Abstract:
A medical shaft instrument includes an instrument head with at least one jaw member for applying clamps with two jaw member branches. The instrument head is connectable over an instrument shaft having an outer tube with a handle for actuation of the jaw member. A clip magazine includes a retaining rail for supporting clamps in a predetermined storage position distance from each other. All the clamps are advanceable by a forth and back movable conveying and advancing rail. The clamp closest to the instrument head is conveyable by a tongue into the jaw member between the jaw member branches. The retaining rail has a distally extending support plate or bridge, which covers a jaw member region of a jaw member branch on the other jaw member branch facing side such that a tipping of an advanced or advanceable clamp on the jaw member branch is prevented.

Description:
RELATED APPLICATION(S) 
       [0001]    This application is the United States National Phase entry of International Application No. PCT/EP2015/052445, filed Feb. 5, 2015, which is related to and claims the benefit of priority of German Application No. DE 10 2014 207 900.4, filed Apr. 28, 2014, German Application No. DE 10 2014 207 955.1, filed Apr. 28, 2014, and German Application No. DE 10 2014 207 971.3, filed Apr. 28, 2014, all of the foregoing applications listed in this paragraph being incorporated by reference herein in their entireties. 
     
    
     FIELD 
       [0002]    The invention relates to a medical shaft-type instrument, preferably of the minimal invasive type, with at least one jaw member/assembly having an instrument head for applying clamps, clips, fasteners or (spring) clamps, thus plastically deformable constriction members, by means of two scissor-like movable jaw member branches (jaws). 
       BACKGROUND 
       [0003]    Medical shaft-type instruments are already known from prior art, such as from EP 0 697 198 A1. This document discloses a surgical application device for clips. In order to allow a reuse of the essential parts of the application device in a surgical application device provided for U-shaped clips and comprising a handle, a tube shaft connecting thereto, a pincer-shaped contact tool on the free end of the tube shaft and a clip magazine in the tube shaft, comprising a closure mechanism for the contact tool which can be actuated from the handle and is arranged in the tube shaft, and comprising a feed motion mechanism for the clips which can also be actuated from the handle and is arranged in the tube shaft, said document suggests to provide the tube shaft with a lateral opening in which the clip magazine can be detachably inserted from outside in such a manner that it becomes operatively connected with the feed motion mechanism and that the outlet of the clip magazine is aligned with a feed motion path guiding the clips into the contact tool. 
         [0004]    Such a clip magazine is also known from DE 10 2009 018 820 A1. In order to the simplify the construction of the magazine and to reduce the size with a magazine comprising a plurality of C-shaped ligature clamps, a housing receiving the ligature clamps which are arranged serially in a row and parallel to one another, a transport element which is able to reciprocate relative to the housing in the direction of the row and causes at least one a ligature clamp to advance toward the outlet end of the magazine upon the forward and backward motion relative to the housing, this document suggests that the ligature clamps each comprise two legs connected via a bridge portion and are subdivided by a longitudinal slit in two portions adjoining each other and connected to each other in the area of the free ends of the leg, and that the transport element penetrates the ligature clamps arranged in a row in the intermediate space between the two adjoining portions of the ligature clamp. 
         [0005]    Thus, these existing devices use surgical clamps or clips which are also already known in principle. 
         [0006]    By way of example, the company Applied Medical sells a surgical clip named EPIX Universal CA500, in which the two essentially straight clamp webs/legs/clip arms are connected to each other by a substantially V-shaped portion. The two straight clip arms extend substantially parallel to the longitudinal axis of the surgical clip and in the transition zones between the clip arms and the connecting portion, and relative small bending radii are provided in the area of the fillet of the connecting portion. This means that the transition zones are formed by kinks. Comparable surgical clips having a comparable geometry are also marketed by United States Surgical under the name Endo Clip Autosuture 5 mm and by Ethicon under the name Ligamax 5. The Endo Clip Autosuture III 5 mm likewise sold by United States Surgical has a somewhat different geometry. This clip also comprises two substantially straight, parallel clip arms as well as a connecting portion for the two straight clip arms, which is formed with a fillet having a quite small radius of curvature. Other than the surgical clips described above, the transition zones between the clip arms and the connecting portion are formed so as to have a considerably larger radius of curvature, so to speak rather as bent portions than as kinked portions. The Patent application US 2011/0224701 A1 discloses a surgical clip comprising a semicircular outer surface and a profiled inner surface. The semicircular outer surface serves to prevent the clip from getting wedged in the jaw part of a clip applicator and the profiled inner surface serves to improve the adherence on the clamped tissue. As seen in a side view, the clip arms of the clips each comprise straight portions which extend parallel to each other in the area of the distal end of the clip, i.e. at its open side. In addition, the clip arms consist of several substantially non-deformable portions which are connected by deformable portions. All known clips have the common feature that each of the clip arms comprises one substantially straight portion and the connecting portion includes two substantially straight portions. Formed in the fillet as well as in the transition zones between the clip arm and the connecting portion are sections which are curved to a greater or lesser extent. What is more, all these clips are single-web clips, namely clips which can be bent out of a piece of wire and extend substantially in a plane (except for a wire beading). 
         [0007]    Single-web clips always have two clip arms. It is a problem with such type of clips that they have unfavorable properties in some cases during applying, i.e. in the course of being compressed by a clip applicator. On the one hand, the provision of the quite small radius of curvature in the transition zone from the clip arm to the connecting portion creates a zone in which the material of the clip (a metal, for instance titanium or titanium alloys) is stretched to a greater extent than in the adjacent zones, having the effect that said zone, in the following referred to as a kinked area, cannot be completely re-deformed into the straight shape when compressing the clip with an applicator. Consequently, the compressed clip will have an area where the two clip arms have a larger distance between them. This results in a suboptimal closure of the clipped, i.e. compressed vessel. A further problem with this kind of clips is that the closure of said clips in the compressed state is weak at the distal end of the clip arms. This means that the distal clip ends hardly apply a force onto the vessel, with said force being supposed to result in the closing of the vessel. During the compression procedure, the two parallel clip arms are deformed inwards around the fillet of the clip. In doing so, only the kinked area or the transition zone of the clip remains in contact with the respective branch of the clip applicator. Only if the distal ends of the clip touch each other (in case no tissue is grasped) or come into contact on both sides of the tissue to be grasped (in case tissue is grasped), the kinked area between the clip arm and the connecting portion is bent up. In this process, the distal ends of the clip arm are deformed towards outside and the relevant point of transmitting the force into the tissue is displaced toward the kinked area. This again releases the distal ends of the clip arms, and they will relax from their elastic deformation (while mostly maintaining their current position). If the kinked area in the clip arm has been re-deformed as far as possible, i.e. the clip is completely pressed, this has the effect that the clip is hardly able to apply a closing or compression force at the distal ends of the clip arms, as the distal ends of the clip arms can be easily deformed outwards in elastic fashion and there are zones in the middle region at which the clip arms contact each other (if no tissue is grasped) or the clip arms have a substantially punctiform contact on both sides of the grasped tissue (in the following, this area is referred to as a middle contact area in both cases). In this way, the distal ends have been fully relieved towards the end of the compression procedure, as the kinked area in the clip arm has been re-deformed with a force which by far exceeds the force which is required for bringing the remaining areas of the clip into the compressed shape of the clip. The compression force, which actually should be distributed over the length of the compressed clip as uniformly as possible, will then be concentrated in the vicinity of the clip fillet and the middle contact area of the clip. 
         [0008]    The European Patent application EP 1 712 187 A2 shows an instrument head in which the two jaw part branches are connected via a common base in an elastic/resilient manner. In the area of their distal ends which are provided for holding the surgical clip and compressing it and applying the clip in this way, the two branches have their outer side provided with one sliding surface each. For closing the instrument head and applying the clip, the instrument head is displaced in a proximal end direction with respect to the shaft in which it is arranged (i.e. the instrument head is partially pulled into the shaft or the shaft is slipped over the instrument head), and the distal edge of the shaft glides along the sliding surfaces. Due to the fact that the sliding surfaces are inclined with respect to the axis of the shaft, the distal ends of the branches are urged inwards, whereas the proximal ends of the branches are held by the base. In this way, the branches each perform a rotary movement around that point at which the branches are connected to the base. The opening procedure of the instrument head proceeds without any guidance and is exclusively ensured by the elasticity of the branches which are urged back into their initial position if the instrument head is pushed out of the shaft during the opening procedure. 
         [0009]    A comparable instrument head is also shown in the International Patent Application WO 2008/127968, even though the instrument illustrated therein differs greatly from the above-described instrument. The rotary movement of the branches during opening and closing the instrument head is still more apparent from the US Patent application US 2005/0171560 A1. According to this document, the distal areas of two branches are articulated on the base and rotate around the fastening point. Also in this construction, the clip is applied by the distal edge of the shaft gliding along the sliding surfaces which are provided on the outer sides of the branches, and in this way presses the branches in inward direction. The problem with this type of instrument heads is that they always have a closing geometry which is always the same, to be more precise, that first the distal ends of the branches make contact with each other or slide past each other; subsequently, those areas of the branches which are arranged to be further proximal make contact with each other or slide past each other. This means in the case of clip applicators that the clip is always closed starting from the distal end. For other surgical instruments such as endoscopic scissors, this structure of an instrument head is not useful for this reason. A further problem relating to this kind of instrument head is that the process of opening the instrument head is solely achieved by the elasticity of the branches. The opening movement of the instrument head is performed without any guidance. If it should happen that a piece of tissue or some other piece gets between the front edge of the shaft and a branch of the instrument head, the opening procedure of the instrument head could be impeded thereby. In that case, it would be necessary to first remove the instrument from the cavity within the patient, to free it of the piece of tissue, and to insert it into the patient again. This entails delays and disturbances in the surgical procedure. 
       SUMMARY 
       [0010]    The invention relates to a medical shaft-type instrument, preferably of the minimal invasive type, with at least one jaw member/assembly having an instrument head for applying clamps, clips, fasteners or (spring) clamps, thus plastically deformable constriction members, by means of two scissor-like movable jaw member branches (jaws), wherein the instrument head is connectable over an instrument shaft having an outer tube with an instrument handle, inter alia for operation/actuation of the jaw member/assembly, and a clip magazine in which a retaining rail/support rail for supporting a number of clamps according to the storage principle/single storage principle is fixed with a predetermined storage position distance from one another, wherein all clamps by means of a back and forth movable conveying and advancing rail/bar, according to the manner of a conveying sheet, within of a single conveying stroke advance forward by one storage position respectively in the direction of the distal end of the instrument shaft respectively, and of which the clip which is closest to the instrument head conveyable by means of a tongue/driving tongue into the jaw member between the jaw member branches. 
         [0011]    The instrument head forms a jaw part area by means of an upper and a lower jaw part or an upper and a lower jaw part branch. The instrument handle may be designed as a “Challenger” handle and/or be operated with manual force and/or gas pressure. 
         [0012]    The term “clip” is used as a synonym for the term “clamp”. A clamp has a non-compressed initial state and a compressed final state. In the compressed state, there is normally some tissue between two matching clamp arms/clip arms, for instance a hollow organ such as a blood vessel. In this case, the thickness and consistency of the wall of the blood vessel dictate the width of the gap between the clamp arms/clip arms in the compressed state. 
