【０００１】[0001]
【産業上の利用分野】本発明は遠隔操作によって駆動さ
れて生体内組織部位の観察や処置を行なう手術用マニピ
ュレータに関する。BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a manipulator for surgery which is driven by remote control to observe and treat a tissue part in a living body.
【０００２】[0002]
【従来の技術】腹壁等の体壁に穴を開け、この穴を通じ
て内視鏡や処置具を経皮的に体腔内に挿入することによ
り体腔内で様々な処置を行なう内視鏡下手術が従来から
行なわれており、こうした術式は大きな切開を要しない
低侵襲なものとして胆のう摘出手術や肺の一部を摘出除
去する手術等で広く行なわれている。2. Description of the Related Art Endoscopic surgery is performed in which a body wall such as an abdominal wall is perforated and an endoscope or a treatment tool is percutaneously inserted into the body cavity through the hole to perform various treatments in the body cavity. Conventionally, such an operation method is widely performed as a minimally invasive operation that does not require a large incision, such as a cholecystectomy operation and an operation to remove and remove a part of the lung.
【０００３】また、内視鏡や処置具を搭載し、遠隔操作
により作動して、前記内視鏡や処置具を用いた手術を術
者に代わって行なう手術用マニピュレータが例えば米国
特許第５２１７００３号に開示されている。こうした手
術用マニピュレータは、通常、内視鏡や処置具を備える
挿入部が多関節構造となっており、各関節をアクチュエ
ータにより動作させることで、体腔内における目的部位
に対するアプローチを容易ならしめている。A surgical manipulator equipped with an endoscope and a treatment tool and operated by remote control to perform surgery using the endoscope and the treatment tool on behalf of the operator is, for example, US Pat. No. 5,217,003. Is disclosed in. In such a manipulator for surgery, an insertion portion including an endoscope and a treatment tool usually has a multi-joint structure, and each joint is operated by an actuator, which facilitates an approach to a target site in a body cavity.
【０００４】[0004]
【発明が解決しようとする課題】ところで、前述した内
視鏡下手術にあっては、体壁に開けた穴から体腔内に挿
入される内視鏡や処置具が体腔内の極力広い範囲で動作
できることが望まれる。しかしながら、術者が片手で操
作できる内視鏡や処置具は自由度の少ない直線形状のも
のであり、内視鏡や処置具が目的の位置に届いたとして
も所望のオリエンテーションで処置または観察を行なう
ことが困難であった。例えば、縫合の際に処置具で針を
持って臓器等に針をかけようとする場合に、縫合線に対
し直角に針をかけるのが望ましいが、処置具の自由度不
足が原因で困難な場合があった。By the way, in the above-mentioned endoscopic surgery, an endoscope or a treatment instrument to be inserted into a body cavity through a hole formed in the body wall is used in a wide range within the body cavity. It is desired to be able to operate. However, the endoscope and the treatment tool that can be operated by the operator with one hand have a linear shape with few degrees of freedom, and even if the endoscope or the treatment tool reaches the target position, the treatment or observation can be performed at the desired orientation. It was difficult to do. For example, it is desirable to hang a needle at a right angle to the suture line when trying to hang a needle on an organ or the like with a treatment tool at the time of suturing, but it is difficult due to insufficient flexibility of the treatment tool. There were cases.
【０００５】こうした問題は、自由度の大きい多関節構
造の挿入部を備えた前述の手術用マニピュレータを用い
ることで解消されるが、この場合、目的の位置でかつ所
望のオリエンテーションで作業を行なうために多関節構
造の挿入部を動作させると、関節部が目的とする以外の
臓器に接触して無理な力を与える可能性があった。This problem is solved by using the above-mentioned surgical manipulator provided with an insertion portion having a multi-joint structure having a large degree of freedom. In this case, however, the work is performed at a desired position and at a desired orientation. When the insertion part of the multi-joint structure is operated, the joint part may come into contact with an organ other than the intended one and give an excessive force.
【０００６】本発明は上記事情に着目してなされたもの
であり、その目的とするところは、体腔内で観察および
処置を行なうのに十分な自由度を有するとともに、それ
らの作業中に目的以外の臓器に接触して無理な力を与え
ることのない手術用マニピュレータを提供することにあ
る。The present invention has been made in view of the above circumstances, and an object thereof is to have a sufficient degree of freedom to perform observation and treatment in a body cavity and to perform other operations during those operations. The purpose of the present invention is to provide a manipulator for surgery that does not apply unreasonable force to the internal organs.
【０００７】[0007]
【課題を解決するための手段】上記課題を解決するため
に、本発明は、遠隔操作によって駆動されて生体内組織
部位の観察及びまたは処置を行なう手術用マニピュレー
タにおいて、生体内に挿入可能なストレート状の挿入部
と、この挿入部を進退自在に連結するとともにこの挿入
部の位置決めを行なう位置決め手段を備えたマニピュレ
ータ本体と、屈曲自在な屈曲部を有して前記挿入部の先
端に接続され生体内組織部位の観察及びまたは処置を行
なう作業部とを具備したものである。In order to solve the above problems, the present invention relates to a surgical manipulator which is driven by remote operation to observe and / or treat a tissue part in a living body, which is insertable into the living body. -Shaped insertion part, a manipulator body having a positioning means for connecting the insertion part so as to move back and forth and positioning the insertion part, and a manipulator body having a bendable bending part and connected to the tip of the insertion part. And a working unit for observing and / or treating a tissue part in the body.
【０００８】[0008]
【作用】上記構成では、挿入部を所望の位置に位置決め
することで、進退自在な挿入部を直線的に患部にアプロ
ーチさせることができ、その後、作業部を屈曲させれば
安全かつ確実に処置または観察が可能である。この構成
では、作業部を体腔内で複雑に屈曲させる必要がないた
め患部以外の組織を傷付けることがない。また、作業部
の長さを挿入部の長さよりも十分に短くするなど処置に
必要な最小限の長さに設定することにより、さらに安全
に患部のみを処置もしくは観察することができる。In the above structure, by positioning the insertion portion at a desired position, the insertion / removal insertion portion can be linearly approached to the affected area, and then the working portion can be bent for safe and reliable treatment. Or it can be observed. With this configuration, since it is not necessary to bend the working portion intricately within the body cavity, the tissue other than the affected portion is not damaged. Further, by setting the length of the working portion to be sufficiently shorter than the length of the insertion portion to be set to the minimum length necessary for the treatment, it is possible to further safely treat or observe only the affected portion.
