JP5646186B2 - Organ contactor and medical master / slave system - Google Patents

Description

  The present invention relates to an organ contact tool that contacts an organ and a medical master / slave system including the organ contact tool.

  In conventional cardiac surgery, access to the thoracic cavity is performed by incising the sternum (median sternotomy). When access to the thoracic cavity is performed as described above, the retractor is placed at the incision position of the chest, and the sternum and tissue are expanded by the retractor to form a large opening. A surgical instrument is then placed through the opening and a cardiac surgery is performed.

  By the way, one of the most common cardiac surgery is coronary artery bypass grafting (hereinafter referred to as CABG). In this CABG, an occlusion in one or more coronary arteries is bypassed by connecting a graft vessel (hereinafter referred to as a graft) to the coronary artery downstream of the occlusion.

  This technique of connecting a graft to a coronary artery is known as anastomosis. As the graft, for example, an internal thoracic artery incised from the chest wall is used. In this case, the upstream end of the internal thoracic artery is left intact, and the downstream end of the internal thoracic artery is connected to the coronary artery.

  Further, as the graft, an artery or vein from any part of the patient's body may be used. Furthermore, an artificial blood vessel graft can also be used as the graft. In this case, the upstream end of the graft is connected to an artery such as the aorta, and the downstream end is connected to the coronary artery. As described above, occlusion of multiple coronary arteries at various locations on the front, side and back of the heart is bypassed using multiple grafts.

  CABG is performed with the patient's heart stopped. Thus, the patient's blood is circulated using an oxygenator. However, CABG can also be performed while the heart is beating using a technique known as “off-pump coronary artery bypass (hereinafter referred to as OPCAB)”. That is, OPCAB can avoid the use of an oxygenator.

  In this OPCAB, the surface of the heart near the anastomosis site of the coronary artery is fixed using an instrument called a stabilizer while the heart is beating. By fixing the local heart surface (the surface of the heart near the anastomosis site of the coronary artery) by this stabilizer, the pulsation of the heart at the site can be suppressed. In other words, by using the stabilizer, the anastomosis site is kept from moving as much as possible while the graft is connected to the coronary artery, and a precise treatment can be performed.

  As a technique related to such a stabilizer, for example, Patent Document 1 discloses the following technique. That is, Patent Document 1 discloses a surgical field securing device that secures a surgical field when a predetermined treatment is performed on an organ, and includes a contact portion that contacts the organ, the organ and the organ. An operation field securing device including a manipulator holding portion that holds the manipulator portion while fixing a relative position to a manipulator portion that performs the above-described treatment is disclosed.

JP 2008-188113 A

  By the way, the surgical field securing device disclosed in Patent Document 1 adopts a structure in which a contact portion that contacts an organ and a manipulator portion are fixed by a manipulator holding portion. The structure for fixing the member that comes into contact with the organ and the surgical instrument in this manner is not a structure that increases the degree of freedom of treatment (treatment ease).

  The present invention has been made in view of the above-described circumstances, and an object thereof is to provide an organ contact tool and a medical master / slave system in which the degree of freedom of treatment (treatment ease) is improved.

In order to achieve the above object, an organ contact device according to the first aspect of the present invention comprises:
A plurality of contact portions that contact the organ;
A surgical instrument for treating the organ;
A contact part support part for supporting the contact part;
It is composed of one or more members respectively disposed on the plurality of contact portions so as to have at least one degree of freedom of movement, and rotatably disposed with respect to the plurality of contact portions. A manipulator holding part for holding one or more of the surgical tools used in the treatment;
An observation unit for observing the organ treated by the surgical instrument;
An observation holding unit that is provided in the contact part support unit and holds the observation unit;
Comprising
The manipulator holding portion and against the organ by the observation unit holder by rotating the surgical instrument and said applying treated.

In order to achieve the above object, a medical master-slave system according to the second aspect of the present invention comprises:
A medical master / slave system,
A master device that converts operation information into position / posture information and outputs it;
A control device for controlling the operation of the slave device based on the output of the master device;
Comprising
The slave device is
A plurality of contact portions that contact the organ;
A surgical instrument for treating the organ;
A contact part support part for supporting the contact part;
It is composed of one or more members respectively disposed on the plurality of contact portions so as to have at least one degree of freedom of movement, and rotatably disposed with respect to the plurality of contact portions. A manipulator holding part for holding one or more of the surgical tools used in the treatment;
An observation unit for observing the organ treated by the surgical instrument;
An observation holding unit that is provided in the contact part support unit and holds the observation unit;
Comprising
The manipulator holding portion and against the organ by the observation unit holding portion subjected to treatment by rotating the surgical instrument,
It is characterized by that.

  ADVANTAGE OF THE INVENTION According to this invention, the organ contact tool and medical master / slave system which improved the freedom degree (procedure ease) of treatment can be provided.

