CN113226148A - 成像数据的整合 - Google Patents

成像数据的整合 Download PDF

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Publication number
CN113226148A
CN113226148A CN201980060412.5A CN201980060412A CN113226148A CN 113226148 A CN113226148 A CN 113226148A CN 201980060412 A CN201980060412 A CN 201980060412A CN 113226148 A CN113226148 A CN 113226148A
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CN
China
Prior art keywords
imaging data
anatomical structure
surgical visualization
surgical
visualization system
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.)
Pending
Application number
CN201980060412.5A
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English (en)
Inventor
C·J·谢伊布
P·G·里特奇
S·A·穆尔
J·S·斯韦兹
J·D·塔尔伯特
J·D·扬
V·C·莫雷诺
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Ethicon LLC
Original Assignee
Ethicon LLC
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Publication date
Application filed by Ethicon LLC filed Critical Ethicon LLC
Publication of CN113226148A publication Critical patent/CN113226148A/zh
Pending legal-status Critical Current

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Abstract

本发明公开了一种外科可视化***(4000,4006)。外科可视化***被配置成能够识别一个或多个结构(4001a,4001b)以及/或者确定相对于遮蔽组织和/或所识别的结构的一个或多个距离。外科可视化***可有利于外科装置避开所识别的结构。外科可视化***(4006)可包括被配置成能够发射多个组织穿透光波的第一发射器以及被配置成能够将结构化光(4008)发射到组织(4003)的表面(4005)上的第二发射器。外科可视化***还可包括被配置成能够检测反射的可见光、组织穿透光和/或结构化光的图像传感器。外科可视化***可向一个或多个临床医生传达关于一个或多个隐藏识别结构(4001a,400b)的方位的信息以及/或者提供一个或多个接近度指示标识。在各种情况下，可对来自不同源和/或在不同时间获得的成像数据进行整合。

Description

成像数据的整合
相关申请的交叉引用
此申请根据35U.S.C.§119(e)要求2018年7月16日提交的名称为“DIGITALSURGERY IMAGING/VISUALIZATION SYSTEM”的美国临时专利申请序列号62/698,625的优先权的权益，该临时专利申请的公开内容全文以引用方式并入本文。
背景技术
外科***通常结合有成像***，该成像***可允许临床医生例如在一个或多个显示器(诸如监视器)上观看外科部位和/或其一个或多个部分。显示器可以是手术室本地的和/或远程的。成像***可包括具有相机的观察镜，该观察镜观看外科部位并将视图传输到临床医生可观看的显示器。观察镜包括但不限于关节镜、血管镜、支气管镜、胆道镜、结肠镜、膀胱镜、十二指肠镜、肠镜、食管胃-十二指肠镜(胃镜)、内窥镜、喉镜、鼻咽-肾镜、乙状结肠镜、胸腔镜、输尿管镜和外镜。成像***可受到它们能够识别和/或传达给临床医生的信息的限制。例如，某些成像***可能无法在术中识别三维空间内的某些隐蔽结构、物理轮廓和/或尺寸。另外，某些成像***可能无法在术中将某些信息传送和/或传达给临床医生。
发明内容
外科可视化***可包括控制电路，该控制电路被配置成能够从第一源接收指示解剖结构和解剖结构内的嵌入结构的第一成像数据；从第二源接收指示解剖结构的第二成像数据；根据第二成像数据生成解剖结构的三维数字表示；将指示解剖结构的第一成像数据与三维数字表示匹配；以及将指示嵌入结构的第一成像数据与三维数字表示配准。
一种外科可视化***可包括：结构化光源，该结构化光源被配置成能够将结构化光图案发射在解剖结构上；图像传感器，该图像传感器被配置成能够检测解剖结构上的结构化光图案；以及控制电路，该控制电路被配置成能够：从第一源接收指示解剖结构和解剖结构内的嵌入结构的第一成像数据；从图像传感器接收指示解剖结构的第二成像数据；根据第二成像数据生成解剖结构的三维数字表示；以及将第一成像数据和第二成像数据进行整合。
一种非暂态计算机可读介质可以存储计算机可读指令，该计算机可读指令在被执行时致使机器：从第一源接收指示解剖结构和解剖结构内的嵌入结构的第一成像数据；从第二源接收指示解剖结构的第二成像数据；根据第二成像数据生成解剖结构的三维数字表示；将指示解剖结构的第一成像数据与三维数字表示匹配；将指示嵌入结构的第一成像数据与三维数字表示配准；从第二源接收指示解剖结构的更新的成像数据；根据更新的成像数据更新解剖结构的三维数字表示；以及提供配准的嵌入结构在解剖结构的三维数字表示上的更新的方位。
附图说明
各种方面的新型特征在随附权利要求书中具体阐述。然而，关于组织和操作方法两者的所述方面可通过结合附图参照以下描述最好地理解，其中：
图1是根据本公开的至少一个方面的包括成像装置和外科装置的外科可视化***的示意图，该外科可视化***被配置成能够识别组织表面下方的关键结构。
图2是根据本公开的至少一个方面的用于外科可视化***的控制***的示意图。
图2A示出了根据本公开的至少一个方面的被配置成能够控制外科可视化***的各方面的控制电路。
图2B示出了根据本公开的至少一个方面的被配置成能够控制外科可视化***的各方面的组合逻辑电路。
图2C示出了根据本公开的至少一个方面的被配置成能够控制外科可视化***的各方面的时序逻辑电路。
图3是根据本公开的至少一个方面的描绘在图1的外科装置、成像装置与关键结构之间进行三角测量以确定关键结构在组织表面下方的深度dA的示意图。
图4是根据本公开的至少一个方面的被配置成能够识别组织表面下方的关键结构的外科可视化***的示意图，其中该外科可视化***包括用于确定关键结构在组织表面下方的深度dA的脉冲光源。
图5是根据本公开的至少一个方面的包括成像装置和外科装置的外科可视化***的示意图，该外科可视化***被配置成能够识别组织表面下方的关键结构。
图6是根据本公开的至少一个方面的包括三维相机的外科可视化***的示意图，其中该外科可视化***被配置成能够识别嵌入组织内的关键结构。
图7A和图7B是根据本公开的至少一个方面的由图6的三维相机拍摄的关键结构的视图，其中图7A是来自三维相机的左侧透镜的视图，并且图7B是来自三维相机的右侧透镜的视图。
图8是根据本公开的至少一个方面的图6的外科可视化***的示意图，其中可确定从三维相机到关键结构的相机-关键结构距离dw。
图9是根据本公开的至少一个方面的利用两个相机来确定嵌入关键结构的方位的外科可视化***的示意图。
图10A是根据本公开的至少一个方面的利用相机的外科可视化***的示意图，该相机在多个已知方位之间轴向移动以确定嵌入关键结构的方位。
图10B是根据本公开的至少一个方面的图10A的外科可视化***的示意图，其中相机在多个已知方位之间轴向且旋转移动以确定嵌入关键结构的方位。
图11是根据本公开的至少一个方面的用于外科可视化***的控制***的示意图。
图12是根据本公开的至少一个方面的用于外科可视化***的结构化光源的示意图。
图13是根据本公开的至少一个方面的用于对陆地特征或物体进行成像的高光谱可视化***的示意图。
图14是根据本公开的至少一个方面的各种陆地特征或物体的高光谱特征的图形表示。
图15A至图15C示出了根据本公开的至少一个方面的用于对煎蛋进行成像的高光谱可视化***的示例，其中图15A是煎蛋的照片，图15B是煎蛋的蛋黄部分和蛋白部分的高光谱特征的图形表示，并且图15C是煎蛋的高光谱图像(以黑白示出)，其中增强图像基于高光谱特征数据来区分蛋黄部分和蛋白部分。
图16至图18描绘了根据本公开的至少一个方面的用于区分解剖结构与遮蔽物的例示性高光谱识别特征，其中图16是输尿管特征与遮蔽物的图形表示，图17是动脉特征与遮蔽物的图形表示，并且图18是神经特征与遮蔽物的图形表示。
图19是根据本公开的至少一个方面的被配置成能够感测关键解剖结构的距离的近红外(NIR)飞行时间测量***的示意图，该飞行时间测量***包括定位在公共装置上的传输器(发射器)和接收器(传感器)。
图20是根据本公开的至少一个方面的图19的NIR飞行时间测量***的发射波、接收波以及发射波与接收波之间的延迟的示意图。
图21示出了根据本公开的一个方面的被配置成能够感测不同结构的距离的NIR飞行时间测量***，该飞行时间测量***包括单独装置上的传输器(发射器)和接收器(传感器)。
图22是根据本公开的至少一个方面的来自术前图像的肺的示意图，其中肺处于充胀状态并且标识肺内的结构。
图23是根据本公开的至少一个方面的来自术中图像的图22的肺的示意图，其中肺处于泄放状态并且结构处于更新的方位，其中虚线指示肺在充胀状态下的方位以用于比较目的。
图24是根据本公开的至少一个方面的用于对图22的肺进行成像的可视化***的示意图，其中肺处于充胀状态并且来自术前图像的结构被配准。
图25是根据本公开的至少一个方面的图24的可视化***和肺的示意图，其中肺处于泄放状态并且配准结构处于更新的方位，并且其中虚线指示肺在充胀状态下的方位以用于比较目的。
图26是根据本公开的至少一个方面的用于整合来自多个源的成像数据的流程图。
具体实施方式
本申请的申请人还拥有2018年9月11日提交的以下美国专利申请，这些专利申请中的每一项全文以引用方式并入本文：
·名称为“SURGICAL VISUALIZATION PLATFORM”的美国专利申请16/128,179，代理人案卷号为END8605USNP/180230；
·名称为“SURGICAL VISUALIZATION CONTROLS”的美国专利申请16/128,191，代理人案卷号为END8605USNP1/180230-1；
·名称为“CONTROLLING AN EMITTER ASSEMBLY PULSE SEQUENCE”的美国专利申请16/128,180，代理人案卷号为END8606USNP/180231；
·名称为“COMBINATION EMITTER AND CAMERA ASSEMBLY”的美国专利申请16/128,198，代理人案卷号为END8606USNP1/180231-1；
·名称为“SINGULAR EMR SOURCE WITH DUAL OUTPUT EMITTER ASSEMBLY”的美国专利申请16/128,207，代理人案卷号为END8606USNP2/180231-2；
·名称为“SURGICAL VISUALIZATION WITH PROXIMITY TRACKING FEATURES”的美国专利申请16/128,176，代理人案卷号为END8607USNP/180232；
·名称为“SURGICAL VISUALIZATION OF MULTIPLE TARGETS”的美国专利申请16/128,187，代理人案卷号为END8607USNP1/180232-1；
·名称为“VISUALIZATION OF SURGICAL DEVICES”的美国专利申请16/128,192，代理人案卷号为END8607USNP2/180232-2；
·名称为“OPERATIVE COMMUNICATION OF LIGHT”的美国专利申请16/128,163，代理人案卷号为END8608USNP/180233；
·名称为“ROBOTIC LIGHT PROJECTION TOOLS”的美国专利申请16/128,197，代理人案卷号为END8609USNP/180234；
·名称为“SURGICAL VISUALIZATION FEEDBACK SYSTEM”的美国专利申请16/128,164，代理人案卷号为END8610USNP/180235；
·名称为“SURGICAL VISUALIZATION AND MONITORING”的美国专利申请16/128,193，代理人案卷号为END8611USNP/180236；
·名称为“ROBOTICALLY-ASSISTED SURGICAL SUTURING SYSTEMS”的美国专利申请16/128,170，代理人案卷号为END8613USNP/180238；
