MULTIFUNCTIONAL CAMERA SYSTEM FOR VIDEO ASSISTED THORACIC SURGERY
1. A multifunctional camera system for video-assisted thoracic surgery comprising a bendable arm configured to be inserted into the thoracic cavity of a patient and camera head at a distal end of the bendable arm, wherein the camera head comprises a high defmition video camera and a light source, the camera head further comprising a view adjustment mechanism for changing a view angle of the camera without changing the position of the camera head, and a controller for controlling the view adjustment mechanism under command of a surgeon.
A multifunctional camera system having a bendable arm configured to be inserted into the thoracic cavity of a patient and camera head at a distal end of the bendable arm. The camera head has a high definition video camera and a light source. The camera head has a view adjustment mechanism for changing a view angle of the camera without changing the position of the camera head. A controller controls the view adjustment mechanism under command of a surgeon.
- 1. A multifunctional camera system for video-assisted thoracic surgery comprising a bendable arm configured to be inserted into the thoracic cavity of a patient and camera head at a distal end of the bendable arm, wherein the camera head comprises a high defmition video camera and a light source, the camera head further comprising a view adjustment mechanism for changing a view angle of the camera without changing the position of the camera head, and a controller for controlling the view adjustment mechanism under command of a surgeon.
- 20. A multifunctional camera system for video-assisted thoracic surgery comprising a bendable arm configured to be inserted into the thoracic cavity of a patient and camera head at a distal end of the bendable arm, wherein the camera head comprises a high definition video camera and a light source, the camera head further comprising view adjusting means for adjusting a view angle of the camera without changing the position of the camera head.
The application claims priority under 35 U.S.C. § 119 and all applicable statutes and treaties from prior U.S. provisional application Ser. No. 62/653,845, which was filed Apr. 6, 2018.
A field of the invention is surgical devices. The invention concerns a camera system for video assisted thoracic surgery.
Video-assisted thoracoscopic surgery (VATS) is a type of thoracic surgery performed with the assistance of a small video camera that is introduced into the patient'"'"'s chest, via one or more small incisions made specifically to introduce the camera or via a common opening through which surgical tools are also introduced. The camera allows the surgeon to view the instruments that are being used along with the anatomy on which the surgeon is operating. Most commonly, the camera and instruments are inserted through separate, 10 mm to 30 mm holes or “ports” in the chest wall. The small size of these ports corresponds with reduced prevalence of infection and wound dehiscence for VATS patients as compared to those subjected to thoracotomy, sternotomy, or other approaches that require large incisions to provide direct visual access to the surgeon. VATS patients thus enjoy shorter recovery times, reduced post-operative pain, and lower complication rates as compared to patients that undergo comparable non-VATS surgeries.
VATS came into widespread use beginning in the early 1990s. Operations that traditionally were carried out with thoracotomy or sternotomy that today can be performed with VATS include: biopsy for diagnosis of pulmonary, pleural or mediastinal pathology; decortication for empyema; pleurodesis for recurrent pleural effusions or spontaneous pneumothorax; surgical stapler assisted wedge resection of lung masses; resection of mediastinal or pleural masses; thoracic sympathectomy for hyperhidrosis; operations for diaphragmatic hernias or paralysis; esophageal resection or resection of esophageal masses or diverticula; and VATS lobectomy/mediastinal lymphadenectomy for lung cancer.
Similarly to laparoscopy, VATS has enjoyed widespread use for technically straightforward operations such as pulmonary decortication, pleurodesis, and lung or pleural biopsies. More technically demanding operations such as esophageal operations, mediastinal mass resections, or pulmonary lobectomy for early stage lung cancer are at present performed via VATS primarily at selected centers. It is expected, however, that the prevalence of advanced VATS techniques will continue to increase in response to patient demand and increased surgeon familiarity with the techniques.
Conventional camera systems for VATS typically include a camera-linked 5 mm or 10 mm fiber-optic scope and thoracic or laparoscopic instruments. Scopes commonly feature a 30-degree angle of visualization. Unlike with laparoscopy, carbon dioxide insufflation is not generally required with VATS due to the inherent vault-like shape of the thoracic cavity. However, lung deflation on the side of the chest where VATS is being performed is required to support visualization and allow for instruments to pass into the thorax. Lung deflation is usually accomplished with a double-lumen endo-tracheal tube that allows for single lung ventilation or a bronchial blocker delivered via a standard single-lumen endotracheal tube.
