 15D can be obtained.
[0219] According to this third embodiment, the second observational
means, e.g., the rigid scope or an ultrasonic observation apparatus
of the front-scan type, can be effectively used in particular when
an object is observed in a given direction from the distal end of
the probe, and the observational image is displayed in the
observational direction of the probe. Accordingly, the
observational direction and position of the second observational
means can be grasped with ease, and besides, the optical image of
the actual affected region and the image obtained by means of the
second observational means are positioned in association with each
other as they are displayed. Thus, the state of the affected region
can be grasped quickly and accurately.
[0220] Although the second observational means has been described
as means for observing a narrower range than the operating
microscope or first observational means does, in connection with
the second and third embodiments, the present invention is not
limited to this arrangement. If an image of a wide range that
includes the affected region is obtained by means of an X-ray CT
apparatus or the like, for example, a part of the image may be cut
out and projected in the microscopic field in like manner provided
that the positional relations between the image, the actual
affected region, and the position of the body of the microscope can
be grasped. According to each of the foregoing embodiments, the
image is displayed following the distal end of each probe. In the
case of a wide-range image such as the aforesaid X-ray CT image,
however, a cursor may be displayed in the microscopic field so that
the operator can move it by means of the footswitch or the like,
thereby causing the cut image to follow the cursor. Thus, the
operator can observe only a desired portion of the X-ray CT image
to be referred to, in association with the affected region, so that
the effects of the present invention can be accomplished.
[0221] Although the operating microscope is used as the first
observational means and the image of the second observational means
is superposed on the microscopic optical image according to the
first to third embodiments, the present invention is not limited to
this arrangement. It is to be understood that quite the same
effects can be produced if the display image of the first
observational means is a TV monitor.
FOURTH EMBODIMENT
[0222] A fourth embodiment of the present invention will now be
described. The following is a description of a configuration of a
fluorescent image observation apparatus of an operating microscope
with position detecting means that can detect the position of an
affected region.
[0223] FIG. 16 shows a configuration of the operating microscope
with the position detecting means that can detect the affected
region position. This configuration will be briefly described
herein, since it is described in Jpn. Pat. Appln. No. 10-319190
filed by the assignee of the present invention. Numeral 101 denotes
the operating microscope, which comprises a microscope body 102
that constitutes an observational optical system through which an
operator 108 can observe an affected region of a patient 107. The
microscope body 102 is provided with an emissive index 103.
[0224] Numeral 104 denotes a digitizer 104, which includes two CCD
cameras 105a and 105b for use as receivers and a camera support
member 106 for supporting these cameras. The digitizer 104 serves
as optical position detecting means that uses the CCD cameras 105a
and 105b to detect the emissive index 103 of the microscope body
102, thereby detecting the observational position of the
microscope.
[0225] FIG. 17 shows a configuration of an illumination system of
the operating microscope 101, and FIG. 18 shows a configuration of
the observational optical system of the microscope 101. FIG. 17 is
a diagram as viewed from a position A of FIG. 18.
[0226] The illumination system shown in FIG. 17 comprises a light
source 109, condensing lens 110, illumination lens 112, and beam
splitter 113. The members 110, 112 and 113 serve to guide
illumination light emitted from the light source 109 to the
affected region P of the patient 107.
[0227] An illumination light switching filter 111 includes an
illumination light transmitting filter 111a for transmitting
illumination light for the affected region P, an excitation light
transmitting filter 111b for transmitting only excitation light
that is inductive to fluorescence, and a drive motor 111c for use
as a switching mechanism for changing these two filters. Thus, the
filter 111 serves as illumination light switching means for the
affected region P. Further, an objective lens 114, zoom optical
systems 115L and 115R, and beam splitters 116L and 116R are
provided for the observation of light reflected by the affected
region P.
[0228] The observational optical system shown in FIG. 18 comprises
the beam splitters 116L and 116R and eyepieces 117L and 117R, as
well as the zoom optical systems 115L and 115R. An image from the
affected region P is transmitted through the beam splitter 116L to
a lens 118L, a mirror 120L, and an image-pickup device 121L, which
constitute a shooting system.
[0229] An observational light switching filter 119L includes an
illumination light transmitting filter 119L1 for transmitting the
illumination light for the affected region P, a cutoff filter 119L2
for cutting off the excitation light and illumination light, and a
drive motor 119L3 for use as a switching mechanism for changing
these two filters. Thus, the filter 119L serves as observational
light switching means for the affected region P.
[0230] FIG. 19 is a general functional block diagram of the
operating microscope 101. In FIG. 19, the motors 111c and 119L3 are
connected to a filter drive controller 123, which can control these
motors simultaneously, in response to a signal from an input switch
(display mode setting means) 122 for fluorescent image observation.
The filter drive controller 123 serves to control the motors 111c
and 119L3 so that the illumination light transmitting filter 111a
of the illumination light switching filter 111 and the illumination
light transmitting filter 119L1 of the observational light
switching filter 119L are simultaneously situated on the optical
axis. The controller 123 also serves to control the motors 111c and
119L3 so that the excitation light transmitting filter 111b of the
illumination light switching filter 111 and the cutoff filter 119L2
of the observational light switching filter 119L are simultaneously
situated on the optical axis. Under this control, the operation
mode can be changed from a fixed-time fluorescent observation mode
to a normal (visible zone) observation mode by means of a timer
circuit (not shown).
[0231] Further, the image-pickup device 121L is connected to a
video signal processor 128. The device 121L is composed of a drive
processor circuit (not shown) and a video signal generator circuit
(not shown). A memory (storage means) 129, which can operate in
response to a signal from the input switch 122, is composed of an
image memory and a binary coder circuit (not shown) for
binary-coding a video signal delivered from the video signal
processor 128.
[0232] Furthermore, a workstation (hereinafter referred to as WS)
125 is connected with a microscope body controller 126, digitizer
124, monitor 127, and mixer 130. The controller 126 can detect and
transmit information data such as the magnification, focal length,
etc. of the operating microscope 101 that is provided with the
emissive index 103. The digitizer 124 can detect the position of
the affected region P by detecting the index 103. If the
magnification and focus information data are changed, they are
transmitted from the controller 126 to the WS 125. Thereupon, the
WS 125 selects a preoperative image corresponding to the operating
position in consideration of the transmitted data and position
information from the digitizer 124. The digitizer 124 and the WS
125 constitute position computing means.
[0233] The mixer 130, which is connected to the WS 125, video
signal processor 128, and memory 129, serves to superpose video
signals that are transmitted individually from the WS 125,
processor 128, and memory 129, and can display the superposed video
signals on a monitor 131 outside the microscope body. The mixer 130
and the monitor 131 constitute display means.
[0234] In the arrangement described above, the observational
position of the operating microscope is detected by detecting the
emissive index 103 on the microscope by means of the digitizer 124
and computing the positional relation between the microscope and
the detected index 103 by means of the WS 125. By doing this, the
correlation with a two-dimensional preoperative tomographic image
as a diagnostic image of the patient's body stored in the WS 125
can be obtained (the apparatus of this type is called a navigation
apparatus).
[0235] FIG. 20 is a flowchart for illustrating the operation of the
present invention. Since a method for simultaneously shooting the
image based on the illumination light and the fluorescent image is
described in detail in Jpn. Pat. Appln. KOKAI Publication No.
9-24052, only features of the present invention will be described
in the following.
[0236] If the input switch 122 for fluorescent image observation is
turned on (A1), the filter drive controller 123 controls the motors
111c and 119L3 (A2-1) to locate the excitation light transmitting
filter 111b of the illumination light switching filter 111 and the
cutoff filter 119L2 of the observational light switching filter
119L simultaneously on the optical axis.
[0237] Fluorescent shooting (A3-1) is carried out in this state.
Light transmitted through the excitation light transmitting filter
111b of the illumination light switching filter 111 is applied to
the affected region P, thereby inducing fluorescence. The
illumination light and the excitation light is cut off by means of
the cutoff filter 119L2 of the observational light switching filter
119L, and only the detected fluorescent image induced by the
affected region P is reflected by the mirror 120L and landed on the
image-pickup device 121L.
[0238] The detected fluorescent image incident upon the
image-pickup device 121L is converted into a video signal by means
of the video signal processor 128 and applied to the memory 129 and
the mixer 130. The video signal that is applied to the memory 129
is binary-coded (A4). Thereafter, it is applied to the mixer 130
and displayed as a fluorescent observational image on the monitor
131.
[0239] If the motors 111c and 119L3 are controlled by means of the
filter drive controller 123 so that the illumination light
transmitting filter 111a of the illumination light switching filter
111 and the illumination light transmitting filter 119L1 of the
observational light switching filter 119L are located
simultaneously on the optical axis, the illumination light is
applied to the affected region P, and an image of the affected
region is landed on the image-pickup device 121L. This illumination
light is processed by means of the video signal processor 128 and
applied to the mixer 130.
[0240] As this is done, a two-dimensional preoperative image that
matches the observational position information (A2-2) on the
affected region P obtained according to the emissive index 103,
which is detected by means of the digitizer 124, and the
magnification and focus information data on the operating
microscope 101, which are transmitted from the microscope body
controller 126 to the WS 125, is selected from ones that are
previously recorded in the WS 125 (A3-2) and applied to the mixer
130.
[0241] The mixer 130 synthesizes (superposes) the video image based
on the illumination light form the video signal processor 128, the
fluorescent image binary-coded by means of the memory 129, and the
preoperative image selected and inputted by means of the WS 125
(A5).
[0242] In these circumstances, the filter drive controller 123
selects the illumination light transmitting filter 111a and the
illumination light transmitting filter 119L1 on illumination and
shooting light paths, respectively. The image-pickup device 121L
shoots an image in a normal or visible zone. A tumor position
obtained by the aforesaid fluorescent observation and a tumor
position based on the two-dimensional preoperative tomographic
image selected by means of the WS 125 are superposed on the image
of the affected region presently obtained by the operator and are
displayed on the monitor 131.
[0243] FIG. 21 is a diagram for illustrating the way of
synthesizing the fluorescent observational image and the
two-dimensional preoperative tomographic image.
[0244] In an entire tumor image 142 as an affected region in an
entire head image 141 of FIG. 21, a plane image (fluorescent
observational image) 145a, based on a fluorescent image obtained
from a certain curved surface in a surgical treatment position
(exposed tumor portion 144), and a two-dimensional preoperative
tomographic image 145b, selected as a microscopic observational
position by the WS 125, can be synthesized and displayed on the
monitor 131.
[0245] If the operator then moves the focal center position from B
to C by focusing operation, the center of observation (center of
the depth of focus) can be detected by means of the digitizer 124
and the WS 125 so that a corresponding tomographic image can be
selected and synthesized with the aforesaid fluorescent
observational image. In terminating the fluorescent observation,
the operator is expected to turn off the input switch 122, thereby
switching off the superposed display.
[0246] The fourth embodiment described above enjoys the following
effects. Since an actual affected region has no flat surface,
display of only a tomographic image as a diagnostic image in the
microscopic observational position can hardly cover the state of
the affected region. With use of the arrangement of the present
embodiment, however, tomographic images based on the focusing
operation for the present treatment position are superposed on the
fluorescent observational image as they are displayed, so that the
progress of a surgical operation and the conditions of a tumor can
be recognized visually.
[0247] Further, the fluorescent observational image is superposed
on the two-dimensional preoperative tomographic image as it is
displayed. If the surgical operation is advanced according to the
preoperative tomographic image, therefore, the operator can
recognize supplementary correction of the position according to the
fluorescent observational image during the operation. Thus, the
correction is easy.
[0248] Since the mode for the superposed observation can be set by
the input switch operation, moreover, the superposed observation
can be selectively carried out as required. If only the external
shape of the tumor portion is expected to be emphasized in the
tomographic image from the WS, the operator can easily discriminate
it by making its display color different from that of the
fluorescent observational image.
FIFTH EMBODIMENT
[0249] FIGS. 22 and 23 show a configuration according to a fifth
embodiment. Since left- and right-hand observational images of an
affected region are processed in the same manner, the way of
processing the left-hand observational image will now be described
representatively.
[0250] As in the case of the fourth embodiment, illumination or
excitation light is applied to the affected region, and an image of
the affected region is obtained by means of an image-pickup device
121L. The device 121L is connected to a video signal processor 135L
for converting an image into a video signal. An output signal from
the processor 135L is applied to a left-hand memory 136L. The
memory 136L serves to binary-code the image, and its signal is
applied to a left-hand mixer 137L that can superpose a plurality of
video images. Output signals from the left-hand mixer 137L and a
right-hand mixer 137R are applied to a 3D converter 139 to be
converted into a three-dimensional video image thereby, whereupon
the video image can be displayed on a 3D monitor 140.
[0251] Further, output signals from the left-hand video signal
processor 135L and a right-hand video signal processor 135R are
applied to the 3D converter 139 to be converted into a
three-dimensional video image thereby, and the image can be
displayed on the 3D monitor 140.
[0252] The WS 125 can apply the three-dimensional video image to
bilateral screen dividing means 138, which can divide the
three-dimensional video image into images with a lateral parallax.
A left-hand video image is generated and applied to the left-hand
mixer 137L. The mixer 137L is connected to a left-hand monitor
134L. Further, a lens 133L and a beam splitter 132L are arranged in
order to guide the video image on the monitor 134L to the eyepiece
117L (see FIG. 22).
[0253] With the arrangement described above, fluorescence is
excited, and the resulting fluorescent image is delivered to left-
and right-hand image-pickup devices 121L and 121R, as in the case
of the fourth embodiment. Since video images applied to the
image-pickup devices 121L and 121R are processed in the same
manner, only the processing on the left-hand side will now be
described. The fluorescent image obtained by means of the
image-pickup device 121L is applied to the left-hand video signal
processor 135L to be converted into a video signal thereby, and
applied to the left-hand memory 136L and the 3D converter 139.
[0254] In order to divide stereoscopic image information, based on
the preoperative tomographic image information recorded in the WS
125, into images with a lateral parallax, moreover, the
preoperative tomographic image is applied to the bilateral screen
dividing means 138. In the left-hand mixer 137L, a left-hand image
produced by the dividing means 138 is superposed on the signal from
the left-hand memory 136L that binary-codes the signal from the
left-hand video signal processor 135L.
[0255] A synthetic image delivered from the left-hand mixer 137L is
applied to the 3D converter 139 and the left-hand monitor 134L. The
converter 139 can convert the video image from the left- and
right-hand mixers 137L and 137R into a three-dimensional image and
display the image on the 3D monitor 140.
[0256] The light applied to the left-hand monitor 134L is guided to
the eyepiece 117L via the lens 133L and the beam splitter 132L.
[0257] In this manner, the observational image of the affected
region P based on the illumination light, the fluorescent
observational image based on the application of the excitation
light to the affected region, and the three-dimensional image based
on the preoperative image can be simultaneously cast into the
operator's field of vision and displayed on the 3D monitor 140. In
this case, the present treated section information based on the
fluorescent observational image is superposed three-dimensionally
on a three-dimensional exterior view of a tumor (three-dimensional
tumor image 147), such as the one shown in FIG. 25, so that the
present progress of operation for the whole tumor can be
recognized. In FIG. 25, the outline is formed by a position
detecting function, and broken lines represent a stereoscopic
affected region image based on the fluorescent observational
image.
[0258] According to the fifth embodiment described above, the
optical observational images obtained by microscopic observation
are superposed, so that the present treatment position and progress
of the affected region P in the whole tumor can be grasped
three-dimensionally, and the direction of the treatment to be
advanced thereafter can be recognized accurately. Dislocation of
the preoperative tomographic image from the entire external shape
can be also recognized, and it can be minutely corrected by
stereoscopic observation. Thus, an environment can be provided for
high-safety surgical operations.
SIXTH EMBODIMENT
[0259] The following is a description of only differences of a
sixth embodiment of the present invention from the fifth
embodiment. FIG. 24 is a diagram showing a configuration of the
sixth embodiment. An image signal based on illumination light
incident upon a left-hand video signal processor 135L is applied to
a left-hand mixer 137L. In the sixth embodiment, the mixer 137L is
connected to a left-hand in-field display controller 148L. The
controller 148L is constructed in the same manner as an in-field
display controller that constitutes an in-field display device
(in-field display controller and lens tube portion) described with
reference to FIG. 1 in Jpn. Pat. Appln. No. 10-248672. According to
the sixth embodiment, the display according to the fifth embodiment
is indicated and observed as an image display separate from the
microscopic field.
