Abstract:
The invention relates to a medical cutting and/or holding instrument having a shaft, a handle consisting of two gripping members on the proximal end of the shaft, and a push-pull rod for activating a tool that is positioned on the distal end of the shaft and consists of two jaw members, such that the push-pull rod can be coupled with at least one rotatable jaw member of the tool on the distal end and with one movable gripping member of the handle on the proximal end. To produce a medical cutting and/or holding instrument that is of simple construction and allows simple and versatile handling, it is proposed with the invention that the push-pull rod is configured as a component that is independent of the shaft and mounted outside the shaft, entirely on the rotatable jaw member of the tool and on the movable gripping member of the handle.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS  
       [0001]     The present application is a continuation of pending International patent application PCT/EP2005/001804 filed on Feb. 22, 2005 which designates the United States and claims priority from German patent application 10 2004 009 199.4 filed on Feb. 25, 2004, the content of which is incorporated herein by reference. 
     
    
     FIELD OF THE INVENTION  
       [0002]     The invention relates to a medical cutting and/or holding instrument having a shaft, a handle consisting of two gripping members on the proximal end of he shaft, and a push-pull rod for activating a tool that is positioned on the distal end of the shaft and consists of two jaw members, such that the push-pull rod can be coupled with at least one rotatable jaw member of the tool on the distal end and with one movable gripping member of the handle on the proximal end for opening and closing the tool.  
       BACKGROUND OF THE INVENTION  
       [0003]     Medical cutting and/or holding instruments are widely employed both in open surgery and in endoscopic surgery. Because the nature of their use demands a very slender construction for endoscopic instruments, which as a rule are inserted through hollow trocar sleeves into the surgical area, in endoscopic surgery so-called tubular shaft instruments have established and proved themselves for the configuration of cutting and/or holding instruments. These tubular shaft instruments are distinguished in that the instrument shaft is configured as a hollow tube and the push-pull rod provided for activating the distal-end jaw member is positioned so that it can be slid along the interior of the hollow shaft tube. Because of this miniaturizing of the push-pull rod, required by the construction, and the dual-sided jointed mechanisms, tubular shaft instruments of this kind are not suited for use in open surgery, in which it is frequently necessary to transmit considerable force by means of the push-pull rod.  
         [0004]     In addition, the hollow instrumental shafts of these instruments can only be cleaned with difficulty and require a complex structure for dismantling the instruments.  
         [0005]     A generic medical instrument for open surgery is known, for instance, from DE 195 13 572 C2. In this familiar surgical instrument the push-pull rod is mounted in slit channels on the instrumental shaft. This construction allows the use of massive forceps profiles in configuring the shaft as well as the push-pull rod, so that great force can also be transmitted by the handle to the distal-end tool.  
         [0006]     The disadvantage of this known construction, however, is that the push-pull rod and the shaft are coupled to one another by the slit channels and thus the two components must be precisely adapted to one another. First, this requires a precise technical manufacturing adaptation of the components that are to be coupled to one another and, secondly, it clearly limits flexibility for using the instrument for other purposes.  
         [0007]     It is consequently the aim of the invention to design a medical cutting and/or holding instrument of the aforementioned type in such a way that, along with simple construction, it makes possible a simple and versatile operation.  
       SUMMARY OF THE INVENTION  
       [0008]     This aim is fulfilled by means of the invention in that the push-pull rod is configured as a component that is independent of the shaft and that is mounted outside the shaft, exclusively on the rotatable jaw member of the tool and on the movable gripping member of the handle.  
         [0009]     Because of the complete separation of the components—the shaft and push-pull rod—according to the invention, it becomes possible for the first time to configure both components independently of one another precisely as required by the particular intended use. In addition to allowing easy and thorough cleaning of the two separate components, this design has the advantage that the shaft and/or the push-pull rod are individually replaceable for the purposes of adapting the instrument.  
         [0010]     According to a practical embodiment of the invention, it is possible to expand the usefulness of a medical instrument designed according to the invention for a range of surgical purposes because the push-pull rod and the shaft are of distinct configuration in terms of shape and/or length.  