These conventional VATS camera systems feature long, rigid camera rods that are passed between a patient'"'"'s ribs. This design introduces a number of challenges to both the surgical team and the patient. First, it is often necessary to create one or more separate incisions to accommodate the camera, with the surgeon operating from a separate port. The incisions themselves cause some amount of postoperative pain to the patient. Even for uniportal approaches (wherein the scope is inserted through the same incision that the surgeon operates through), pain can be exacerbated by intracostal nerve damage caused by manipulation and re-insertion of the rigid scope against the patients'"'"' rib bones. This damage can cause post-operative neuralgia and even induce chronic pain in some patients.
From the surgical team'"'"'s perspective, conventional VATS scopes must be held and manually manipulated during the procedure. Even with such manipulation, it is often difficult to visualize the relevant structures due to the camera form factor. A camera at the end of a rigid rod may be sufficient for laparoscopic procedures that only require navigation around a patient'"'"'s soft tissues. However, such designs are deficient for thoracic surgeries that necessitate navigation around the patient'"'"'s ribs.
Conventional VATS are operated by a dedicated camera operator or an existing member of the surgical team. Dedicated operators add additional expense to the procedure, take up valuable room in the operating room, and often introduce additional barriers to the operational field itself, particularly for uniportal approaches that require both the camera operator and surgeon to work through the same small incision. Use of existing members of the surgical team as camera operators distracts them from their other duties in the operating room, and any camera operator may fail to manipulate the camera in a way that the surgeon prefers. Indeed, some surgeons prefer to operate their own cameras with one hand while performing surgery with the other.
A state-of-the art surgical robot with a camera is the da Vinci® surgical system. This system includes a tubular camera that is mounted to a robotic arm. Such a camera is poorly suited for thoracic surgery because of the limited space between the ribs with the cameras tubular shape. Current laparoscopic and robotic instrumentation designed for abdominal surgery is based on a circular port system, even for newer uniportal platforms. This is because there is no specific limitation in any particular direction when inserting ports into the abdomen. The circular or tubular design allows for the most efficient space for instrument insertion. In contrast, the spaces between the ribs, the intercostal spaces, are limited and vary widely based on the patients'"'"' body habitus. The intercostal space may range from approximately 5 mm up to 20 mm in width. A circular or tubular port will be restricted by the width of the intercostal space while the length of the intercostal space could better accommodate ports with more oblong shape or systems that provide a flat interface as the instruments or cameras enter between the ribs. The da Vinci® surgical system is therefore most often employed for other surgeries, including surgeries of the abdomen and pelvis.
A preferred embodiment is a multifunctional camera system for video-assisted thoracic surgery having a bendable arm configured to be inserted into the thoracic cavity of a patient and camera head at a distal end of the bendable arm. The camera head has a high definition video camera and a light source. The camera head has a view adjustment mechanism for changing a view angle of the camera without changing the position of the camera head. A controller controls the view adjustment mechanism under command of a surgeon.
A preferred embodiment is multifunctional camera system having a bendable arm configured to be inserted into the thoracic cavity of a patient and camera head at a distal end of the bendable arm. The camera head has a high definition video camera and a light source. The camera head has a view adjustment mechanism for changing a view angle of the camera without changing the position of the camera head. A controller controls the view adjustment mechanism under command of a surgeon. The controller can respond, for example, to voice-controlled activation. Preferably, the profile of the camera head is 20 millimeters or less, and preferably 10 millimeters or less.
The view adjustment mechanism can include a first substrate separated from a second substrate and an actuator that adjusts a relative angle between the first and second substrate. The first substrate can be a circuit board with the camera and the light source mounted thereupon. The actuator can be a spring between the first and second substrate and a plurality of tension cables connected to the first substrate. A conical spring can be centrally positioned between the first and second substrates. A plurality of springs can be positioned between corner portions of the first and second substrates. The tension cables can be routed through the second substrate and through the springs and through or along the flexible arm to a plurality of motors controlled by the controller. The motors can be stepper motors with spools or linear actuators. The view adjustment mechanism can also include a rotatable mount hub for rotating a plane of the camera head about a central axis.
