JPH11197156A - Catheter with integrated surgical tool - Google Patents

Abstract

PROBLEM TO BE SOLVED: To use a catheter for exactly distinguishing a small separation causing a problem between a surgical tool and a surgical treatment part and a small separation not causing a problem by constituting a monitoring configuration part so as to deal with the temporary change of the monitoring configuration part in a spatial separation. SOLUTION: A detector 5 receives the sine fluctuation ultrasonic signal of reflected illumination, supplies that signal to an analyze 6 and converts it to digital indication. Through programming based on well-known techniques, the analyzer 6 compares the frequency of a reflected waveform from the detector 5 with the frequency of a wavefom used for a generator 9 and provides information on the temporary change of relative separation between an electrode 3 and the surgical treatment part. For example, a skilled person can expect the sudden repetition of fibrous contraction of the heart just under the surgical operation of the heart. In such a case, the rapid and small amplitude change is predicted in the beginning. The monitoring system of the temporary change can detect such a rapid action and suppresses the operation of the electrode 3 before enlarging a spatial breakaway.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

FIELD OF THE INVENTION The present invention relates to a surgical instrument for in-body surgery, which includes a catheter, the catheter comprising an operably connected surgical tool, a monitoring component and , Control means, wherein the monitoring component is operable to monitor the spatial separation of the surgical tool from a region inside the body to be operated on by the surgical tool, and further comprises the monitoring change. Provides a control signal output when exceeds a predetermined threshold, the control means, in order to suppress the operation of the surgical tool according to the signal coming out,
A surgical instrument operably connected to the monitoring component.

[0002]

BACKGROUND OF THE INVENTION Many surgical procedures today exist because of the benefits of using minimally invasive surgical techniques. Such surgical techniques use surgical tools, such as resection electrodes and small scalpels incorporated into catheters, for separation of some tissue inside the body, and sensors for mapping inside the body. Skilled surgeons using such surgical tools must be able to perform delicate body tissue operations, such as the heart and brain, within very small errors and without the need for large incisions. No.

[0003] When performing a procedure using a catheter in which such a tool is incorporated, it is inevitable for a surgeon who operates the catheter using only a monitor image of a body part of the patient near the catheter using a computer or the like. High concentration is required. In modern operating rooms, there are many instruments using electronics such as monitors required by surgeons. When the surgeon's attention is so diverse, in some cases, some movement of the catheter device can occur at the current treatment site, causing some damage to the heart tissue and surrounding tissue of the surgical treatment site,
When shooting without quickness, an error occurs.

[0004] In addition, when operating on a body part with a natural movement, such as a beating heart, the surgeon is frequently forced to modify the catheter to accommodate the movement of the body part. This correction is even more difficult when unexpected or sudden movements occur. Under these circumstances, separation between the surgical procedure site and the surgical instrument suddenly occurs, and even if the degree of separation is small,
This, in turn, can lead to damage to heart tissue and tissue surrounding the surgical site.

[0005] Positioning systems that can sense the position of the catheter within the body using a non-ionizing beam are known. Examples of such systems are eg US patent applications
US Pat. No. 5,042,486 and US patent application US Pat. No. 5,391,199. In these systems, electromagnetic or ultrasonic beams are used for catheter tracking. PCT WO 95/09562 discloses a catheter tracking system using a magnetic field. This is incorporated herein by reference. In this system, the catheter to be tracked is equipped with a beam receiver or transmitter, and a complementary transmitter or receiver is also located outside the body. From the beam received from the transmitter, information analysis is performed on the position of the catheter inside the body. With the additional use of a computer, this information is overlaid on an image of the desired internal body part of the patient captured using conventional imaging techniques (eg, x-ray, magnetic resonance, ultrasound, etc.). .
The combined contrast image is used by the surgeon to guide the catheter incorporating the surgical tool through the body to the surgical site. WO 9
5/17131 discloses an ablation catheter with an ultrasonic sonar or radar positioning system similar to that described above. The positioning system is additionally connected to the power supply of the ablation catheter, so that the energy supply to the ablation electrode is controlled by the detection position of the catheter and the separation between the catheter and the site to be ablated. This is done depending on the state. In this system, if the separation exceeds a predetermined threshold, power to the electrodes is automatically cut off.