The figure which shows the example of 1 structure of the medical master / slave system to which the organ contact tool which concerns on 1st Embodiment of this invention was applied. The block diagram which shows the control system structure of the medical master / slave system shown in FIG. The perspective view which shows one structural example of an organ contact tool. The side view of the contact part in an organ contact tool. The figure which shows an example of a rotation operation mechanism. The side view of the contact part of the organ contact tool which concerns on the modification 1. FIG. The figure which shows the example of 1 structure of the organ contact tool which concerns on 2nd Embodiment. The figure which shows a node ring structure typically. The figure which shows the example of 1 structure of the organ contact tool which concerns on the modification 2. As shown in FIG. The figure which shows the example of 1 structure of the organ contact tool which concerns on the modification 3. FIG. The figure which shows one structural example of the organ contact tool using the surgical instrument holding part which comprised the manipulator holding part and the observation part holding part integrally.

Hereinafter, an organ contact device and a medical master / slave system according to an embodiment of the present invention will be described with reference to the drawings.
[First embodiment]
FIG. 1 is a diagram illustrating a configuration example of a medical master / slave system to which an organ contact tool according to a first embodiment of the present invention is applied. FIG. 2 is a block diagram showing a control system configuration of the medical master / slave system shown in FIG.

As shown in FIGS. 1 and 2, the medical master / slave system to which the organ contact device according to the present embodiment is applied includes a control unit 2, a master unit 4, a camera display unit 6, an organ contact device. And a slave main body 8 comprising:
The control unit 2 includes a calculation unit 2A that performs operations for performing operation control of each unit to be described later in the slave main body 8 based on an operation of the master unit 4 by a user, and a slave based on the calculation result by the calculation unit 2A. A slave main body control section 2B that controls the operation of the main body 8, a power supply section 2C for supplying power to each of the control unit 2, the master section 4, the camera display section 6, and the slave main body 8, and an observation section that will be described later 10B5 and the observation camera unit 14, and a camera control unit 2D that performs display control on the camera display unit 6 of images acquired by the 10B5 and the observation camera unit 14.

The master unit 4 converts an operation performed by the user on the master unit 4 into position / posture information and outputs the position / posture information to the calculation unit 2A of the control unit 2.
The camera display unit 6 outputs and displays an image acquired by imaging by the observation unit 10B5 and the observation camera unit 14.
The slave body 8 includes an organ contact tool slave portion 10 including the organ contact tool 10B according to the first embodiment, a manipulator slave portion 12 for performing various treatments on the organ and the like, and the manipulator slave portion 12. And an observation camera unit 14 that captures and acquires an image of a site to be treated or the like.

  The organ contact tool slave unit 10 supports an organ contact tool 10B and an organ contact tool support arm unit 10A for moving the organ contact tool 10B to a user's desired position under the control of the slave main body control unit 2B. This is a slave device having a motor 11A for driving the organ contact tool support arm 10A, an organ contact tool 10B described later, and a motor 11B for operating the organ contact tool 10B under the control of the slave main body control section 2B.

  In FIG. 1, the dimension of the organ contact tool 10B is drawn larger than the dimension of the body wall passage portion through which the organ contact tool 10B passes, but this is the organ contact tool according to the first embodiment. This is due to expedient considerations for facilitating understanding of 10B. Therefore, it goes without saying that the dimension of the organ contact tool 10B is actually a dimension that can pass through the body wall passage portion.

As shown in FIG. 2, the organ contact tool 10B includes a contact part 10B1, a manipulator part 10B2, an organ contact tool support part 10B3, a manipulator holding part 10B4, an observation part 10B5, an observation part holding part 10B6, Is provided.
FIG. 3 is a perspective view showing a configuration example of the organ contact tool 10B. FIG. 4 is a side view of the contact portion 10B1 in the organ contact tool 10B.

  As shown in FIG. 4, the contact portion 10B1 includes a contact base portion 10B1a that comes into contact with an organ 50 (for example, the heart), and a surgical instrument holding portion 10B1b that holds various surgical tools. In the side view shown in FIG. 4, for convenience of explanation, a cross-section is shown with respect to an engagement portion between the contact base portion 10B1a and the surgical instrument holding portion 10B1b.

  The contact base portion 10B1a is a substantially ring-shaped member that engages with one or more suction ports 10b1 provided on a surface that comes into contact with the organ 50 and a recess portion 10b3 of the surgical instrument holding portion 10B1b described later. 50, and a convex portion 10b2 that holds the surgical instrument holding portion 10B1b so as to be rotatable in a substantially horizontal direction with respect to the surface. Due to the contact of the contact base 10B1a with the organ 50, the contact base 10B1a pulsates in synchronization with the pulsation of the organ 50.

  Although details will be described later, the surgical instrument holding part 10B1b engaged with the contact base part 10B1a, the manipulator part 10B2 and the observation part 10B5 held by the surgical instrument holding part 10B1b are naturally synchronized with the organ 50. Move. Thereby, the relative positional relationship between the manipulator unit 10B2 and the observation unit 10B5 and the organ 50 is always fixed regardless of the pulsation of the organ 50. Therefore, even if the pulsation of the organ 50 cannot be completely suppressed, a desired treatment can be performed on the organ 50 by the manipulator unit 10B2 without being inhibited by the pulsation of the organ 50.

  The surgical instrument holding portion 10B1b is a substantially annular member that follows the outer shape of the contact base portion 10B1a, and has a concave portion 10b3 that engages with the convex portion 10b2 of the contact base portion 10B1a on the contact base portion 10B1a, and a peripheral wall portion 10w in the radial direction. A through-hole portion 10b4 that penetrates, and a screw-hole portion 10b5 into which a surgical-tool fixing screw 106 that presses and fixes a surgical instrument or the like inserted into the through-hole portion 10b4 in a direction perpendicular to the surface of the organ 50 is screwed. .