         [0013]    It is therefore the object of a parallel patent application to provide a surgical clip in which a gap is formed between the clip arms which is uniform and as small as possible and in which the clip arms make available a sufficient compression force towards their distal ends. A further object is to provide a surgical clip which applies a mostly constant force onto the grasped tissue over substantially the entire length of the clip. In this context, another object is to provide a manufacturing method for such a clip. 
         [0014]    To this end, the applicant has already developed a solution. In the case of a surgical clip for a surgical clip applicator comprising at least one pair of clip arms, with each of the clip arms comprising a distal end or proximal end and the two clip arms of a pair of clip arms being connected to each other at their proximal ends such so that they define a clip fillet, the above-mentioned object is achieved in said parallel invention in that a tangential angle between a tangent line on a neutral fiber of a clip arm and a perpendicular line on a longitudinal axis of the clip shows an essentially steady increase over the entire length of the clip arm. 
         [0015]    The present invention also relates to a medical shaft-type instrument comprising such a surgical clip which may also be referred to as a double-web clip. The clip may be further developed in the manner which has been already described. 
         [0016]    It is advantageous for the clip if the tangential angle (at a 6% length on the clip arm) has a value of at most 40°, preferably a value of 30°, and more preferably a value from 20° to 30°. At a length of 15% on the clip arms, the tangential angle may have a value of at least 50°, preferably a value of at least 58° and more preferably a value from 58° to 75°. 
         [0017]    It is also advantageous if the tangential angle (at a length of 22% on the clip arm) has a value of at least 60°, preferably a value of at least 67° and more preferably a value from 67° to 80°. 
         [0018]    If the tangential angle (at a length of 27% on the clip arm) has a value of at least 65°, preferably a value of at least 72°, and more preferably a value from 72° to 85°, it is possible to achieve an advantageous design of the clip. 
         [0019]    At a 100% length on the clip arm, the tangential angle may have a value of at most 88°, preferably a value from 80° to 88°. It is of advantage here if a first derivative of the curvature of a neutral fiber of a clip arm does not have a change of sign in the range of 8% to 100% of the clip arm length; it is more preferable if there is no change of sign over the entire length of the clip arm. 
         [0020]    At least two pairs of clip arms may be provided, of which a clip arm of a pair of clip arms may have its distal end connected to at least one distal end of another clip arm of a further pair of clip arms and may define a distal connecting portion. The clip may comprise two or three pairs of clip arms, and it may be formed as an open or closed ring clip or double ring clip, and may be preferably made by stamping, laser sintering, rolling, casting, metal injection molding and/or cutting, in particular laser cutting or water jet cutting. 
         [0021]    In the area of the distal end of a clip arm and/or of a distal connecting portion, a recess may be provided which is open toward the proximal end and is closed toward the distal end, so that the recess is accessible from the proximal end and forms a first abutment surface toward the distal end and preferably forms a second abutment surface toward a lateral or medial direction, with the recess being more preferably manufactured by stamping and/or impressing. The recess may be formed in a distal connection area of two distally connected clip arms, preferably by forming the cross-sectional dimensions of the distal connecting portion on the proximal and/or medial side of the clip arm, with a reduction of the cross-sectional dimension being made preferably to distal and/or lateral ends, a tapering being made more preferably to the half cross-sectional dimension. 
         [0022]    It is also advantageous if a proximal connection area of two clip arms, a clip arm and/or possibly a distal connecting portion of two clip arms has a variable height and/or width of preferably at least ±10% in at least one direction transverse to the neutral phase. It is expedient if the cross-sectional area of a clip arm and/or of a proximal connection area changes toward the clip fillet, whereby particularly the width of the clip arm and/or of the proximal connection area which is changed, in particular enlarged. Here, at least one clip arm may comprise at least one portion having a wavy shape and/or a zigzag shape in a direction parallel, transverse to and/or perpendicular to the clip&#39;s plane. A pair of clip arms may comprise clip arms which change their cross-section laterally, in particular are tapered, preferably by an edge break in the distal region of the clip arm, in particular by an enlarged radius on the outer edge of the clip arm. At least one clip arm may have its inner surface provided with a profile which is preferably formed by means of impressing, rolling, cutting or by electric discharge wire cutting or electric discharge die cutting. 
         [0023]    Such surgical clips may be produced in a sequence of steps, for instance by stamping a blank out of sheet metal, wherein the blank remains connected to the remaining sheet metal, at least on one point, preferably in the area of the later clip fillet, a subsequent process of bending the blank in a direction transverse to the remaining sheet metal, so that the clip arms protrude from the sheet metal plane, with the option that said bending process may be carried out in several steps and after which a cutting off from the remaining sheet metal takes place. It is possible to carry out a step of impressing a profile on at least one side of the sheet metal prior to and/or following the process of stamping the blank, wherein the impressing process may be performed in several steps. 
         [0024]    The clip arms of a pair of clip arms are usually made in one piece and hence are physically connected to each other. In principle, the clip arms may also be formed to be separate and subsequently be connected to each other by welding, for example. The prior art also knows jaw parts which may be synonymously referred to as instrument heads. 
         [0025]    The object which is achieved in a parallel patent application is to provide an instrument head for a surgical tube shaft instrument with which the closure geometry of the instrument head can be adjusted as needed, on the one hand, and in which the process of closing and opening the jaw part branches is performed in a guided manner, on the other hand. 
         [0026]    With a device comprising a jaw part for a surgical tube shaft instrument, comprising a support component, a first branch having a first operating range and a second branch having a second operating range, this object is achieved in that the first branch and/or the second branch comprises one slot-type guide element in each case, and the branches are held in the axial direction by the support component, wherein a cam carrier component/slider is provided which can be shifted relative to the support component in the axial direction and is provided with at least two cams, with each of the slot-type guide elements being adapted to be in contact with at least two cams (and to glide along these) which are provided on the cam carrier component or on the slider, in the event of a relative axial displacement between the support component and the cam carrier component, in order to bring about the opening or closing of the jaw part branches. 
         [0027]    The present invention also relates to a medical shaft-type instrument comprising such an instrument head. 
         [0028]    Here, it is advantageous if the instrument head is further developed in that the support component is integrally formed with a shaft component of the shaft or is fastened to it and that the cam carrier component is a slider which can be axially moved relative to the shaft. The one jaw part branch/the first branch and the other jaw part branch/the second branch are preferably elastically coupled. Advantageously, at least two slot-type guideways may be formed on at least one slot-type guide element. The first branch and/or the second branch comprise(s) e.g. a protrusion which engages an area of the support component and in this way limits an axial movement of the branch with respect to the support component and preferably prevents said movement. 
         [0029]    The at least one protrusion may be provided on a flexible extension of the related slot-type guide elements of the branch and the resilient extension may be able to urge the protrusion toward the support component and in this way ensure the engagement of the at least one protrusion in the support component, with the elasticity of bending of the extension being adjusted such that the movability and the movements of the slot-type guide element and the operating range are essentially not impaired by the extension. At least one slot-type guide element may be designed so as to have an essentially sheet-like design; the cam carrier component may be designed so as to have an essentially sheet-like design, and the at least one slot-type guide element may only rest against a flat side of the cam carrier component which is designed as a sandwich-like structure; preferably, one slot-type guide element each is arranged on two sides of the cam carrier component. 
         [0030]    The cam carrier component and at least one slot-type guide element may define at least one area in which a slot-type guideway and the pertaining cam of the cam carrier component form an undercut, so that the slot-type guide element lifting off from the cam carrier component is prevented; it is preferred here that at least one area of an undercut is present across the entire range of motion of the slot-type guide element to the cam carrier component from a completely opened position to a completely closed position of the instrument head. Further, the surgical instrument may be a surgical clip applicator and the branches of the instrument head may be adapted to support a surgical clip and to apply it by closing the instrument head, wherein the surgical clip preferably is a double-web more preferably consisting of two clip halves which are each (firmly) connected to each other at their two distal ends. The operating ranges of the two branches of the instrument head may be adapted to be shifted—by a clip which is arranged in the instrument head—towards outside and beyond the lateral position of the operating range of the branches in the completely opened position of the instrument head, which can be achieved by the operating ranges in the completely opened position of the instrument head if there is no clip in the instrument head. At least three slot-type guideways may be provided on at least one slot-type guide element, and at any point in time during the opening and closing procedure of the instrument head, at least two slot-type guideways rest against respective cams which are provided on the cam carrier. 
         [0031]    The instrument head may comprise a clip storage means/a clip magazine which can be attached in a preferably exchangeable manner, in that a plurality of clips/clamps is provided, wherein the clip storage means/the clip magazine is at least partially arranged in a plane which is parallel to a sandwich-like structure of the at least one slot-type guide element including the cam carrier component, wherein the clips can be supplied at least partially in a clip storage means passing a sandwich-like stacked structure toward the distal areas of the branches. In a special embodiment, at least the operating ranges of the first branch and second branch comprise a movement curve which is symmetrical with respect to a central axis of the instrument head. The surgical instrument may be designed as a pair of scissors, a needle holder, a serrefine or similar surgical instrument, in which the two branches can be moved towards each other and/or past each other. 
         [0032]    The instrument head may also be provided for a surgical tube shaft instrument comprising a first branch having a first operating range and a second branch having a second operating range and may be further developed such that the first branch and/or the second branch comprise(s) one slot-type guide element in each case and the branches are retained in the axial direction, and a cam carrier component is provided which can be shifted in the axial direction relative to the at least one slot-type guide element, wherein the at least one slot-type guide element and the cam carrier component are realized in a substantially flat design and are arranged one above the other in a substantially layered fashion. The cam carrier component and at least one slot-type guide element may comprise at least one area in which they form an undercut, so that the slot-type guide element is prevented from lifting off from the cam carrier component, while it is preferred here that at least one area of an undercut is present over the entire range of motion of the slot-type guide element toward the cam carrier component from a completely opened position into a completely closed position of the jaw part. 
         [0033]    The cam carrier component may be provided with at least one cam which rests against a slot-type guideway at least for a partial axial translation of the cam carrier component relative to the slot-type guide element, which guideway is formed on the slot-type guide element wherein the cam—on the side of its axial cross-section facing the slot-type guideway—is substantially realized with a Z-shape, an S-shape or a combination therefrom. It should be mentioned that the cam carrier component may be provided with at least one cam which rests against a slot-type guideway at least for a part of the axial translation of the cam carrier component relative to the slot-type guide element, which guideway is formed on the slot-type guide element wherein the cam—on the side of its axial cross-section facing the slot-type guideway—is substantially realized with a Z-shape, an S-shape or a combination therefrom. Even the cam and the slot-type guideway basically may have an S-shape at the respectively facing sides of its cross-section, and the cam and the slot-type guideway may form in this way a sort of bulge and a fillet, with said bulge of a component protruding into the fillet of the other component, respectively. 
         [0034]    A straight portion may be formed between the bulge and the fillet of the cam and/or of the slot-type guideway, wherein this straight portion is inclined preferably with respect to the opening or closing direction of the instrument head, more preferably by more than 7°, in particular less than 20°. The curvature of the bulge of the slot-type guideway may be smaller than the curvature of the fillet of the slot-type guideway and/or the curvature of the bulge of the cam may be larger than the curvature of the fillet of the cam. The curvature of the bulge of the slot-type guideway may be larger than the curvature of the fillet of the cam and/or the curvature of the bulge of the cam may be larger than the curvature of the fillet of the slot-type guideway. The direction of the transmission of force from the cam into the slot-type guideway may be inclined with respect to the opening or closing direction of the instrument head, preferably in a range of up to 20°. Further, the surface area of the cam may face the central axis of the cam carrier component in the area of the point of contact with the slot-type guideway. The device is further developed in an advantageous way if the at least one slot-type guide element extends substantially over the entire width of the cam carrier component, so that the respective cam of the cam carrier component is largely covered by the corresponding slot-type guide element. 