         [0011]     To allow an ergonomically favorable operation even in narrow and deep surgical locations, it is further proposed with the invention that the push-pull rod and/or the shaft has at least one bend or curvature with respect to its longitudinal axis.  
         [0012]     According to a practical embodiment of the invention it is proposed that a breech is made in the shaft or in the push-pull rod for passage of the other respective component.  
         [0013]     For example, according to another embodiment of the invention, at least one channel is configured running in the axial direction in or on the shaft and/or the push-pull rod to receive lighting wires and/or to form irrigation and suction channels for liquid and gas media.  
         [0014]     Work on deeply situated surgical access spots, according to the invention, can be further facilitated by an illumination element, for instance with internal power supply, that can be secured on the shaft or on the push-pull rod.  
         [0015]     According to a preferred embodiment of the invention it is proposed that the push-pull rod on the proximal end can be dissolubly secured on the movable gripping member by a coupling mechanism. This dissoluble coupling onto the movable gripping member clearly facilitates the cleaning and simplifies the assembly and disassembly of the instrument. This coupling mechanism preferably takes the form of a screw-in connection, so that it is possible, for instance, to screw the push-pull rod directly into the movable gripping member to form this screw-in connection, or else to connect the two components to one another by means of a screw-in threaded bolt.  
         [0016]     It is further proposed with a first embodiment of the invention that the movable gripping member of the handle takes the form of a gripping member that can rotate around a pivot axis, so that the pivot axis, around which the gripping member can rotate, can be mounted either on the shaft or on the rigid gripping member of the handle.  
         [0017]     According to an alternative second embodiment of the invention it is proposed that the movable gripping member of the handle is configured as a gripping member that can be slid axially in the direction of the push-pull rod.  
         [0018]     The number of total components to be installed can be reduced, according to the invention, if the non-movable gripping member is configured as a one-piece unit with the shaft.  
         [0019]     Finally, it is proposed with the invention that a support independent of the movable gripping member is configured on the handle for the user&#39;s index finger. This index finger support, independent of the movable gripping member, in addition to supporting the hand on the rigid gripping member of the handle, allows a gentle, stable activation of the medical instrument.  
         [0020]     Further characteristics and advantages of the invention can be seen with the support of the accompanying illustrations, in which six embodiments of a medical cutting and/or holding instrument according to the invention are depicted in schematic, exemplary form. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0021]      FIG. 1   a  shows a partly cut-out side view of a first embodiment of a medical cutting and/or holding instrument according to the invention.  
         [0022]      FIG. 1   b  shows an alternative embodiment of detail  1   b  from  FIG. 1   a.    
         [0023]      FIG. 2  shows a partly cut-out side view of a second embodiment of a medical cutting and/or holding instrument according to the invention.  
         [0024]      FIG. 3  shows a partly cut-out side view of a third embodiment of a medical cutting and/or holding instrument according to the invention.  
         [0025]      FIG. 4  shows a partly cut-out side view of a fourth embodiment of a medical cutting and/or holding instrument according to the invention.  
         [0026]      FIG. 5  shows a side view of a fifth embodiment of a medical cutting and/or holding instrument according to the invention.  
         [0027]      FIG. 6  shows a partly cut-out side view of a sixth embodiment of a medical cutting and/or holding instrument according to the invention. 
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0028]     The medical cutting and/or holding instruments depicted in  FIGS. 1   a  and  2  to  6  consist essentially of a stalk-shaped shaft  1 , a tool  2  that is positioned on the distal end of the shaft  1  and consists of two jaw members  2   a  and  2   b , a handle  3  positioned on the proximal end of the shaft and equipped with two gripping members  3   a  and  3   b , and a push-pull rod  4  that can be slid axially for activating the tool  2  by means of the handle  3 .  