  A suction tube T1 is connected to the suction port 10b1. The suction port 10b1 is adsorbed and fixed to the organ 50 by applying a negative pressure via the connected suction tube T1. That is, the suction port 10b1 is a constituent requirement for firmly fixing the organ contact tool 10B to the organ 50. Of course, the suction port 10b1 is not necessary if the organ contact tool 10B and the organ 50 are in stable contact with each other so as to be synchronized.

In the case where the organ 50 is a beating organ such as a heart, for example, the organ 50 and the contact portion 10B1 pulsate synchronously, so that treatment with a surgical instrument or the like supported by the surgical instrument holding portion 10B1b is performed as if the organ 50. It can be performed as if there is no pulsation.
As the convex portion 10b2 and the concave portion 10b3 are engaged, the surgical instrument holding portion 10B1b is held on the contact base portion 10B1a so as to be rotatable in a substantially horizontal direction with respect to the organ 50 surface. In other words, the surgical instrument holding portion 10B1b is held by the contact base portion 10B1a so that the movement with respect to the surface of the organ 50 has one degree of freedom.

  Of course, the contact base portion 10B1a and the surgical instrument holding portion 10B1b may be engaged by providing the contact base portion 10B1a with the concave portion 10b3 and providing the surgical instrument holding portion 10B1b with the convex portion 10b2. That is, in the engagement between the contact base portion 10B1a and the surgical instrument holding portion 10B1b with the concavo-convex structure, the member provided with the convex portion 10b2 / concave portion 10b3 is not limited. Moreover, as a formation site | part of the said uneven | corrugated structure, the radial direction inner side, radial direction outer side, and radial inner side outer side of a substantially cyclic | annular member (contact base 10B1a, surgical-tool holding | maintenance part 10B1b) can be mentioned, for example.

  In the through-hole portion 10b4, for example, a surgical instrument such as an observation unit 10B5 such as an endoscope or a manipulator unit 10B2 (or a guide tube 105 that is a tubular member through which the manipulator unit 10B2 or the like is inserted) is provided at the distal end of the surgical tool. Is inserted into the hollow portion of the contact portion 10B1 so as to be exposed to the organ 50.

Since this through-hole part 10b4 is provided with two or more by the surrounding wall part 10w of cyclic | annular surgical tool holding | maintenance part 10B1b, a several surgical tool can be utilized simultaneously.
As shown in FIG. 3, the surgical instrument holding portion 10B1b is configured by inserting the guide tube 105 into the through hole portion 10b4 and inserting the surgical instrument such as the manipulator portion 10B2 through the guide tube 105. It is easy to insert and remove the surgical tool. That is, since the surgical instrument is guided by the guide tube 105, the surgical instrument can easily reach the hollow portion of the surgical instrument holding part 10B1b, and the surgical instrument can be easily replaced.

  The screw hole portion 10b5 is formed perpendicular to the through hole portion 10b4 (perpendicular to the radial direction of the substantially annular surgical instrument holding portion 10B1b). The surgical instrument fixing screw 106 screwed into the screw hole portion 10b5 is used for operating tools such as the observation unit 10B5 and the manipulator unit 10B2 inserted into the through-hole portion 10b4 (or the guide tube 105 through which they are inserted). Press and fix in a direction substantially perpendicular to the surface of the organ 50. With this configuration, the surgical instrument (and the guide tube 105 through which they are inserted) is fixed so that it cannot be inserted and removed.

Note that this fixing may be performed as necessary, and when complete fixing is not necessary, it may of course be fixed to such an extent that it can be slightly inserted and removed. By fixing to such an extent that it can be slightly inserted and removed, it is possible to handle the surgical instrument more flexibly.
Hereinafter, an example of a mechanism for rotating the surgical instrument holding unit 10B1b on the contact base 10B1a (hereinafter referred to as a rotation operation mechanism) will be described. FIG. 5 is a top view showing an example of the rotation operation mechanism. For convenience of explanation, illustration of members other than the surgical instrument holding portion 10B1b is omitted in FIG.

As shown in FIG. 5, the rotation operation mechanism includes a pair of drive cables 10c1 and 10c2 and cable pipes 10d1 and 10d2 through which the drive cables 10c1 and 10c2 are inserted.
The drive cables 10c1 and 10c2 are small-diameter wires having one end fixed to the outer peripheral wall surface 10wo of the surgical instrument holding unit 10B1b and the other end connected to an operation unit (not shown). The fixing point 10s1 between the drive cable 10c1 and the outer peripheral wall surface 10wo of the surgical instrument holding portion 10B1b and the fixing point 10s2 between the drive cable 10c2 and the outer peripheral wall surface 10wo of the surgical instrument holding portion 10B1b are a straight line L ( It is preferable that they are provided substantially symmetrically with respect to a straight line passing through the center of the circle having the outer peripheral wall surface 10wo as a circumference.