         [0035]    At least one slot-type guide element may comprise at least two slot-type guideways each forming an undercut with a corresponding number of cams on the cam carrier ring over a part of the axial displacement of the two components relative to each other from a completely opened position to a completely closed position of the instrument head, wherein the undercuts allow for the assembly of a cam carrier component and a slot-type guide element exclusively in that they can be screwed into each other or are screwed into each other. 
         [0036]    If the slot-type guide element and the cam carrier component are in a mounted position after the screwing and assembly process, which is outside the relative axial translation of the slot-type guide element and the cam carrier component from a completely opened position to a completely closed position of the component, a further optimized embodiment can be achieved. The first branch and the second branch each may have a slot-type guide element and the branches may be retained in the axial direction, and a cam carrier component may be provided which is movable in the axial direction relative to the at least one slot-type guide element, wherein the slot-type guide elements are realized in a substantially flat design and are arranged one above the other in a substantially layered manner, the cam carrier component having a substantially hollow cross-section in which the slot-type guide elements are arranged. In a mounted position, the slot-type guide component and the cam carrier component are moved or can be moved into a completely opened position by an axial displacement relative to each other. 
         [0037]    In this context, it is advantageous to implement a method of assembling a branch and a cam carrier component for an instrument head which uses the following steps: providing a branch and a cam carrier component in a state in which a slot-type guide element of the branch faces the associated side of the cam carrier component, wherein the branch and the cam carrier component are arranged in two parallel planes spaced from each other, and the longitudinal axes of the two components form a specific angle between them, approaching the branch and the cam carrier component until they make contact with each other, and rotating the branch and the cam carrier component relative to each other in the plane determined by their contact area in such a manner that the angle between their longitudinal axes is reduced, until at least one cam of the cam carrier component on both sides of the crossing point of the two longitudinal axes achieves contact with a slot-type guideway. 
         [0038]    A shaft component and a fastening rod may be added by the following steps: providing a branch and a cam carrier component in a state in which a slot-type guide element of the branch faces the associated side of the cam carrier component, wherein the branch and the cam carrier component are arranged in two parallel planes spaced from each other, and the longitudinal axes of the two components form a specific angle between them, approaching the branch and the cam carrier component until they make contact with each other, and rotating the branch and the cam carrier component relative to each other in the plane determined by their contact area in such a manner that the angle between their longitudinal axes is reduced, until at least one cam of the cam carrier component on both sides of the crossing point of the two longitudinal axes achieves contact with a slot-type guideway of the branch, attaching another branch to the opposite side of the cam carrier component, with the option that this step may also be carried out at the outset of the method, and inserting the proximal end of the instrument head into a distal end of the shaft component, wherein the branch and/or the other branch as well as the cam carrier component engage the shaft component or the actuation rod at different points in time, resulting in an axial displacement between the cam carrier component and the branch and/or the other branch into a position which corresponds to the completely opened position of the instrument head. 
         [0039]    It is the object of the invention to eliminate the disadvantages of the prior art and in particular to ensure a better guidance. 
         [0040]    This object is solved in a generic device in that the retaining rail/bar has a (support) plate or bridge, approximately in the manner of a plate like or shank like extension portion which extends towards distal direction and which covers/overlaps a jaw member region/area in the region of the one jaw member branch on its side facing the other jaw member branch such that a tilting of a slided or slidable clamp onto the one jaw member branch is/will be prevented. 
         [0041]    Advantageous embodiments are claimed in the sub-claims and will be explained in more detail below. 
         [0042]    If one of the jaw member branches or both jaw member branches is/are prepared for receiving a portion of the clip preferably in a form-fitted manner, a safe applying of the clip is thus possible. 
         [0043]    The clip is particularly securely held at bending when one of the jaw member branches or all of the jaw member branches is/are formed as a shell which is/are open in direction toward the other jaw member branch. 
         [0044]    Further it is advantageous for the safe guidance of the clamp if the support plate or the bridge protrudes (one-sided) laterally, as a guidance member or guide member when seen in the longitudinal direction of the retaining rail. 
         [0045]    The invention also relates to an advancement/embodiment, namely a medical shaft instrument, preferably of the minimal invasive type, having an instrument head, with at least one jaw member/assembly, for applying clamps, clips, fasteners or (spring-) clamps by means of two scissor-like movable jaw member branches/jaws, wherein the instrument head is connectable over/by an instrument shaft having an outer tube with an instrument handle, inter alia for operation/actuation of the jaw member/assembly, and having a clip magazine in which a retaining rail/support rail for supporting a number of clamps/clips according to the “one—storage principle”/“single storage principle” is fixed with a predetermined storage position distance from one another, wherein by means of a back and forth movable conveying and advancing rail/bar, according to the manner of a (metal) driving sheet, all clamps/clips are advanceable by one storage position towards the distal end of the instrument shaft, respectively, in the context of a single conveying stroke, wherein that clip of all the stored clips which is closest to the instrument head is conveyable by means of a tongue/driving tongue into the jaw member/assembly between the jaw member branches. The advancement/further embodiment is characterized in that the retaining rail has in its distal end portion a kicker-like/ski jump-like deflector for end-accelerating and/or redirecting the clamp/clip upon leaving the retaining rail and immersing into an intermediate region between the two jaw member branches. 
         [0046]    It is advantageous if the deflector extends in the manner of an elevation towards the tongue and/or the conveying and advancing rail. 
         [0047]    It is also expedient when the deflector is configured as a non-swarf shaped (non-cutted) (guiding-) crimp. 
         [0048]    An advantageous embodiment is also characterized in that the deflector is pillared configured into proximal direction. 
         [0049]    A mounting hole for engagement of a mounting tool can also be provided between the deflector and the support plate/bridge. Such a mounting tool prepared for hooking is then brought into engagement with an object through the instrument shaft, in particular through the outer tube, thereby facilitating the mounting. 
         [0050]    For the mounting, it is also advantageous if the mounting hole is formed as a through hole with a round, oval or square floor plan/cross section. 
         [0051]    If the deflector, the support plate or the bridge, and the clamp/clamps are coordinated/adapted to each other so that a proximal clamp portion while passing over the deflector is forced to lift and distal clamp shank tips are forced to sink to enhance a blocking-free sliding in the jaw member/assembly and preferably in the respective jaw member branches, a smooth function with the medical shaft instrument is then facilitated. 
         [0052]    The invention also relates to an advancement/embodiment, namely a medical shaft instrument, which also can be referred as tubular shafted instrument, preferably of the minimal invasive type, with an instrument head for applying clamps, especially ligature clamps, clips or fasteners, wherein these components to be applied are prepared for plastic deformation, wherein the instrument head, furthermore, is connectable over/by an instrument shaft having an outer tube/casing pipe with an proximal instrument handle for operation/actuation of the instrument head, and a clip magazine (built-in the shaft) having a housing in which a plurality/majority of the clamps/clips are accumulated/accumulateable or stored/storable according to the “one storage principle”/“single storage principle”. The advancement/embodiment consists in that the clip magazine is integrated into the (long) instrument shaft wherein the housing of the clip magazine is (exclusively) formed by the outer tube of the instrument shaft itself, on/at which the clamps support/abut themselves slidably at least sectional or on/at which the clamps can support/abut themselves slidably at least sectional. 
         [0053]    Also this advancement/embodiment is advantageous developable. 
         [0054]    Thus, it is advantageous if the outer tube is provided with at least two contact surfaces/abutment surfaces which are spaced in circumferential direction and permit contact by one or more clamps in a sliding fashion. Over the entire length during a guide stroke or only a partial length thereof, a sliding surface having a relative low friction coefficient can be provided for the clamps on one of their outer sides. 
         [0055]    In this context, it is advantageous if two, three or four contact surfaces spaced in circumferential direction are formed, for instance, with one of the clamps or all the clamps. A high tilt protection is achieved by the plurality of contact surfaces. 
         [0056]    Furthermore, it is expedient if two contact surfaces are provided for contacting a leg of the clamp, preferably at different points. This means that the outer tube is especially and explicitly prepared for making a direct contact with clamp portions to allow a forward sliding motion in a precise manner. If, on the one hand, the contact surfaces are formed on the inner side of the outer tube or, on the other hand, are formed on slots and/or grooves in the outer tube which are aligned in longitudinal direction and provided on the inner side of the tube, a projection or penetration by clamps can be prevented, on the one hand, and it is possible to realize the outer tube with a smaller diameter, on the other hand, so that a particularly compact construction is achieved. 
         [0057]    An advantageous embodiment may be implemented in said second case in that the slots extend completely through the wall of the outer tube or in that grooves, for instance at the radially outer side, are closed on one side. On the one hand, the contact surfaces may be formed only by embossing portions, beads, flanges, slots or grooves; on the other hand, the slits and grooves form the contact surfaces. In this way, some legs of the clamp/clip may protrude through the outer tube while other legs may be slidably arranged exclusively within the outer tube, allowing a use of the instrument as needed. 
         [0058]    If the outer tube is formed as a stiffening sheet metal tube, for instance is made of stainless steel, or as a plastic tube/glass tube/ceramic tube (round or cornered cross-section), it is possible to apply materials which are predestinated for medical use. 
         [0059]    The outer tube may have an annular cross-section, a cornered cross-section or an oval cross-section. This allows an easier and versatile design of adequate configurations of a medical shaft-type instrument which are optimized for the respective use. 
         [0060]    Thus, it is advantageous if the inner diameter of the outer tube and/or the position of the contact surfaces are matched with the clamps to be applied such that the clamp(s), when used or in the interior of the instrument prior to leaving the instrument, are in a preloaded state or are preloaded at least for a short time. 
         [0061]    It is advantageous if one clamp or more clamps is/are inserted such that two of its/their clamp webs/webs rest against the contact surfaces. The clamp may be configured as a double-web clip or alternatively as a single-web/shank clip. 
         [0062]    The invention also relates to an advancement/further development, namely, a medical shaft instrument, preferably of the minimal invasive type, with an instrument head for applying clamps, clips, fasteners or (spring) clamps, wherein the instrument head is connectable over/by an instrument shaft with an instrument handle for operation/actuation of the instrument head, and with a clip magazine, having a housing, in which a plurality of clamps/clips according to the “one-storage principle”/“single storage principle” are stored at a predetermined storage distance from one another, all of which are advanceable/conveyable with a back and forth movable conveying and advancing rail/bar in the form of a driving rod, particularly in the form of a (metal) driving sheet, in the context of a (one) single conveying stroke by only one storage position/idle state/home position, respectively (step per step-advancement), thus the position in which the respective clamp/clip is positioned in the clip magazine at a standstill/stop of the conveying and advancing rail/bar, wherein the conveying and advancing rail per clamp comprises at least one clamp-advancing member. 
