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WO2006040309A1 - Appareil d'imagerie a ultrasons destine a la chirurgie a guidage par ultrasons - Google Patents

Appareil d'imagerie a ultrasons destine a la chirurgie a guidage par ultrasons Download PDF

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Publication number
WO2006040309A1
WO2006040309A1 PCT/EP2005/055139 EP2005055139W WO2006040309A1 WO 2006040309 A1 WO2006040309 A1 WO 2006040309A1 EP 2005055139 W EP2005055139 W EP 2005055139W WO 2006040309 A1 WO2006040309 A1 WO 2006040309A1
Authority
WO
WIPO (PCT)
Prior art keywords
holding
arm
support structure
ultrasound
imaging apparatus
Prior art date
Application number
PCT/EP2005/055139
Other languages
English (en)
Other versions
WO2006040309A8 (fr
Inventor
Christoph De Haen
Original Assignee
Bracco Imaging Spa
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Bracco Imaging Spa filed Critical Bracco Imaging Spa
Publication of WO2006040309A1 publication Critical patent/WO2006040309A1/fr
Publication of WO2006040309A8 publication Critical patent/WO2006040309A8/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/42—Details of probe positioning or probe attachment to the patient
    • A61B8/4209—Details of probe positioning or probe attachment to the patient by using holders, e.g. positioning frames
    • A61B8/4218—Details of probe positioning or probe attachment to the patient by using holders, e.g. positioning frames characterised by articulated arms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/44—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device
    • A61B8/4405—Device being mounted on a trolley
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/44—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device
    • A61B8/4427—Device being portable or laptop-like
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves

Definitions

  • the invention relates to an ultrasound imaging apparatus for ultrasound-guided surgery. It also relates to a flexible support structure for said apparatus and to a chirurgical method for ultrasound-guided surgery using said apparatus .
  • Ultrasound echography allows imaging of internal structures of the human body. Ultrasound imaging is commonly performed by a clinician using a hand held probe which is positioned adjacent to a patient. Ultrasound echography typically involves taking planar images of a sector parallel to the probe. The clinician explores a three-dimensional territory by moving the hand-held probe to let the sector cover the entire territory of interest.
  • Echographic visualization of internal structures in principle allows ultrasound-guided surgery.
  • Localized applications such as biopsies, thermoablation or localized injection of therapeutic substances, as in brachiterapy for example, are currently performed in combination with imaging means, and particularly in combination with ultrasound probes.
  • Ultrasonic imaging allows to see minimally invasive surgical utensils (e.g. needles) and the target region to safely orient and move them to the target point.
  • minimally invasive surgical utensils e.g. needles
  • Support structures capable of positioning a medical imaging device, such as a probe, and maintain it in a fixed position are known.
  • US patent 5,022,410 describes a support structure to be used for non-invasive cardiac output monitor and more particularly for positioning a transducer for long term or continuous use in such monitoring.
  • US patent 6,261,231 discloses an ultrasound probe holder which allows reducing frame-to-frame variability in images due to the movement of the probe between successive images and monitoring an organ of interest while the patient is undergoing exercise-induced stress.
  • US patent 6,732,988 discloses an articulated arm system for attaching different medical imaging devices to support structures. Said arm is used to ensure that the imaging device will stay in place during imaging.
  • ultrasound imaging machines are rather complex and are usually formed of various medical imaging devices, other than the probe, that require the surgeon's attention.
  • the screen is one of them.
  • the surgeon needs to look sideways at the screen located on the imaging machine, his view may be distracted from the operating field.
  • it would thus be desirable to conceive a viewing configuration that facilitates the surgeons viewing of ultrasound image and operating field without head movement while contemporarily freeing his hands from holding the ultrasonic probe.
  • the control-panel is another part of an imaging machine that may divert the surgeon' s attention from the operating field. As the surgeon may want to adjust some ultrasound operating parameter during operation, he may do this by asking a collaborator to operate the control-panel, but it would be desirable for the surgeon himself to be able to operate the control panel, always with minimal movement. That may be possible only if the control panel is adequately supported close to the screen and the operating field.
  • Document WO-A-02/30348 describes a surgical system having a swing arm for holding a video screen and flexible arms for holding various working instruments close to the surgery region, such arms being connected to a main workstation.
  • a system is quite complex as it is mainly concerned with controlling several types of working instruments and/or medical imaging devices. This is achieved by a central control unit interfaced with modular subunits accommodated in the workstation. Hence this configuration does not allow the surgeon to fully control the surgical system without relaying on an assistant.
  • the present invention provides an improved integrated support structure for the various imaging devices forming an ultrasound imaging apparatus, said devices being positionable close to the surgery region, thus allowing minimal movements of the surgeon fully operating such apparatus thus improving the effectiveness and quality of ultrasound-guided surgery.
  • the invention offers unprecedented ease of use with little encumbrance of the vicinity of the surgical field. This provides advantages in terms of number of people needed for ultrasound-guided surgery and, through the ergonomic optimization, it favors efficiency and quality of surgery.
  • An aspect of the invention relates to an ultrasound imaging apparatus for ultrasound-guided surgery, comprising a probe, a display unit (e.g. a screen, a monitor or the like) , an electronic control unit for driving the probe, processing the received echo signals to form ultrasound images onto the display unit and controlling the overall operations, a first displaceable arm, a supporting member connected to said arm, means for holding said display unit, means for holding said probe, means for holding said control unit, wherein said means for holding the electronic control unit are associated to said first arm.
  • a display unit e.g. a screen, a monitor or the like
  • an electronic control unit for driving the probe, processing the received echo signals to form ultrasound images onto the display unit and controlling the overall operations
  • a first displaceable arm e.g. a supporting member connected to said arm, means for holding said display unit, means for holding said probe, means for holding said control unit, wherein said means for holding the electronic control unit are associated to said first arm.
  • control unit By moving the control unit from the mounting structure to the holding arm, it is possible to provide for a simple and cost effective integrated structure with a reduced number of wires and connections allowing full control of the ultrasound imaging system directly by the surgeon without relaying on an assistant.
  • the number of pads or switches that can be used as input to the control unit are, in fact, not limited by the complexity of the wiring extending from the far-end of the arm close to the surgery region to the mounting structure, thus allowing a full control-panel to be displaced and located close to the surgery region, in particular close to the monitor.
  • the control panel is integrated into the monitor, e.g. in the form of a touch-pad.
  • the expression "close to the surgery region”, when referred to the location of a device means that said device is positionable in a region close to the operating surgeon, such that the surgeon can substantially avoid any action or movement, to interact with said device, which may distract himself from the surgical operations.
  • the display unit is held in a stable position close to the surgery region by holding means associated to a portion of the first displaceable arm.
  • the means for holding the probe are advantageously associated to a portion of a second displaceable arm independently movable and lockable from the first arm.