·名称为“SAFETY LOGIC FOR SURGICAL SUTURING SYSTEMS”的美国专利申请16/128,183，代理人案卷号为END8613USNP1/180238-1；
·名称为“ROBOTIC SYSTEM WITH SEPARATE PHOTOACOUSTIC RECEIVER”的美国专利申请16/128,172，代理人案卷号为END8614USNP/180239；以及
·名称为“FORCE SENSOR THROUGH STRUCTURED LIGHT DEFLECTION”的美国专利申请16/128,185，代理人案卷号为END8615USNP/180240。
本申请的申请人还拥有2015年7月7日公布的名称为“SURGICAL STAPLINGINSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS”的美国专利9,072,535，该专利全文以引用方式并入本文。
本申请的申请人还拥有2017年12月28日提交的名称为“ROBOT ASSISTEDSURGICAL PLATFORM”的美国临时专利申请62/611,339，该专利申请全文以引用方式并入本文。
本申请的申请人还拥有2018年3月29日提交的以下美国专利申请，这些专利申请中的每一项全文以引用方式并入本文：
·名称为“DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”的美国专利申请15/940,627；
·名称为“AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICALPLATFORMS”的美国专利申请15/940,676；
·名称为“SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”的美国专利申请15/940,711；以及
·2018年3月29日提交的名称为“CHARACTERIZATION OF TISSUE IRREGULARITIESTHROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY”的美国专利申请15/940,722，该专利申请全文以引用方式并入本文。
在详细说明外科可视化平台的各个方面之前，应当指出，例示性示例在应用或使用上不限于附图和说明书中所示出的部件的构造和布置的细节。例示性示例可在其他方面、变型和修改中实现或并入，并且可以各种方式实践或执行。此外，除非另外指明，否则本文所用的术语和表达是为了方便读者而对例示性示例进行描述而所选的，并非为了限制性的目的。而且，应当理解，以下描述的方面、方面的表达和/或示例中的一者或多者可与其他以下描述的方面、方面的表达和/或示例中的任何一者或多者组合。
本公开涉及一种外科可视化平台，该外科可视化平台利用“数字外科手术”来获得关于患者的解剖结构和/或外科手术的附加信息。该外科可视化平台被进一步配置成能够以有帮助的方式将数据和/或信息传达给一个或多个临床医生。例如，本公开的各个方面提供了患者的解剖结构和/或外科手术的改善的可视化。
“数字外科手术”可涵盖机器人***、高级成像、高级仪器、人工智能、机器学***台可与机器人外科***结合使用，但是外科可视化平台不限于与机器人外科***一起使用。在某些情况下，高级外科可视化可在没有机器人以及/或者具有有限的和/或任选的机器人辅助的情况下进行。类似地，数字外科可在没有机器人以及/或者具有有限的和/或任选的机器人辅助的情况下进行。
在某些情况下，结合有外科可视化平台的外科***可实现智能解剖以便识别和避开关键结构。关键结构包括解剖结构诸如输尿管、动脉诸如肠系膜上动脉、静脉诸如门静脉、神经诸如膈神经和/或肿瘤等解剖结构。在其他情况下，关键结构可以是例如解剖场中的外来结构，诸如外科装置、外科紧固件、夹具、大头钉、探条、带和/或板。关键结构可基于不同患者和/或不同手术来确定。本文还描述了示例性关键结构。例如，智能解剖技术可提供用于解剖的改善的术中指导，并且/或者可利用关键解剖结构检测和避开技术来实现智能决策。
结合有外科可视化平台的外科***还可实现智能吻合技术，该智能吻合技术利用改善的工作流程在最佳位置处提供更一致的吻合。也可利用本文所述的各种外科可视化平台和手术来改善癌症定位技术。例如，癌症定位技术可识别和跟踪癌症位置、取向及其边界。在某些情况下，癌症定位技术可在外科手术期间补偿工具、患者和/或患者的解剖结构的移动，以便为临床医生提供回到感兴趣的点的指导。
在本公开的某些方面，外科可视化平台可提供改善的组织表征和/或***诊断和标测。例如，组织表征技术可在不需要物理触觉的情况下表征组织类型和健康，特别是当在组织内解剖和/或放置缝合装置时。本文所述的某些组织表征技术可在没有电离辐射和/或造影剂的情况下使用。关于***诊断和标测，外科可视化平台可在术前定位、标测和理想地诊断涉及例如癌性诊断和分期的淋巴***和/或***。
这些和其他相关主题在本文和/或前述同时提交的美国专利申请中有所描述，这些专利申请全文以引用方式并入本文。
在外科手术期间，临床医生可经由“肉眼”和/或成像***获得的信息可提供外科部位的不完整视图。例如，某些结构(诸如嵌入或掩埋在器官内的结构)可至少部分地被隐蔽或隐藏起来使其不被看见。另外，某些尺寸和/或相对距离可能难以利用现有的传感器***探知和/或难以让“肉眼”感知。此外，某些结构可在术前(例如，在外科手术之前但在术前扫描之后)和/或术中移动。在此类情况下，临床医生可能无法在术中准确地确定关键结构的位置。
当关键结构的方位不确定时和/或当关键结构与外科工具之间的接近度未知时，临床医生的决策过程可能受到阻碍。例如，临床医生可避开某些区域，以便避免意外解剖关键结构；然而，所避开的区域可能不必要地较大和/或至少部分地错位。由于不确定性和/或过于/过度谨慎操作，临床医生可能无法进入某些期望的区域。例如，过度谨慎可能导致临床医生留下肿瘤和/或其他不期望的组织的一部分，以企图避开关键结构，即使关键结构不在该特定区域中和/或不会受到在该特定区域中工作的临床医生的负面影响。在某些情况下，可通过增加知识和/或确定性来改善外科结果，这可使得外科医生在特定解剖区域方面更加准确，并且在某些情况下，使得外科医生不那么保守/更有进取性。
在各个方面，本公开提供了用于术中识别和避开关键结构的外科可视化***。在一个方面，本公开提供了一种外科可视化***，该外科可视化***实现了加强的术中决策和改善的外科结果。在各个方面，所公开的外科可视化***提供了高级可视化能力，超出临床医生用“肉眼”所见的内容以及/或者超出成像***可识别和/或传达给临床医生的内容。各种外科可视化***可增强和加强临床医生在组织治疗(例如，解剖)之前能够知道的内容，并且因此可在各种情况下改善结果。
例如，可视化***可包括被配置成能够发射多个光谱波的第一光发射器、被配置成能够发射光图案的第二光发射器以及被配置成能够检测可见光、对光谱波的分子响应(光谱成像)和/或光图案的一个或多个接收器或传感器。外科可视化***还可包括成像***以及与接收器和成像***信号通信的控制电路。基于来自接收器的输出，控制电路可确定外科部位处可见表面的几何表面标测图(即三维表面形貌)以及相对于外科部位的一个或多个距离。在某些情况下，控制电路可确定到至少部分隐蔽的结构的一个或多个距离。此外，成像***可将几何表面标测图和一个或多个距离传达给临床医生。在此类情况下，提供给临床医生的外科部位的增强视图可提供外科部位的相关环境内的隐蔽结构的表示。例如，成像***可在隐蔽和/或阻挡组织的几何表面标测图上虚拟地增强隐蔽结构，类似于在地面上绘制的线以指示表面下方的实用线。另外或另选地，成像***可传达一个或多个外科工具与可见的阻挡组织和/或与至少部分隐蔽的结构的接近度以及/或者隐蔽结构在阻挡组织的可见表面下方的深度。例如，可视化***可确定相对于可见组织的表面上的增强线的距离，并且将该距离传达到成像***。
在本公开的各个方面，公开了用于术中识别和避开关键结构的外科可视化***。此类外科可视化***可在外科手术期间向临床医生提供有价值的信息。因此，例如，临床医生知道外科可视化***正在跟踪例如可在解剖期间接近的关键结构(诸如输尿管、特定神经和/或关键血管)，可在整个外科手术过程中确信地保持动力。在一个方面，外科可视化***可在足够长的时间内向临床医生提供指示，以使临床医生暂停和/或减慢外科手术并且评估与关键结构的接近度，以防止对其造成意外损坏。外科可视化***可向临床医生提供理想的、优化的和/或可定制的信息量，以允许临床医生确信地和/或快速地移动穿过组织，同时避免对健康组织和/或关键结构造成意外损坏，并且因此最小化由外科手术引起的伤害风险。
图1是根据本公开的至少一个方面的外科可视化***100的示意图。外科可视化***100可在解剖场内创建关键结构101的视觉表示。外科可视化***100可用于例如临床分析和/或医疗干预。在某些情况下，外科可视化***100可在术中使用，以在外科手术期间向临床医生提供关于接近度数据、尺寸和/或距离的实时或接近实时的信息。外科可视化***100被配置用于在术中识别关键结构和/或有利于外科装置避开关键结构101。例如，通过识别关键结构101，临床医生可避免在外科手术期间在关键结构101和/或关键结构101的预定接近度中的区域周围操纵外科装置。例如，临床医生可避免对例如被识别为关键结构101的静脉、动脉、神经和/或血管进行解剖和/或避免在这些关键结构附近进行解剖。在各种情况下，关键结构101可基于不同患者和/或不同手术来确定。
外科可视化***100结合距离传感器***104结合有组织识别和几何表面标测。结合起来，外科可视化***100的这些特征可确定关键结构101在解剖场内的方位以及/或者外科装置102与可见组织的表面105和/或与关键结构101的接近度。此外，外科可视化***100包括成像***，该成像***包括例如被配置成能够提供外科部位的实时视图的成像装置120，诸如相机。在各种情况下，成像装置120是光谱相机(例如，高光谱相机、多光谱相机或选择性光谱相机)，该光谱相机被配置成能够检测反射的光谱波形并且基于对不同波长的分子响应来生成图像的光谱立方体。来自成像装置120的视图可被提供给临床医生，并且在本公开的各个方面，可基于组织识别、地形标测和距离传感器***104用附加信息来增强这些视图。在此类情况下，外科可视化***100包括多个子***，即成像子***、表面标测子***、组织识别子***和/或距离确定子***。这些子***可配合以在术中向临床医生提供高级数据合成和集成信息。
成像装置可包括相机或成像传感器，该相机或成像传感器被配置成能够检测例如可见光、光谱光波(可见光或不可见光)和结构化光图案(可见光或不可见光)。在本公开的各个方面，成像***可包括例如成像装置，诸如内窥镜。另外或另选地，成像***可包括例如成像装置，诸如关节镜、血管镜、支气管镜、胆道镜、结肠镜、膀胱镜、十二指肠镜、肠镜、食管胃-十二指肠镜(胃镜)、喉镜、鼻咽-肾镜、乙状结肠镜、胸腔镜、输尿管镜或外镜。在其他情况下，诸如在开放外科手术应用中，成像***可不包括观察镜。
在本公开的各个方面，组织识别子***可用光谱成像***来实现。光谱成像***可依赖于例如高光谱成像、多光谱成像或选择性光谱成像。组织的高光谱成像进一步在2016年3月1日公布的名称为“SYSTEM AND METHOD FOR GROSS ANATOMIC PATHOLOGY USINGHYPERSPECTRAL IMAGING”的美国专利9,274,047中描述，该专利全文以引用方式并入本文。
在本公开的各个方面，表面标测子***可用光图案***来实现，如本文进一步所述。光图案(或结构化光)用于表面标测是已知的。已知的表面标测技术可用于本文所述的外科可视化***中。
结构化光是将已知图案(通常为网格或水平条)投射到表面上的过程。2017年3月2日公布的名称为“SET COMPRISING A SURGICAL INSTRUMENT”的美国专利申请公布2017/0055819以及2017年9月7日公布的名称为“DEPICTION SYSTEM”的美国专利申请公布2017/0251900公开了一种外科***，该外科***包括光源以及用于投射光图案的投射仪。2017年3月2日公布的名称为“SET COMPRISING A SURGICAL INSTRUMENT”的美国专利申请公布2017/0055819以及2017年9月7日公布的名称为“DEPICTION SYSTEM”的美国专利申请公布2017/0251900全文以引用方式并入本文。
在本公开的各个方面，距离确定***可结合到表面标测***中。例如，可利用结构化光来生成可见表面的三维虚拟模型并且确定相对于可见表面的各种距离。另外或另选地，距离确定***可依赖于飞行时间测量来确定到外科部位处所识别的组织(或其他结构)的一个或多个距离。