         [0063]    The advancement/embodiment is characterized in that the relative distance of the individual clamp advancing members (seen in the axial direction) is different from the respective storage position distances of the clamps, such that the entrainment of the stored clamps in the context of a single conveying stroke takes place clocked/staggered in time (at different time points, respectively within one stroke). The force development inside the device takes place continuously (small steps) during operation and avoids collisions and impacts (peaks). 
         [0064]    It is also advantageous for the force development that those clip-conveying and clip-guiding devices, such as the conveying and advancing rail as well as a retaining rail/a retaining sheet, and the clamps are adapted to each other such that the clamps are deposited at other distances between two conveying strokes in the shaft instrument, as predetermined through/by the conveying devices (alone), such as the clamp advancing members or similar driving members. 
         [0065]    Advantageous for the precision is also that the clamp advancing members, the storage positions, that are predetermined by retaining lugs of a retaining rail/support rail, the clamps and the conveying and advancing rail which moves the clamps at its movement toward distal, are coordinated/adapted to each other so that at first a (most) proximal clamp and chronologically thereafter during the pumping/advancing stroke the distal upstream stored clips (one after the other) is moved or at the first a (most) distal clamp and chronologically thereafter the proximal downstream stored clips (one after the other) is moved. 
         [0066]    The distances between the clamp advancing members (seen in the axial direction) can be different, and for example either increase uniformly or abruptly toward a distal end of the instrument head or decrease uniformly or abruptly. 
         [0067]    When the distances between the retaining lugs (seen in the axial direction) are different and preferably increase either in direction towards a distal end of the instrument head uniformly or abruptly or decrease uniformly or abruptly, a further advantageous embodiment is achieved. 
         [0068]    It is expedient if the distances between the individual clamp advancing members correlate (exactly) to the distances between the individual retaining lugs or the relative change of the distances between the clamp advancing members on the one hand and the retaining lugs on the other hand, is smaller or larger. 
         [0069]    An advantageous embodiment is also characterized in that the retaining lugs, while being over-passed by the clamps during the way moved by the clamps toward the distal end of the instrument head from the movement path of the clamps, are sufficiently bendable or pivotable connected to the retaining rail. 
         [0070]    In order to avoid the appearance of too many/too high frictional forces, it is advantageous that the retaining lugs in the manner of butterfly lugs preferably in the form of integral components of the retaining rail are supported bendable or pivotable about/around a transversely to the longitudinal direction of the retaining rail oriented axis. The concept of bendability and/or pivotability, as implemented at the retaining lugs, is also transferable to the clamp advancing members. 
         [0071]    It is also advantageous that two wings of a butterfly lug form one retaining lug, wherein each wing is bendable or pivotable around a bend- or pivot-axis, which intersect each other at a distal or proximal area with respect to the retaining lug. A particularly suitable evasive behaviour of the retaining lug can then be achieved. 
         [0072]    If the retaining lugs are geometrically and materially formed in such a way, that they (approximately) lie down planar while being over-passed by the clamps/clips, that means proceed oriented in the axial direction, and preferably do not protrude through the retaining rail away from the clamps, the shaft instrument can be built particularly narrow. Additional functionality can be integrated if the height of at least some of the retaining lugs, measured transversely to the axial direction, is great such that the one tongue/driving tongue, which is guided through the clamps, leads to an ejection of the most distal clamp and/or prevents/restrains a buckling of the tongue. 
         [0073]    It is particularly advantageous if the distances of one clip contacting form-fit member to the next one differ from the maximum distance to the minimum distance between about 5% and 40%, preferably 15% to 20%, wherein the form-fit members are a part of the conveying and advancing rail or of the retaining rail. This leads to result that the distances increase continuously between two clamp-advancing members or two retaining lugs towards distal (and/) or proximal direction. 
         [0000]    
       
         
           
             
               
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         [0074]    If the retaining rail is formed as a retaining sheet made of a metal material, a particularly good stability is achieved. Of course plastics can be used, alternatively. 
         [0075]    In this context, the invention can also be advanced differently. Thus, the invention also relates to a medical shaft instrument, preferably of the minimal invasive type, with an instrument head for applying clamps, clips, fasteners or (spring) clamps, wherein the instrument head is connectable via an instrument shaft having an outer tube with an instrument handle for actuation of the instrument head, and with a clip magazine in which a retaining rail/support rail for depositing/storing a number of clamps according to the “one-storage principle”/“single storage principle” is fixed with a predetermined storage position distance from one another, wherein all clamps are stored such that they can by means of a back and forth movable conveying and advancing rail, within a single conveying stroke be advanced/moved forward by (exactly) one storage position toward the distal end of the instrument shaft respectively, and the clamp/clip which is closest to the instrument head can be conveyed/moved by means of a tongue/driving tongue into the instrument head for being ejected and bent. This further development is characterized in that in particular in the area of the clip magazine the retaining rail, the conveying and advancing rail and the tongue are arranged in a layer construction/stacked construction (relative to each other/one above the other). 
         [0076]    It is advantageous for a compact design if the retaining rail, the conveying and advancing rail and the tongue are arranged superimposed layer-like (stacked upon each other) in a transverse/perpendicular direction defined by the longitudinal axis of the shaft instrument and preferably extending substantially along the longitudinal axis, which indicates the axial direction. 
         [0077]    It is advantageous for a good functioning if the tongue is arranged between the retaining rail and the conveying and advancing rail. 
         [0078]    If at the distal end of the instrument head a jaw member/assembly is formed, into which the distal clamp from the tongue can be brought to interaction with a treated member, vessel or organ to be treated, an efficient medical use made possible on-site at a ligament. 
         [0079]    The invention can also be advanced/further developed. Thus, the invention also relates to a medical shaft instrument, preferably of the minimal invasive type, having an instrument head, with at least one jaw member, for applying clamps, clips, fasteners or spring clamps, wherein the instrument head is connectable via an instrument shaft having an outer tube with an instrument handle, inter alia for operation/actuation of the jaw member/assembly, and with a clip magazine in which a retaining rail/support rail for supporting/storing a number/plurality of clamps according to the “one-storage principle”/“single storage principle” is fixed with a predetermined storage position distance from one another, wherein all the clips can be moved by means of a back and forth movable conveying and advancing rail, in the context of a single conveying stroke by (exactly) one storage position (toward the direction of the distal end), and the clamp which is closest to the instrument head is conveyable by means of a tongue/driving tongue into the jaw member/part/assembly. The advancement/further development is characterized in that the conveying and advancing rail is connected/bound via a coupling device on the tongue or a driving distributor such that in case of a triggered driving movement for a conveying stroke of the tongue when reaching or exceeding a given/predetermined advancing path, the conveying and advancing rail is entrained. 
         [0080]    The production/manufacture can be simplified if the coupling device is designed in the form of a driving distributor as a component separate from the tongue and the conveying and advancing rail or as a component in one piece with the tongue or the conveying and advancing rail piece (integral and/or one material). 
         [0081]    It is also expedient if the coupling device employs a cam—elongated hole—combination for a delayed transmission of forces and movements from a driving rod onto the conveying and advancing rail, wherein the tongue is connected directly/fixed to a drive train. 
         [0082]    It is expedient if a tongue-sided cam engages in a conveying sided and advancing sided elongated hole for generating of a form-fit. 
         [0083]    The invention is also subject-matter of an advancement/further development. The invention also relates to a medical shaft instrument, preferably of the minimal invasive type, having an instrument head, with at least one jaw member/assembly, for applying clamps, clips, fasteners or (spring-) clamps, which is connectable via an instrument shaft having an outer tube with an instrument handle for operation/actuation of the instrument head, and a clip magazine in which a retaining rail/support rail for the support of clamps according to the “one-storage-principle”/“single-storage-principle” having a predetermined storage position distance in between is fixed, wherein all clamps are advanceable respectively by one (single) storage position by means of a back and forth movable conveying and advancing rail in the context of one conveying stroke, for which separated/distanced retaining lugs are provided on the retaining rail and separated/distanced clamp driving members/clamp entraining flaps are provided on the conveying and advancing rail which are formed, respectively to be spring elastically pivotable out of the clamp sliding path if they are over-passing the clamps in case of a movement in the respective other direction. This advancement/further development is characterized in that all or a number of retaining lugs and/or clamp-driving members are formed in a butterfly shape, which is formed, respectively, with two abutment wings being tiltable to each other in conveying direction/conveying stroke direction/driving direction and/or a number of retaining lugs and/or clamp advancing members are formed in a support wedge shape having a tip at the distal free edge being pivotable in a direction transverse to the conveying direction. 
         [0084]    Advantageously a substantially perpendicular or a at least inclined to the conveying direction continuing abutment plate or abutment surface is formed on the retaining lugs and/or clamp advancing members, such as in the region of the tip. 
         [0085]    It is expedient if the tongue is supported by the conveying and advancing rail and/or the retaining rail. 
         [0086]    It is also advantageous if spring flaps are protruding from the retaining rail in the direction toward the tongue for supporting the tongue, preferably two flaps being side by side in the region of the distal end of the tongue, wherein predominantly both are directed towards proximal or one is directed towards proximal, while the other one is directed towards distal. 
         [0087]    The invention also relates to a further development, namely a medical shaft-type instrument preferably of the minimally invasive type, comprising an instrument head having at least one jaw part and intended for applying clamps, clips or (spring) serrefines, i.e. plastically deformable constricting elements, by means of two jaw part branches which can be moved in a scissor-like fashion, wherein the instrument head, via an instrument shaft comprising an outer tube, is able to be connected to an instrument handle (inter alia) for operating/actuating the jaw part, and comprising a clip magazine in which a retaining rail/support rail for storing a number of clamps at a predetermined storage position spacing relative to each other according to the storage principle/individual storage principle is fixed, wherein all the clamps can be moved forward by one storage position by means of a reciprocating transport and entraining rail (such as in the manner of a metal feed plate) within the scope of a single delivery stroke toward the distal end of the instrument shaft, and the clamp which is closest to the instrument head can be transported by means of a tongue/feed tongue into the jaw part between the jaw part branches. The further development is characterized in that the retaining rail comprises an abutment plate or bridge extending in the distal direction, for instance in the manner of a plate-shaped or web-shaped prolonged portion, covering a jaw part area in the region of the one jaw part branch on the side facing the other jaw part branch such that a clamp which has been moved forward or can be moved forward is prevented from tilting toward the one jaw part branch. 
         [0088]    A vessel can also be pressed off/compressed easily if the one jaw member branch is a lower jaw member branch—due to gravity. 
         [0089]    If one of the jaw member branches or both jaw member branches is/are prepared to preferably form-fittingly accommodate a portion of the clamp, a safe applying is possible. 
         [0090]    The clamp is particularly securely held at bending, if one of the jaw member branches or all of the jaw member branches is/are formed as a shell, which is/are open in direction toward the other jaw member branch. 
         [0091]    Further, it is advantageous for a safe guidance of the clamp if the support plate or bridge protrudes in the lateral direction, preferably one-sided, as a guidance or guide member when seen in the longitudinal direction of the retaining rail. 