[0260] In the arrangement described above, the image signal based
on the illumination light incident upon the left-hand video signal
processor 135L is applied to the left-hand mixer 137L. In the mixer
137L, a microscopic image based on the illumination light, a
fluorescent image based on excitation light, and a preoperative
image selected according to the outer peripheral surface of an
affected region are synthesized and applied to the left-hand
in-field display controller 148L. The video image applied to the
controller 148L is displayed as an in-field display image by means
of the in-field display device, and only an image based on the
illumination light is visible as the microscopic image.
[0261] The sixth embodiment described above has the following
effects as well as the effects of the fifth embodiments. In the
microscopic image based on the illumination light, as shown in FIG.
26, an exposed tumor portion 151 that cannot be recognized by the
operator can be identified by being compared with the superposed
in-field display image. Further, the three-dimensional shape of a
tumor and the position of an affected region in the whole tumor can
be grasped without screening a microscopic image 150 with the
preoperative image and the fluorescent observational image.
SEVENTH EMBODIMENT
[0262] A seventh embodiment of the present invention will now be
described with reference to FIGS. 27 to 35B. FIG. 27 shows the
general external appearance of an operating microscope 201 of an
operating microscope apparatus according to the present embodiment.
A stand 202 of the operating microscope 201 of the present
embodiment is provided with a base 203 movable on a floor surface
and a support post 204 set up on the base 203.
[0263] Further, the support post 204 is provided, on its top
portion, with a body 205 of the operating microscope 201, including
an optical system for observing an affected region, and a support
mechanism 206 for supporting the body 205 for movement in any
desired direction. The mechanism 206 is a combination of a
plurality of moving arms 207 for locating the microscope body 205
in a desired position.
[0264] As shown in FIG. 28, moreover, the body 205 of the operating
microscope 201 of the present embodiment is provided with an
operator eyepiece unit 208 and a mate eyepiece unit 209. The body
205 is also provided with a barre1 210 for rotatably holding the
mate eyepiece unit 209. The eyepiece unit 209 can be rotated with
respect to the operator eyepiece unit 208 by means of the barre1
210.
[0265] Located near the barre1 210, moreover, is a position
detecting encoder 211 that detects the rotational angle of the mate
eyepiece unit 209 with respect to the operator eyepiece unit 208
and outputs it as an electrical signal.
[0266] FIG. 29 is a schematic view of an optical system of the body
205 of the operating microscope 201, and FIG. 30 is a block diagram
of an electric circuit of the microscope 201. As shown in FIG. 29,
the optical system of the body 205 of the operating microscope 201
according to the present embodiment is provided with a beam
splitter 212 for dividing a microscopic image (incident light) into
two parts for an operator-side optical system La and a mate-side
optical system Lb. The light incident upon the beam splitter 212 is
divided into two light beams, transmitted and reflected. The
transmitted and reflected light beams, divided from the microscopic
image by means of the beam splitter 212, are landed on the
operator- and mate-side optical systems La and Lb,
respectively.
[0267] Further, the operator-side optical system La includes a main
image display optical system La1 for displaying a main microscopic
image and an in-field display optical system La2 for projecting an
index and a sub-image, which is different from the main image, on a
part of the microscopic field. The main image display optical
system La1 is provided with an objective lens 213a, LCD 214a for
microscopic image masking, total-reflection mirror 215a, imaging
lens 216a, prism 217a, and eyepiece 218a. The LCD 214a is located
on a first imaging point 213a1 of the objective lens 213a.
[0268] The in-field display optical system La2 is provided with an
LCD (in-field monitor) 219a for in-field display, imaging lens
220a, prism 217a, and eyepiece 218a. The prism 217a and the
eyepiece 218a are used in common in the main image display optical
system La1 and the in-field display optical system La2. The
microscopic image from the main image display optical system La1
and an in-field display image from the in-field display optical
system La2 are superposed and landed on the side of the eyepiece
218a by means of the prism 217a.
[0269] Likewise, the mate-side optical system Lb includes a main
image display optical system Lb1 for displaying a main microscopic
image and an in-field display optical system Lb2 for projecting an
index and a sub-image, which is different from the main image, on a
part of the microscopic field. The main image display optical
system Lb1 is provided with an objective lens 213b, LCD 214b for
microscopic image masking, total-reflection mirror 215b, imaging
lens 216b, prism 217b, and eyepiece 218b. The LCD 214b is located
on a first imaging point 213b1 of the objective lens 213b.
[0270] The in-field display optical system Lb2 is provided with an
LCD (in-field monitor) 219b for in-field display, imaging lens
220b, prism 217b, and eyepiece 218b. The prism 217b and the
eyepiece 218b are used in common in the main image display optical
system Lb1 and the in-field display optical system Lb2. The
microscopic image from the main image display optical system Lb1
and an in-field display image from the in-field display optical
system Lb2 are superposed and landed on the side of the eyepiece
218b by means of the prism 217b.
[0271] In the operating microscope 201 according to the present
embodiment, an endoscopic image from an endoscope 221 shown in FIG.
30 is displayed on the respective LCD's 219a and 219b for in-field
display of the operator- and mate-side optical systems La and Lb. A
TV camera head 222 is coupled to the endoscope 221. A CCTV unit 223
is connected to the camera head 222. The endoscopic image of the
endoscope 221 is picked up by means of the camera head 222, and the
resulting optical video image is photoelectrically converted by
means of an image-pickup device (not shown) in the camera head 222.
Thereafter, the image is applied as an electrical signal to the
CCTV unit 223 and processed, whereupon a TV signal is
outputted.
[0272] As shown in FIG. 30, moreover, an electric circuit block of
the operating microscope 201 according to the present embodiment is
provided with an operator-side processing system Ka and a mate-side
processing system Kb. The CCTV unit 223 is connected with an
in-field image generator circuit 224a of the operator-side
processing system Ka and an in-field image generator circuit 224b
of the mate-side processing system Kb.
[0273] The operator-side processing system Ka is provided with a
first LCD driver 225a for driving the LCD 214a for microscopic
image masking, a second LCD driver 226a for driving the LCD 219a
for in-field display, a display changing circuit 227a, the in-field
image generator circuit 224a, and a microscopic image masking
processor 228a. Further, the in-field image generator circuit 224a
and the microscopic image masking processor 228a are connected with
an in-field display controller (input means) 229 for inputting
observation conditions in which the size, position, etc. of images
to be displayed on the LCD's 219a and 219b for in-field display are
changed.
[0274] Furthermore, the in-field image generator circuit 224a and
the microscopic image masking processor 228a are connected to the
input side of the display changing circuit 227a. The first and
second LCD drivers 225a and 226a are connected to the output side
of the circuit 227a.
[0275] The output of the CCTV unit 223 is applied to the in-field
image generator circuit 224a of the operator-side processing system
Ka, the output of which is applied to the display changing circuit
227a. An output signal from the microscopic image masking processor
228a is also applied to the circuit 227a, the output of which is
applied to the LCD drivers 225a and 226a. Further, output signals
from the LCD drivers 225a and 226a are applied to the LCD 214a for
microscopic image masking and the LCD 219a for in-field display,
respectively.
[0276] The mate-side processing system Kb is provided with a third
LCD driver 225b for driving the LCD 214b for microscopic image
masking, a fourth LCD driver 226b for driving the LCD 219b for
in-field display, a display changing circuit 227b, the in-field
image generator circuit 224b, and a microscopic image masking
processor 228a. Further, the in-field image generator circuit 224b
and the microscopic image masking processor 228b are connected with
the in-field display controller 229.
[0277] In the mate-side processing system Kb according to the
present embodiment, moreover, a first rotation computing circuit
(observational state changing means) 230 is interposed between the
in-field image generator circuit 224b and the display changing
circuit 227b, while a second rotation computing circuit
(observational state changing means) 231 is interposed between the
microscopic image masking processor 228b and the display changing
circuit 227b.
[0278] The first and second rotation computing circuits 230 and 231
are connected to the input side of the display changing circuit
227b. Further, the third and fourth LCD drivers 225b and 226b are
connected to the output side of the circuit 227b.
[0279] On the side of the mate-side processing system Kb, the
output of the CCTV unit 223 is applied to the in-field image
generator circuit 224b of the mate-side processing system Kb, the
output of which is applied to the display changing circuit 227b via
the first rotation computing circuit 230. A signal from the
microscopic image masking processor 228b is also applied to the
display changing circuit 227b via the second rotation computing
circuit 231. The output of the circuit 227b is applied to the LCD
drivers 225b and 226b. Further, output signals from the drivers
225b and 226b are applied to the LCD 214b for microscopic image
masking and the LCD 219b for in-field display, respectively.
[0280] The position detecting encoder 211 is connected to the first
and second rotation computing circuits 230 and 231. An output
signal from the encoder 211 is applied to the circuits 230 and 231,
while the control output of the in-field display controller 229 is
applied to the in-field image generator circuits 224a and 224b and
the microscopic image masking processors 228a and 228b.
[0281] The following is a description of the function of the
operating microscope 201. In starting the operation of the
operating microscope 201 of the present embodiment, a microscopic
image of an affected region in an operative field j (see FIG. 74)
as an object of surgical operation is divided into two parts for
the operator- and mate-side optical systems La and Lb by means of
the beam splitter 212. The divided image for the operator-side
optical system La is focused on the first imaging point 213a1 of
the objective lens 213a, whereupon a microscopic image 232a for the
optical system La is formed, as shown in FIG. 31A. Further, the
image for the mate-side optical system Lb, divided by means of the
beam splitter 212, is focused on the first imaging point 213b1 of
the objective lens 213b, whereupon a microscopic image 232b for the
optical system Lb is formed, as shown in FIG. 31A.
[0282] In FIG. 30, the endoscopic image shot by means of the
endoscope 221 is picked up by means of the camera head 222. The
resulting optical video image is photoelectrically converted by
means of the image-pickup device (not shown) in the camera head
222. Thereafter, the image is applied as an electrical signal to
the CCTV unit 223 and processed, whereupon a TV signal is
outputted. The TV signal delivered from the CCTV unit 223 is
applied to the respective in-field image generator circuits 224a
and 224b of the operatorand mate-side processing system Ka and
Kb.
[0283] The output signal processed in the in-field image generator
circuit 224a of the operator-side processing system Ka is applied
to the display changing circuit 227a. As this is done, the output
signal from the microscopic image masking processor 228a is also
applied to the circuit 227a. Further, the output signal from the
circuit 227a is applied to the LCD drivers 225a and 226a. The
control signals from the LCD drivers 225a and 226a are applied to
the LCD 214a for microscopic image masking and the LCD 219a for
in-field display, respectively.
[0284] Since the LCD 214a for microscopic image masking is located
on the first imaging point 213a1 of the objective lens 213a, a mask
portion 233a for sub-image is inserted into a part of the
microscopic image 232a for the operator-side optical system La by
means of the LCD 214a, as shown in FIG. 31A. As this is done,
moreover, an endoscopic image 234a is partially displayed on a part
of the whole LCD screen of the LCD 219a for in-field display, and
the remaining part is left as a shielding portion 235a, as shown in
FIG. 31B.
[0285] The image of FIG. 31A that combines the microscopic image
232a and the mask portion 233a for sub-image inserted therein and
the image of FIG. 31B that combines the endoscopic image 234a and
the shielding portion 235a are superposed by means of the prism
217a. Thereupon, a composite image 238a is formed having an
endoscopic image (sub-image) 237a inserted in a microscopic image
(main image) 236a, as shown in FIG. 32A.
[0286] The same operation on the operator side is also carried out
on the mate side. More specifically, the output signal processed in
the in-field image generator circuit 224b of the mate-side
processing system Kb is applied to the display changing circuit
227b through the first rotation computing circuit 230. As this is
done, the output signal from the microscopic image masking
processor 228b is also applied to the circuit 227b through the
second rotation computing circuit 231. Further, the output signal
from the circuit 227b is applied to the LCD drivers 225b and 226b.
The output signals from the LCD drivers 225b and 226b are applied
to the LCD 214a for microscopic image masking and the LCD 219a for
in-field display, respectively.
[0287] Since the LCD 214b for microscopic image masking is located
on the first imaging point 213b1 of the objective lens 213b, a mask
portion 233b for sub-image is inserted into a part of the
microscopic image 232b for the mate-side optical system Lb by means
of the LCD 214b, as shown in FIG. 31A. As this is done, moreover,
an endoscopic image 234b is partially displayed on a part of the
whole LCD screen of the LCD 219b for in-field display, and the
remaining part is left as a shielding portion 235b, as shown in
FIG. 31B.
[0288] The image of FIG. 31A that combines the microscopic image
232b and the mask portion 233b for sub-image inserted therein and
the image of FIG. 31B that combines the endoscopic image 234b and
the shielding portion 235b are superposed by means of the prism
217b. Thereupon, a composite image 238b is formed having an
endoscopic image (sub-image) 237b inserted in a microscopic image
(main image) 236b, as shown in FIG. 32A.
[0289] As the in-field display controller 229 is operated, the
observation conditions in which the size, position, etc. of the
images to be displayed on the LCD's 219a and 219b for in-field
display are changed are inputted. Depending on the conditions
inputted by means of the controller 229, the in-field image
generator circuits 224a and 224b output control signals for
changing the size, position, etc. of the images to be displayed on
the LCD's 219a and 219b.
[0290] In the microscopic image masking processors 228a and 228b,
moreover, the mask portions 233a and 233b are formed having the
same size and position as the endoscopic images 234a and 234b that
are generated by means of the in-field image generator circuits
224a and 224b, as shown in FIG. 31A. Thus, the mask portion 233a of
FIG. 31A and the endoscopic image 234a of FIG. 31B are equal in
size.
[0291] According to the present embodiment, furthermore, two images
are alternatively changed by means of the display changing circuit
227a by the operator's processing, and images are displayed
individually on the LCD's 214a and 219a by means of the LCD drivers
225a and 226a. In the mate-side processing system, the images of
FIGS. 31A and 31B, generated by means of the in-field image
generator circuit 224b and the microscopic image masking processor
228b, are subjected to map conversion in the rotation computing
circuits 230 and 231 in accordance with the output of the position
detecting encoder 211 that detects the rotational angle of the mate
eyepiece unit 209, and then rotated in the manner shown in FIGS.
31C and 31D. The images shown in FIGS. 31C and 31D are obtained by
rotating the images of FIGS. 31A and 31B, respectively, for
180.degree..
[0292] The mate-side image processed in this manner forms the
composite image 238b of FIG. 32B, which is an image obtained by
rotating the composite image 238a of FIG. 32A without changing the
relative positions of the microscopic images 236a and 2326b and the
endoscopic images 237a and 237b therein.
[0293] The following is a description of operation for the case
where preoperative diagnostic images, such as X-ray CT's, are
displayed on the LCD's 219a and 219b for in-field display of the
operator- and mate-side optical systems La and Lb. According to the
present embodiment, computer images, such as X-ray CT's (not
shown), are applied to the in-field image generator circuits 224a
and 224b of FIG. 30. In this case, the output of the circuit 224b
is applied directly to the display changing circuit 227b without
actuating the rotation computing circuits 230 and 231 of the
mate-side processing system Kb. In consequence, composite images
240a and 240b are obtained including computer images 239a and 239b
inserted in the microscopic images 236a and 2326b, as shown in
FIGS. 33A and 33B, respectively. FIGS. 33A and 33B show the
operator- and mate-use composite images 240a and 240b,
respectively. The computer images 239a and 239b, which serve as
in-field images in the microscopic images 236a and 236b, are common
to the operator- and mate-use composite images 240a and 240b, and
are displayed in like manner in a fixed direction.
[0294] FIGS. 35A and 35B show states in which indexes (markers)
242a and 242b are overlaid on microscopic images 241a and 241b,
respectively. The microscopic images 241a and 241b are used on the
operator side and on the mate side, respectively.
[0295] Further, FIG. 34A shows a mask image 243a or 243b overlain
by the index 242a or 242b, and FIG. 34B shows an in-field display
image. In this case, the mask size for the mask image 243a or 243b
is reduced to zero, so that the index 242a or 242b appears as the
in-field display image. The microscopic images 241a and 241b
obtained in this case have their corresponding indexes 242a and
242b superposed thereon, as shown in FIGS. 35A and 35B,
respectively.
