Patent Publication Number: US-2021186650-A1

Title: Medical control apparatus, medical system, and method for controlling marking device

Description:
This application is a continuation application based on a PCT International Application No. PCT/JP2019/036126, filed on Sep. 13, 2019, whose priority is claimed on a U.S. provisional application No. 62/731,135, filed on Sep. 14, 2018. The content of both the PCT International Application and the US provisional application are incorporated herein by reference. 
    
    
     TECHNICAL FIELD 
     The present disclosure relates to a medical control apparatus configured to control a marking device to perform marking through a hole on the abdominal wall and the like, a medical system having a marking device, a marking device, and a method for controlling a marking device. 
     BACKGROUND ART 
     Conventionally, procedures of performing treatment by inserting a treatment device and an endoscope through different holes (openings) on the abdominal wall respectively are used in a laparoscopic surgery. According to the laparoscopic surgery, the incised wound is small compared with an abdominal operation and the laparoscopic surgery is superior in the minimally invasive characteristic. 
     In a case of resecting living tissues in the laparoscopic surgery, marking on the surface of the living tissues is performed so as to clarify a separation line. A surgeon performs the marking using a marking device (monopolar device and the like) while confirming the affected area using a laparoscopic image. A filed of view is narrow under the laparoscopic observation. It is difficult to operate the treatment device and endoscope in a narrow space such as inside the body cavity. Accordingly, it is difficult to accurately perform marking on the surface of the living tissues under the laparoscopic observation and it is a time-consuming operation. 
     An ablation device disclosed in Japanese Patent Publication No. 6461193 has a cauterization portion having a plurality of electrodes arranged in a line. The ablation device is configured to suitably perform adjustment so as to cause a cauterization surface to be contact in the living tissues and then cauterizes the living tissues linearly along the cauterization surface having an elongated shape. 
     SUMMARY 
     According to an aspect of the present disclosure, a medical system includes a marking device inserted into a body cavity, the marking device having an applicator configured to transmit energy so as to perform marking on target tissues; and a controller comprises at least a processor and configured to control the marking device. The applicator has a plurality of application elements which individually applies energy. The controller is configured to set a marking region on the target tissues in the body cavity; and selectively control the application elements among the plurality of application elements corresponding to the marking region to apply the energy. 
     According to another aspect of the present disclosure, a medical control apparatus includes a control circuit configured to control a marking device inserted into a body cavity, wherein the marking device has an applicator configured to transmit energy so as to perform marking on target tissues, and the applicator has a plurality of application elements which individually applies energy. The control circuit is configured to set a marking region on the target tissues in the body cavity; and selectively control the application elements among the plurality of application elements corresponding to the marking region to apply the energy. 
     According to a further aspect of the present disclosure, a method for controlling a marking device inserted into a body cavity, wherein the marking device has an applicator configured to transmit energy so as to perform marking on target tissues, and the applicator has a plurality of application elements which individually applies energy, includes setting a marking region on the target tissues in the body cavity for performing the marking; and selectively controlling the application elements among the plurality of application elements corresponding to the marking region to apply the energy. 
    
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
         FIG. 1  is a view showing an overall configuration of a medical system having a control apparatus according to a first embodiment of the present disclosure. 
         FIG. 2  is a diagram showing a hardware configuration of the medical system. 
         FIG. 3  is a view showing a marking device of the medical system. 
         FIG. 4  is a view showing a treatment portion of the marking device when viewing from an axial direction. 
         FIG. 5  is a view showing an overall configuration example of a control circuit of the control apparatus of the medical system. 
         FIG. 6  is a control flow chart of the control circuit. 
         FIG. 7  is a view showing an example of a determined separation line. 
         FIG. 8  is a view showing an example of the determined separation line. 
         FIG. 9  is a view showing an example of the determined separation line. 
         FIG. 10  is a view showing the treatment portion approaching the separation line. 
         FIG. 11  is a view showing the treatment portion whose heating element is generating heat. 
         FIG. 12  is a view showing the treatment portion having a modification example of an applicator. 
         FIG. 13  is a view showing the treatment portion of the marking device that is controlled by a control apparatus according to a second embodiment of the present disclosure. 
     
    
    
     DESCRIPTION OF EMBODIMENT 
     First Embodiment 
     A first embodiment of the present disclosure will be described with reference from  FIG. 1  to  FIG. 11 . 