         [0092]    The invention also relates to a further development, namely a medical shaft-type instrument preferably of the minimally invasive type, comprising an instrument head having at least one jaw part and intended for applying clamps, clips or (spring) serrefines by means of two jaw part branches which can be moved in a scissor-like fashion, wherein the instrument head, via an instrument shaft comprising an outer tube, can be connected to an instrument handle (inter alia) for operating/actuating the jaw part, and comprising a clip magazine in which a retaining rail/support rail for storing a number of clamps at a predetermined storage position spacing relative to each other according to the storage principle/individual storage principle is fixed, wherein all the clamps can be moved forward by one storage position toward the distal end of the instrument shaft by means of a reciprocating transport and entraining rail (such as in the manner of metal feed plate) within the scope of a single delivery stroke, and the clamp which is closest to the instrument head can be transported by means of a tongue/feed tongue into the jaw part between the jaw part branches. The further development is characterized in that the retaining rail has its distal end region provided with a kicker-like or ski jump-like deflector for giving the clamp a final acceleration and/or for deflecting the clamp during its exit from the retaining rail and entering an intermediate space between the two jaw part branches. 
         [0093]    It is advantageous if the deflector extends in a manner similar to a ridge in the direction of the tongue and/or of the transport and entraining rail. 
         [0094]    It is also expedient if the deflector is formed in a chipless manner as a (guiding) bead. 
         [0095]    An advantageous exemplary embodiment is also characterized in that the deflector is provided with an arrow design/a directional design pointing in the proximal direction. 
         [0096]    It is also possible to provide a mounting hole between the deflector and the abutment plate/bridge for the engagement of an assembly tool. Such an assembly tool prepared for being hooked in place extends through the instrument shaft, in particular through the outer tube, facilitating the assembly process. 
         [0097]    For the assembly process, it is also advantageous if the mounting hole is formed as a through-hole having a round, oval or cornered outline/cross-section. 
         [0098]    In case the deflector, the abutment plate or bridge and the clamp(s) are adapted to one another such that a proximal clamp portion—when run over by the deflector—is lifted up by force and distal clamp web tips are lowered by force, in order to favor a smooth sliding into the jaw part and preferably into the respective jaw part branch, a jerk-free working with the medical shaft-type instrument is facilitated. 
         [0099]    The invention can also be developed further, namely as a medical shaft-type instrument preferably of the minimally invasive type, comprising an instrument head having at least one jaw part and intended for applying clamps, clips or (spring) serrefines, which are able to have a constricting effect on organs and vessels by plastic deformation, wherein the instrument head, via an instrument shaft comprising an outer tube, is able to be connected to an instrument handle (inter alia) for operating the jaw part, and comprising a clip magazine in which a retaining rail/support rail for storing a number of clamps at a predetermined storage position spacing relative to each other according to the storage principle/individual storage principle is fixed, wherein all the clamps can be moved forward by one storage position by means of a reciprocating transport and entraining rail within the scope of a single delivery stroke, and the clamp which is closest to the instrument head can be transported by means of a tongue/feed tongue into the jaw part. This further development is characterized in that the tongue is manufactured as a stamped/bent part of a sheet metal material, with the tongue having a distal end plate provided with an insertion recess allowing a portion of the clamp to penetrate/enter into/through the tongue. This allows for a thinner structure of the medical shaft-type instrument and achieves a uniform ejection of the clamp. 
         [0100]    It is advantageous if the insertion recess is formed as a through-hole, blind hole, slot, groove or notch. 
         [0101]    The insertion recess may have a circular, oval, rectangular, square or polygonal outline or cross-section. 
         [0102]    In any case, it is advantageous if the end plate comprises lateral pushing edges or thrust lugs and predefines an open box section together with these. 
         [0103]    It is expedient if the open box section is based on a manufacture which involves a bending-, embossing- and/or a flanging step, so that the pushing edges or thrust lugs are formed from crimped sheet metal. 
         [0104]    An advantageous exemplary embodiment is also characterized in that the box section is matched with at least the proximal end of the clamp such that the clamp, when entering the jaw part during moving away from the most distal storage position, is guided for the maximum possible length. 
         [0105]    If an abutment plate/bridge for the clamp is present in a transition zone between the tongue and a jaw part, which ensures a sliding process free of blocking of the clamp over the transition zone, it is possible to work intraoperatively with relatively low forces. 
         [0106]    It is advantageous if the tongue comprises a central tissue spacer pointing toward the distal end. 
         [0107]    If the tissue spacer extends towards the distal end beyond the distal extension of the pushing edges or thrust lugs, a further advantageous embodiment can be realized. 
         [0108]    The invention is also subject-matter of another further development, also relating to a medical shaft-type instrument preferably of the minimally invasive type, comprising an instrument head (having at least one jaw part) intended for applying clamps, clips or (spring) serrefines, wherein the instrument head, via an instrument shaft comprising an outer tube, can be connected to an instrument handle (inter alia) for actuating at least one jaw part, and comprising a clip magazine in which a retaining rail/support rail for storing a number of clamps at a predetermined storage position spacing relative to each other according to the storage principle/individual storage principle is fixed, wherein all the clamps can be moved forward by one storage position by means of a reciprocating transport and entraining rail within the scope of a single delivery stroke, and the clamp which is closest to the instrument head can be transported by means of a tongue/feed tongue into the jaw part. The further development is characterized in that the tongue as a stamped/bent part is manufactured from a sheet metal material, wherein two web-like pushing edges or thrust lugs are provided on one side of the tongue in the distal end region. 
         [0109]    For a trouble-free operation, it is advantageous here if the pushing edges or thrust lugs are matched with the shape of the clamp. 
         [0110]    It is expedient here if the pushing edges or thrust lugs at the margin of the tongue, extending in longitudinal direction, flank the insertion recess. This results in a better protection against buckling. 
         [0111]    In the end, a double-web clip applicator is made available. It goes without saying that said clip applicator is also capable of applying single-web clips. The functioning of such a medical shaft-type instrument is briefly explained in the following. 
         [0112]    If the handle is operated like a “Challenger Handle”, an outer lobe of the handle is axially moved toward the distal end and acts on a directly adjacent pusher tube with a stroke and a force oriented in the axis of the shaft. A spring stop firmly connected to the pusher tube is pushed against a return spring which is supported on the shaft tube, whereby the spring force increases. The pusher tube directs the movement directly to a slider of a jaw part packet, which is firmly connected to the pusher tube by means of a bracket, and causes it to move. The jaw part packet may also be referred to as an instrument head. The slider located between two jaw part shafts, which may also be referred to as jaw part branches, converts the axial movement into a closing movement of the jaw parts. The cams of the slider rest against the slot-type guideway of the jaw parts and urge the latter inwards, whereupon the jaw parts move toward each other and compress the clip or clamp present therebetween. 
         [0113]    If the clamp is compressed, the handle may be released, resulting in the return spring being relaxed and returning the pusher tube and hence the slider, and the jaw parts being forced into the upward position by the cam being in engagement. 
         [0114]    If the handle is completely released, the feed motion is automatically triggered by the pneumatic mechanism of the “Challenger Handle”. 
         [0115]    In this process, the valve of a gas cartridge is opened and an internal feed motion piston of the handle acts upon the feed rod with the axial movement and feed force. The feed rod moves toward the distal end and acts against the return spring force of a compression spring which is prestressed in the course of the feed motion. The spring has supported its one side on a shoulder of the feed rod. The other side is supported by a spring support which is axially fixed on the shaft tube by corresponding lugs. Here, the feed rod extends through the spring support. 
         [0116]    The feed rod which has been set in motion transfers the movement directly to the feed motion divider which is firmly connected to it, the latter having the function to divide the feed travel in two or more sections. 
         [0117]    If the feed motion divider is in motion, it transfers the movement directly to the tongue which is firmly connected to it and picks up and entrains the most distal clip. Here, the tongue is passed through all the clips. Having covered a specific distance which is defined by a cam window in the metal feed motion plate and a cam on the feed motion divider, the metal feed motion plate also moves toward the distal end. This is why the stroke of the metal feed motion plate is always smaller than or equal to that of the tongue. 
         [0118]    The metal feed motion plate which is set in motion picks up each individual clip one by one (incrementally) from their individual placement with the aid of the engaged feed lugs and causes them to move. The clips are now pushed toward the distal end and overcome the incrementally arranged retaining lugs of the metal retaining plate, wherein the clips are transported toward the distal end by one position at a time with each feed motion hub/delivery stroke. 
         [0119]    At the same time, the most distal clip is pushed into the jaw by the tongue via the clip guideway. 
         [0120]    If the full feed travel is achieved and all clips have arrived at their predetermined position, the feed rod or feed divider impinges on a stop, or in other words, the end of a groove in the feed rod impinges on a transverse cylinder pin, resulting in an increase of the force in the handle. If said force reaches approximately 40 N, while values of approx. 10 N, approx. 20 N, approx. 30 N, approx. 50 N, approx. 60 N and approx. 70 N (in each case ±5 N) are also conceivable, a valve in the handle is automatically opened which has the effect that the feed force falls to zero and the return stroke is initiated by the relaxation of the entire return spring in the shaft. 
         [0121]    When the return stroke has been initiated, the feed rod is moved toward the proximal end. The feed motion divider which is firmly connected to the feed rod as well as the firmly connected tongue are directly pulled toward the proximal end. If the cam of the feed motion divider has covered the distance in the cam section of the metal feed motion plate, the metal feed motion plate is moved toward the proximal end as well. 
         [0122]    In this process, the feed lugs are pulled over the clips/clamps which are displaced by one position. In case the clamps are entrained during the return stroke movement, the retaining lugs of the metal retaining plate which oppose said movement serve for holding them in place. 
         [0123]    In the return stroke, the tongue is simultaneously retracted through the most distal clip and returns to the initial position. The return stroke movement ends if the feed motion divider hits the counterpart of the spring stop of the return spring. 
         [0124]    Following said sequence, the clip applicator is ready to start the next cycle. 
         [0125]    It has proven to be successful to dimension the outer tube with diameter values of 5.5 mm, 10 mm or 12 mm±10% in each case and with a length of 318 mm, with a variance of ±50% appearing to be reasonable. 
         [0126]    The tongue or tongue lug is put through several clamps without providing any guiding function for these. It is realized as an elongated element with a pronounced buckling tendency for advancing and guiding the most distal clip with tolerances, but buckling is prevented by a lengthwise positioned flange and/or incorporated longitudinal beads. The tongue ensures safe gripping of the clamp/clip. It transfers forces onto the clamp with an angular and positional change. For compensating any tolerances, it is provided with a flexible tip, for instance made of a material with reduced thickness, or also with elasticity holes for instance in the form of cut-outs for reducing the bending cross-section. Any process of levering out the thrust lugs/pushing edges is prevented by a free zone in the form of a cut-out on the upper side of the tongue&#39;s tip. Due to the fact that the sheet metal protrudes beyond the tip of the tongue and rests on a support on the inner side of the clamp leg&#39;s fillet, a tissue protection is achieved and slipping off the tongue from the clamp web is prevented. This sheet metal element jutting out is referred to as a spacer or overhang. 
         [0127]    The feed motion divider serves for a direct, firm mechanical connection to the drive train. This allows a feed motion hub or delivery stroke. The feed motion divider has a direct mechanical firm connection to the tongue. It has also a direct mechanical connection to the transport and entraining rail, but a loose one, i.e. a connection which is movable in one direction. This allows to subdivide a linear movement in two or more sections. It is useful to employ a cam which engages an elongated hole in a movable manner. 
