WO2015129395A1 - Exclusion device and robot system - Google Patents

Exclusion device and robot system Download PDF

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Publication number
WO2015129395A1
WO2015129395A1 PCT/JP2015/052877 JP2015052877W WO2015129395A1 WO 2015129395 A1 WO2015129395 A1 WO 2015129395A1 JP 2015052877 W JP2015052877 W JP 2015052877W WO 2015129395 A1 WO2015129395 A1 WO 2015129395A1
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WO
WIPO (PCT)
Prior art keywords
exclusion
suction
smoke
body cavity
organ
Prior art date
Application number
PCT/JP2015/052877
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French (fr)
Japanese (ja)
Inventor
悟 菊池
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オリンパス株式会社
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Publication of WO2015129395A1 publication Critical patent/WO2015129395A1/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A61B2017/00305—Constructional details of the flexible means
    • A61B2017/00314—Separate linked members
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A61B2017/2906—Multiple forceps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2217/00—General characteristics of surgical instruments
    • A61B2217/002—Auxiliary appliance
    • A61B2217/005—Auxiliary appliance with suction drainage system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
    • A61B2218/007—Aspiration
    • A61B2218/008—Aspiration for smoke evacuation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots

Definitions

  • the present invention relates to an exclusion device and a robot system, and more particularly to an exclusion device and a robot system for excluding an organ in a body cavity.
  • an exclusion device that excludes organs around a treatment site is known (for example, (See Patent Document 1).
  • a suction port used for adsorption of an exclusion surface to an organ and suction of liquid accumulated in the abdominal cavity is provided on the exclusion surface.
  • the present invention has been made in view of the above-described circumstances, and an object thereof is to provide an exclusion device and a robot system capable of simultaneously securing a treatment space by organ exclusion and discharging smoke.
  • an elongated insertion portion that can be inserted into a body cavity of a living body, an exclusion surface that is provided at the distal end of the insertion portion and is in contact with the surface of an organ within the body cavity, and suction
  • a pressure relief portion having a suction surface with an opening, a suction passage having the suction port at a distal end, extending to a proximal end side of the insertion portion, and disposed on a proximal end side of the insertion portion;
  • a suction part that sucks the suction surface, and the suction surface and the suction surface face each other in different directions.
  • the insertion part is inserted into the body cavity, the exclusion part is arranged in the vicinity of the treatment site, the exclusion surface of the exclusion part is brought into contact with an organ around the treatment part, and the exclusion part
  • a treatment space for observing and treating the treatment site can be secured around the treatment site.
  • the suction surface facing in a direction different from the exclusion surface is exposed to the treatment space without contacting the organ. Therefore, the smoke in the treatment space can be discharged to the outside of the living body through the suction port and the suction passage by sucking the inside of the suction passage with the suction portion while excluding the organ and securing the treatment space.
  • the smoke detection part which detects the smoke in the said body cavity, and the attraction
  • produced in the body cavity can be automatically detected by the smoke detection part, and the exhaust_gas
  • the smoke detection unit may receive an endoscope image from an endoscope that images the inside of the body cavity, and may detect the smoke based on a luminance value of the endoscope image. .
  • the smoke detection unit may receive an endoscope image from an endoscope that images the inside of the body cavity, and may detect the smoke based on a luminance value of the endoscope image.
  • the said smoke detection part may detect a smoke based on the action
  • an exclusion device according to any one of the above, a medical instrument inserted into the body cavity, and an electric arm that holds the exclusion device and the medical instrument, respectively, outside the living body.
  • a robot system including an operation input unit operated by an operator and an arm control unit that operates the electric arm based on an operation input to the operation input unit.
  • the arm control unit may control the electric arm holding the exclusion device based on the position and posture of the electric arm holding the medical instrument.
  • FIG. 1 is an overall configuration diagram of an exclusion device according to a first embodiment of the present invention. It is a figure explaining the usage method in the laparoscopic surgery of the exclusion apparatus of FIG. It is a whole block diagram of the exclusion apparatus which concerns on the 2nd Embodiment of this invention. It is a block diagram of the exclusion part with which the exclusion apparatus which concerns on the 3rd Embodiment of this invention is provided. It is a whole block diagram which shows the modification of an exclusion apparatus provided with the exclusion part of FIG. It is a block diagram which shows the collapsed state of the exclusion part with which the exclusion apparatus which concerns on the 4th Embodiment of this invention is provided. It is a block diagram which shows the state which the exclusion part of FIG. 6A spread.
  • FIG. 10 is a diagram showing the exclusion part of FIG. 9 supporting an organ. It is a whole block diagram of the robot system which concerns on the 7th Embodiment of this invention.
  • the exclusion apparatus 10 which concerns on the 1st Embodiment of this invention is demonstrated with reference to FIG. 1 and FIG.
  • the exclusion device 10 includes an exclusion device 1 and a suction device (suction unit) 2.
  • FIG. 2 is a diagram illustrating a method of using the retraction tool 1.
  • the exclusion device 10 according to the present embodiment is used together with an endoscope 21 for observing the abdominal cavity A and an energy treatment tool 22 such as an electric knife or an ultrasonic treatment tool in laparoscopic surgery.
  • the exclusion tool 1 includes an elongated insertion portion 3 that can be inserted into the abdominal cavity (body cavity), an exclusion portion 4 provided at the distal end of the insertion portion 3, a gripping portion 5 provided at the proximal end of the insertion portion 3, A suction passage 7 provided through the inside of the exclusion part 4, the insertion part 3, and the grip part 5 is provided.
  • the exclusion part 4 is provided with a rectangular thin plate-like single exclusion member 6 extending from the distal end of the insertion part 3 in the longitudinal direction of the insertion part 3.
  • the exclusion member 6 has an exclusion surface 6A and a suction surface 6B that face each other in the thickness direction. A plurality of suction ports 6b are open on the suction surface 6B.
  • the grip part 5 includes a suction operation part 5a such as a switch for turning on and off the suction operation of the suction device 2.
  • the suction operation unit 5a transmits an ON signal to the suction device 2 when operated by the surgeon.
  • the suction passage 7 is formed along the longitudinal direction of the insertion portion 3 and connects the suction port 6 b and the suction device 2. The suction device 2 sucks the inside of the suction passage 7 when receiving an ON signal from the suction operation unit 5a.
  • the insertion part 3 is inserted into the abdominal cavity A, the exclusion surface 6A is brought into contact with the surface of the organ B located in the treatment space by the energy treatment tool 22, and the organ B is excluded by the exclusion part 4. That is, the organ B is moved away from the treatment space by pressing the organ B with the exclusion part 4. Thereby, a treatment space for operating the energy treatment tool 22 is secured, and a visual field of the treatment space by the endoscope 21 is secured.
  • the surgeon operates the suction operation unit 5a at hand to start suction by operating the suction operation unit 5a.
  • the inside of the suction passage 7 is sucked, the smoke is sucked into the suction port 6b of the suction surface 6B facing the treatment space, and the smoke is removed from the treatment space.
  • the suction surface 6B facing in the direction opposite to the exclusion surface 6A in the state in which the organ B is excluded by the exclusion unit 4 is in the vicinity of the treatment site where smoke is generated. It is exposed to the treatment space without contacting the organ B. Therefore, there is an advantage that the smoke can be efficiently discharged from the suction port 6b of the suction surface 6B while the organ B is excluded by the exclusion unit 4. Further, since it is possible to simultaneously perform the exclusion and the exhaust using the single exclusion device 1, it is possible to continuously observe the treatment space by the endoscope 21 and to operate with the exclusion and the exhaust. Therefore, there is an advantage that the efficiency of the operation can be improved.
  • the exclusion device 20 according to the present embodiment operates the suction device 2 that detects smoke in the abdominal cavity A, and when the smoke is detected by the smoke detection unit 8. It differs from 1st Embodiment in the point further provided with the suction control part 9 to be made. Therefore, in the present embodiment, the smoke detection unit 8 and the suction control unit 9 will be mainly described, and the components common to the first embodiment will be denoted by the same reference numerals and description thereof will be omitted.
  • the smoke detector 8 receives an endoscopic image from the endoscopic system 100 that processes an endoscopic image in the abdominal cavity A photographed by the endoscope 21, and analyzes the received endoscopic image. Detect the occurrence of fumes. Specifically, when smoke occurs in the abdominal cavity A, the illumination light emitted from the distal end of the endoscope 21 is irregularly reflected by the smoke, thereby increasing the luminance value of the endoscope image. Therefore, the smoke detection unit 8 sequentially calculates the average value of the luminance values of the received endoscopic image, calculates the time change rate of the average value of the luminance values, and when the time change rate is equal to or greater than a predetermined threshold value. That is, smoke is detected when the rate of increase in the average value of the luminance values is large. The smoke detection unit 8 transmits a smoke detection signal to the suction control unit 9 when the smoke is detected. The suction control unit 9 operates the suction device 2 when receiving the smoke detection signal.