图2是可与外科可视化***100一起使用的控制***133的示意图。控制***133包括与存储器134信号通信的控制电路132。存储器134存储可由控制电路132执行的指令，以确定和/或识别关键结构(例如，图1中的关键结构101)，确定和/或计算一个或多个距离和/或三维数字表示，并将某些信息传送给一个或多个临床医生。例如，存储器134存储表面标测逻辑部件136、成像逻辑部件138、组织识别逻辑部件140或距离确定逻辑部件141或者逻辑部件136、138、140和141的任何组合。控制***133还包括成像***142，该成像***具有一个或多个相机144(如图1中的成像装置120)、一个或多个显示器146或者一个或多个控件148或者这些元件的任何组合。相机144可包括一个或多个图像传感器135，以接收来自发射各种可见光谱和不可见光谱下的光的各种光源(例如，可见光、光谱成像器、三维透镜等)的信号。显示器146可包括一个或多个屏幕或监视器，用于向一个或多个临床医生描绘真实、虚拟和/或虚拟增强的图像和/或信息。
在各个方面，相机144的心脏是图像传感器135。一般来讲，现代图像传感器135是包含高达数百万个离散光电探测器位点(称为像素)的固态电子装置。图像传感器135技术属于以下两类中的一类：电荷耦合器件(CCD)和互补金属氧化物半导体(CMOS)成像器，并且近来，短波红外(SWIR)是一种新兴的成像技术。另一种类型的图像传感器135采用混合CCD/CMOS架构(以名称“sCMOS”出售)，并且由凸块粘结到CCD成像基板的CMOS读出集成电路(ROIC)组成。CCD和CMOS图像传感器135对大约350nm至1050nm的波长敏感，但该范围通常被给出为400nm至1000nm。一般来讲，CMOS传感器比CCD传感器对IR波长更敏感。固态图像传感器135基于光电效应，并且因此不能区分颜色。因此，存在两种类型的彩色CCD相机：单芯片和三芯片。单芯片彩色CCD相机提供常见的低成本成像解决方案，并且使用马赛克(例如，拜耳)光学滤光器将入射光分成一系列颜色，并且采用内插算法来解析全色图像。然后，每种颜色指向不同的像素集。三芯片彩色CCD相机通过采用棱镜将入射光谱的每个部分引导到不同的芯片来提供更高的分辨率。更准确的颜色再现是可能的，因为物体的空间中的每个点具有单独的RGB强度值，而不是使用算法来确定颜色。三芯片相机提供极高的分辨率。
控制***133还包括光谱光源150和结构化光源152。在某些情况下，单个源可以是脉冲式的，以发射光谱光源150范围内的光的波长和结构化光源152范围内的光的波长。另选地，单个光源可以是脉冲式的，以提供不可见光谱中的光(例如红外光谱光)和可见光谱上的光的波长。光谱光源150可以是例如高光谱光源、多光谱光源和/或选择性光谱光源。在各种情况下，组织识别逻辑部件140可经由由相机144的图像传感器135部分接收的来自光谱光源150的数据来识别关键结构。表面标测逻辑部件136可基于反射的结构化光来确定可见组织的表面轮廓。利用飞行时间测量结果，距离确定逻辑部件141可确定到可见组织和/或关键结构101的一个或多个距离。来自表面标测逻辑部件136、组织识别逻辑部件140和距离确定逻辑部件141的一个或多个输出可被提供给成像逻辑部件138，并且可被组合、共混和/或重叠以经由成像***142的显示器146传达给临床医生。
说明书现在简要转到图2A至图2C，以描述用于控制外科可视化***100的各个方面的控制电路132的各个方面。转到图2A，示出了根据本公开的至少一个方面的被配置成能够控制外科可视化***100的各方面的控制电路400。控制电路400可被配置成能够实现本文所述的各种过程。控制电路400可包括微控制器，该微控制器包括联接到至少一个存储器电路404的一个或多个处理器402(例如，微处理器、微控制器)。存储器电路404存储机器可执行指令，这些机器可执行指令在由处理器402执行时致使处理器402执行机器指令以实现本文所述的各种过程。处理器402可以是本领域中已知的多种单核或多核处理器中的任一种。存储器电路404可包括易失性存储介质和非易失性存储介质。处理器402可包括指令处理单元406和运算单元408。指令处理单元可被配置成能够从本公开的存储器电路404接收指令。
图2B示出了根据本公开的至少一个方面的被配置成能够控制外科可视化***100的各方面的组合逻辑电路410。组合逻辑电路410可被配置成能够实现本文所述的各种过程。组合逻辑电路410可包括有限状态机，该有限状态机包括组合逻辑部件412，该组合逻辑部件被配置成能够在输入414处接收与外科器械或工具相关联的数据，通过组合逻辑部件412处理数据并提供输出416。
图2C示出了根据本公开的至少一个方面的被配置成能够控制外科可视化***100的各方面的时序逻辑电路420。时序逻辑电路420或组合逻辑部件422可被配置成能够实现本文所述的各种过程。时序逻辑电路420可包括有限状态机。时序逻辑电路420可包括例如组合逻辑部件422、至少一个存储器电路424和时钟429。至少一个存储器电路424可存储有限状态机的当前状态。在某些情况下，时序逻辑电路420可以是同步的或异步的。组合逻辑部件422被配置成能够从输入426接收与外科装置或***相关联的数据，通过组合逻辑部件422处理数据并提供输出428。在其他方面，电路可包括处理器(例如，图2A中的处理器402)和有限状态机的组合以实现本文的各种过程。在其他方面，有限状态机可包括组合逻辑电路(例如，组合逻辑电路410，图2B)和时序逻辑电路420的组合。
再次参见图1中的外科可视化***100，关键结构101可以是感兴趣的解剖结构。例如，关键结构101可以是输尿管、动脉诸如肠系膜上动脉、静脉诸如门静脉、神经诸如膈神经和/或肿瘤等解剖结构。在其他情况下，关键结构101可以是例如解剖场中的外来结构，诸如外科装置、外科紧固件、夹具、大头钉、探条、带和/或板。示例性关键结构在本文和前述同时提交的美国专利申请(包括例如名称为“VISUALIZATION OF SURGICAL DEVICES”的美国专利申请_______________，代理人案卷号为END8607USNP2/180232-2)中进一步描述，这些专利申请全文以引用方式并入本文。
在一个方面，关键结构101可嵌入组织103中。换句话说，关键结构101可定位在组织103的表面105下方。在此类情况下，组织103隐蔽关键结构101使其不被临床医生看见。从成像装置120的视角来看，关键结构101也被组织103遮蔽。组织103可以是例如脂肪、***、粘连和/或器官。在其他情况下，关键结构101可被部分地遮蔽使其不被看见。
图1还描绘了外科装置102。外科装置102包括端部执行器，该端部执行器具有从外科装置102的轴的远侧端部延伸的相对钳口。外科装置102可以是任何合适的外科装置，诸如例如解剖器、缝合器、抓紧器、施夹器和/或能量装置(包括单极探针、双极探针、消融探针和/或超声端部执行器)。另外或另选地，外科装置102可包括例如另一个成像或诊断模态，诸如超声装置。在本公开的一个方面，外科可视化***100可被配置成能够实现识别一个或多个关键结构101以及外科装置102与关键结构101的接近度。
外科可视化***100的成像装置120被配置成能够检测各种波长的光，诸如例如可见光、光谱光波(可见光或不可见光)和结构化光图案(可见光或不可见光)。成像装置120可包括用于检测不同信号的多个透镜、传感器和/或接收器。例如，成像装置120可以是高光谱、多光谱或选择性光谱相机，如本文进一步所述。成像装置120还可包括波形传感器122(诸如光谱图像传感器、检测器和/或三维相机透镜)。例如，成像装置120可包括一起使用以同时记录两个二维图像的右侧透镜和左侧透镜，并且因此生成外科部位的三维图像，渲染外科部位的三维图像，并且/或者确定外科部位处的一个或多个距离。另外或另选地，成像装置120可被配置成能够接收指示可见组织的形貌以及隐藏关键结构的识别和方位的图像，如本文进一步所述。例如，成像装置120的视场可与组织的表面105上的光(结构化光)的图案重叠，如图1所示。
在一个方面，外科可视化***100可结合到机器人***110中。例如，机器人***110可包括第一机器人臂112和第二机器人臂114。机器人臂112、114包括刚性结构构件116和接头118，这些接头可包括伺服马达控件。第一机器人臂112被配置成能够操纵外科装置102，并且第二机器人臂114被配置成能够操纵成像装置120。机器人控制单元可被配置成能够向机器人臂112、114发出控制运动，这些控制运动可影响例如外科装置102和成像装置120。
外科可视化***100还包括发射器106，该发射器被配置成能够发射光的图案，诸如条纹、网格线和/或点，以使得能够确定表面105的形貌或地形。例如，投射光阵列130可用于表面105上的三维扫描和配准。投射光阵列130可从位于例如外科装置102和/或机器人臂112、114中的一者和/或成像装置120上的发射器106发射。在一个方面，投射光阵列130用于确定由组织103的表面105和/或表面105在术中的运动限定的形状。成像装置120被配置成能够检测从表面105反射的投射光阵列130，以确定表面105的形貌以及相对于表面105的各种距离。
在一个方面，成像装置120还可包括光学波形发射器123，该光学波形发射器被配置成能够发射可穿透组织103的表面105并到达关键结构101的电磁辐射124(NIR光子)。成像装置120及其上的光学波形发射器123可能够由机器人臂114定位。成像装置120上的对应波形传感器122(例如，图像传感器、光谱仪或振动传感器)被配置成能够检测由波形传感器122接收的电磁辐射的影响。由光学波形发射器123发射的电磁辐射124的波长可被配置成能够使得能够识别解剖结构和/或物理结构(诸如关键结构101)的类型。关键结构101的识别可通过例如光谱分析、光声学和/或超声来实现。在一个方面，电磁辐射124的波长可以是可变的。波形传感器122和光学波形发射器123可包括例如多光谱成像***和/或选择性光谱成像***。在其他情况下，波形传感器122和光学波形发射器123可包括例如光声学成像***。在其他情况下，光学波形发射器123可定位在与成像装置120分开的外科装置上。
外科可视化***100还可包括距离传感器***104，该距离传感器***被配置成能够确定外科部位处的一个或多个距离。在一个方面，飞行时间距离传感器***104可以是包括发射器(诸如发射器106)以及可定位在外科装置102上的接收器108的飞行时间距离传感器***。在其他情况下，飞行时间发射器可与结构化光发射器分开。在一个一般方面，飞行时间距离传感器***104的发射器106部分可包括非常微小的激光源，并且飞行时间距离传感器***104的接收器108部分可包括匹配传感器。飞行时间距离传感器***104可检测“飞行时间”或由发射器106发射的激光反弹回到接收器108的传感器部分所花费的时间。在发射器106中使用非常窄的光源使得距离传感器***104能够确定到距离传感器***104正前方的组织103的表面105的距离。仍然参见图1，de是从发射器106到组织103的表面105的发射器-组织距离，并且dt是从外科装置102的远侧端部到组织的表面105的装置-组织距离。距离传感器***104可用于确定发射器-组织距离de。装置-组织距离dt可根据发射器106在外科装置102的轴上相对于外科装置102的远侧端部的已知方位获得。换句话讲，当发射器106与外科装置102的远侧端部之间的距离已知时，装置-组织距离dt可根据发射器-组织距离de确定。在某些情况下，外科装置102的轴可包括一个或多个关节运动接头，并且可能够相对于发射器106和钳口进行关节运动。关节运动构型可包括例如多接头椎骨状结构。在某些情况下，三维相机可用于对到表面105的一个或多个距离进行三角测量。
在各种情况下，飞行时间距离传感器***104的接收器108可安装在单独的外科装置上而不是外科装置102上。例如，接收器108可安装在插管或套管针上，外科装置102延伸穿过该插管或套管针以到达外科部位。在其他情况下，飞行时间距离传感器***104的接收器108可安装在单独的机器人控制的臂(例如，机器人臂114)上，安装在由另一个机器人操作的可移动臂上和/或安装到手术室(OR)工作台或固定装置。在某些情况下，成像装置120包括飞行时间接收器108，以使用外科装置102上的发射器106与成像装置120之间的线来确定从发射器106到组织103的表面105的距离。例如，可基于飞行时间距离传感器***104的发射器106(在外科装置102上)和接收器108(在成像装置120上)的已知方位来对距离de进行三角测量。接收器108的三维方位可以是已知的和/或在术中与机器人坐标平面配准。
在某些情况下，飞行时间距离传感器***104的发射器106的方位可由第一机器人臂112控制，并且飞行时间距离传感器***104的接收器108的方位可由第二机器人臂114控制。在其他情况下，外科可视化***100可与机器人***分开使用。在此类情况下，距离传感器***104可独立于机器人***。
在某些情况下，机器人臂112、114中的一者或多者可与外科手术中使用的主机器人***分开。机器人臂112、114中的至少一者可在没有伺服马达控件的情况下定位并与特定坐标系配准。例如，用于机器人臂110的闭环控制***和/或多个传感器可控制和/或配准机器人臂112、114相对于特定坐标系的方位。类似地，外科装置102和成像装置120的方位可相对于特定坐标系配准。