【０００９】[0009]
【実施例】以下、図面を参照しつつ本発明の実施例を説
明する。図１ないし図４は本発明の第１の実施例を示す
ものである。本実施例の手術用マニピュレータ１は、マ
ニピュレータ本体３と、生体壁９０に穿設された挿入孔
８を通じて体腔内に挿入可能なストレート形状の細径挿
入部２とからなる。マニピュレータ本体３は挿入部２の
位置決めを行なう位置決め手段としてのリンク機構およ
び調整機構（いずれも後述する。）を備えたアーム構造
になっており、このマニピュレータ本体３には後述する
ように挿入部２が進退自在に連結されている。また、挿
入部２の先端には作業部としてのエンドエフェクタが屈
曲自在に接続されている。このエンドエフェクタはマニ
ピュレータ１の作業目的によって異なっており、図１に
は内視鏡４と処置具５とが示されている。エンドエフェ
クタとして処置具５を有するマニピュレータの本体３は
図１に示されていないが、内視鏡４を備えたマニピュレ
ータ１と同じ構造を有するものとして省略してある。Embodiments of the present invention will be described below with reference to the drawings. 1 to 4 show a first embodiment of the present invention. The surgical manipulator 1 of this embodiment includes a manipulator body 3 and a straight-shaped small-diameter insertion portion 2 that can be inserted into a body cavity through an insertion hole 8 formed in a living body wall 90. The manipulator main body 3 has an arm structure including a link mechanism and an adjusting mechanism (both will be described later) as positioning means for positioning the insertion portion 2. The manipulator main body 3 has an insertion portion 2 as described later. Are connected so that they can move back and forth. An end effector as a working unit is flexibly connected to the tip of the insertion unit 2. This end effector differs depending on the working purpose of the manipulator 1, and FIG. 1 shows an endoscope 4 and a treatment tool 5. Although the main body 3 of the manipulator having the treatment tool 5 as the end effector is not shown in FIG. 1, it is omitted because it has the same structure as the manipulator 1 having the endoscope 4.
【００１０】内視鏡４および処置具５と挿入部２との間
には図示のごとく屈曲部が１か所しか設けられていな
い。そして、内視鏡４および処置具５の長さは挿入部２
の長さに比べて十分に小さい。また、内視鏡４は照明手
段および観察手段を有しており、処置具５は生体組織の
把持や剥離、縫合のための針の把持等を行なうための開
閉機構６を有している。Between the endoscope 4 and the treatment instrument 5 and the insertion portion 2, there is only one bent portion as shown in the figure. The length of the endoscope 4 and the treatment instrument 5 is the insertion portion 2
Small enough compared to the length of. The endoscope 4 has an illuminating means and an observing means, and the treatment tool 5 has an opening / closing mechanism 6 for gripping and peeling a living tissue, and a needle for suturing.
【００１１】ところで、マニピュレータ１の軸数は、エ
ンドエフェクタの位置及びオリエンテーションに関する
自由度と、挿入孔８の位置に関する拘束条件とから決定
される。前者については、体腔内の任意の位置にある臓
器等を任意のオリエンテーションで観察あるいは処置を
行なうために、一般に、６自由度が必要となる。ただ
し、エンドエフェクタが内視鏡４である場合には観察さ
れた画像の回転を画像処理により補正することで１つ自
由度を減らして５自由度とすることができる。図１に示
すような形状を有する処置具５の場合には６自由度が必
要となる。また、後者については、マニュッピレータ１
が動作した際に生体壁９０に開けた挿入孔８内で挿入部
２が移動して生体壁９０に無理な力がかからないよう
に、挿入部２を常に一定の位置に保持することが望まし
く、そのためには、３自由度の拘束条件が必要となる。
したがって、両者を加えると、内視鏡４の場合は８自由
度、処置具５の場合は９自由度が必要となる。この自由
度を満足させるために、通常、マニピュレータ１の軸数
も自由度の数だけ必要となるが、図１に示すマニピュレ
ータ１は図３に示すポイントロック機構によってその軸
数を３つ削減することが可能である。By the way, the number of axes of the manipulator 1 is determined from the degree of freedom regarding the position and orientation of the end effector and the constraint condition regarding the position of the insertion hole 8. The former generally requires 6 degrees of freedom in order to observe or treat an organ or the like at an arbitrary position in the body cavity at an arbitrary orientation. However, when the end effector is the endoscope 4, it is possible to reduce one degree of freedom to five degrees of freedom by correcting the rotation of the observed image by image processing. In the case of the treatment tool 5 having a shape as shown in FIG. 1, 6 degrees of freedom are required. Regarding the latter, manipulator 1
It is desirable to always hold the insertion portion 2 at a fixed position so that the insertion portion 2 does not move inside the insertion hole 8 formed in the living body wall 90 when the is operated and an unreasonable force is applied to the living body wall 90. For that purpose, a constraint condition of three degrees of freedom is required.
Therefore, when both are added, the endoscope 4 needs 8 degrees of freedom and the treatment instrument 5 needs 9 degrees of freedom. In order to satisfy this degree of freedom, normally, the number of axes of the manipulator 1 is also required to be the number of degrees of freedom, but the manipulator 1 shown in FIG. 1 reduces the number of axes by three by the point lock mechanism shown in FIG. It is possible.
【００１２】すなわち、このポイントロック機構は、２
組の四節回転連鎖が互いに対偶をなすような状態に６本
のリンクを図３に示すように支点ピンを介して連結し、
互いに向き合うリンク同志が平行になるように構成した
ものであり、先端側に位置する第１の平行四節リンク部
９と手元側に位置する第２の平行四節リンク部９´とか
らなる。第２の平行四節リンク部９´の手元側に位置す
る固定リンク１２は回転軸１０によってその軸心回りに
回転することができる。That is, this point lock mechanism has two
As shown in FIG. 3, the six links are connected via a fulcrum pin in such a manner that a set of four-bar rotation chains are paired with each other.
