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EP2349054A1 - Device for controlling the movement of a surgical instrument - Google Patents

Device for controlling the movement of a surgical instrument

Info

Publication number
EP2349054A1
EP2349054A1 EP09797073A EP09797073A EP2349054A1 EP 2349054 A1 EP2349054 A1 EP 2349054A1 EP 09797073 A EP09797073 A EP 09797073A EP 09797073 A EP09797073 A EP 09797073A EP 2349054 A1 EP2349054 A1 EP 2349054A1
Authority
EP
European Patent Office
Prior art keywords
movements
sensor
operator
support arm
voice
Prior art date
Legal status (The legal status 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 status listed.)
Withdrawn
Application number
EP09797073A
Other languages
German (de)
French (fr)
Inventor
Améziane Aoussat
Jean-François OMHOVER
Alain Sezeur
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Groupe Hospitalier Diaconesses Croix Saint-Simon
Universite Pierre et Marie Curie
GROUPE HOSPITALIER DIACONESSES CROIX SAINT SIMON
ENSAM CER DE PARIS
Original Assignee
Groupe Hospitalier Diaconesses Croix Saint-Simon
Universite Pierre et Marie Curie
GROUPE HOSPITALIER DIACONESSES CROIX SAINT SIMON
ENSAM CER DE PARIS
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 Groupe Hospitalier Diaconesses Croix Saint-Simon, Universite Pierre et Marie Curie, GROUPE HOSPITALIER DIACONESSES CROIX SAINT SIMON, ENSAM CER DE PARIS filed Critical Groupe Hospitalier Diaconesses Croix Saint-Simon
Publication of EP2349054A1 publication Critical patent/EP2349054A1/en
Withdrawn legal-status Critical Current

Links

Classifications

    • 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
    • A61B34/70—Manipulators specially adapted for use in surgery
    • 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
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A61B34/74—Manipulators with manual electric input means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00203—Electrical control of surgical instruments with speech control or speech recognition
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00207—Electrical control of surgical instruments with hand gesture control or hand gesture recognition

