Source: https://patents.google.com/patent/WO2008040483A1/en
Timestamp: 2019-07-19 13:31:25
Document Index: 342857871

Matched Legal Cases: ['arts 10', 'art 10', 'art 10', 'art 10', 'art 10', 'arts 10', 'arts 10', 'art 10', 'art 10', 'art 10', 'art 10', 'arts 10', 'arts 10', 'art 10', 'arts 10', 'art 10', 'art 10', 'art 10', 'art 10', 'arts 10', 'art 10', 'art 10', 'arts 10', 'art 10', 'arts 10', 'arts 10', 'arts 10', 'arts 10', 'art\n12', 'art\n100']

WO2008040483A1 - Tubular shaft instrument - Google Patents
2006-10-05 Priority to DE102006047215.2 priority Critical
2007-09-26 Application filed by Erbe Elektromedizin Gmbh filed Critical Erbe Elektromedizin Gmbh
2007-09-26 Priority claimed from CN 200780036059 external-priority patent/CN101516285B/en
2008-04-10 Publication of WO2008040483A1 publication Critical patent/WO2008040483A1/en
The invention relates to a tubular shaft instrument according to the preamble of claim 1.
In modern medicine, we try in general to keep the damage to intact tissue to a minimum. Minimally invasive surgery is therefore, if circumstances permit, usually the preferred method by which a surgical procedure is performed. Small cuts and a small injury to the tissue result in less pain after surgery and a rapid recovery and mobilization of the patient. This is also true for laparoscopic surgery are performed in the complex operations in the abdomen.
For manufacturers of medical instruments, this type of operation and the needed devices represent a particular challenge because much of the operational steps in very confined spaces and without line of sight to be performed. Thus, the medical equipment used must be handled not only in the smallest spaces but also work so sure that a visual inspection is unnecessary. The instruments are preferably configured such that the surgeon is always a feedback signal is available even without visual contact, which allows a conclusion on the course of the operation.
There are tubular-shaft instruments are known which comprise a handle, a tubular shaft and at least two jaw parts. These tubular shaft instruments are suitable for gripping and fixing tissue. Often these tubular shaft instruments have additional functionality. Thus, for example, from EP 1211995 Bl a tubular shaft instrument with respective mouth parts is known which applies a high-frequency current to the fixed tissue in order to coagulate it. It is also known, such pipe sheep tinstrumente be provided with a cutting device for cutting through the wider web. Since tubular shaft instruments are used in very restricted areas of the body, they must be kept as small as possible. Nevertheless, safe operation and high functionality must, as already noted, are guaranteed. So it is problematic, among other things, to ensure a sufficiently stable power transmission to actuate the jaws.
Starting from this prior art, the object of the present invention to provide a tubular shaft instrument which is simple to manufacture, has a long service life and has very functional characteristics.
This object is achieved by a tubular shaft instrument according to present claim. 1
In particular, the object is achieved by a tubular shaft instrument, comprising:
first and second jaw member at a distal end of the tubular shaft with at least one clamping surface,
at least one joint, for rotatably supporting the jaw members such that the jaw members from an open position can be brought into a closed position in order to fix the tissue with the clamping surfaces, the joint being formed such that the axis of rotation of the joint harbors outside of the jaw parts and the distal end at least one jaw member when opening the distal end of the tubular shaft can be moved away.
An essential idea of ​​the present invention is therefore to provide a ready joint, by means of which the jaw parts against each other are movable in rotation about a rotation axis. This rotation axis is virtual in the end and is located outside, preferably above the elongate jaw members. Due to these outsourced virtual axis of rotation at least one of the two jaws happens not only a rotational movement, but also a translational motion. The translational motion is oriented such that when opening the jaw members, the distal tip of one of the jaw parts at least in sections moves the tubular shaft instrument with respect distally. When closing an opposite movement takes place. Thus, the moving jaw part promotes tissue that is located between the two jaws, when closing in the direction of the tubular shaft. so it can be gripped a larger area of ​​tissue.
Furthermore, can be assured by swapping the axis of rotation an improved power transfer. Since usually the traction cable to the jaw part used for actuation of the movable jaw part acts directly, the supporting lever effect is greater for actuating the jaw parts, the more the starting point is away from the rotational axis.