  • the exclusion device 20 when smoke is generated in association with the treatment by the energy treatment tool 22, the brightness value of the endoscope image is increased by the smoke. From the increase in the luminance value of the endoscopic image, the generation of smoke is detected by the smoke detection unit 8, and the body cavity is exhausted by the suction device 2 automatically. In this way, the detection of the occurrence of fumes in the abdominal cavity A and the execution of exhaust are automatically performed without the operator operating the suction operation unit 5a, so that the operator's effort is saved and the efficiency of the operation is reduced. There is an advantage that it can be further improved.
  • the smoke detection unit 8 detects the generation of the smoke based on the increase in the luminance value of the endoscopic image, but instead of this, or in addition to this, the energy treatment device 22.
  • the generation of smoke may be detected based on the operation of For example, when the smoke detection unit 8 acquires a signal indicating the operating state of the energy treatment tool 22 from the energy treatment tool 22 and detects the start of operation of the energy treatment tool 22, that is, the tissue of the tissue by the energy treatment tool 22.
  • the occurrence of fumes is detected when the treatment starts and a situation occurs where fumes are generated.
  • the exclusion device 30 according to the present embodiment is different from the first and second embodiments in that a suction port 6 a is formed in the exclusion surface 6 ⁇ / b> A in addition to the suction surface 6 ⁇ / b> B. ing.
  • the same reference numerals are assigned to configurations common to the first and second embodiments, and the description thereof is omitted.
  • the exclusion device 30 is provided in parallel with the suction passage 7 (hereinafter referred to as the first suction passage 7), passes through the inside of the exclusion portion 4, the insertion portion 3, and the grip portion 5, and the suction port 6a of the exclusion surface 6A.
  • Another suction passage 72 (hereinafter referred to as the second suction passage 72) for connecting the suction device 2 is provided.
  • the suction device 2 includes, for example, a first switch corresponding to the first suction passage 7 and a second switch corresponding to the second suction passage 72 as the suction operation unit 5a.
  • the suction operation in one suction passage 7 and the suction operation in the second suction passage 72 can be turned on and off separately.
  • the exclusion device 30 configured in this manner, the inside of the second suction passage 72 is aspirated by the aspiration device 2 by operating the aspiration operation unit 5a while the exclusion surface 6A is in contact with the surface of the organ B.
  • the exclusion surface 6A is fixed to the surface of the organ B by the suction force into the suction port 6a.
  • the suction surface 6A on the exclusion surface 6A the exclusion surface 6A can be strongly fixed to the surface of the organ B, and there is an advantage that the exclusion operation of the organ B can be performed stably.
  • Other effects are the same as those of the second embodiment, and thus the description thereof is omitted.
  • either the front surface or the back surface of the exclusion member 6 may be used as the exclusion surface 6A and the suction surface 6B.
  • the suction device 2 includes a suction pressure detection unit 11 that detects the suction pressure of the suction passages 7 and 72, and is based on the suction pressure detected by the suction pressure detection unit 11. Thus, it is determined which of the front surface and the back surface is used as the exclusion surface 6A.
  • the suction control unit 9 causes the suction device 2 to suck both suction passages 7 and 72 and compares the suction pressures of the two suction passages 7 and 72 after a predetermined time from the start of suction. Then, the suction controller 9 determines that the surface to which the suction passage 7 or 72 having the higher suction pressure is connected is the exclusion surface 6A, and continues the suction in the suction passage 7 or 72.
  • the suction control unit 9 determines that the surface to which the suction passage 72 or 7 with the lower suction pressure is connected is the suction surface 6B, stops the suction in the suction passage 72 or 7, and thereafter The suction passage 72 or 7 is sucked based on the detection of the smoke by the smoke detection unit 8 or the operation of the suction operation unit 5a.
  • usability can be improved by making it possible to use the front surface and the back surface of the exclusion member 6 as both the exclusion surface 6A and the suction surface 6B.
  • the exclusion surface 6A is fixed to the surface of the organ B by suction, but instead of or in addition to this, other fixing means may be adopted.
  • the suction surface 6A may be provided with a suction cup, or the relief surface 6A may be subjected to uneven processing for increasing friction with the surface of the organ B.
  • an exclusion apparatus according to a fourth embodiment of the present invention will be described with reference to FIGS. 6A and 6B.
  • the exclusion device according to the present embodiment is different from the first to third embodiments in the structure of the exclusion portion 4. Therefore, in this embodiment, the exclusion part 4 is mainly demonstrated, about the structure which is common in the 1st to 3rd embodiment, the same code
  • the exclusion part 4 includes a plurality (three in this example) of the exclusion members 6 described in the third embodiment.
  • the plurality of exclusion members 6 are stacked in the thickness direction, and base end portions are connected to each other so as to be rotatable around a rotation axis in the stacking direction.
  • the exclusion portion 4 is fan-shaped by the state where the exclusion members 6 are overlapped with each other, and as shown in FIG. 6B, the exclusion members 6 are displaced from each other in the rotational direction. It is designed to deform between the expanded state.
  • the rotation operation of the exclusion member 6 around the rotation axis is performed by a motor (not shown) in accordance with an input to an extension operation unit (not shown) provided in the grip 5.
  • the insertion portion 3 is inserted into the abdominal cavity A in the same manner as in the first embodiment with the exclusion portion 4 folded, and the expansion portion is operated by operating the expansion operation portion. 4 is spread, the surface 6A is brought into contact with the surface of the organ B, and the surface of the organ B is supported by the three surfaces 6A.
  • the expansion portion is operated by operating the expansion operation portion. 4 is spread, the surface 6A is brought into contact with the surface of the organ B, and the surface of the organ B is supported by the three surfaces 6A.
  • an exclusion apparatus 50 according to a fifth embodiment of the present invention will be described with reference to FIGS.
  • the exclusion device 50 according to the present embodiment is different from the first to fourth embodiments in that the exclusion member 6 has a joint structure. Therefore, in this embodiment, the retraction tool 1 is mainly demonstrated and about the structure which is common in the 1st-4th embodiment, the same code
  • the exclusion member 6 has an elongated shape like a finger and has a plurality of joints arranged in the longitudinal direction. Each joint is provided so as to be swingable about a swing axis that intersects the longitudinal direction. The exclusion member 6 is bent at an intermediate position in the longitudinal direction as each joint swings, and can be deformed from a linear shape to a curved shape.
  • the suction ports 6a are provided on the cylindrical side surface of the exclusion member 6 in a line in the longitudinal direction.
  • the suction port 6b is arranged in a line in the longitudinal direction at a position on the side surface of the exclusion member 6 that is 180 ° different from the suction port 6a in the circumferential direction.
  • which position of the exclusion member 6 becomes the exclusion surface 6A and which position becomes the suction surface 6B differs according to the bending direction of the exclusion member 6, which position of the exclusion member 6 becomes the exclusion surface 6A and which position becomes the suction surface 6B differs. That is, the side surface located inside the curved shape of the exclusion member 6 is the exclusion surface 6A, and the side surface located outside is the suction surface 6B.
  • the grip portion 5 is provided with a bending operation portion (not shown) such as a switch for operating the deformation of the exclusion member 6.
  • a bending operation portion such as a switch for operating the deformation of the exclusion member 6.
  • the linear exclusion member 6 brought into contact with the surface of the organ B is bent along the curved shape of the organ B by operating the bending operation unit. Accordingly, as shown in FIG. 8, there is an advantage that the organ B can be supported by the exclusion surface 6A along the curved shape of the organ B and the organ B can be more gently excluded.
  • an exclusion apparatus 60 according to a sixth embodiment of the present invention will be described with reference to FIGS. 9 and 10.
  • An exclusion device 60 according to the present embodiment is a modification of the fifth embodiment, and as shown in FIG. 9, a plurality of (three in this example) exclusion members 6 provided in parallel with each other. I have. Therefore, in this embodiment, the retraction tool 1 is mainly demonstrated and about the structure which is common in 1st to 5th embodiment, the same code
  • the three exclusion members 6 are arranged at equal intervals in the circumferential direction around the central axis of the insertion portion 3. When the bending operation part is operated to be in the on state, the three exclusion members 6 are curved outwardly convex with respect to the central axis, so that the exclusion part 4 expands in the radial direction. Yes.
  • the suction port 6 a for adsorbing the organ B is provided on the central axis side of the side surface of each exclusion member 6.
  • the suction port 6 b for sucking the smoke is provided on the side of each of the extruding members 6 on the side opposite to the central axis.
  • the exclusion member 6 by operating the bending operation unit, the exclusion member 6 is moved so that the exclusion member 6 follows the three-dimensional curved shape of the organ B as shown in FIG.
  • the organ B is three-dimensionally supported inside the three exclusion members 6 by bending the three exclusion members 6.
  • the organ B can be more gently and stably removed by supporting the organ B three-dimensionally with the exclusion surface 6A along the curved surface shape of the organ B.
  • stable exclusion is possible even when the organ B is removed with a stronger force.
  • the exclusion device 70 according to the present embodiment includes a plurality of electric arms 12, 13, and 14 each holding a medical instrument, and remotely operating the electric arms 12, 13, and 14. This is different from the first to sixth embodiments in that it is applied to a robot system 200 that moves a medical instrument in a body cavity. Therefore, in the present embodiment, the configuration of the robot system 200 will be mainly described, and the configurations common to the first to sixth embodiments will be denoted by the same reference numerals and description thereof will be omitted.