The links facing each other are configured to be parallel to each other, and are composed of a first parallel four-bar link part 9 located on the tip side and a second parallel four-bar link part 9'located on the hand side. The fixed link 12 located on the proximal side of the second parallel four-bar link section 9'can be rotated about its axis by the rotary shaft 10.
【００１３】このようなリンク機構では、第１の平行四
節リンク部９の先端に位置する従動節２１の中心線と固
定リンク１２の中心線との交点Ｐがこのリンク機構の動
作（マニピュレータ本体３の振り動作）および回転軸１
０を介した固定リンク１２の回転動作によらず常に一定
の位置に固定される。In such a link mechanism, the intersection point P between the center line of the driven link 21 located at the tip of the first parallel four-bar link section 9 and the center line of the fixed link 12 is the operation of the link mechanism (manipulator body). 3 swing motion) and rotating shaft 1
It is always fixed at a fixed position regardless of the rotational movement of the fixed link 12 via 0.
【００１４】また、このリンク機構の手元側には固定リ
ンク１２の位置や方向を変化させる調整機構が設けられ
ている。この調整機構は、それ自身その軸心回りに回転
（図中Ｃ１の方向）可能でかつ上下動（図中Ｃ２の方
向）可能な支持部１１として構成されている。そして、
この支持部１１には回転軸１０が回転（図中Ａ１の方
向）かつ進退（図中Ｃ３の方向）可能に支持されてい
る。したがって、支持部１１を回転させたり上下動させ
たり、あるいは、支持部１１に対して回転軸１０を進退
させたりすることにより、固定リンク１２の位置や方向
を変化させることができ、結果的に交点Ｐを任意の位置
に移動させることができる。無論、交点Ｐを所定の位置
に移動させた後に調整機構と固定リンク１２の進退動作
とをロックさせれば、第２の平行四節リンク部９´を図
中Ａ２で示す方向に回転させてリンク機構を動作させて
も、また、固定リンク１２を回転動作させても、交点Ｐ
の位置はその所定位置に固定されたままである。An adjusting mechanism for changing the position and direction of the fixed link 12 is provided on the hand side of the link mechanism. This adjusting mechanism is configured as a supporting portion 11 which is rotatable about its axis (direction C1 in the drawing) and vertically movable (direction C2 in the drawing). And
The rotating shaft 10 is supported by the support portion 11 so as to be rotatable (direction A1 in the drawing) and movable back and forth (direction C3 in the drawing). Therefore, the position or direction of the fixed link 12 can be changed by rotating or vertically moving the support portion 11, or advancing or retracting the rotary shaft 10 with respect to the support portion 11, and as a result, The intersection P can be moved to any position. Of course, if the adjusting mechanism and the forward / backward movement of the fixed link 12 are locked after the intersection point P is moved to a predetermined position, the second parallel four-joint link portion 9'is rotated in the direction indicated by A2 in the figure. Even if the link mechanism is operated or the fixed link 12 is rotated, the intersection P
Position remains fixed in place.
【００１５】したがって、交点Ｐ（挿入部２上に位置し
ている。）が挿入孔８の位置に一致するように調整機構
を調整すれば、その後にリンク機構を動作させても挿入
孔８内における挿入部２の部位は常に一定の位置に保持
される。つまり、交点Ｐを挿入孔８の位置にロックさせ
た状態でリンク機構を動作させると、挿入部２は生体壁
９０に無理な力を与えることなくその体腔内での位置を
任意に変化させることができる。よって、このポイント
ロック機構によれば、マニュッピレータ１が動作した際
に生体壁９０に開けた挿入孔８内で挿入部２が移動して
生体壁９０に無理な力がかからないため、前述した３自
由度の拘束条件は不要となる。したがって、本実施例の
マニピュレータ１の場合、本体３のリンク機構と挿入部
２とを合わせても、その軸数はエンドエフェクタを内視
鏡４とした場合で５つ、処置具５とした場合で６つとな
る。Therefore, if the adjusting mechanism is adjusted so that the intersection point P (located on the insertion portion 2) coincides with the position of the insertion hole 8, even if the link mechanism is subsequently operated, the inside of the insertion hole 8 is changed. The portion of the insertion portion 2 in is always held at a fixed position. That is, when the link mechanism is operated in a state where the intersection P is locked at the position of the insertion hole 8, the insertion section 2 can arbitrarily change the position within the body cavity without applying an excessive force to the living body wall 90. You can Therefore, according to this point lock mechanism, when the manipulator 1 is operated, the insertion portion 2 does not move within the insertion hole 8 formed in the living body wall 90 and an unreasonable force is applied to the living body wall 90. The degree constraint condition is unnecessary. Therefore, in the case of the manipulator 1 of the present embodiment, even if the link mechanism of the main body 3 and the insertion portion 2 are combined, the number of axes thereof is 5 when the end effector is the endoscope 4 and when the treatment tool 5 is used. Will be six.
【００１６】次に、エンドエフェクタとして内視鏡４を
有する挿入部２の駆動機構について図４を参照しつつ説
明する。図４の（ａ）に示すように、挿入部２は、円筒
状の直動部７と、直動部７を進退自在に支持するガイド
部２４と、ガイド部２４を支持し図中Ａ４で示す回転方
向に回転自在な回転部２５とからなる。回転部２５は前
述した従動節２１を有して従動節２１と同一の動作を行
なう手元側部９１に回転自在に支持されている。Next, a drive mechanism of the insertion section 2 having the endoscope 4 as an end effector will be described with reference to FIG. As shown in (a) of FIG. 4, the insertion portion 2 has a cylindrical linear moving portion 7, a guide portion 24 that supports the linear moving portion 7 so that the linear moving portion 7 can move back and forth, and the guide portion 24 is supported by A4 in the drawing. The rotary unit 25 is rotatable in the rotation direction shown. The rotating portion 25 includes the driven portion 21 described above and is rotatably supported by the hand side portion 91 that performs the same operation as the driven portion 21.