         [0128]    It is possible to do without the feed divider, but in that case one should make recourse to an integration in the tongue. Both the retaining rail and the transport and entraining rail/feed rail comprise lugs. The latter serve for safely gripping the clamps with small slippage and small tolerances. A low friction is desirable here. They serve for the guiding/supporting of components such as the tongue, for example. They serve for guiding the clamps and define a clip guideway which dictates the axial position of the clamps, wherein the clip guideway is exclusively defined by the tube&#39;s inner wall and the upper side of the metal retaining plate. The guiding of the metal feed motion plate is effected by the inner wall of the outer tube and by the packet formed by the clamps or, when the clamps are depleted, by the tongue which in turn is supported on the retaining rail. It is also conceivable to exchange the positions of the metal plates: Arranging the clips on the metal feed motion plate and supporting them on the tube&#39;s outer wall is plausible. 
         [0129]    The following functions are fulfilled here:
       Controlling the elasticity by the geometry of the lugs (minimizing the frictional forces) and   Controlling the guiding and supporting tasks by the geometry/height of the lugs.       
 
         [0132]    Regarding the first control function, recourse is made to the following parameters: thickness of the sheet metal, width of the lugs and the cut-outs, position of beads and buckles, geometry of bends and positions of bending lines, sagittal geometry of the lugs, frontal and axial geometry as well as the incorporation of cut-outs for instance via elasticity holes. For the second point, the individually adapted geometry of the lugs, the mounting and supporting of the tongue by means of at least one lug, and the mounting and supporting of the sheet metal on the tongue by means of at least one lug is taken into consideration. Each of the lugs has a specific task. Some lugs may have a larger height than the others in order to protect the tongue. This means that the lugs do not all have the same height. This minimizes the friction. The aim is to achieve stiff guiding and transporting elements oriented in the longitudinal direction and configured so as to be elastic in the transverse direction. 
         [0133]    Regarding the bridge on the retaining rail, it is to be mentioned that the retaining rail is assigned the function of a clip way/clamp guideway. It is designed such that the lug is supported on the upper jaw and is displaced by the latter in the course of a closure movement. 
         [0134]    There are different ways of fixing the retaining rail on the outer tube, for instance by protrusions on the outer tube which project radially inwards, by suitable lugs and cut-outs in the retaining rail and/or lugs/protrusions and cut-outs on the outer tube, preferably in such a manner that a tensile force acts on the retaining rail during the return stroke, so that the retaining rail does not have to withstand any buckling load. A direct fixation of the retaining rail on the spring support is possible. An offset in fixation is also desirable (left-right-asymmetry), in order to increase the rigidity and for preventing a direct bending line. Providing the retaining rail with spring elements, which press it upwards toward the clip line/clamp line, acts as a compensation of tolerances. 
         [0135]    There are also measures for stiffening the sheet metal for transferring a force with a low proneness to buckling. Skillfully placed beads and a defined edge collar would be suitable for this. The outer tube has supporting functions such as fastening the jaw, fastening the retaining rail, fastening a feed motion apparatus. It is preferably an integral, one-piece component with short tolerance chains. It may be produced in a single cutting operation in a single clamping process and with high accuracy. 
         [0136]    The tube portion which is free of lugs fulfills a guiding function, namely the function of guiding the clamps on the tube wall, in particular while contacting the tube wall. A guidance of the sheet metal, the pusher tube, the feed motion divider and the metal retaining plate is also achieved. 
         [0137]    The aforementioned lugs serve for fastening e.g. a metal retaining plate and can be used for positional fixation. They are elastic in their height, but also elastic in the lateral direction. As seen in the axial direction, they have small tolerances. As seen from one direction, they can be (unilaterally) joined. They can be manufactured by a (single) cut and a bending process. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWING FIGURES 
         [0138]    The invention will be explained below on the basis of drawings in which different exemplary embodiments are illustrated and in which: 
           [0139]      FIG. 1  is a perspective view of an assembly of a medical shaft instrument with a handle according to the invention, 
           [0140]      FIG. 2  is an exploded view of the medical shaft instrument of  FIG. 1 , in a perspective view without the handle included in  FIG. 1 , 
           [0141]      FIG. 3  is the assembly of the individual parts of  FIG. 2  in a perspective view, 
           [0142]      FIGS. 4 to 6  are perspective views only of the distal tip of the medical shaft instrument of  FIG. 1 , without the outer tube, 
           [0143]      FIG. 7  is a cross section through an instrument shaft of the shaft instrument of  FIG. 1 , 
           [0144]      FIG. 8  is a diagram for displaying the force curve due to friction when passing over an clamp applied by the shaft instrument of  FIG. 1  via a single form closure member, such as a retaining lug or a clamp driving member, 
           [0145]      FIG. 9  is a diagram for displaying the increase in force while “collecting” the clamps/clips during driving, due to a conveying stroke and during a return stroke, based to friction when passing over the lugs by the clamps, 
           [0146]      FIG. 10  is an enlarged perspective view of a portion of a retaining rail having fastening projections and retaining lugs, 
           [0147]      FIG. 11  is a further enlargement of a retaining lug from  FIG. 10 , 
           [0148]      FIG. 12  is a top view of the retaining lug of  FIGS. 10 and 11 , 
           [0149]      FIG. 13  is the contact of a retaining lug at a clamp which is configured as a double shank clip, on the proximal side, 
           [0150]      FIG. 14  is the state of a retaining lug in which a clamp passed over and released the position, 
           [0151]      FIG. 15  is a reenactment of a retaining lug in which a clamp passes over and didn&#39;t release the position yet, 
           [0152]      FIG. 16  is the contact of a clamp at one issued and shaped retaining lug as support on the clamp back/clip back for preventing a reverse driving of the clamp, 
           [0153]      FIG. 17  is the assembly of a retaining rail on which a plurality of clamps are stored in storage positions which are permeated by a tongue, wherein the clamps are contacted from above by a conveying and advancing rail, 
           [0154]      FIG. 18  is a longitudinal section through the members of  FIG. 17 , wherein a sandwich-like sheet package and a clip stack/clamp stack with mutual support via the lugs is effected, 
           [0155]      FIG. 19  is a perspective view of a first embodiment of a component for stroke distribution, in the manner of a driving distributor, 
           [0156]      FIG. 20  is a rotated perspective view of the components of  FIG. 19 , 
           [0157]      FIG. 21  is a longitudinal section through the components of  FIGS. 20 and 21 , 
           [0158]      FIG. 22  is a second embodiment for achieving a stroke distribution, at an integrated tongue, 
           [0159]      FIG. 23  is a longitudinal section through the embodiment of  FIGS. 19 and 20  in the region of a driving distributor, 
           [0160]      FIG. 24  is a partially perspective view of an assembly of an outer tube and a retaining sheet in a mounted position, 
           [0161]      FIG. 25  is the combination of the components of  FIG. 24  in a position at the beginning of the mounting, 
           [0162]      FIG. 26  are the components of  FIGS. 25 and 26  at a time, in which the mounting has already progressed, 
           [0163]      FIG. 27  are the components of  FIG. 25  at a time of completion of the mounting, as shown in  FIG. 25 , however increased, 
           [0164]      FIG. 28  is a further embodiment for fixing the retaining sheet via a spring counter holder on a not shown outer tube by the use of cut outs, 
           [0165]      FIG. 29  is a distal tip of the retaining sheet with a proximal to the tip mounted clip/clamp, 
           [0166]      FIG. 30  is a rotated view of the components of  FIG. 29 , 
           [0167]      FIG. 31  is a top view between two jaw member branches, that form a jaw member region, wherein a distal tip of the retaining sheet is used as cover (partially) in the manner of a support platen or bridge, 
           [0168]      FIG. 32  is a view similar to  FIG. 10  in the region of mounting lugs acting projections that provide an asymmetrical bending line and avoid a direct bending line, 
           [0169]      FIG. 33  is a bottom view of the retaining sheet in a perspective form for visualizing of the existing spring lugs there, 
           [0170]      FIG. 34  is a distal end portion of a tongue/driving tongue with a gap which acts as immersion opening, 
           [0171]      FIG. 35  is a view in perspective form from below onto the distal tip of the tongue of  FIG. 34 , with a guide crimp in the manner of a deflector, which acts as movement guidance member and acts enhancing for the bending stiffness, 
           [0172]      FIG. 36  is a partial view of the clamps, the retaining sheet and the tongue in the region of guide crimp, 
           [0173]      FIG. 37  is a view of the components of  FIG. 36  in a rotated form, 
           [0174]      FIG. 38  is a view of the components of  FIGS. 36 and 37 , in perspective form from behind, 
           [0175]      FIG. 39  is the engagement of the tongue at the most distal clamp, 
           [0176]      FIG. 40  are the components of  FIG. 39  in a perspective view in, from behind 
           [0177]      FIG. 41  is enlargement of the contact region between the clamp and a sliding edge/pressure lug of the tongue, 
           [0178]      FIG. 42  is the clamp at immersion in the immersion opening of the tongue in a perspective view from above, 
           [0179]      FIG. 43  is a clamp at conveying along the tongue to the distal tip portion of the tongue, 
           [0180]      FIG. 44  is the spring counter holder in a perspective view, 
           [0181]      FIG. 45  is a cross-sectional view through the spring counter holder in the region of the sealing surfaces, 
           [0182]      FIG. 46  is a perspective view of the spring counter holder of  FIGS. 44 and 45  from below, 
           [0183]      FIGS. 47 and 48  is a side view and a front view of the spring counter holder of  FIGS. 44 to 46 , 
           [0184]      FIG. 49  is a side view of the spring counter holder of  FIGS. 44 to 48  with on him attached retaining sheets and coupled conveying and advancing rail, 
           [0185]      FIG. 50  is the spring counter holder, as he is clipped into a retaining sheet, and 
           [0186]      FIG. 51  is a view of the components of  FIG. 50  with view onto the slot (elongated hole with stroke restriction) for the driving distributor when the retaining sheet is clipped in the spring counter holder. 
       
    
    
       [0187]    The Figures are merely of schematic nature and serve exclusively for the understanding of the invention. The same elements are provided with the same reference symbols. Features of the individual exemplary embodiments are interchangeable. Hence, such features can be exchanged among themselves. 
       DETAILED DESCRIPTION 
       [0188]      FIG. 1  illustrates a first embodiment of a medical shaft-type instrument  1 . It comprises an instrument handle  2  on its proximal end. In brief, the instrument handle  2  may also be referred to as a handle. The handle may be designed in the manner of a “Challenger Handle”. An instrument head  3  is formed on the distal end of the medical shaft-type instrument  1 . Arranged between the instrument handle  2  and the instrument head  3  is an instrument shaft  4  connecting the two components to each other. 
         [0189]    The instrument shaft  4  comprises an external outer tube  5 . The outer tube  5  may have an annular cross-section and be formed in the manner of a hollow cylinder. The instrument handle  2  acting as a contact area for a hand forwards an instruction of an operating surgeon to the instrument shaft  4  in order to actuate the instrument head  3  by means of it. A clip magazine  7  is present within the outer tube  5  functioning as a housing  6 . The clip magazine  7  is a magazine for storing clamps, clips, brackets or other clamping configurations suitable for ligature use. Such clamps, in particular ligature clamps or clips are provided for being plastically deformed or locked in place, in order to stanch an organ of a mammalian, for instance a blood vessel of a human, in the deformed state. 
         [0190]    A plurality of such clamps  8  is represented in  FIG. 2 . 