  • the second arm can be directly connected, i.e. without interposing elements, to the first arm or to the supporting member.
  • the means for holding the display unit are advantageously associated to the second arm.
  • the electronic control unit and the display unit of the ultrasonic imaging apparatus are integrated to form a single device and are held in stable position close to the surgery- region by holding means associated to said first arm.
  • the ultrasound imaging apparatus further comprises a control- panel which is displaceable and locatable close to the surgery region.
  • the control-panel is an input of the electronic control unit and preferably comprises touch- sensitive means, like a touch screen, that can be advantageously integrated in the display.
  • the control-panel is associated to the arm provided for holding the display unit and is preferably held by the same means used for holding the display unit, when, for example, the touch- sensitive means and the display unit are part of the same device.
  • the control-panel may also be advantageously associated to the arm provided for holding the probe or to the supporting member, for example using a further displaceable arm.
  • the touch-screen is preferably covered by a disposable cover, typically of plastic material, for sterility reasons .
  • a flexible support structure for ultrasound-guided surgery comprising a first displaceable arm, a supporting member connected to said arm, means for holding a first medical imaging device in a stable position, means for holding at least a second medical imaging device in a stable position, means for holding electronic control means (100) of an imaging apparatus, said means for holding electronic control means being associated to a portion of said arm.
  • the at least second medical device is held in a stable position by a second arm independently movable and lockable from the first arm.
  • the means for holding the second medical imaging device are associated to a portion of the second arm that can be directly connected to the first arm or to the supporting member, thus allowing maximum flexibility of use.
  • the means for holding one of the at least two medical imaging devices are suitable for holding an ultrasonic probe, typically a volumetric scanning probe, of an ultrasound imaging apparatus .
  • the means for holding the other of the at least two medical imaging devices are suitable for holding the display unit, such as a monitor, of an ultrasound imaging apparatus close to the surgery region.
  • one of the two arms comprises means for holding in a stable position close to the surgery region both the electronic control means and the display unit of an integrated ultrasound imaging apparatus .
  • the flexible support comprises means for holding touch- sensitive means, such as a touch screen, to be used for example, as control-panel or generically as input of an ultrasound imaging apparatus .
  • touch- sensitive means such as a touch screen
  • Such holding means are associated to the displaceable arm provided for holding the display means and preferably are the same means used for holding the display unit, when, for example, the touch- sensitive means and the display unit are part of the same device.
  • the means for holding the touch-sensitive means may be also advantageously associated to the arm provided for holding the probe or to the supporting member, for example using another displaceable arm.
  • the invention provides a method for ultrasound-guided surgery comprising the steps of imaging the region to be subjected to ultrasound-guided surgery with an ultrasound imaging apparatus in order to find proper displacement of the probe, placing the probe in position and fixing it, placing the display unit close to the surgery region, adjusting the imaging parameters by acting on a control panel interfaced with the control unit, starting imaging the region of surgery on the display unit, surgically operating on such zone under the guide of such imaging, all with minimal movements of the surgeon operating the ultrasound imaging apparatus while performing surgery.
  • Fig. 1 to 6 schematically show some embodiments of the invention.
  • Fig. 7 (which is a particular of figure 1 of US 5,957,423) illustrates a support with one arm to be fixed to flat side rails of an operating table.
  • Fig. 8 shows a support clamped onto a mounting rod from the ceiling.
  • Fig. 9 shows the same flexible support of fig 8 clamped onto a mounting rod on a heavy floor stand on wheels.
  • Fig. 10 (corresponding to fig. 2 of US 5,022,410) and fig.
  • Fig. 12 shows an exemplary lay out of an operating room for ultrasound-guided surgery (e.g. sentinel lymph node resection in the breast) according to the invention.
  • ultrasound-guided surgery e.g. sentinel lymph node resection in the breast
  • a first embodiment of the invention is schematically shown.
  • Two displaceable arms, for example of the lockable articulated type, 102, 103 are connected to a supporting member 101 acting as a mounting structure like a pillar, a wall or operating table rails.
  • the first arm 102 holds the electronic control unit 100 and an image screen 104 while the second arm 103 holds an ultrasound probe (or transducer) 106 through a probe holder 105.
  • the image screen 104 is preferably an Led supported by a holder that may be of any known type such as the one described in US patent 5,854,735.
  • volume-scanning probes are probes which can mechanically, electronically or part mechanically, part electronically move the angulation of the sector, when the probe is held in fixed position. The periodic movement of the sector through an angle thus allows to monitor a three-dimensional territory.
  • the probe 106 is preferably of the volume-scanning type. This allows to scan the entire surgery region with minimum interaction between the surgeon and the probe that needs only to be initially placed by the surgeon himself.
  • the probe holder 105 is advantageously one of the type described in US patent 5,022,410.
  • a second embodiment of the invention is shown.
  • the first arm 102 is used for holding the whole ultrasound apparatus, with the image screen 104 integrated into the control unit 100 .
  • the screen is typically a liquid crystal display (led) .
  • Commercially available portable ultrasound apparatus are, for example, CarisPlus by Esaote or Aquila or Falco by PieMedical Imaging.
  • displaceable arm 102 holding the integrated image screen 104 and control unit 100, also holds the second displaceable arm 103.
  • the ultrasound apparatus has a touch screen 107, which is held by a holder attached to the first arm 102 used also for holding the image screen 104, typically a led, and the control unit 100.
  • the led 104 is used as output for the echographic images of the zone under investigation, while the touch screen 107 is used by the surgeon for inputting data and commands .