【００１７】内視鏡４の図中Ａ５方向の回転を可能にす
る軸心部にはプーリー１７が設けられている。このプー
リー１７にはワイヤ１８が掛けらており、このワイヤ１
８の両端はそれぞれ回転部２５に回転自在に支持された
第１のボールねじ１９ａと第２のボールねじ１９ｂとに
牽引可能に固定されている。また、第１のボールねじ１
９ａと第２のボールねじ１９ｂはそれぞれ第１のモータ
２０ａと第２のモータ２０ｂとによって回転される。プ
ーリー１７を支持する直動部７はガイド部２４との間に
配設されたスプリング２２によって先端方向に付勢され
ており、常にワイヤ１８に張力が掛かるようになってい
る。A pulley 17 is provided at the axial center portion of the endoscope 4 which allows the endoscope 4 to rotate in the A5 direction in the figure. A wire 18 is hung on the pulley 17 and the wire 1
Both ends of 8 are fixed to a first ball screw 19a and a second ball screw 19b, which are rotatably supported by a rotating portion 25, so as to be pulled. Also, the first ball screw 1
9a and the 2nd ball screw 19b are rotated by the 1st motor 20a and the 2nd motor 20b, respectively. The linear motion part 7 supporting the pulley 17 is biased in the distal direction by a spring 22 arranged between the linear motion part 7 and the guide part 24 so that the wire 18 is always tensioned.
【００１８】モータ２０ａ，２０ｂの駆動によってボー
ルねじ１９ａ，１９ｂがワイヤ１８のそれぞれの端部を
右側に牽引すると、ワイヤ１８の各端部の移動量の和の
半分に相当する距離だけ直動部７が図中Ａ３で示す右側
方向に移動し、ワイヤ１８の各端部の移動量の差分だけ
先端にある軸（プーリー）１７が図中Ａ５で示す回転方
向に回転する。When the ball screws 19a and 19b pull the respective ends of the wire 18 to the right by the driving of the motors 20a and 20b, the linear motion portion is moved by a distance corresponding to half the sum of the movement amounts of the respective ends of the wire 18. 7 moves to the right as indicated by A3 in the figure, and the shaft (pulley) 17 at the tip rotates by the difference in the amount of movement of each end of the wire 18 in the direction of rotation indicated by A5 in the figure.
【００１９】回転部２５は、ベアリング２２により支持
されており、第３のモータ２０ｃにより平歯車２３，２
３を介して回転される。ガイド部２４は回転部２５にボ
ルト２６等の結合部材によって固定されている。このボ
ルト２６を外して、さらに、ワイヤ１８をボールねじ１
９ａ，１９ｂから取り外すことにより、ガイド部２４を
含めた体腔内に挿入される挿入部２の部分を取り外すこ
とができ（図４の（ｂ）参照）、これらの部分を単独に
洗浄・消毒・滅菌することができる。The rotating portion 25 is supported by a bearing 22, and the spur gears 23, 2 are driven by a third motor 20c.
It is rotated through 3. The guide portion 24 is fixed to the rotating portion 25 by a connecting member such as a bolt 26. Remove the bolt 26, and further wire 18 to the ball screw 1
By removing from 9a and 19b, the part of the insertion part 2 including the guide part 24 that is inserted into the body cavity can be removed (see (b) of FIG. 4), and these parts can be individually washed / disinfected / disinfected. It can be sterilized.
【００２０】上記構成では、Ａ１〜Ａ６の回転もしくは
進退動作を可能とさせる全ての軸が駆動手段としてアク
チュエータと駆動伝達要素とを有しており、これらの駆
動手段はマニピュレータ１の図示しない制御装置におい
て演算された動作指令に基づいて動作する。動作指令を
決定する手段として、マニピュレータ１の前記制御装置
に予めプログラムされた動作パターンを呼び出して実行
させるいわゆるプレイバック方式の他に、図２に示すマ
スターアーム１４を操作者が手で動作させるとその動き
を制御装置により計測した後にマニピュレータ１の動作
指令を演算して実行させるいわゆるマスタースレーブ方
式がある。マスターアーム１４は、マニピュレータ１に
相当する自由度を持つ関節機構１５と、各関節に設けた
エンコーダ１６とを有する。In the above structure, all the shafts that enable the rotation or forward / backward movement of A1 to A6 have actuators and drive transmission elements as driving means, and these driving means are control devices (not shown) of the manipulator 1. It operates based on the operation command calculated in. As a means for determining an operation command, in addition to a so-called playback method in which a control device of the manipulator 1 calls and executes a pre-programmed operation pattern, when the operator manually operates the master arm 14 shown in FIG. There is a so-called master-slave system in which the movement of the manipulator 1 is calculated and executed after the movement is measured by the control device. The master arm 14 has a joint mechanism 15 having a degree of freedom equivalent to that of the manipulator 1, and an encoder 16 provided at each joint.
【００２１】このように、本実施例のマニピュレータ１
は、エンドエフェクタとして内視鏡４を用いた場合には
Ａ１〜Ａ５の５つの自由度を有し、また、エンドエフェ
クタとして処置具５を用いた場合には先端の回転Ａ６を
含めた６つの自由度を有しており、前述した調整機構と
リンク機構とによって挿入部２の位置決めを行なうこと
ができる。すなわち、調整機構（Ｃ１〜Ｃ３）によって
交点Ｐを挿入孔８に位置固定させた状態で、今度はリン
ク機構を動作させる（Ａ１〜Ａ２）ことにより、体腔内
における挿入部２の位置決めが行なえる。In this way, the manipulator 1 of this embodiment is
Has five degrees of freedom A1 to A5 when the endoscope 4 is used as the end effector, and six rotations A6 including the tip rotation A6 when the treatment instrument 5 is used as the end effector. It has a degree of freedom, and the insertion portion 2 can be positioned by the adjusting mechanism and the link mechanism described above. That is, with the intersection mechanism P fixed in position in the insertion hole 8 by the adjustment mechanism (C1 to C3), the link mechanism is operated this time (A1 to A2) to position the insertion portion 2 in the body cavity. .