       FIG. 1  is a view showing an overall configuration of a medical system  100  having a control apparatus  3  according to the present embodiment.  FIG. 2  is a hardware configuration diagram of the medical system  100 . 
     [Medical System  100 ] 
     As shown in  FIG. 1  and  FIG. 2 , the medical system  100  has a marking device  1 , an endoscope  2 , a control apparatus  3 , a display apparatus  4 , an input apparatus  5 , and an assistance treatment device  1 A. The medical system  100  is configured to assist the procedures performed by inserting the marking device  1  and the endoscope  2  into the body cavity through different holes (openings) opened on the abdominal wall respectively during the laparoscopic surgery. 
       FIG. 3  is a view showing the marking device  1 . 
     The marking device (treatment device)  1  has an elongated insertion portion  10  that is insertable into the abdominal cavity (body cavity) of a patient, an operation portion  11  provided at a proximal end side of the insertion portion  10 , and a treatment portion  12  provided at a distal end side of the insertion portion  10 . The surgeon introduces the treatment portion  12  and the insertion portion  10  into the abdominal cavity by inserting the treatment portion  12  and the insertion portion  10  through a trocar T puncturing the abdomen B of the patient. 
       FIG. 4  is a view showing the treatment portion  12  viewing from an axial direction A. 
     The treatment portion  12  is configured to apply a power on the affected area due to the energy supplied from an energy supply source. The treatment portion  12  is attached to the insertion portion  10  to be bendable. The treatment portion  12  is formed in a columnar shape and to be rigid. The treatment portion  12  has an applicator  15 , a light emitter  16  and a marker  17 . The applicator  15  and the light emitter  16  are disposed on an external circumferential surface of the treatment portion  12 , while the applicator  15  and the light emitter  16  are disposed to sandwich a central axis O in the axial direction A to be at opposite sides with each other. 
     The applicator (energy applicator)  15  is configured to have a plurality of application elements  15   a  which are arrayed along the axial direction A of the treatment portion  12 . According to the present embodiment, the application elements  15   a  are monopolar electrodes. The plurality of application elements  15   a  are individually controlled to generate heat. For example, there is a possibility that all of the plurality of application elements  15   a  are controlled to generate heat, and there is a possibility that only one selected application element  15   a  is controlled to generate heat. The application element  15   a  is formed to be elongated along a circumferential direction orthogonal to the axial direction A. 
     The light emitter  16  is configured to have a plurality of light-emitting elements  16   a  which are arrayed along the axial direction A of the treatment portion  12 . The plurality of light-emitting elements  16   a  are individually controlled to emit light. For example, there is a possibility that all of the plurality of light-emitting elements  16   a  are controlled to emit light, and there is a possibility that only one selected light-emitting element  16   a  is controlled to emit light. 
     The application element  15   a  has a corresponding light-emitting element  16   a.  A pair of the application element  15   a  and the light-emitting element  16   a  are positioned at two sides of the central axis O in the axial direction A. The light-emitting element  16   a  is configured to emit light in response to the heat generation of the corresponding application element  15   a.  The surgeon can specify the heated application element  15   a  by visually confirming the position of the light-emitting element  16   a  that is emitting light. 
     The marker  17  is a member applied with a pattern and a color suitable for image recognition. The marker  17  is provided at two locations at the distal end side and the proximal end side in the axial direction A of the treatment portion  12 . The applicator  15  and the light emitter  16  are positioned between the two markers  17 . 
     The operation portion  11  is a member operated by the surgeon. The surgeon can change the position and orientation of the treatment portion  12  of the marking device  1  by grasping the operation portion  11  to move the marking device  1 . The operation portion  11  has a handle  11   a.  The surgeon can bend the operation portion  12  with respect to the insertion portion  10  by rotating the handle  11   a  with respect to the operation portion  11 . 
     Inside the insertion portion  10  and the operation portion  11 , control-signal lines for controlling the treatment portion  12 , power lines for supplying the power to the treatment portion  12  are wired therein. The control-signal lines and power lines are connected with the control apparatus  3 . 
     As shown in  FIG. 1 , the assistance treatment device  1 A has an elongated insertion portion  10 A being insertable into the abdominal cavity of the patient and an operation portion  11 A provided at a proximal end side of the insertion portion  10 A. The surgeon introduces the insertion portion  10 A into the abdominal cavity by inserting the insertion portion  10 A through the trocar T puncturing the abdomen B of the patient. 