The bendable arm is adjustable to a predetermined position by a surgeon and then retains that predetermined position to permit the surgeon to position the camera head flush with pleura or inner thoracic wall. The arm can include flexible rebar. A stabilizer can connect a portion of the flexible arm to the patient or another device.
The actuator can also be a pneumatic actuator between the first and second substrate. The pneumatic actuator can include pneumatic balloons, and system pneumatic lines routed through or along the flexible arm to a plurality of pneumatic pumps. With a plurality of balloons, each balloon can be positioned between separate quadrants of the first and second substrates.
Preferred systems of the invention provide improved visualization of the surgical field for surgeons performing VATS. Preferred systems can be patient-mounted, and provide hands-free view adjustment, which eliminates the need for a dedicated camera operator in surgery, reducing personnel cost and allowing the surgeon greater freedom of movement due to the lack of a camera operator near the incision. Hands-free operation can be achieved, for example, via voice activation (available by using commercial voice recognition software) could be one mechanism (i.e., the surgeon saying “left”, “right”, “up”, or “down”). A foot pedal is another method of hands-free control. Automatic tracking is another option, where the camera view tracks the surgical instrument. Furthermore, the bendable arm used to secure the camera within the thoracic cavity reduces or eliminates potential intercostal nerve damage caused by pressure applied to rib bones while maneuvering conventional VATS cameras within the patient. This nerve damage can increase post-operative pain and cause chronic pain in some patients.
A preferred multifunctional camera system for video-assisted thoracic surgery features at least one small, high-definition video camera mounted on a flexible and adjustable arm. The arm is structured and configured to introduce the video camera into a surgical patient'"'"'s thoracic cavity and place the camera against the patient'"'"'s inner thoracic wall. The camera system also features at least one light source mounted adjacent to the video camera to illuminate the surgeon'"'"'s field of view. At least one actuator allows the camera to roll, pan, and/or tilt so as to adjust the camera'"'"'s field of view within the surgical field. A controller located outside the thoracic cavity is in electrical communication with the actuator. An optional camera cleaning mechanism allows blood or other materials that may obscure the camera view to be removed in-situ.
Preferred embodiments of the invention will now be discussed with respect to the drawings and experiments used to demonstrate the invention. The drawings may include schematic representations, which will be understood by artisans in view of the general knowledge in the art and the description that follows. Features may be exaggerated in the drawings for emphasis, and features may not be to scale.
Introduction and Positioning of Camera System in Thoracic Cavity
The camera head 102 is preferably low-profile and is positioned flush against the pleura or inner thoracic wall (105 in
In a preferred embodiment, the arm 104 comprises flexible rebar that may be bent or molded prior to insertion. Such bending or molding allows the camera head'"'"'s 102 position to be customized to accommodate variables such as patient physique, incision 100 location and size, surgical target, surgeon preference, etc.
The surgical stabilizing device may be circular, oblong, or some other shape. Tension cabling 124 within or along the arm 104 can adjust the view the camera 103 while the camera head 102 remains flush against the inner thoracic wall. The tension cabling 124 adjusts portions of the camera head 102 to adjust the view of the camera 103. The arm 104 remains in a fixed position and a portion of the camera head 102 remains positioned against the thoracic wall 105, while the camera view is adjusted. The tension cabling 124 adjusts movable portions of the camera head 102. Springs 128 can change the angle of the camera head 102 and are controlled by an external motor or linear actuator. A cleaning mechanism 130 can be realized by a movable film across a lens of the camera 103 and serves to keep the lens free of debris such as blood during surgery. Once moved into the position flush on the thoracic wall, the camera head 102 is held in place by the friction and normal forces exerted on the arm 104 by the surgical stabilizing device and the patient'"'"'s body adjacent to the incision 100. In this position, the tilt of the camera head can be changed by adjusting springs 128.
The view of the camera(s) 210 can be adjusted, preferably in multiple ways such that a surgeon can control the view without needing to reposition the arm 104. View adjustments can include translation of the entire camera head 102 so as to shift the camera view laterally or tilting and rolling of the camera portions 200 or its constituent high-definition video camera(s) 210. Any or all of these view adjustments can be implemented separately or together. A preferred embodiment includes all of the view adjustments. The view adjustment portion of the system can be very low profile. The substrates, mechanical portions, and actuators are preferably 10 cm or less in profile, which limits trauma during introduction and minimally obstruct the incision space and occupy a minimal portion of the thoracic cavity during surgery.