[0296] If the mask portion 233a or 233b is larger than the
endoscopic image 234a or 234b in FIGS. 31A to 31D, the endoscopic
image 234a or 234b in the field has a frame (not shown). If the
mask portion 233a or 233b is smaller than the endoscopic image 234a
or 234b, on the other hand, the periphery of the endoscopic image
234a or 234b in the field is blurred.
[0297] In the case where the endoscopic image 234a or 234b in the
field of the microscopic image 232a or 232b represents a graphic
form, such as a line or circle, the graphic form is replaced with
the microscopic image 232a or 232b if the mask portion 233a or 233b
has the same shape as the in-field endoscopic image 234a or 234b.
Overlay display is made if the mask portion 233a or 233b need not
be formed.
[0298] The arrangement described above produces the following
effects. In the mate-side processing system Kb according to the
present embodiment, the first rotation computing circuit 230 is
interposed between the in-field image generator circuit 224b and
the display changing circuit 227b, while the second rotation
computing circuit 231 is interposed between the microscopic image
masking processor 228b and the display changing circuit 227b.
Further, the position detecting encoder 211 for detecting the
rotational angle of the mate eyepiece unit 209 with respect to the
operator eyepiece unit 208 is connected to the first and second
rotation computing circuits 230 and 231. If the mate eyepiece unit
209 is rotated with respect to the operator eyepiece unit 208 with
the in-field image of an auxiliary optical system projected into
the microscopic field so that the composite image 238a or 238b is
formed including the endoscopic image 237a or 237b inserted in the
microscopic 236a or 236b, as shown in FIG. 32A, therefore, the
images of FIGS. 31A and 31B that are generated by means of the
in-field image generator circuit 224b and the microscopic image
masking processor 228b of the mate-side processing system Kb are
subjected to map conversion in the rotation computing circuits 230
and 231 in accordance with the output of the position detecting
encoder 211 that detects the rotational angle of the mate eyepiece
unit 209, and then rotated in the manner shown in FIGS. 31C and
31D. Accordingly, the composite image 238b of FIG. 32B is displayed
on the mate eyepiece unit 209 with the composite image 238a of FIG.
32A displayed on the operator eyepiece unit 208. If the mate
eyepiece unit 209 is rotated with respect to the operator eyepiece
unit 208, therefore, a microscopic field of the same positional
relations for the operator can be continuously secured for the
mate. Thus, the in-field image of the auxiliary optical system
produces no dead angles in the microscopic field.
[0299] If necessary, moreover, an image in the same direction as
the one on the operator side can be projected on the in-field image
of the auxiliary optical system on the mate side by a simple
method, or the in-field image can be displayed with a desired size
and in a free position. Further, an index such as a marker overlaid
on the microscopic image, as well as the in-field image of the
auxiliary optical system, can be realized by only the image
processing without changing the system configuration, so that a lot
of types of display and observation methods can be selected without
entailing any troublesome manipulation during the surgical
operation. In consequence, necessary in-field information can be
properly offered to the operator or his or her mate, and the aimed
microscopic field can be easily secured during the operation.
EIGHTH EMBODIMENT
[0300] FIGS. 36 and 37 show an eighth embodiment of the present
invention. In the present embodiment, the configuration of the mate
eyepiece unit 209 of the seventh embodiment is modified in the
following manner.
[0301] According to the present embodiment, the rotation computing
circuits 230 and 231 in the mate-side processing system Kb of the
seventh embodiment are omitted or replaced with an LCD rotating
mechanism 251 for rotating the LCD 214b for microscopic image
masking and the LCD 219b for in-field display in the mate-side
optical system Lb.
[0302] As shown in FIG. 37, the LCD rotating mechanism 251 of the
present embodiment comprises a ring-shaped first LCD driving gear
252, to which the LCD 214b for microscopic image masking is fixed,
and a ring-shaped second LCD driving gear 253, to which the LCD
219b for in-field display is fixed. The LCD 214b for microscopic
image masking is fixed in the ring of the first LCD driving gear
252. Likewise, the LCD 219b for in-field display is fixed in the
ring of the second LCD driving gear 253.
[0303] A gear 255 is fixed to the rotating shaft of a drive motor
254 of the LCD rotating mechanism 251. The gear 255 is in mesh with
an intermediate gear 256 as well as with the second LCD driving
gear 253. Further, the intermediate gear 256 is in mesh with the
first LCD driving gear 252. The gear ratio between the gears 255
and 256 is adjusted to 1:1. Thus, the first and second LCD driving
gears 252 and 253 can rotate in the same direction and at the same
speed as the gear 255 rotates.
[0304] A motor control circuit 257 is connected to the drive motor
254. A position detecting encoder 211 is connected to the circuit
257. An output signal from the encoder 211 is applied to the
circuit 257, whereby the operation of the motor 254 is
controlled.
[0305] The following is a description of the operation of the
present embodiment arranged in this manner. If a mate eyepiece unit
209 is rotated with respect to an operator eyepiece unit 208,
according to the present embodiment, the output signal from the
position detecting encoder 211, corresponding to the rotational
angle of the mate eyepiece unit 209, is applied to the motor
control circuit 257. Thus, the circuit 257 controls the operation
of the drive motor 254.
[0306] As this is done, the motor 254 causes the gear 255 to rotate
according to the rotational angle of the mate eyepiece unit 209.
The second LCD driving gear 253 is rotated in association with the
rotation of the gear 255, and the first LCD driving gear 252 is
rotated through the medium of the intermediate gear 256. Since the
gear ratio between the gears 255 and 256 is adjusted to 1:1, the
first and second LCD driving gears 252 and 253 rotate in the same
direction and at the same speed. Accordingly, the positional
relation between the LCD 219b for in-field display and the LCD 214b
for microscopic image masking can be kept fixed, and image display
equivalent to the one obtained by the image rotation shown in FIGS.
31C and 31D can be realized.
[0307] According to the present embodiment, therefore, the output
signal from the position detecting encoder 211 that detects the
rotational angle of the mate eyepiece unit 209 is applied to the
motor control circuit 257, and the operation of the drive motor 254
is controlled by means of the circuit 257. Thus, if the mate
eyepiece unit 209 is rotated with respect to the operator eyepiece
unit 208, according to the present embodiment, the LCD rotating
mechanism 251 is driven according to the rotational angle .alpha.
the mate eyepiece unit 209 by means of the motor 254, so that the
LCD 214b for microscopic image masking and the LCD 219b for
in-field display in the mate-side optical system Lb can be rotated
individually. According to the present embodiment, therefore, a lot
of types of display and observation methods can be selected without
entailing any troublesome manipulation during the surgical
operation, as in the case of the first embodiment, and besides, the
in-field image can be offered without lowering the image quality
during image computation for the image rotating process.
NINTH EMBODIMENT
[0308] FIG. 38A shows a ninth embodiment of the present invention.
In the present embodiment, the LCD rotating mechanism 251 of the
eighth embodiment is modified in the following manner.
[0309] The LCD rotating mechanism 251 of the eighth embodiment is
designed so that the LCD 214b for microscopic image masking and the
LCD 219b for in-field display in the mate-side optical system Lb
are rotated individually by means of the gear mechanism. However,
the present embodiment is provided with an LCD rotating mechanism
261 that is formed of a belt drive mechanism.
[0310] The LCD rotating mechanism 261 of the present embodiment
comprises a first LCD driving pulley 262, to which the LCD 214b for
microscopic image masking is fixed, and a second LCD driving pulley
263, to which the LCD 219b for in-field display is fixed.
[0311] A pulley 264 is fixed to the rotating shaft of a drive motor
(not shown) of the LCD rotating mechanism 261. Further, an endless
belt 265 is passed around and between the pulley 264 and the first
and second LCD driving pulleys 262 and 263. The driving pulleys 262
and 263 are equal in diameter. Thus, the first and second LCD
driving pulleys 262 and 263 can rotate in the same direction and at
the same speed.
[0312] As in the case of the eighth embodiment, moreover, the motor
control circuit 257 (see FIG. 36) is connected to the drive motor
for the pulley 264. The position detecting encoder 211 is connected
to the circuit 257. An output signal from the encoder 211 is
applied to the circuit 257, whereby the operation of the drive
motor is controlled.
[0313] The following is a description of the operation of the
present embodiment arranged in this manner. If a mate eyepiece unit
209 is rotated with respect to an operator eyepiece unit 208,
according to the present embodiment, the output signal from the
position detecting encoder 211, corresponding to the rotational
angle of the mate eyepiece unit 209, is applied to the motor
control circuit 257. Thus, the circuit 257 controls the operation
of the drive motor.
[0314] As this is done, the motor causes the pulley 264 to rotate
according to the rotational angle of the mate eyepiece unit 209,
and the first and second LCD driving pulleys 262 and 263 are
rotated in the same direction and at the same speed by means of the
belt 265. Accordingly, the positional relation between the LCD 219b
for in-field display and the LCD 214b for microscopic image masking
can be kept fixed, and image display equivalent to the one obtained
by the image rotation shown in FIGS. 31C and 31D can be realized.
Thus, the present embodiment can provide the same effects of the
second embodiment.
TENTH EMBODIMENT
[0315] FIG. 38B shows a tenth embodiment of the present invention.
In the present embodiment, the respective configurations of the
operator- and mate-side LCD's 214a and 214b for microscopic image
masking of the seventh embodiment are modified in the following
manner.
[0316] As shown in FIG. 38B, the present embodiment is provided
with a support frame 272 that has a circular window 271. The window
271 of the frame 272 is located on the first imaging point 213a1of
the objective lens 213a.
[0317] A shielding plate 273 is movably supported on the support
frame 272 so as to cover a part of the circular window 271.
Further, racks 274 are formed individually on the opposite sides of
the shielding plate 273. The racks 275 are in mesh with driving
gears 275, individually. The gears 275 are fixed to the rotating
shaft of a motor 276. As the gears 275 rotate, the shielding plate
273 is advanced or retreated so as to cover a part of the window
271 of the frame 272.
[0318] The following is a description of the operation of the
present embodiment arranged in this manner. According to the
present embodiment, the drive of the motor 276 is controlled by
means of a control signal delivered from in-field display range
setting means (not shown). As the motor 276 rotates, the gear 275
rotates. In association with the rotation of the gear 275, the
shielding plate 273 moves in the direction of the arrow in FIG.
38B, whereupon the area of the part of the circular window 271 that
is covered by the support frame 272 is changed. Thus, the
microscopic image masking area is changed.
[0319] The arrangement described above also fulfills the same
functions of the operator- and mate-side LCD's 214a and 214b for
microscopic image masking of the seventh embodiment. Thus, the
present embodiment can provide the same effects of the seventh
embodiment.
ELEVENTH EMBODIMENT
[0320] FIGS. 39 to 42B show an eleventh embodiment of the present
invention. FIG. 39 shows an outline of the whole system of an
operating microscope apparatus 281 according to the present
embodiment.
[0321] The operating microscope apparatus 281 of the present
embodiment comprises an operating microscope 282 constructed
substantially in the same manner as the operating microscope 201 of
the seventh embodiment, index/in-field display controller 283,
position information computing means 284, and position detecting
means 285 for detecting the position of the operating microscope
282.
[0322] A stand 286 of the operating microscope 282 of the present
embodiment is provided with a base 287 movable on a floor surface
and a support post 288 set up on the base 287.
[0323] Further, the support post 288 is provided, on its top
portion, with a body 289 of the operating microscope 282, including
an optical system for observing an affected region, and a support
mechanism 290 for supporting the body 289 for movement in any
desired direction. The mechanism 290 is a combination of a
plurality of moving arms 291 for locating the microscope body 289
in a desired position.
[0324] Furthermore, the microscope 282 is connected with the
index/in-field display controller 283, position information
computing means 284, and position detecting means 285. The
microscope 282 is supplied with an index/in-field display control
signal 292 from the controller 283 and a position information
computing means image signal 293 and an arm driving signal 294 from
the computing means 284.
[0325] FIG. 40B is an exterior view of the index/in-field display
controller 283. A body 295 of the controller 283 is provided with a
joystick 296 and two switches 297 and 298. An index control signal
283a is delivered from the controller 283 to the position
information computing means 284.
[0326] FIG. 40A shows a microscopic image 299 of the operating
microscope 282. A position information computing means image 300
and a marker 301 are displayed in the field of the microscopic
image 299. Two indexes 302a and 302b are displayed in the image
300.
[0327] The following is a description of the operation of the
present embodiment. According to the present embodiment, the
microscope 282 is supplied with the position information computing
means image signal 293 from the position information computing
means 284. The image signal 293 is displayed as an in-field display
image 304 on an LCD 303 for in-field display, as shown in FIG. 41B.
A preoperative image, such as an X-ray CT, is displayed in the
in-field display image 304. Further, the indexes 302a and 302b are
displayed in the image 304, while the marker 301 is displayed on
the LCD 303.
[0328] A microscopic image mask 306, which is as large as the
in-field display image 304, is displayed on an LCD 305 for
microscopic image masking shown in FIG. 41A. A microscopic image
308 shown in FIG. 42B is superposed on a microscopic image 307
shown in FIG. 42A.
[0329] Referring to FIG. 40A, the index 302a in the position
information computing means image 300, an MIR or X-ray CT
diagnostic image, and the marker 301 in the field of the
microscopic image 299 are pointed in the same direction in the
operative field.
[0330] The joystick 296 and switches 297 and 298 of the controller
283 of FIG. 40B are operated to transmit the index control signal
283a to the position information computing means 284. Based on this
information, the control means 284 transmits the image, moved to
the indexes 302a and 302b, as shown in FIG. 40A, to the microscope
282 in response to the position information computing means image
signal 293, and displays the image in the in-field display image
304 of the microscope 282.
[0331] Further, the position information computing means 284
controls the support mechanism 290 of the microscope 282 in
response to the arm driving signal 294, thereby moving the
microscope body 289 so that the index 302b and the marker 301 are
situated in the same position in the operative field.
[0332] According to the present embodiment arranged in this manner,
the operator can designate his or her desired view point on a
position information computing means image, and the observational
position can be automatically moved to the point. Thus, the field
of vision can be easily moved to a target region during the
surgical operation.
TWELFTH EMBODIMENT
[0333] FIGS. 43 to 47 show a twelfth embodiment of the present
invention.
[0334] FIG. 43 shows an outline of an operating microscope
apparatus 401 and an endoscopic apparatus according to the present
embodiment. The microscopic apparatus 401 of the present embodiment
is supported on a stand 402. The stand 402 is provided with a base
402a movable on a floor surface and a support post 402b set up on
the base 402a. A moving arm mechanism 404 for movably supporting a
microscope body 403 of the microscopic apparatus 401 is provided on
the top portion of the support post 402b. The mechanism 404 is
formed of a plurality of moving arms including first, second, and
third arms 405, 406 and 407 and a swing arm 408.
[0335] One end of the first arm 405 is mounted on the upper end
portion of the support post 402b for rocking motion around an axis
Oa. The first arm 405 has an illumination light source (not shown)
therein. One end of the second arm 406 is mounted on the other end
of the first arm 405 for rocking motion around an axis Ob.
[0336] The second arm 406 is a pantograph arm that is formed of a
link mechanism and a balancing spring member, whereby the
microscope body 403 can be moved in the vertical direction. The
third arm 407 is mounted on the other end of the second arm 406 for
rocking motion around an axis Oc.
[0337] The proximal end portion of the swing arm 408 is coupled to
the third arm 407. The microscope body 403, a binocular tube 409
for stereoscopic observation, and a handle 410 are provided on the
distal end portion of the arm 408. The swing arm 408 is supported
for longitudinal swinging motion such that it causes the microscope
body 403 to rock in the longitudinal direction around an axis Od,
which extends at right angles to the drawing plane of FIG. 43, with
respect to the direction of the operator's observation, and for
transverse swinging motion such that it causes the microscope body
403 to rock in the transverse direction of the operator around an
Oe.
[0338] Further, electromagnetic brakes (not shown) are provided
individually on rocking portions corresponding to the axes Oa to Oe
of the moving arm mechanism 404, whereby the position of the
microscope body 403 can be freely spatially adjusted and fixed.
These brakes are designed so that their locking or free state can
be freely selected by operating a switch (not shown) on the handle
410. Preferably, a light source unit (not shown) for the moving arm
mechanism 404 should be incorporated in the support post 402b of
the stand 402, for example.