  The cable pipes 10d1 and 10d2 are tubular members that house the drive cables 10c1 and 10c2, respectively. The cable pipes 10d1 and 10d2 may be provided fixed to the suction pipe T1, for example, or may be provided separately from the suction pipe T1.

  As a rotation operation method, a force is applied to the surgical instrument holding part 10B1b via the fixing points 10s1 and 10s2 by appropriately adjusting the tension of the drive cables 10c1 and 10c2 by the operation part (not shown). As a result, the surgical instrument holder 10B1b rotates on the contact base 10B1a. Detailed operation means will be described later.

By this rotation operation, for example, the surgical instrument holding part 10B1b is substantially horizontal with respect to the surface of the organ 50 while maintaining the relative positional relationship between the observation part 10B5 such as an endoscope and the manipulator part 10B2 which is a treatment tool. Can be rotated in the direction.
That is, the treatment can be performed as if the organ 50 itself is rotating. Therefore, the degree of freedom of treatment (treatment ease) is dramatically improved as compared with the prior art.

  By the way, the manipulator unit 10B2 is an instrument that constitutes a treatment instrument for performing a treatment or the like on the organ 50. In addition, it is preferable to comprise this manipulator part 10B2 with what is called a soft material provided with the bending part mentioned later from a viewpoint of improving the freedom degree of treatment. However, as a matter of course, the manipulator portion 10B2 may be formed of a so-called hard material that does not include a bent portion.

The organ contact tool support 10B3 is a member that connects the organ contact tool 10B and the support arm 10A.
The manipulator holding part 10B4 is a member that connects and holds the manipulator part 10B2 to the organ contact tool support part 10B3.
The observation unit 10B5 is an image pickup device that picks up an image of a part to be treated by the manipulator unit 10B2.

The observation part holding part 10B6 is a member that connects and holds the observation part 10B5 to the organ contact tool support part 10B3.
By the way, the manipulator slave unit 12 supports a manipulator mechanism unit 12B and a manipulator support arm unit 12A for moving the manipulator mechanism unit 12B to a user's desired position under the control of the slave body control unit 2B, and a manipulator support arm. A motor 13A for driving the part 12A, a manipulator mechanism part 12B for performing a desired treatment on the organ 50, and a motor 13B for operating the manipulator mechanism part 12B under the control of the slave body control part 2B. Prepare.

The manipulator slave unit 12 is not a feature of the present invention, and a detailed description thereof will be omitted.
The observation camera unit 14 supports the observation camera 14B, and the observation camera support arm unit 14A for moving the observation camera 14B to a user's desired position under the control of the slave main body control unit 2B, and the observation camera support arm unit 14A. And an observation camera 14B that captures and acquires an image for observing a region where the organ 50 is pressed by the organ contact tool slave unit 10, a region where the manipulator slave unit 12 treats the organ 50, and the like. .

The observation camera unit 14 is not a feature of the present invention, and a detailed description thereof will be omitted.
By the way, the rotation operation of the surgical instrument holding portion 10B1b on the contact base portion 10B1a described above can be realized mainly by the following two means.
<< Operation means 1 >> Manual operation of the surgeon ・ With the movement of the surgical instrument operated by the surgeon, the surgical instrument holder 10B1b rotates on the contact base 10B1a.
The surgeon directly rotates the surgical instrument holder 10B1b on the contact base 10B1a.
<< Operation means 2 >> Operation using a drive member (for example, a motor and a wire)-A drive member for rotating the surgical instrument holder 10B1b on the contact base 10B1a is provided. For example, the drive member using the master unit 4 is provided. Is operated to rotate the surgical instrument holder 10B1b on the contact base 10B1a.

As described above, according to the first embodiment, it is possible to provide an organ contact tool and a medical master / slave system with improved treatment flexibility (treatment ease).
Specifically, the contact portion 10B1 that holds the manipulator portion 10B2 and the observation portion 10B5 and is fixed to the surface of the organ 50 is configured by the contact base portion 10B1a and the surgical instrument holding portion 10B1b. Then, the surgical instrument holding portion 10B1b and the contact base portion 10B1a are engaged so that the surgical instrument holding portion 10B1b can be rotated on the contact base portion 10B1a. By adopting such a configuration, it is as if an organ is maintained without changing the relative positional relationship between the manipulator unit 10B2 and the observation unit 10B5 while maintaining a state of being stably placed on the organ 50. The treatment can be performed by creating a state as if the 50 itself is rotating.

  Furthermore, the surgical instrument holding part 10B1b has at least one degree of freedom with respect to the contact base part 10B1a while maintaining the relative positional relationship between the manipulator part 10B2 and the observation part 10B5 supported by the surgical instrument holding part 10B1b. It is configured as follows. Therefore, no matter how the surgical instrument holding unit 10B1b moves, the position of the manipulator unit 10B2 with respect to the visual field by the observation unit 10B5 does not change. This markedly improved the ease of treatment.

Even if the pulsation of the organ 50 cannot be completely suppressed, the organ contact tool 10B can pulsate synchronously with the pulsation of the organ 50, so that a desired treatment can be performed on the organ 50 by the manipulator unit 10B2.
Further, as described above, since the image captured by the observation unit 10B5 that beats synchronously with the organ 50 is reproduced and output to the camera display unit 6, the state of the treatment applied to the organ 50 by the manipulator unit 10B2 It is possible to observe without suffering from blurring caused by 50 beats.