  • FIG. 11 shows an example of the exclusion device 70 including the exclusion device 1 described in the sixth embodiment, but any of the exclusion devices described in other embodiments may be adopted. Good.
  • the robot system 200 includes a retraction tool 1, an endoscope (medical instrument) 21 and an energy treatment tool (medical instrument) 22, and a retraction tool 1, an endoscope 21, and an energy treatment tool 22.
  • a retraction tool 1 Based on the articulated electric arms 12, 13, and 14 that hold the respective base end portions outside the body, the operation input unit 15 operated by the operator (operator), and the operation input to the operation input unit 15 And an arm control unit 16 that drives and controls the joints of the electric arms 12, 13, and 14.
  • the arm control unit 16 receives detection values from an encoder (not shown) provided on the electric arms 12, 13, and 14 that detects the rotation angle of each joint, and based on the received detection values of the encoder, The positions and postures of the retraction tool 1, the endoscope 21, and the energy treatment tool 22 are calculated. Then, the arm control unit 16 moves the joint of the electric arm 12 holding the relieving tool 1 so as to move the relieving tool 1 based on the calculated position and posture of the endoscope 21 and the energy treatment tool 22. Control.
  • the retraction device when the endoscope 21 and the energy treatment device 22 approach the retraction device 1 and the distance between the arm control unit 16 and the retraction device 1 becomes less than a predetermined threshold, the retraction device The joint of the electric arm 12 is controlled so that 1 is moved away from the endoscope 21 or the energy treatment tool 22.
  • the robot system 200 configured as described above, when the energy treatment tool 22 approaches the retraction tool 1 while performing the treatment by operating the endoscope 21 and the energy treatment tool 22 in the abdominal cavity A, By automatically moving the retraction device 1 away from the energy treatment device 22, the organ B located near the energy treatment device 22 is further relieved, and a treatment space for the energy treatment device 22 is newly secured. .
  • the retraction tool 1 automatically moves so as to move away from the endoscope 21, and the visual field of the endoscope 21 is ensured.
  • Exclusion device 1, 20, 30, 50, 60, 70 Exclusion device 1 Exclusion tool 2 Suction device (suction part) DESCRIPTION OF SYMBOLS 3 Insertion part 4 Exclusion part 5 Grasp part 5a Suction operation part 6 Exclusion member 6A Exclusion surface 6B Suction surface 6a, 6b Suction port 7 Suction passage 8 Smoke detection part 9 Suction control part 11 Suction pressure detection part 12, 13, 14 Electric arm 15 Operation Input Unit 16 Arm Control Unit 21 Endoscope (Medical Instrument) 22 Energy treatment device (medical device) 100 Endoscopic system 200 Robot system A Abdominal cavity (body cavity) B organ

Abstract

An exclusion device (10) is provided with: a slender insertion part (3) capable of insertion into the body cavity of a living body; an exclusion part (4) provided to the distal end of the insertion part (3) and provided with an exclusion face (6A) disposed in contact with the surface of an organ in the body cavity, and a suction face (6B) in which a suction port (6b) is formed; a suction passage (7) having the suction port (6b) at the distal end thereof and extending to the proximal-end side of the insertion part (3); and a suction part (2) for suctioning the inside of the suction passage (7), the suction part (2) being disposed on the proximal-end side of the insertion part (3); the exclusion face (6A) and the suction face (6B) facing mutually different directions.

Description

圧排装置およびロボットシステムExclusion device and robot system
　本発明は、圧排装置およびロボットシステムに関し、特に、体腔内の臓器を圧排するための圧排装置およびロボットシステムに関するものである。 The present invention relates to an exclusion device and a robot system, and more particularly to an exclusion device and a robot system for excluding an organ in a body cavity.
　従来、腹腔鏡下手術においては、内視鏡や処置具を操作するための処置空間を腹腔内に確保するために、処置部位の周辺の臓器を圧排する圧排装置が知られている（例えば、特許文献１参照。）。特許文献１の圧排装置は、圧排面の臓器への吸着と、腹腔内に溜まった液体の吸引とに使用される吸引口が圧排面に設けられている。 Conventionally, in laparoscopic surgery, in order to secure a treatment space for operating an endoscope and a treatment tool in the abdominal cavity, an exclusion device that excludes organs around a treatment site is known (for example, (See Patent Document 1). In the exclusion device of Patent Document 1, a suction port used for adsorption of an exclusion surface to an organ and suction of liquid accumulated in the abdominal cavity is provided on the exclusion surface.
特開２００６－３０４９４８号公報JP 2006-304948 A
　腹腔鏡下手術において、電気メスや超音波処置具等のエネルギ処置具によって処置部位を切開したり止血したりすると、処置部位から発生する煙霧によって内視鏡の視野が曇り、処置部位を観察できなくなる。特許文献１の圧排装置を用いて吸引口から煙霧を吸引することにより腹腔内の煙霧を体外に排出することは可能である。しかしながら、この圧排装置によって一度に行うことができる操作は、臓器の圧排と煙霧の吸引とのうち一方のみである。すなわち、圧排面で臓器を圧排しているときには吸引口が臓器によって塞がれた状態にあるため、煙霧を腹腔内から排出することができないという問題がある。 In laparoscopic surgery, if the treatment site is incised or stopped with an energy treatment tool such as an electrosurgical knife or an ultrasonic treatment tool, the field of view of the endoscope becomes cloudy due to fumes generated from the treatment site, and the treatment site can be observed. Disappear. It is possible to discharge the smoke in the abdominal cavity outside the body by sucking the smoke from the suction port using the exclusion device of Patent Document 1. However, the operation that can be performed at once by this excluding device is only one of organ excluding and smoke suction. In other words, there is a problem that when the organ is being evacuated on the evacuation surface, the suction port is blocked by the organ, so that the smoke cannot be discharged from the abdominal cavity.
　本発明は、上述した事情に鑑みてなされたものであって、臓器の圧排による処置空間の確保と煙霧の排出とを同時に行うことができる圧排装置およびロボットシステムを提供することを目的とする。 The present invention has been made in view of the above-described circumstances, and an object thereof is to provide an exclusion device and a robot system capable of simultaneously securing a treatment space by organ exclusion and discharging smoke.
　上記目的を達成するため、本発明は以下の手段を提供する。
　本発明の第１の態様は、生体の体腔内に挿入可能な細長い挿入部と、該挿入部の先端に設けられ、前記体腔内の臓器の表面に接触して配置される圧排面と、吸引口が開口する吸引面とを備える圧排部と、前記吸引口を先端に有し、前記挿入部の基端側まで延びる吸引通路と、前記挿入部の基端側に配置され、前記吸引通路内を吸引する吸引部とを備え、前記圧排面および前記吸引面が、互いに異なる方向に面している圧排装置である。 In order to achieve the above object, the present invention provides the following means.
According to a first aspect of the present invention, there is provided an elongated insertion portion that can be inserted into a body cavity of a living body, an exclusion surface that is provided at the distal end of the insertion portion and is in contact with the surface of an organ within the body cavity, and suction A pressure relief portion having a suction surface with an opening, a suction passage having the suction port at a distal end, extending to a proximal end side of the insertion portion, and disposed on a proximal end side of the insertion portion; And a suction part that sucks the suction surface, and the suction surface and the suction surface face each other in different directions.
　本発明の第１の態様によれば、挿入部を体腔内に挿入して圧排部を処置部位の近傍に配置し、該処置部位の周囲の臓器に圧排部の圧排面を接触させ、圧排部で臓器を押圧して該臓器を処置部位から退かすことにより、処置部位の周囲に該処置部位を観察および処置するための処置空間を確保することができる。
　この場合に、圧排面を臓器に接触させた状態において、圧排面とは異なる方向に面した吸引面は、当該臓器と接触することなく処置空間に露出している。したがって、臓器を圧排して処置空間を確保しながらも、吸引通路内を吸引部で吸引することによって、処置空間の煙霧を吸引口および吸引通路を介して生体外に排出することができる。 According to the first aspect of the present invention, the insertion part is inserted into the body cavity, the exclusion part is arranged in the vicinity of the treatment site, the exclusion surface of the exclusion part is brought into contact with an organ around the treatment part, and the exclusion part By pressing the organ and retreating the organ from the treatment site, a treatment space for observing and treating the treatment site can be secured around the treatment site.
In this case, when the exclusion surface is in contact with the organ, the suction surface facing in a direction different from the exclusion surface is exposed to the treatment space without contacting the organ. Therefore, the smoke in the treatment space can be discharged to the outside of the living body through the suction port and the suction passage by sucking the inside of the suction passage with the suction portion while excluding the organ and securing the treatment space.
　上記第１の態様においては、前記体腔内の煙霧を検知する煙霧検知部と、該煙霧検知部によって煙霧が検知されたときに前記吸引部によって吸引させる吸引制御部とを備えていてもよい。
　このようにすることで、体腔内に発生した煙霧を煙霧検知部によって自動で検知し、体腔内の排気を吸引制御部によって自動で実行することができる。 In the said 1st aspect, the smoke detection part which detects the smoke in the said body cavity, and the attraction | suction control part made to inhale with the said suction part, when a smoke is detected by this smoke detection part, may be provided.