     The insertion portion  10 A has a pair of grasping members  12 A configured to perform treatment on the affected area of the patient at the distal end thereof. The operation portion  11 A is a member configured to operate the pair of grasping members  12 A. The operation portion  11 A has a handle, and the operation portion  11 A is configured to open and close the pair of grasping members  12 A by relatively moving the handle with respect to the other part of the operation portion  11 A. 
     The assistance treatment device  1 A is introduced into the abdominal cavity so as to grasp and retain the marking device  1 . The assistance treatment device  1 A is not an essential configuration element of the medical system  100 . 
     The endoscope (image apparatus)  2  has an elongated and rigid insertion portion  20  being insertable into the abdominal cavity of the patient and a handheld portion  21 . The surgeon introduces the insertion portion  20  into the abdominal cavity by inserting the insertion portion  20  through the trocar T puncturing the abdomen B of the patient. 
     The insertion portion  20  has an imaging portion  22  at the distal end thereof. The imaging portion  22  has lens and imaging element configured to capture images inside the abdomen of the patient. The insertion portion  20  introduced into the abdominal cavity is disposed at a position so as to cause the imaging portion  22  to be able to capture images of the affected area of the treatment target inside the abdomen. The imaging portion  22  may have an optical zoom function or electrical zoom function. 
     The handheld portion  21  is a member operated by the surgeon. The surgeon can change the position and the orientation of the imaging portion  22  of the endoscope  2 . The insertion portion  20  may further have a bending portion. It is possible to change the position and orientation of the imaging portion  22  by bending the bending portion provided in part of the insertion portion  20 . 
     Inside the handheld portion  21 , the control-signal lines for controlling the imaging portion  22 , the transmission-signal lines for transmitting the captured images by the imaging portion  22  and the like are wired therein. The control-signal lines and the transmission-signal lines are connected with the control apparatus  3 . 
     As shown in  FIG. 2 , the control apparatus  3  (medical control apparatus) has a control circuit  33 . The control apparatus  3  is configured to receive the captured image by the imaging portion  22  of the endoscope  2  and transmit them as display image to the display apparatus  4 . The control apparatus  3  is configured to control the treatment portion  12  of the marking device  1 . 
     The control circuit  33  is an apparatus (computer) having hardware including a processor such as a Central Processing Unit (CPU), a memory and the like so as to be able to execute program. Functions of the control circuit  33  is realizable as the functions of the program (software) by making the control circuit  33  to read and execute the program for controlling the processor. At least part of the control circuit  33  may be configured by exclusive logic circuit and the like. Furthermore, the same functions may be realized by connecting at least part of the hardware configuring the control circuit  33  by communication lines. 
       FIG. 5  is a view showing an overall configuration example of the control circuit  33 . 
     The control circuit  33  has a processor  34 , a memory  35  capable of reading program, a storage  36  and an input-output control portion  37 . The program supplied to the control circuit  33  for controlling the operation of the circuit  33  is read into the memory  35  and executed by the processor  34 . 
     The storage  36  is a non-volatility recording medium for storing the above-described program and necessary data. The storage  36 , for example, may be configured from a ROM or a hard disk and the like. The program stored in the storage  36  is read into the memory  35  and executed by the processor  34 . 
     The input-output control portion  37  receives input data from the endoscope  2  and transmits the input data to the processor  34  and the like. The input-output control portion  37  is configured to generate data and control signals with respect to the marking device  1 , the endoscope  2  and the display apparatus  4  according to the instructions from the processor  34 . 
     The control circuit  33  is configured to receive the captured image as the input data from the endoscope  2  and causes the captured image to be read in the memory  35 . The processor  34  performs image processing with respect to the captured image according to the program read into the memory  35 . The captured image to which the image processing is performed is transmitted to the display apparatus  4  as the display image. 
     The control circuit  33  is configured to generate the display image by performing image processing with respect to the captured image, such as an image format transformation, a contrast adjustment, and a resize processing. The control circuit  33  performs the image processing of superimposing a virtual image of the separation line SL described below on the display image. 