Furthermore, when exchanging an instrument such as a surgical instrument, the instrument can be exchanged only by inserting / removing the instrument with respect to the through hole 10b4. When the guide tube 105 is used, the insertion / removal operation is further facilitated.
In the first embodiment, the surgical instrument holder 10B1b that holds a surgical instrument or the like is configured to be relatively displaceable with respect to the organ 50. The joint structure that realizes this relative displacement may be a structure having at least one degree of freedom.

  In addition, you may comprise the surgical instrument holding | maintenance part 10B1b so that a movement to an up-down direction (arrow C direction shown in FIG. 3) is possible with respect to contact base 10B1a. As a result, the movable range of the observation unit 10B5 and the manipulator unit 10B2 with respect to the surface of the organ 50 is expanded, and the configuration has two degrees of freedom.

By the way, this 1st Embodiment is not limited to the above-mentioned aspect, Of course, for example, the following deformation | transformation and application are possible within the range of the summary of this invention.
<Modification 1>
Hereinafter, in order to avoid duplication of description, differences from the first embodiment will be described. FIG. 6 is a side view of the contact portion 10B1 of the organ contact tool 10B in the organ contact tool and medical master / slave system according to the first modification. In addition, in the side view shown in FIG. 6, the cross-section is shown about the engagement site | part of contact base 10B1a and operation tool holding | maintenance part 10B1b for convenience of explanation.

In the first modification, the contact base portion 10B1a has a screw hole formed through the convex portion 10b2 in the radial direction of the surgical instrument holding portion 10B1b, and a rotation restraining screw 10b6 screwed into the screw hole. Is provided.
On the other hand, the surgical instrument holding portion 10B1b has an engagement hole portion 10b7 into which a distal end of the rotation restraining screw 10b6 inserted into the screw hole formed in the convex portion 10b2 and inserted through the convex portion 10b2 is inserted at a predetermined interval. (For example, corresponding to the screw hole 10b5 as shown in FIG. 6).

  By adopting the above-described configuration, rotation of the surgical instrument holding portion 10B1b can be stopped and fixed in a state where the surgical instrument held by the surgical instrument holding portion 10B1b is directed in a desired direction. That is, the surgeon sets the contact base 10B1a and the surgical instrument holder 10B1b in a desired relative positional relationship (after turning the surgical instrument or the like held by the surgical instrument holder 10B1b in a desired direction), and then prevents rotation. The screw 10b6 is inserted into the engagement hole 10b7 and engaged to fix the surgical instrument holding unit 10B1b.

In other words, in the first modification, the rotation restraining screw 10b6 and the engagement hole portion 10b7 constitute a temporary fixing mechanism called a so-called “lock free mechanism”. This temporary fixing mechanism is particularly useful when the “operation means 1” is employed.
[Second Embodiment]
Hereinafter, an organ contact device and a medical master / slave system according to a second embodiment of the present invention will be described. In order to avoid duplication of explanation, differences from the first embodiment will be described.

  FIG. 7 is a diagram illustrating a configuration example of an organ contact tool according to the second embodiment. As shown in the figure, an organ contact tool 10B according to the second embodiment includes a contact part 10B1, a manipulator part 10B2, an organ contact tool support part 10B3, a manipulator holding part 10B4, an observation part 10B5, and an observation part. A part holding part 10B6 and a contact part support part 10B7 are provided.

  A difference from the organ contact tool according to the first embodiment is an aspect of each component. In the first embodiment, the degree of freedom of treatment is realized by the structure of the contact portion 10B1, but in the second embodiment, the degree of freedom of treatment is “manipulator holding portion 10B4 and observation portion holding portion 10B6” or the like. To achieve.

  The contact portion 10B1 is composed of two plate-like members and is a member having a substantially “U” shape together with the contact portion support portion 10B7. The contact portion 10B1 contacts the organ 50 and suppresses its pulsation. In addition, the fixing force to the organ 50 can be improved by providing the contact portion 10B1 with an adsorption portion (not shown) having a function of adsorbing to the organ 50.

The contact part support part 10B7 supports the contact part 10B1 in the above-described form, and is connected to the organ contact tool support part 10B3 (not shown in FIG. 7).
The manipulator portion 10B2 includes a bent portion 10B222 formed by connecting a plurality of joined bodies 10B22 so as to form a so-called “node ring structure”, and a grip portion 10B23 provided at the tip.

  Specifically, a long cable 10B25 having a small diameter such as a wire is inserted into the joined body 10B22 constituting the bent portion 10B222. FIG. 8 is a diagram schematically showing a node ring structure. Each connecting portion of the plurality of joined bodies 10B22 is configured to have a predetermined degree of freedom as a joint portion as shown in FIG. 8, so that the entire bent portion 10B222 can have a bent shape. Specifically, the bent portion 10B222 can be bent into a desired shape by appropriately adjusting the tension of the cable 10B25.