仍然参见图1，dw是从位于成像装置120上的光学波形发射器123到关键结构101的表面的相机-关键结构距离，并且dA是关键结构101在组织103的表面105下方的深度(即，表面105的最靠近外科装置102的部分与关键结构101之间的距离)。在各个方面，从位于成像装置120上的光学波形发射器123发射的光学波形的飞行时间可被配置成能够确定相机-关键结构距离dw。光谱成像结合飞行时间传感器的使用在本文中进一步描述。此外，现在参见图3，在本公开的各个方面，关键结构101相对于组织103的表面105的深度dA可通过以下方法来确定：根据距离dw以及发射器106在外科装置102上和光学波形发射器123在成像装置120上的已知方位(以及因此它们之间的已知距离dx)进行三角测量，以确定距离dy(其为距离de和dA之和)。
另外或另选地，来自光学波形发射器123的飞行时间可被配置成能够确定从光学波形发射器123到组织103的表面105的距离。例如，第一波形(或波形范围)可用于确定相机-关键结构距离dw，并且第二波形(或波形范围)可用于确定到组织103的表面105的距离。在此类情况下，不同波形可用于确定关键结构101在组织103的表面105下方的深度。
另外或另选地，在某些情况下，距离dA可由超声、配准磁共振成像(MRI)或计算机断层摄影(CT)扫描来确定。在其他情况下，距离dA可用光谱成像来确定，因为由成像装置接收的检测信号可基于材料的类型而变化。例如，脂肪可以第一方式或第一量降低检测信号，并且胶原可以不同的第二方式或第二量降低检测信号。
现在参见图4中的外科可视化***160，其中外科装置162包括光学波形发射器123以及被配置成能够检测反射的波形的波形传感器122。光学波形发射器123可被配置成能够发射波形，以用于确定与公共装置(诸如外科装置162)的距离dt和dw，如本文进一步所述。在此类情况下，从组织103的表面105到关键结构101的表面的距离dA可如下确定：
dA＝dw-dt。
如本文所公开，关于可见组织、嵌入的关键结构和外科装置的各种信息可通过利用组合方法来确定，该组合方法结合被配置成能够检测光谱波长和结构化光阵列的图像传感器结合有一个或多个飞行时间距离传感器、光谱成像和/或结构化光阵列。此外，图像传感器可被配置成能够接收可见光，并且因此将外科部位的图像提供给成像***。采用逻辑或算法来识别从飞行时间传感器接收的信息、光谱波长、结构化光和可见光，并且渲染表面组织和下面的解剖结构的三维图像。在各种情况下，成像装置120可包括多个图像传感器。
相机-关键结构距离dw也可以一种或多种替代方式进行检测。在一个方面，可利用例如荧光透视可视化技术(诸如荧光吲哚菁绿(ICG))来照亮关键结构201，如图6至图8所示。相机220可包括两个光学波形传感器222、224，这两个光学波形传感器同时拍摄关键结构201的左侧图像和右侧图像(图7A和图7B)。在此类情况下，相机220可描绘关键结构201在组织203的表面205下方的辉光，并且距离dw可由传感器222与224之间的已知距离来确定。在某些情况下，可通过利用多于一个相机或通过在多个位置之间移动相机来更准确地确定距离。在某些方面，一个相机可由第一机器人臂控制，并且第二相机可由另一个机器人臂控制。在此类机器人***中，一个相机可以是例如从动件臂上的从动件相机。从动件臂及其上的相机可被编程为跟踪另一个相机并保持例如特定的距离和/或透镜角度。
在其他方面，外科可视化***100可采用两个单独的波形接收器(即，相机/图像传感器)来确定dw。现在参见图9，如果关键结构301或其内容物(例如，血管或血管内容物)可诸如利用荧光透视发射信号302，则可根据已知位置处的两个单独的相机320a、320b对实际位置进行三角测量。
在另一方面，现在参见图10A和图10B，外科可视化***可采用抖动或移动相机440来确定距离dw。相机440是机器人控制的，使得相机440在不同方位处的三维坐标是已知的。在各种情况下，相机440可在插管或患者接口处枢转。例如，如果关键结构401或其内容物(例如，血管或血管内容物)可诸如利用荧光透视发射信号，则可根据在两个或更多个已知位置之间快速移动的相机440对实际位置进行三角测量。在图10A中，相机440沿轴线A轴向移动。更具体地，相机440沿轴线A更靠近关键结构401平移距离d1，以平移到被指示为位置440'的位置，诸如通过在机器人臂上移入和移出。当相机440移动距离d1并且视图的尺寸相对于关键结构401改变时，可计算到关键结构401的距离。例如，4.28mm的轴向平移(距离d1)可对应于6.28度的角度θ1和8.19度的角度θ2。另外或另选地，相机440可沿不同方位之间的弧线旋转或扫掠。现在参见图10B，相机440沿轴线A轴向移动并且围绕轴线A旋转角度θ3。用于相机440的旋转的枢转点442定位在插管/患者接口处。在图10B中，相机440平移并旋转到位置440”。当相机440移动并且视图边缘关于关键结构401改变时，可计算到关键结构401的距离。在图10B中，距离d2可为例如9.01mm，并且角度θ3可为例如0.9度。
图5描绘了外科可视化***500，其在许多方面类似于外科可视化***100。在各种情况下，外科可视化***500可以是外科可视化***100的另一个范例。类似于外科可视化***100，外科可视化***500包括外科装置502和成像装置520。成像装置520包括光谱光发射器523，该光谱光发射器被配置成能够发射多个波长的光谱光，以获得例如隐藏结构的光谱图像。在各种情况下，成像装置520还可包括三维相机和相关联的电子处理电路。外科可视化***500被示出为在术中用于识别和有利于避开在表面上不可见的某些关键结构，诸如器官503(在该示例中为子宫)中的输尿管501a和血管501b。
外科可视化***500被配置成能够经由结构化光确定从外科装置502上的发射器506到子宫503的表面505的发射器-组织距离de。外科可视化***500被配置成能够基于发射器-组织距离de来外推从外科装置502到子宫503的表面505的装置-组织距离dt。外科可视化***500还被配置成能够确定从输尿管501a到表面505的组织-输尿管距离dA以及从成像装置520到输尿管501a的相机-输尿管距离dw。如本文关于图1所述，例如，外科可视化***500可利用例如光谱成像和飞行时间传感器来确定距离dw。在各种情况下，外科可视化***500可基于本文所述的其他距离和/或表面标测逻辑部件来确定(例如，三角测量)组织-输尿管距离dA(或深度)。
现在参见图11，其中描绘了用于例如外科可视化***(诸如外科可视化***100)的控制***600的示意图。例如，控制***600是转换***，该转换***整合光谱特征组织识别和结构化光组织定位以识别关键结构，特别是当这些结构被其他组织(诸如脂肪、***、血液和/或其他器官)遮蔽时。此类技术也可用于检测组织可变性，诸如区分器官内的肿瘤和/或不健康组织与健康组织。
控制***600被配置用于实现高光谱成像和可视化***，其中利用分子响应来检测和识别外科视场中的解剖结构。控制***600包括转换逻辑电路648以将组织数据转换成外科医生可用的信息。例如，可利用基于相对于遮蔽材料的波长的可变反射率来识别解剖结构中的关键结构。此外，控制***600将所识别的光谱特征和结构光数据组合在图像中。例如，控制***600可用于创建三维数据集，以在具有增强图像叠加的***中用于外科用途。可在术中和术前两者使用附加视觉信息来使用技术。在各种情况下，控制***600被配置成能够在接近一个或多个关键结构时向临床医生提供警告。可采用各种算法来基于外科手术和与关键结构的接近度引导机器人自动化和半自动化方法。
采用投射光阵列在术中确定组织形状和运动。另选地，闪光激光雷达可用于组织的表面标测。
控制***600被配置成能够检测关键结构并提供关键结构的图像叠加，并且测量到可见组织的表面的距离和到嵌入/掩埋关键结构的距离。在其他情况下，控制***600可测量到可见组织的表面的距离或检测关键结构，并且提供关键结构的图像叠加。
控制***600包括光谱控制电路602。例如，光谱控制电路602可以是现场可编程门阵列(FPGA)或如本文结合图2A至图2C所述的另一种合适的电路配置。光谱控制电路602包括处理器604以从视频输入处理器606接收视频输入信号。例如，处理器604可被配置用于高光谱处理并且可利用C/C++代码。例如，视频输入处理器606接收控制(元数据)数据的视频输入，诸如快门时间、波长和传感器分析。处理器604被配置成能够处理来自视频输入处理器606的视频输入信号并将视频输出信号提供给视频输出处理器608，该视频输出处理器包括例如接口控制(元数据)数据的高光谱视频输出。视频输出处理器608将视频输出信号提供给图像叠加控制器610。
视频输入处理器606经由患者隔离电路614联接到患者侧处的相机612。如前所述，相机612包括固态图像传感器634。患者隔离电路可包括多个变压器，使得患者与***中的其他电路隔离。相机612通过光学器件632和图像传感器634接收术中图像。图像传感器634可包括例如CMOS图像传感器，或者可包括例如本文结合图2所述的任何图像传感器技术。在一个方面，相机612以14位/像素信号输出图像。应当理解，在不脱离本公开的范围的情况下，可采用更高或更低的像素分辨率。隔离的相机输出信号613被提供给彩色RGB融合电路616，该融合电路利用硬件寄存器618和Nios2协处理器620来处理相机输出信号613。彩色RGB融合输出信号被提供给视频输入处理器606和激光脉冲控制电路622。
激光脉冲控制电路622控制激光引擎624。激光引擎624输出包括近红外(NIR)在内的多个波长(λ1、λ2、λ3、......、λn)的光。激光引擎624可在多种模式下操作。在一个方面，激光引擎624可在例如两种模式下操作。在第一模式(例如正常操作模式)下，激光引擎624输出照明信号。在第二模式(例如，识别模式)下，激光引擎624输出RGBG和NIR光。在各种情况下，激光引擎624可在偏振模式下操作。
来自激光引擎624的光输出626照亮术中外科部位627中的目标解剖结构。激光脉冲控制电路622还控制用于激光图案投射仪630的激光脉冲控制器628，该激光图案投射仪将预先确定的波长(λ2)的激光图案631(诸如线和/或点的网格或图案)投射在外科部位627处的手术组织或器官上。相机612接收图案化光以及通过相机光学器件632输出的反射光。图像传感器634将所接收的光转换成数字信号。
彩色RGB融合电路616还将信号输出到图像叠加控制器610和视频输入模块636，以用于读取由激光图案投射仪630投射到外科部位627处的目标解剖结构上的激光图案631。处理模块638处理激光图案631并且输出表示到外科部位627处的可见组织的距离的第一视频输出信号640。数据被提供给图像叠加控制器610。处理模块638还输出表示外科部位处的目标解剖结构的组织或器官的三维渲染形状的第二视频信号642。
第一视频输出信号640和第二视频输出信号642包括表示关键结构在三维表面模型上的方位的数据，该数据被提供给整合模块643。结合来自光谱控制电路602的视频输出处理器608的数据，整合模块643可确定到掩埋关键结构的距离dA(图1)(例如，经由三角测量算法644)，并且距离dA可经由视频输出处理器646提供给图像叠加控制器610。上述转换逻辑部件可涵盖转换逻辑电路648、中间视频监视器652以及定位在外科部位627处的相机624/激光图案投射仪630。
在各种情况下，可采用来自CT或MRI扫描的术前数据650来配准或匹配某些三维可变形组织。此类术前数据650可被提供给整合模块643并最终提供给图像叠加控制器610，使得此类信息可与来自相机612的视图叠加并被提供给视频监视器652。术前数据的配准在本文和前述同时提交的美国专利申请中进一步描述，这些专利申请全文以引用方式并入本文。
视频监视器652可从图像叠加控制器610输出整合/增强视图。临床医生可在一个或多个监视器上在不同视图之间选择和/或切换。在第一监视器652a上，临床医生可在(A)其中描绘可见组织的三维渲染的视图与(B)其中在可见组织的三维渲染上描绘一个或多个隐藏关键结构的增强视图之间切换。在第二监视器652b上，临床医生可例如将距离测量切换到一个或多个隐藏关键结构和/或可见组织的表面。
控制***600和/或其各种控制电路可结合到本文所公开的各种外科可视化***中。
图12示出了根据本公开的至少一个方面的结构化(或图案化)光***700。如本文所述，条纹或线形式的结构化光例如可从光源和/或投射仪706被投射到目标解剖结构的表面705上，以识别表面705的形状和轮廓。在各个方面可类似于成像装置120(图1)的相机720例如可被配置成能够检测光在表面705上的投射图案。投射图案在撞击表面705时变形的方式允许视觉***计算目标解剖结构的深度和表面信息。
在某些情况下，可利用不可见的(或察觉不到的)结构化光，其中在不干扰投射图案可能混淆的其他计算机视觉任务的情况下使用该结构化光。例如，可利用在两个完全相反的图案之间交替的红外光或极快的可见光帧速率来防止干扰。结构化光在en.wikipedia.org/wiki/Structured_light处进一步描述。
现在参见图13，以举例的方式示出了高光谱成像的概念，示出了陆地高光谱成像***800。例如，陆地高光谱成像***800被配置成能够对陆地特征或物体(诸如土壤、水和/或植被)进行成像。陆地高光谱成像***700包括航天器820上的星载高光谱传感器822，以对地球的表面805的一部分进行高光谱成像。光谱维度包括若干层。图像的每个像素包含采样光谱，该采样光谱用于通过像素中存在的材料的反射率来识别这些材料。数据可被转换成例如分别作为土壤、水和植被的波长的函数的反射率的图形表示850、852、854。陆地高光谱成像在www.markelowitz.com/Hyperspectral.html处进一步描述。