By doing in this way, the smoke which generate | occur | produced in the body cavity can be automatically detected by the smoke detection part, and the exhaust_gas | exhaustion in a body cavity can be automatically performed by the suction control part.
　上記第１の態様においては、前記煙霧検知部は、前記体腔内を撮影する内視鏡から内視鏡画像を受信し、該内視鏡画像の輝度値に基づいて煙霧を検知してもよい。
　このようにすることで、体腔内に煙霧が発生すると内視鏡の画像の輝度値が上昇するので、内視鏡の画像の輝度値に基づいて煙霧の発生を簡単に検知することができる。 In the first aspect, the smoke detection unit may receive an endoscope image from an endoscope that images the inside of the body cavity, and may detect the smoke based on a luminance value of the endoscope image. .
By doing in this way, since the brightness value of the endoscope image increases when smoke occurs in the body cavity, it is possible to easily detect the generation of smoke based on the brightness value of the endoscope image.
　上記第１の態様においては、前記煙霧検知部は、前記体腔内に挿入されたエネルギ処置具の作動に基づいて煙霧を検知してもよい。
　このようにすることで、煙霧の発生の原因となるエネルギ処置具が作動を開始して煙霧が発生し得る状況になったときに、煙霧が検知されて腹腔内の排気が行われるので、エネルギ処置具による組織の処置に伴って発生した煙霧を迅速に排出することができる。 In the said 1st aspect, the said smoke detection part may detect a smoke based on the action | operation of the energy treatment tool inserted in the said body cavity.
By doing in this way, when the energy treatment tool that causes the generation of the smoke starts to be in a situation where the smoke can be generated, the smoke is detected and the intraperitoneal exhaust is performed. It is possible to quickly discharge fumes generated with the treatment of the tissue by the treatment tool.
　本発明の第２の態様は、上記いずれかに記載の圧排装置と、前記体腔内に挿入される医療器具と、前記生体の外部において、前記圧排装置および前記医療器具を各々保持する電動アームと、操作者によって操作される操作入力部と、該操作入力部に入力された操作に基づいて前記電動アームを作動させるアーム制御部とを備えるロボットシステムである。 According to a second aspect of the present invention, there is provided an exclusion device according to any one of the above, a medical instrument inserted into the body cavity, and an electric arm that holds the exclusion device and the medical instrument, respectively, outside the living body. A robot system including an operation input unit operated by an operator and an arm control unit that operates the electric arm based on an operation input to the operation input unit.
　上記第２の態様においては、前記アーム制御部が、前記医療器具を保持している前記電動アームの位置および姿勢に基づき、前記圧排装置を保持している前記電動アームを制御してもよい。
　このようにすることで、体腔内で医療器具が移動したときに、この医療器具の移動に協調させて圧排部を移動させることができる。 In the second aspect, the arm control unit may control the electric arm holding the exclusion device based on the position and posture of the electric arm holding the medical instrument.
By doing in this way, when a medical instrument moves in a body cavity, an exclusion part can be moved in coordination with the movement of this medical instrument.
　本発明によれば、臓器の圧排による処置空間の確保と煙霧の排出とを同時に行うことができるという効果を奏する。 According to the present invention, there is an effect that it is possible to simultaneously secure a treatment space by excluding an organ and discharge smoke.
本発明の第１の実施形態に係る圧排装置の全体構成図である。1 is an overall configuration diagram of an exclusion device according to a first embodiment of the present invention. 図１の圧排装置の腹腔鏡下手術での使用方法を説明する図である。It is a figure explaining the usage method in the laparoscopic surgery of the exclusion apparatus of FIG. 本発明の第２の実施形態に係る圧排装置の全体構成図である。It is a whole block diagram of the exclusion apparatus which concerns on the 2nd Embodiment of this invention. 本発明の第３の実施形態に係る圧排装置が備える圧排部の構成図である。It is a block diagram of the exclusion part with which the exclusion apparatus which concerns on the 3rd Embodiment of this invention is provided. 図４の圧排部を備える圧排装置の変形例を示す全体構成図である。It is a whole block diagram which shows the modification of an exclusion apparatus provided with the exclusion part of FIG. 本発明の第４の実施形態に係る圧排装置が備える圧排部の、畳まれた状態を示す構成図である。It is a block diagram which shows the collapsed state of the exclusion part with which the exclusion apparatus which concerns on the 4th Embodiment of this invention is provided. 図６Ａの圧排部の広がった状態を示す構成図である。It is a block diagram which shows the state which the exclusion part of FIG. 6A spread. 本発明の第５の実施形態に係る圧排装置の全体構成図である。It is a whole block diagram of the exclusion apparatus which concerns on the 5th Embodiment of this invention. 臓器を支持した図７の圧排部を示す図である。It is a figure which shows the exclusion part of FIG. 7 which supported the organ. 本発明の第６の実施形態に係る圧排装置の全体構成図である。It is a whole block diagram of the exclusion apparatus which concerns on the 6th Embodiment of this invention. 臓器を支持した図９の圧排部を示す図である。FIG. 10 is a diagram showing the exclusion part of FIG. 9 supporting an organ. 本発明の第７の実施形態に係るロボットシステムの全体構成図である。It is a whole block diagram of the robot system which concerns on the 7th Embodiment of this invention.
（第１の実施形態）
　以下に、本発明の第１の実施形態に係る圧排装置１０について図１および図２を参照して説明する。
　本実施形態に係る圧排装置１０は、図１に示されるように、圧排具１と、吸引装置（吸引部）２とを備えている。図２は、圧排具１の使用方法を示す図である。本実施形態に係る圧排装置１０は、腹腔鏡下手術において、腹腔Ａ内を観察する内視鏡２１と、電気メスや超音波処置具等のエネルギ処置具２２と共に使用される。 (First embodiment)
Below, the exclusion apparatus 10 which concerns on the 1st Embodiment of this invention is demonstrated with reference to FIG. 1 and FIG.
As shown in FIG. 1, the exclusion device 10 according to this embodiment includes an exclusion device 1 and a suction device (suction unit) 2. FIG. 2 is a diagram illustrating a method of using the retraction tool 1. The exclusion device 10 according to the present embodiment is used together with an endoscope 21 for observing the abdominal cavity A and an energy treatment tool 22 such as an electric knife or an ultrasonic treatment tool in laparoscopic surgery.
　圧排具１は、腹腔（体腔）内に挿入可能な細長い挿入部３と、該挿入部３の先端に設けられた圧排部４と、挿入部３の基端に設けられた把持部５と、圧排部４、挿入部３および把持部５の内部を通って設けられた吸引通路７とを備えている。
　圧排部４は、挿入部３の先端から該挿入部３の長手方向に延びる矩形の薄板状の単一の圧排部材６を備えている。圧排部材６は、厚さ方向に対向する圧排面６Ａと吸引面６Ｂとを有している。吸引面６Ｂには、複数の吸引口６ｂが開口している。 The exclusion tool 1 includes an elongated insertion portion 3 that can be inserted into the abdominal cavity (body cavity), an exclusion portion 4 provided at the distal end of the insertion portion 3, a gripping portion 5 provided at the proximal end of the insertion portion 3, A suction passage 7 provided through the inside of the exclusion part 4, the insertion part 3, and the grip part 5 is provided.
The exclusion part 4 is provided with a rectangular thin plate-like single exclusion member 6 extending from the distal end of the insertion part 3 in the longitudinal direction of the insertion part 3. The exclusion member 6 has an exclusion surface 6A and a suction surface 6B that face each other in the thickness direction. A plurality of suction ports 6b are open on the suction surface 6B.
　把持部５は、吸引装置２の吸引動作をオンオフする、スイッチのような吸引操作部５ａを備えている。吸引操作部５ａは、術者によってオン状態に操作されると、吸引装置２にオン信号を送信する。
　吸引通路７は、挿入部３の長手方向に沿って形成され、吸引口６ｂと吸引装置２とを接続している。
　吸引装置２は、吸引操作部５ａからオン信号を受信したときに、吸引通路７内を吸引する。 The grip part 5 includes a suction operation part 5a such as a switch for turning on and off the suction operation of the suction device 2. The suction operation unit 5a transmits an ON signal to the suction device 2 when operated by the surgeon.
The suction passage 7 is formed along the longitudinal direction of the insertion portion 3 and connects the suction port 6 b and the suction device 2.
The suction device 2 sucks the inside of the suction passage 7 when receiving an ON signal from the suction operation unit 5a.
　次に、このように構成された圧排装置１０の作用について説明する。
　まず、腹腔Ａ内に挿入部３を挿入し、エネルギ処置具２２による処置空間に位置する臓器Ｂの表面に圧排面６Ａを接触させて圧排部４によって当該臓器Ｂを圧排する。すなわち、圧排部４によって臓器Ｂを押圧することによって、臓器Ｂを処置空間から退かす。これにより、エネルギ処置具２２を操作するための処置空間を確保し、内視鏡２１による処置空間の視野を確保する。エネルギ処置具２２による組織の切開や止血等に伴って処置部位から煙霧が発生したときには、術者は、手元の吸引操作部５ａを操作することによって、吸引装置２を作動させて吸引を開始する。吸引通路７内が吸引されると、処置空間に面している吸引面６Ｂの吸引口６ｂ内へ煙霧が吸引され、処置空間から煙霧が除去される。 Next, the operation of the exclusion device 10 configured as described above will be described.