         [0029]     As can further be seen from the illustrations, the tool  2  consists of a rigid jaw member  2   a  firmly connected with the shaft  1  and a jaw member  2   b  that can rotate by means of the push-pull rod  4 . The handle  3  likewise has a rigid gripping member  3   a  that is firmly connected with the shaft  1  as well as a gripping member  3   b  that can move with respect to the rigid gripping member  3   b . The rotatable jaw member  2   b  and the movable gripping member  3   b  are coupled to one another by means of the push-pull rod  4 , so that the push-pull rod  4  and the rotatable gripping member  3   b  can be dissolubly connected to one another by a coupling mechanism in such a way that the push-pull rod  4  can be rotated upward away from the shaft  1 , for instance for purposes of cleaning.  
         [0030]     While the movable gripping member  3   b  can be rotated around its pivot axis  5  with respect to the rigid gripping member  3   a  in the medical instruments depicted in  FIGS. 1   a  to  4 ,  FIGS. 5 and 6  show an embodiment in which the rotatable gripping member is configured so that it can slide axially in the shaft direction.  
         [0031]     By configuring the push-pull rod  4  as a self-sufficient component, independent of the configuration of the shaft  1 , and positioned outside the shaft  1 , exclusively on the rotatable jaw member  2   b  of the tool  2  and on the movable gripping member  3   b  of the handle  3 , both components  1  and  4  can be configured so that they are individual and adapted to the particular use. The components  1  and  4  can also take the form of massive shafts, as required for use in open surgery, by which even strong forces can be transmitted from the handle  3  to the tool  2 .  
         [0032]     In addition to the varied manner of mounting the movable gripping member  3   b  of the handle  3 , i.e. as a rotatable gripping member  3   b  as in  FIGS. 1   a  to  4 , or as a gripping member  3   b  that can slide axially as in  FIGS. 5 and 6 , the embodiments of medical cutting and/or holding instruments depicted in  FIGS. 1   a  to  6  are distinguished essentially by the shape and length of configuration of the shafts  1  and the push-pull rods  4 .  
         [0033]     In the first embodiment, depicted in  FIG. 1   a , the push-pull rod  4  and the shaft  1  each run parallel to one another with a bend downward, with the push-pull rod  4  in this embodiment situated below the shaft  1 .  
         [0034]     The gripping member  3   b , which can rotate around the pivot axis  5  positioned on the rigid gripping member  3   a , can be fixed by a preferably spring-weighted stopping device  6  in the position that can rotate with respect to the rigid gripping member  3   a . As can further be seen from  FIG. 1   a , on the rigid gripping member  3   a  of the handle  3  a support  7  for the index finger of the user of the medical instrument is configured in order to be able to compensate for the thrust usually caused in open surgery in activating the movable gripping member  3   b . This index finger support  7 , independent of the movable gripping member  3   b , in addition to supporting the hand on the rigid gripping member  3   a  of the handle  3 , allows a gentle, stable activation of the medical instrument.  
         [0035]     The embodiments illustrated in  FIGS. 1   a  and  1   b  are distinguished by the orientation of the jaw members  2   a  and  2   b  of the tool  2  to the longitudinal axis of the shaft as well as to the push-pull rod  4 . Whereas in the embodiment in  FIG. 1   a  the jaw members  2   a  and  2   b  of the tool  2  are clearly configured as bent with respect to the longitudinal axis, in the embodiment in  FIG. 1   b  they run essentially in the axial direction.  
         [0036]     In the second embodiment shown in  FIG. 2  the push-pull rod  4  and shaft  1  run only partially parallel to one another, so that the push-pull rod  4  in this embodiment is situated above the shaft  1 .  
         [0037]     The gripping member  3   b  that can rotate around the pivot axis  5  on the shaft  1 , in turn, can be fixed in the position rotated with respect to the rigid gripping member  3   a  by means of a spring-loaded stopping device  6 . As further to be seen from  FIG. 2 , in this embodiment the support  7  for the user&#39;s index finger and the stopping device  6  are configured as a single piece so that the stopping device  6  is deactivated when the index finger is applied, but upon releasing the index finger support  7  the stopping device  6  immediately engages as a block on the rigid gripping member  3   a  because of the spring loading. To make room for the index finger support  7 , the shaft  1  at this site is configured as strongly bent downward from the push-pull rod  4 .  