[0339] The binocular tube 409 of the microscope body 403 is formed
having left- and right-hand observational optical paths for
stereoscopic observation. Each of the observational optical paths
of the lens tube 409 is provided with an objective lens (not shown)
and a variable-scale optical system (not shown). Numeral 440
denotes an endoscopic system for observing dead angles of the
operating microscope.
[0340] As shown in FIG. 44, the endoscopic system 440 comp a rigid
scope 441 having an observation port axis Og at a given angle to
the direction of insertion, a TV camera 442 including a TV camera
head 442a for picking up an observational image of the scope 441
and a TV controller 442b, and a monitor 443 connected to the
controller 442b and displaying the observational image of the scope
441. The rigid scope 441 is fixed to a bedside stay 445 by means of
a scope holder 444.
[0341] The scope holder 444 is provided with a fixing portion 446
fixed to the bedside stay 445, vertical arm 447, moving arms 448a
and 448b, slanting arm 449, and holding portion 450, which are
connected to one another in the order named. The arms 447, 448a,
448b and 449 and the holding portion 450 are rotatable around axes
Op, Og, Or, Os and Ot, respectively. Electromagnetic brakes 451a to
451e are provided individually at portions corresponding to these
axes of rotation, whereby the position of the rigid scope 441 can
be freely three-dimensionally adjusted and fixed.
[0342] These electromagnetic brakes are designed so that their
locking or free state can be selected by operating a switch 452 on
the holding portion 450. The switch 450 and the brakes 451a to 451e
are connected to a holder control section 453. The control section
453 is provided with a driver circuit (not shown), which outputs
driving signals for disengagement to the brakes 451a to 451e while
an operating signal from the switch 452 is being inputted, and a
circuit that delivers the input signal from the switch 452 to an
in-field display controller 454 (mentioned later).
[0343] FIG. 45 shows an outline of the binocular tube 409 according
to the present embodiment. The lens tube 409 is provided with a
right-eye observational optical system 411 shown in FIG. 45 and a
left-eye observational optical system (not shown). FIG. 45 shows a
part of the right-eye optical system 411, viewed from the lateral
of the lens tube 409. Since the left-eye observational optical
system is constructed in the same manner as the optical system 411
shown in FIG. 45, the following is a description of the optical
system 411 only.
[0344] The right-eye optical system 411 according to the present
embodiment comprises a binocular tube optical system (first
observational optical system) 412 for observing the observational
image of the operating microscope and an image projection optical
system (second observational optical system) 413 for observing
optional image information that is different from the observational
image. The binocular tube optical system 412 is provided with an
imaging optical system 414, image rotator 415, parallelogrammatic
prism 416, and eyepiece optical system 417. The observational image
of the operating microscope, incident upon the binocular tube
optical system 412, is guided from the imaging optical system 414
to the eyepiece optical system 417 via the image rotator 415 and
the prism 416 in succession.
[0345] Further, the image projection optical system 413 is provided
with an LCD display 420 as an in-field display function,
collimating optical system 421, variable-scale optical system 422
having a variable projection magnification, imaging optical system
423, and movable prism 424. The prism 424, which is oriented in the
direction of arrow S within the plane of a reflective surface 424a,
is movable with respect to the image projection optical system 413
by means of a motor 425a. On the other hand, the variable-scale
optical system 422 is connected so that its magnification can be
changed by driving a motor 425b.
[0346] The movable prism 424 and the variable-scale optical system
422 are driven in a relation such that the image on the LCD display
420 is enlarged in proportion to the depth of insertion of the
prism 424 in the binocular tube optical system 412 as it is
projected by means of the optical system 422.
[0347] The image information displayed on the LCD display 420 is
guided to the eyepiece optical system 417 successively through the
collimating optical system 421, variable-scale optical system 422,
imaging optical system 423, and movable prism 424. The eyepiece
optical system 417 ensures simultaneous observation of the
observational image of the operating microscope transmitted through
the binocular tube optical system 412 and the optional image
information transmitted through the image projection optical system
413.
[0348] Numeral 454 denotes the in-field display controller (display
format changing means), which is connected to the holder control
section 453 to which the switch 452 of the scope holder 444 is
connected, LCD display 420, TV controller 442b, and motors 425a and
425b. The controller 454 is composed of driver circuits for the
motor 425a for moving the prism 424 and the motor 425b for driving
the variable-scale optical system 422, control circuits for
controlling the drive of the driver circuits, and a display control
circuit that is supplied with a video signal from the TV controller
442b of the TV camera 442 and displays an image on the LCD display
420.
[0349] The observational image of the operating microscope
apparatus 401 ensures stereoscopic observation of an affected
region through the microscope body 403 by means of the binocular
tube optical system 412 of the binocular tube 409. As this is done,
the movable prism 424 of the image projection optical system 413 is
on the optical path of the binocular tube optical system 412, as
shown in FIG. 45. The image of the affected region observed through
the rigid scope 441 is picked up by means of the TV camera head
442a shown in FIG. 44. This image is displayed on the monitor 443
and the LCD display 420 by means of the TV controller 442b and the
in-field display controller 454 shown in FIG. 45, respectively. The
display image is observed through the image projection optical
system 413 and the eyepiece optical system 417.
[0350] FIG. 46 shows a state of observation for the case where the
image of the rigid scope is mainly observed as the surgical
operation is carried out. In FIG. 46, numerals 455 and 456 denote a
microscopic image and an image observed through the rigid scope
441, respectively. The rigid scope 441 itself is displayed in the
microscopic image 455.
[0351] On the other hand, the operator can change the observational
position of the rigid scope 441 by depressing the switch 452 of the
scope holder 444 to disengage the electromagnetic brakes 451a to
451f. By doing this, the rigid scope 441 can be freely moved in a
three-dimensional manner. As this is done, the holder control
section 453 disengages the electromagnetic brakes 451a to 451b to
cancel the locked state, and delivers an ON-signal of the switch
452 to the in-field display controller 454.
[0352] On receiving this input signal, the in-field display
controller 454 drives the motors 425a and 425b to a previously
stored specified extent, and the depth of insertion of the movable
prism 424 in the binocular tube optical system is reduced. At the
same time, the magnification of the variable-scale optical system
422 is changed into (or lowered to) a value that is settled
properly for the movement of the movable prism 424. Thereupon, the
image observed through the eyepiece optical system 417 looks like
the one shown in FIG. 47. Thus, the image 456 of the rigid scope,
compared to the microscopic image 455, moves to an end of the field
of vision, and is displayed in a contracted form.
[0353] In this manner, the image 456 of the rigid scope 441,
compared to the observational image 455 of the operating
microscope, is observed in a wide range in the case where the
observational position of the scope 441 is fixed, and in a narrow
range if the observational position of the scope 441 is changed (or
if the scope 441 is moved). When no normal rigid scope observation
is carried out, a footswitch (not shown) of the microscope can be
operated entirely to remove the movable prism 424 from the optical
path of the binocular tube optical system 412 with ease. Thus,
observation can be effected in the same manner as the observation
by means of the conventional operating microscope.
[0354] The rigid scope image 456 is displayed wide on the
observational image 455 of the operating microscope when it is used
for a required treatment or observation, so that the treatment
operation is easy. Since the display of the rigid scope image 456
is small while the rigid scope 441 is being moved, on the other
hand, the state of insertion of the rigid scope 441 in the
microscopic image 455 can be observed satisfactorily.
[0355] According to the present embodiment, the operating state of
the rigid scope 441 is detected by detecting the disengagement of
the scope holder 444 for holding the scope 441, so that the
surgical operation can be smoothly carried out without requiring
use of any special device for detection and its operation.
[0356] Further, the movement of the rigid scope 441 can be detected
more easily than by using an optical position detector according to
a thirteenth embodiment described below.
THIRTEENTH EMBODIMENT
[0357] FIGS. 48 to 50B show a thirteenth embodiment.
[0358] As is schematically shown in FIG. 48, an operating
microscope apparatus 401 and an endoscopic system 440 according to
the present embodiment are constructed in the same manner as the
ones according to the twelfth embodiment, so that a detailed
description of those elements is omitted. The following is a
description of the optical position detector for the operating
microscope apparatus 401 and the endoscopic system 440. This
optical position detector may be a conventional one.
[0359] As shown in FIG. 48, emissive indexes 460 and 461 are
attached to the operating microscope apparatus 401 and the
endoscopic system 440, respectively. The indexes 460 and 461 can be
shot by means of an illuminant image-pickup device 462 that is
provided with image-pickup means. The device 462 is connected with
a position detecting section 463 for computing the position and
angle of an illuminant in response to a signal from the device 462.
The position detecting section 463 is composed of a position data
computing section for a microscope body 403, a position data
computing section for a rigid scope 441, and a position calculating
section for calculating the position of the rigid scope 441
relative to the position of the microscope body 403. The detecting
section 463 delivers information on the observational direction of
the rigid scope with respect to the microscope body 403 to an
in-field display controller 464, which will be mentioned later.
[0360] FIG. 49 shows an outline of a binocular tube 465 according
to the present embodiment.
[0361] A binocular tube optical system 412 of the binocular tube
465 is constructed in the same manner as the one according to the
twelfth embodiment. Therefore, a description of the system 412 is
omitted, and the following is a description of an arrangement of an
image projection optical system 469, a unique element.
[0362] The image projection optical system 469 comprises an LCD
display 420 for use as an in-field display function, collimating
optical system 466, imaging optical system 467, and prism 468.
Image information displayed on the LCD display 420 is guided to an
eyepiece optical system 417 successively through the collimating
optical system 466, imaging optical system 467, and prism 468.
[0363] The image projection optical system 469, which is
incorporated in a chassis 470, is connected so that it can be
rocked integrally with the chassis 470 around an optical axis Of of
the eyepiece optical system 417 of the binocular tube 465 by means
of a motor 471. The eyepiece optical system 417 ensures
simultaneous observation of the observational image of the
operating microscope transmitted through the binocular tube optical
system 412 and optional image information transmitted through the
image projection optical system 469.
[0364] The in-field display controller 464 is connected to the
position detecting section 463 of the aforesaid optical position
detector, a TV controller 442b, the LCD display 420, and the
chassis rotating motor 471. The controller 464 is composed of a
driver circuit for the chassis rotating motor 471, control circuit
for controlling the drive of the driver circuit, display control
circuit for the LCD display 420, control circuit for controlling
the rotation of the motor 471 in response to a position signal from
the position detecting section 463, and a display control circuit
that is supplied with a video signal from the TV camera 442 and
displays an image on the LCD display 420.
[0365] The observational image of the operating microscope
apparatus according to the thirteenth embodiment ensures
stereoscopic observation of an affected region through the
microscope body 403 by means of the binocular tube optical system
412 of the binocular tube 465. As this is done, the movable prism
468 of the image projection optical system 469 is on the optical
path of the binocular tube optical system 412, as shown in FIG. 49.
The image of the affected region observed through the rigid scope
441 is picked up by means of a TV camera head 442a. This image is
displayed on a monitor 443 and the LCD display 420 by means of the
TV controller 442b and the in-field display controller 464,
respectively. The display image on the display 420 is observed
through the image projection optical system 469 and the eyepiece
optical system 417.
[0366] During a surgical operation, the respective positions of the
microscope body 403 and the rigid scope 441 are always detected by
means of a conventional optical position detector. The position
detecting section 463 obtains the direction (angle) of observation
of the rigid scope 441 with respect to the observation direction of
the microscope body 403, and delivers angle information to the
in-field display controller 464. In response to this angle
information, the controller 464 rotates the motor 471 as required,
thereby causing the image projection optical system 469 always to
rotate integrally with the chassis in the same direction as the
observation direction of the rigid scope. FIGS. 50A and 50B show
states that are observed by means of the eyepiece optical system
417. In this case, an image of the rigid scope 441 is displayed in
the same direction as the observational direction (indicated by
arrow B) of the scope 441.
[0367] According to the operating microscope 401 of the present
embodiment, the image 456 that is obtained through the rigid scope
441 and displayed in the field of observation is displayed in the
same direction as the observational direction of the rigid scope,
so that the operator can intuitively recognize the observational
direction of the rigid scope 441. Thus, the operator can be intent
on the surgical operation without suffering troublesomeness, and
therefore, the operation time can be shortened.
[0368] Since the optical position detecting means is used in the
present embodiment, moreover, the system is readily compatible with
a conventional navigation system that displays the respective
observational positions of the surgical operation and the rigid
scope 441 on a diagnostic image.
[0369] According to the present embodiment, furthermore, the
optical position detecting means is used to detect the
observational direction of the rigid scope 441 with respect to the
microscope body 403. Alternatively, however, the observational
direction of the rigid scope 441 can be easily detected by means of
an encoder or the like that is attached to a joint portion of the
scope holder of the twelfth embodiment and serves as rotational
angle detecting means. In this case, a simple system can be
enjoyed.
FOURTEENTH EMBODIMENT
[0370] A fourteenth embodiment will be described with reference to
FIG. 51. According to the present embodiment, the operating
microscope apparatus of the twelfth embodiment is modified so that
the binocular tube is designed differently and its visibility is
automatically adjusted to the operator's eyes.
[0371] FIG. 51 shows an outline of a binocular tube 480 according
to the present embodiment. The binocular tube 480 is provided with
a binocular tube optical system (first observational optical
system) 412, which is similar to the one according to the first
embodiment, an image projection optical system 481 for observing
optional image information that is different from an observational
image, a measurement optical system 487 for refractive index
measurement, and a light receiving optical system 488. The optical
systems 481, 487 and 488 constitute a second observational means. A
detailed description of the binocular tube optical system 412,
which is constructed in the same manner as the one according to the
twelfth embodiment, is omitted.
[0372] The image projection optical system 481 comprises an LCD
display 482 for use as in-field display means, collimating optical
system 483, imaging optical system 484, and movable prism 485. A
dichroic mirror 486 is located on an optical path between the prism
485 and the imaging optical system 484. The movable prism 485 is
provided on the optical path in a manner such that it can be
removed by means of a motor (not shown).
[0373] The measurement optical system 487 comprises the movable
prism 485, the dichroic mirror 486, a half-mirror 489, a slit plate
490 in a position conjugate to the eyeground of a subject eye
having a reference refractive force, a diffuser panel 491, and a
light emitting diode for emitting infrared light. Thus, the optical
system 487 shares some components with the image projection optical
system 481.
[0374] The light receiving optical system 488 comprises the movable
prism 485, the dichroic mirror 486, the half-mirror 489, a
shielding member 494 in a position conjugate to the slit plate 490,
and a light receiving element 495 in a position conjugate to the
pupil. Thus, the optical system 488 shares some components with the
measurement optical system 487. Numeral 496 denotes a measurement
section for computing the refractive force of the subject eye
according to the light quantity distribution of the light receiving
element 495. The measurement section 496 is connected to a
visibility correction motor drive control section 499 and an
in-field display controller 500 (mentioned later), as well as to
the light emitting diode 492.
[0375] The eyepiece optical system 417 ensures simultaneous
observation of the observational image of the operating microscope
transmitted through the binocular tube optical system 412 and
optional image information transmitted through the image projection
optical system 481. Further, the optical system 417 is designed so
that it can make visibility adjustment by moving in the direction
of its optical axis Of. A motor 498 can be used for the movement in
the direction of the optical axis Of. Numeral 499 denotes the
visibility correction motor drive control section that is connected
to the motor 498 and the in-field display controller (mentioned
later). The control section 499 is provided with a driver circuit
for the motor 498 and a control circuit for controlling the drive
of the motor. The motor 498 and the visibility correction motor
drive control section 499 constitute visibility correction motor
drive means.
[0376] The in-field display controller 500 is connected to the LCD
display 482, the measurement section 496, a switch 502 that is
connected to the operating microscope apparatus, a motor (not
shown) for the movable prism 485, and an external image apparatus.
The controller 500 comprises a motor drive control circuit for the
prism 485, a display control circuit, and a driving signal output
circuit for driving the measurement section. The display control
circuit displays an image on the LCD display 482 and displays a
stored fixed-view display pattern for measurement in response to
input from the switch 502.
[0377] The observational image of the operating microscope
according to the present embodiment and the image displayed on the
LCD display 482 are observed through the eyepiece optical system
417 in the same processes of operation of the twelfth and
thirteenth embodiments. The images can be observed in the same
manner as in the conventional operating microscope if the movable
prism 485 is removed from the optical path.