The cable 10B25 is inserted through the guide tube 10B25 ′ connected to the bent portion 10B222, and one end of the cable 10B25 is connected to the operation unit (not shown) for adjusting the tension described above or the control unit 2. Yes.
Furthermore, for example, a gripping part 10B23 is provided at the tip of the manipulator part 10B2. This grip 10B23 is operated by appropriately adjusting the tension of the cable 10B25 inserted into the joined body 10B22. That is, a desired treatment can be performed on the organ 50 by the manipulator unit 10B2 by appropriately adjusting the tension of the cable 10B25.

  The manipulator holding portion 10B4 is a cylindrical member that holds the manipulator portion 10B2 and is connected so as to form a joint portion having one degree of freedom with respect to the contact portion 10B1. Specifically, the manipulator holding portion 10B4 is formed by arranging a cylindrical member holding the manipulator portion 10B2 on the contact portion 10B1 on the outer peripheral surface thereof. Specifically, the cylindrical member is disposed on the contact portion 10B1 so as to be rotatable in the horizontal direction with respect to the surface of the organ 50.

The manipulator holding portion 10B4 is formed with a through hole penetrating in the radial direction. A bent portion 10B222 including a plurality of joined bodies 10B22 is inserted into the through hole, and the manipulator portion 10B2 is held.
The observation part holding part 10B6 is a cylindrical member that holds the observation part 10B5 and is connected so as to form a joint part having one degree of freedom with respect to the contact part support part 10B7. Specifically, the observation unit holding unit 10B6 includes a cylindrical member that holds the observation unit 10B5 disposed on the contact unit support unit 10B7 on the outer peripheral surface thereof. Specifically, the cylindrical member is disposed on the contact portion support portion 10B7 so as to be rotatable in the horizontal direction with respect to the organ 50 surface.

As described above, the manipulator unit 10B2 and the observation unit 10B5 are configured so as to have one degree of freedom that can be individually rotated in the horizontal direction with respect to the surface of the organ 50.
By the way, the contact portion 10B1 is in contact with the organ 50 stably to such an extent that it is synchronized with the pulsating organ 50. Accordingly, since the contact portion support portion 10B7 that supports the contact portion 10B1 also beats synchronously with respect to the organ 50, the observation portion 10B5 fixed to the contact portion support portion 10B7 by the observation portion holding portion 10B6, and the manipulator The manipulator unit 10B2 fixed to the contact unit 10B1 by the holding unit 10B4 also pulsates synchronously with the organ 50.

  The observation unit 10B5 is connected to a thin and long cable 10B51 for transmitting electrical signals for various operations and operations. The cable 10B51 is inserted into the guide tube 10B51 ′ and has one end thereof. Is connected to an operation unit (not shown) or the control unit 2.

  As described above, according to the second embodiment, the same effects as those of the organ contact tool and the medical master / slave system according to the first embodiment can be obtained, and the rotation operation of each surgical tool can be performed independently. It is possible to provide an organ contactor and a medical master / slave system that can be performed in this manner.

Specifically, since the manipulator holding unit 10B4 and the observation unit holding unit 10B6 have one degree of freedom that can rotate in the horizontal direction with respect to the surface of the organ 50, the manipulator unit 10B2 and the observation unit 10B5 themselves can be easily changed in direction. can do.
Here, as specific operation means for realizing the rotation operation, both << operation means 1 >> in the first embodiment, that is, manual operation by the operator, and << operation means 2 >>, that is, operation using the driving member. Can be applied.

A cylindrical member constituting the manipulator holding portion 10B4 is disposed so as to be movable in the longitudinal direction of the contact portion 10B1 (arrow A direction shown in FIG. 7), and the manipulator portion 10B2 itself is moved back and forth with respect to the organ 50 surface. You may comprise in 1 degree of freedom which can advance / retreat to a direction.
Furthermore, a cylindrical member constituting the manipulator holding portion 10B4 is disposed so as to be movable in the vertical direction (direction of arrow B shown in FIG. 7) with respect to the contact portion 10B1, and the manipulator portion 10B2 with respect to the organ 50 surface. You may comprise itself in 1 degree of freedom which can move to an up-down direction.

By the way, this 2nd Embodiment is not limited to the aspect mentioned above, Of course, the following deformation | transformation and application are possible within the range of the summary of this invention, for example. For example, by configuring the organ contact tool 10B as described below, the degree of freedom of movement of each surgical tool can be further improved.
[Modification 2]
Hereinafter, an organ contact tool and a medical master / slave system according to Modification 2 will be described. In order to avoid duplication of explanation, differences from the second embodiment will be described.

FIG. 9 is a diagram illustrating a configuration example of an organ contact tool according to the second modification. In the figure, the observation unit 10B5 and the observation unit holding unit 10B6 are not shown in order to prevent complication of the drawing, but it is needless to say that the organ contact tool 10B may be provided with them.
As shown in the figure, in the organ contact tool 10B according to the second embodiment, the manipulator holding portion 10B4 includes the first joint portion 10B41, the second joint portion 10B42, the third joint portion 10B43, and the fourth joint. Part 10B44.

  The first joint part 10B41 is a cylindrical member connected to the contact part 10B1 and the second joint part 10B42, and forms a joint part having one degree of freedom. Specifically, the first joint portion 10B41 is arranged vertically with respect to the contact portion 10B1, and is configured to be rotatable in the horizontal direction with respect to the surface of the organ 50.