[0006] However, if the separation threshold is set too high, there is a risk of damaging the heart tissue and the tissue around the resection site. If the separation threshold is set too low, a surgical procedure may be performed. Unnecessary resection of the site causing the current problem may occur.

[0007]

SUMMARY OF THE INVENTION It is an object of the present invention to accurately distinguish between problematic and non-trivial small separations between a surgical tool and a surgical site. It is an object of the present invention to provide a control means for operating a catheter which incorporates a surgical tool, such as an ablation electrode.

[0008]

SUMMARY OF THE INVENTION The above object is achieved according to the invention in that a monitoring component is arranged and adapted to adapt to temporary changes of the monitoring component in spatial separation.

According to the surgical instrument of the present invention, the time automatically detected depending on changes in the spatial separation between the surgical tool and the surgical site exceeds a predetermined safety limit. In addition, the operation of the catheter in which the surgical tool is incorporated is suppressed. This will detect any signs (excessive separation) that could lead to erroneous detachment of the tissue.

[0010] Advantageously, for the separation to be monitored, an emitter / detector device is used which is configured to operate as a sonar or radar and is positionable within the patient. Also preferably, the emitter / detector device is located inside or on the catheter. In this way, there is no need to insert additional catheters into the patient's body beyond those normally used in surgical procedures.

[0011] It is further advantageous that the operation of the surgical tool is automatically suppressed, for example, by de-energizing or reducing the power of the removal catheter or laser scalpel, or by accommodating the blade of the cutting instrument, or from the current surgical procedure. It is automatically suppressed to further reduce the surgeon's distraction.

[0012] Further advantageously, according to the surgical instrument of the present invention, in order to make the surgeon aware of the moment of the problematic separation, an acoustic or visual alarm is additionally or selectively provided. Is provided to warn the surgeon that a temporary change in the relative separation between the surgical tool and the surgical site has exceeded a predetermined limit.

[0013]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Next, the present invention will be described in detail with reference to the drawings.

Referring to FIG. 1, a surgical instrument 1 includes a catheter 2. This catheter 2 has an ablation electrode 3 at one end and a complementary ultrasound emitter 4 and a detector 5 component close to the electrode, which component comprises an analyzer 6 and is programmed accordingly. Operably connected to the output side of the detector 5 in the form of a connected computer.

The analyzer 6 is operably connected to an ablation electrode power supply controller 7 and an alarm 12 via a cable 8, and further connected to a waveform generator 9 via a cable 10. This waveform generator 9 is also connected to the ultrasonic emitter 4.

In use, the ablation electrode 3 is positioned at a surgical site, such as within the heart of a patient. The surgeon controls the movement of the catheter 2 to maintain that position during the surgical procedure. The operation of the power supply controller 7 is manually operated by the surgeon via the input side 11. The input side 11 is connected to, for example, a foot control type on / off switch.

The waveform generator 9 provides a sinusoidal variation supply to the ultrasound emitter 4, which in turn emits a corresponding sinusoidal ultrasound output to reveal the body area including the surgical site. I have to. The waveform generator 9 serves for displaying the supply waveform in a form suitable for use of the analyzer 6 via the cable 10.

The following method is apparent to a skilled person. That is, a sinusoidal waveform may be formed which can be used selectively by the analyzer 6 to provide a corresponding output from the generator 9.

The detector 5 receives a sinusoidally fluctuating ultrasonic signal composed of reflected illumination. This signal is supplied to an analyzer 6, where it is converted to a digital representation. Analyzer 6
Is programmed using known programming techniques, and compares the frequency of the reflected waveform from detector 5 with the frequency of the waveform used by generator 9. This comparison provides information about temporal changes in the relative separation between electrode 3 and the surgical procedure site.