还以举例的方式示出了高光谱成像的概念，图14是根据本公开的至少一个方面的各种陆地特征或物体的高光谱特征的图形表示850。反射率百分比沿竖直轴线示出，而波长(nm)沿水平轴线示出。如图所示，每个物体(松林、草地、红沙坑和泥水)都具有独特的高光谱特征，该高光谱特征可用于识别该物体。
根据本公开的至少一个方面，结合图13和图14所述的高光谱成像概念可用于具有不同吸收波长和波段的不同材料。下表示出了各种材料的吸收波长和波段。介于400nm与700nm之间的第一波长范围表示可见光光谱。介于700nm与1400nm之间的第二波长范围表示近红外(NIR)光谱。介于1400nm与3000nm之间的第三波长范围表示短波红外(SWIR)光谱。以1250nm为中心的第一波段表示铁吸收和叶片含水量。介于1500nm与1750nm之间的第二波段表示塑料、玻璃纤维和石油。介于200nm与2400nm之间的第三波段表示矿物ID。
表1指定了各种材料的吸收波长和波段。
Figure BDA0002977308490000231
表1
现在参见图15A至图15C，作为高光谱成像概念的进一步说明，进行了其中将光谱成像应用于煎蛋952的测试。具有黄色蛋黄954以及围绕蛋黄954的蛋白956的煎蛋952的图像在图15A中示出。煎蛋952的光谱特征的图形表示950在图15B中示出。具体地，图形表示950示出了煎蛋952的蛋黄954和蛋白956的吸收单位与波长(nm)的关系。在图15C中，示出了煎蛋952的光谱图像(以黑白示出)，其中该图像被增强以基于高光谱特征数据区分蛋黄部分和蛋白部分。
在各种情况下，可采用如本文关于陆地特征和物体以及煎蛋出于例示性目的所述的高光谱成像技术来识别解剖结构中的特征，以便区分关键结构与遮蔽物。例如，高光谱成像技术可提供可视化***，该可视化***可提供识别关键结构诸如输尿管和/或血管的方式，特别是当那些结构被例如脂肪、***、血液或其他器官遮蔽时。可使用红外(IR)光谱中不同波长的反射率差异来确定关键结构与遮蔽物的存在。现在参见图16至图18，描绘了例如输尿管、动脉和神经组织相对于遮蔽物诸如脂肪、肺组织和血液的例示性高光谱特征。
图16是例示性输尿管特征相对于遮蔽物的图形表示1050。该曲线图表示脂肪、肺组织、血液和输尿管对于各波长的反射率与波长(nm)的关系。图17是例示性动脉特征相对于遮蔽物的图形表示1052。该曲线图表示脂肪、肺组织、血液和血管的反射率与波长(nm)的关系。图18是例示性神经特征相对于遮蔽物的图形表示1054。该曲线图表示脂肪、肺组织、血液和神经的反射率与波长(nm)的关系。
在各种情况下，可基于外科部位处的预期关键结构和/或遮蔽物来识别和利用用于光谱成像的选定波长(即，“选择性光谱”成像)。通过利用选择性光谱成像，可最小化获得光谱图像所需的时间量，使得可实时或接近实时地获得信息，并在术中加以利用。在各种情况下，波长可由临床医生选择或由控制电路基于临床医生的输入来选择。在某些情况下，波长可基于例如机器学习和/或控制电路可经由云访问的大数据来选择。
光谱成像到组织的前述应用可在术中用于测量波形发射器与被组织遮蔽的关键结构之间的距离。在本公开的一个方面，现在参见图19和图20，示出了利用波形1124、1125的飞行时间传感器***1104。在某些情况下，飞行时间传感器***1104可结合到外科可视化***100(图1)中。飞行时间传感器***1104包括相同外科装置1102上的波形发射器1106和波形接收器1108。发射波1124从发射器1106延伸到关键结构1101，并且接收波1125被接收器1108从关键结构1101反射回去。外科装置1102穿过延伸到患者的腔1107中的套管针1110定位。
波形1124、1125被配置成能够穿透遮蔽组织1103。例如，波形1124、1125的波长可在NIR或SWIR波长光谱中。在一个方面，光谱信号(例如，高光谱、多光谱或选择性光谱)或光声学信号可从发射器1106发射并且可穿透其中隐蔽有关键结构1101的组织1103。所发射的波形1124可被关键结构1101反射。所接收的波形1125可由于外科装置1102的远侧端部与关键结构1101之间的距离d而被延迟。在各种情况下，可基于关键结构1101的光谱特征来选择波形1124、1125以靶向组织1103内的关键结构1101，如本文进一步所述。在各种情况下，发射器1106被配置成能够提供二进制信号开和关，如图20所示，例如该二进制信号可由接收器1108测量。
基于发射波1124与接收波1125之间的延迟，飞行时间传感器***1104被配置成能够确定距离d(图19)。图19的发射器1106和接收器1108的飞行时间时序图1130在图20中示出。延迟是距离d的函数，并且距离d由下式给出：
Figure BDA0002977308490000251
其中：
c＝光的速度；
t＝脉冲的长度；
q1＝发射光时累积的电荷；并且
q2＝不发射光时累积的电荷。
如本文所提供，波形1124、1125的飞行时间对应于图19中的距离d。在各种情况下，附加发射器/接收器和/或来自发射器1106的脉冲信号可被配置成能够发射非穿透信号。非穿透组织可被配置成能够确定从发射器到遮蔽组织1103的表面1105的距离。在各种情况下，关键结构1101的深度可由下式确定：
dA＝dw-dt。
其中：
dA＝关键结构1101的深度；
dw＝从发射器1106到关键结构1101的距离(图19中的d)；以及
dt,＝从发射器1106(在外科装置1102的远侧端部上)到遮蔽组织1103的表面1105的距离。
在本公开的一个方面，现在参见图21，示出了利用波1224a、1224b、1224c、1225a、1225b、1225c的飞行时间传感器***1204。在某些情况下，飞行时间传感器***1204可结合到外科可视化***100(图1)中。飞行时间传感器***1204包括波形发射器1206和波形接收器1208。波形发射器1206定位在第一外科装置1202a上，并且波形接收器1208定位在第二外科装置1202b上。外科装置1202a、1202b分别穿过其相应的套管针1210a、1210b定位，这两个套管针延伸到患者的腔1207中。发射波1224a、1224b、1224c从发射器1206朝向外科部位延伸，并且接收波1225a、1225b、1225c从外科部位处的各种结构和/或表面反射回接收器1208。
不同的发射波1224a、1224b、1224c被配置成能够靶向外科部位处的不同类型的材料。例如，波1224a靶向遮蔽组织1203，波1224b靶向第一关键结构1201a(例如，血管)，并且波1224c靶向第二关键结构1201b(例如，癌性肿瘤)。波1224a、1224b、1224c的波长可在可见光、NIR或SWIR波长光谱中。例如，可见光可从组织1203的表面1205反射，并且NIR和/或SWIR波形可被配置成能够穿透组织1203的表面1205。在各个方面，如本文所述，光谱信号(例如，高光谱、多光谱或选择性光谱)或光声学信号可从发射器1206发射。在各种情况下，可基于关键结构1201a、1201b的光谱特征来选择波1224b、1224c以靶向组织1203内的关键结构1201a、1201b，如本文进一步所述。光声学成像在本文和前述同时提交的美国专利申请中进一步描述，这些专利申请全文以引用方式并入本文。
发射波1224a、1224b、1224c可从目标材料(即，分别为表面1205、第一关键结构1201a和第二结构1201b)反射。所接收的波形1225a、1225b、1225c可由于图21所示的距离d1a、d2a、d3a、d1b、d2b、d2c而被延迟。
在其中发射器1206和接收器1208可独立定位(例如，定位在单独的外科装置1202a、1202b上和/或由单独的机器人臂控制)的飞行时间传感器***1204中，可根据发射器1206和接收器1208的已知方位计算各种距离d1a、d2a、d3a、d1b、d2b、d2c。例如，当外科装置1202a、1202b由机器人控制时，这些方位可以是已知的。关于发射器1206和接收器1208的方位以及光子流靶向某一组织的时间的知识以及由接收器1208接收的该特定响应的信息可允许确定距离d1a、d2a、d3a、d1b、d2b、d2c。在一个方面，可使用穿透波长对到被遮蔽的关键结构1201a、1201b的距离进行三角测量。由于光的速度对于任何波长的可见光或不可见光是恒定的，因此飞行时间传感器***1204可确定各种距离。
仍然参见图21，在各种情况下，在提供给临床医生的视图中，接收器1208可被旋转成使得所得图像中的目标结构的质心保持恒定，即在垂直于所选目标结构1203、1201a或1201b的轴线的平面中。此类取向可快速传送关于关键结构的一个或多个相关距离和/或视角。例如，如图21所示，从关键结构1201a垂直于视平面(即，血管在页面内/页面外取向)的视角显示外科部位。在各种情况下，此类取向可以是默认设置；然而，该视图可由临床医生旋转或以其他方式调整。在某些情况下，临床医生可在限定由成像***提供的外科部位的视角的不同表面和/或目标结构之间切换。
在各种情况下，接收器1208可安装在套管针或插管(诸如套管针1210b)上，例如外科装置1202b通过该套管针或插管定位。在其他情况下，接收器1208可安装在三维方位已知的单独机器人臂上。在各种情况下，接收器1208可安装在与控制外科装置1202a的机器人分开的可移动臂上，或者可安装到可在术中与机器人坐标平面配准的手术室(OR)工作台。在此类情况下，发射器1206和接收器1208的方位可能够与同一坐标平面配准，使得可根据来自飞行时间传感器***1204的输出对距离进行三角测量。
将飞行时间传感器***和近红外光谱(NIRS)(称为TOF-NIRS，其能够测量具有纳秒分辨率的NIR光的时间分辨特征图)组合可见于名称为“TIME-OF-FLIGHT NEAR-INFRAREDSPECTROSCOPY FOR NONDESTRUCTIVE MEASUREMENT OF INTERNAL QUALITY INGRAPEFRUIT”(美国园艺科学学会杂志(Journal of the American Society forHorticultural Science)，2013年5月，第138卷，第3期，第225-228页)的文章(该文章全文以引用方式并入本文)中，并且可在journal.ashspublications.org/content/138/3/225.full处获取。
在各种情况下，飞行时间光谱波形被配置成能够确定关键结构的深度和/或外科装置与关键结构的接近度。此外，本文所公开的各种外科可视化***包括表面标测逻辑部件，该表面标测逻辑部件被配置成能够创建可见组织的表面的三维渲染。在此类情况下，即使当可见组织阻挡关键结构时，临床医生也可知道外科装置与关键结构的接近度(或缺乏接近度)。在一种情况下，外科部位的形貌由表面标测逻辑部件提供在监视器上。如果关键结构靠近组织的表面，则光谱成像可将关键结构的方位传达给临床医生。例如，光谱成像可检测表面的5mm或10mm内的结构。在其他情况下，光谱成像可检测组织的表面下方10mm或20mm的结构。基于光谱成像***的已知限值，***被配置成能够在光谱成像***根本无法检测到关键结构的情况下传达该关键结构在范围外。因此，临床医生可继续移动外科装置和/或操纵组织。当关键结构移动到光谱成像***范围内时，***可识别该结构，并且因此传送该结构在范围内。在此类情况下，当初始识别结构和/或在预定义的接近度区域内进一步移动结构时，可提供警示。在此类情况下，即使光谱成像***利用已知边界/范围未识别关键结构，也可向临床医生提供接近度信息(即，缺乏接近度)。
本文所公开的各种外科可视化***可被配置成能够在术中识别关键结构的存在和/或关键结构的接近度，并且在通过意外解剖和/或横切损坏关键结构之前警示临床医生。在各个方面，外科可视化***被配置成能够识别例如以下关键结构中的一种或多种关键结构：输尿管、肠、直肠、神经(包括膈神经、喉返神经[RLN]、骶岬面部神经、迷走神经以及它们的分支)、血管(包括肺动脉和大叶动脉以及肺静脉和大叶静脉、肠系膜下动脉[IMA]及其分支、直肠上动脉、乙状动脉和左结肠动脉)、肠系膜上动脉(SMA)及其分支(包括中结肠动脉、右结肠动脉、回肠动脉)、肝动脉及其分支、门静脉及其分支、脾动脉/静脉及其分支、外部和内部(下腹部)回肠血管、短胃动脉、子宫动脉、骶中血管和***。此外，外科可视化***被配置成能够指示外科装置与关键结构的接近度和/或在外科装置靠近关键结构时警告临床医生。
本公开的各个方面提供了术中关键结构识别(例如，输尿管、神经和/或血管的识别)和器械接近度监视。例如，本文所公开的各种外科可视化***可包括光谱成像和外科器械跟踪，这使得能够可视化例如组织的表面下方(诸如组织的表面下方1.0cm至1.5cm)的关键结构。在其他情况下，外科可视化***可识别组织的表面下方小于1.0cm或大于1.5cm的结构。例如，如果结构由于深度原本不能被看到，则即使例如可识别仅在表面0.2mm内的结构的外科可视化***也可以是有价值的。在各个方面，外科可视化***可例如利用关键结构的虚拟描绘作为叠加在可见组织的表面上的可见白光图像来增强临床医生的视图。外科可视化***可提供外科器械的远侧末端的实时三维空间跟踪，并且可例如在外科器械的远侧末端在关键结构的特定范围内(诸如在关键结构的1.0cm内)移动时提供接近度警示。