【００２２】また、このように挿入部２を位置決めした
後の目的部位へのアプローチは、Ａ３，Ａ４、Ａ５によ
って直線的かつ屈曲的に行なうことができる。つまり、
本実施例の挿入部２は、円筒形状の直動部７とその先端
に屈曲自在に支持されるエンドエフェクタとを有する構
造となっており、直動部７が直線状でかつ細く、回動軸
１７からエンドエフェクタの先端までの長さが直動部７
の長さに比べて十分に小さいことが特徴である。したが
って、この構成では、細長い直動部７により挿入孔８か
ら目的とする部位まで直線状にアプローチし、屈曲する
エンドエフェクタの姿勢により目的とする部位における
所望のオリエンテーションを得ることができる。この
際、直動部７は直線状であるため、直線的なアプローチ
の際に目的とする以外の臓器に接触することがない。ま
た、挿入部２はエンドエフェクタをも含めてその屈曲部
が１か所のみであり且つエンドエフェクタの長さが直動
部７の長さに比べて十分に小さいため、エンドエフェク
タの屈曲動作の際にも目的とする以外の臓器に接触しに
くい。Further, the approach to the target site after positioning the insertion portion 2 in this way can be performed linearly and flexibly by A3, A4 and A5. That is,
The insertion portion 2 of the present embodiment has a structure having a cylindrical linear motion portion 7 and an end effector that is flexibly supported at the tip thereof, and the linear motion portion 7 is linear and thin, and can rotate. The length from the shaft 17 to the tip of the end effector is the linear motion part 7.
The feature is that it is sufficiently smaller than the length. Therefore, in this configuration, the slender linear motion section 7 linearly approaches from the insertion hole 8 to a target site, and a desired orientation can be obtained in the target site depending on the posture of the bending end effector. At this time, since the linearly moving portion 7 has a linear shape, it does not come into contact with an organ other than the intended organ during the linear approach. In addition, since the insertion portion 2 includes only one bending portion including the end effector and the length of the end effector is sufficiently smaller than the length of the linear motion portion 7, the bending movement of the end effector can be prevented. Also, it is difficult to make contact with organs other than the intended one.
【００２３】以上のように、本実施例の手術用マニピュ
レータ１は、挿入部２のエンドエフェクタが体腔内の広
い範囲に対してアプローチできるとともに、その際に挿
入部２とエンドエフェクタとが目的とする以外の臓器に
接触しにくい構造となっている。つまり、体腔内で観察
および処置を行なうのに十分な自由度を有するととも
に、それらの作業中に目的以外の臓器に接触して無理な
力を与えることがない。As described above, in the surgical manipulator 1 of this embodiment, the end effector of the insertion section 2 can approach a wide range in the body cavity, and at that time, the purpose of the insertion section 2 and the end effector is to aim. It has a structure that makes it difficult to contact organs other than those that do. In other words, it has a sufficient degree of freedom to perform observation and treatment in the body cavity, and does not apply unreasonable force by contacting organs other than the target during those operations.
【００２４】なお、本実施例の場合、屈曲部１７からエ
ンドエフェクタの先端までの長さは直動部７の長さに対
し５分の１以下であることが望ましい。図５は本発明の
第２の実施例を示すものである。本実施例のマニピュレ
ータ１ａは、エンドエフェクタとして、生体組織の把持
や剥離の他に図４に示すように縫合のための針２７の把
持を行なう処置具５ａを用いたものであり、その他の構
成は第１の実施例と同一である。なお、マニピュレータ
１ａの動作指令を決定するための手段も、第１の実施例
と同様に、プレイバック方式の他、図２に示すマスター
アーム１４を操作者が手で動作させることによるいわゆ
るマスタースレーブ方式が可能である。In the present embodiment, the length from the bent portion 17 to the tip of the end effector is preferably not more than 1/5 of the length of the linear motion portion 7. FIG. 5 shows a second embodiment of the present invention. The manipulator 1a of the present embodiment uses, as an end effector, a treatment tool 5a for gripping and peeling a living tissue and gripping a needle 27 for suturing as shown in FIG. 4, and other configurations. Is the same as in the first embodiment. The means for determining the operation command of the manipulator 1a is also a so-called master slave in which the operator manually operates the master arm 14 shown in FIG. 2 in addition to the playback method, as in the first embodiment. A method is possible.
【００２５】本実施例の場合、処置具５ａは緩やかな曲
線を描いて湾曲する湾曲部２８を有しており、この湾曲
部２８が円筒形状の直動部７に接続された構造となって
いる。したがって、細長い直動部７により挿入孔８から
目的とする部位まで直線状にアプローチし、湾曲部２８
により目的とする部位における所望のオリエンテーショ
ンを得ることができる。この構成の場合も、直動部７は
直線状であるため、その途中で目的とする以外の臓器に
接触することがない。また、湾曲部２８は緩やかに湾曲
するため、目的とする以外の臓器に接触しても無理な力
がかかることがない。なお、湾曲部２８の長さは直動部
７の長さに対し３分の１以下であることが望ましい。In the case of the present embodiment, the treatment instrument 5a has a curved portion 28 that curves in a gentle curve, and this curved portion 28 is connected to the cylindrical linear motion portion 7. There is. Therefore, the slender linear motion portion 7 linearly approaches from the insertion hole 8 to a target portion, and the curved portion 28
The desired orientation can be obtained at the target site. Also in this configuration, since the linearly moving portion 7 is linear, it does not come into contact with an organ other than the intended organ during the movement. In addition, since the bending portion 28 is gently bent, even if it contacts an organ other than the intended one, an unreasonable force is not applied. The length of the curved portion 28 is preferably one third or less of the length of the linear motion portion 7.