[0378] The following is a description of visibility adjustment.
[0379] If the operator turns on the switch 502 of the operating
microscope apparatus, the in-field display controller 500 displays
the previously stored fixed-view display pattern on the LCD display
482. This image is observed through the image projection optical
system 481 and the eyepiece optical system 417 by the operator. The
operator's eyes are fixed as they gaze steadily at the fixed-view
display pattern. At the same time, the controller 500 causes the
measurement section 496 to start measuring the refractive
force.
[0380] The following is a description of operation for the
refractive force measurement.
[0381] In response to a signal from the measurement section 496,
infrared light is emitted from the light emitting diode 492. This
infrared light is projected on the operator's eyeground via a slit
(not shown) of the slit plate 490, half-mirror 489, dichroic mirror
486, movable prism 485, and eyepiece optical system 417. Thus, a
slit image of the slit plate 490 is projected on the eyeground.
[0382] The projected infrared light is reflected by the eyeground
and delivered to the light receiving element 495 via the eyepiece
optical system 417, the movable prism 485, the dichroic mirror 486,
the half-mirror 489, a mirror 493, and the shielding member 494.
Based on information on the light quantity distribution from the
light receiving element, the measurement section computes the
refractive force of the operator's eyes. Based on the result of
this computation, the visibility correction motor drive control
section causes the motor 498 to rotate, thereby moving the eyepiece
optical system 417 for a required distance in the direction of the
optical axis Of. Thereupon, the operator's visibility adjustment is
completed.
[0383] The operating microscope of the present embodiment has a
very simple construction, since the image projection optical
system, which can display another image in the field, and the
optical systems (measurement optical system and light receiving
optical system) for measuring the refractive force share some of
their components. Since the optical path separate from the one for
the observational image of the operating microscope is used,
moreover, the observational performance of the microscope cannot be
ruined.
[0384] Since the fixed-view display that causes the operator to
gaze steadily at the image is made on the LCD display screen,
furthermore, accurate measurement can be accomplished without being
influenced by the focusing capability of the eyes.
[0385] Further, the observational performance of the operating
microscope cannot be lowered if the movable prism is removed from
the optical path.
FIFTEENTH EMBODIMENT
[0386] According to a fifteenth embodiment shown in FIGS. 52 to
53B, an image of a nerve monitor device that displays the nerve
state of a patient in the field of an operating microscope during a
surgical operation. The present embodiment differs from the twelfth
embodiment only in the construction of the in-field display
controller.
[0387] As shown in FIG. 52, an in-field display controller 510 of
the present embodiment is connected to a binocular tube 409 that is
similar to the one according to the twelfth embodiment. A nerve
monitor device 511 displays a wavy image indicative of the nerve
state on a monitor (not shown), and delivers a video signal for the
wavy image to the controller 510. Further, the monitor device 511
is provided with abnormal signal output means through which the
operator can be informed of change of the nerve state. The output
means is connected to the controller 510.
[0388] The in-field display controller 510 is composed of driver
circuits for a motor 425a for moving the movable prism 424 of the
twelfth embodiment and a motor 425b for driving the variable-scale
optical system 422, control circuits that are supplied with signals
from the abnormal signal output means from the nerve monitor device
511 and controls the drive of the motors 425a and 425b, and a
display control circuit that is supplied with a video signal from
the monitor device 511 and displays an image on an LCD display
420.
[0389] In the operating microscope according to the present
embodiment, an image 515 of the nerve monitor device 511 is
normally displayed in the field of the operating microscope in the
manner shown in FIG. 53A during the surgical operation. If the
nerve state of the patient is changed during the operation, a
signal is outputted from the abnormal signal output means of the
monitor device 511, whereupon the in-field display controller 510
drives the motors 425a and 425b in the same manner as in the
twelfth embodiment. In consequence, the nerve monitor image 515 is
displayed wide, as shown in FIG. 53B.
[0390] Thus, the operator can easily recognize the nerve state of
the patient.
[0391] According to the operating microscope of the present
embodiment, therefore, the size of the display information of the
nerve monitor device varies despite the operator's concentration on
the surgical operation, so that the operator never overlooks the
change of the patient's nerve state.
[0392] The following is a description of rigid scope systems
according to three alternative embodiments that are applicable to
the surgical system described above. These embodiments are
solutions to the rigid scopes described in Jpn. UM Appln. KOKAI
Publications Nos. 5-78201 and 56-176703, U.S. Pat. No. 5,168,863,
and Jpn. Pat. Appln. KOKAI Publication No. 11-155798. More
specifically, these alternative embodiments are intended to improve
a rigid scope that is adapted to be inserted into the body cavity
under surgical microscopic observation and ensure observation in
the direction at a given angle to the direction of insertion, to
prevent the rigid scope and a TV camera and a light guide connected
thereto from hindering the microscopic observation or surgical
operation, and to enable the operator to observe desired positions
with ease.
SIXTEENTH EMBODIMENT
[0393] A system according to a sixteenth embodiment will now be
described with reference to FIGS. 54 and 55.
[0394] FIG. 54 shows a general configuration of a rigid scope
system. In FIG. 54, numeral 601 denotes a body of an operating
microscope. The microscope body 601 is held over an affected region
by means of an arm stand (not shown) in a manner such that its
observational direction can be changed freely. Numeral 602 denotes
a rigid scope, which comprises an insert member 603 adapted to be
inserted into the affected region (body cavity) and having an
objective lens and an internal light guide (mentioned later) fixed
therein, a coupling portion 604 composed of first and second bent
portions 604a and 604b, and a grip portion 605 having an eyepiece.
Symbol R designates a point of observation of the rigid scope
602.
[0395] An upper surface 604c of the coupling portion 604 is coated
with light absorbing paint such as matte black. The grip portion
605 has therein a camera connecting portion, which is connectable
with a TV camera 606 that is connected optically to an imaging lens
(mentioned later).
[0396] Numeral 607 denotes an external light guide, one end of
which is connected to a light source unit (not shown). A connector
607a on the other end of the light guide 607 can be attached to and
detached from a light guide mouthpiece 608 that projects
substantially parallel to the bending direction of the first bent
portion 604a, at the upper end of the insert portion 603 of the
rigid scope 602.
[0397] The construction of the rigid scope 602 will now be
described in detail with reference to FIG. 55. An objective lens
609 is provided in the distal end portion of the insert portion
603. The lens 609 is fixed obliquely to the distal end of the
insert portion 603 so that it is inclined at a given angle .alpha.
to the longitudinal direction of the insert portion 603. A prism
610 and a relay optical system 611 are also arranged in the insert
portion 603. The respective optical axes of the objective lens 609
and the optical system 611 are kept at the aforesaid angle .alpha.
with the prism 610 between them.
[0398] A prism 612 is located in the first bent portion 604a of the
coupling portion 604, whereby an observational optical axis O1 of
the relay optical system 611 can be bent at about 90.degree.. A
relay optical system 613 is provided in an intermediate portion of
the coupling portion 604, and a prism 614 is disposed in the second
bent portion 604b of the coupling portion 604. The prism 614 serves
to bend the observational optical axis, bent by means of the prism
612, so as to extend substantially in the longitudinal direction of
the insert portion 603. Further, the grip portion 605 has therein a
relay optical system 615 located on a luminous flux that is guided
by means of the prism 614. An imaging lens 616 is disposed in the
rear end portion of the grip portion 605. The lens 616 serves to
focus an observational luminous flux on an image-pickup device 617
of the TV camera 606.
[0399] A cable 618 that is connected electrically to the
image-pickup device 617 of the TV camera 606 is connected to a
drive unit (not shown), and a TV monitor (not shown) is connected
electrically to the drive unit. The TV camera 606 is detachably
connected to the grip portion 605 by means of a mounting screw
portion 619.
[0400] In the vicinity of the objective lens 609, an illuminating
lens 620 is disposed in the distal end of the insert portion 603.
The distal end of an internal light guide 621 is fixed to the
inside of the lens 620 in a manner such that it is situated on the
optical axis of the lens 620 and that the respective centers of the
guide 621 and the lens 620 are substantially aligned with each
other. The illuminating lens 620 and the internal light guide 621
constitute an illumination optical system according to the present
embodiment. In a space portion 622 that is defined at the junction
between the insert portion 603 and the coupling portion 604, the
light guide 621 is fixed to the light guide mouthpiece 608 with
some slack. The light guide mouthpiece 608 is formed having a
mounting screw portion 623 that serves to connect the external
light guide 607 optically to the internal light guide 621.
[0401] The coupling portion 604 is provided with a bearing portion
624, which engages a flange 625 on the rear end of the insert
portion 603 so as to hold the insert portion 603 for rotation
around its longitudinal central axis. The bearing portion 624 and
the flange 625 constitute a rotation mechanism portion 626.
[0402] With the arrangement described above, the operator operates
the arm stand (not shown) that supports the operating microscope
body 601, thereby adjusting the microscope body 601 to a desired
position and angle. Further, illumination light is applied to the
affected region through the microscope body 601, and the affected
region is subjected to enlarged-scale observation.
[0403] Then, the observational dead-angle region R of the operating
microscope in the affected region is observed by means of the rigid
scope 602. First, the connector 607a of the external light guide
607 is connected to the light guide mouthpiece 608 of the rigid
scope 602, and the other end of the light guide 607 is connected to
the light source unit (not shown). Further, the cable 618 of the TV
camera 606 is connected to the drive unit (not shown).
[0404] As shown in FIG. 54, the insert portion 603 is inserted into
the affected region with the grip portion 605 and the TV camera 606
kept at a distance L from the microscope body 601, and the
objective lens 609 is directed to a position near the observational
dead-angle region R.
[0405] The illumination light emitted from the light source (not
shown) guided to the observational dead-angle region R by means of
the external light guide 607, internal light guide 621, and
illuminating lens 620. The light from the region R is transmitted
through the objective lens 609, prism 610, and relay optical system
611, and then bent at about 90.degree. by means of the prism 612.
After it is transmitted through the relay optical system 613,
moreover, the light is bent in the same direction as the
longitudinal direction of the insert portion 603 by means of the
prism 614, and focused on the image-pickup device 617 of the TV
camera 606 via the relay optical system 615 and the imaging lens
616. A video image of the observational dead-angle region R is
displayed on the TV monitor (not shown) by means of the drive unit
(not shown) and observed by the operator.
[0406] Then, in changing the observational position of the rigid
scope 602 from the observational dead-angle region R within a plane
perpendicular to the direction of insertion of the insert portion
603, the operator operates the rotation mechanism portion 626 to
rotate the insert portion 603 in the direction of an arrow 627
shown in FIG. 55 with respect to the coupling portion 604. As this
is done, the rotation of the insert portion 603 is absorbed by the
slack of the internal light guide 621 in the space portion 622, so
that the light guide 621 can never be pulled. Thus, the
observational position of the rigid scope 602 can be changed
without changing the respective positions of the coupling portion
604 and the grip portion 605 with respect to the operating
microscope body 601.
[0407] As the operator's treatment advances, it sometimes may be
hindered by the coupling portion 604, grip portion 605, TV camera
606, etc. during the observation of the observational dead-angle
region R. In this case, the coupling portion 604 is rotated
reversely in the direction of the arrow 627 with respect to the
insert portion 603 by means of the rotation mechanism portion 626.
Thus, the respective positions of the grip portion 605, coupling
portion 604, external light guide 607, and TV camera 606 with
respect to the operating microscope body 601 can be changed without
changing the observational position of the rigid scope 602.
[0408] According to the present embodiment, the grip portion 605 is
located at the fixed distance L from the insert portion 603 with
the coupling portion 604 between them. If the rigid scope 602 is
inserted into the affected region (body cavity) under surgical
microscopic observation, therefore, the microscope body 601, grip
portion 605, and TV camera 606 can avoid interfering with each
other. Since the external light guide 607 that is connected to the
light source unit is guided in the same direction as the coupling
portion 604, moreover, it can be prevented from unexpectedly
intercepting the microscopic field. Thus, the light guide 607
exerts no bad influence upon the microscopic observation.
[0409] Since the length of projection of the grip portion 605 and
the TV camera 606 within the plane of the affected region is
restricted to the minimum, e.g., the distance L, furthermore, the
space required by the operator's surgical operation is reasonable,
and the possibility of the projecting part hindering the operation
can be minimized.
[0410] Further, the observational direction of the rigid scope 602
can be changed without changing the respective positions of the
grip portion 605 and the TV camera 606. When the observational
direction of the rigid scope 602 is changed, therefore, the grip
portion 605 and the TV camera 606 can be prevented from interfering
with the operator's hands or body, and the external light guide 607
and the TV camera cable 618 can be prevented from intercepting the
microscopic field. Thus, the efficiency of the surgical operation
cannot be lowered. Since the respective positions of the grip
portion 605 and the TV camera 606 can be changed without changing
the observational position of the rigid scope 602, moreover, change
of a style can be quickly tackled with the progress of the
operation, so that the efficiency of the operation is improved
further.
[0411] Moreover, the upper surface 604c of the coupling portion 604
is coated with light absorbing paint such as matte black. If the
coupling portion 604 gets into the surgical microscopic field,
therefore, the illumination light of the operating microscope can
be prevented from being reflected by the coupling portion 604 and
dazzling in the microscopic field.
[0412] In connection with the present embodiment, furthermore, the
coating method, e.g., matte black coating, has been described as
reflection preventing means on the upper surface 604c of the
coupling portion 604. However, satin finish, filling, or other
means for restraining reflection may be used with the same
result.
[0413] With the arrangement in which the insert portion and the
grip portion are coupled by means of the coupling portion so as to
bend like a crank, as in the case of the sixteenth embodiment or
the embodiments mentioned later, a plurality of rigid scopes 602
with different squint directions for the insert portion 603 may be
prepared, or a joint structure may be provided such that a
plurality of rigid scopes or insert portions with different squint
directions can be attached and detached for replacement. According
to the sixteenth embodiment, the squint direction is opposite to
the direction of the coupling portion (and the direction of the
mouthpiece for the external light guide 607) against the grip
portion. Alternatively, however, the direction of the coupling
portion 604 or the mouthpiece for the external light guide 607 may
be shifted around the axis of the insert portion. Rigid scopes of
the conventional type may be available with various angular
relations between the squint direction and the direction of the
lateral mouthpiece for the external light guide.
SEVENTEENTH EMBODIMENT
[0414] A system according to a seventeenth embodiment will now be
described with reference to FIGS. 56 to 58. In the description of
the present embodiment to follow, like reference numerals are used
to designate the same portions of the sixteenth and seventeenth
embodiments, and a description of those portions is omitted.
[0415] FIG. 56 shows a general configuration of a rigid scope
system. The present embodiment is related mainly to an arm-type
stand 630 for fixedly locating the rigid scope 602 in the
operator's desired angular position.
[0416] The arm-type stand 630 for holding the rigid scope 602
comprises a first arm 631 that can be connected to the grip portion
605 of the rigid scope 602. The first arm 631 is connected to a
second arm 632 by means of a connecting portion 633 for rotation
around axes O2 and O3. Likewise, the second arm 632 is connected to
a third arm 634 by means of a connecting portion 635 for rotation
around an axis O4, and the third arm 634 is connected to a stand
holder 636 by means of a connecting portion 637 for rotation around
an axis O5.
[0417] The axis O2 is the center line of the first arm 631 that
extends at right angles to a reflected light axis O1' (mentioned
later) of the rigid scope 602, and the axis O3 extends at right
angles to the axis O2. The axis O4 extends at right angles to the
center line of the second arm 632, while the axis O5 extends at
right angles to the axis O4.
[0418] The third arm 634 is supported vertically on the stand
holder 636 and connected thereto for up-and-down motion. The holder
636 can be attached integrally to a side rail of an operating table
(not shown).
[0419] Each of the connecting portions 633, 635 and 637 has an
electromagnetic lock (brake, not shown) therein. The rotation
around each of the axes O2 to O5 can be allowed by turning on an
input switch (not shown) on the distal end of the first arm 631,
for example, and it can be prohibited by turning off the input
switch.
[0420] All of the first to third arms 631, 632 and 634 have a
hollow structure. The cable 618 of the TV camera 606, an arm light
guide 638 (mentioned later), etc. are passed through the respective
bores of these arms. The cable 618 and the guide 638 are exposed
downward to the outside from the lower surface of the connecting
portion 637. The cable 618 and the arm light guide 638, like the
ones according to the sixteenth embodiment, can be connected to a
drive unit and a light source unit (not shown).