本文所公开的各种外科可视化***可识别解剖何时太靠近关键结构。基于温度(即，在可能有损坏/加热/熔融关键结构的风险的关键结构附近太热)和/或基于张力(即，在可能有损坏/撕裂/牵拉关键结构的风险的关键结构附近张力太大)，解剖可能“太靠近”关键结构。例如，当在结扎之前使血管骨架化时，此类外科可视化***可有利于在血管周围进行解剖。在各种情况下，可利用热成像相机来读取外科部位处的热量并向临床医生提供基于所检测到的热量和从工具到结构的距离的警告。例如，如果工具的温度高于预定义阈值(诸如例如120℉)，则可在第一距离(诸如例如10mm)处向临床医生提供警示，并且如果工具的温度小于或等于预定义阈值，则可在第二距离(诸如例如5mm)处向临床医生提供警示。预定义阈值和/或警告距离可以是默认设置和/或可临床医生编程。另外或另选地，接近度警示可与由工具本身(诸如测量例如单极或双极解剖器或血管密封器的远侧钳口中的热量的热电偶)进行的热测量关联。
本文所公开的各种外科可视化***可提供关于关键结构和特异性的足够的灵敏度，以使得临床医生能够基于护理和/或装置安全性数据的标准对快速但安全的解剖有信心地进行。***可在外科手术期间在术中实时地起作用，而对患者或临床医生的电离辐射风险最小，并且在各种情况下，对患者或临床医生没有电离辐射风险。相反地，在荧光透视过程中，患者和临床医生可经由例如用于实时观察解剖结构的X射线束暴露于电离辐射。
诸如当外科装置的路径由机器人控制时，本文所公开的各种外科可视化***可被配置成能够例如检测和识别外科装置的向前路径中的一种或多种期望类型的关键结构。另外或另选地，外科可视化***可被配置成能够检测和识别例如外科装置的周围区域中和/或多个平面/维度中的一种或多种类型的关键结构。
本文所公开的各种外科可视化***可易于操作和/或解释。此外，各种外科可视化***可结合允许临床医生覆写默认设置和/或操作的“覆写”特征。例如，诸如当关键结构的风险小于避开该区域的风险(例如，当摘除关键结构周围的癌症时，留下癌性组织的风险可能大于对关键结构造成损坏的风险)时，临床医生可选择性地关闭来自外科可视化***的警示和/或比外科可视化***所建议的更靠近关键结构。
本文所公开的各种外科可视化***可结合到外科***中和/或在对工作流程具有有限影响的情况下在外科手术期间使用。换句话讲，外科可视化***的具体实施可能不会改变实施外科手术的方式。此外，与意外横切的成本相比，外科可视化***可能更经济。数据表明，对关键结构的意外损坏减少可驱动增量补偿。
本文所公开的各种外科可视化***可实时或接近实时地并且提前足够远地操作，以使得临床医生能够预期关键结构。例如，外科可视化***可提供足够的时间以“减慢、评估和避开”，以便使外科手术的效率最大化。
本文所公开的各种外科可视化***可能不需要注射到组织中的造影剂或染料。例如，光谱成像被配置成能够在不使用造影剂或染料的情况下在术中可视化隐藏结构。在其他情况下，造影剂可比其他可视化***更容易注射到适当的组织层中。例如，造影剂的注射与关键结构的可视化之间的时间可少于两小时。
本文所公开的各种外科可视化***可与临床数据和/或装置数据关联。例如，数据可提供关于能量启用的外科装置(或其他潜在损坏装置)应与外科医生不想损坏的组织相距多近的边界。与本文所公开的外科可视化***交互的任何数据模块可与机器人整体地或分开地提供，以使得能够与独立的外科装置一起用于例如开放式或腹腔镜式手术中。在各种情况下，外科可视化***可与机器人外科***兼容。例如，可视化图像/信息可显示在机器人控制台中。
某些成像***向临床医生提供关于关键结构相对于患者解剖结构的方位的有价值的信息。例如，解剖结构内肿瘤或血管的位置在外科手术期间可为有帮助的信息。各种技术能够识别隐藏关键结构。例如，超声成像***、磁共振成像(MRI)***和计算机断层摄影(CT)成像***被配置成能够识别隐藏关键结构。然而，来自此类源的成像数据可在一个时间点(例如，术前)采集，并且在第二时间点(例如，术中)由临床医生依赖。在此类情况下，临床医生可能需要参考单独的图像来确定关键结构的方位。当解剖结构在第一时间点和第二时间点之间移动(例如，在外科手术期间肺的泄放或肝脏或胰腺的移动)时，可能难以确定关键结构在第二时间点的方位。在某些情况下，可利用基准标记和/或有限元分析来估计关键结构在第二时间点的方位。然而，临床医生可能想要以不同的方式确定一个或多个关键结构的方位，以获得更准确的估计和/或校准现有的建模技术。
外科可视化***可被配置成能够整合来自不同源的成像数据。例如，外科可视化***可将来自术前扫描的成像数据与来自实时三维模型的成像数据进行整合。实时三维模型可经由结构化光***和对应的结构光逻辑来计算，如本文进一步所述。在此类情况下，外科可视化***可在不具有基准标记和/或有限元分析的情况下确定一个或多个关键结构的方位。
在本公开的一个方面，外科可视化***可以包括：结构化光源，该结构化光源被配置成能够将结构化光图案发射在解剖结构上；图像传感器，该图像传感器被配置成能够检测解剖结构上的结构化光图案；以及控制电路，该控制电路被配置成能够从第一源接收指示解剖结构和解剖结构内的嵌入结构的第一成像数据，以及从图像传感器接收指示解剖结构的第二成像数据。此外，例如，控制电路可以被配置成能够根据第二成像数据生成解剖结构的三维数字表示，并且通过将指示解剖结构的第一成像数据与三维数字表示匹配来整合第一成像数据和第二成像数据，以及将指示嵌入结构的第一成像数据与三维数字表示配准。
这种外科可视化***可在不具有基准标记和/或有限元分析的情况下确定一个或多个关键结构的方位。此外，当解剖结构移动时，可实时地生成三维数字表示。外科可视化***可将术前图像与实时三维模型进行整合，以在术中向临床医生传达附加信息。另外，三维数字表示可提供比三维相机范围更多的数据，该三维相机范围仅提供人眼随后可从中感知深度的图像。例如，相对于解剖结构的表面形貌和距离可提供给机器人***并由机器人***利用，以用于调节控制运动和/或算法。
现在参见图22和图23，肺4003包括嵌入其中的关键结构4001a、4001b。关键结构4001a是肿瘤并且关键结构4001b是血管；然而，读者将会知道，还设想了其他关键结构。图22中的肺4003的视图来自术前图像，其中肺处于充胀状态并且标识在充胀的肺内的结构。例如，图22的视图中的数据可用超声、MRI扫描或CT扫描获得。图23中的肺4003的视图来自术中图像，其中肺4003处于泄放状态。当肺4003泄放时，关键结构4001a、4001b移动到更新的方位。关键结构4001a、4001b的更新的方位在图23中示出。另外，出于比较目的，虚线指示当肺处于充胀状态时肺4003和关键结构4001a的方位。
仍然参见图22和图23，接近度区域4002被限定在关键结构4001a周围。在各种情况下，接近度区域4002可通过例如由临床医生确定的成像技术的准确性、肿瘤的类型和/或治疗的进取性来确定。例如，临床医生可能想要移除围绕关键结构4001a的整个接近度区域4002。在此类情况下，接近度区域4002可例如被限定在来自术前扫描的第一图像上。
现在参见图24和图25，示出了用于对肺4003进行成像的外科可视化***4000。读者将会知道，可用外科可视化***4000对其他解剖结构进行成像。例如，外科可视化***4000可被配置成能够对其他解剖结构(包括易于从术前状态移动的结构)进行成像。外科可视化***4000可用于例如对胰腺或肝脏进行成像。
外科可视化***4000可以在许多方面类似于外科可视化***100(图1)。例如，外科可视化***4000可被配置成能够识别嵌入在肺4003的表面4005下方的一个或多个关键结构4001a、4001b，并且确定相对于表面4005和/或关键结构4001a、4001b的一个或多个距离。
外科可视化***4000包括外科装置4006，该外科装置包括结构化光发射器和图像传感器。如本文进一步所述，结构化光发射器被配置成能够发射结构化光的图案4008，并且图像传感器被配置成能够检测肺4003的表面4005上的图案4008。基于由图像传感器检测到的图案4008，控制电路被配置成能够确定肺4003的表面轮廓。例如，控制电路可生成表面4005的三维模型。如图24所示，肺4003处于充胀状态，并且外科装置4006上的结构化光源将图案4008发射到肺4003的表面4005上。在图25中，肺4003被泄放。出于比较目的，图25中的虚线指示肺4003处于充胀状态的方位。当肺4003泄放时，关键结构4001a、4001b移动到更新的方位。
来自肺4003的术前图像(图22)的成像数据可与来自术中图像(图23)的三维数字表示或虚拟模型匹配。例如，临床医生可将肺4003的术前图像与肺4003的三维虚拟表示匹配。在其他情况下，算法可将图像绘制成匹配。图23中的虚线指示肺4003在充胀状态下的轮廓。在各种情况下，利用结构化光***和对应的逻辑来生成用图23中的虚线指示的肺4003的形状和方位。在此类情况下，用虚线指示的肺4003的形状和方位可与用图22所示的术前图像获得的肺4003的形状和方位匹配以整合图像。
关于关键结构4001a、4001b(其可隐藏在利用结构化光获得的肺4003的三维数字表示中)的数据可从术前图像传输到三维数字表示中。如图24所示，关键结构4001a、4001b可配准到三维虚拟表示中的肺4003上的方位。关键结构4001a、4001b可配准到肺4003的三维数字表示的体积部分。
在各种情况下，外科可视化***4000被配置成能够通过外科手术继续扫描肺4003。基于由图像传感器检测到的变化图案4008，控制电路被配置成能够更新表面4005的三维数字表示。换句话讲，可实时地监测肺4003的移动、偏转和/或泄放。
由本文所述的结构化光***监测的肺4003的移动可在视频监视器上传送给临床医生。例如，可从外科可视化***4000向视频监视器提供视频信号，该视频信号实时地指示解剖结构的三维数字表示。配准到三维虚拟表示中的肺4003上的方位的关键结构4001a、4001b也随着肺4003从充胀状态(图24)变化到泄放状态(图25)而移动。视频信号还可实时地指示配准的嵌入结构在三维数字表示上的方位。在此类情况下，视频监视器可呈现关键结构4001a、4001b在移动肺4003内的相对体积方位。
在一种情况下，图23中的肺4003的视图可在术中传送给临床医生。例如，图23的视图可在例如视频监视器上提供和/或在手术室中广播。视频监视器上的视图可示出肺处于充胀状态(诸如用虚线和/或作为虚影或阴影)以及处于泄放状态。在某些情况下，临床医生可选择性地隐藏图像的一个或多个部分，诸如处于充胀状态的肺4003的轮廓。
在各种情况下，外科可视化***4000可不利用光谱成像。例如，临床医生可能不依赖于利用光谱成像检测到的肺4003的材料特性。在其他情况下，可利用光谱成像。例如，光谱成像可产生一个或多个隐藏结构的图像，如本文进一步所述。再次参见图24和图25，在此类情况下，外科装置4006可包括光谱光发射器，该光谱光发射器被配置成能够发射适于穿透肺4003并到达关键结构4001a、4001b的多个波长的光。外科装置4006上的图像传感器还可被配置成能够检测多个波长的光谱光，并且控制电路可从由图像传感器检测到的光谱图像中识别关键结构4001a、4001b。
在某些情况下，临床医生可能想要通过光谱成像来确定一个或多个关键结构4001a、4001b的方位。例如，光谱成像可用于增强和/或校准移动/变形肺4003在其从充胀状态移动到泄放状态或以其他方式在外科手术期间移动时的有限元分析建模。在此类情况下，由图像传感器检测到的结构化光图案4008的变化可用于实时地更新有限元分析模型。
现在参见图26，提供了用于对来自多个源的成像数据进行整合的整合图4100。外科可视化***4000(图24和图25)和/或各种其他外科可视化***和机器人***可以采用整合图4100。在本公开的一个方面，控制电路132(图2)可以实现整合图4100。时间线4102可定义包括术前、术中和术后时间段的术前时间线。在一种情况下，时间t1可为术前的，并且时间t2可为术中的。在其他情况下，时间线4102可涵盖术中时间段。
在框4104处，用于外科可视化***的控制电路可被配置成能够从第一源接收指示解剖结构(例如，肺、肝、肾或胰腺)和解剖结构内的隐藏结构(例如，肿瘤或血管)的第一成像数据。例如，控制电路可从MRI扫描、CT扫描或超声接收术前成像数据。在其他情况下，可以在术中(诸如从术中超声)提供第一成像数据。在框4106处，控制电路还可从第二源接收指示解剖结构的第二成像数据。例如，第二源可以是结构化光***。在此类情况下，结构化光源可能无法分析组织的特性，并且因此无法识别其中的隐藏结构。
在各种情况下，可同时提供第一成像数据和第二成像数据。在其他情况下，可在外科手术之前将第一成像数据提供给控制电路，并且可在外科手术开始时将第二成像数据提供给控制电路。基于第二成像数据，控制电路可在框4108处生成解剖结构的三维虚拟模型。
随后，在框4110处，控制电路可将指示解剖结构的第一成像数据与解剖结构的三维虚拟模型匹配。例如，临床医生可将解剖结构的术前图像与解剖结构的三维虚拟模型匹配。在框4112处，可将包含在第一成像数据而非第二成像数据中的关于隐藏结构的数据传输到三维虚拟模型中。例如，隐藏结构可与三维虚拟模型配准和整合。基于隐藏结构与三维虚拟模型的整合，可在框4114处更新模型并且在框4118处将其传送给临床医生。