         [0191]      FIG. 2  shows the individual parts of the medical shaft-type instrument  1 , without the instrument handle  2 . In particular, an upper jaw part/an upper jaw part branch  9 , a lower jaw part/a lower jaw part branch  10 , a slider  11  which may be referred to as a cam carrier component and a retaining rail  12  can be seen. 
         [0192]    In the embodiment illustrated there, twenty clamps  8  are utilized in total. It would also be possible, however, to use a higher or smaller number of said clamps  8 . A tongue  13  which may also be referred to as a feed tongue, a feed divider  14 , a spring support  15  and a transport and entraining rail  16  which may also be referred to as a feed rail, are also included. Further, a feed spring  17 , a sealing disc  18 , a feed rod/pusher rod  19  and a feed rod end piece  20  are used. A pusher tube  21  adjoins a sealing ring  22 . The sealing ring  22  is a distal limitation of a compression spring  23  which is adjacent to a spring flange  24 . The compression spring  23  is supported on the spring flange  24 . The compression spring  23  is responsible for a return motion of the jaw parts  9  and  10 , hence for moving the upper jaw part  9  away from the lower jaw part  10 . 
         [0193]    The components  9  to  24  are provided for being inserted within the outer tube  5 . The outer tube  5  is inserted in a handle flange  25  after the assembly process. The handle flange  25  for its part is in a force-fitting, form-fitting and/or material-bond type contact with a handle piece/handle coupling component  26  in order to connect to the instrument handle  2 . A hollow cylinder end piece  27  is arranged proximally with respect to the spring flange  24 . Said hollow cylinder end piece  27  as well as the feed rod end piece  20  can be seen as proximally protruding from the handle piece  26 . 
         [0194]      FIG. 3  illustrates the components known from  FIG. 2  in the assembled state. 
         [0195]      FIGS. 4 to 6  suggest the assembly unit made up of the upper jaw part branch  9  and the lower jaw part branch  10  for receiving the most distal clamp  8  within a shell form  28 . A retaining rail  12  formed as a metal retaining plate is arranged below the transport and entraining rail  16 . 
         [0196]      FIG. 7  allows to clearly see the guidance of the clamps  8  in a cross-sectional view. As can be seen, the clamp  8  illustrated there has its four clamp webs  29  supported on the retaining rail  12  as well as on the outer tube  5 . The clamp webs  29  may be briefly referred to as webs. 
         [0197]    In this arrangement, the outer tube  5  comprises contact surfaces/abutment surfaces  30  for contacting the upper clamp webs  29  of the clamp  8 . The clamp  8  is designed here in the manner of a double-web clip. The tongue  13  is provided for ejecting the foremost, first clamp  8 , i.e. the most distal clamp  8 , whereas the transport and entraining rail  16  is provided in the manner of a metal feed plate for moving all the clamps  8  in the clip magazine  7 . The contact surfaces/abutment surfaces  30  are designed such that they allow a sliding motion of the clamps  8  along it. 
         [0198]    Optionally, but not illustrated, the outer tube  5 —in the area of the contact surface  30  intended for being contacted by the clamp webs  29 —may be provided with recesses such as slots, grooves, serrations or through-holes, through which the clamps  8  may project outwards to the outer side of the outer tube  5 , i.e. so as to penetrate the outer tube  5 . This allows to achieve a particularly compact configuration of the shaft-type instrument  1 . 
         [0199]    The clamps  8  also rest on the retaining rail  12  with their clamp webs  29 , in fact in such a manner that a compression/deflection of the clamps  8  is forced in cooperation with the support on the outer tube  5 . The clamps  8  do not contact each other here. The tongue  13  is fed through the double-web clip-like clamps  8 , resulting in a sort of threading of the clamps  8 . 
         [0200]    In this arrangement, the clamp webs  29  form leg portions. The feed motion of the clamps  8  is effected by a forward and rearward movement of an elongated component comprising lugs in the style of protrusions, lamellas or barbs. The clamps  8  are exclusively guided on an inner wall  31  of the outer tube  5  and on a sheet-metal type retaining rail  12 . This results in an effective use of the installation space. Noises, in particular rattling noises, are prevented. This results in a precise guidance. A compensation of the tolerances is achieved as well. A separate channel is not required. 
         [0201]    A channel-like construction as shown in  FIG. 7  is sufficient here, and the use of metal sheets has advantages in terms of dimensioning the stiffness. 
         [0202]    The retaining rail  12  comprises retaining lugs  32 . These can be clearly seen in  FIGS. 10 to 16 , for instance. In said Figures, a butterfly-type segmentation of the retaining lugs  32  into a first retaining lug portion  33  and a second retaining lug portion  34  can be seen as well. Thus, these two retaining lug portion  33  and  34  constitute a kind of butterfly lug. The wings of a butterfly lug may also be referred to as first and second retaining lug portions  33  and  34 . 
         [0203]    The clamp webs  29 , which may also be designated as legs, slide/slip over the retaining lug portions  33  and  34  and result in the retaining lug portions  33  and  34  folding along a swivel or bending line  35 . The swivel or bending line  35  may also be referred to as a bending axis or swivel axis. 
         [0204]    As can be clearly seen especially in  FIGS. 13 and 16 , a movement of the clamps  8  in proximal direction is prevented by a proximal end of the clamp  8  resting against a distal edge  36  of the retaining lug  32 . As can be clearly taken from  FIGS. 10 and 16 , the shape of the lugs is also implemented in a butterfly-type shape. The protruding lugs including wings having the largest possible edge/area for supporting the clamps  8  on the clamp&#39;s back should offer a high rigidity. The geometry of the retaining lugs is designed such that it can get out of the way during the run-over process, without going below the level of the metal sheet. In other words, the retaining lugs  32  lay down flat. In the erected state, side edges  37  of the retaining lugs  32  form lines which are almost parallel. They extend predominantly in the longitudinal direction. At least an angle from proximal larger than 0° is acceptable. This provides for minimum friction. If the clamp  8  runs over the retaining lug  32  from proximal, this angle will be enlarged. 
         [0205]    Looking ahead to  FIG. 18 , it is mentioned that also the transport and entraining rail  16  comprises lugs, namely clamp entraining elements or clamp entraining lugs  38 . Increments and distances of the lugs are important for the limitation of the length of the component, in particular for the length of the magazine. They dictate the work of friction. They have to be arranged in a skillful way with respect to their position in relation to the feed hub which may also be referred to as a delivery stroke. They can be formed in a simple manner if a shaped metal strip or a plastic component is used as a starting base for them. They should be arranged preferably in the style of springy lugs with precisely defined distances. The mutual distances between the retaining lugs  32  may be variable along the length of the sheet metal, i.e. does not have to be kept constant. The distances of the clamp entraining elements/lugs  38  relative to each other should also be variable along the length of the sheet metal, i.e. should not remain constant. 
         [0206]    The spacing increments of the lugs should be selected such that a sequential collecting of the clamps  8  is carried out starting from a rest position of the clamps  8 , resulting from non-constant distances. This has the effect of a continuous increase of force. In that case, a predetermined amount of a force to be applied will not be exceeded. The spacing increments of the lugs should be selected such that the length of the magazine is minimized. The spacing increments of the lugs are selected here such that the collecting process occurs sequentially from distal to proximal depending on the rest position of the clamps in order to avoid a mutual collision of the clamps or counteract it. The following relationship is suitable for the determination of the spacing A: 
         [0207]    The spacing (A) is referred to as the spacing between the j th  and the (j−1) th  lug either of the retaining rail  12  or of the feed rail/transport and entraining rail  16 , with j specifying the position of the lug starting from distal and n corresponding to the total number of the clips in the applicator. 
         [0000]      Spacing of the retaining lug ( ARHL )=constant spacing ( AK )+incremental spacing  RHL  ( AjRHL ) 
         [0000]      Incremental spacing  RHL  ( AjRHL )=increment  RHL IKRHL ·( n−j )
 
         [0000]      Spacing of the feed lug ( AVSL )=constant spacing ( AK )+constant ( K )+incremental spacing  VSL  ( AjVSL ) 
         [0000]      Incremental spacing  VSL  ( AjVsL )=increment  VSL IKVSL ·( n−j )
 
         [0208]    However, the constant spacing (AK) depends on the clamps, their size and their geometry and amounts to approximately 8.5 mm, for example. It is also possible to provide a constant increment (iK) and a variable increment (iV). The total increment I is then calculated as follows: I=IK+IV. This allows to determine the location of the occurring maximum force and hence the buckling of the sheet metal. 
         [0209]      FIG. 8  illustrates the friction-related behavior as a function of the position where the clamp  8  runs over one of the lugs  32  and  38 . The abscissa shows the length of the lugs in mm, whereas the ordinate shows the total force F ges  in Newton. 
         [0210]    In  FIG. 9  is an illustration of the increase in force during “collecting” the clamps  8  in the course of a delivery stroke, on the one hand, and in the course of a return stroke on the other hand, due to the friction when all the clamps  8  run over all the lugs (retaining lugs  32  and clamp entrainment lugs  38 ). Here, the solid line represents the increase in force/force progression during the feed motion/delivery stroke, and the broken line represents the increase in force/force progression during the return stroke. The abscissa shows the feed travel in mm, whereas the ordinate shows the need of physical force in Newton. 
         [0211]    Returning to  FIGS. 17 and 18 , reference is made to the sandwich-like arrangement of the transport and entraining rail  16  above the tongue  13  which for its part is situated above the retaining rail  12 . Thus, the retaining rail  12 , the transport and entraining rail  16  and the tongue  13  are arranged one above the other and so as to be axially movable. The lug heights of at least some of the lugs  32  and/or  38  are dimensioned here such that they guide the tongue  13  situated in the middle. 
         [0212]    In consideration of the  FIGS. 19 to 21 , it should be obvious that it is desirable to achieve a feed motion division by means of an elongated hole  39  which is engaged by a cam  40 . The cam  40  protrudes from a feed divider  41  which may be designed so as to be separate from a spring support  42 . The cam  40  may be an integral constituent part of the spring support  42 . In any case, the feed rod  19  extends through the spring support  42  and is connected to the feed divider  41  in an axially fixed manner. The cam  40  of the feed divider  41  extends through the elongated hole  39  of the transport and entraining rail  16 . The tongue  13  is connected to the feed rod  19  in an axially fixed manner, so that any movement transferred from the feed rod  19  is directly imparted to the tongue  13  and passed on to the transport and entraining rail  16  not until the cam  40  impinges on a stop edge  43 . In this way, two engaging components are configured such that a pin, a cam or any other protrusion engages in a hole, a groove or a recess such that an axial relative movement of the two parts with respect to each other by a specific amount is allowed, but a combined movement is caused upon reaching a stop. 
         [0213]    As can be seen particularly well in  FIGS. 19 and 20 , the spring support comprises recesses  44  which can be engaged by protrusions or lugs of the outer tube  5  in order to bring about an axial fastening. 