[0421] The construction of the rigid scope 602 will now be
described in detail with reference to FIG. 57. In FIG. 57, numeral
640 denotes a mirror that is fixed in the first bent portion 604a
of the coupling portion 604. The mirror 640 serves to bend a
luminous flux, guided by the insert portion 603, at about
90.degree. to the longitudinal direction of the insert portion 603.
A relay optical system 641 is fixed in the coupling portion 604.
Located in the middle of the coupling portion 604 is a mirror 642,
which bends the luminous flux guided by the optical system 641 and
guides it to the imaging lens 616. The mirror 642 is fixed in the
second bent portion 604b of the coupling portion 604 in a manner
such that an extension of the reflected light axis O1' crosses the
optical axis O1 of the relay optical system 611, which is
substantially in line with the central axis of the insert portion
603, in the vicinity of the objective lens 609. The reflected light
axis O1' is substantially in line with the central axis of the grip
portion 605.
[0422] The insert portion 603 is provided with an internal light
guide 643, which, in conjunction with the illuminating lens 620,
constitutes an illumination optical system. One end of the guide
643 is connected optically to the lens 620. The rear end portion of
the guide 643 is led out in the same direction as the bending
direction of the first bent portion 604a in a manner such that it
is attached integrally to a light guide mouthpiece 644 on the rear
end of the insert portion 603 by means of a sheathing 645. A
connecting portion 646 is provided on the other end of the internal
light guide 643. Further, the guide. 643 can be fixed to the
underside of the coupling portion 604 by means of hooks 647.
[0423] A connecting portion 648 is provided on the rear end portion
of the grip portion 605. The connecting portion 648 engages a
mounting portion 649 on the first arm 631 of the arm-type stand
630, and is positioned by being fixed to the arm 631 by means of a
so-called click mechanism that includes a groove portion 650 and a
fixing ball 651 . Thus, the rigid scope 602 can be attached
integrally to the stand 630. The TV camera 606 can be also attached
integrally to the first arm 631 of the stand 630 so that its
image-pickup device 617 is located in the imaging position of the
imaging lens 616.
[0424] The connecting portion 648 of the grip portion 605 is
provided with a bearing portion 652 that engages a flange 653. The
bearing portion 652 constitutes a rotation mechanism portion 654
for holding the coupling portion 604 for rotation around the axis
O1'.
[0425] As mentioned before, moreover, the arm light guide 638 is
incorporated in the arms that constitute the arm-type stand 630.
One end of the guide 638 is fixed by means of a light guide
mouthpiece 656 at the distal end of the first arm 631. The
mouthpiece 656 has a mounting screw portion 657 that engages the
connecting portion 646 to be connected optically to the internal
light guide 643.
[0426] As shown in FIG. 58, the upper surface 604c of the coupling
portion 604 has slopes 658 and 659 that are inclined at right
angles to their longitudinal direction.
[0427] With this arrangement, the operator observes the
observational dead-angle region R of the operating microscope by
means of the rigid scope 602, as in the case of the sixteenth
embodiment. First, the operator holds the grip portion 605 of the
rigid scope 602 and inserts the scope 602 into an affected region.
Then, the operator, holding the grip portion 605, turns on the
input switch (not shown) on the first arm 631. Thereupon, the
electromagnetic locks in the connecting portions of the arm-type
stand 630 are disengaged, so that the rotation around each of the
axes O2 to O5 is allowed, and the rigid scope 602 can be operated
freely. In this state, the objective lens 609 of the rigid scope
602 is located on the extension of the axis O1' that corresponds to
the axis of the grip portion 605. Accordingly, the operator can
insert the insert portion 603 into the affected region and locate
the objective lens 609 near the observational dead-angle region R
with a feeling such that the rigid scope is a conventional
rod-shaped scope without the coupling portion 604 and in a manner
such that the grip portion 605 and the TV camera 606 are kept at
the distance L from the microscope body 601, as in the case of the
sixteenth embodiment.
[0428] When the objective lens 609 is located in the observational
dead-angle region R, the operator then turns off the input switch
on the arm-type stand 630. Thereupon, the respective
electromagnetic locks of the connecting portions are fixed, and the
rigid scope 602 is fixed with the objective lens 609 kept near the
region R. If the coupling portion 604 then gets into the
microscopic field of the microscope body 601, as shown in FIG. 58,
the illumination light from the body 601 is reflected away from the
microscopic field by the slopes 658 and 659 of the coupling portion
604, as indicated by arrows W1 and W2 in FIG. 58.
[0429] The illumination light emitted from the light source (not
shown) is guided to the observational dead-angle region R by means
of the arm light guide 638, internal light guide 643, and
illuminating lens 620. The light from the region R is transmitted
through the objective lens 609, prism 610, and relay optical system
611, and then bent at about 90.degree. by means of the mirror 640.
After it is transmitted through the relay optical system 641,
moreover, the light is bent in the direction of the axis O1' by
means of mirror 642, and focused on the image-pickup device 617 of
the TV camera 606 via the relay optical system 615 and the imaging
lens 616. A video image of the observational dead-angle region R is
displayed on a TV monitor (not shown) by means of the drive unit
(not shown) and observed by the operator.
[0430] Then, in changing the observational position of the rigid
scope 602 from the observational dead-angle region R within a plane
perpendicular to the direction of insertion of the insert portion
603, the operator operates the rotation mechanism portion 654 to
rotate the coupling portion 604 in the direction of an arrow 660
shown in FIG. 57 with respect to the grip portion 605. As this is
done, the internal light guide 643 is rotated integrally with the
coupling portion 604 around the axis O1', since it is guided in the
same direction as the bending direction of the first bent portion
604a and fixed integrally to the coupling portion 604 by means of
the hooks 647. Thus, the observational position of the rigid scope
602 can be changed without changing the respective positions of the
grip portion 605, TV camera 606, and arm-type stand 630.
[0431] If the operator's treatment is hindered by the grip portion
605, coupling portion 604, TV camera 606, and arm-type stand 630
during the observation of the observational dead-angle region R as
it advances, as in the case of the sixteenth embodiment, the grip
portion 605 is rotated reversely in the direction of the arrow 660
with respect to the coupling portion 604 by means of the rotation
mechanism portion 654. Thus, the respective positions of the grip
portion 605, the TV camera 606, and the arms that constitute the
arm-type stand 630 with respect to the operating microscope body
601 can be changed without changing the observational position of
the rigid scope 602.
[0432] Depending on the conditions of the region to be observed,
moreover, the operator must change the rigid scope 602 during a
surgical operation. The rigid scope may be selected among ones of
which the observational angle .alpha. of the objective lens 609 to
the longitudinal direction of the insert portion 603 is different
or the outside diameter of the insert portion 603 varies depending
on the diameter of the opening of the body cavity to be penetrated
thereby. In this case, the operator first loosens the mounting
screw portion 657 to remove the connecting portion 646 of the
internal light guide 643 from the light guide mouthpiece 656.
Further, the operator, holding the grip portion 605 in one hand and
the first arm 631 in the other, pulls out the rigid scope 602 in
the direction of an arrow 661 from the first arm 631. Thereupon,
the groove portion 650 of the connecting portion 648 is disengaged
from the pin 651 of the first arm 631, and the rigid scope 602 is
removed from the first arm 631.
[0433] Subsequently, a preferred rigid scope that is different from
the one described above in the observational angle .alpha. and the
outside diameter of the insert portion 603 is attached to the first
arm 631, reversely following the aforementioned steps of procedure,
and is used in the same manner as aforesaid. According to the
present embodiment, the grip portion 605 is located at the fixed
distance L from the insert portion 603 with the coupling portion
604 between them, as in the case of the sixteenth embodiment.
Therefore, the surgical operation microscope body 601, grip portion
605, and TV camera 606 can avoid interfering with one another.
Further, the length of projection of the grip portion 605 and the
TV camera 606 within the plane of the affected region is restricted
to the minimum or the distance L, and besides, the internal light
guide 643 is guided in the same direction as the bending direction
of the first bent portion 604a and fixed to the underside of the
coupling portion 604. Accordingly, the internal light guide 643 can
be securely prevented from wrongly intercepting the microscopic
field during the surgical operation.
[0434] Since the objective lens 609 of the rigid scope 602 is
located on the axis of the grip portion 605, moreover, the operator
can adjust the observational position of the rigid scope with the
same feeling of operation as that for a conventional rigid scope
without the coupling portion 604, and locate the objective lens 609
more quickly and securely in the target region. Since the cable 618
of the TV camera 606 and the light guides are incorporated in the
holding arm for fixedly holding the rigid scope 602 itself,
furthermore, the whole rigid scope system never unduly occupies the
space for the operator's surgical operation, and the efficiency of
the surgical operation can be prevented from lowering.
[0435] Since the observational direction of the rigid scope 602 can
be changed by only rotating the coupling portion 604 with the
length L, moreover, the grip portion 605 and the TV camera 606 can
be prevented from interfering with the operator's hands or body
when the observational direction is changed. Since the respective
positions of the grip portion 605, the TV camera 606, and the arms
of the arm-type stand 630 can be changed without changing the
observational position of the rigid scope 602, furthermore, change
of the style can be quickly tackled with the progress of the
operation, so that the efficiency of the operation is improved
further.
[0436] Since the rigid scope 602 can be easily replaced with a new
one during the surgical operation, moreover, an optimum rigid scope
can be selected according to the progress of the operation, so that
the efficiency of the operation is improved additionally.
[0437] Furthermore, the upper surface 604c of the coupling portion
604 is composed of the slopes 658 and 659. If the coupling portion
604 gets into the field of the operating microscope, therefore, the
illumination light of the operating microscope is reflected to the
outside of the microscopic field and prevented from entering the
field. Thus, the illumination light can be prevented from dazzling
in the field of the operating microscope.
EIGHTEENTH EMBODIMENT
[0438] A system according to an eighteenth embodiment will now be
described with reference to FIGS. 59 to 61. In the description of
the present embodiment to follow, like reference numerals are used
to designate the same portions of the sixteenth to eighteenth
embodiments, and a description of those portions is omitted.
[0439] FIG. 59 shows a general configuration of a rigid scope
system. In FIG. 59, numeral 670 denotes an arm-type stand for
holding the rigid scope 602. The stand 670 is obtained by modifying
only the distal end portion of the first arm 631 of the arm-type
stand 630 according to the seventeenth embodiment. More
specifically, the TV camera 606 is held in a distal end portion 672
of a first arm 671, and the cable 618 is housed in the arms 671,
632 and 634 without being exposed to the outside. The grip portion
605 of the rigid scope 602 is provided with a control knob 673 for
changing the observational direction.
[0440] The rigid scope 602 will now be described in detail with
reference to FIG. 60. An image guide 674, formed of a light guide
fiber, is fixedly incorporated in the coupling portion 604. One end
of the image guide 674 is connected optically to the relay optical
system 611 in the insert portion 603 at the first bent portion
604a, while the other end of the guide 674 is connected optically
to the relay optical system 615 in the grip portion 605 at the
second bent portion 604b.
[0441] In the present embodiment, as in the seventeenth embodiment,
the objective lens 609 is located in a position near the point of
intersection of an extension of the optical axis O1' of the relay
optical system 615, which is substantially in line with the central
axis of the grip portion 605, and the optical axis O1 of the relay
optical system 611, which is substantially in line with the central
axis of the insert portion 603.
[0442] In FIG. 60, numeral 675 denotes a light guide fixing
portion, which serves to fix one end of the arm light guide 638 in
the first arm 671. A connecting light guide 676 is held in the grip
portion 605 and the coupling portion 604. One end of the light
guide 676 is fixed in a connecting portion 677 of the grip portion
605 so as to be connected optically to the arm light guide 638. The
other end portion 678 of the connecting light guide 676 is
circumferentially located so as to cover the outer periphery of the
image guide 674 in the first bent portion 604a, and is fixed in the
coupling portion 604 so as to be guided in the same direction as
the bending direction of the first bent portion 604a.
[0443] In the insert portion 603, on the other hand, an internal
light guide 679, which is connected optically to the illuminating
lens 620, is circumferentially located so as to cover the outer
periphery of the relay optical system 611. In the first bent
portion 604a, the internal light guide 679 is circumferentially
fixed so as to be connected optically to the connecting light guide
676. The illuminating lens 620, internal light guide 679, and
connecting light guide 676 constitutes an illumination optical
system according to the present embodiment.
[0444] Provided in the grip portion 605, moreover, is a cylindrical
member 680 that is attached to the coupling portion 604 for
rotation around a shaft 681. The cylindrical member 680 is coupled
with the observational direction changing control knob 673 on the
grip portion 605. As shown in FIG. 61, a gear 682 is provided
integrally on the outer periphery of the cylindrical member
680.
[0445] In the coupling portion 604, on the other hand, a gear 680
in mesh with the gear 682 is rotatably supported on a shaft 684. In
the first bent portion 604a, moreover, a gear 686 is provided in
mesh with the gear 683. The gear 686, in conjunction with a bearing
portion 687 in the housing of the coupling portion 604, constitutes
a rotation mechanism portion 688.
[0446] With this arrangement, as in the cases of the sixteenth and
seventeenth embodiments, the operator observes the observational
dead-angle region R of the surgical microscope by means of the
rigid scope 602. First, the electromagnetic locks in the arm-type
stand 670 are disengaged with the grip portion 605 of the rigid
scope 602 held in position, the objective lens of the rigid scope
602 is moved to the observational dead-angle region R, and the
electromagnetic locks of the stand 670 are worked again to hold and
fix j rigid scope 602. In this state, as in the case of the second
embodiment, the objective lens 609 of the rigid scope 602 is
located on the extension of the axis O1' that corresponds to the
axis of the grip portion 605. Accordingly, the operator can
position the rigid scope 602 with a feeling such that the rigid
scope is a conventional one without the coupling portion 604.
[0447] Illumination light emitted from a light source (not shown)
is guided to the observational dead-angle region R by means of the
arm light guide 638, connecting internal light guide 676, and
illuminating lens 620. After the light from the region R is
transmitted through the objective lens 609, prism 610, and relay
optical system 611, it is guided to the relay optical system 615 in
the grip portion 605 by means of the image guide 674 in the
coupling portion 604 and focused on the image-pickup device 617 of
the TV camera 606. Thereupon, a video image of the observational
dead-angle region R is displayed on a TV monitor (not shown) by
means of a drive unit (not shown) and observed by the operator.
[0448] Then, in changing the observational position of the rigid
scope 602 from the region R, the operator turns the observational
direction changing control knob 673 in the direction of an arrow
690. As the knob 673 rotates, the gear 682 also rotates in the
direction of the arrow 690 around the shaft 681, so that the
engaging gears 683 and 686 also rotate. Thereupon, the insert
portion 603 is rotated in its central axis or the optical axis O1
by means of the rotation mechanism portion 688 that is composed of
the gear 686 and the bearing portion 687, whereby the observational
direction of the objective lens 609 is changed. In this state, the
internal light guide 679 and the connecting light guide 676 are
circumferentially connected around the relay optical system 611
that has the optical axis O1. Accordingly, there is no possibility
of the light guides being pulled or the illumination light
suffering a loss as the insert portion 603 rotates. Thus, the
illumination light is guided to the observational region, and the
observational position of the rigid scope 602 is changed without
changing the respective positions of the grip portion 605, TV
camera 606, arm-type stand 670, etc.
[0449] If the operator's treatment is hindered by the grip portion
605, coupling portion 604, TV camera 606, and arm-type stand 670
during the observation of the observational dead-angle region R as
it advances, the aforementioned processes of operation are carried
out the other way around. The rotation mechanism portion 688 is
operated by means of the observational direction changing control
knob 673 to change the observational direction of the objective
lens 609. Thereafter, the arm-type stand 670 is operated to
redirect the objective lens 609 to the observational dead-angle
region R. Then, respective positions of the grip portion 605, the
TV camera 606, and the arms that constitute the arm-type stand 670
are changed without. moving the observational position of the rigid
scope 602 from the region R.
[0450] In replacing the rigid scope 602 with one that is different
in the observational angle and the outside diameter of the insert
portion, as in the case of the seventeenth embodiment, the
operator, holding the grip portion 605 in one hand and the first
arm 671 in the other, pulls out the grip portion 605 of the rigid
scope 602 in the direction of an arrow 691 from the first arm 671.