First, the insertion part 3 is inserted into the abdominal cavity A, the exclusion surface 6A is brought into contact with the surface of the organ B located in the treatment space by the energy treatment tool 22, and the organ B is excluded by the exclusion part 4. That is, the organ B is moved away from the treatment space by pressing the organ B with the exclusion part 4. Thereby, a treatment space for operating the energy treatment tool 22 is secured, and a visual field of the treatment space by the endoscope 21 is secured. When smoke is generated from the treatment site due to tissue incision or hemostasis by the energy treatment tool 22, the surgeon operates the suction operation unit 5a at hand to start suction by operating the suction operation unit 5a. . When the inside of the suction passage 7 is sucked, the smoke is sucked into the suction port 6b of the suction surface 6B facing the treatment space, and the smoke is removed from the treatment space.
　このように、本実施形態によれば、圧排部４によって臓器Ｂを圧排した状態において、圧排面６Ａとは反対方向に面している吸引面６Ｂは、煙霧が発生する処置部位の近傍において、臓器Ｂと接触することなく処置空間に対して露出されている。したがって、圧排部４によって臓器Ｂを圧排しながら、煙霧を吸引面６Ｂの吸引口６ｂから効率的に排出することができるという利点がある。また、圧排と排気とを単一の圧排具１を用いて同時に行うことが可能であるので、内視鏡２１による処置空間の観察を絶えず行うことができるとともに、圧排と排気とで操作する器具を取り替える必要が無く、手術の効率を向上することができるという利点がある。 Thus, according to the present embodiment, the suction surface 6B facing in the direction opposite to the exclusion surface 6A in the state in which the organ B is excluded by the exclusion unit 4 is in the vicinity of the treatment site where smoke is generated. It is exposed to the treatment space without contacting the organ B. Therefore, there is an advantage that the smoke can be efficiently discharged from the suction port 6b of the suction surface 6B while the organ B is excluded by the exclusion unit 4. Further, since it is possible to simultaneously perform the exclusion and the exhaust using the single exclusion device 1, it is possible to continuously observe the treatment space by the endoscope 21 and to operate with the exclusion and the exhaust. Therefore, there is an advantage that the efficiency of the operation can be improved.
（第２の実施形態）
　次に、本発明の第２の実施形態に係る圧排装置２０について図３を参照して説明する。
　本実施形態に係る圧排装置２０は、図３に示されるように、腹腔Ａ内の煙霧を検知する煙霧検知部８と、該煙霧検知部８によって煙霧が検知されたときに吸引装置２を作動させる吸引制御部９とをさらに備えている点において、第１の実施形態と異なっている。したがって、本実施形態においては、煙霧検知部８および吸引制御部９について主に説明し、第１の実施形態と共通する構成については、同一の符号を付して説明を省略する。 (Second Embodiment)
Next, an exclusion device 20 according to a second embodiment of the present invention will be described with reference to FIG.
As shown in FIG. 3, the exclusion device 20 according to the present embodiment operates the suction device 2 that detects smoke in the abdominal cavity A, and when the smoke is detected by the smoke detection unit 8. It differs from 1st Embodiment in the point further provided with the suction control part 9 to be made. Therefore, in the present embodiment, the smoke detection unit 8 and the suction control unit 9 will be mainly described, and the components common to the first embodiment will be denoted by the same reference numerals and description thereof will be omitted.
　煙霧検知部８は、内視鏡２１によって撮影された腹腔Ａ内の内視鏡画像を処理する内視鏡システム１００から内視鏡画像を受信し、受信した内視鏡画像を解析することによって煙霧の発生を検知する。具体的には、腹腔Ａ内で煙霧が発生すると、内視鏡２１の先端から出射される照明光が煙霧によって乱反射されることにより、内視鏡画像の輝度値が上昇する。したがって、煙霧検知部８は、受信した内視鏡画像の輝度値の平均値を逐次計算し、輝度値の平均値の時間変化率を計算し、時間変化率が所定の閾値以上であるときに、すなわち、輝度値の平均値の上昇率が大きいときに、煙霧を検知する。煙霧検知部８は、煙霧を検知したときに、煙霧検知信号を吸引制御部９へ送信する。
　吸引制御部９は、煙霧検知信号を受信したときに、吸引装置２を作動させる。 The smoke detector 8 receives an endoscopic image from the endoscopic system 100 that processes an endoscopic image in the abdominal cavity A photographed by the endoscope 21, and analyzes the received endoscopic image. Detect the occurrence of fumes. Specifically, when smoke occurs in the abdominal cavity A, the illumination light emitted from the distal end of the endoscope 21 is irregularly reflected by the smoke, thereby increasing the luminance value of the endoscope image. Therefore, the smoke detection unit 8 sequentially calculates the average value of the luminance values of the received endoscopic image, calculates the time change rate of the average value of the luminance values, and when the time change rate is equal to or greater than a predetermined threshold value. That is, smoke is detected when the rate of increase in the average value of the luminance values is large. The smoke detection unit 8 transmits a smoke detection signal to the suction control unit 9 when the smoke is detected.
The suction control unit 9 operates the suction device 2 when receiving the smoke detection signal.
　このように構成された圧排装置２０によれば、エネルギ処置具２２による処置に伴って煙霧が発生したときに、煙霧によって内視鏡画像の輝度値が上昇する。この内視鏡画像の輝度値の上昇から煙霧検知部８によって煙霧の発生が検知され、吸引装置２による体腔内の排気が自動で行われる。
　このように、腹腔Ａ内の煙霧の発生の検知と排気の実行とが、術者が吸引操作部５ａを操作せずとも自動で実行されるので、術者の手間を省き、手術の効率をさらに向上することができるという利点がある。 According to the exclusion device 20 configured as described above, when smoke is generated in association with the treatment by the energy treatment tool 22, the brightness value of the endoscope image is increased by the smoke. From the increase in the luminance value of the endoscopic image, the generation of smoke is detected by the smoke detection unit 8, and the body cavity is exhausted by the suction device 2 automatically.
In this way, the detection of the occurrence of fumes in the abdominal cavity A and the execution of exhaust are automatically performed without the operator operating the suction operation unit 5a, so that the operator's effort is saved and the efficiency of the operation is reduced. There is an advantage that it can be further improved.
　本実施形態においては、煙霧検知部８が、内視鏡画像の輝度値の上昇に基づいて煙霧の発生を検知することとしたが、これに代えて、またはこれに加えて、エネルギ処置具２２の作動に基づいて煙霧の発生を検知してもよい。例えば、煙霧検知部８が、エネルギ処置具２２から該エネルギ処置具２２の作動状態を示す信号を取得し、エネルギ処置具２２の作動開始を検出したときに、すなわち、エネルギ処置具２２による組織の処置が開始して煙霧が発生する状況となったときに、煙霧の発生を検知する。 In the present embodiment, the smoke detection unit 8 detects the generation of the smoke based on the increase in the luminance value of the endoscopic image, but instead of this, or in addition to this, the energy treatment device 22. The generation of smoke may be detected based on the operation of For example, when the smoke detection unit 8 acquires a signal indicating the operating state of the energy treatment tool 22 from the energy treatment tool 22 and detects the start of operation of the energy treatment tool 22, that is, the tissue of the tissue by the energy treatment tool 22. The occurrence of fumes is detected when the treatment starts and a situation occurs where fumes are generated.
　このようにすることで、エネルギ処置具２２が作動を開始するのと同時に吸引口６ｂから生体外へ排気が開始されるので、エネルギ処置具２２による組織の切開や止血等に伴って発生した煙霧が迅速に体腔内から除去され、内視鏡２１の視野が常に鮮明に維持される。これにより、排気のための術者の操作入力を省略することができ、手術の効率をさらに向上することができるという利点がある。 By doing so, since the exhaust from the suction port 6b is started at the same time when the energy treatment tool 22 starts to operate, fumes generated due to tissue incision, hemostasis, etc. by the energy treatment tool 22 Is quickly removed from the body cavity, and the field of view of the endoscope 21 is always kept clear. Thereby, the operator's operation input for exhaust can be omitted, and there is an advantage that the efficiency of the operation can be further improved.
（第３の実施形態）
　次に、本発明の第３の実施形態に係る圧排装置３０について図４および図５を参照して説明する。
　本実施形態に係る圧排装置３０は、図４に示されるように、吸引面６Ｂに加えて圧排面６Ａにも吸引口６ａが形成されている点において、第１および第２の実施形態と異なっている。本実施形態においては、第１および第２の実施形態と共通する構成については、同一の符号を付して説明を省略する。 (Third embodiment)
Next, an exclusion apparatus 30 according to a third embodiment of the present invention will be described with reference to FIGS. 4 and 5.
As shown in FIG. 4, the exclusion device 30 according to the present embodiment is different from the first and second embodiments in that a suction port 6 a is formed in the exclusion surface 6 </ b> A in addition to the suction surface 6 </ b> B. ing. In the present embodiment, the same reference numerals are assigned to configurations common to the first and second embodiments, and the description thereof is omitted.