     The control circuit  33  is configured to control the treatment portion  12  of the marking device  1 . The control circuit  33  selects the application elements  15   a  satisfying conditions described below among the plurality of application elements  15   a  and controls the selected application elements  15   a  to apply energy. The control circuit  33  selects the light-emitting elements  16   a  satisfying conditions described below among the plurality of light-emitting elements  16   a  and controls the selected light-emitting elements  16   a  to emit light. 
     The control circuit  33  is not limited to a single apparatus having hardware. For example, the control circuit  33  may be configured by separating the processor  34 , the memory  35 , the storage  36  and the input-output control portion  37  as individual hardware and connecting the hardware by communication lines. Otherwise, the control circuit  33  maybe configured by separating the storage  36  and implementing a cloud system by connecting the storage  36  using communication lines. 
     The control circuit  33  may have further configurations necessary for controlling the operations of the control apparatus  3  besides the processor  34 , the memory  35 , the storage  36  and the input-output control portion  37  as shown in  FIG. 5 . For example, the control circuit  33  may further have an image calculation portion configured to perform part or the whole of the image processing and image recognition processing by the processor  34 . By further including the image calculation portion, the control circuit  33  may execute particular image processing and image recognition processing rapidly. An image transmission portion configured to perform the transmission of the display image from the memory  35  to the display apparatus  4  may be further implemented. 
     The display apparatus  4  is an apparatus configured to display the display image transmitted by the control apparatus  3 . The display apparatus  4  has a conventional monitor  41  such as an LCD display and the like. The display apparatus  4  may have multiple monitors  41 . The display apparatus  4  may have a head mounted display or a projector instead of the monitor  41 . 
     The monitor  41  may perform a GUI display by displaying a Graphic User Interface (GUI) image generated by the control apparatus  3 . For example, the monitor  41  may display the control information and caution information of the medical system  100  as the GUI display to the surgeon. In a case in which an information input from the surgeon is necessary for the control circuit  33 , the control circuit  33  may control the display apparatus  4  to display a message for prompting the information input from the input apparatus  5  and other GUI display necessary for the information input. 
     Then input apparatus  5  is an apparatus configured to input instructions of the surgeon to the control circuit  33 . As shown in  FIG. 2 , the input apparatus  5  has an input portion  51  and an operation input portion  52 . 
     The input portion  51 , for example, is a keyboard or a mouse. The input portion  51  may be configured by a switch or a touch panel. The touch panel may be integrally configured with the monitor  41 . The input to the input portion  51  is transmitted to the control circuit  33 . 
     The operation input portion  52  is an apparatus configured to input operation instructions with respect to the treatment portion  12  of the marking device  1 . For example, the operation input portion  32  has an operation button, and the operation button is an energization-permission button for inputting the instruction of permitting the energization to the marking device  1 . The input to the operation input portion  52  is transmitted to the control circuit  33 . The control circuit  33  permits the energization to the treatment portion  12  according to the operation to the operation input portion  52 . 
     [Operation of Medical System  100 ] 
     Next, operations of the medical system  100  will be described by taking the laparoscopic surgery as an example by referring to  FIG. 6  to  FIG. 11 . According to the present embodiment, living tissues of the liver L are taken as the target tissues. 
     The Surgeons perform preoperative planning to create anatomical information of the target tissues using conventional method before the laparoscopic surgery. For example, the surgeons create three-dimensional shape data of the target tissues as the anatomical information from a plurality of CT images. A three-dimensional coordinate system of the three-dimensional shape data generated during the preoperative planning is referred to as a “model coordinate system (first coordinate system) C 1 ”. 
     The surgeons create a model M of the target tissues during the preoperative planning. The model M is associated with the three-dimensional coordinates in the model coordinate system C 1 , and positions of each part of the model M may be specified by the three-dimensional coordinates in the model coordinate system C 1 . The position coordinate (three-dimensional coordinate in the model coordinate system C 1 ) of the tumor TU removed during the laparoscopic surgery is included in the model M. 
     The model M of the target tissues created as the anatomical information during the preoperative planning is stored in the storage  36  of the control circuit  33  of the control apparatus  3  (anatomical information acquisition processing). The model M may be created by an external device besides the medial system  100 , or the medical system  100  may obtain the created model M from the external device. 