Preferably, the joint comprises a sliding guide, that at least one of the two jaws is guided by a fixed structure. Here, the link guide sets out the movement of the respective jaw part. Limited by appropriate means, the jaw part slides along a profile, whereby the translational and rotational movement caused.
Preferably, the joint comprises a hinge guide on one of the two jaw parts and at least one rail or slot on the other of the two jaw parts. In this case, the rail or groove dictates the trajectory of the corresponding jaw part. The joint guide engages in the groove or rail, and supplies the jaw part along the movement path. Ordinarily, such a slotted guides on a wide distinct contact area over which the mutually movable portions of the joint engage. Thus, such joints are much more stable and can absorb greater forces. Since no selective force transmission to occur, these joints usually have a longer lifespan.
In a preferred embodiment the tubular shaft instrument comprises at least two part-joints, which are spaced apart to form a, preferably arranged centrally between the joints passage from each other. Another advantage of the sliding guide is that these relative space can be arranged saving. A particularly positive effect arises when at least two part-joints are used to guide the jaw part. These paired training is not only very stable, but it also allows to provide passages through the actual center of the joint, in which cables or other instruments, such as a blade for cutting through tissue can be performed.
Preferably, the tubular-shafted instrument comprising a blade for separating the fixed tissue. This cutting edge can be guided by the fixed jaw parts by means of the tissue by means of a suitable guide device. The passages described make it possible to establish the management directly through the joint center.
Preferably at least one jaw member includes a blade guide for the cutting edge. Thus the jaw part is for example formed such pairs that said cutting edge is guided centrally between the adjacent portions of the jaw part. A twist or a tilting of the cutting edge or blade is prevented.
Preferably, one of the two jaw parts is rigidly connected to the tubular shaft. Although it is conceivable to fasten both jaw members rotatably mounted on the tubular shaft, thus ensuring the opening and closing of both jaws. It is better, however, to connect one of the two jaw parts directly to the tubular shaft, so that this jaw part is an extension of the tubular shaft. The second jaw member may then be secured by means of the joint either on the tubular shaft, or on the other jaw part. The rigid connection to the tubular shaft instrument can easily and safely handle.
Preferably, for opening and closing a jaw member to be moved, a substantially linearly movable belt or a power transmission device is provided which is attached with an elastic at the end portion to be moved or jaw part. In a preferred disclosed embodiment, these are a drawstring, whose end portion is fixedly connected to the jaw part. During the rotational movement of the jaw portion about the virtual pivot point, the winding around the axis of rotation bendable band around the jaw part. The push and pull motion that is transferred by the force transfer member to the jaw member to be moved, thus act always tangent to a circle about the rotational axis. In a convex configuration of the mouth part to be moved to the side on which the actuating element attaches, regular transmission of power is ensured regardless of the position of the displaceable jaw portion.
Preferably, the strip of spring steel.
Preferably, the band is fixed by welding on the mouth part, wherein the weld preferably extends un-perpendicular or curved to a longitudinal axis of the belt, not perpendicular to it. The tape is thus so arranged to be moved on the jaw part that its longitudinal axis is substantially perpendicular to the axis of rotation. The weld seam extends along the rotational axis, but describes an arc or angle, so that the weld seam is formed as long as possible. Thus, the force is distributed over a long distance as possible. The durability of the device can be significantly increased. Alternatively, the weld may have a jagged shape.
In another embodiment, a pin is inserted into a bore of the tension band and additionally welded. Thus the jaw part to be moved and the tension belt includes a Zugbandzapfen a corresponding bore.
Preferably at least one of the clamping surfaces comprises an electrode for coagulation of the fixed tissue. Thus, in the tubular shaft instrument is a mono- or bipolar clamp by means of which the fixed between the clamping surfaces tissue is not only mechanically but also electrically deserted.
Preferably, at least one of the jaw parts at least in the region of the joint of electrically insulating material, in particular made of ceramic. The jaws can thus be molded and then sintered. A production by injection molding is possible. Particularly in the training of said rail or groove, so the joint leadership, this type of production is preferable. By at least partly forming the joint of electrically insulating material, at least the clamping surfaces of the jaw parts are insulated from each other and can be used for coagulation without further measures as electrodes.
Further advantageous embodiments will emerge from the further subclaims. The invention will now be described by way of exemplary embodiments, which are explained in more detail by means of figures. show:
- Figure 1 is a tubular shaft instrument for cutting tissue;.
