Method and device for visualization of positions and orientation of intracorporeally guided instruments during a surgical intervention

[0001] [Technical field to which the invention belongs] The present invention provides a visualization device for visualizing data on medical invasion to a patient as described in the preamble of claim 1 and data on medical invasion in a patient as described in the preamble of claim 10. Regarding methods and methods for visualization. [0002] [Conventional technology] During a medical, or surgical invasion, the position and orientation of a surgical instrument, eg, equipped with a navigation system sensor for determining the position and orientation, is displayed in the medical image data during the surgical invasion. [0003] Thus, in certain areas of application, there is a need to guide many surgical instruments that are guided within the patient's body and that cannot be visually tracked by an invasive surgeon to match each other. Such a situation is, for example, in some gastroenterological Laparoscopy invasions where a surgical instrument introduced into the abdominal cavity must be introduced in the same position as the endoscope introduced into the colon. Occurs at the time. It is not easy for the surgeon to guide them to match each other in this way. This is because there is no visible tracking possibility for the guided instrument. [0004] International Patent Application Publication WO 97/29709 details the use of many sensors for visualization of surgical instruments. It also describes a user interface with one or more monitors and a "virtual reality device" for visualization of instrument position. Here, the appliance is displayed on a flat computer display. [0005] The drawback of this device is that the visualization of surgical instruments on a flat computer display is not intuitive. From the surgeon's point of view, it is inefficient to constantly switch the visual direction between the computer display and the surgical area during the invasion. In addition, the room conditions in the operating room are very narrow, so it is desirable to save components (eg computer displays, if shown). [0006] U.S. Pat. No. 5,6914,142 describes a solution in which the surgeon looks at the surgical area through a translucent plate that projects medical image data overlaid on the surgical area. .. [0007] [Problems to be Solved by the Invention] Therefore, the subject of the present invention is a visualization device according to the preamble of claim 1 for visualizing data relating to medical invasion to a patient and a method according to the preamble of claim 10 for visualizing data relating to medical invasion to a patient. Is configured to have the following characteristics. That is, -The position and orientation of equipment that cannot be visually tracked must be visualized. -The positions and orientations of many instruments that cannot be visually tracked must be visible relative to each other. -Visualization must be possible without the surgeon having to look away from the surgical area during the invasion. -Visualization must be relative to the patient, i.e. in the patient coordinate system rather than the image data-specific coordinate system. [0008] [Means for solving problems] This task is a visualization device for visualizing data relating to medical invasion to a patient, wherein the visualization device projects the data onto the surface of the patient's body, for example, by light projection. It is solved by a visualization device for visualization. [0009] Further, this problem is solved by the method for visualization of data according to claim 10, characterized in that the data is projected onto the surface of the patient's body in a method for visualizing data regarding medical invasion to a patient. To. [0010] In the present invention, data is projected onto the body surface within the range of invasiveness. During gastroenterological Laparoscopy invasion, projection is performed, for example, on the patient's upper abdomen. The surgeon can thus capture surgical data without looking away from the surgical area. [0011] In addition, components such as computer displays can be saved. [0012] Advantageous embodiments of the present invention are set forth in each dependent claim. [0013] In an embodiment of the invention, data regarding the position and orientation of one or more instruments guided through the body is projected onto the surface of the patient's body. [0014] These data, as geometric patterns or figures, such as circles and / or arrows, are often projected onto the patient's body surface in a specific relationship to the position of the surgical instrument. The geometric pattern moves on the surface of the patient's body as the device moves. The surgeon can thus track the position and orientation of one or more instruments that cannot be directly followed visually during the invasion without having to divert their line of sight from the surgical area. The orientation is represented, for example, by the direction of the arrow. [0015] The problem of guiding many instruments (eg endoscopy and surgical instruments) to match each other without the possibility of direct visual tracking is the geometry projected onto the patient's body surface in this solution. It comes down to overlapping scientific patterns. [0016] According to the present invention, the projection of a surgical instrument or geometric pattern is performed within the patient coordinate system. That is, the position and orientation are accurately projected onto the surface of the body where the surgical instrument is actually located. [0017] The geometric pattern is projected correctly and vertically onto the surgical instrument in the patient's body, that is, the instrument position projected on the patient's body surface is always projected with the actual position of the surgical instrument. It can also be located on a vertical connecting line to the position where it is to be. However, in this projection format, the projection location is not located in the line of sight of the invasive surgeon. [0018] In order to position the projection point on the surgeon's line of sight, it is suggested that a geometric pattern be projected onto the patient's body surface at a point diagonally above the surgical instrument in the direction of the invasive surgeon's line of sight. This means that the projection of the geometric pattern on the surface of the body is located on the connection line between the actual spatial position of the surgical instrument and the surgeon's line of sight directed at the instrument. A navigation calculator that attaches one or more reference marks to or near the surgeon's head so that the surgeon can determine the starting point of this line of sight, each of which has a spatial position that also determines the position and orientation of the surgical instrument. In front of a new projection of the position of the instrument, it is transmitted. That is, the surgeon's head is continuously tracked, for example, by a stereo camera, and thus its position is captured. [0019] For example, one or more cross-shaped reference marks detected continuously or optionally by two cameras (stereo cameras) are attached to the surgeon's surgical cap. This method gives the coordinates of the surgeon's head. [0020] Many reference marks attached to the head or surgical cap are detected so that the orientation of the head, and thus the direction of its line of sight, can be determined in addition to the position of the head. The instrument position is then projected onto the patient's body surface as the intersection of the line of connection between the position of the