Definitions

  • the present invention relates to a device for controlling the movement of a surgical instrument, of the type comprising an arm supporting the instrument and at least one motion sensor, said arm being able to move in at least one degree of freedom, said motion sensor being intended to be positioned on the operator of the control device and being arranged to capture the movements of said operator according to the degree of freedom of the support arm.
  • the invention applies more particularly to minimally invasive surgery, such as arthroscopy, laparoscopy or laparoscopy or thoracoscopy.
  • minimally invasive surgery such as arthroscopy, laparoscopy or laparoscopy or thoracoscopy.
  • incisions of 5 to 10 mm in length are made in the body of the patient and trocars are introduced into the incisions to allow the passage of surgical instruments in the body of the patient.
  • An imaging apparatus such as a camera, is also introduced into the patient's body to allow the surgeon to visualize the area of intervention.
  • Such systems generally comprise a robotized support arm of the camera and means for controlling the movement of this arm according to instructions from the surgeon.
  • WO-96/09587 describes for example a voice recognition control system for controlling a robotic arm.
  • a microphone is used to collect the vocal instructions of the surgeon. These instructions are analyzed and converted into control signals for moving the robotic arm.
  • a large number of instructions must be provided to allow and control the movement of the camera in all desired directions and to adjust other parameters of the displacement, such as speed and / or range of motion of the robotic arm.
  • One of the aims of the invention is to overcome these drawbacks by proposing a device for controlling the movement of an ergonomic and instinctive surgical instrument, facilitating the positioning of the instrument by the surgeon while leaving his hands free to maneuver the instrument. other instruments and ensuring a precise displacement of the instrument according to the wishes of the surgeon.
  • the invention relates to a control device of the aforementioned type, in which said device comprises means for processing the signals emitted by the motion sensor, said means being arranged for processing the signals emitted by the motion sensor and for transmitting corresponding control signals to the support arm so that the movements by the motion sensor comprise corresponding movements of the support arm, the device further comprising means for triggering and stopping the transmission arm; detection of the movements of the operator by the sensor.
  • the motion sensor is arranged to capture the movements of the operator in a reference system whose point of origin is the point of entry into the body of a patient of a trocar that allows the passage of a surgical instrument, held by the operator.
  • the means for triggering and stopping the detection of movements of the operator comprise voice or sound control means, said means being arranged to trigger the detection of the movements of the operator by the sensor and the corresponding displacement of the support arm when said voice or sound control means receive a first predefined voice or sound instruction and to stop the detection of the movements of the operator and the corresponding displacement of the support arm when said control means voice or sound receive a second predefined voice or sound instruction.
  • motion detection makes it possible to precisely and simply position the instrument at the desired location.
  • voice or sound control makes it easy to trigger motion detection without adding bulky hardware to the operating room.
  • the number of voice prompts is reduced because voice or sound control only serves a limited number of actions, such as triggering and stopping the detection of surgeon movements.
  • voice recognition can be easily implemented and the risk of errors in the interpretation of commands is decreased. According to other characteristics of the control device:
  • the support arm is able to move in four degrees of freedom, the sensor being arranged to capture the movements of the operator according to at least said four degrees of freedom; the sensor is an electromagnetic sensor with six degrees of freedom able to detect the movements along three axes of translation and along three axes of rotation;
  • the processing means are arranged to transmit identical control signals to the signals emitted by the sensor, the support arm reproducing identically the movements picked up by the sensor;
  • the processing means are furthermore arranged to transmit amplified, reduced or inverted control signals with respect to the signals emitted by the sensor, the control arm making movements of an amplitude proportional to the amplitude of the movements picked up by the sensor according to a predefined proportionality ratio;
  • the selection between the transmission of identical control signals and the transmission of amplified, reduced or inverted control signals is done by means of at least one predefined speech or sound instruction;
  • the support arm moves at a speed identical to the speed of the movements sensed by the sensor or at a speed modulated with respect to said movements;
  • the selection between identical speed or modulated speed is done by means of a predefined voice or sound command;
  • the voice or sound control means comprise a microphone receiving the voice instructions and voice recognition software;
  • the control device comprises means for fixing the sensor to a part of the body of the operator, in particular on a wrist of the operator, the sensor being arranged to capture the movements of said body part.
  • the invention also relates to a surgical operating system, comprising at least one trocar of a surgical instrument intended to be held by an operator and to be introduced into the body of a patient and at least one auxiliary surgical instrument worn. by a support arm, said system comprising a device for controlling the movement of the auxiliary surgical instrument as described above.
  • the trocar includes an insertion point, said insertion point being intended to be the point of entry of the trocar into the body of a patient, the motion sensor is arranged to capture the movements of the operator in a coordinate system whose point of origin is the point of introduction of the trocar.
  • FIG. 1 is a diagrammatic representation in perspective of an operating room in which the control device according to the invention is put in place
  • FIG. 2 is a schematic representation of a reference showing the degrees of freedom of movement of the surgical instrument controlled by the control device according to the invention
  • FIG. 3 is a diagram showing the control chain of the control device of the invention.
  • FIG. 1 there is shown an operating room 1 in which a surgeon 2, or operator, performs a minimally invasive surgery on a patient 4.
  • the surgeon 2 handles with both hands surgical instruments 6 introduced in the body of the patient 4 by means of trocars 8 passing through incisions (not shown) made on the patient 4.
  • Each trocar 8 comprises a point of introduction 9 disposed along the length of the trocar 8 and corresponding to the entry point of the patient. trocar 8 in the patient's body 4.
  • an optic connected to a camera (not shown) is also introduced into the body of the patient via a trocar 8.
  • the camera projects images of the intervention zone on a monitor 10, which allows the surgeon 2 to view the action of his instruments in the area of intervention.
  • the two hands of the surgeon 2 being taken by the surgical instruments 6, the camera is carried by a robotized support arm 12, or robot effector, whose movements are controlled by the surgeon 2, as will be described later.
  • the support arm 12, or optical carrier robot is known per se and will not be described in detail here. It is articulated so as to allow the camera to move in several degrees of freedom, as shown in FIG. 2.
  • a reference X, Y, Z whose origin O is the insertion point of an auxiliary surgical instrument 14 in the body of the patient.
  • the plane defined by the XZ axes substantially represents the surface of the patient's body, and the Y axis is an axis substantially perpendicular to the patient's body at the point of introduction O.
  • the instrument 14 is for example a camera.
  • Fig. 2 shows the possibilities of movement of the instrument 14 in the X, Y, Z coordinate system.
  • the instrument 14 can move in four degrees of freedom.
  • the first degree of freedom is represented by the double arrow F of FIG. 2 and is a displacement in translation along the axis of the instrument 14, that is to say a depression or withdrawal of the instrument 14 relative to the point of origin O.
  • the second degree of freedom is represented by the angle ⁇ of FIG. 2 and is an inclination of the instrument 14 relative to the Y axis. By inclining more or less the instrument 14, the end portion of this instrument is at a greater or lesser height in the body of the patient. This degree of freedom thus represents a movement in ascent or descent of the instrument 14 relative to the body of the patient 4.
  • the third degree of freedom is represented by the angle ⁇ of FIG. 2 and is a displacement in rotation about the Y axis.
  • the fourth degree of freedom is represented by the arrow F 'of FIG. 2 and is a rotation of the instrument 14 around its own axis, that is to say a rotation of the instrument on itself.
  • the support arm 12 is thus arranged and articulated to allow the movement of the camera according to the four degrees of freedom described above.
  • the device for controlling the displacement of the camera using the support arm 12 described above is now described.
  • This device comprises, in addition to the support arm 12, at least one motion sensor 16 and voice or sound control means 18, as well as processing means 20 for the signals emitted by the motion sensor 16 and the voice control means or sound 18.
  • the motion sensor 16 is arranged to capture the movements of the surgeon according to the degrees of freedom of the support arm 12 in an x, y, z coordinate system relative to the surgeon (Fig. 3).
  • the motion sensor 16 is placed on a part the body of the surgeon to produce the movements according to the degrees of freedom of the support arm 12.
  • the motion sensor 16 is for example positioned on the wrist of the surgeon, as shown in FIG. 1. The positioning of the sensor 16 on the wrist allows the surgeon to make intuitive movements when manipulating his instruments 6 to control the movement of the camera, as will be described later.
  • the positioning of the sensor 16 on the wrist allows the surgeon (because of the autonomy of movement of the wrist relative to the hand) to move the auxiliary instrument 14 without necessarily moving the trocar 8 held by the surgeon's arm by relative to the wrist, that is to say that the hand of the surgeon holding the trocar 8 does not necessarily move while the surgeon makes wrist movements to move the camera.
  • the motion sensor 16 is for example an electromagnetic sensor with six degrees of freedom able to detect the movements along three axes of translation and along three axes of rotation.
  • This sensor 16 is for example a sensor "Flock of Birds" marketed by Ascension Technology Corporation.
  • the sensor 16 is attached to the wrist of the surgeon 2 by fastening means 19, for example of the watchband type or scratch strap. In other embodiments, the motion sensor 16 is placed on other parts of the surgeon's body, such as the head or the like.
  • the voice or sound control means 18 comprise a microphone 22 and a speech recognition program programmed to recognize predefined vocal instructions pronounced in the microphone 22 by the surgeon 2.
  • the microphone 22 is for example disposed on a helmet 24 worn by the surgeon and arranged to place the microphone near the mouth thereof.
  • the processing means 20 are for example formed by electronic means and computer software programmed adequately to perform the signal transmissions and the different processing steps described below.
  • the surgeon 2 wishes to move the camera and thus actuate the movement of the support arm, it states a first voice or sound instruction predefined in the microphone 22.
  • This first voice or sound instruction for example "go” or “start”, is recognized by the speech recognition software that transmits a signal corresponding to the processing means 20.
  • the detection of the surgeon's movements by the sensor 16 is then triggered. It should be noted that the detection by the sensor 16 is triggered only by waiver of the first predefined vocal or sound instruction, that is to say that the movements of the surgeon are taken into account only when the latter wish, which avoids a permanent displacement of the camera during the movements of the surgeon.
  • the surgeon performs wrist movements as shown by the arrow f in FIG. 3. These movements are picked up by the sensor 16 during a step B. The movements are sensed relative to a reference x, y, z relative to the surgeon.
  • the point of origin of this marker is advantageously the point of introduction 9 of the trocar 8, that is to say the point of entry of the trocar 8 of the surgical instrument 6 held by the surgeon in the patient's body. .
  • the point of origin of the x, y, z mark is for example the point where the sensor 16 is at the moment of giving up the first voice or sound instruction or another selected fixed point in the scope of the operation. and fixed before the operation.
  • the sensor 16 emits trajectory signals corresponding to the displacement of the sensor 16 in the x, y, z coordinate to the processing means 20.
  • step C the signals emitted during step B are analyzed and converted into coordinates in the x, y, z coordinate of the sensor 16.
  • step D the coordinates thus obtained are associated with, or transformed into, the corresponding displacement coordinates of the support arm 12 with respect to its own X, Y, Z mark.
  • step E the displacement coordinates of the support arm 12 are transformed into trajectory data in order to adapt these displacements to the driving capacities of the support arm.
  • step F the movement orders adapted to the driving capacities of the support arm are transmitted to it by means of control signals.
  • the support arm 12 then performs the movements corresponding to the movements of the surgeon as represented by the arrow f of FIG. 3.
  • the latter states a second predefined voice or sound instruction, for example "stop", in the microphone 22, which interrupts the detection of the movements of the surgeon 2 and immobilizes the camera.
  • voice instructions are preferably simple and concise, which facilitates the programming of voice recognition software and avoids interpretation errors. In order to avoid complex programming of this software and to limit the risk of errors, the number of predefined voice instructions is also reduced. However, other voice instructions may be provided to adjust the behavior of the support arm 12 according to the movements of the surgeon 2.
  • the speed and range of motion of the support arm 12 can be modulated by combining various degrees of amplification with the surgeon's movements.
  • the processing means 20 are arranged to transmit identical control signals to the signals emitted by the sensor 16, the support arm 12 then reproducing identically the movements sensed by the sensor 16, or to transmit amplified or reduced control signals, and / or accelerated or slowed, with respect to the signals emitted by the sensor 16, the control arm 12 then making movements of an amplitude and / or or a speed proportional to the amplitude and / or speed of the movements sensed by the sensor 16 according to a predefined proportionality ratio.
  • the selection of the degree of amplification of the movements picked up by the sensor 16 is done by means of predefined vocal instructions, for example "profile 1", “profile 2", etc., each profile, previously recorded in the processing means 20 , corresponding to a degree of amplification for modulating the amplitude and / or the speed of the movements of the support arm.
  • different degrees of amplification according to the degrees of freedom are provided in order to modulate the amplitude and / or the speed of displacement of the support arm 12 according to these degrees of freedom. For example, it is expected that the speed of rotation of the camera about its axis is greater than the speed of translation of the camera along its axis.
  • These degrees of amplification are selected by means of predefined speech instructions.
  • the choice of the amplification degrees is made by entries in the computer software, for example by means of a keyboard, which limits the number of voice instructions to be taken into account.
  • an "inverted" profile may be chosen.
  • the movements made by the surgeon to control the movement of the camera are reproduced inverted by the support arm 12.
  • the camera will move to the left .
  • Such a profile is advantageous when the trocar bearing the camera is disposed in front of the surgeon. Indeed, the camera then moves "in mirror" of the movements made by the sensor 16 carried by the surgeon.
  • Other voice instructions may be provided, such as camera focal length instructions, allowing for zooming on the area of intervention.
  • the movement of the surgeon corresponding to the degree of freedom of translation of the camera along its axis is interpreted as a request for a change of focal length. That is to say that a movement of the surgeon according to this degree of freedom does not cause a displacement of the camera according to this degree of freedom but causes a change of focal length of the camera.
  • the more the surgeon's arm advances towards the point of origin of the marker the more the camera zooms in on the intervention zone and inversely, the more the surgeon's arm moves away from the point of origin, the more the camera offers a wide field of the intervention area.
  • the means for triggering and stopping the detection of the movements of the sensor 16 are other than by voice.
  • a particular instrument such as a whistle, for example ultrasonic, a whistling trigger detection and two whistles, or a second hissing, would stop.
  • the detection could be triggered by a tapping of the foot if the microphone is positioned accordingly or by pressing a button or other.
  • the support arm 12 can also be disengaged, that is to say that its movements are no longer managed by the control device but are performed manually, for example by a wizard.
  • the device described above is particularly simple to implement and allows precise positioning of the camera by the surgeon without the latter having to drop his instruments 6 or to interrupt his operation.
  • the voice or sound command triggering the taking into account of the movements of the surgeon and the simplification of the transmitted instructions can limit the elements in the operating room and simplify the work of the surgeon with respect to the placement of the surgeon. the camera, which can then focus only on the operation it performs.
  • the control device can in particular be used to control the movement of an imaging device or of compression instruments for example.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Robotics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Manipulator (AREA)

Abstract

The invention relates to a control device that includes an arm (12) for mounting the instrument and at least one motion sensor (16) to be placed on the operator (2) of the control device and equipped to sense the movement of said operator according to the degree of freedom of the mounting arm (12), said device including a means (20) for processing signals emitted by the motion sensor (16), said means (20) being equipped to process the signals emitted by the motion sensor (16) and to send the corresponding control signals to the mounting shaft (12) so that the movement sensed by the motion sensor (16) controls the corresponding movements of the mounting arm (12). The device also includes a means for starting and stopping the detection of the motion of the operator by the sensor (16).

Description

Dispositif de commande du déplacement d'un instrument chirurgical Device for controlling the movement of a surgical instrument

La présente invention concerne un dispositif de commande du déplacement d'un instrument chirurgical, du type comprenant un bras de support de l'instrument et au moins un capteur de mouvement, ledit bras étant apte à se déplacer selon au moins un degré de liberté, ledit capteur de mouvement étant destiné à être positionné sur l'opérateur du dispositif de commande et étant agencé pour capter les mouvements dudit opérateur selon le degré de liberté du bras de support.The present invention relates to a device for controlling the movement of a surgical instrument, of the type comprising an arm supporting the instrument and at least one motion sensor, said arm being able to move in at least one degree of freedom, said motion sensor being intended to be positioned on the operator of the control device and being arranged to capture the movements of said operator according to the degree of freedom of the support arm.