     The control apparatus  3  extracts and stores a plurality of characteristic points F in the model M (characteristic point extraction processing). The plurality of characteristic points F are extracted by using conventional characteristic point extraction method. The plurality of characteristic points F, together with characteristic values calculated according to a predetermined standard suitable to express the characteristic, are specified by the three-dimensional coordinates in the model coordinate system C 1  and stored in the storage  36 . The extraction and the storage of the plurality of characteristic points F may be performed before the surgery or during the surgery. 
     Subsequently, operations of the medical system  100  during the laparoscopic surgery will be described. The surgeon creates multiple holes (openings) for locating the trocar T in the abdomen of the patient and punctures the trocar T into the holes. 
     Subsequently, the scopist operates the endoscope  2  to insert the insertion portion  20  of the endoscope  2  through the trocar T puncturing the abdomen of the patient so as to introduce the insertion portion  20  into the abdominal cavity. Subsequently, the surgeon inserts the insertion portion  10  of the marking device  1  through the trocar T puncturing the abdomen of the patient so as to introduce the insertion portion  10  into the abdominal cavity. As shown in  FIG. 1 , the surgeon also inserts the insertion portion  10 A of the assistance treatment device  1 A through the trocar T so as to introduce the insertion portion  10 A into the abdominal cavity. The surgeon uses the assistance treatment device  1 A to hold the marking device  1 . 
     Hereinafter, the description will be made following the control flow chart of the control circuit  33  shown in  FIG. 6 . As shown in  FIG. 6 , when the control circuit  33  is started up, the control circuit  33  performs the initiation and starts the control (Step S 10 ). Subsequently, the control circuit  33  executes Step S 11 . 
     During Step S 11 , the control circuit  33  extracts a plurality of corresponding points A in the display image in correspondence with the plurality of characteristic points F (corresponding point extraction processing). The control circuit  33  extracts the corresponding points A in the display image according to the characteristic values of the characteristic points F that are stored in the storage  36  in advance. During the extraction processing, a method suitably selected from the conventional template-matching method and the like is used. A three-dimensional coordinate system of a display space for displaying the display image is referred to as a “display coordinate system (second coordinate system) C 2 ”. The three-dimensional coordinates of the extracted corresponding points A in the display coordinate system are stored in the storage  36 . 
     During Step S 12 , the control circuit  33  performs position aligning (registration) of the model coordinate system C 1  of the model M and the display coordinate system C 2  of the display space shown by the display image according to the plurality of characteristic points F and the plurality of corresponding points A (registration processing). During the registration, a method suitably selected from the conventional coordinate transformation methods is used. For example, the control circuit  33  performs the registration by calculating the association for transforming the coordinate position in the model coordinate system C 1  to the coordinate position in the display coordinate system C 2 . 
     When the control circuit  33  finishes the registration processing, the coordinate position of the model M in the model coordinate system C 1  may be transformed into the coordinate position of the display space in the display coordinate system C 2 . Subsequently, the control circuit  33  executes Step S 13 . 
     During Step S 13 , the control circuit  33  sets the separation line (marking region) SL of the target tissues according to the position of the tumor TU in the display coordinate system C 2  (marking region setting processing). The position coordinates of the tumor TU included in the model M in the model coordinate system C 1  are transformed into the position coordinates of the tumor TU in the display coordinate system C 2 . 
       FIG. 7  is a view showing an example of the determined separation line (marking region) SL. 
     For example, the surgeon inputs a radius R of the separation line SL from the input portion  51 . The control circuit  33  sets a circle on the surface of the target tissues as the separation line SL, wherein the circle has the input radius R from the center of the tumor TU. 
       FIG. 8  is a view showing an example of the determined separation line (marking region) SL. 
     For example, the surgeon inputs a margin distance D of the separation line SL from the input portion  51 . The control circuit  33  sets a line on the surface of the target tissues as the separation line SL, wherein the line is set to around the tissue TU and has the margin distance D from the external edge of the tumor TU. 
       FIG. 9  is a view showing an example of the determined separation line (marking region) SL. 
     For example, the surgeon inputs a depth F and a resection angle θ of the separation line SL from the input portion  51 . A position having the depth F at the central point of the tumor TU is set to be a reference point G, and the control circuit  33  sets an intersection line of the surface of the target tissues and a cone having an apex at the reference point G and an apex angle equal to the resection angle θ as the separation line SL. 
     In a case in which the input portion  51  is a pen tablet, the surgeon may use the pen tablet so as to directly trace on the tablet where the display image is displayed using the pen. The control circuit  33  may set the region in the display image that is designated by the user using the pen as the separation line SL. 