For example, according to the skilled person, the following can be expected during cardiac surgery. That is, it can be expected that the heart suddenly repeats fibrous contractions. In such a case, a sudden and small amplitude change is expected at first. A monitoring regime for temporary changes allows the detection of this sudden movement, thereby suppressing the operation of the electrodes 3 before the spatial deviation increases.

The analyzer 6 has a threshold value which is programmed for comparison with a predetermined value but can be changed externally. If the analyzer identifies that the threshold value is exceeded, it forms an output signal by itself and sends it to the ablation electrode power supply controller 7.
This signal is used by this controller 7 to suppress the power supply to the electrodes 3.

The output signal of the analyzer 6 is a sensor alarm 12
It is clear that it can be used additionally or selectively for the control of. This sensor alarm may be a warning lamp, which helps to draw the surgeon's attention to the fact that the threshold has been exceeded.

FIG. 1 shows that the surgical instrument 1 comprises a conventional positioning system as described, for example, in US Pat. No. 5,042,486. A radio frequency (RF) transmission antenna 13 is disposed near the ablation electrode 3 inside the catheter 2, and is supplied from an RF transmitter 14. The receiving antennas 15a, b, c are provided on the body 18 of the patient,
It is operatively connected to a signal processor 16. This signal processor 16 controls the ablation electrode 3 in the catheter.
RF received from antenna 13 to detect the position of
The signal is analyzed based on, for example, the flight analysis time of the transmitted RF waveform. This detected position is used in a known manner to guide the catheter 2 to the surgical treatment site with the aid of the surgeon.

Further, the detected position of the catheter 2 may be used to control the operation of the electrode 3 when the physical separation between the electrode 3 and the surgical treatment site exceeds a predetermined threshold value. It is also used to form control signals. This control signal is supplied from the signal processor 16 to the controller 7 via the cable 17 in this embodiment. By appropriate selection of the threshold value, this control means is adapted in the present invention as a safety backup control.

[Brief description of the drawings]

FIG. 1 schematically shows an embodiment of the invention with a sonar device and a positioning system.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Surgical instrument 2 Catheter 3 Surgical tool 4 Ultrasonic emitter 5 Detector 6 Analyzer 7 Controller 8,10 Cable 9 Waveform generator 12 Control means

Claims (5)

[Claims] 1. A surgical instrument (1) for a surgical procedure in a body, comprising a catheter (2), wherein the catheter (2) is operatively connected to a surgical tool (3).
A monitoring component (4, 5, 6) and a control means (7, 12)
Wherein said monitoring component (4,5,6) is used to monitor the spatial separation of said surgical tool (3) from an internal body area to be operated on by said surgical tool (3). Providing a control signal output when the monitored change exceeds a predetermined threshold, wherein the control means (7, 12) operates the surgical tool (3) in response to the signal output In a form operably connected to the monitoring component (4,5,6) to reduce the monitoring component, the monitoring component (4,5,6) in a spatial separation A surgical instrument characterized in that it is adapted to adapt to temporary changes in the body. 2. The monitoring component includes an emitter (4) and a detector (5), wherein the emitter and the detector are disposed on a catheter (2) toward a surgical tool (3). ,
The analyzer is configured to irradiate a region of the body with a non-ionizing beam of periodically varying amplitude and to generate an output signal depending on the level of the irradiating beam reflected from the region, the analyzer comprising: 6) is operably connected to the detector (5) and adapts to the change of the monitoring frequency between the illuminated periodically varying signal and the correspondingly detected periodically varying signal. The surgical instrument of claim 1, wherein the surgical instrument is further configured to detect a temporal change in spatial separation from the region. 3. The control means includes an alarm (12) adapted to provide a sensing alert for operation of the surgical instrument to enable manual suppression of operation of the surgical tool. Item 3. The surgical instrument according to item 1 or 2. 4. The surgical instrument according to claim 1, wherein the control means includes a controller operable to automatically inhibit the function of the surgical tool. . 5. The surgical instrument according to claim 1, wherein the surgical tool includes an ablation electrode (3).