L'invention s'applique plus particulièrement à la chirurgie mini-invasive, telle que l'arthroscopie, la laparoscopie ou coelioscopie ou encore la thoracoscopie. Dans ce type d'interventions, des incisions de 5 à 10 mm de longueur sont pratiquées dans le corps du patient et des trocarts sont introduits dans les incisions afin de permettre le passage d'instruments chirurgicaux dans le corps du patient. Un appareil d'imagerie, telle qu'une caméra, est également introduit dans le corps du patient afin de permettre au chirurgien de visualiser la zone d'intervention.The invention applies more particularly to minimally invasive surgery, such as arthroscopy, laparoscopy or laparoscopy or thoracoscopy. In this type of procedure, incisions of 5 to 10 mm in length are made in the body of the patient and trocars are introduced into the incisions to allow the passage of surgical instruments in the body of the patient. An imaging apparatus, such as a camera, is also introduced into the patient's body to allow the surgeon to visualize the area of intervention.

Afin d'avoir un confort visuel satisfaisant, le chirurgien doit manipuler lui- même la caméra pour suivre, voire anticiper, les mouvements qu'il imprime aux instruments. Cependant, cette manipulation de la caméra oblige le chirurgien à n'utiliser qu'une main pour manipuler les instruments chirurgicaux proprement dits. Pour pallier cet inconvénient, la manipulation de la caméra peut être confiée à un assistant. Cet assistant est alors en charge de centrer l'image sur l'action chirurgicale, ce qui implique une grande connaissance de l'acte opératoire et des habitudes du chirurgien. Un temps très important d'apprentissage est donc nécessaire pour que l'assistant positionne correctement la caméra et anticipe les mouvements du chirurgien au cours de l'opération.In order to have satisfactory visual comfort, the surgeon must manipulate the camera himself to follow, or even anticipate, the movements he prints to the instruments. However, this manipulation of the camera forces the surgeon to use only one hand to manipulate the surgical instruments themselves. To overcome this disadvantage, the manipulation of the camera can be entrusted to an assistant. This assistant is then in charge of centering the image on the surgical action, which implies a great knowledge of the surgical procedure and habits of the surgeon. A very important time of learning is thus necessary so that the assistant positions correctly the camera and anticipates the movements of the surgeon during the operation.

Afin de pallier cet inconvénient, des systèmes automatisés de commande des mouvements de la caméra ont été proposés, permettant au chirurgien de déplacer la caméra en tenant des instruments chirurgicaux dans ses deux mains.To overcome this disadvantage, automated camera movement control systems have been proposed, allowing the surgeon to move the camera by holding surgical instruments in both hands.

De tels systèmes comprennent généralement un bras de support robotisé de la caméra et des moyens de commande du déplacement de ce bras selon des instructions du chirurgien.Such systems generally comprise a robotized support arm of the camera and means for controlling the movement of this arm according to instructions from the surgeon.

Le document WO-96/09587 décrit par exemple un système de commande à reconnaissance vocale permettant de piloter un bras robotisé. Un microphone est utilisé pour recueillir les instructions vocales du chirurgien. Ces instructions sont analysées et transformées en signaux de commande du déplacement du bras robotisé. Dans un tel système, un grand nombre d'instructions doit être prévu pour permettre et commander le déplacement de la caméra selon toutes les directions souhaitées et pour régler d'autres paramètres du déplacement, tels que la vitesse et/ou l'amplitude de mouvement du bras robotisé.WO-96/09587 describes for example a voice recognition control system for controlling a robotic arm. A microphone is used to collect the vocal instructions of the surgeon. These instructions are analyzed and converted into control signals for moving the robotic arm. In such a system, a large number of instructions must be provided to allow and control the movement of the camera in all desired directions and to adjust other parameters of the displacement, such as speed and / or range of motion of the robotic arm.

Ce grand nombre d'instructions est problématique. Techniquement, il complique le logiciel de commande vocale utilisé, qui doit mémoriser un grand nombre de possibilités en relation avec l'empreinte vocale de chaque chirurgien utilisant le système. De fait, lors de l'utilisation d'un tel système, on constate des erreurs fréquentes de l'interprétation des instructions données par le chirurgien par le logiciel de reconnaissance vocale, ce qui oblige le chirurgien à répéter ses instructions. De plus, l'utilisation d'un grand nombre d'instructions peut être gênante pour le chirurgien, qui a besoin d'une grande concentration pour la manipulation des instruments chirurgicaux. Enfin, le bruit ambiant dans la salle d'opération peut gêner l'acquisition des instructions du chirurgien, lesquelles instructions peuvent alors ne pas être prises en compte par le logiciel.This large number of instructions is problematic. Technically, it complicates the voice control software used, which must memorize a large number of possibilities in relation to the voiceprint of each surgeon using the system. In fact, when using such a system, there are frequent errors in the interpretation of the instructions given by the surgeon by the voice recognition software, which forces the surgeon to repeat his instructions. In addition, the use of a large number of instructions can be troublesome for the surgeon, who needs a high concentration for the manipulation of surgical instruments. Finally, the ambient noise in the operating room may interfere with the acquisition of the surgeon's instructions, which instructions may not be taken into account by the software.

D'autres systèmes de commande utilisent une détection des mouvements du chirurgien pour déplacer la caméra. Ainsi, on connaît un système dans lequel le chirurgien porte un casque muni de capteurs infrarouge, les mouvements de la tête du chirurgien étant détectés et transformés en mouvements correspondants du bras robotisé. Un tel système nécessite des moyens de déclenchement de l'acquisition des mouvements du chirurgien afin que seuls les mouvements destinés à déplacer la caméra soient pris en compte. De tels moyens de déclenchement sont par exemple formés par une pédale actionnée par le chirurgien. Le déclenchement peut être problématique pour le chirurgien, qui doit alors coordonner les mouvements complexes de ses mains pratiquant l'opération et celui de son pied pour actionner la pédale. De plus, d'autres instruments chirurgicaux utilisent une pédale pour leur actionnement, par exemple un bistouri électrique. L'intégration de la pédale de déclenchement avec d'autres pédales peut amener à des confusions de la part du chirurgien, qui est susceptible d'actionner la mauvaise pédale, et augmente l'encombrement dans la salle d'opération. En outre, de tels systèmes ne sont pas très ergonomiques ni instinctifs pour le chirurgien qui doit être en mesure de dissocier la réflexion pour assurer les mouvements de la caméra de la réflexion pour assurer les mouvements des instruments chirurgicaux qu'il a en main. En effet, le chirurgien doit faire un effort conscient pour déplacer la caméra en effectuant des mouvements ou des actions différents de ceux permettant de manipuler les instruments chirurgicaux, tels que déplacer sa tête ou émettre des instructions précises. Un tel effort réduit la concentration du chirurgien et peuvent nuire à la réalisation de l'opération chirurgicale. L'un des buts de l'invention est de pallier ces inconvénients en proposant un dispositif de commande du déplacement d'un instrument chirurgical ergonomique et instinctif, facilitant le positionnement de l'instrument par le chirurgien tout en laissant ses mains libres pour manœuvrer d'autres instruments et assurant un déplacement précis de l'instrument selon les souhaits du chirurgien.Other control systems use motion detection of the surgeon to move the camera. Thus, a system is known in which the surgeon wears a helmet equipped with infrared sensors, the movements of the surgeon's head being detected and transformed into corresponding movements of the robotic arm. Such a system requires means for triggering the acquisition of the movements of the surgeon so that only the movements intended to move the camera are taken into account. Such triggering means are for example formed by a pedal actuated by the surgeon. The trigger can be problematic for the surgeon, who must then coordinate the complex movements of his hands practicing the operation and that of his foot to operate the pedal. In addition, other surgical instruments use a pedal for their actuation, for example an electrocautery. The integration of the trigger pedal with other pedals can lead to confusion on the part of the surgeon, who is likely to actuate the wrong pedal, and increases the size in the operating room. In addition, such systems are not very ergonomic or instinctive for the surgeon who must be able to dissociate the reflection to ensure the movement of the camera reflection to ensure the movements of surgical instruments he has in hand. Indeed, the surgeon must make a conscious effort to move the camera by performing movements or actions different from those for manipulating surgical instruments, such as moving his head or issue specific instructions. Such an effort reduces the concentration of the surgeon and may interfere with performing the surgical operation. One of the aims of the invention is to overcome these drawbacks by proposing a device for controlling the movement of an ergonomic and instinctive surgical instrument, facilitating the positioning of the instrument by the surgeon while leaving his hands free to maneuver the instrument. other instruments and ensuring a precise displacement of the instrument according to the wishes of the surgeon.