  The second joint portion 10B42 is a cylindrical member connected to the first joint portion 10B41 and the third joint portion 10B43, and forms a joint portion having one degree of freedom. Specifically, the second joint portion 10B42 is disposed laterally with respect to the contact portion 10B1, and is configured to be rotatable in the intersecting direction with respect to the surface of the organ 50.

  The third joint portion 10B43 is a cylindrical member connected to the second joint portion 10B42 and the fourth joint portion 10B44, and forms a joint portion having one degree of freedom. Specifically, the third joint portion 10B43 is arranged vertically with respect to the contact portion 10B1, and is configured to be rotatable in the horizontal direction with respect to the organ 50 surface.

  The fourth joint portion 10B44 is a cylindrical member connected to the third joint portion 10B43 and the manipulator portion 10B2, and forms a joint portion having one degree of freedom. Specifically, the fourth joint portion 10B44 is disposed laterally with respect to the contact portion 10B1, and is configured to be rotatable in the crossing direction with respect to the surface of the organ 50. A through hole penetrating in the radial direction is formed in the fourth joint portion 10B44 disposed at the top of the manipulator holding portion 10B4. A bent portion 10B222 including a plurality of joined bodies 10B22 is inserted and supported in the through hole.

Here, through the first joint portion 10B41 to the fourth joint portion 10B44, a thin and long drive cable (not shown) is inserted as a power transmission member for driving, and each of these drive cables (not shown). By appropriately adjusting the tension of each joint, each joint is operated.
By adopting the above configuration, the manipulator holding unit 10B4 has four degrees of freedom with respect to the contact unit 10B1.

  Incidentally, the structure of the manipulator holding unit 10B4 may be applied to the observation unit holding unit 10B6. In other words, the observation unit holding unit 10B6 may be configured with a plurality of joints using, for example, a cylindrical member, and the observation unit 10B5 may be configured to have multiple degrees of freedom with respect to the contact unit 10B1. .

Here, as specific operation means for realizing the operation of each joint, << operation means 1 >> in the first embodiment, that is, manual operation by the operator, and << operation means 2 >>, that is, operation using a drive member Both can be applied.
As described above, according to the second modification, in addition to the same effects as the organ contact tool and the medical master / slave system according to the second embodiment, each surgical tool held by the organ contact tool 10B. It is possible to provide an organ contact device and a medical master / slave system that further improve the degree of freedom of movement.

  Specifically, the manipulator holding part 10B4 has four degrees of freedom actively with respect to the contact part 10B1. And the operability at the time of treatment improves also in remote operation by remotely operating the rotation operation of each joint part of manipulator holding part 10B4 by master part 4.

Of course, the manipulator holding portion 10B4 may be provided not on the contact portion 10B1 but on the contact portion support portion 10B7.
[Modification 3]
Hereinafter, an organ contact tool and a medical master / slave system according to Modification 3 will be described. In order to avoid duplication of explanation, differences from the second embodiment will be described.

FIG. 10 is a diagram illustrating a configuration example of an organ contact tool according to the third modification. In the figure, in order to prevent complication of the drawing, the components that are not largely related to the characteristic part of the third modification are not shown.
In the third modification, the manipulator part 10B2 is fixed “relatively movable” to the manipulator holding part 10B4 coupled to the contact part support part 10B7. That is, as shown in FIG. 10, the fixing part 10BS itself between the manipulator part 10B2 and the manipulator holding part 10B4 is configured to be movable in the direction indicated by the double arrow A shown in FIG. Specifically, for example, the manipulator holding part 10B4 and the manipulator part 10B2 may be connected by a fixed point 10BS that is inserted and movable in the manipulator holding part 10B4.

  Similarly, the observation unit 10B5 is fixed so as to be “relatively movable” with respect to the observation unit holding unit 10B6 connected to the contact unit support unit 10B7. That is, as shown in FIG. 10, the fixing part 10BS itself between the observation unit 10B5 and the observation unit holding unit 10B6 is configured to be movable in the direction indicated by the double arrow A shown in FIG. Specifically, for example, the observation unit holding unit 10B5 and the observation unit 10B5 may be connected by a fixed point 10BS that is inserted and movable in the observation unit holding unit 10B6.

  As described above, according to the third modification, in addition to the same effects as the organ contact tool and the medical master / slave system according to the second embodiment, each surgical tool held by the organ contact tool 10B. It is possible to provide an organ contact device and a medical master / slave system that further improve the degree of freedom of movement.

The configuration can be simplified by using the surgical instrument holding unit 10B46 (see FIG. 11) in which the manipulator holding unit 10B4 and the observation unit holding unit 10B6 are integrally configured.
That is, as shown in FIG. 11, the surgical instrument holding part 10B46 is connected to the contact part support part 10B7 so as to have a predetermined degree of freedom with respect to the contact part 10B1. Specifically, the surgical instrument holding portion 10B46 is configured by, for example, a single cylindrical member.

And the fixed part 10BS of manipulator part 10B2, observation part 10B5, and surgical instrument holding | maintenance part 10B46 is comprised so that relative movement with respect to surgical instrument holding | maintenance part 10B46 is possible.
As described above, the ease of manufacturing is further improved by employing the configuration shown in FIG.