Thereupon, the groove portion 650 of the connecting portion is
disengaged from the pin 651 in the distal end portion 672 of the
first arm 671, and the rigid scope 602 is removed from the arm-type
stand 670.
[0451] Then, the rigid scope that is different in the observational
angle .alpha. and the outside diameter of the insert portion 603 is
attached to the first arm 631, reversely following the
aforementioned steps of procedure. As this is done, the connecting
light guide 676 is fixed in a position (position shown in FIG. 60)
where it is connected optically to the arm light guide 638 by means
of the groove portion 650 and the pin 651.
[0452] The present embodiment has the following effects as well as
the effects of the fifth embodiments. Since the cable 618 of the TV
camera 606 and the light guides can be incorporated in the rigid
scope 602 and the arm-type stand 670, the whole rigid scope system
never unduly occupies the space for the operator's surgical
operation, and cables can be prevented from coiling around the
operator's hands during the operation of the rigid scope 602. Thus,
the efficiency of the rigid scope 602 itself can be improved.
[0453] Further, the observational direction of the rigid scope 602
can be changed by operating the observational direction changing
control knob 673 on the grip portion 605. Thus, the observational
direction can be easily changed one-handed according to the
operation of the rigid scope 602.
[0454] Since the light guides need not be attached or detached when
the rigid scope is replaced during a surgical operation, the rigid
scope can be changed more quickly, so that the efficiency of the
surgical operation is enhanced.
[0455] According to the present embodiment, the gears are used as
means for connecting the observational direction changing control
knob 673 and the rotation mechanism portion 688. It is to be
understood, however, that the gears may be replaced with any other
suitable motion transmitting mechanism, such as a wire belt or cam
mechanism, with the same result.
[0456] The present invention is not limited to the embodiments
described herein. According to the description of the foregoing
embodiments, systems of the following particulars and optional
combinations thereof can be obtained at the least.
[0457] In short, the rigid scope according to any of the sixteenth
to eighteenth embodiments, having the observational optical system
and the illumination optical system therein, comprises the insert
portion, grip portion, and coupling portion that couples the insert
and grip portions. The coupling portion includes the first and
second bent portions, and the illumination optical system is guided
in the same direction as the bending direction of the first bent
portion.
[0458] This rigid scope is inserted into and fixed in the affected
region under surgical microscopic observation without allowing its
grip portion to interfere with the body of the operating
microscope. Accordingly, the TV camera, cables, etc. can be
securely prevented from interfering with the microscope body or
intercepting the microscopic field.
[0459] The rigid scope may be provided with a rotation mechanism
portion that can hold the insert portion and/or the grip portion
for rotation with respect to the coupling portion.
[0460] In this case, the rigid scope can be inserted into and fixed
in the affected region under surgical microscopic observation
without having its grip portion interfere with the body of the
operating microscope, and the position of observation by means of
the rigid scope can be changed without changing the position of the
rigid scope with respect to the operating microscope body.
Therefore, the operator can set the observational position (or
direction) in the affected region and the respective positions of
the TV camera, light guides, holding arm, etc. in his or her
desired relation. Further, the rigid scope can be located optimally
depending on the location of the operating microscope and the
operator's treatment style and method, changes during the surgical
operation can be quickly tackled, and besides, the efficiency of
the surgical operation can be enhanced considerably.
[0461] Moreover, a light guide that is connected to the
illumination optical system may be detachably connected near the
junction between the insert portion and the coupling portion.
[0462] Furthermore, a connecting portion to which the light guide
connected to the illumination optical system is detachably
connected may be provided in the vicinity of the grip portion.
[0463] Preferably, the respective central axes of the grip portion
and the insert portion extend substantially parallel to each
other.
[0464] Preferably, moreover, the objective lens should be fixed in
the insert portion near an extension of the central axis of the
grip portion.
[0465] The rotation mechanism portion should preferably be provided
on the grip portion or the coupling portion.
[0466] An operating portion for operating the rotation mechanism
portion should preferably be provided on the grip portion.
[0467] Reflection preventing means may be provided on the
grip-portion-side surface of the coupling portion. Preferably, this
preventing means is formed of a slope.
[0468] The following is a description of an endoscopic surgical
system in an alternative form.
[0469] FIG. 72 shows the conventional endoscopic surgical system
that includes a squint-type rigid scope 701. This endoscopic
surgical system comprises a TV camera system 702 formed of a TV
camera head 702a and a controller 702b, monitor 703 for displaying
an image picked up by means of the camera system 702, light source
unit 704 for supplying illumination light to the rigid scope 701,
and light guide 705. During the surgical operation, the rigid scope
701 is fixedly supported by means of a scope holder 706. The TV
camera head 702a is connected to the rigid scope 701 in a manner
such that the lower and upper parts of the display screen of the
monitor 703 correspond to the deep side (distal end side) and the
shallow side (hand side), respectively, with respect to the
direction of insertion of the rigid scope 701. An operator 700
operates an instrument 707 to perform extraction of a tumor,
hemostasis, etc. while watching an endoscopic observational image
on the monitor 703.
[0470] Described in Jpn. Pat. Appln. KOKAI Publication No.
7-328015, for example, is a surgical manipulator that remotely
operates the instrument under endoscopic observation in place of an
operator. If the operator operates this surgical manipulator, a
treatment manipulator is then actuated by means of an actuator,
whereupon an affected region is treated. Further, the operator gets
a display device on his or her head so that s/he can watch a
display image thereon as s/he operates the manipulator to carry out
a surgical operation. In this case, the operator's head is
detected, and the observational position of the endoscope is moved
correspondingly.
[0471] In FIG. 72, the rigid scope 701 is used to observe a region
on the left of the operator 700, and a rigid scope image is
displayed on the monitor 703. If the operator moves the instrument
707 to the right (in the direction of arrow D1) on the monitor 703
while watching the image displayed on the monitor 703 in these
conditions, the actual instrument 707 is moved forward or away from
the operator (in the direction of arrow d1). If the operator 700
moves the instrument 707 to the left (in the direction of arrow B1)
on the monitor 703, on the other hand, the actual instrument 707 is
moved toward the operator (in the direction of arrow b1).
[0472] In order to move the instrument 707 on the monitor 703 to
the right or left (in the direction of arrow D2 or B2) as the rigid
scope in the state of FIG. 72 is turned counterclockwise for
90.degree. to observe the operator side, as shown in FIG. 73, the
operator 700 is expected actually to move the instrument 707 in the
opposite direction when compared to the image on the monitor 703.
Thus, in a surgical operation using an endoscope of which the
observational direction is different from the direction of its
insertion, the direction of actual movement of the instrument is
not coincident with the moving direction of the instrument on the
monitor. Accordingly, the operator must deliberate on the direction
of the instrument to be moved while watching the monitor or confirm
the moving direction by delicately moving the instrument to
determine the direction in which the instrument is to be moved
next. Therefore, the operation time is so long that the operator is
fatigued inevitably. The operator can solve this problem by
shifting his or her position relative to the affected region,
depending on the observational direction of the endoscope, so that
the operator's frontal direction is coincident with the
observational direction. It is hard to attain this, however, since
the instrument may interfere with a patient's body or some other
surgical device.
[0473] On the other hand, the system described in Jpn. Pat. Appln.
KOKAI Publication No. 7-328015 is designed to detect the operator's
head in moving the endoscopic field. This system, however, is
large-scaled and not easy to handle. In order to change the
observational position of the endoscope, moreover, the operator's
body or head must be moved. Therefore, this system is an effective
measure for remote-controlled operation. Since the operating room
is furnished with a lot of instruments and cables, however, the use
of this system in the operating room is obstructive and narrows the
range of the operator's movement. If the endoscope rotates around
the course of insertion, moreover, the direction of the display
image observed by the operator changes inevitably. Thus, the
direction in which the master manipulator is to be moved is
deviated from the direction in which the manipulator for treatment
moves on the display image.
[0474] Accordingly, there is a demand for an endoscopic surgical
system designed so that the manipulating direction of the
instrument with respect to the operator's position is coincident
with the moving direction of the instrument even if the
observational direction of the endoscope is changed, whereby the
operation time can be shortened, and the operator's fatigue can be
eased.
[0475] FIGS. 62 to 71 show embodiments of endoscopic surgical
systems that can fulfill these requirements.
[0476] The endoscopic surgical system shown in FIG. 62 comprises a
rigid scope 801, TV system 803 formed of a TV camera head 803a and
a controller 803b attached to the hand-side portion the rigid scope
801, and monitor 805. An optical axis 813 of an objective lens 802
that is provided on the distal end of the rigid scope 801 is
inclined at an angle a to a central axis O1 of an insert portion
801a of the rigid scope 801. An observational image that is
obtained through the objective lens 802 is picked up by means of an
image-pickup device (not shown) of the TV camera head 803a through
the medium of a relay optical system and an imaging optical system
(not shown). The TV camera head 803a causes the controller 803b to
display the observational image on the monitor 805. In FIG. 62,
numeral 806 denotes a light guide that is connected to a light
source unit (not shown) for supplying illumination light to the
field of the rigid scope 801. The TV camera head 803 is connected
to the rigid scope 801 in a manner such that the lower and upper
parts of the display image of the monitor 805 correspond to the
deep side (distal end side) and the shallow side (hand side),
respectively, with respect to the direction of insertion of the
rigid scope 801.
[0477] In FIG. 62, numeral 807 denotes a flexible scope holder for
supporting the rigid scope 801. It is fixed to a bedside stay (not
shown). The scope holder 807 supports the rigid scope 801 for
rocking motion around the central axis O1. In FIG. 62, numeral 808
denotes an instrument 808. The instrument 808 is fixed integrally
to the insert portion 801a of the rigid scope 801 by means of a
connecting member 812. The instrument 808 includes an input portion
809 for the operator's manipulation and an output portion 810 that
operates in response to the manipulation of the input portion 809.
Further, the instrument 808 is fitted with a bipolar probe 811 that
is adapted to arrest bleeding or coagulate blood in an affected
region when a high-frequency current is supplied across electrodes.
The instrument 808 is connected to the rigid scope 801 in a
positional relation such that the output portion 810 extends along
the optical axis 813 of the scope 801 to ensure image-pickup
operation by means of the scope 801 at all times.
[0478] FIGS. 63 and 64 show a specific configuration of the
instrument 808. As shown in FIG. 63, the instrument 808 includes a
lower chassis 808a connected integrally to the insert portion 801a
of the rigid scope 801 by means of the connecting member 812, upper
chassis 808b rockably connected to the lower chassis 808a, and a
joint 808c that connects the lower and upper chassis 808a and 808b.
The upper chassis 808b can rock around an axis O3 that extends
substantially parallel to the central axis O1 of the insert portion
801a of the rigid scope 801.
[0479] The input portion 809 is provided with a hollow input lever
815. The lever 815 includes a small-diameter grip portion 815a on
the hand side (operator side) and a disk-shaped displacement
portion 815b on the distal end side. The input lever 815 is formed
having a narrow hole 815c and a recess 815d in the form of a
spherical depression, located successively from the hand side in
the order named. The bipolar probe 811 is inserted in the hole
815c. One end of a flexible tube 816, which has an inside diameter
equal to the diameter of the hole 815c, is connected to the
terminal end of the hole 815c (or the boundary between the hole
815c and the recess 815d). The bipolar probe 811 is inserted for
axial movement in the tube 816. One end of an upper support shaft
817 is fixed integrally to the upper chassis 808b. The other end of
the shaft 817, having a spherical shape, is fitted in the recess
815d of the input lever 815, thereby supporting the distal end side
of the lever 815 so that the lever 815 can tilt around its central
portion T1. The upper support shaft 817 has a hollow structure that
is penetrated by the tube 816.
[0480] As is also shown in FIG. 64, one end of each of four wires
820a to 820d is fixed to the displacement portion 815b of the input
lever 815. The wires 820a to 820d are fixedly arranged at angular
spaces of 90.degree. on the circumference of a circle with a radius
r around the axis O4 that passes through the central portion T1. On
the other hand, one end of each of four hollow flexible hoses 821a
to 821d is connected to that part of the upper chassis 808b which
faces the displacement portion 815b. The positions where the hoses
821a to 821d are connected correspond to the four positions where
the wires 820a to 820d are fixed, respectively. The wires 820a to
820d are passed for axial movement in their corresponding hoses
821a to 821d.
[0481] The output portion 810 is provided with a hollow output
lever 825. The lever 825 includes a small-diameter portion 825a on
the distal end side (affected region side) and a disk-shaped
displacement portion 825b on the side farther from the affected
region. The output lever 825 is formed having a narrow hole 825c
and a recess 825d in the form of a spherical depression, located
successively from the affected region side in the order named. The
bipolar probe 811 is inserted in the hole 825c. The flexible tube
816, which has the inside diameter equal to the diameter of the
hole 825c, is connected to the terminal end of the hole 825c (or
the boundary between the hole 825c and the recess 825d).
[0482] One end of a lower support shaft 827 is fixed integrally to
the lower chassis 808a. The other end of the shaft 827, having a
spherical shape, is fitted in the recess 825d of the output lever
825, thereby supporting the lever 825 so that the lever 825 can
tilt around its central portion T2. The lower support shaft 827 has
a hollow structure that is penetrated by the tube 816.
[0483] The respective other ends of the four wires 820a to 820d are
fixed to the displacement portion 825b of the output lever 825. The
wires 820a to 820d are fixedly arranged at angular spaces of
90.degree. on the circumference of a circle with the radius r
around an axis O4 that passes through the central portion T1.
Further, the respective other ends of the hoses 821a to 821d are
connected to that part of the lower chassis 808a which faces the
displacement portion 825b. The positions where the other ends of
the hoses 821a to 821d are connected correspond to the four
positions where the wires 820a to 820d are fixed, respectively. As
shown in FIG. 64, in this case, the wires 820a to 820d and the
hoses 821a to 821d are fixed to the displacement portion 825b and
the lower chassis 808a in a manner such that the arrangement around
the axis O4 on the side of the input portion 809 is rotated for
180.degree. to realize the arrangement around the axis O5.
[0484] The following is a description of the operation of the
endoscopic surgical system constructed in this manner.
[0485] When the rigid scope 801 is directed forward from the
operator side, the observational image that is picked up by means
of the scope 801 and the TV camera system 803 is displayed on the
TV monitor 805, as shown in FIG. 65.
[0486] The bipolar probe 811 can be actually moved in the
directions of arrows A3, B3, C3 and D3 on the screen of the monitor
805 by correspondingly tilting the input lever 815 in the
directions of arrows a3, b3, c3 and d3. For example, the probe 811
can be moved to the right on the monitor 805 by tilting the lever
815 to the right. Thus, it is necessary only that the input lever
815 be tilted in a desired direction with reference to the image on
the monitor 805.
[0487] In moving the distal end of the bipolar probe 811 in the
direction of arrow A3 (or upward) on the monitor 805, for example,
the input lever 815 is moved in the direction of arrow a3 (or
upward). Thereupon, the lever 815 tilts around the central portion
T1 with respect to the upper support shaft 817, so that the wire
820c is pulled to the hand side, while the wire 820a is pushed out
to the distal end side (or loosens). The pushed wire 820a advances
in the hose 821a, thereby causing the output lever 825 to tilt in
the direction of arrow a3 around the central portion T2. Thus, the
distal end of the bipolar probe 811 moves in the direction of arrow
A3 on the monitor 805. For other directions, the system operates in
the same manner. More specifically, if the input lever 815 is moved
in the direction of arrow b3 (or to the left), the output lever 825
tilts in the direction of arrow b3, and the bipolar probe 811 moves
in the direction of arrow B3 on the monitor 805. If the input lever
815 is moved in the direction of arrow c3 (or downward), the output
lever 825 tilts in the direction of arrow c3, and the probe 811
moves in the direction of arrow C3 on the monitor 805. If the input
lever 815 is moved in the direction of arrow d3 (or to the right),
the output lever 825 tilts in the direction of arrow d3, and the
probe 811 moves in the direction of arrow D3 on the monitor 805.
Moreover, the operator 700 can advance or retreat the bipolar probe
811 to a target region by moving it toward or away from the input
lever 815. As this is done, the probe 811 advances or retreats in
the tube 816 so that it projects or recedes from the distal end of
the output lever 825.