A cet effet, l'invention concerne un dispositif de commande du type précité, dans lequel ledit dispositif comprend des moyens de traitement des signaux émis par le capteur de mouvement, lesdits moyens étant agencés pour traiter les signaux émis par le capteur de mouvement et pour transmettre des signaux de commande correspondants au bras de support de sorte que les mouvements ca ptés par l e capteu r de mouvement com ma ndent des mouvem ents correspondants du bras de support, le dispositif comprenant en outre des moyens de déclenchement et d'arrêt de la détection des mouvements de l'opérateur par le capteur. Selon une caractéristique de l'invention, le capteur de mouvement est agencé pour capter les mouvements de l'opérateur dans un repère dont le point d'origine est le point d'entrée dans le corps d'un patient d'un trocart qui permet le passage d'un instrument chirurgical, tenu par l'opérateur.For this purpose, the invention relates to a control device of the aforementioned type, in which said device comprises means for processing the signals emitted by the motion sensor, said means being arranged for processing the signals emitted by the motion sensor and for transmitting corresponding control signals to the support arm so that the movements by the motion sensor comprise corresponding movements of the support arm, the device further comprising means for triggering and stopping the transmission arm; detection of the movements of the operator by the sensor. According to a feature of the invention, the motion sensor is arranged to capture the movements of the operator in a reference system whose point of origin is the point of entry into the body of a patient of a trocar that allows the passage of a surgical instrument, held by the operator.

Une telle caractéristique permet d'obtenir un dispositif de commande particulièrement ergonomique et instinctif. En effet, le fait de placer l'origine du repère dans lequel le capteur capte les mouvements du chirurgien au point d'entrée d'un trocart d'un instrument chirurgical tenu par le chirurgien confère à celui-ci l'impression de tenir l'instrument chirurgical porté par le bras de support dans la main. De ce fait, le chirurgien effectue des mouvements identiques à ceux qu'il effectuerait s'il tenait l'instrument chirurgical porté par le bras de support dans sa main. Ainsi, la commande des déplacements de l'instrument chirurgical s'effectue sans effort conscient de la part du chirurgien, ce qui lui permet de se concentrer uniquement sur l'opération chirurgicale en elle-même et non sur le déplacement de la caméra. Cette caractéristique est d'autant plus avantageuse si le capteur est placé par exemple sur le poignet du bras du chirurgien qui tient le trocart.Such a characteristic makes it possible to obtain a particularly ergonomic and instinctive control device. Indeed, placing the origin of the marker in which the sensor captures the movements of the surgeon at the point of entry of a trocar of a surgical instrument held by the surgeon gives it the impression of holding the surgical instrument carried by the support arm in the hand. As a result, the surgeon performs movements identical to those he would perform if he held the surgical instrument carried by the support arm in his hand. Thus, the control of the movements of the surgical instrument is effected without conscious effort on the part of the surgeon, which allows him to focus solely on the surgical operation itself and not on the movement of the camera. This feature is even more advantageous if the sensor is placed for example on the wrist of the arm of the surgeon who holds the trocar.

Selon une autre caractéristique de l'invention, les moyens de déclenchement et d'arrêt de la détection des mouvements de l'opérateur comprennent des moyens de commande vocale ou sonore, lesdits moyens étant agencés pour déclencher la détection des mouvements de l'opérateur par le capteur et le déplacement correspondant du bras de support lorsque lesdits moyens de commande vocale ou sonore reçoivent une première instruction vocale ou sonore prédéfinie et pour arrêter la détection des mouvements de l'opérateur et le déplacement correspondant du bras de support lorsque lesdits moyens de commande vocale ou sonore reçoivent une deuxième instruction vocale ou sonore prédéfinie.According to another characteristic of the invention, the means for triggering and stopping the detection of movements of the operator comprise voice or sound control means, said means being arranged to trigger the detection of the movements of the operator by the sensor and the corresponding displacement of the support arm when said voice or sound control means receive a first predefined voice or sound instruction and to stop the detection of the movements of the operator and the corresponding displacement of the support arm when said control means voice or sound receive a second predefined voice or sound instruction.

La combinaison de la détection de mouvement et d'une commande vocale ou sonore de déclenchement permet d'obtenir un dispositif de commande efficace. En effet, la détection de mouvement permet de positionner précisément et simplement l'instrument à l'endroit souhaité. La commande vocale ou sonore permet de déclencher la détection de mouvement de façon simple, sans ajout de matériel encombrant dans la salle d'opération. En outre, le nombre d'instructions vocales est réduit car la commande vocale ou sonore ne sert qu'à un nombre limité d'actions, telles que le déclenchement et l'arrêt de la détection des mouvements de chirurgien. Ainsi, la reconnaissance vocale peut être facilement mise en œuvre et le risque d'erreurs dans l'interprétation des commandes est diminué. Selon d'autres caractéristiques du dispositif de commande :The combination of motion detection and voice or sound triggering control provides an effective control device. Indeed, motion detection makes it possible to precisely and simply position the instrument at the desired location. The voice or sound control makes it easy to trigger motion detection without adding bulky hardware to the operating room. In addition, the number of voice prompts is reduced because voice or sound control only serves a limited number of actions, such as triggering and stopping the detection of surgeon movements. Thus, voice recognition can be easily implemented and the risk of errors in the interpretation of commands is decreased. According to other characteristics of the control device:

- le bras de support est apte à se déplacer selon quatre degrés de liberté, le capteur étant agencé pour capter les mouvements de l'opérateur selon au moins lesdits quatre degrés de liberté ; - le capteur est un capteur électromagnétique à six degrés de liberté apte à détecter les mouvements selon trois axes de translation et selon trois axes de rotation ;- The support arm is able to move in four degrees of freedom, the sensor being arranged to capture the movements of the operator according to at least said four degrees of freedom; the sensor is an electromagnetic sensor with six degrees of freedom able to detect the movements along three axes of translation and along three axes of rotation;

- les moyens de traitement sont agencés pour transmettre des signaux de commande identiques aux signaux émis par le capteur, le bras de support reproduisant à l'identique les mouvements captés par le capteur ;the processing means are arranged to transmit identical control signals to the signals emitted by the sensor, the support arm reproducing identically the movements picked up by the sensor;

- les moyens de traitement sont en outre agencés pour transmettre des signaux de commande amplifiés, réduits ou inversés par rapport aux signaux émis par le capteur, le bras de commande effectuant des mouvements d'une amplitude proportionnelle à l'amplitude des mouvements captés par le capteur selon un rapport de proportionnalité prédéfini ;the processing means are furthermore arranged to transmit amplified, reduced or inverted control signals with respect to the signals emitted by the sensor, the control arm making movements of an amplitude proportional to the amplitude of the movements picked up by the sensor according to a predefined proportionality ratio;

- la sélection entre la transmission de signaux de commande identiques et la transmission de signaux de commande amplifiés, réduits ou inversés se fait au moyen d'au moins une instruction vocale ou sonore prédéfinie ; - le bras de support se déplace à une vitesse identique à la vitesse des mouvements captés par le capteur ou à une vitesse modulée par rapport auxdits mouvements ;the selection between the transmission of identical control signals and the transmission of amplified, reduced or inverted control signals is done by means of at least one predefined speech or sound instruction; the support arm moves at a speed identical to the speed of the movements sensed by the sensor or at a speed modulated with respect to said movements;

- la sélection entre vitesse identique ou vitesse modulée se fait au moyen d'une commande vocale ou sonore prédéfinie ; - les moyens de commande vocale ou sonore comprennent un microphone recevant les instructions vocales et un logiciel de reconnaissance vocale ; etthe selection between identical speed or modulated speed is done by means of a predefined voice or sound command; the voice or sound control means comprise a microphone receiving the voice instructions and voice recognition software; and

- le dispositif de commande comprend des moyens de fixation du capteur à une partie du corps de l'opérateur, notamment sur un poignet de l'opérateur, le capteur étant agencé pour capter les mouvements de ladite partie du corps. L'invention concerne également un système d'opération ch irurg ical, comprenant au moins un trocart d'un instrument chirurgical destiné à être tenu par un opérateur et à être introduit dans le corps d'un patient et au moins un instrument chirurgical auxiliaire porté par un bras de support, ledit système comprenant un dispositif de commande du déplacement de l'instrument chirurgical auxiliaire tel que décrit ci-dessus.- The control device comprises means for fixing the sensor to a part of the body of the operator, in particular on a wrist of the operator, the sensor being arranged to capture the movements of said body part. The invention also relates to a surgical operating system, comprising at least one trocar of a surgical instrument intended to be held by an operator and to be introduced into the body of a patient and at least one auxiliary surgical instrument worn. by a support arm, said system comprising a device for controlling the movement of the auxiliary surgical instrument as described above.

Selon une autre caractéristique du système d'opération, le trocart comprend un point d'introduction, ledit point d'introduction étant destiné à être le point d'entrée du trocart dans le corps d'un patient, le capteur de mouvement est agencé pour capter les mouvements de l'opérateur dans un repère dont le point d'origine est le point d'introduction du trocart.According to another feature of the operating system, the trocar includes an insertion point, said insertion point being intended to be the point of entry of the trocar into the body of a patient, the motion sensor is arranged to capture the movements of the operator in a coordinate system whose point of origin is the point of introduction of the trocar.