　圧排装置３０は、吸引通路７（以下、第１の吸引通路７という。）と並列に設けられ、圧排部４、挿入部３および把持部５の内部を通って圧排面６Ａの吸引口６ａと吸引装置２とを接続するもう１つの吸引通路７２（以下、第２の吸引通路７２という。）を備えている。
　吸引装置２は、吸引操作部５ａとして、例えば、第１の吸引通路７に対応する第１のスイッチと、第２の吸引通路７２に対応する第２のスイッチとを備え、吸引装置２の第１の吸引通路７内の吸引動作と第２の吸引通路７２の吸引動作とを別々にオンオフ可能になっている。 The exclusion device 30 is provided in parallel with the suction passage 7 (hereinafter referred to as the first suction passage 7), passes through the inside of the exclusion portion 4, the insertion portion 3, and the grip portion 5, and the suction port 6a of the exclusion surface 6A. Another suction passage 72 (hereinafter referred to as the second suction passage 72) for connecting the suction device 2 is provided.
The suction device 2 includes, for example, a first switch corresponding to the first suction passage 7 and a second switch corresponding to the second suction passage 72 as the suction operation unit 5a. The suction operation in one suction passage 7 and the suction operation in the second suction passage 72 can be turned on and off separately.
　このように構成された圧排装置３０によれば、臓器Ｂの表面に圧排面６Ａを接触させた状態で、吸引操作部５ａを操作して吸引装置２によって第２の吸引通路７２内を吸引することにより、吸引口６ａ内への吸引力によって圧排面６Ａが臓器Ｂの表面に固定される。
　このように、圧排面６Ａにも吸引口６ａを設けることによって、圧排面６Ａを臓器Ｂの表面に強く固定することができ、臓器Ｂの圧排動作を安定的に行うことができるという利点がある。その他の効果については、第２の実施形態と同様であるので説明を省略する。 According to the exclusion device 30 configured in this manner, the inside of the second suction passage 72 is aspirated by the aspiration device 2 by operating the aspiration operation unit 5a while the exclusion surface 6A is in contact with the surface of the organ B. Thus, the exclusion surface 6A is fixed to the surface of the organ B by the suction force into the suction port 6a.
Thus, by providing the suction surface 6A on the exclusion surface 6A, the exclusion surface 6A can be strongly fixed to the surface of the organ B, and there is an advantage that the exclusion operation of the organ B can be performed stably. . Other effects are the same as those of the second embodiment, and thus the description thereof is omitted.
　本実施形態においては、圧排部材６のおもて面と裏面のうちいずれを圧排面６Ａおよび吸引面６Ｂとして使用してもよい。この場合、吸引装置２は、図５に示されるように、各吸引通路７，７２の吸引圧力を検出する吸引圧力検出部１１を備え、該吸引圧力検出部１１によって検出された吸引圧力に基づいて、おもて面と裏面とのうちいずれが圧排面６Ａとして使用されているかが判断される。 In the present embodiment, either the front surface or the back surface of the exclusion member 6 may be used as the exclusion surface 6A and the suction surface 6B. In this case, as shown in FIG. 5, the suction device 2 includes a suction pressure detection unit 11 that detects the suction pressure of the suction passages 7 and 72, and is based on the suction pressure detected by the suction pressure detection unit 11. Thus, it is determined which of the front surface and the back surface is used as the exclusion surface 6A.
　すなわち、圧排面６Ａとして使用されている面の吸引口は臓器Ｂによって塞がれるため、吸引圧力が高くなる。吸引制御部９は、吸引装置２に両方の吸引通路７，７２内を吸引させ、吸引開始から一定時間後の２つの吸引通路７，７２の吸引圧力を比較する。そして、吸引制御部９は、吸引圧力が高い方の吸引通路７または７２が接続されている面を圧排面６Ａであると判断し、当該吸引通路７または７２内の吸引を継続させる。また、吸引制御部９は、吸引圧力が低い方の吸引通路７２または７が接続されている面を吸引面６Ｂであると判断して当該吸引通路７２または７内の吸引を停止し、その後は、煙霧検知部８による煙霧の検知、または、吸引操作部５ａの操作に基づいて当該吸引通路７２または７を吸引させる。
　このように、圧排部材６のおもて面および裏面を、圧排面６Ａおよび吸引面６Ｂのいずれとしても使用可能とすることによって、使い勝手を向上することができる。 That is, since the suction port of the surface used as the exclusion surface 6A is blocked by the organ B, the suction pressure is increased. The suction control unit 9 causes the suction device 2 to suck both suction passages 7 and 72 and compares the suction pressures of the two suction passages 7 and 72 after a predetermined time from the start of suction. Then, the suction controller 9 determines that the surface to which the suction passage 7 or 72 having the higher suction pressure is connected is the exclusion surface 6A, and continues the suction in the suction passage 7 or 72. Further, the suction control unit 9 determines that the surface to which the suction passage 72 or 7 with the lower suction pressure is connected is the suction surface 6B, stops the suction in the suction passage 72 or 7, and thereafter The suction passage 72 or 7 is sucked based on the detection of the smoke by the smoke detection unit 8 or the operation of the suction operation unit 5a.
Thus, usability can be improved by making it possible to use the front surface and the back surface of the exclusion member 6 as both the exclusion surface 6A and the suction surface 6B.
　本実施形態においては、吸引によって圧排面６Ａを臓器Ｂの表面に固定することとしたが、これに代えて、またはこれに加えて、他の固定手段を採用してもよい。例えば、圧排面６Ａに吸盤が設けられていてもよく、または、圧排面６Ａに臓器Ｂの表面との間の摩擦を高めるための凹凸加工が施されていてもよい。 In the present embodiment, the exclusion surface 6A is fixed to the surface of the organ B by suction, but instead of or in addition to this, other fixing means may be adopted. For example, the suction surface 6A may be provided with a suction cup, or the relief surface 6A may be subjected to uneven processing for increasing friction with the surface of the organ B.
（第４の実施形態）
　次に、本発明の第４の実施形態に係る圧排装置について図６Ａおよび図６Ｂを参照して説明する。
　本実施形態に係る圧排装置は、図６Ａおよび図６Ｂに示されるように、圧排部４の構造が第１から第３の実施形態と異なっている。したがって、本実施形態においては、圧排部４について主に説明し、第１から第３の実施形態と共通する構成については、同一の符号を付して説明を省略する。 (Fourth embodiment)
Next, an exclusion apparatus according to a fourth embodiment of the present invention will be described with reference to FIGS. 6A and 6B.
As shown in FIGS. 6A and 6B, the exclusion device according to the present embodiment is different from the first to third embodiments in the structure of the exclusion portion 4. Therefore, in this embodiment, the exclusion part 4 is mainly demonstrated, about the structure which is common in the 1st to 3rd embodiment, the same code | symbol is attached | subjected and description is abbreviate | omitted.
　本実施形態において、圧排部４は、第３の実施形態において説明した圧排部材６を複数（本例においては３個）備えている。複数の圧排部材６は、厚さ方向に積層され、基端部分が互いに、積層方向の回転軸回りに回転可能に連結されている。これにより、圧排部４は、図６Ａに示されるように、圧排部材６が互いに重なり合って畳まれた状態と、図６Ｂに示されるように、圧排部材６が互いに回転方向にずれることによって扇状に広がった状態との間で、変形するようになっている。これらの圧排部材６の回転軸回りの回転動作は、把持部５に設けられた図示しない拡張操作部への入力に従って図示しないモータによって行われる。 In this embodiment, the exclusion part 4 includes a plurality (three in this example) of the exclusion members 6 described in the third embodiment. The plurality of exclusion members 6 are stacked in the thickness direction, and base end portions are connected to each other so as to be rotatable around a rotation axis in the stacking direction. As a result, as shown in FIG. 6A, the exclusion portion 4 is fan-shaped by the state where the exclusion members 6 are overlapped with each other, and as shown in FIG. 6B, the exclusion members 6 are displaced from each other in the rotational direction. It is designed to deform between the expanded state. The rotation operation of the exclusion member 6 around the rotation axis is performed by a motor (not shown) in accordance with an input to an extension operation unit (not shown) provided in the grip 5.
　このように構成された圧排装置によれば、圧排部４を畳んだ状態で第１の実施形態と同様にして挿入部３を腹腔Ａ内に挿入し、拡張操作部を操作することによって圧排部４を広げて臓器Ｂの表面に圧排面６Ａを接触させ、臓器Ｂの表面を３個の圧排面６Ａで支持する。
　このように、臓器Ｂの表面を支持する圧排面６Ａの面積を拡大可能とすることにより、大きな臓器Ｂであっても広い圧排面６Ａによって安定に支持しながら圧排することができるという利点がある。 According to the exclusion device configured as described above, the insertion portion 3 is inserted into the abdominal cavity A in the same manner as in the first embodiment with the exclusion portion 4 folded, and the expansion portion is operated by operating the expansion operation portion. 4 is spread, the surface 6A is brought into contact with the surface of the organ B, and the surface of the organ B is supported by the three surfaces 6A.
Thus, by making it possible to expand the area of the exclusion surface 6A that supports the surface of the organ B, there is an advantage that even a large organ B can be excluded while being stably supported by the wide exclusion surface 6A. .