[0488] The following is a description of the operation of the
instrument 808 for the case where the rigid scope 801 is rotated
counterclockwise for 90.degree. around the axis O1 with respect to
the operator 700 (case where the operator's left-hand side is
observed, see FIG. 66).
[0489] If the rigid scope 801 is rotated counterclockwise for
90.degree., as shown in FIG. 66, the instrument 808 also rotates
counterclockwise for 90.degree. in one with the scope 801. Since
the position of the operator 700 relative to an affected region
never changes during a surgical operation, however, the operator
700 can restore the input lever 815 to be operated to the position
right in front of him or her by rotating the upper chassis 808b for
90.degree. in the direction of arrow M with respect to the lower
chassis 808a. Thus, the output lever 825 is deviated at 90.degree.
from the input lever 815. Even in this case, however, the optical
axis 813 of the rigid scope 801 and the output portion 810 of the
instrument 808 are already moved integrally with each other, so
that the relation shown in FIG. 65 is maintained between the moving
direction of the output lever 825 of the instrument 808 on the
monitor 805 and the manipulating direction of the input lever 815.
Thus, the output lever 825 or the bipolar probe 811 can be
appropriately moved by tilting the input lever 815 in a desired
direction to move the instrument 808 on the monitor 805, only if
the monitor 805 is located right in front of the operator 700 and
if the input lever 815 of the instrument 808 is directed frontally
(or toward the operator) as it is used.
[0490] According to the rigid scope system described above, change
of the observational direction of the rigid scope 801 is
transmitted mechanically to the instrument 808 to change the
direction of the output with respect to the input with the scope
801 and the instrument 808 connected integrally with each other.
Therefore, the construction of the system is simple and never
hinders surgical operations. Since the manipulation of the input
portion 809 is transmitted to the output portion 810 by means of
the flexible wires and hoses, moreover, the system can enjoy a
simple configuration without requiring use of any complicated
mechanisms.
[0491] According to the present embodiment, the instrument 808 is
fixed integrally to the insert portion 801a of the rigid scope 801.
Alternatively, however, it may be fitted on the insert portion 801a
of the rigid scope 801, as in the case of the sheathing of a
conventional endoscope, or may be formed having a bipolar probe or
the like inserted therein, as in the case of the present
embodiment.
[0492] FIG. 67 shows a modification. In this modification, the
scope holder 807 is fixed mechanically to the upper chassis 808b by
means of a rotation regulating member 830. According to this
arrangement, the input portion 809 never fails to be situated right
in front of the operator if the rigid scope 801 is rotated around
the axis O1. Thus, the operation time can be shortened.
[0493] FIGS. 68 to 70 show another embodiment. In the description
of the present embodiment to follow, like reference numerals are
used to designate those components which are common to the present
embodiment and the embodiment shown in FIGS. 62 to 67, and a
description of those portions is omitted.
[0494] As shown in FIG. 68, an endoscopic surgical system according
to the present embodiment comprises a scope holder 840 that
supports the rigid scope 801 for sliding motion in X-, Y-, and
Z-axis directions. The holder 840 is fixed to a bedside stay 841a.
The holder 840 includes a rigid scope connecting member 842. The
connecting member 842 is provided with angle detecting means 843
for detecting the rotational angle of the rigid scope 801 compared
to the scope holder 840. The detecting means 843, which is formed
of an encoder 844 (see FIG. 70), serves to detect the rotational
angle of the insert portion 801a of the scope 801 around the
central axis O1.
[0495] Further, this endoscopic surgical system comprises an
instrument holder 845 that holds the instrument 808 for sliding
motion in the X-, Y-, and Z-axis directions. The holder 845, which
is fixed to a bedside stay 841b, includes an instrument connecting
member 846 for supporting the instrument 808.
[0496] As shown in FIG. 69, the instrument connecting member 846 on
the distal end portion of the instrument holder 845 includes a gear
847 that is fixed to the lower chassis 808a of the instrument 808
in a nonrotatable manner. The gear 847, along with the connecting
member 846, restrains the lower chassis 808a from moving along the
axis O3 and holds it for rocking motion around the axis O3 at the
joint 808c. On the other hand, the upper chassis 808b is restrained
from rocking around the axis O3 by means of a pin 852 that is
attached to the connecting member 846.
[0497] The instrument connecting member 846 is provided with a
motor 848 that is fixed to a holding member 899. A gear 849 in mesh
with the gear 847 is fixed coaxially to an output shaft 848a of the
motor 848. The input and output portions 809 and 810 of the
instrument 808 and the mechanism for transmitting their motions are
constructed in the same manner as the ones according to the first
embodiment.
[0498] As shown in FIG. 70, the encoder 844 that constitutes the
angle detecting means 843 is connected to a control circuit 850.
The circuit 850 is connected to a motor driver circuit 851 that is
connected to the motor 848. In response to an input signal from the
encoder 844, the control circuit 850 delivers a given signal to the
driver circuit 851 according to predetermined conditions, in order
to rock the instrument 808 around the axis O3 in the same direction
and at the same angle as the rotation of the rigid scope 801 around
the central axis O1.
[0499] The following is a description of the operation of the
endoscopic surgical system constructed in this manner.
[0500] If the rigid scope 801 is rotated around the axis O1, the
rotational angle of the rigid scope 801 compared to the rigid scope
connecting member 842 is detected by means of the encoder 844 of
the angle detecting means 843, and angle information is delivered
to the control circuit 850. Based on this angle information, the
control circuit 850 computes the rotational angle of the rigid
scope 801, and delivers a signal to the motor driver circuit 851 to
rotate the instrument 808 for the same angle. In response to this
input signal, the driver circuit 851 causes the motor 848 to rotate
for a required amount. The rotation of the motor 848 is transmitted
to the lower chassis 808a with the gear 847 in mesh with the gear
849 that is fixed coaxially to the output shaft 848a, whereupon the
chassis 808a rotates for the same angle as the rigid scope 8O1.
Thus, the observational direction of the scope 801 and the
direction of the output portion 810 of the instrument 808 have the
same relation as in the embodiment shown in FIGS. 62 to 67. In this
state, the upper chassis 808b is prevented from rotating with
respective to the instrument connecting member 846 by the agency of
the pin 852. Therefore, the position of the input portion 809
compared to the operator 700 never changes. Accordingly, the
direction of the operator's manipulation of the instrument 808 can
be made to coincide with the moving direction of the instrument 808
on the monitor 805. If the output portion 810 of the instrument 808
is deviated from the range of observation as the rigid scope 801
rotates around the central axis O1, the instrument 808 is moved in
the X-, Y-, and Z-axis directions for adjustment by means of the
instrument holder 845.
[0501] As described above, the present embodiment, unlike the
embodiment shown in FIGS. 62 to 67, is designed so that the
rotation of the rigid scope 801 around the direction of insertion
is detected electrically, and the output portion 810 of the
instrument 808 is rotated electrically. Therefore, the scope 801
and the instrument 808 can be held separately from each other, so
that they can be inserted from different directions into different
positions, depending on the conditions of the surgical operation.
Thus, the system of the present embodiment can cope with a wide
variety of styles of surgical operations.
[0502] According to the present embodiment, moreover, the rotation
of the rigid scope 801 is detected by means of the encoder 844.
Alternatively, however, it may be detected by means of conventional
optical position detecting means, which is designed so that an
illuminant is connected to the rigid scope 801, its image is picked
up by means of image-pickup means (TV camera), and the position and
rotational angle of the rigid scope are computed in accordance with
the resulting image-pickup signal. Thus, the position detection can
be effected even without the use of any scope holder.
[0503] FIG. 71 shows still another embodiment. The rigid scope 801,
TV camera system 803, monitor 805, scope holder 840, and rotational
angle detecting means for detecting the position of the rigid scope
801 with respect to the holder 840, according to the present
embodiment, are constructed in the same manner as the ones
according to the foregoing embodiment, so that a description of
those components is omitted. The following is a description of an
instrument 863, a component of an alternative construction,
only.
[0504] In FIG. 71, numeral 860 denotes a slave manipulator
(hereinafter referred to as treatment manipulator) that has the
instrument 863 fixed on its distal end and is attached to the
bedside stay 841b. The treatment manipulator 860 is composed of a
first operating arm 860a for use as a support mechanism movable in
the vertical direction and turning direction, a second operating
arm 860b attached to the first arm 860a and movable in the
horizontal direction, and a joint portion 860c attached to the
distal end portion of the second arm 860b. Further, the treatment
manipulator 860 is connected, by means of a manipulator control
device 861 and a direction changing circuit 865, to a master
manipulator 862 in a region that is accessible to the operator.
[0505] As is generally known, the manipulator control device 861
receives a signal from the master manipulator 862 and delivers a
driving signal to the treatment manipulator 860 such that the
manipulator 860 moves in the same manner as the manipulator 862
does.
[0506] The direction changing circuit 865 is connected with an
encoder 844 that constitutes the same angle detecting means 843 as
aforesaid. On receiving an input signal from the encoder 844, the
circuit 865 changes a signal from the manipulator control device
861 according to a given transformation formula, and delivers a
driving signal for changing the operating direction of the
treatment manipulator 860, compared to the manipulation of the
master manipulator 862, to the manipulator 860.
[0507] The first and second operating arms 860a and 860b of the
treatment manipulator 860 have the drive structure of a manipulator
of a so-called cylindrical-coordinate type, formed of vertical,
turning, and horizontal operation axes e, f and g that are
activated by means of actuators (not shown), such as
electromagnetic motors. Alternatively, however, the operating arms
may have the structure of a so-called multi-joint manipulator
formed of a plurality of joint portions. The joint portion 860c is
connected to the instrument 863 so that it can be actuated by means
of an actuator, such as an electromagnetic motor, to tilt the
instrument 863 around two axes h and i that extend at right angles
to each other.
[0508] The following is a description of the operation of the
endoscopic surgical system constructed in this manner.
[0509] A distal end position Q of the instrument 863 that is
connected to the treatment manipulator 860 is known by means of the
manipulator control device 861, based on the respective operating
positions of the vertical, turning, horizontal, and tilting axes e,
f, g, h and i and the geometric dimensions of the individual
members. On the other hand, the position of a point of action 862a
of the master manipulator 862 is obtained by computation by means
of the manipulator control device 861. A signal is delivered from
the control device 861 to the direction changing circuit 865 such
that the instrument distal end Q moves to the position of the point
of action 862a of the master manipulator 862. As in the case of the
foregoing embodiment, moreover, the observational direction of the
rigid scope 801 is detected by means of the encoder 844 of the
angle detecting means 843 and transmitted to the direction changing
circuit 865.
[0510] Based on the signal from the encoder 844, the direction
changing circuit 865 computes the input signal from the manipulator
control device 861 according to a previously stored computational
formula, and delivers a driving signal to the treatment manipulator
860 such that the manipulating direction of the master manipulator
862 is always coincident with the moving direction of the
instrument 863 on the monitor 805. Thus, the signal is delivered to
the treatment manipulator 860 so that the moving direction of the
distal end position Q of the instrument 863 displayed on the screen
of the monitor 805 is coincident with the manipulating direction of
the master manipulator 862, as in the case of the foregoing
embodiment. Thereupon, the direction of the operator's manipulation
of the instrument 863 is coincident with the moving direction of
the instrument 863 on the monitor 805.
[0511] According to the present embodiment, as described above, the
instrument 863 can be remotely manipulated by means of the master
manipulator 862, so that the operator can carry out a surgical
operation in any convenient position without restrictions on the
location of the manipulator 862. Thus, the operator can perform the
operation in a more comfortable posture.
[0512] In short, the endoscopic surgical systems described with
reference to FIGS. 62 to 71 comprises an endoscope capable of
observation in directions different from the direction of its
insertion; image-pickup means connected to the endoscope and
capable of picking up an observational image of the endoscope;
display means for displaying information from the image-pickup
means; an instrument including an input portion for an operator's
manipulation, an output portion adapted to operate in response to
the manipulation of the input portion, and operating direction
changing means capable of changing the operating direction of the
output portion with respect to the input portion; and control means
adapted to operate the operating direction changing means as the
direction of observation around the direction of insertion of the
endoscope changes.
[0513] In this system, the control means drives the operating
direction changing means to control the operating direction of the
output portion of the instrument with respect to the direction of
manipulation of the input portion, in response to vertical and
horizontal shifts of an affected region on the display means caused
when the endoscope rotates around the direction of insertion. The
operating direction of the output portion of the instrument on the
display means is controlled so that it is always coincident with
the direction of actual manipulation of the input portion of the
instrument. Thus, if the operator manipulates the input portion of
the instrument in the same direction as the direction in which the
output portion of the instrument is expected to move, while
watching the display means, the output portion moves in the
intended or expected direction on the display means. Accordingly,
the moving direction need not be considered or confirmed during the
surgical operation. In consequence, the manipulation of the
instrument is easy, the operation time is shortened, and therefore,
the operator's fatigue can be eased.
[0514] Preferably, the operating direction changing means includes
manipulation transmitting means for transmitting the manipulation
of the input portion to the output portion and a rotating portion
capable of rotating the output portion around the direction of
insertion of the instrument into the affected region, with respect
to the input portion, and the control means includes rotation
transmitting means for transmitting the rotation around the
direction of insertion of the endoscope, thereby rotating the
rotating portion. When the endoscope rotates around the direction
of insertion, in this case, the rotation transmitting means rotates
the rotating portion of the instrument. Thereupon, the output
portion rotates around the direction of insertion with respect to
the input portion of the instrument. In this state, the
manipulation transmitting means transmits the manipulation of the
input portion to the output portion, so that the operating
direction of the output portion is changed with respect to the
input operation.
[0515] The manipulation transmitting means may be mechanical
transmitting means.
[0516] In the case where the rotation transmitting means is
provided with a connecting member for connecting the endoscope and
the instrument integrally to each other, the connecting member
causes the instrument to rotate integrally with the rigid scope so
that the rotating portion of the instrument rotates when the
endoscope rotates around the direction of insertion. Thereupon, the
output portion rotates in the direction of insertion with respect
to the input portion of the instrument. In this state, the
manipulation transmitting means transmits the manipulation of the
input portion to the output portion, so that the operating
direction of the output portion is changed with respect to the
input operation.
[0517] Preferably, the rotation transmitting means includes
rotation detecting means for detecting the rotational displacement
of the endoscope in the direction of insertion with respect to a
given region, drive means capable of rotating the rotating portion,
and electrical control means for controlling the drive of the drive
means in accordance with a signal from the rotation detecting
means. In this case, the rotation of the endoscope around the
direction of insertion is detected by the rotation detecting means
and applied to the electrical control means. Based on this input
signal, the electrical control means drives the drive means to
rotate the rotating portion. Thereupon, the output portion rotates
in the direction of insertion with respect to the input portion of
the instrument. In this state, the manipulation transmitting means
transmits the manipulation of the input portion to the output
portion, so that the operating direction of the output portion is
changed with respect to the input operation.
[0518] The rotation detecting means may be an encoder.
[0519] Preferably, moreover, the rotation detecting means is
provided with an optical illuminant, second image-pickup means for
picking up an image of the optical illuminant, and optical position
detecting means including computing means for computing the
rotational angle of the endoscope in accordance with a signal from
the second image-pickup means.
[0520] The drive means may be a motor.
[0521] The mechanical transmitting means may be provided with a
first flexible member and a second flexible member capable of being
displaced relatively to the first flexible member. Preferably, the
first flexible member is a wire, and the second flexible member is
a hose fitted on the wire.
[0522] Further, there may be provided an endoscopic surgical system
comprising an endoscope capable of lateral observation;
image-pickup means connected to the endoscope and capable of
picking up an observational image of the endoscope; display means
for displaying information from the image-pickup means; an
instrument including a master manipulator for an operator's
manipulation, a slave manipulator adapted to operate in response to
the manipulation, and manipulator control means for controlling the
slave manipulator so that the slave manipulator operates following
the master manipulator; rotation detecting means for detecting the
rotational displacement of the endoscope around the direction of
insertion, and manipulator operating direction changing means for
controlling the operating direction of the slave manipulator in
accordance with information from the manipulator control means and
the rotation detecting means.
[0523] Additional advantages and modifications will readily occur
to those skilled in the art. Therefore, the invention in its
broader aspects is not limited to the specific details and
representative embodiments shown and described herein. Accordingly,
various modifications may be made without departing from the spirit
or scope of the general inventive concept as defined by the
appended claims and their equivalents.
* * * * *