  • the touch ⁇ screen 107 and the led 104 can be integrated together so that only one device needs to be supported by the arm 102.
  • FIG.6 An alternative embodiment is shown in fig.6 where the second displaceable arm 103 is attached onto the first arm 102, which holds the image screen 104, the touch screen 107 and the control unit 100.
  • the supporting member can be clamped to a mounting rod 801 attached to the ceiling 802 as shown in fig. 8.
  • it can be clamped on a mounting rod 801 on a heavy floor stand 901 on wheels 902 as shown in fig. 9.
  • Stable positioning is achieved with lockable wheels and lockable rising and lowering rail grips.
  • the supporting member can also be attached to operating table rails 74 through a rail grip 56, as disclosed e.g. in US patent 5,957,423, here incorporated by reference, from which figure 7 of the present application has been taken.
  • a pivot assembly 44 is mounted atop a keyed shank 52 by a clamp assembly 54 having a handle 55.
  • Shank 52 is matingly insertable in a base 56.
  • a base clamp assembly 60 secures shank 52 at any desired height providing a multiplicity of height settings for the pivot assembly 44 and provides for attachment to mounting rail 74.
  • Each displaceable arm is preferably an articulated arm comprising a parallelogram device including a counterbalancing mechanism for holding the arm itself and the device supported by it in place when the device is located in the desired imaging position.
  • An example of such an arm is disclosed in US patent 6,732,988, here incorporated by reference, from which figure 11 of the present application has been taken.
  • the articulated arm system 20 comprises a first parallelogram device 15a, a spacing piece 10 and a second parallelogram device 15b.
  • the first parallelogram device 15a is attached through a connecting piece 18 and articulation pieces 13 and 12 to the support member 14.
  • At the free end of the second parallelogram device 15b is attached, for example, the led 11 through a connecting piece 19.
  • Both parallelogram devices 15a, 15b comprise parallel strut bars 6, 7 which are connected to the spacing piece 10 and the connecting pieces 18 and 19 by means of articulations 8a and 8b.
  • the mutual distance between the pivots 8a in the connecting piece 18 of the parallelogram device 15a is equal to the mutual distance between the pivots 8b in the spacing piece 10, and correspondingly, the mutual distance between the pivots 8a in the parallelogram device 15b is equal to the mutual distance between the pivots 8b.
  • Both parallelogram devices have a counterbalancing mechanism with an additional strut bar 1, around which there is a counterbalancing spring 16 for holding the articulated arm and the device supported by it in place.
  • the additional strut bar 1 is preferably round and connected with bar 9 in parallelogram device 15a to the connecting piece 18 and in parallelogram device 15b with the spacing piece 10.
  • braking and/or locking means have been mounted around the additional strut bar 1. These means comprise a locking piece 2 which includes a sleeve part surrounding the additional strut bar 1. This piece 2 is connected to a lever arm 3 which is loaded by force F to press the sleeve against the additional strut bar 1. The force F is generated by means of the spring 4.
  • the locking is normally always on, and in order to adjust the device into the desired position, at the end of the lever arm 3 are arranged actuators 5, for example, a solenoid, which is made to pull by pressing the switch button 17 on the connecting piece 19, whereby the lever arm 3 presses against the force of the spring 4, allowing easy movement of the additional strut bar 1 inside the sleeve part of the locking piece 2.
  • actuators 5 for example, a solenoid, which is made to pull by pressing the switch button 17 on the connecting piece 19, whereby the lever arm 3 presses against the force of the spring 4, allowing easy movement of the additional strut bar 1 inside the sleeve part of the locking piece 2.
  • this locking piece 2 can also be implemented vice versa, whereby the lever arm 3 is normally turned in such a way that the additional strut bar 1 is able to move inside the sleeve part, and when the articulated arm is to be locked, for example, a solenoid 5 is used for turning the lever arm 3 in such a way that the sleeve part presses against the additional strut bar 1.
  • the actuator of the lever arm 3 may be, for example, a motor equipped with a self-locking worm gear, or even manual operation.
  • Each of the arms may also be telescoping two axis pivotable arms with elbow articulation such as those sold by Baitella AG, Zurich under the tradename Fisso Endoskophalterung or lockable snake arms such as those sold by SonoTech Medical Electronics AG, Neu-Ulm, Germany.
  • Lockable snake arms such as those sold by SonoTech Medical Electronics AG, Neu-Ulm, Germany.
  • the tension device 1010 may advantageously be a pistol-grip device that allows generation and release of tension in a cord inside the lockable snake arm.
  • Fig. 12 shows a typical lay out of an operating room for ultrasound-guided surgery according to the invention.
  • a patient (represented under cover sheets) lies on the surgery- table 209 wearing anesthesia mask 212.
  • the surgery table 209 is of the type with side rails 207a and 207b.
  • the mounting device 101 of the support structure is attached to the side rail 207 opposite to the surgeon.
  • the support structure is of the type with two displaceable arms with one arm connected to the other as in fig.6.
  • the first arm 102 is of the lockable pivot type and is used for holding a portable ultrasound apparatus 200, including an image viewing screen 201 (with an integrated touch screen control panel, not shown) and an electronic control input device 202.
  • the second arm 103 is of the lockable snake type and is used for holding the ultrasound probe 106 close to the area of intervention 211.
  • the cables 208 for electric supply and for the control of the ultrasound probe 106 and image viewing screen pass through respective cavities (not shown) provided in the two arms 102 and 103 of the supporting structure.
  • this configuration facilitates the surgeons 203 viewing of ultrasound image and operating field while contemporarily freeing his hands from holding the ultrasonic probe and allowing minimal movements, thus improving the effectiveness and quality of ultrasound-guided surgery at surgery location 204.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Molecular Biology (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Pathology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Physics & Mathematics (AREA)
  • Biophysics (AREA)
  • Radiology & Medical Imaging (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Ultra Sonic Daignosis Equipment (AREA)