【００２６】図６は本発明の第３の実施例を示すもので
ある。本実施例の手術用マニピュレータ１ｂは、エンド
エフェクタが２つの処置具５ｂ，５ｂから成り、縫合を
行なう際に針２７の受け渡しを行なうことができるよう
になっている。その他の構成は第１の実施例と同一であ
る。この構成の場合も、マニピュレータ１ｂの動作指令
を決定するための手段として、図６の（ｂ）に示すよう
にマスターアーム１４を操作者が手で動作させることに
よるいわゆるマスタースレーブ方式を採用することがで
きる。FIG. 6 shows a third embodiment of the present invention. In the surgical manipulator 1b of this embodiment, the end effector is composed of two treatment tools 5b, 5b, and the needle 27 can be delivered and received when performing suturing. The other structure is the same as that of the first embodiment. Also in the case of this configuration, as a means for determining the operation command of the manipulator 1b, the so-called master-slave method in which the operator manually operates the master arm 14 as shown in FIG. 6B is adopted. You can
【００２７】図７は本発明の第４の実施例を示すもので
ある。本実施例のマニピュレータ１ｃは腎臓６０の摘出
作業を行なうためのものである。腎臓６０を摘出する場
合、一般に、背側からアプローチする方法と、腹側から
アプローチする方法とがある。背側からアプローチする
方が腎臓６０に到達するのに近いが、開腹せずに内視鏡
や処置具を挿入して手術を行なういわゆる内視鏡下手術
においては、体腔内において十分な術野確保できないと
いう問題があった。FIG. 7 shows a fourth embodiment of the present invention. The manipulator 1c of the present embodiment is for performing the excision work of the kidney 60. When removing the kidney 60, generally, there are a method of approaching from the back side and a method of approaching from the ventral side. Approaching from the dorsal side is closer to reaching the kidney 60, but in so-called endoscopic surgery in which an operation is performed by inserting an endoscope or a treatment tool without opening the abdomen, a sufficient surgical field in the body cavity is obtained. There was a problem that it could not be secured.
【００２８】本実施例のマニピュレータ１ｃは、直線状
の挿入部３０と、挿入部３０の周囲に設けた透明バルー
ン３１と、挿入部３０の先端に設けた立体視内視鏡２９
と、同じく挿入部３０の先端に設けた双腕多自由度アー
ム３２とからなり、背側からアプローチする際にも術野
を確保することができるとともに、双腕多関節アーム３
２が処置を行なう際に目的とする以外の臓器に接触する
ことなく腎臓６０を摘出することができる。すなわち、
まず、挿入部３０を後腹膜６１を通じて体腔内に挿入し
たら、それと同時に生理食塩水でバルーン３１を膨らま
せて後腹膜腔を拡張し、十分な視野を確保する。これに
より、双腕多関節アーム３２は、周囲の臓器から距離を
離すことができ、関節部３３が目的とする臓器に接触し
にくくなる。さらに、立体内視鏡２９の視野を十分広く
取り、その視野の中に双腕多関節アーム３２全体を納め
ることにより関節部３３が周囲の臓器に接触しようとす
るのを観察できるため、目的以外の臓器への接触を事前
に防ぐことができる。そして、腎臓６０を尿管６２、腎
動脈６３および腎静脈６４から切離した後に挿入孔８か
ら摘出する。なお、マニピュレータ１ｃの本体部の構成
は第１の実施例と同一である。The manipulator 1c of this embodiment has a linear insertion portion 30, a transparent balloon 31 provided around the insertion portion 30, and a stereoscopic endoscope 29 provided at the tip of the insertion portion 30.
And a dual-arm multi-degree-of-freedom arm 32 also provided at the distal end of the insertion section 30, so that the operative field can be secured even when approaching from the back side, and the dual-arm multi-joint arm 3
When performing treatment, the kidney 60 can be removed without contacting an organ other than the intended organ. That is,
First, after the insertion section 30 is inserted into the body cavity through the retroperitoneum 61, at the same time, the balloon 31 is inflated with physiological saline to expand the retroperitoneal cavity and secure a sufficient visual field. As a result, the double-armed articulated arm 32 can be separated from the surrounding organs, and the joint portion 33 is less likely to contact the target organ. Furthermore, since the field of view of the stereoscopic endoscope 29 is set sufficiently wide and the entire dual-arm articulated arm 32 is housed within the field of view, it is possible to observe that the joint 33 is trying to contact the surrounding organs. It is possible to prevent contact with other organs in advance. Then, the kidney 60 is separated from the ureter 62, the renal artery 63, and the renal vein 64, and then removed from the insertion hole 8. The structure of the main body of the manipulator 1c is the same as that of the first embodiment.
【００２９】図８および図９は本発明の第５の実施例を
示すものである。本実施例のマニピュレータ１ｄも腎臓
６０の摘出作業を行なうためのものである。本実施例の
マニピュレータ１ｄは、直線状の挿入部３４と、挿入部
３４の周囲に設けられて体腔内への挿入後にパラソル状
に開く体腔内視野拡張具３５（複数の拡張部材３５ａ…
から成る。）と、体腔内視野拡張具３５の内側に設けた
臓器摘出用組織粉砕器３６と、立体視内視鏡３７と、挿
入部３４の先端に設けられた剥離鉗子・圧排子用のマイ
クロマニピュレータ３８，３８と、縫合・結紮用の双腕
マイクロマニピュレータ７０，７０とからなり、双腕マ
イクロマニピュレータ７０，７０の把持面には触覚セン
サ３９が設けられている。尿管、腎動脈および腎動脈か
ら切離されて挿入孔８を通じて摘出される腎臓６０はそ
のままの大きさでは挿入孔８を通ることができないの
で、体腔内視野拡張具３５で腎臓６０を包んだ後にこの
腎臓６０を臓器摘出用組織粉砕器３６によって粉砕す
る。そのため、臓器摘出用組織粉砕器３６には強力超音
波振動子と吸引装置とが備えられている。8 and 9 show a fifth embodiment of the present invention. The manipulator 1d of the present embodiment is also for excising the kidney 60. The manipulator 1d of the present embodiment is provided with a linear insertion portion 34 and a body cavity visual field expander 35 (a plurality of expansion members 35a ...) which is provided around the insertion portion 34 and opens like a parasol after insertion into the body cavity.
Consists of. ), A tissue crusher 36 for organ excision provided inside the intracorporeal field-of-view expander 35, a stereoscopic endoscope 37, and a micromanipulator 38 for detaching forceps / exclude provided at the tip of the insertion portion 34. , 38 and dual-arm micromanipulators 70, 70 for suturing / ligating, and a tactile sensor 39 is provided on the gripping surface of the dual-arm micromanipulators 70, 70. The kidney 60 separated from the ureter, the renal artery and the renal artery and removed through the insertion hole 8 cannot pass through the insertion hole 8 with the same size. Therefore, the kidney 60 is wrapped with the intracorporeal visual field dilator 35. After that, the kidney 60 is crushed by the tissue crusher 36 for organ excision. Therefore, the tissue excision device 36 for organ excision is equipped with a powerful ultrasonic vibrator and a suction device.