     The control circuit  33  generates a virtual image of the determined separation line SL in the display coordinate system C 2  and superimposes the virtual image on the display image. The control circuit  33  subsequently executes Step S 14 . 
     During Step S 14 , the control circuit  33  detects the input for permitting the energization. The control circuit  33  is on standby until the input for permitting the energization from the operation input portion  52  is detected. When the control circuit  33  detects the input for permitting the energization, the circuit  33  executes Step S 15 . 
       FIG. 10  is a view showing the treatment portion  12  approaching the separation line SL. 
     After the surgeon inputs the instruction for permitting the energization to the marking device  1  from the operation input portion  52 , the surgeon moves the treatment portion  12  to approach the separation line SL. 
     During Step S 15 , the control circuit  33  detects whether the applicator  15  approaches the separation line (marking region) SL according to the information indicating the separation line (marking region) SL. More specifically, the control circuit  33  detects whether at least one of the application elements  15   a  of the applicator  15  and the separation line approach to each other to a markable distance. The markable distance refers to a distance from which the application element  15   a  is capable of performing the marking on the surface of the target tissues. The application element  15   a  according to the present embodiment is the monopolar electrode such that the markable distance refers to the distance that the application element  15   a  and the target tissues come in contact with each other. A region in the separation line (marking region) SL where the applicator  15  approaches until the markable distance is defined as a “proximity area PA”. 
     The control circuit  33  may determine an overlapping region where the superimposed separation line SL and a device region in which the applicator  15  is displayed in the display image overlap with each other as the proximity area PA. 
     The control circuit  33  may determine the proximity area PA by performing image processing with respect to the display image. According to the image processing, for example, the distance between the imaging portion  22  and the application element  15   a  and the distance between the imaging portion  22  and the surface of the target tissues shown by the separation line SL are calculated and compared. It is possible to attach a contact sensor to each application element  15   a  and only permit the application element  15   a  which is in contact with the target tissues. 
     The control circuit  33  may determine the proximity area PA from the three-dimensional position of the separation line SL and the applicator  15 . For example, the applicator  15  has a position sensor. The control circuit  33  calculates the position coordinate of the applicator  15  in the display coordinate system C 2  according to the output of the position sensor. The control circuit  33  compares the position coordinate of the separation line SL in the display coordinate system C 2  and the position coordinate of the applicator  15  in the display coordinate system C 2  so as to determine the proximity area PA. 
     The control circuit  33  is on standby until the proximity area PA is determined. When the proximity area PA is determined, the control circuit  33  executes Step S 16 . 
       FIG. 11  is a view showing the treatment portion  12  whose application element  15   a  generates heat. 
     During Step S 16 , the control circuit  33  causes the application element  15   a  closest to the proximity area PA to generate heat so as to cauterize the surface of the target tissues (marking processing). In a case in which multiple application elements  15   a  approach the separation line SL at the markable distance, all of the corresponding application elements  15   a  may be controlled to generate heat. The light-emitting elements  16   a  emit light in response to the heat generation of the corresponding application elements  15   a.  The surgeon may identify the application elements  15   a  which are generating heat by visually confirming the positions of the light-emitting elements  16   a  which are emitting light. 
     The control circuit  33  subsequently executes Step S 17 . During Step S 17 , the control circuit  33  determines whether to finish the control processing. In a case in which the control processing is not finished, the control circuit  33  executes Step S 15  again. Ina case in which the control processing is finished, the control circuit  33  subsequently executes Step S 18  and finished the control processing. 
     According to the control apparatus  3  and medical system  100  disclosed in the present embodiment, the surgeon may simply and accurately perform the marking processing along the separation line SL on the surface of the target tissues by moving the treatment portion  12  to trace on the separation line SL until the whole surface on the separation line SL is cauterized. Since the light-emitting elements  16   a  corresponding to the application elements  15   a  emit light, the surgeon may easily identify the application elements  15   a  which are generating heat. 
     The applicator  15  of the marking device  1  is disposed on the external circumferential surface of the columnar-shaped treatment portion  12 . As shown in  FIG. 3 , the treatment portion  12  may be disposed to be orthogonal with respect to the insertion portion  10 . Accordingly, the surgeon may perform the marking processing on the surface of the target tissues by sliding the treatment portion  12  inserted into the abdominal cavity on the surface of the target tissues only. The surgeon may simply and accurately perform the marking without greatly moving the treatment portion  12  in the narrow abdominal cavity. 