  Furthermore, the above-described embodiments include inventions at various stages, and various inventions can be extracted by appropriately combining a plurality of disclosed constituent elements. For example, even if some constituent elements are deleted from all the constituent elements shown in each embodiment, the problem described in the column of the problem to be solved by the invention can be solved, and the effect described in the column of the effect of the invention Can be extracted as an invention.

    DESCRIPTION OF SYMBOLS 2 ... Control unit, 2A ... Calculation part, 2B ... Slave main body control part, 2C ... Power supply part, 2D ... Camera control part, 4 ... Master part, 6 ... Camera display part, 8 ... Slave main body, 10B ... Organ contact tool, DESCRIPTION OF SYMBOLS 10 ... Organ contact tool slave part, 10A ... Organ contact tool support arm part, 10B1 ... Contact part, 10B2 ... Manipulator part, 10B3 ... Organ contact tool support part, 10B4 ... Manipulator holding part, 10B5 ... Observation part, 10B6 ... Observation part Holding part, 10B1b ... surgical instrument holding part, 10b1 ... suction port, 10b2 ... convex part, 10b3 ... concave part, 10w ... peripheral wall part, 10b4 ... through hole part, 10b5 ... screw hole part, 10c1, 10c2 ... drive cable, 10d1, 10d2 ... cable tube, 10wo ... outer peripheral wall surface, 10s1, 10s2 ... fixed point, 10B23 ... grip , 10A ... support arm, 10B1a ... contact base, 10b6 ... rotation restraining screw, 10b7 ... engagement hole, 10B7 ... contact part support, 10B22 ... joint, 10B222 ... bend, 10B25 ... cable, 10B25 '... guide Tube, 10B51 ... Cable, 10B51 '... Guide tube, 10B41 ... First joint part, 10B42 ... Second joint part, 10B43 ... Third joint part, 10B44 ... Fourth joint part, 10BS ... Fixing site, 10B46 ... Holding tool 11A: Motor, 11B ... Motor, 12 ... Manipulator slave part, 12B ... Manipulator mechanism part, 12A ... Manipulator support arm part, 13A ... Motor, 13B ... Motor, 14 ... Observation camera part, 14B ... Observation camera, 14A ... Observation camera support arm 15, motor 50 ... an organ, 105 ... a guide tube, 106 ... a surgical instrument fixing screw.

Claims (13)

A plurality of contact portions that contact the organ;
A surgical instrument for treating the organ;
A contact part support part for supporting the contact part;
It is composed of one or more members respectively disposed on the plurality of contact portions so as to have at least one degree of freedom of movement, and rotatably disposed with respect to the plurality of contact portions. A manipulator holding part for holding one or more of the surgical tools used in the treatment;
An observation unit for observing the organ treated by the surgical instrument;
An observation holding unit that is provided in the contact part support unit and holds the observation unit;
Comprising
Organ contact device, characterized in that subjecting the treated rotates the surgical instrument in pairs in the organ by the manipulator holding portion and the observation portion holding portion.   2. The organ contact tool according to claim 1, wherein the movement of the manipulator holding portion with respect to the contact portion is performed manually by an operator or driven by a drive member.   The organ contact tool according to claim 2, wherein the surgical tool is a manipulator and an imaging device.   The organ contact tool according to claim 1, wherein the contact portion includes an adsorbing portion that adsorbs to the organ. The contact portion is a substantially U-shaped plate member,
The said manipulator holding | maintenance part consists of one or more cylindrical members arrange | positioned rotatably with respect to the said contact part, and it is provided with two or more on the said contact part. Organ contactor. The cylindrical member is provided with a hole penetrating in the radial direction,
The surgical instrument is held by the manipulator holding part by being inserted into the hole part,
The organ contact tool according to claim 5.   The organ contactor according to claim 6, wherein each of the plurality of manipulator holding portions has a degree of freedom of movement with respect to the contact portion independently of each other.   The organ contact tool according to claim 7, wherein the manipulator holding portion rotates with respect to the contact portion manually by an operator or driven by a drive member.   The organ contact tool according to claim 8, wherein the surgical tool is a manipulator and an imaging device.   The organ contact tool according to claim 1, wherein the manipulator holding portion is formed by connecting a plurality of joint portions.   The organ contact tool according to claim 1, wherein the surgical tool is provided so as to be relatively movable with respect to the manipulator holding portion. A medical master / slave system,
A master device that converts operation information into position / posture information and outputs it;
A control device for controlling the operation of the slave device based on the output of the master device;
Comprising
The slave device is
A plurality of contact portions that contact the organ;
A surgical instrument for treating the organ;
A contact part support part for supporting the contact part;
It is composed of one or more members respectively disposed on the plurality of contact portions so as to have at least one degree of freedom of movement, and rotatably disposed with respect to the plurality of contact portions. A manipulator holding part for holding one or more of the surgical tools used in the treatment;
An observation unit for observing the organ treated by the surgical instrument;
An observation holding unit that is provided in the contact part support unit and holds the observation unit;
Comprising
The manipulator holding portion and against the organ by the observation unit holding portion subjected to treatment by rotating the surgical instrument,
A medical master / slave system.   The medical master / slave system according to claim 12, wherein the surgical instrument is a manipulator and an imaging device.

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