【００３０】図９は腎臓を切り離す際に縫合・結紮用の
双腕マイクロマニピュレータ７０，７０により腎動脈６
３の結紮を行なう動作を示したものである。図示のよう
に、腎動脈６３に糸４０をかけ（図９の（ａ）（ｂ）参
照）、この糸４０によって腎動脈６３を結紮する（図９
の（ｃ）（ｄ）参照）といった繁雑な一連の作業は、予
めプログラムされたシーケンスに従い、双腕マイクロマ
ニピュレータ７０，７０により自動的に行なわれる。な
お、マニピュレータ１ｄの本体部の構成は第１の実施例
と同一であるが、異なった構成であっても良い。FIG. 9 shows the renal artery 6 by means of a dual-arm micromanipulator 70, 70 for suturing and ligating when the kidney is cut off.
3 shows an operation of performing ligation of No. 3. As shown in the drawing, a thread 40 is applied to the renal artery 63 (see (a) and (b) of FIG. 9), and the renal artery 63 is ligated by this thread 40 (FIG. 9).
The complicated series of operations (see (c) and (d)) are automatically performed by the dual-arm micromanipulators 70, 70 according to a preprogrammed sequence. The main body of the manipulator 1d has the same structure as that of the first embodiment, but may have a different structure.
【００３１】本実施例においては、気腹作業を行なうこ
となく体腔内術野拡張具３５が十分な術野を確保すると
同時に体腔の内壁を保護し、また、触覚センサ３９によ
り臓器への損傷を防ぐことができるため、マイクロマニ
ピュレータ３８，７０が目的とする以外の臓器に接触す
ることが少ない上に、接触しても体腔内術野拡張具３５
で保護されているため、臓器に無理な力を及ぼすことが
ない。In the present embodiment, the intracorporeal operative field expander 35 secures a sufficient operative field without performing pneumoperitoneum, and at the same time protects the inner wall of the body cavity, and the tactile sensor 39 prevents damage to the organ. Since it can be prevented, the micromanipulators 38 and 70 rarely come into contact with organs other than the intended one, and even if they do come in contact with the intracorporeal surgical field expander 35.
Since it is protected by, it does not exert excessive force on the organs.
【００３２】図１０は、前述した各実施例におけるマニ
ピュレータ１の操作手段として、操作者の腕の筋電位を
使用する場合を示している。操作者の腕に複数の筋電位
電極４１を配列した筋電アレイセンサ４２を取り付け、
操作者が手を動かしたときに筋肉から発生する筋電位信
号を検出する。検出処理回路４３は、手の動きと検出さ
れた筋電位の分布との相関関係を予め求めておくことに
より、検出された筋電位の分布からどのように手を動か
したかを認識することが可能である。本実施例では、手
の開閉時と手首の振り動作との際に発生する筋電位の分
布を予め求めておき、これらの筋電位の分布が発生した
ときに、マニピュレータ１の処置具５の開閉及び湾曲部
２８の湾曲動作が操作者の手の動きと一致するように、
マニピュレータ制御回路４４が動作指令を発する。FIG. 10 shows a case where the myoelectric potential of the operator's arm is used as the operating means of the manipulator 1 in each of the above-described embodiments. The myoelectric array sensor 42 in which a plurality of myoelectric potential electrodes 41 are arranged is attached to the operator's arm,
The myoelectric potential signal generated from the muscle when the operator moves the hand is detected. The detection processing circuit 43 can recognize how the hand is moved from the detected myoelectric potential distribution by previously obtaining the correlation between the hand movement and the detected myoelectric potential distribution. Is. In the present embodiment, the distribution of myoelectric potentials generated when the hand is opened and closed and when the wrist is swung is obtained in advance, and when the distribution of these myoelectric potentials is generated, the treatment tool 5 of the manipulator 1 is opened and closed. And so that the bending motion of the bending portion 28 matches the movement of the operator's hand,
The manipulator control circuit 44 issues an operation command.
【００３３】図１１は、操作者が前述のマスタースレー
ブ方式あるいは筋電アレイセンサを用いて体腔内に挿入
されたマニピュレータ１を操作する場合に、体腔内の観
察像をマニピュレータ１の本体であるアーム部３に取り
付けた小型ディスプレイ４７で見ながら行なうことがで
きるようになっているものである。第４の実施例のよう
に挿入部３４の先端に取り付けられた内視鏡３７の光軸
と小型ディスプレイ４７の法線とが平行となるように小
型ディスプレイ４７がマニピュレータ１のアーム部３に
取り付けられている。これにより、マニピュレータ１が
動作して視野が変化しても小型ディスプレイ４７もこれ
に伴って動作するため、観察方向と表示される方向とが
常に一致し、操作者は観察方向を感覚的に把握しながら
マニピュレータ１を操作することができる。FIG. 11 shows an arm which is the main body of the manipulator 1 when the operator operates the manipulator 1 inserted into the body cavity by using the master-slave system or the myoelectric array sensor described above. The operation can be performed while watching the small display 47 attached to the section 3. As in the fourth embodiment, the small display 47 is attached to the arm portion 3 of the manipulator 1 so that the optical axis of the endoscope 37 attached to the tip of the insertion portion 34 and the normal line of the small display 47 are parallel to each other. Has been. As a result, even if the manipulator 1 operates and the field of view changes, the small display 47 also operates accordingly, so that the observation direction and the displayed direction always match, and the operator perceptually grasps the observation direction. While manipulator 1 can be operated.