     The first embodiment of the present disclosure has been described above in details by referring to figures; however, the specific configuration is not limited to the embodiment and design changes are possible without departing from the spirit of the present disclosure. The configuration elements shown in the above-described embodiment and following modification examples may be suitably combined. 
     FIRST MODIFICATION EXAMPLE 
     For example, according to the above-described embodiment, the light emitter  16  emits light only when the applicator  15  is activated; however, the embodiment of the light emitter is not limited thereto. The light emitter may emit multicolor light. For example, the light emitter capable of emitting multicolor light may be configured to emit red color light when the applicator  15  is activated and emit blue color light when the contact sensor included in the applicator  15  detects the predetermined condition. 
     SECOND MODIFICATION EXAMPLE 
     For example, according to the above-described embodiment, the application element  15   a  is the monopolar electrode; however, the embodiment of the application element is not limited thereto. The application element only has to be able to cauterize the target tissues by extracting energy, for example, the application element may be a laser light source. In the case in which the application element is the laser light source, the markable distance is larger than the markable distance according to the first embodiment. 
     THIRD MODIFICATION EXAMPLE 
     For example, according to the above-described embodiment, the separation line (marking region) SL is formed in a linear shape; however, the embodiment of the separation line (marking region) is not limited thereto. The separation line (marking region) may have a surface shape. 
     FOURTH MODIFICATION EXAMPLE 
     For example, according to the above-described embodiment, the applicator  15  is configured from the plurality of application elements  15   a  arrayed along the axial direction A; however, the embodiment of the applicator is not limited thereto.  FIG. 12  is a view showing a treatment portion  12 B having an applicator  15 B as a modification example of the applicator  15 . The applicator may be configured to have a plurality of application elements  15   a  arrayed in two rows as the applicator  15 B shown in  FIG. 12 . The applicator may be configured to have the plurality of application elements  15   a  arrayed in three or more than rows. 
     Second Embodiment 
     A second embodiment of the present disclosure will be described by referring to  FIG. 13 . In the following description, the common configuration that has been described will be designated with the same reference sign and the duplicated description will be omitted. A control apparatus  3 C (not shown) according to the present embodiment is different from the control apparatus  3  according to the first embodiment in the control processing with respect to the marking device  1 C. The configuration of the control apparatus  3 C is the same with that of the control apparatus  3  according to the first embodiment. 
       FIG. 13  is a view showing a treatment portion  12 C of the marking device  1 C. 
     The treatment portion  12 C is formed in a columnar shape and rigid. The treatment portion  12 C has an applicator  15 C, the light emitter  16  and the marker  17 . The applicator  15 C and the light emitter  16  are disposed on the external circumferential surface of the treatment portion  12 C and disposed to sandwich the central axis O in the axial direction A to be at opposite sides with each other. 
     The applicator  15 C has a guide rail  18 , a slider  19  and the application element  15   a.  The guide rail  18  is a rail extending along the axial direction A of the treatment portion  12 C. The slider  19  is attached to the guide rail  18  to be advanceable and retractable. The application element  15   a  is attached to the slider  19 . The control circuit  33  may cause the slider  19  to move along the guide rail  18  so as to move the application element  15   a.    
     After detecting the proximity area PA, the control circuit  33  is configured to move the application element  15   a  to a region closest to the proximity area PA and then activate the application element  15   a.  Accordingly, the control circuit  33  causes the application element  15   a  in the proximity area PA to generate heat so as to cauterize the surface of the target tissues (marking processing). 
     According to the control apparatus  3 C disclosed in the present embodiment, it is possible to only activate the application element  15   a  in the proximity area PA without arraying the plurality of application elements  15   a  so as to simply and accurately performing the marking processing. 
     The second embodiment of the present disclosure has been described above in details; however, the specific configuration is not limited to the embodiment and design changes are possible without departing from the spirit of the present disclosure. The configuration elements shown in the above-described embodiments and modification examples may be suitably combined. 
     Several embodiments and modification examples of the present disclosure have been described above; however, the technical scope of the present disclosure is not limited to the embodiment and the application examples. The present disclosure is not limited to the above-described embodiments and is limited only by the accompanying claims.