D'autres aspects et avantages de l'invention apparaîtront à la lecture de la description qui suit, donnée à titre d'exemple et faite en référence aux dessins annexés, dans lesquels :Other aspects and advantages of the invention will appear on reading the description which follows, given by way of example and with reference to the appended drawings, in which:

- la Fig. 1 est une représentation schématique en perspective d'une salle d'opération dans laquelle le dispositif de commande selon l'invention est mis en place,FIG. 1 is a diagrammatic representation in perspective of an operating room in which the control device according to the invention is put in place,

- la Fig. 2 est une représentation schématique d'un repère figurant les degrés de liberté de déplacement de l'instrument chirurgical commandé par le dispositif de commande selon l'invention,FIG. 2 is a schematic representation of a reference showing the degrees of freedom of movement of the surgical instrument controlled by the control device according to the invention,

- la Fig. 3 est un diagramme représentant la chaîne de commande du dispositif de commande de l'invention.FIG. 3 is a diagram showing the control chain of the control device of the invention.

Sur la Fig. 1 , on a représenté une salle d'opération 1 dans laquelle un chirurgien 2, ou opérateur, effectue une intervention en chirurgie mini-invasive sur un patient 4. A cet effet, le chirurgien 2 manipule de ses deux mains des instruments chirurgicaux 6 introduits dans le corps du patient 4 au moyen de trocarts 8 passant par des incisions (non représentées) pratiquées sur le patient 4. Chaque trocart 8 comprend un point d'introduction 9 disposé sur la longueur du trocart 8 et correspondant au point d'entrée du trocart 8 dans le corps du patient 4.In FIG. 1, there is shown an operating room 1 in which a surgeon 2, or operator, performs a minimally invasive surgery on a patient 4. For this purpose, the surgeon 2 handles with both hands surgical instruments 6 introduced in the body of the patient 4 by means of trocars 8 passing through incisions (not shown) made on the patient 4. Each trocar 8 comprises a point of introduction 9 disposed along the length of the trocar 8 and corresponding to the entry point of the patient. trocar 8 in the patient's body 4.

Afin de visualiser la zone d'intervention dans laquelle les instruments chirurgicaux agissent, une optique connectée à une caméra (non représentée) est également introduite dans le corps du patient par l'intermédiaire d'un trocart 8. La caméra projette des images de la zone d'intervention sur un moniteur 10, ce qui permet au chirurgien 2 de visualiser l'action de ses instruments dans la zone d'intervention.In order to visualize the intervention zone in which the surgical instruments act, an optic connected to a camera (not shown) is also introduced into the body of the patient via a trocar 8. The camera projects images of the intervention zone on a monitor 10, which allows the surgeon 2 to view the action of his instruments in the area of intervention.

Les deux mains du chirurgien 2 étant prises par les instruments chirurgicaux 6, la caméra est portée par un bras de support 12 robotisé, ou robot effecteur, dont les déplacements sont commandés par le chirurgien 2, comme cela sera décrit ultérieurement. Le bras de support 12, ou robot porte-optique, est connu en soi et ne sera pas décrit en détail ici. Il est articulé de manière à permettre le déplacement de la caméra selon plusieurs degrés de liberté, comme représenté sur la Fig. 2. Sur cette figure, on a représenté un repère X, Y, Z dont l'origine O est le point d'introduction d'un instrument chirurgical auxiliaire 14 dans le corps du patient. Le plan défini par les axes X-Z représente sensiblement la surface du corps du patient, et l'axe Y est un axe sensiblement perpendiculaire au corps du patient au point d'introduction O. L'instrument 14 est par exemple une caméra. La Fig. 2 représente les possibilités de déplacement de l'instrument 14 dans le repère X, Y, Z. L'instrument 14 est susceptible de se déplacer selon quatre degrés de libertés.The two hands of the surgeon 2 being taken by the surgical instruments 6, the camera is carried by a robotized support arm 12, or robot effector, whose movements are controlled by the surgeon 2, as will be described later. The support arm 12, or optical carrier robot, is known per se and will not be described in detail here. It is articulated so as to allow the camera to move in several degrees of freedom, as shown in FIG. 2. In this figure, there is shown a reference X, Y, Z whose origin O is the insertion point of an auxiliary surgical instrument 14 in the body of the patient. The plane defined by the XZ axes substantially represents the surface of the patient's body, and the Y axis is an axis substantially perpendicular to the patient's body at the point of introduction O. The instrument 14 is for example a camera. Fig. 2 shows the possibilities of movement of the instrument 14 in the X, Y, Z coordinate system. The instrument 14 can move in four degrees of freedom.

Le premier degré de liberté est représenté par la double flèche F de la Fig. 2 et est un déplacement en translation selon l'axe de l'instrument 14, c'est-à-dire un enfoncement ou un retrait de l'instrument 14 par rapport au point d'origine O.The first degree of freedom is represented by the double arrow F of FIG. 2 and is a displacement in translation along the axis of the instrument 14, that is to say a depression or withdrawal of the instrument 14 relative to the point of origin O.

Le deuxième degré de liberté est représenté par l'angle α de la Fig. 2 et est une inclinaison de l'instrument 14 par rapport à l'axe Y. En inclinant plus ou moins l'instrument 14, la partie extrême de cet instrument se trouve à une hauteur plus ou moins importante dans le corps du patient. Ce degré de liberté représente donc un déplacement en ascension ou descente de l'instrument 14 par rapport au corps du patient 4.The second degree of freedom is represented by the angle α of FIG. 2 and is an inclination of the instrument 14 relative to the Y axis. By inclining more or less the instrument 14, the end portion of this instrument is at a greater or lesser height in the body of the patient. This degree of freedom thus represents a movement in ascent or descent of the instrument 14 relative to the body of the patient 4.

Le troisième degré de liberté est représenté par l'angle β de la Fig. 2 et est un déplacement en rotation autour de l'axe Y. Le quatrième degré de liberté est représenté par la flèche F' de la Fig. 2 et est une rotation de l'instrument 14 autour de son propre axe, c'est-à-dire une rotation de l'instrument sur lui-même.The third degree of freedom is represented by the angle β of FIG. 2 and is a displacement in rotation about the Y axis. The fourth degree of freedom is represented by the arrow F 'of FIG. 2 and is a rotation of the instrument 14 around its own axis, that is to say a rotation of the instrument on itself.

Le bras de support 12 est donc agencé et articulé pour permettre le déplacement de la caméra selon les quatre degrés de liberté décrits ci-dessus. On décrit à présent le dispositif de commande du déplacement de la caméra utilisant le bras de support 12 décrit ci-dessus.The support arm 12 is thus arranged and articulated to allow the movement of the camera according to the four degrees of freedom described above. The device for controlling the displacement of the camera using the support arm 12 described above is now described.

Ce dispositif comprend, outre le bras de support 12, au moins un capteur de mouvement 16 et des moyens de commande vocale ou sonore 18, ainsi que des moyens de traitement 20 des signaux émis par le capteur de mouvement 16 et les moyens de commande vocale ou sonore 18.This device comprises, in addition to the support arm 12, at least one motion sensor 16 and voice or sound control means 18, as well as processing means 20 for the signals emitted by the motion sensor 16 and the voice control means or sound 18.

Le capteur de mouvement 16 est agencé pour capter les mouvements du chirurgien selon les degrés de liberté du bras de support 12 dans un repère x, y, z relatif au chirurgien (Fig. 3). Le capteur de mouvement 16 est placé sur une partie du corps du chirurgien permettant de produire les mouvements selon les degrés de liberté du bras de support 12. A cet effet, le capteur de mouvement 16 est par exemple positionné sur le poignet du chirurgien, comme représenté sur la Fig. 1. Le positionnement du capteur 16 sur le poignet permet au chirurgien d'effectuer des mouvements intuitifs lorsqu'il manipule ses instruments 6 pour piloter le déplacement de la caméra, comme cela sera décrit ultérieurement. Notamment, le positionnement du capteur 16 sur le poignet permet au chirurgien (en raison de l'autonomie de mouvement du poignet par rapport à la main) de déplacer l'instrument auxiliaire 14 sans nécessairement déplacer le trocart 8 tenu par le bras du chirurgien par rapport au poignet, c'est-à-dire que la main du chirurgien tenant le trocart 8 ne se déplace pas nécessairement pendant que le chirurgien effectue des mouvements du poignet pour déplacer la caméra.The motion sensor 16 is arranged to capture the movements of the surgeon according to the degrees of freedom of the support arm 12 in an x, y, z coordinate system relative to the surgeon (Fig. 3). The motion sensor 16 is placed on a part the body of the surgeon to produce the movements according to the degrees of freedom of the support arm 12. For this purpose, the motion sensor 16 is for example positioned on the wrist of the surgeon, as shown in FIG. 1. The positioning of the sensor 16 on the wrist allows the surgeon to make intuitive movements when manipulating his instruments 6 to control the movement of the camera, as will be described later. In particular, the positioning of the sensor 16 on the wrist allows the surgeon (because of the autonomy of movement of the wrist relative to the hand) to move the auxiliary instrument 14 without necessarily moving the trocar 8 held by the surgeon's arm by relative to the wrist, that is to say that the hand of the surgeon holding the trocar 8 does not necessarily move while the surgeon makes wrist movements to move the camera.