【００３４】図１２は、前立腺摘除術（ＴＵＲ−Ｐ）の
ロボットシステムの全体構成図を示している。本システ
ムは、レゼクトスコープ４８を取り付けたロボット４９
と、超音波スコープ５０を取り付けたロボット５１と、
レゼクトスコープ４８に取り付けたカメラ５２と、カメ
ラ５２で撮影した画像と超音波エコー像とを同時に表示
するモニタ５３と、２台のロボット４９，５１を操作す
るための操作部５４と、ロボット制御装置５５とを備え
ている。また、レゼクトスコープ４８の先端にはロープ
形状の高周波電極５６が設けられている。FIG. 12 shows the overall configuration of a robot system for prostatectomy (TUR-P). This system consists of a robot 49 with a resectoscope 48 attached.
And a robot 51 to which the ultrasonic scope 50 is attached,
A camera 52 attached to the resectoscope 48, a monitor 53 that simultaneously displays an image captured by the camera 52 and an ultrasonic echo image, an operation unit 54 for operating the two robots 49, 51, and robot control And a device 55. A rope-shaped high-frequency electrode 56 is provided at the tip of the resectoscope 48.
【００３５】この構成にあっては、操作者はモニタに映
しだされた前立腺８０の切除対象を観察しながらロボッ
ト４９，５１を操作し、レゼクトスコープ４８の先端を
切除対象に向け、高周波電極５６を尿道４８の開口側に
引きながら前立腺８０を切除することができる。この
際、高周波電極５６は常にレゼクトスコープ４８の視野
の中に納まってモニタ５３に映しだされているため、操
作者は誤って目的とする以外の部位を切除することがな
い。In this structure, the operator operates the robots 49 and 51 while observing the ablation target of the prostate 80 displayed on the monitor, directing the tip of the resectoscope 48 toward the ablation target, and the high frequency electrode. The prostate 80 can be resected while pulling 56 toward the open side of the urethra 48. At this time, since the high-frequency electrode 56 is always contained in the field of view of the resectoscope 48 and is displayed on the monitor 53, the operator does not accidentally cut off a portion other than the intended one.
【００３６】[0036]
【発明の効果】以上説明したように、本発明の手術用マ
ニピュレータは、体腔内で観察および処置を行なうのに
十分な自由度を有するとともに、それらの作業中に目的
以外の臓器に接触して無理な力を与えることがない。As described above, the surgical manipulator of the present invention has a sufficient degree of freedom to perform observation and treatment in a body cavity, and also makes contact with an organ other than the target during those operations. It does not give undue force.
【図１】本発明の第１の実施例を示す手術用マニピュレ
ータの全体構成図である。FIG. 1 is an overall configuration diagram of a surgical manipulator showing a first embodiment of the present invention.
【図２】手術用マニピュレータの動作指令を決定するた
めのマスターアームを有するマスタースレーブ方式の構
成図である。FIG. 2 is a configuration diagram of a master-slave system having a master arm for determining an operation command of the surgical manipulator.
【図３】図１の手術用マニピュレータのポイントロック
機構の構成図である。3 is a configuration diagram of a point lock mechanism of the surgical manipulator of FIG. 1. FIG.
【図４】図１の手術用マニピュレータの挿入部の駆動機
構を示す断面図である。4 is a cross-sectional view showing a drive mechanism of an insertion portion of the surgical manipulator of FIG.
【図５】（ａ）は本発明の第２の実施例を示す手術用マ
ニピュレータの全体構成図、（ｂ）は（ａ）の手術用マ
ニピュレータの動作指令を決定するためのマスターアー
ムを有するマスタースレーブ方式の構成図である。5A is an overall configuration diagram of a surgical manipulator showing a second embodiment of the present invention, and FIG. 5B is a master having a master arm for determining an operation command of the surgical manipulator of FIG. It is a block diagram of a slave system.
【図６】（ａ）は本発明の第３の実施例を示す手術用マ
ニピュレータの全体構成図、（ｂ）は（ａ）の手術用マ
ニピュレータの動作指令を決定するためのマスターアー
ムを有するマスタースレーブ方式の構成図である。FIG. 6A is an overall configuration diagram of a surgical manipulator showing a third embodiment of the present invention, and FIG. 6B is a master having a master arm for determining an operation command of the surgical manipulator of FIG. It is a block diagram of a slave system.
【図７】本発明の第４の実施例を示す手術用マニピュレ
ータの挿入部を腎臓にアプローチさせた状態を示す状態
図である。FIG. 7 is a state diagram showing a state in which the insertion portion of the surgical manipulator showing the fourth embodiment of the present invention is made to approach the kidney.
【図８】本発明の第５の実施例を示す手術用マニピュレ
ータの挿入部を腎臓にアプローチさせた状態を示す状態
図である。FIG. 8 is a state diagram showing a state in which the insertion portion of the surgical manipulator showing the fifth embodiment of the present invention is made to approach the kidney.
【図９】図８の手術用マニピュレータのエンドエフェク
タを用いた動脈の結紮作業を作業工程別に示した工程図
である。FIG. 9 is a process diagram showing an arterial ligation work using the end effector of the surgical manipulator of FIG. 8 for each work process.
【図１０】操作者の腕の筋電位を用いたマニピュレータ
操作方法の概略構成図である。FIG. 10 is a schematic configuration diagram of a manipulator operating method using the myoelectric potential of the operator's arm.
【図１１】小型ディスプレイで体腔内の観察像を見なが
ら作業を行なうことが可能な好適な構成例を示す斜視図
である。FIG. 11 is a perspective view showing a preferred configuration example in which work can be performed while observing an observation image inside a body cavity on a small display.
【図１２】前立腺摘除術（ＴＵＲ−Ｐ）のロボットシス
テムの全体構成図である。FIG. 12 is an overall configuration diagram of a robot system for prostatectomy (TUR-P).
１，１ａ，１ｂ，１ｃ，１ｄ…手術用マニピュレータ、
２…挿入部、４，５…エンドエフェクタ（作業部）、３
…マニピュレータ本体、１１…支持部。1, 1a, 1b, 1c, 1d ... Manipulator for surgery,
2 ... insertion part, 4, 5 ... end effector (working part), 3
… Manipulator body, 11… Supporting part.
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP28520693AJP3476878B2 (en) | 1993-11-15 | 1993-11-15 | Surgical manipulator |
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|---|---|
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| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP28520693AExpired - Fee RelatedJP3476878B2 (en) | 1993-11-02 | 1993-11-15 | Surgical manipulator |
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