（第５の実施形態）
　次に、本発明の第５の実施形態に係る圧排装置５０について図７および図８を参照して説明する。
　本実施形態に係る圧排装置５０は、図７に示されるように、圧排部材６が関節構造を有している点で、第１から第４の実施形態と異なっている。したがって、本実施形態においては、圧排具１について主に説明し、第１から第４の実施形態と共通する構成については、同一の符号を付して説明を省略する。 (Fifth embodiment)
Next, an exclusion apparatus 50 according to a fifth embodiment of the present invention will be described with reference to FIGS.
As shown in FIG. 7, the exclusion device 50 according to the present embodiment is different from the first to fourth embodiments in that the exclusion member 6 has a joint structure. Therefore, in this embodiment, the retraction tool 1 is mainly demonstrated and about the structure which is common in the 1st-4th embodiment, the same code | symbol is attached | subjected and description is abbreviate | omitted.
　本実施形態において、圧排部材６は、指のような細長い形状を有し、その長手方向に配列する複数の関節を有している。各関節は、長手方向に交差する揺動軸回りに揺動可能に設けられている。圧排部材６は、各関節が揺動することによって長手方向の途中位置で屈曲し、直線形状から湾曲形状へ変形可能になっている。 In this embodiment, the exclusion member 6 has an elongated shape like a finger and has a plurality of joints arranged in the longitudinal direction. Each joint is provided so as to be swingable about a swing axis that intersects the longitudinal direction. The exclusion member 6 is bent at an intermediate position in the longitudinal direction as each joint swings, and can be deformed from a linear shape to a curved shape.
　吸引口６ａは、圧排部材６の円筒状の側面に、長手方向に一列に配列して設けられている。吸引口６ｂは、圧排部材６の側面の、吸引口６ａとは周方向に１８０°異なる位置に、長手方向に一列に配列して設けられている。本実施形態において、圧排部材６の湾曲方向に応じて、圧排部材６のどの位置が圧排面６Ａとなり、どの位置が吸引面６Ｂとなるかが異なる。すなわち、圧排部材６の湾曲形状の内側に位置する側面が圧排面６Ａとなり、外側に位置する側面が吸引面６Ｂとなる。 The suction ports 6a are provided on the cylindrical side surface of the exclusion member 6 in a line in the longitudinal direction. The suction port 6b is arranged in a line in the longitudinal direction at a position on the side surface of the exclusion member 6 that is 180 ° different from the suction port 6a in the circumferential direction. In this embodiment, according to the bending direction of the exclusion member 6, which position of the exclusion member 6 becomes the exclusion surface 6A and which position becomes the suction surface 6B differs. That is, the side surface located inside the curved shape of the exclusion member 6 is the exclusion surface 6A, and the side surface located outside is the suction surface 6B.
　把持部５には、圧排部材６の変形を操作する、スイッチのような湾曲操作部（図示略）が設けられている。術者によって湾曲操作部がオン状態に操作されると、図示しないモータが作動して関節を駆動し、湾曲操作部がオフ状態に操作されると、その時点での位置に各関節が停止するようになっている。これにより、術者は、圧排部材６を任意の曲率の湾曲形状に変形することができるようになっている。 The grip portion 5 is provided with a bending operation portion (not shown) such as a switch for operating the deformation of the exclusion member 6. When the bending operation unit is operated to be turned on by an operator, a motor (not shown) is actuated to drive the joint, and when the bending operation unit is operated to be turned off, each joint is stopped at the current position. It is like that. As a result, the surgeon can deform the exclusion member 6 into a curved shape having an arbitrary curvature.
　このように構成された圧排装置５０によれば、臓器Ｂの表面に接触させた直線形状の圧排部材６を、湾曲操作部を操作することによって、臓器Ｂの湾曲形状に沿うように湾曲させる。これにより、図８に示されるように、臓器Ｂを、該臓器Ｂの湾曲形状に沿って圧排面６Ａで支持し、臓器Ｂをより優しく圧排することができるという利点がある。 According to the exclusion device 50 configured in this manner, the linear exclusion member 6 brought into contact with the surface of the organ B is bent along the curved shape of the organ B by operating the bending operation unit. Accordingly, as shown in FIG. 8, there is an advantage that the organ B can be supported by the exclusion surface 6A along the curved shape of the organ B and the organ B can be more gently excluded.
（第６の実施形態）
　次に、本発明の第６の実施形態に係る圧排装置６０について図９および図１０を参照して説明する。
　本実施形態に係る圧排装置６０は、第５の実施形態の変形例であって、図９に示されるように、互いに並列に設けられた複数（本例においては３個）の圧排部材６を備えている。したがって、本実施形態においては、圧排具１について主に説明し、第１から第５の実施形態と共通する構成については、同一の符号を付して説明を省略する。 (Sixth embodiment)
Next, an exclusion apparatus 60 according to a sixth embodiment of the present invention will be described with reference to FIGS. 9 and 10.
An exclusion device 60 according to the present embodiment is a modification of the fifth embodiment, and as shown in FIG. 9, a plurality of (three in this example) exclusion members 6 provided in parallel with each other. I have. Therefore, in this embodiment, the retraction tool 1 is mainly demonstrated and about the structure which is common in 1st to 5th embodiment, the same code | symbol is attached | subjected and description is abbreviate | omitted.
　３個の圧排部材６は、挿入部３の中心軸回りの周方向に等間隔に配置されている。湾曲操作部がオン状態に操作されると、３個の圧排部材６が前記中心軸に対して外側に凸の湾曲形状に湾曲することによって、圧排部４が径方向に拡張するようになっている。
　臓器Ｂの吸着のための吸引口６ａは、各圧排部材６の側面の前記中心軸側に設けられている。煙霧の吸引のための吸引口６ｂは、各圧排部材６の側面の前記中心軸とは反対側に設けられている。 The three exclusion members 6 are arranged at equal intervals in the circumferential direction around the central axis of the insertion portion 3. When the bending operation part is operated to be in the on state, the three exclusion members 6 are curved outwardly convex with respect to the central axis, so that the exclusion part 4 expands in the radial direction. Yes.
The suction port 6 a for adsorbing the organ B is provided on the central axis side of the side surface of each exclusion member 6. The suction port 6 b for sucking the smoke is provided on the side of each of the extruding members 6 on the side opposite to the central axis.
　このように構成された圧排装置６０によれば、湾曲操作部を操作することにより、図１０に示されるように、臓器Ｂの３次元の湾曲形状に圧排部材６が沿うように圧排部材６を湾曲させ、３個の圧排部材６によって該３個の圧排部材６の内側に臓器Ｂを３次元的に支持する。
　このように、臓器Ｂを、該臓器Ｂの湾曲した表面形状に沿って圧排面６Ａで立体的に支持することによって、臓器Ｂをより優しくかつより安定して圧排することができるという利点がある。また、臓器Ｂをより強い力で圧排する場合にも安定した圧排が可能になるという利点がある。 According to the exclusion device 60 configured as described above, by operating the bending operation unit, the exclusion member 6 is moved so that the exclusion member 6 follows the three-dimensional curved shape of the organ B as shown in FIG. The organ B is three-dimensionally supported inside the three exclusion members 6 by bending the three exclusion members 6.
Thus, there is an advantage that the organ B can be more gently and stably removed by supporting the organ B three-dimensionally with the exclusion surface 6A along the curved surface shape of the organ B. . In addition, there is an advantage that stable exclusion is possible even when the organ B is removed with a stronger force.
（第７の実施形態）
　次に、本発明の第７の実施形態に係る圧排装置７０について図１１を参照して説明する。
　本実施形態に係る圧排装置７０は、図１１に示されるように、各々医療器具を保持する複数の電動アーム１２，１３，１４を備え、該電動アーム１２，１３，１４を遠隔操作することによって医療器具を体腔内で動かすロボットシステム２００に適用される点で、第１から第６の実施形態と異なっている。したがって、本実施形態においては、ロボットシステム２００の構成について主に説明し、第１から第６の実施形態と共通する構成については、同一の符号を付して説明を省略する。図１１には、圧排装置７０として、第６の実施形態において説明した圧排具１を備えたものが一例として示されているが、他の実施形態において説明した任意の圧排装置を採用してもよい。 (Seventh embodiment)
Next, an exclusion device 70 according to a seventh embodiment of the present invention will be described with reference to FIG.
As shown in FIG. 11, the exclusion device 70 according to the present embodiment includes a plurality of electric arms 12, 13, and 14 each holding a medical instrument, and remotely operating the electric arms 12, 13, and 14. This is different from the first to sixth embodiments in that it is applied to a robot system 200 that moves a medical instrument in a body cavity. Therefore, in the present embodiment, the configuration of the robot system 200 will be mainly described, and the configurations common to the first to sixth embodiments will be denoted by the same reference numerals and description thereof will be omitted. FIG. 11 shows an example of the exclusion device 70 including the exclusion device 1 described in the sixth embodiment, but any of the exclusion devices described in other embodiments may be adopted. Good.