在各种情况下，第二源可继续扫描解剖结构并实时地更新三维虚拟模型以示出解剖结构的移动(例如，肺的偏转和/或泄放)。然后，在框4116处，控制电路可从第二源接收指示解剖结构的第三成像数据。在框4114处，可基于第三成像数据更新三维虚拟模型。更具体地，可更新虚拟模型的方位和几何形状，以及在框4112处配准到虚拟模型的隐藏结构的方位和几何形状。
示例性临床应用
本文所公开的各种外科可视化***可用于以下临床应用中的一种或多种临床应用中。以下临床应用是用于本文所公开的各种外科可视化***中的一个或多个外科可视化***的非穷举性和仅例示性应用。
如本文所公开的外科可视化***可用于多种不同类型的手术中，以用于例如不同的医学专业，诸如泌尿科、妇科、肿瘤科、结肠直肠科、胸科、肥胖科/胃科和肝胰胆管科(HPB)。例如，在泌尿手术(诸如***切除术)中，例如可在脂肪中检测输尿管，或者可在脂肪中检测***和/或神经。例如，在妇科肿瘤手术(诸如例如子宫切除术)中，以及在结肠直肠手术(诸如例如低位前切除(LAR)手术)中，可在脂肪和/或***中检测到输尿管。例如，在胸部手术(诸如叶切除术)中，可在肺或***中检测到血管，并且/或者可在***中检测到神经(例如，食管造口术)。在肥胖手术中，可在脂肪中检测到血管。例如，在HPB手术(诸如肝切除术或胰切除术)中，可在脂肪(肝外)、***(肝外)中检测到血管，并且可在薄壁(肝脏或胰腺)组织中检测到胆管。
在一个示例中，临床医生可能想要摘除子宫内膜肌瘤。根据术前磁共振成像(MRI)扫描，临床医生可知道子宫内膜肌瘤位于肠的表面上。因此，临床医生可能想要在术中知道哪些组织构成肠的一部分以及哪些组织构成直肠的一部分。在此类情况下，如本文所公开的外科可视化***可指示不同类型的组织(肠与直肠)，并且经由成像***将该信息传达给临床医生。此外，成像***可确定外科装置与所选组织的接近度并传送该接近度。在此类情况下，外科可视化***可提供增加的手术效率而没有严重的并发症。
在另一个示例中，临床医生(例如，妇科医生)可保持远离某些解剖区域以避免太靠近关键结构，并且因此临床医生可能无法摘除例如所有子宫内膜异位。如本文所公开的外科可视化***可使得妇科医生能够降低太靠近关键结构的风险，使得妇科医生可用外科装置足够靠近以摘除所有子宫内膜异位，这可改善患者结果(使外科手术大众化)。此类***可使得外科医生能够在外科手术期间“保持移动”而不是反复停止和重新开始，以便识别要避开的区域，例如特别是在施加治疗能量诸如超声或电外科能量期间。在妇科应用中，子宫动脉和输尿管是重要的关键结构，并且考虑到所涉及组织的呈现和/或厚度，***对于子宫切除术和子宫内膜异位手术可能特别有用。
在另一个示例中，临床医生可能有在太近的位置处解剖血管的风险，并且因此这可能影响到除了目标叶之外的叶的血液供应。此外，患者与患者之间的解剖学差异可能导致解剖基于特定患者影响不同叶的血管(例如分支)。如本文所公开的外科可视化***可使得能够识别期望位置处的正确血管，这使得临床医生能够以适当的解剖确定性进行解剖。例如，***可确认正确的血管在正确的位置，并且然后临床医生可安全地将血管分开。
在另一个示例中，由于血管的解剖结构的不确定性，临床医生可能会在最佳位置处进行解剖之前进行多次解剖。然而，希望在第一种情况下在最佳位置进行解剖，因为更多解剖可增加出血的风险。如本文所公开的外科可视化***可通过指示正确的血管和用于解剖的最佳位置来最小化解剖数量。例如，输尿管和主韧带很密集，并且在解剖期间会带来独特的挑战。在此类情况下，可能特别希望最小化解剖数量。
在另一个示例中，临床医生(例如，摘除癌性组织的外科肿瘤医生)可能希望知道关键结构的识别、癌症的定位、癌症的分期和/或组织健康的评估。此类信息超出临床医生用“肉眼”所见的内容。如本文所公开的外科可视化***可在术中确定此类信息和/或将此类信息传达给临床医生，以加强术中决策并改善外科结果。在某些情况下，外科可视化***可与例如使用内窥镜或外镜的微创外科手术(MIS)、开放式外科手术和/或机器人方法兼容。
在另一个示例中，临床医生(例如，外科肿瘤医生)可能想要关闭关于外科工具与一个或多个关键结构的接近度的一个或多个警示，以避免在外科手术期间过于保守。在其他情况下，临床医生可能想要接收某些类型的警示诸如触觉反馈(例如，振动/蜂鸣)以指示接近度和/或“禁飞区”，从而保持充分远离一个或多个关键结构。例如，如本文所公开的外科可视化***可基于临床医生的经验和/或手术的期望进取性来提供灵活性。在此类情况下，***提供“知道太多”和“知道足够多”之间的平衡以预期和避开关键结构。外科可视化***可有助于在外科手术期间规划接下来的步骤。
实施例
本文所述主题的各个方面在以下编号的实施例中陈述。
实施例1-一种外科可视化***，所述外科可视化***包括控制电路。所述控制电路被配置成能够：从第一源接收指示解剖结构和所述解剖结构内的嵌入结构的第一成像数据；从第二源接收指示所述解剖结构的第二成像数据；根据所述第二成像数据生成所述解剖结构的三维数字表示；将指示所述解剖结构的所述第一成像数据与所述三维数字表示匹配；以及将指示所述嵌入结构的所述第一成像数据与所述三维数字表示配准。
实施例2-根据实施例1所述的外科可视化***，其中，所述控制电路被进一步配置成能够：从所述第二源接收指示处于后续状态的所述解剖结构的第三成像数据；根据所述第三成像数据更新所述解剖结构的所述三维数字表示；以及提供所述嵌入结构在所述解剖结构的所述三维数字表示上的更新的方位。
实施例3-根据实施例1所述的外科可视化***，其中，所述控制电路被进一步配置成能够：实时地从所述第二源接收指示所述解剖结构的更新的成像数据；实时地根据所述更新的成像数据更新所述解剖结构的所述三维数字表示；以及实时地提供所述嵌入结构在所述解剖结构的所述三维数字表示上的更新的方位。
实施例4-根据实施例1、2或3所述的外科可视化***，其中，所述控制电路被进一步配置成能够向监视器提供视频信号，所述视频信号实时地指示所述解剖结构和所配准的嵌入结构的所述三维数字表示。
实施例5-根据实施例1、2、3或4所述的外科可视化***，其中，所述第一成像数据由术前成像***提供给所述控制电路。
实施例6-根据实施例5所述的外科可视化***，其中，所述术前成像***选自超声成像***、磁共振成像(MRI)***和计算机断层摄影(CT)成像***中的一者。
实施例7-根据实施例1、2、3、4、5或6所述的外科可视化***，其中，所述第一成像数据包括所述解剖结构的三维数据。
实施例8-根据实施例1、2、3、4、5、6或7所述的外科可视化***，其中，所述第二成像数据由结构化光***提供给所述控制电路。
实施例9-根据实施例1、2、3、4、5、6、7或8所述的外科可视化***，其中，所述第二成像数据包括由图像传感器检测到的所述解剖结构的表面上的结构化光图案。
实施例10-根据实施例1、2、3、4、5、6、7、8或9所述的外科可视化***，其中，所述嵌入结构被配准到所述解剖结构的所述三维数字表示的体积部分。
实施例11-根据实施例1、2、3、4、5、6、7、8、9或10所述的外科可视化***，其中，所述控制电路被进一步配置成能够实时地确定相对于所配准的嵌入结构的距离。
实施例12-根据实施例11所述的外科可视化***，其中，相对于所配准的嵌入结构的所述距离包括从所配准的嵌入结构到机器人工具的距离。
实施例13-一种外科可视化***，所述外科可视化***包括：结构化光源，所述结构化光源被配置成能够将结构化光图案发射在解剖结构上；图像传感器，所述图像传感器被配置成能够检测所述解剖结构上的所述结构化光图案；以及控制电路。所述控制电路被配置成能够：从第一源接收指示所述解剖结构和所述解剖结构内的嵌入结构的第一成像数据；从所述图像传感器接收指示所述解剖结构的第二成像数据；根据所述第二成像数据生成所述解剖结构的三维数字表示；以及对所述第一成像数据和所述第二成像数据进行整合。
实施例14-根据实施例13所述的外科可视化***，其中，所述控制电路被进一步配置成能够：从所述图像传感器接收指示处于后续状态的所述解剖结构的第三成像数据；根据所述第三成像数据更新所述解剖结构的所述三维数字表示；以及提供所述嵌入结构在所述解剖结构的所述三维数字表示上的更新的方位。
实施例15-根据实施例14所述的外科可视化***，还包括光谱光源，所述光谱光源被配置成能够发射适于穿透所述解剖结构并到达所述嵌入结构的多个波长的光，其中所述图像传感器被进一步配置成能够检测所述多个波长的反射率，并且其中所述控制电路被进一步配置成能够基于所检测到的反射率从光谱图像检测所述嵌入结构。
实施例16-根据实施例15所述的外科可视化***，其中，所述控制电路被进一步配置成能够根据由所述图像传感器检测到的所述嵌入结构的所述光谱图像来校准所述嵌入结构在所述解剖结构的所述三维数字表示上的所述更新的方位。
实施例17-根据实施例13、14、15或16所述的外科可视化***，其中，所述第一成像数据和所述第二成像数据的整合包括将指示所述解剖结构的所述第一成像数据与所述三维数字表示匹配，以及将指示所述嵌入结构的所述第一成像数据与所述三维数字表示配准。
实施例18-根据实施例17所述的外科可视化***，其中，将指示所述嵌入结构的所述第一成像数据与所述三维数字表示配准包括将所述三维数字表示的体积部分指定为所述嵌入结构。
实施例19-一种存储计算机可读指令的非暂态计算机可读介质，所述计算机可读指令在被执行时致使机器：从第一源接收指示解剖结构和所述解剖结构内的嵌入结构的第一成像数据；从第二源接收指示所述解剖结构的第二成像数据；根据所述第二成像数据生成所述解剖结构的三维数字表示；将指示所述解剖结构的所述第一成像数据与所述三维数字表示匹配；将指示所述嵌入结构的所述第一成像数据与所述三维数字表示配准；从所述第二源接收指示所述解剖结构的更新的成像数据；根据所述更新的成像数据更新所述解剖结构的所述三维数字表示；以及提供所配准的嵌入结构在所述解剖结构的所述三维数字表示上的更新的方位。
实施例20-根据实施例19所述的存储计算机可读指令的非暂态计算机可读介质，所述计算机可读指令在被执行时致使所述机器向监视器提供视频信号，所述视频信号实时地指示所述解剖结构和所配准的嵌入结构的所述三维数字表示。
尽管已举例说明和描述了多个形式，但是申请人的意图并非将所附权利要求的范围约束或限制在此类细节中。在不脱离本公开的范围的情况下，可实现对这些形式的许多修改、变型、改变、替换、组合和等同物，并且本领域技术人员将想到这些形式的许多修改、变型、改变、替换、组合和等同物。此外，另选地，可将与所描述的形式相关联的每个元件的结构描述为用于提供由所述元件执行的功能的器件。另外，在公开了用于某些部件的材料的情况下，也可使用其他材料。因此，应当理解，上述具体实施方式和所附权利要求旨在涵盖属于本发明所公开的形式范围内的所有此类修改、组合和变型。所附权利要求旨在涵盖所有此类修改、变型、改变、替换、修改和等同物。
上述具体实施方式已经由使用框图、流程图和/或示例阐述了装置和/或方法的各种形式。只要此类框图、流程图和/或示例包含一个或多个功能和/或操作，本领域的技术人员就要将其理解为此类框图、流程图和/或示例中的每个功能和/或操作都可以单独和/或共同地通过多种硬件、软件、固件或实际上它们的任何组合来实施。本领域的技术人员将会认识到，本文公开的形式中的一些方面可作为在一台或多台计算机上运行的一个或多个计算机程序(例如，作为在一个或多个计算机***上运行的一个或多个程序)，作为在一个或多个处理器上运行的一个或多个程序(例如，作为在一个或多个微处理器上运行的一个或多个程序)，作为固件，或作为实际上它们的任何组合全部或部分地在集成电路中等效地实现，并且根据本公开，设计电路***和/或编写软件和/或硬件的代码将在本领域技术人员的技术范围内。另外，本领域的技术人员将会认识到，本文所述主题的机制能够作为多种形式的一个或多个程序产品进行分布，并且本文所述主题的例示性形式适用，而不管用于实际进行分布的信号承载介质的具体类型是什么。
用于编程逻辑以执行各种所公开的方面的指令可存储在***中的存储器内，诸如动态随机存取存储器(DRAM)、高速缓存、闪存存储器或其他存储器。此外，指令可经由网络或通过其他计算机可读介质来分发。因此，机器可读介质可包括用于存储或传输以机器(例如，计算机)可读形式的信息的任何机构，但不限于软盘、光学盘、光盘只读存储器(CD-ROM)、和磁光盘、只读存储器(ROM)、随机存取存储器(RAM)、可擦除可编程只读存储器(EPROM)、电可擦除可编程只读存储器(EEPROM)、磁卡或光卡、闪存存储器、或经由电信号、光学信号、声学信号或其他形式的传播信号(例如，载波、红外信号、数字信号等)在因特网上传输信息时使用的有形的、机器可读存储装置。因此，非暂态计算机可读介质包括适于以机器(例如，计算机)可读的形式存储或传输电子指令或信息的任何类型的有形机器可读介质。