         [0214]    The  FIGS. 22 and 23  show a variant differing therefrom, namely a variant in which the pusher rod  19  is directly connected to the tongue  13 . To this end, the tongue  13  is crimped around a distal end of the pusher rod  19  in the manner of a folded sheet. It goes without saying that the tongue  13  may also be an integral constituent part of the pusher rod  19 . With the configuration of  FIGS. 22 and 23 , there is no separate feed divider  41 . However, said folded sheet  45  which provides for the connection between the tongue  13  and the pusher rod  19  vertically engages an elongated hole  39  provided in the transport and entraining rail  16 , in order to come in contact with a stop edge  43 —similar to the exemplary embodiment as described above—to bring about the initiation of the delivery stroke on the transport and entraining rail. Whereas  FIG. 22  illustrates a perspective view predominantly from below,  FIG. 23  shows a longitudinal section. It is possible that the tongue  13  is glued to the pusher rod  19 , welded to it or crimped with it. In the end, two very precise stops are made available, allowing a very accurate working with the medical shaft-type instrument  1 . 
         [0215]    The retaining rail  12  does not only have a retaining function for the clamps  8 , namely the prevention of the return motion of the clamps  8  during the return stroke into the neutral position of the transport and entraining rail  16 , but (as seen in cross-section) also defines the lower limitation of the clip line formed by the clamps  8 . Further, the retaining lugs  35  should be realized in the manner of barbs which can be run over in one direction by the clamps  8  and can also be displaced by the latter. 
         [0216]    The retaining rail  12  is also supposed to be fixed on the tube wall of the outer tube  5  by means of retaining rail mounting lugs  46  which can be seen in  FIGS. 24 to 27 . To this end, a mounting hole  47  is provided in the outer tube  5 . The mounting hole  47  is worked into the material in the form of a slit for instance by means of a laser cutting procedure. An outer tube fold area  48 , provided in the manner of a lug and comprising an inspection window  49 , is bent radially inwards and offers sufficient space so that the retaining rail mounting lug  46  can engage below a lower edge  50  limited by the outer tube fold area  48 . 
         [0217]    This results in an axial stop toward the proximal end, provided with the reference symbol  51 , and an axial stop toward distal, provided with the reference symbol  52 . A height fixation means  53  is realized by the lower edge  50 . 
         [0218]    The mounting hole  47  is shaped in the manner of a window. The inspection window  49  is for checking purposes during the assembly process. In this way, a self-catching system is realized. The outer tube fold area  48 , which acts as a lug and is formed in one piece on the outer tube  5 , catches the retaining rail mounting lug  46  which is a single constituent part of the retaining rail  12  formed as a metal retaining plate and fixes the metal retaining plate at a predetermined level and in an axial position. 
         [0219]    The sequence during the assembly process is apparent from the  FIGS. 25 to 27  which show the assembly protrusions of the retaining rail  12  from proximal to distal, caught under/caught by the outer tube fold area  48  with the retaining rail mounting lug  46 .  FIG. 24  shows the completely assembled state. 
         [0220]    A modified exemplary embodiment is shown in  FIG. 28  in which the retaining rail  12  is fixed on the spring support  42  by means of cut-outs. The spring support  42  for its part is already immobilized on the outer tube  5  in radial and axial direction. In this arrangement, the spring support  42  comprises cams  54 , which penetrate the retaining rail  12  and fix both components to each other in a form- and/or force-fitting manner. Here too, a cam  40  enters an elongated hole  39 , so that a limitation of the delivery stroke is reached if the cam  40  hits the stop edge  43 , which is advantageous with a force-controlled use of the handle. In fact, the handle switches over the direction of movement as from a specific limit value on. An active retraction of the transport and entraining rail  16  and of the tongue  13  is then possible. 
         [0221]      FIGS. 29 to 31  have their focus on a distal end of the retaining rail  12 . At this place, a bridge/abutment plate  55  is formed which facilitates the gliding of the clamp  8  into the shell forms  28  of the upper jaw part branch  9  and the lower jaw part branch  10 . The bridge/abutment plate  55  may also be referred to as a cover for the lower jaw part  10 . In addition, a retaining rail mounting hole  56  is provided, which is arranged between the bridge/abutment plate  55  and a kicker- or ski jump-like deflector  57 . This deflector  57  serves in the manner of a kicker for lifting the clamp  8  at its tail, i.e. at its proximal end, so that the clamp  8  slides better into the upper and lower jaw part branch  9  and  10 , respectively. The deflector  57  also serves for stiffening purposes. During the assembly process, the retaining rail mounting hole  56  is used by an assembly tool (not shown), in order to be hooked in place there. 
         [0222]    In  FIG. 32 , laterally protruding retaining rail mounting lugs  46  offset in longitudinal direction are connected to each other by a (theoretical) asymmetrical bending line  58 , so that the (theoretical) direct bending line  59  provided with the reference symbol  59  does not occur. Such a direct bending line  59  orthogonal relative to the longitudinal direction is avoided, as asymmetrical bending lines  58  are preferred in the event of the occurrence of critical torsional forces, because torsional forces do not occur here. 
         [0223]    Spring lugs  60  which serve for supporting the retaining rail  12  on the pusher tube  21  can be seen in  FIG. 33 . Thus, a residual force is made available which tries to decrease the clip channel into which the clamps  8  are directed. This results in a mutual stabilization of all components and prevents the clamps  8  from missing the retaining lugs  32  upon retraction. Otherwise, retaining lugs  32  having a larger height and requiring more power would then be necessary, which would result in higher friction, entailing an increased physical effort during the feed motion process. In the end, a compensation of tolerances is also achieved by the spring lugs. As an alternative or in addition, the spring lugs  60  could rest on the upper and/or lower jaw part branch  9  and  10 , respectively. 
         [0224]      FIGS. 34 to 43  have their focus on the tongue  13  and its special configuration. The tongue  13  has its distal end provided with a tissue-protecting protrusion  61  which prevents that any tissue of the organ to be treated enters the area between the clamp webs/legs  29  of the clamp  8  and is pinched here unintentionally. The tissue-protecting protrusion  61  may also be referred to as a tissue spacer  61 . At a site proximal relative thereto, a notch  62  is provided which forms an insertion opening  63 . The insertion recess may be synonymously referred to as insertion opening  63 . 
         [0225]    As can be seen particularly clear in  FIGS. 40 and 41 , this insertion opening  63  allows the proximal portion of the clamp  8 , namely the clamp web/leg  29 , to swivel or enter into the free zone provided by the notch  62 . The insertion opening  63  may also be referred to as an insertion recess and makes it possible that a portion of the clamp  8  projects from below into the notch  62  at least by some extent or even right through it. 
         [0226]    Further, a protrusion in the manner of a movement-guiding element  64  is formed on the underside of the tongue  13 . This movement-guiding element  64  is formed in the manner of a deflector  65  or pilot bead  66 . It has the effect of increasing the flexural rigidity and at the same time provides for a catching protection. The catching protection prevents the clamp  8  from undesirably contacting the tongue  12  in the area of impact edges  67 , as otherwise the clamp  8  would be moved in axial direction ahead of time or in the wrong sense. Abutment edges  68  for providing a targeted pushing effect on the clamp  8  are provided as well. This abutment edge  68  may also be referred to as a pushing edge or thrust lug. This is why it is provided with the reference symbol  69 . The tongue rests against a part of a clamp web  29  over the length designated with the reference line  70 . In this context, the insertion opening  63  also enables that the contact between the tongue  13  and the clamp  8  is maintained during the tilting of the clamp  8 . 
         [0227]    The tissue-protecting protrusion  61  with its protective function for animal or human tissue can be clearly deduced from  FIG. 34 . The guiding effect of the movement-guiding element  64 /deflector  65 /pilot bead  66  can be clearly taken from  FIGS. 35 to 39 and 43 . Here, it can also be clearly seen that the pilot bead  66  prevents the clamp  8  from getting caught. The movement-guiding element  64  also enhances the stiffness of the tongue  13 . In this way, a catching protection and an edge shielding function are provided in addition to an anti-bulging function. This is why the clamp  8  cannot get caught on a folded sheet metal portion of the tongue  13 . This may also be referred to as “edge shielding”. 
         [0228]    The tongue  13  is threaded through several clamps  8  without taking the function of guiding it. It is an elongated element with a high proneness of kinking in the course of advancing and guiding the most distal clip/the most distal clamp  8 , with smallest tolerances. A lengthwise flange  71  prevents the tongue  13  from buckling. Longitudinal beads as shown in  FIGS. 34 to 43  also have an anti-buckling effect. The point of the tongue  13  allows to reliably grasp the clamp  8 , and the transmission of forces onto the clamp  8  in the event of an angular or positional change is achieved just as the compensation of tolerances. Implementing the tip as a flexible portion, for instance by using a material with smaller thickness, by the provision of elasticity holes, by means of cut-outs for reducing the bending forces, allows to achieve an advantageous embodiment. All those special lug or tip shapes are advantageous which prevent the thrust lugs  69  from getting levered out. The situation of the tongue  13  slipping off from a clamp web/leg  29  is effectively prevented in the manner described above. 
         [0229]    The tissue-protecting protrusion  61  protrudes beyond the sheet metal at the tip of the tongue and is in abutment on the inner side of a clamp  8  in the leg fillet provided there. It is to be noted that the deflector  65 /the pilot bead  66  has the same depth as the flange  71  of the tongue  13 , to prevent any thrust transmission to the clamp  8 . 
         [0230]    In the following  FIGS. 44 to 51 , the spring support  42  is illustrated and explained in more detail. The spring support  42  comprises a holding catch/a cam  72  provided for being hooked into the retaining rail  12  in order to establish an axial and/or radial fixation. Further, the spring support  42  comprises a cam/a lug  73  for immobilizing the spring support on the outer tube  8 . 
         [0231]    Said cam  73  is surrounded by a sealing surface  74 . The latter serves for sealing off the recess in the outer tube  5 , so that no fluid can escape from the shaft-type instrument towards outside, and fluids from outside the shaft-type instrument  1  should not reach its interior either. The area which forms the sealing surface  74  is designed in the manner of a dome spring which is provided with the reference symbol  75 . Thus, the wedge-shaped cam  73  lies within the sealing surface  74  of the dome spring  75 . This dome spring  75  gets caulked radially in one direction, because it is arranged so as to be off-center. 
         [0232]    The holding catch  72  and a recess accommodating it may be designed such that the respective fixations of the metal retaining plate  12  on the spring support  42  in radial and axial direction are effected separate from each other. In this case, the tolerances can be better used as if this was performed on a component in both directions. This is why a protrusion  76  is provided which is only designed for axially supporting the retaining rail  12 , whereas the holding catches  72  are designed for the radial fixation. Thus, the spring support  42  has shell design having a positive effect on the elasticity. The spring support  42  serves for the fixation on the outer tube  5 . It may be implemented as an injection-molded part comprising a central feed-through for guiding the pusher rod/feed rod  19 . It may be designed in the manner of an integrated annular spring and comprise a springy, thin-walled oversize bulge. An extensive contact around the cam  73 , being configured in the manner of a retaining cam, is advantageous in terms of producing tightness. A protrusion/retaining cam having a centering effect engages in the outer tube  5  easier if it has chamfered edges. Such chamfered edges may be provided on all protrusions or lugs. The spring support  42  is firmly clipped in place on the retaining rail  12 . Thus, the spring support  42  comprises a through-hole  77  provided in the longitudinal direction and having the function of guiding the feed rod  19 . 
         [0233]      FIG. 50  shows the state of the spring support  42  in the state when clipped in place in the metal retaining plate forming the retaining rail  12 . This situation is also illustrated in  FIG. 51 . 
         [0234]    The bridge/abutment plate  55  may also be referred to as an abutment plate. Further, the retaining rail mounting hole  56  may be briefly referred to as a mounting hole.