Le capteur de mouvement 16 est par exemple un capteur électromagnétique à six degrés de liberté apte à détecter les mouvements selon trois axes de translation et selon trois axes de rotation. Ce capteur 16 est par exemple un capteur « Flock of Birds » commercialisé par la société Ascension Technology Corporation. Le capteur 16 est fixé au poignet du chirurgien 2 par des moyens de fixation 19, par exemple du type bracelet de montre ou bracelet scratch. Selon d'autres modes de réalisation, le capteur de mouvement 16 est placé sur d'autres parties du corps du chirurgien, telles que la tête ou autre.The motion sensor 16 is for example an electromagnetic sensor with six degrees of freedom able to detect the movements along three axes of translation and along three axes of rotation. This sensor 16 is for example a sensor "Flock of Birds" marketed by Ascension Technology Corporation. The sensor 16 is attached to the wrist of the surgeon 2 by fastening means 19, for example of the watchband type or scratch strap. In other embodiments, the motion sensor 16 is placed on other parts of the surgeon's body, such as the head or the like.

Les moyens de commande vocale ou sonore 18 comprennent un microphone 22 et un logiciel de reconnaissance vocale programmé pour reconnaître des instructions vocales prédéfinies prononcées dans le microphone 22 par le chirurgien 2. Le microphone 22 est par exemple disposé sur un casque 24 porté par le chirurgien et agencé pour placer le microphone à proximité de la bouche de celui-ci.The voice or sound control means 18 comprise a microphone 22 and a speech recognition program programmed to recognize predefined vocal instructions pronounced in the microphone 22 by the surgeon 2. The microphone 22 is for example disposed on a helmet 24 worn by the surgeon and arranged to place the microphone near the mouth thereof.

Les moyens de traitement 20 sont par exemple formés par des moyens électroniques et un logiciel informatique programmé de façon adéquate pour réaliser les transmissions de signaux et les différentes étapes de traitement décrites ci-dessous.The processing means 20 are for example formed by electronic means and computer software programmed adequately to perform the signal transmissions and the different processing steps described below.

Le fonctionnement du dispositif de commande va à présent être décrit en relation avec la Fig. 3. Lorsque le chirurgien 2 souhaite déplacer la caméra et donc actionner le déplacement du bras de support, il énonce une première instruction vocale ou sonore prédéfinie dans le microphone 22. Cette première instruction vocale ou sonore, par exemple « go » ou « start », est reconnue par le logiciel de reconnaissance vocale qui transmet un signal correspondant aux moyens de traitement 20. Au cours d'une étape A, la détection des mouvements du chirurgien par le capteur 16 est alors déclenchée. Il convient de noter que la détection par le capteur 16 n'est déclenchée que par renonciation de la première instruction vocale ou sonore prédéfinie, c'est-à-dire que les mouvements du chirurgien ne sont pris en compte que lorsque celui-ci le souhaite, ce qui évite un déplacement permanent de la caméra lors des mouvements du chirurgien.The operation of the controller will now be described in connection with FIG. 3. When the surgeon 2 wishes to move the camera and thus actuate the movement of the support arm, it states a first voice or sound instruction predefined in the microphone 22. This first voice or sound instruction, for example "go" or "start", is recognized by the speech recognition software that transmits a signal corresponding to the processing means 20. During a step A, the detection of the surgeon's movements by the sensor 16 is then triggered. It should be noted that the detection by the sensor 16 is triggered only by waiver of the first predefined vocal or sound instruction, that is to say that the movements of the surgeon are taken into account only when the latter wish, which avoids a permanent displacement of the camera during the movements of the surgeon.

Le chirurgien effectue des mouvements du poignet comme représenté par la flèche f de la Fig. 3. Ces mouvements sont captés par le capteur 16 au cours d'une étape B. Les mouvements sont captés par rapport à un repère x, y, z relatif au chirurgien. Le point d'origine de ce repère est avantageusement le point d'introduction 9 du trocart 8, c'est-à-dire le point d'entrée du trocart 8 de l'instrument chirurgical 6 tenu par le chirurgien dans le corps du patient.The surgeon performs wrist movements as shown by the arrow f in FIG. 3. These movements are picked up by the sensor 16 during a step B. The movements are sensed relative to a reference x, y, z relative to the surgeon. The point of origin of this marker is advantageously the point of introduction 9 of the trocar 8, that is to say the point of entry of the trocar 8 of the surgical instrument 6 held by the surgeon in the patient's body. .

Le fait de choisir le point d'origine du repère x, y, z comme étant le point d'introduction 9 permet de conférer au chirurgien l'impression de tenir la caméra en main bien que celle-ci soit portée par le bras de support 12. Comme mentionné précédemment, cela rend la commande des mouvements de la caméra particulièrement intuitive et ergonomique, le chirurgien n'ayant pas besoin d'effectuer un effort conscient pour replacer la caméra dans le repère X, Y, Z dans lequel celle-ci se déplace. En alternative, le point d'origine du repère x, y, z est par exemple le point où se trouve le capteur 16 au moment de renonciation de la première instruction vocale ou sonore ou un autre point fixe choisi dans le périmètre de l'opération et fixé préalablement à l'opération.Choosing the point of origin of the x, y, z mark as the point of introduction 9 makes it possible for the surgeon to have the impression of holding the camera in hand although it is carried by the support arm 12. As mentioned above, this makes the control of the movements of the camera particularly intuitive and ergonomic, the surgeon does not need to make a conscious effort to put the camera back in the X, Y, Z mark in which it moves. Alternatively, the origin point of the x, y, z mark is for example the point where the sensor 16 is at the moment of giving up the first voice or sound instruction or another selected fixed point in the scope of the operation. and fixed before the operation.

Le capteur 16 émet des signaux de trajectoire correspondant au déplacement du capteur 16 dans le repère x, y, z vers les moyens de traitement 20.The sensor 16 emits trajectory signals corresponding to the displacement of the sensor 16 in the x, y, z coordinate to the processing means 20.

On notera que le positionnement du capteur 16 sur le poignet est plus intuitif, car le chirurgien 2 peut manipuler les instruments chirurgicaux qu'il tient tout en assurant un déplacement de la caméra par les mouvements du poignet assurant la manipulation de la caméra. Ainsi, la caméra vient se placer « naturellement » à l'endroit souhaité sans que le chirurgien ait besoin d'effectuer un effort conscient pour assurer ce positionnement. Au cours d'une étape C, les signaux émis au cours de l'étape B sont analysés et convertis en coordonnées dans le repère x, y, z du capteur 16.Note that the positioning of the sensor 16 on the wrist is more intuitive, because the surgeon 2 can manipulate the surgical instruments that he holds while ensuring a movement of the camera by the movements of the wrist ensuring the manipulation of the camera. Thus, the camera is placed "naturally" at the desired location without the surgeon needs to make a conscious effort to ensure this positioning. During a step C, the signals emitted during step B are analyzed and converted into coordinates in the x, y, z coordinate of the sensor 16.

Au cours d'une étape D, les coordonnées ainsi obtenues sont associées à, ou transformées en, des coordonnées de déplacement correspondantes du bras de support 12 par rapport à son propre repère X, Y, Z. Au cours d'une étape E, les coordonnées de déplacement du bras de support 12 sont transformées en données de trajectoire afin d'adapter ces déplacements aux capacités motrices du bras de support.During a step D, the coordinates thus obtained are associated with, or transformed into, the corresponding displacement coordinates of the support arm 12 with respect to its own X, Y, Z mark. During a step E, the displacement coordinates of the support arm 12 are transformed into trajectory data in order to adapt these displacements to the driving capacities of the support arm.

Au cours d'une étape F, les ordres de déplacements adaptés aux capacités motrices du bras de support lui sont transmis par l'intermédiaire de signaux de commande.During a step F, the movement orders adapted to the driving capacities of the support arm are transmitted to it by means of control signals.

Le bras de support 12 effectue alors les mouvements correspondant aux mouvements du chirurgien comme représenté par la flèche f de la Fig. 3.The support arm 12 then performs the movements corresponding to the movements of the surgeon as represented by the arrow f of FIG. 3.

Lorsque le placement de la caméra est satisfaisant pour le chirurgien, celui- ci énonce une deuxième instruction vocale ou sonore prédéfinie, par exemple « stop », dans le microphone 22, ce qui interrompt la détection des mouvements du chirurgien 2 et immobilise la caméra.When the placement of the camera is satisfactory for the surgeon, the latter states a second predefined voice or sound instruction, for example "stop", in the microphone 22, which interrupts the detection of the movements of the surgeon 2 and immobilizes the camera.

On notera que les instructions vocales sont de préférence simples et concises, ce qui facilite la programmation du logiciel de reconnaissance vocale et évite les erreurs d'interprétation. Afin d'éviter la programmation complexe de ce logiciel et de limiter le risque d'erreurs, le nombre d'instructions vocales prédéfinies est en outre réduit. Toutefois, d'autres instructions vocales peuvent être prévues afin de régler le comportement du bras de support 12 en fonction des mouvements du chirurgien 2.Note that the voice instructions are preferably simple and concise, which facilitates the programming of voice recognition software and avoids interpretation errors. In order to avoid complex programming of this software and to limit the risk of errors, the number of predefined voice instructions is also reduced. However, other voice instructions may be provided to adjust the behavior of the support arm 12 according to the movements of the surgeon 2.