The cable sheaths 226 are affixed to the underside of the mounting plate/lower substrate 220b, with the tension cables 224 running through the sheaths 226, as in a Bowden cable. The sheath 226 from each spring 222 and cable 224, along with the power and signaling for the camera and lighting are routed along the mounting arm 104, such as inside a sheath that covers the arm 104 or inside the arm itself The tension cables 224 are attached to the computer-controlled stepper motors 204, which individually adjust the amount of tension in each of the four springs 222. This changes the view of the camera 210 via tilt about the z-x plane (left-right on the displayed image) or z-y plane (up-down on the displayed image) with the z-axis normal to the center of the camera lens. Linear actuators can be used instead of the spools 206. Changing the tension of individual ones of the springs 222 causes compression or decompression to cause the camera 210 to tilt about the z-axis normal to the center of the camera lens in the z-x plane (left-right) or z-y plane (up-down). The springs 224 can be compressed by pulling the tension cables tight, preferably the default state as provides the thinnest profile for the camera head during insertion. The external motors 204 can then selectively release the tension for any of the four springs 222 to move adjust the camera view by changing the angle of the top substrate 220a.
In the following example view adjustments, “right” and “left” can be assigned arbitrarily but are opposite to each other, and are adjacent to “up” and “down”. Looking furthest to the left would have two cables on left side maximally tight and the two on the right side minimally tight. A maximum right adjustment is achieved by tightening the right springs by pulling the cable while releasing tension on the left springs. Positions between maximum and minimum tensions provide steps between maximum left and maximum right view. Similarly, adjusting tension in springs on up and down sides adjusts the view up and down. Adjusting tension in opposite corners provides a combination of view adjustment, e.g., up and left.
For a rotational adjustment, as shown in
Other view adjustment mechanisms can feature pneumatic actuation, as opposed to tension cable manipulation, to effect adjustment of the camera view.
The camera head 102 as shown in
The balloon actuators 700 can be selected from a variety of cross-sections.
Another type of actuator that can be used is a piezoelectric actuators. Such actuators also can adjust the view angle in place of springs or pneumatic balloons and can be triggered to adjust the camera viewing angle merely via electrical signals.
The camera systems of the invention may be controlled by the surgeon or an assistant manually, using voice control, or using eye tracking capabilities. Microsoft® has a speech API built in to Windows® and Dragon Naturally Speaking® are examples for speech recognition programs to convert speech comments to control. Stryker has a voice control package (SDC3) for medical equipment. Open source solutions include the Carnegie Mellon Sphinx library, and the Kaldi library. Alternatively, camera system control may be automated by, for example, causing the camera(s) to track surgical tools introduced to the thoracic cavity. Google Glass, the Microsoft Hololens, and products like the Tobii can be leveraged. Manual control may be achieved by a joystick, a remote with physical buttons, a mobile application for a touch-screen device, control mechanisms built into the surgical tools, or some other means. In a preferred embodiment, the camera system features automated control with a manual override.
Preferred embodiments feature hardwired connections between the camera head 102 components and power supplies, processors, and controllers. Other preferred embodiments feature modified camera heads 102 that have: a first portion that is introduced into the thoracic cavity comprised of one or more high-definition video cameras, one or more light sources, an optional mounting apparatus 308, any necessary actuators 300, and a cleaning apparatus; and a second portion that is in physical and electrical communication with the first portion but is not introduced to the thoracic cavity comprised of signal transmission hardware and a power source.
Cleaning of Camera Lens
Over the course of a VATS procedure, the camera portion 200 typically will become at least partially obscured with blood or other bodily fluids.
Another cleaning mechanism shown in
In preferred embodiments, the camera system features a disposable camera head 102 and an adjustable arm 104 that is either disposable or can be sterilized. Most or all camera system components that are not introduced to the thoracic cavity may be sterilized and used for multiple procedures. In other embodiments, the camera head is encased in a water- and steam-proof layer that allows for sterilization and re-use of the camera head 102.
While specific embodiments of the present invention have been shown and described, it should be understood that other modifications, substitutions and alternatives are apparent to one of ordinary skill in the art. Such modifications, substitutions and alternatives can be made without departing from the spirit and scope of the invention, which should be determined from the appended claims.
Various features of the invention are set forth in the appended claims.