　ロボットシステム２００は、図１１に示されるように、圧排具１、内視鏡（医療器具）２１およびエネルギ処置具（医療器具）２２と、圧排具１、内視鏡２１およびエネルギ処置具２２の各々の基端部分を体外において保持する多関節の電動アーム１２，１３，１４と、術者（操作者）によって操作される操作入力部１５と、操作入力部１５に入力された操作に基づいて電動アーム１２，１３，１４の関節を駆動制御するアーム制御部１６とを備えている。 As shown in FIG. 11, the robot system 200 includes a retraction tool 1, an endoscope (medical instrument) 21 and an energy treatment tool (medical instrument) 22, and a retraction tool 1, an endoscope 21, and an energy treatment tool 22. Based on the articulated electric arms 12, 13, and 14 that hold the respective base end portions outside the body, the operation input unit 15 operated by the operator (operator), and the operation input to the operation input unit 15 And an arm control unit 16 that drives and controls the joints of the electric arms 12, 13, and 14.
　術者によって操作入力部１５に操作が入力されると、その操作に対応する信号がアーム制御部１６へ送信され、アーム制御部１６が、受信した信号に基づいて関節を駆動することによって電動アーム１２，１３，１４が作動する。これにより、術者は、体腔内に挿入されている圧排具１、内視鏡２１およびエネルギ処置具２２を、操作入力部１５を介して遠隔操作することができるようになっている。 When an operation is input to the operation input unit 15 by the surgeon, a signal corresponding to the operation is transmitted to the arm control unit 16, and the arm control unit 16 drives the joint based on the received signal, whereby the electric arm 12, 13, and 14 operate. Thus, the surgeon can remotely operate the retraction tool 1, the endoscope 21, and the energy treatment tool 22 inserted into the body cavity via the operation input unit 15.
　さらに、アーム制御部１６は、電動アーム１２，１３，１４に設けられた、各関節の回転角度を検出する図示しないエンコーダから検出値を受信し、受信したエンコーダの検出値に基づいて体腔内における圧排具１、内視鏡２１およびエネルギ処置具２２の位置および姿勢を計算する。そして、アーム制御部１６は、算出した内視鏡２１およびエネルギ処置具２２の位置および姿勢に基づいて圧排具１を移動させるように、該圧排具１を保持している電動アーム１２の関節を制御する。具体的には、アーム制御部１６は、内視鏡２１およびエネルギ処置具２２が圧排具１へ接近して該圧排具１との間の距離が所定の閾値未満になったときに、圧排具１を内視鏡２１またはエネルギ処置具２２から遠ざける方向へ移動させるように、電動アーム１２の関節を制御する。 Furthermore, the arm control unit 16 receives detection values from an encoder (not shown) provided on the electric arms 12, 13, and 14 that detects the rotation angle of each joint, and based on the received detection values of the encoder, The positions and postures of the retraction tool 1, the endoscope 21, and the energy treatment tool 22 are calculated. Then, the arm control unit 16 moves the joint of the electric arm 12 holding the relieving tool 1 so as to move the relieving tool 1 based on the calculated position and posture of the endoscope 21 and the energy treatment tool 22. Control. Specifically, when the endoscope 21 and the energy treatment device 22 approach the retraction device 1 and the distance between the arm control unit 16 and the retraction device 1 becomes less than a predetermined threshold, the retraction device The joint of the electric arm 12 is controlled so that 1 is moved away from the endoscope 21 or the energy treatment tool 22.
　このように構成されたロボットシステム２００によれば、腹腔Ａ内の内視鏡２１およびエネルギ処置具２２を操作して処置を行っている最中にエネルギ処置具２２が圧排具１に近づくと、圧排具１がエネルギ処置具２２から遠ざかるように自動的に移動することによってエネルギ処置具２２の近傍に位置していた臓器Ｂがさらに圧排され、エネルギ処置具２２の処置空間が新たに確保される。同様に、内視鏡２１が圧排具１に近づくと、圧排具１が内視鏡２１から遠ざかるように自動的に移動して内視鏡２１の視野が確保される。このように、圧排具１と同時に使用される他の医療器具の動作と協調するように圧排具１を移動させることによって、手術のさらなる効率化を図ることができるという利点がある。 According to the robot system 200 configured as described above, when the energy treatment tool 22 approaches the retraction tool 1 while performing the treatment by operating the endoscope 21 and the energy treatment tool 22 in the abdominal cavity A, By automatically moving the retraction device 1 away from the energy treatment device 22, the organ B located near the energy treatment device 22 is further relieved, and a treatment space for the energy treatment device 22 is newly secured. . Similarly, when the endoscope 21 approaches the retraction tool 1, the retraction tool 1 automatically moves so as to move away from the endoscope 21, and the visual field of the endoscope 21 is ensured. Thus, there is an advantage that further efficiency improvement of the operation can be achieved by moving the exclusion tool 1 so as to cooperate with the operation of other medical instruments used simultaneously with the exclusion tool 1.
１０，２０，３０，５０，６０，７０　圧排装置
１　圧排具
２　吸引装置（吸引部）
３　挿入部
４　圧排部
５　把持部
５ａ　吸引操作部
６　圧排部材
６Ａ　圧排面
６Ｂ　吸引面
６ａ，６ｂ　吸引口
７　吸引通路
８　煙霧検知部
９　吸引制御部
１１　吸引圧力検出部
１２，１３，１４　電動アーム
１５　操作入力部
１６　アーム制御部
２１　内視鏡（医療器具）
２２　エネルギ処置具（医療器具）
１００　内視鏡システム
２００　ロボットシステム
Ａ　腹腔（体腔）
Ｂ　臓器 10, 20, 30, 50, 60, 70 Exclusion device 1 Exclusion tool 2 Suction device (suction part)
DESCRIPTION OF SYMBOLS 3 Insertion part 4 Exclusion part 5 Grasp part 5a Suction operation part 6 Exclusion member 6A Exclusion surface 6B Suction surface 6a, 6b Suction port 7 Suction passage 8 Smoke detection part 9 Suction control part 11 Suction pressure detection part 12, 13, 14 Electric arm 15 Operation Input Unit 16 Arm Control Unit 21 Endoscope (Medical Instrument)
22 Energy treatment device (medical device)
100 Endoscopic system 200 Robot system A Abdominal cavity (body cavity)
B organ

Claims (6)

  1. 　生体の体腔内に挿入可能な細長い挿入部と、
    　該挿入部の先端に設けられ、前記体腔内の臓器の表面に接触して配置される圧排面と、吸引口が開口する吸引面とを備える圧排部と、
    　前記吸引口を先端に有し、前記挿入部の基端側まで延びる吸引通路と、
    　前記挿入部の基端側に配置され、前記吸引通路内を吸引する吸引部とを備え、
    　前記圧排面および前記吸引面が、互いに異なる方向に面している圧排装置。     An elongated insertion part that can be inserted into a body cavity of a living body;
    An exclusion part provided at the distal end of the insertion part, comprising an exclusion surface disposed in contact with the surface of the organ in the body cavity, and an aspiration surface where the aspiration opening opens;
    A suction passage having the suction port at a distal end and extending to a proximal end side of the insertion portion;
    A suction portion that is disposed on the proximal end side of the insertion portion and sucks the suction passage;
    An exclusion device in which the exclusion surface and the suction surface face in different directions.
  2. 　前記体腔内の煙霧を検知する煙霧検知部と、
    　該煙霧検知部によって煙霧が検知されたときに前記吸引部によって吸引させる吸引制御部とを備える請求項１に記載の圧排装置。     A haze detector for detecting haze in the body cavity;
    The exclusion device according to claim 1, further comprising: a suction control unit that causes the suction unit to suck when smoke is detected by the smoke detection unit.
  3. 　前記煙霧検知部は、前記体腔内を撮影する内視鏡から内視鏡画像を受信し、該内視鏡画像の輝度値に基づいて煙霧を検知する請求項２に記載の圧排装置。 3. The exclusion device according to claim 2, wherein the haze detection unit receives an endoscopic image from an endoscope that images the inside of the body cavity, and detects haze based on a luminance value of the endoscopic image.
  4. 　前記煙霧検知部は、前記体腔内に挿入されたエネルギ処置具の作動に基づいて煙霧を検知する請求項２または請求項３に記載の圧排装置。 4. The exclusion device according to claim 2, wherein the smoke detection unit detects the smoke based on an operation of an energy treatment tool inserted into the body cavity.
  5. 　請求項１から請求項４のいずれかに記載の圧排装置と、
    　前記体腔内に挿入される医療器具と、
    　前記生体の外部において、前記圧排装置および前記医療器具を各々保持する電動アームと、
    　操作者によって操作される操作入力部と、
    　該操作入力部に入力された操作に基づいて前記電動アームを作動させるアーム制御部とを備えるロボットシステム。     An exclusion device according to any one of claims 1 to 4,
    A medical instrument inserted into the body cavity;
    Outside the living body, an electric arm for holding the exclusion device and the medical instrument,
    An operation input unit operated by an operator;
    A robot system comprising: an arm control unit that operates the electric arm based on an operation input to the operation input unit.
  6. 　前記アーム制御部が、前記医療器具を保持している前記電動アームの位置および姿勢に基づき、前記圧排装置を保持している前記電動アームを制御する請求項５に記載のロボットシステム。 The robot system according to claim 5, wherein the arm control unit controls the electric arm holding the exclusion device based on the position and posture of the electric arm holding the medical instrument.
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