Ainsi, la vitesse et l'amplitude de déplacement du bras de support 12 peuvent être modulées en associant divers degrés d'amplification aux mouvements du chirurgien. Par exemple, les moyens de traitement 20 sont agencés pour transmettre des signaux de commande identiques aux signaux émis par le capteur 16, le bras de support 12 reproduisant alors à l'identique les mouvements captés par le capteur 16, ou pour transmettre des signaux de commande amplifiés ou réduits, et/ou accélérés ou ralentis, par rapport aux signaux émis par le capteur 16, le bras de commande 12 effectuant alors des mouvements d'une amplitude et/ou d'une vitesse proportionnelles à l'amplitude et/ou à la vitesse des mouvements captés par le capteur 16 selon un rapport de proportionnalité prédéfini.Thus, the speed and range of motion of the support arm 12 can be modulated by combining various degrees of amplification with the surgeon's movements. For example, the processing means 20 are arranged to transmit identical control signals to the signals emitted by the sensor 16, the support arm 12 then reproducing identically the movements sensed by the sensor 16, or to transmit amplified or reduced control signals, and / or accelerated or slowed, with respect to the signals emitted by the sensor 16, the control arm 12 then making movements of an amplitude and / or or a speed proportional to the amplitude and / or speed of the movements sensed by the sensor 16 according to a predefined proportionality ratio.

La sélection du degré d'amplification des mouvements captés par le capteur 16 se fait au moyen d'instructions vocales prédéfinies, par exemple « profil 1 », « profil 2 », etc., chaque profil, préalablement enregistré dans les moyens de traitement 20, correspondant à un degré d'amplification permettant de moduler l'amplitude et/ou la vitesse des déplacements du bras de support.The selection of the degree of amplification of the movements picked up by the sensor 16 is done by means of predefined vocal instructions, for example "profile 1", "profile 2", etc., each profile, previously recorded in the processing means 20 , corresponding to a degree of amplification for modulating the amplitude and / or the speed of the movements of the support arm.

Selon un autre mode de réalisation, des degrés d'amplification différents selon les degrés de liberté sont prévus afin de moduler l'amplitude et/ou la vitesse de déplacement du bras de support 12 selon ces degrés de liberté. Par exemple, on prévoit que la vitesse de rotation de la caméra autour de son axe soit supérieure à la vitesse de translation de la caméra selon son axe. Ces degrés d'amplification sont sélectionnés au moyen d'instructions vocales prédéfinies.According to another embodiment, different degrees of amplification according to the degrees of freedom are provided in order to modulate the amplitude and / or the speed of displacement of the support arm 12 according to these degrees of freedom. For example, it is expected that the speed of rotation of the camera about its axis is greater than the speed of translation of the camera along its axis. These degrees of amplification are selected by means of predefined speech instructions.

En variante, le choix des degrés d'amplification se fait par des entrées dans le logiciel informatique, par exemple au moyen d'un clavier, ce qui limite le nombre d'instructions vocales à prendre en compte.As a variant, the choice of the amplification degrees is made by entries in the computer software, for example by means of a keyboard, which limits the number of voice instructions to be taken into account.

Selon une variante particulière, un profil « inversé » peut être choisi. Dans ce profil, les mouvements effectués par le chirurgien pour commander le déplacement de la caméra sont reproduits de façon inversée par le bras de support 12. Ainsi, si le chirurgien déplace son poignet vers la droite par exemple, la caméra se déplacera vers la gauche. Un tel profil est avantageux lorsque le trocart portant la caméra est disposé en face du chirurgien. En effet, la caméra se déplace alors « en miroir » des déplacements effectués par le capteur 16 porté par le chirurgien.According to one particular variant, an "inverted" profile may be chosen. In this profile, the movements made by the surgeon to control the movement of the camera are reproduced inverted by the support arm 12. Thus, if the surgeon moves his wrist to the right for example, the camera will move to the left . Such a profile is advantageous when the trocar bearing the camera is disposed in front of the surgeon. Indeed, the camera then moves "in mirror" of the movements made by the sensor 16 carried by the surgeon.

D'autres instructions vocales peuvent être prévues, telles que des instructions relatives à la focale de la caméra, ce qui permet d'effectuer des zooms sur la zone d'intervention. En variante, le mouvement du chirurgien correspondant au degré de liberté de la translation de la caméra selon son axe est interprété comme étant une demande de changement de focale. C'est-à-dire qu'un mouvement du chirurgien selon ce degré de liberté n'entraîne pas un déplacement de la caméra selon ce degré de liberté mais entraîne un changement de focale de la caméra. Ainsi, plus le bras du chirurgien avance vers le point d'origine du repère, plus la caméra zoome sur la zone d'intervention et inversement plus le bras du chirurgien s'éloigne du point d'origine, plus la caméra offre un champ large de la zone d'intervention.Other voice instructions may be provided, such as camera focal length instructions, allowing for zooming on the area of intervention. Alternatively, the movement of the surgeon corresponding to the degree of freedom of translation of the camera along its axis is interpreted as a request for a change of focal length. That is to say that a movement of the surgeon according to this degree of freedom does not cause a displacement of the camera according to this degree of freedom but causes a change of focal length of the camera. Thus, the more the surgeon's arm advances towards the point of origin of the marker, the more the camera zooms in on the intervention zone and inversely, the more the surgeon's arm moves away from the point of origin, the more the camera offers a wide field of the intervention area.

On peut également prévoir un enregistrement d'une position de la caméra particulière et une instruction vocale ou sonore permettant de replacer automatiquement la caméra dans cette position enregistrée. Selon des variantes de réalisation, les moyens de déclenchement et d'arrêt de la détection des mouvements du capteur 16 se font autrement que par la voix. Ainsi, on peut prévoir que le chirurgien déclenche la détection par un instrument particulier, tel qu'un sifflet, par exemple ultrasonique, dont un sifflement déclencherait la détection et deux sifflements, ou un deuxième sifflement, l'arrêteraient. De même, la détection pourrait être déclenchée par un tapement du pied si le micro est positionné en conséquence ou par la pression sur un bouton ou autre.One can also provide a recording of a position of the particular camera and a voice or sound instruction to automatically place the camera in this registered position. According to alternative embodiments, the means for triggering and stopping the detection of the movements of the sensor 16 are other than by voice. Thus, it can be expected that the surgeon triggers the detection by a particular instrument, such as a whistle, for example ultrasonic, a whistling trigger detection and two whistles, or a second hissing, would stop. Similarly, the detection could be triggered by a tapping of the foot if the microphone is positioned accordingly or by pressing a button or other.

Le bras de support 12 peut également être débrayé, c'est-à-dire que ses déplacements ne sont plus gérés par le dispositif de commande mais sont effectués manuellement, par exemple par un assistant.The support arm 12 can also be disengaged, that is to say that its movements are no longer managed by the control device but are performed manually, for example by a wizard.

Le dispositif décrit ci-dessus est particulièrement simple à mettre en œuvre et permet un positionnement précis de la caméra par le chirurgien sans que celui- ci n'ait à lâcher ses instruments 6 ou à interrompre son opération. De plus, la commande vocale ou sonore du déclenchement de la prise en compte des mouvements du chirurgien et la simplification des instructions transmises permettent de limiter les éléments dans la salle d'opération et de simplifier le travail du chirurgien en ce qui concerne le placement de la caméra, celui-ci pouvant alors se concentrer uniquement sur l'opération qu'il effectue.The device described above is particularly simple to implement and allows precise positioning of the camera by the surgeon without the latter having to drop his instruments 6 or to interrupt his operation. In addition, the voice or sound command triggering the taking into account of the movements of the surgeon and the simplification of the transmitted instructions can limit the elements in the operating room and simplify the work of the surgeon with respect to the placement of the surgeon. the camera, which can then focus only on the operation it performs.

Bien que la description ait été faite en relation avec le positionnement d'une caméra, on comprendra qu'elle peut s'appliquer à la commande du déplacement de tout type d'instrument chirurgical porté par un bras de support robotisé. Le dispositif de commande peut notamment servir à la commande du déplacement d'un dispositif imageur ou d'instruments de contention par exemple. L'ensemble constitué par les trocarts 8 portant des instruments chirurgicauxAlthough the description has been made in relation to the positioning of a camera, it will be understood that it can be applied to the control of the displacement of any type of surgical instrument carried by a robotic support arm. The control device can in particular be used to control the movement of an imaging device or of compression instruments for example. The assembly constituted by trocars 8 carrying surgical instruments

6 tenus par le chirurgien et l'instrument auxiliaire 14 porté par le bras de support 12 ainsi que le dispositif de commande décrit ci-dessus forme un système d'opération. 6 held by the surgeon and the auxiliary instrument 14 carried by the support arm 12 and the control device described above forms an operating system.