         [0038]     In addition, the handle  3  includes a spring element  8  by means of which the rotatable gripping member  3   b  is pre-tensioned in the position that opens the tool  2 .  
         [0039]     In the third embodiment, illustrated in  FIG. 3 , the push-pull rod  4  and the shaft  1 , as already described in relation to  FIG. 1   a , run parallel to one another, each bent downward, so that the push-pull rod  4  is positioned below the shaft  1 .  
         [0040]     The gripping member  3   b , which can rotate around the pivot axis  5  on the shaft  1  and is pre-tensioned by the spring element  8  in the open direction of the tool  2 , can also be fixed by a spring-loaded stopping device  6  in this embodiment in the position that is rotatable with respect to the rigid gripping member  3   a , so that the support  7  for the user&#39;s index finger and the stopping device  6  are configured as a single piece in the manner described previously in relation to the second embodiment, shown in  FIG. 2 .  
         [0041]     The instruments shown in  FIGS. 2 and 3  are distinguished in addition in that the rigid gripping member  3   a  and the shaft  1  are configured as a one-piece component so that assembly and disassembly of the instrument can be considerably simplified.  
         [0042]     In order to improve viewing conditions for the user in narrower operating passages, on the shaft  1  an illumination element  9  can be secured which preferably has its own power supply by means of a battery or accumulator battery. In addition to the embodiment shown in  FIG. 3 , in which the illumination element  9  can be secured on the shaft  1 , it is also possible of course to position the illumination element  9  on the push-pull rod  4 , especially if this rod, as seen in  FIG. 2 , is positioned above the shaft  1 .  
         [0043]     In the fourth embodiment, shown in  FIG. 4 , the course of the straight push-pull rod  4  and of the shaft  1 , simply turned downward, cross one another. This embodiment includes a breech  10 , to permit the push-pull rod  4  to pass through the shaft so that the push-pull rod  4  is positioned below the shaft  1  on the rotatable gripping member  3   b , but is positioned above the shaft  1  on the rotatable jaw member  2   b.    
         [0044]     The gripping member  3   b , which can rotate around the pivot axis  5  mounted on the rigid gripping member  3   a , can also be fixed, in this embodiment, by a spring-weighted stopping device  6  in the position that can rotate with respect to the rigid gripping member  3   a , so that the support  7  for the user&#39;s index finger and the stopping device  6  are configured as a single unit as described previously in relation to the second embodiment, illustrated in  FIG. 2 .  
         [0045]     This illustrated embodiment also shows the use of an illumination element  9  that can be secured on the instrument. Even if not all the illustrated medical instruments are equipped with an illumination element  9 , with all instruments there is the possibility of providing them with an illumination element  9  of this type if required.  
         [0046]     The fifth and sixth embodiments, illustrated in  FIGS. 5 and 6 , finally, show a medical cutting and/or holding instrument with an axially slidable gripping member  3   b.    
         [0047]     In these two embodiments, the push-pull rod  4  and the shaft  1  run parallel to one another, each bent downward, so that the push-pull rod  4  is situated below the shaft  1  in each case. Of course, with this type of configuration of the movable gripping member  3   b , it is also possible to design the structure in such a way that the push-pull rod  4  is positioned in each case above the shaft  1 .  
         [0048]     The embodiment shown in  FIG. 5  is further distinguished in that the axially slidable gripping member  3   b  is configured as a one-piece unit with the rigid gripping member  3   a  and the ability of the gripping member  3   b  to be displaced depends on the spring elasticity of the handle material.  
         [0049]     For housing the illumination element  9 , the medical instrument shown in  FIG. 5  has on the upper side of the shaft  1  a channel  11 , into which the illumination element  9  can be inserted.  
         [0050]     The medical cutting and/or holding instruments configured according to the illustrations are distinguished in that on the one hand the push-pull rods  4 , which are configured independently of the shafts  1 , can be cleaned and assembled easily and quickly and on the other hand the shafts  1  and push-pull rods  4  can be adapted individually to the immediate operating purpose. The medical instruments configured in this way are appropriate for use in open surgery because of the simple and robust structure.