如本文任一方面所用，术语“控制电路”可指例如硬连线电路***、可编程电路***(例如，计算机处理器，该计算机处理器包括一个或多个单独指令处理内核、处理单元，处理器、微控制器、微控制器单元、控制器、数字信号处理器(DSP)、可编程逻辑装置(PLD)、可编程逻辑阵列(PLA)、场可编程门阵列(FPGA))、状态机电路***、存储由可编程电路***执行的指令的固件、以及它们的任何组合。控制电路可以集体地或单独地实现为形成更大***的一部分的电路***，例如集成电路(IC)、专用集成电路(ASIC)、片上***(SoC)、台式计算机、膝上型计算机、平板计算机、服务器、智能电话等。因此，如本文所用，“控制电路”包括但不限于具有至少一个离散电路的电子电路、具有至少一个集成电路的电子电路、具有至少一个专用集成电路的电子电路、形成由计算机程序配置的通用计算设备的电子电路(如，至少部分地实施本文所述的方法和/或设备的由计算机程序配置的通用计算机，或至少部分地实施本文所述的方法和/或设备的由计算机程序配置的微处理器)、形成存储器设备(如，形成随机存取存储器)的电子电路，和/或形成通信设备(如，调节解调器、通信开关或光电设备)的电子电路。本领域的技术人员将会认识到，可以模拟或数字方式或它们的一些组合实施本文所述的主题。
如本文的任何方面所用，术语“逻辑”可指被配置成能够执行前述操作中的任一者的应用程序、软件、固件和/或电路***。软件可体现为记录在非暂态计算机可读存储介质上的软件包、代码、指令、指令集和/或数据。固件可体现为在存储器装置中硬编码(例如，非易失性)的代码、指令或指令集和/或数据。
如本文任一方面所用，术语“部件”、“***”、“模块”等可指计算机相关实体、硬件、硬件和软件的组合、软件或执行中的软件。
如本文任一方面中所用，“算法”是指导致所期望结果的有条理的步骤序列，其中“步骤”是指物理量和/或逻辑状态的操纵，物理量和/或逻辑状态可(但不一定)采用能被存储、转移、组合、比较和以其他方式操纵的电或磁信号的形式。常用于指这些信号，如位、值、元素、符号、字符、术语、数字等。这些和类似的术语可与适当的物理量相关联并且仅仅是应用于这些量和/或状态的方便的标签。
网络可包括分组交换网络。通信装置可能够使用所选择的分组交换网络通信协议来彼此通信。一个示例性通信协议可包括可能够允许使用传输控制协议/因特网协议(TCP/IP)进行通信的以太网通信协议。以太网协议可符合或兼容电气和电子工程师学会(IEEE)于2008年12月发布的标题为“IEEE 802.3 Standard”的以太网标准和/或本标准的更高版本。另选地或附加地，通信装置可能够使用X.25通信协议彼此通信。X.25通信协议可符合或兼容由国际电信联盟电信标准化部门(ITU-T)发布的标准。另选地或附加地，通信装置可能够使用帧中继通信协议彼此通信。帧中继通信协议可符合或兼容由国际电报电话咨询委员会(CCITT)和/或美国国家标准学会(ANSI)发布的标准。另选地或附加地，收发器可能够使用异步传输模式(ATM)通信协议彼此通信。ATM通信协议可符合或兼容ATM论坛于2001年8月发布的名为“ATM-MPLS Network Interworking 2.0”的ATM标准和/或该标准的更高版本。当然，本文同样设想了不同的和/或之后开发的连接取向的网络通信协议。
除非上述公开中另外明确指明，否则可以理解的是，在上述公开中，使用术语如“处理”、“估算”、“计算”、“确定”、“显示”的讨论是指计算机***或类似的电子计算装置的动作和进程，其操纵表示为计算机***的寄存器和存储器内的物理(电子)量的数据并将其转换成相似地表示为计算机***存储器或寄存器或其他此类信息存储、传输或显示装置内的物理量的其他数据。
一个或多个部件在本文中可被称为“被配置成能够”、“可配置成能够”、“可操作/可操作地”、“适于/可适于”、“能够”、“可适形/适形于”等。本领域的技术人员将会认识到，除非上下文另有所指，否则“被配置成能够”通常可涵盖活动状态的部件和/或未活动状态的部件和/或待机状态的部件。
术语“近侧”和“远侧”在本文中是相对于操纵外科器械的柄部部分的临床医生来使用的。术语“近侧”是指最靠近临床医生的部分，术语“远侧”是指远离临床医生定位的部分。还应当理解，为简洁和清楚起见，本文可结合附图使用诸如“竖直”、“水平”、“上”和“下”等空间术语。然而，外科器械在许多取向和方位中使用，并且这些术语并非是限制性的和/或绝对的。
本领域的技术人员将认识到，一般而言，本文、以及特别是所附权利要求(例如，所附权利要求的正文)中所使用的术语通常旨在为“开放”术语(例如，术语“包括”应解释为“包括但不限于”，术语“具有”应解释为“至少具有”，术语“包含”应解释为“包含但不限于”等)。本领域的技术人员还应当理解，如果所引入权利要求表述的具体数目为预期的，则此类意图将在权利要求中明确表述，并且在不存在此类叙述的情况下，不存在此类意图。例如，为有助于理解，下述所附权利要求可含有对介绍性短语“至少一个”和“一个或多个”的使用以引入权利要求。然而，对此类短语的使用不应视为暗示通过不定冠词“一个”或“一种”引入权利要求表述将含有此类引入权利要求表述的任何特定权利要求限制在含有仅一个这样的表述的权利要求中，甚至当同一权利要求包括介绍性短语“一个或多个”或“至少一个”和诸如“一个”或“一种”(例如，“一个”和/或“一种”通常应解释为意指“至少一个”或“一个或多个”)的不定冠词时；这也适用于对用于引入权利要求表述的定冠词的使用。
另外，即使明确叙述引入权利要求叙述的特定数目，本领域的技术人员应当认识到，此种叙述通常应解释为意指至少所叙述的数目(例如，在没有其他修饰语的情况下，对“两个叙述”的裸叙述通常意指至少两个叙述、或两个或更多个叙述)。此外，在其中使用类似于“A、B和C中的至少一者等”的惯例的那些情况下，一般而言，此类构造意在具有本领域的技术人员将理解所述惯例的意义(例如，“具有A、B和C中的至少一者的***”将包括但不限于具有仅A、仅B、仅C、A和B一起、A和C一起、B和C一起和/或A、B和C一起等的***)。在其中使用类似于“A、B或C中的至少一者等”的惯例的那些情况下，一般而言，此类构造意在具有本领域的技术人员将理解所述惯例的意义(例如，“具有A、B或C中的至少一者的***”应当包括但不限于具有仅A、仅B、仅C、A和B一起、A和C一起、B和C一起和/或A、B和C一起等的***)。本领域的技术人员还应当理解，通常，除非上下文另有指示，否则无论在具体实施方式、权利要求或附图中呈现两个或更多个替代术语的转折性词语和/或短语应理解为涵盖包括所述术语中的一者、所述术语中的任一个或这两个术语的可能性。例如，短语“A或B”通常将被理解为包括“A”或“B”或“A和B”的可能性。
对于所附的权利要求，本领域的技术人员将会理解，其中表述的操作通常可以任何顺序进行。另外，尽管以一个或多个序列出了各种操作流程图，但应当理解，可以不同于所示顺序的其他顺序执行各种操作，或者可同时执行所述各种操作。除非上下文另有规定，否则此类替代排序的示例可包括重叠、交错、中断、重新排序、增量、预备、补充、同时、反向，或其他改变的排序。此外，除非上下文另有规定，否则像“响应于”、“相关”这样的术语或其他过去式的形容词通常不旨在排除此类变体。
值得一提的是，任何对“一个方面”、“一方面”、“一范例”、“一个范例”的提及均意指结合所述方面所述的具体特征部、结构或特征包括在至少一个方面中。因此，在整个说明书的各种位置出现的短语“在一个方面”、“在一方面”、“在一范例中”、“在一个范例中”不一定都指同一方面。此外，具体特征部、结构或特征可在一个或多个方面中以任何合适的方式组合。
本说明书提及和/或在任何申请数据表中列出的任何专利申请，专利，非专利公布或其他公开材料均以引用方式并入本文，只要所并入的材料在此不一致。因此，并且在必要的程度下，本文明确列出的公开内容代替以引用方式并入本文的任何冲突材料。据称以引用方式并入本文但与本文列出的现有定义、陈述或其他公开材料相冲突的任何材料或其部分，将仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入。
概括地说，已经描述了由采用本文所述的概念产生的许多有益效果。为了举例说明和描述的目的，已经提供了一个或多个形式的上述具体实施方式。这些具体实施方式并非意图为详尽的或限定到本发明所公开的精确形式。可以按照上述教导内容对本发明进行修改或变型。选择和描述的一个或多个形式是为了说明原理和实际应用，从而使本领域的普通技术人员能够利用适用于预期的特定用途的各种形式和各种修改。与此一同提交的权利要求书旨在限定完整范围。

Claims (20)

1.一种外科可视化***，包括：
控制电路，所述控制电路被配置成能够：
从第一源接收指示解剖结构和所述解剖结构内的嵌入结构的第一成像数据；
从第二源接收指示所述解剖结构的第二成像数据；
根据所述第二成像数据生成所述解剖结构的三维数字表示；
将指示所述解剖结构的所述第一成像数据与所述三维数字表示匹配；以及
将指示所述嵌入结构的所述第一成像数据与所述三维数字表示配准。
2.根据权利要求1所述的外科可视化***，其中，所述控制电路被进一步配置成能够：
从所述第二源接收指示处于后续状态的所述解剖结构的第三成像数据；
根据所述第三成像数据更新所述解剖结构的所述三维数字表示；以及
提供所述嵌入结构在所述解剖结构的所述三维数字表示上的更新的方位。
3.根据权利要求1所述的外科可视化***，其中，所述控制电路被进一步配置成能够：
实时地从所述第二源接收指示所述解剖结构的更新的成像数据；
实时地根据所述更新的成像数据更新所述解剖结构的所述三维数字表示；以及
实时地提供所述嵌入结构在所述解剖结构的所述三维数字表示上的更新的方位。
4.根据权利要求1所述的外科可视化***，其中，所述控制电路被进一步配置成能够向监视器提供视频信号，所述视频信号实时地指示所述解剖结构和所配准的嵌入结构的所述三维数字表示。
5.根据权利要求1所述的外科可视化***，其中，所述第一成像数据由术前成像***提供给所述控制电路。
6.根据权利要求5所述的外科可视化***，其中，所述术前成像***选自超声成像***、磁共振成像(MRI)***和计算机断层摄影(CT)成像***中的一者。
7.根据权利要求6所述的外科可视化***，其中，所述第一成像数据包括所述解剖结构的三维数据。
8.根据权利要求1所述的外科可视化***，其中，所述第二成像数据由结构化光***提供给所述控制电路。
9.根据权利要求8所述的外科可视化***，其中，所述第二成像数据包括由图像传感器检测到的所述解剖结构的表面上的结构化光图案。
10.根据权利要求1所述的外科可视化***，其中，所述嵌入结构被配准到所述解剖结构的所述三维数字表示的体积部分。
11.根据权利要求1所述的外科可视化***，其中，所述控制电路被进一步配置成能够实时地确定相对于所配准的嵌入结构的距离。
12.根据权利要求11所述的外科可视化***，其中，相对于所配准的嵌入结构的所述距离包括从所配准的嵌入结构到机器人工具的距离。
13.一种外科可视化***，包括：
结构化光源，所述结构化光源被配置成能够将结构化光图案发射在解剖结构上；
图像传感器，所述图像传感器被配置成能够检测所述解剖结构上的所述结构化光图案；以及
控制电路，所述控制电路被配置成能够：
从第一源接收指示所述解剖结构和所述解剖结构内的嵌入结构的第一成像数据；
从所述图像传感器接收指示所述解剖结构的第二成像数据；
根据所述第二成像数据生成所述解剖结构的三维数字表示；以及
对所述第一成像数据和所述第二成像数据进行整合。
14.根据权利要求13所述的外科可视化***，其中，所述控制电路被进一步配置成能够：
从所述图像传感器接收指示处于后续状态的所述解剖结构的第三成像数据；
根据所述第三成像数据更新所述解剖结构的所述三维数字表示；以及
提供所述嵌入结构在所述解剖结构的所述三维数字表示上的更新的方位。
15.根据权利要求14所述的外科可视化***，还包括光谱光源，所述光谱光源被配置成能够发射适于穿透所述解剖结构并到达所述嵌入结构的多个波长的光，其中所述图像传感器被进一步配置成能够检测所述多个波长的反射率，并且其中所述控制电路被进一步配置成能够基于所检测到的反射率从光谱图像检测所述嵌入结构。
16.根据权利要求15所述的外科可视化***，其中，所述控制电路被进一步配置成能够根据由所述图像传感器检测到的所述嵌入结构的所述光谱图像来校准所述嵌入结构在所述解剖结构的所述三维数字表示上的所述更新的方位。
17.根据权利要求13所述的外科可视化***，其中，所述第一成像数据和所述第二成像数据的整合包括：
将指示所述解剖结构的所述第一成像数据与所述三维数字表示匹配；以及
将指示所述嵌入结构的所述第一成像数据与所述三维数字表示配准。
18.根据权利要求17所述的外科可视化***，其中，将指示所述嵌入结构的所述第一成像数据与所述三维数字表示配准包括将所述三维数字表示的体积部分指定为所述嵌入结构。
19.一种存储计算机可读指令的非暂态计算机可读介质，所述计算机可读指令在被执行时致使机器：
从第一源接收指示解剖结构和所述解剖结构内的嵌入结构的第一成像数据；
从第二源接收指示所述解剖结构的第二成像数据；
根据所述第二成像数据生成所述解剖结构的三维数字表示；
将指示所述解剖结构的所述第一成像数据与所述三维数字表示匹配；
将指示所述嵌入结构的所述第一成像数据与所述三维数字表示配准；
从所述第二源接收指示所述解剖结构的更新的成像数据；
根据所述更新的成像数据更新所述解剖结构的所述三维数字表示；以及
提供所配准的嵌入结构在所述解剖结构的所述三维数字表示上的更新的方位。
20.根据权利要求19所述的存储计算机可读指令的非暂态计算机可读介质，所述计算机可读指令在被执行时致使所述机器向监视器提供视频信号，所述视频信号实时地指示所述解剖结构和所配准的嵌入结构的所述三维数字表示。
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