reference mark on the surgeon's head and the actual instrument position given by the sensor in the navigation system and the body surface. Will be done. [0021] [0021] Since only two-dimensional visualization of the instrument position or corresponding geometric pattern on the patient's body surface is possible, a third spatial dimension, i.e. the vertical distance of the surgical instrument from the body surface or the patient's berth, and thus also surgery. It is necessary to code and display the "depth" of the equipment. This information is displayed, for example, coded by color and / or size. Therefore, ring-shaped or circular geometric patterns for displaying the position of surgical instruments or arrow-shaped geometric patterns for displaying their orientations have their colors and / or their sizes. , Depending on the depth of the device within the patient's body, i.e. the body surface or the vertical distance from the patient's berth. [0022] In another embodiment of the invention, medical image data of the patient is projected onto the surface of the patient's body. In this case, it may be, for example, image data acquired at any time before surgery, i.e. before invasion. In this way, real-time image data, such as 2D or 3D, X-ray image data, taken with a movable C-arm X-ray system, such as 2D or 3D ultrasound data, is the patient's. Projected on the surface of the body. [0023] In this method, capturing the position of the invasive surgeon's head so that the anatomical structure mapped in the image data is located directly on the actual organ structure from the surgeon's point of view, and therefore also in the direction of its line of sight. Is also advantageous because it projects the image data onto the patient's body surface. [0024] In addition, a position sensor for the navigation system is provided to determine its orientation, and image data is placed on the patient's body surface so that the central projection line extends along the axis of the surgical instrument guided inside or outside the body. It is also possible to project. This will allow us to find the optimal insertion hole for inserting the surgical instrument into the patient's body for minimally invasive purposes. Organs or other important anatomical structures located beneath the puncture hole can thus be recognized by projecting image data onto the patient's body surface prior to puncture. In another embodiment of the invention, it relates to the result of preoperative surgical planning such as organ, tissue or bone structure, trauma location, planned surgical route, planned insertion start or target point. Data can be projected onto the patient's body surface. [0025] Projection of the results of the surgical procedure onto the patient's body surface is used, for example, for minimally invasive purposes, to determine the optimal puncture hole within the framework of the invasive. By combining the projection of the result of the surgical plan on the surface of the patient's body with the projection of the position of the surgical instrument, it is possible to realize, for example, whether or not to exercise on the surgical route determined at the time of the surgical plan. [0026] It should be noted that the projection of the position and orientation of surgical instruments on the patient's body surface, the projection of medical image data and the projection of the results of previous surgical plans are separate from each other or optionally in combination with each other. You can. [0027] In addition, the patient's anatomy must be considered in the projection. That is, harmony must be achieved between the patient's body surface and the visualization device so that each data is correctly positioned and projected from the patient's body surface. [0028] BEST MODE FOR CARRYING OUT THE INVENTION Hereinafter, preferred embodiments of the present invention will be described in more detail with reference to the accompanying drawings. [0029] FIG. 1 shows an embodiment of the invention that does not take into account the gaze direction of the invasive surgeon when projecting data according to the invention onto the patient's body surface. [0030] As shown in FIG. 1, a surgical instrument (5) is guided through the patient's abdominal cavity. The surgical instrument (5) is equipped with a position sensor (4) of the navigation system (3), which is used to continuously or intermittently transmit spatial coordinates to the control computer (1) via the interface (2). .. As soon as the control computer (1) captures this spatial coordinate of the instrument (5), it passes the visualization device (6) according to the invention through the computer interface (7) and the position of the surgical instrument (5) is geometric. As a pattern, it is driven to project onto the surface of the patient's body vertically (9) at a location (8) located on the instrument (5). [0031] This projected geometric pattern is reshaped, colored and / or sized to encode the depth information of the surgical instrument (5) or other properties of the instrument (5). [0032] The projection of the position and orientation of the instrument, taking into account the patient's anatomy, projects the position and orientation of the surgical instrument (5) onto the correct location (8) on the patient's body surface. Therefore, registration between the navigation system (3), projection system (6) and the patient's anatomy is assumed. [0033] FIG. 2 shows an embodiment of the present invention that takes into account the direction of the invasive surgeon's line of sight when projecting data according to the present invention onto the surface of the patient's body. [0034] As shown in FIG. 1, the surgical instrument (5) guided through the patient's abdominal cavity is equipped with the position sensor (4) of the navigation system (3), which is used to space the surgical instrument (5). Coordinates are continuously or intermittently sent to the control computer (1) via the interface (2). In addition to the spatial coordinates of the surgical instrument (5), the spatial position and orientation of the surgeon's head also controls the position data via the interface (11) (eg Frame Grabber card or parallel or serial interface) computer (1). ) Is captured with the help of a stereo camera (12). The surgeon's head position (8) or head orientation, and thus also the gaze direction, is determined using one or more continuous or occasional reference marks (13) attached to the surgeon's cap. [0035] As soon as the control computer (1) detects the spatial coordinates of the instrument (5) and the position and orientation of the surgeon's head, the control computer (1) causes the visualization device (6) according to the invention to the computer interface (7), eg, in series or Through a parallel interface, the position of the surgical instrument (5) is on the surface of the patient's body, and the projected contour (8) is the connecting line between the surgeon (14)'s head and the tip of the surgical instrument (5). (10) Driven to project so that it is located above. [Simple explanation of drawings] FIG. 1 is a perspective view showing a first embodiment of the present invention. FIG. 2 is a perspective view showing a second embodiment of the present invention. [Explanation of symbols] 1 Control calculator 2 Interface between navigation system and control computer 3 Navigation system 4 Position sensor 5 Surgical instruments 6 Visualization device 7 Calculator interface 8 Patient's body surface 9 Vertical connection between the surgical instrument and the visualization device 10 Surgeon's line of sight 11 Interface between control computer and camera 12 camera 13 Reference mark 14 Surgeon