Abstract

L'invention concerne un appareil d'imagerie à ultrasons destiné à la chirurgie à guidage par ultrasons qui comprend une sonde (106), une unité d'affichage (104), une unité de commande électronique (100), un premier bras (102), un élément de support (101) relié audit premier bras (102), un moyen pour soutenir ladite unité d'affichage (104), un moyen (105) pour soutenir ladite sonde (106), un moyen pour soutenir l'unité de commande (100), lesdits moyens pour soutenir l'unité de commande (100) étant associés audit premier bras (102).
PCT/EP2005/055139 2004-10-12 2005-10-10 Appareil d'imagerie a ultrasons destine a la chirurgie a guidage par ultrasons WO2006040309A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
EP04024244 2004-10-12
EP04024244.8 2004-10-12

Publications (2)

Publication Number Publication Date
WO2006040309A1 true WO2006040309A1 (fr) 2006-04-20
WO2006040309A8 WO2006040309A8 (fr) 2007-07-12

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PCT/EP2005/055139 WO2006040309A1 (fr) 2004-10-12 2005-10-10 Appareil d'imagerie a ultrasons destine a la chirurgie a guidage par ultrasons

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WO (1) WO2006040309A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20220313211A1 (en) * 2021-04-05 2022-10-06 Mahmoud I. Eltorai Ultrasound support device

Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4625731A (en) * 1984-10-10 1986-12-02 Picker International, Inc. Ultrasonic image display mounting
EP0415323A2 (fr) * 1989-08-30 1991-03-06 Kabushiki Kaisha Toshiba Appareil de diagnostic à ultrasons
US5732712A (en) * 1996-07-12 1998-03-31 Adair; Edwin L. Sterile encapsulated operating room video monitor and video monitor support device
DE19719368A1 (de) * 1997-05-07 1998-11-12 Siemens Ag Darreichungseinheit
US6179262B1 (en) * 1998-10-23 2001-01-30 Real World Design & Development Co. Stabilizer assembly for stepper apparatus and ultrasound probe
WO2002030348A2 (fr) * 2000-10-09 2002-04-18 Benca Technology Aps Station de travail chirurgicale
US20030001056A1 (en) * 1999-12-01 2003-01-02 Pekka Ihalainen Articulated arm system for attaching different medical imaging devices to support structures in an articulated manner
US6565050B1 (en) * 2001-07-26 2003-05-20 Pruter Rick L Method and system for supporting an imaging transceiver

Patent Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4625731A (en) * 1984-10-10 1986-12-02 Picker International, Inc. Ultrasonic image display mounting
EP0415323A2 (fr) * 1989-08-30 1991-03-06 Kabushiki Kaisha Toshiba Appareil de diagnostic à ultrasons
US5732712A (en) * 1996-07-12 1998-03-31 Adair; Edwin L. Sterile encapsulated operating room video monitor and video monitor support device
DE19719368A1 (de) * 1997-05-07 1998-11-12 Siemens Ag Darreichungseinheit
US6179262B1 (en) * 1998-10-23 2001-01-30 Real World Design & Development Co. Stabilizer assembly for stepper apparatus and ultrasound probe
US20030001056A1 (en) * 1999-12-01 2003-01-02 Pekka Ihalainen Articulated arm system for attaching different medical imaging devices to support structures in an articulated manner
WO2002030348A2 (fr) * 2000-10-09 2002-04-18 Benca Technology Aps Station de travail chirurgicale
US6565050B1 (en) * 2001-07-26 2003-05-20 Pruter Rick L Method and system for supporting an imaging transceiver

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20220313211A1 (en) * 2021-04-05 2022-10-06 Mahmoud I. Eltorai Ultrasound support device

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