Claims

REVENDICATIONS 1.- Dispositif de commande du déplacement d'un instrument chirurgical, du type comprenant un bras de support (12) de l'instrument et au moins un capteur de mouvement (16), ledit bras (12) étant apte à se déplacer selon au moins un degré de liberté, ledit capteur de mouvement (16) étant destiné à être positionné sur l'opérateur (2) du dispositif de commande et étant agencé pour capter les mouvements dudit opérateur selon le degré de liberté du bras de support (12), ledit dispositif comprenant des moyens de traitement (20) des signaux émis par le capteur de mouvement (16), lesdits moyens (20) étant agencés pour traiter les signaux émis par le capteur de mouvement (16) et pour transmettre des signaux de commande correspondants au bras de support (12) de sorte que les mouvements captés par le capteur de mouvement (16) commandent des mouvements correspondants du bras de support (12), caractérisé en ce qu'il comprend en outre des moyens de déclenchement et d'arrêt de la détection des mouvements de l'opérateur par le capteur (16).1.- Device for controlling the movement of a surgical instrument, of the type comprising a support arm (12) of the instrument and at least one movement sensor (16), said arm (12) being able to move according to at least one degree of freedom, said motion sensor (16) being intended to be positioned on the operator (2) of the control device and being arranged to capture the movements of said operator according to the degree of freedom of the support arm (12). ), said device comprising means for processing (20) the signals emitted by the motion sensor (16), said means (20) being arranged to process the signals emitted by the motion sensor (16) and for transmitting signals of control corresponding to the support arm (12) so that the movements sensed by the motion sensor (16) control corresponding movements of the support arm (12), characterized in that it further comprises triggering means and stop e detection of the movements of the operator by the sensor (16). 2.- Dispositif de commande selon la revendication 1 , caractérisé en ce que le capteur de mouvement (16) est agencé pour capter les mouvements de l'opérateur dans un repère (x, y, z) dont le point d'origine est le point d'entrée d'un trocart (8) d'un instrument chirurgical (6), tenu par l'opérateur, dans le corps d'un patient.2. A control device according to claim 1, characterized in that the motion sensor (16) is arranged to capture the movements of the operator in a reference (x, y, z) whose point of origin is the entry point of a trocar (8) of a surgical instrument (6) held by the operator in the body of a patient. 3.- Dispositif de commande selon la revendication 1 ou 2, caractérisé en ce que les moyens de déclenchement et d'arrêt de la détection des mouvements de l'opérateur comprennent des moyens de commande vocale ou sonore (18), lesdits moyens (18) étant agencés pour déclencher la détection des mouvements de l'opérateur par le capteur (16) et le déplacement correspondant du bras de support (12) lorsque lesdits moyens de commande vocale ou sonore (18) reçoivent une première instruction vocale ou sonore prédéfinie et pour arrêter la détection des mouvements de l'opérateur et le déplacement correspondant du bras de support (12) lorsque lesdits moyens de commande vocale ou sonore reçoivent une deuxième instruction vocale ou sonore prédéfinie.3. Control device according to claim 1 or 2, characterized in that the means for triggering and stopping the detection of the movements of the operator comprise voice or sound control means (18), said means (18). ) being arranged to trigger the detection of the movements of the operator by the sensor (16) and the corresponding displacement of the support arm (12) when said voice or sound control means (18) receive a predefined first voice or sound instruction and to stop the detection of the movements of the operator and the corresponding displacement of the support arm (12) when said voice or sound control means receive a second predefined voice or sound instruction. 4.- Dispositif de commande selon l'une quelconque des revendications 1 à 3, caractérisé en ce que le bras de support (12) est apte à se déplacer selon quatre degrés de liberté, le capteur (16) étant agencé pour capter les mouvements de l'opérateur (2) selon au moins lesdits quatre degrés de liberté.4. A control device according to any one of claims 1 to 3, characterized in that the support arm (12) is able to move according to four degrees of freedom, the sensor (16) being arranged to capture the movements of the operator (2) according to at least said four degrees of freedom. 5.- Dispositif de commande selon la revendication 4, caractérisé en ce que le capteur (16) est un capteur électromagnétique à six degrés de liberté apte à détecter les mouvements selon trois axes de translation et selon trois axes de rotation.5.- control device according to claim 4, characterized in that the sensor (16) is an electromagnetic sensor with six degrees of freedom capable of detecting the movements along three axes of translation and along three axes of rotation. 6.- Dispositif de commande selon l'une quelconque des revendications 1 à6. Control device according to any one of claims 1 to 5, caractérisé en ce que les moyens de traitement (20) sont agencés pour transmettre des signaux de commande identiques aux signaux émis par le capteur (16), le bras de support (12) reproduisant à l'identique les mouvements captés par le capteur (16).5, characterized in that the processing means (20) are arranged to transmit identical control signals to the signals emitted by the sensor (16), the support arm (12) reproducing identically the movements picked up by the sensor (16). 7.- Dispositif de commande selon la revendication 6, caractérisé en ce que les moyens de traitement (20) sont en outre agencés pour transmettre des signaux de commande amplifiés, réduits ou inversés par rapport aux signaux émis par le capteur (16), le bras de commande (16) effectuant des mouvements d'une amplitude proportionnelle à l'amplitude des mouvements captés par le capteur (16) selon un rapport de proportionnalité prédéfini.7. A control device according to claim 6, characterized in that the processing means (20) are further arranged to transmit amplified control signals, reduced or inverted with respect to the signals emitted by the sensor (16), the control arm (16) performing movements of an amplitude proportional to the amplitude of the movements sensed by the sensor (16) according to a predefined proportionality ratio. 8.- Dispositif de commande selon la revendication 7, caractérisé en ce que la sélection entre la transmission de signaux de commande identiques et la transmission de signaux de commande amplifiés, réduits ou inversés se fait au moyen d'au moins une instruction vocale ou sonore prédéfinie.8. A control device according to claim 7, characterized in that the selection between the transmission of identical control signals and the transmission of amplified, reduced or inverted control signals is done by means of at least one voice or sound instruction. predefined. 9.- Dispositif de commande selon l'une quelconque des revendications 1 à 8, caractérisé en ce que le bras de support (12) se déplace à une vitesse identique à la vitesse des mouvements captés par le capteur (16) ou à une vitesse modulée par rapport auxdits mouvements.9. A control device according to any one of claims 1 to 8, characterized in that the support arm (12) moves at a speed identical to the speed of the movements sensed by the sensor (16) or at a speed modulated with respect to said movements. 10.- Dispositif de commande selon la revendication 9, caractérisé en ce que la sélection entre vitesse identique ou vitesse modulée se fait au moyen d'une commande vocale ou sonore prédéfinie.10. A control device according to claim 9, characterized in that the selection between identical speed or modulated speed is by means of a predefined voice or sound command. 11.- Dispositif de commande selon l'une quelconque des revendications 1 à 10, caractérisé en ce que les moyens de commande vocale ou sonore (18) comprennent un microphone (22) recevant les instructions vocales et un logiciel de reconnaissance vocale. 11. A control device according to any one of claims 1 to 10, characterized in that the voice or sound control means (18) comprises a microphone (22) receiving the voice instructions and voice recognition software. 12.- Dispositif de commande selon l'une quelconque des revendications 1 à12. Control device according to any one of claims 1 to 11 , caractérisé en ce qu'il comprend des moyens de fixation (19) du capteur (16) à une partie du corps de l'opérateur (2), notamment sur un poignet de l'opérateur (2), le capteur (16) étant agencé pour capter les mouvements de ladite partie du corps.11, characterized in that it comprises means (19) for fixing the sensor (16) to a part of the body of the operator (2), in particular on a wrist of the operator (2), the sensor (16) ) being arranged to capture the movements of said body part. 13.- Système d'opération chirurgical, comprenant au moins un trocart (8) d'un instrument chirurgical (6) destiné à être tenu par un opérateur et à être introduit dans le corps d'un patient et au moins un instrument chirurgical auxiliaire (14) porté par un bras de support (12), caractérisé en ce que ledit système comprend un dispositif de commande du déplacement de l'instrument chirurgical auxiliaire (14) selon l'une quelconque des revendications 1 à 13.13.- Surgical operation system, comprising at least one trocar (8) of a surgical instrument (6) to be held by an operator and to be introduced into the body of a patient and at least one auxiliary surgical instrument (14) carried by a support arm (12), characterized in that said system comprises a device for controlling the movement of the auxiliary surgical instrument (14) according to any one of claims 1 to 13. 14.- Système d'opération selon la revendication 13, caractérisé en ce que le trocart (8) comprend un point d'introduction, ledit point d'introduction étant destiné à être le point d'entrée dans le corps d'un patient du trocart (8), le capteur de mouvement (16) est agencé pour capter les mouvements de l'opérateur dans un repère (x, y, z) dont le point d'origine est le point d'introduction du trocart (8). 14. Operating system according to claim 13, characterized in that the trocar (8) comprises a point of introduction, said point of introduction being intended to be the point of entry into the body of a patient of the patient. trocar (8), the motion sensor (16) is arranged to capture the movements of the operator in a reference (x, y, z) whose point of origin is the point of introduction of the trocar (8).
EP09797073A 2008-11-28 2009-11-24 Device for controlling the movement of a surgical instrument Withdrawn EP2349054A1 (en)

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FR0858092A FR2939022B1 (en) 2008-11-28 2008-11-28 DEVICE FOR CONTROLLING THE DISPLACEMENT OF A SURGICAL INSTRUMENT.
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CA2744958A1 (en) 2010-06-03
FR2939022B1 (en) 2012-02-17

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