- Figure 2 illustrates the tool head of the tubular shaft instrument of Figure 1, comprising a first and a second jaw part..;
- Figure 3, the second jaw part in a perspective side view.
- Figure 4, the second jaw part in a top view;.
- Figure 5, the second jaw member in a side view.
- Figure 6, the first jaw part in a perspective side view;.
- Figure 7, the first jaw part in a top view;.
- Figure 8, the first jaw member in a side view.
- Fig. 9 is a schematic representation of two different pivots;
- Figure 10 is a cross section through the tool head of Figure 2 with a cutting device..;
- Fig. 11 is a schematic representation of the cutting device;
- Figure 12 is a schematic representation of the cutting device in a tubular shaft of a Rohrschaftinsttuments;.
- Fig. 13-15 from three guide forms a cutting blade;
- Fig. 16 is a block diagram of an interface control device; - Figure 17 is a perspective view of a tool head in an open.
- Figure 18 is the tool head of Figure 17 in a closed position..;
- Fig. 19, the second jaw part drawstring;
- Figure 20, the second jaw part (further disclosed embodiment) in a perspective.
- Fig. 21 section dutch the second jaw member of Figure 20;. and
- Fig. 22 is a schematic side view of the tubular shaft instrument.
FIG. 1 is a rough outline of a disclosed embodiment of a tubular shaft instrument according to the invention. It shows three functional components of the tubular shaft instrument, a handle 110, an elongate tubular shaft 24 and arranged at the distal end of the tubular shaft 24 tool head 30. The tool head 30 represents the actual functionality of the tubular shaft instrument ready. He used to cut and / or coagulate tissue. The handle 110 controls the movement of the tool head 30. In particular, by means of the handle HO mouth parts 10, 10 '(see. Fig. 2) for fixing, coagulation and cutting of tissue are closed, and are opened.
Fig. 2 shows an embodiment of a tool head 30 according to the invention, which comprises a first jaw part 10 and a second jaw part 10 '. The first jaw member 10 is an elongated body having on its side facing the tubular shaft 24 side facing an adapter 25 which is rigidly connected to the tubular shaft 24th Via a joint 40, the second jaw member 10 'is fixed to the first jaw part 10 and can be brought from an open position for grasping tissue to a closed position for fixing the fabric. The joint 40 is formed such that a virtual fulcrum 1 or rotational axis outside the first and second jaw part 10, 10 'is located. Unlike conventional hinges 40 for such instruments that is, the fulcrum 1 is not in the area where the jaw parts 10, 10 'engage each other, or in the tubular shaft 24, near the longitudinal axis of the tubular shaft 24. The mechanism of the joint 40 illustrated acts as that a virtual fulcrum 1 above the second jaw member 10 'side facing the tubular shaft instrument forms.
The particular advantages of such a relocated fulcrum 1 show up reference to the schematic representations of Fig. 9. In the top left corner of a conventional rotary joint there is depicted, whose fulcrum 1 is located substantially on the longitudinal axes of the jaw parts 10 and 10 '. In the opened state, the tip 16 'of the second jaw part 10' opposite the tip 16 of the first jaw member 10 is recessed. However, the situation, the inventive joint 40, which is schematically shown in the other two figures of Fig. 9. Here the fulcrum 1 is well above the longitudinal axes of the two elongated jaw members 10, 10 '. With the same opening in terms of the angle that the first jaw part 10 to the second jaw member 10 'is formed, is the tip 16' of the second jaw member 10 ', also in the opened state essentially on or before a perpendicular straight line through the tip 16 of the first jaw part 10th upon opening the second jaw member 10 'relative to the first jaw part 10, so it does not only come to a rotational motion in which the relative orientation of the second jaw member 10' changes to the first jaw member 10 but also to a longitudinal displacement of the second jaw member 10 ', which is oriented in the distal direction, ie parallel to the longitudinal axis of the first jaw member 10 toward its tip the sixteenth Conversely, it comes during a closing movement of the jaw members 10, 10 'to a longitudinal displacement of the second jaw member 10' in the proximal direction. In this way, tissue located between the two jaw parts 10, 10 ', drawn in the end in the tool head 30th Furthermore, according to the invention the stroke of the second tip 16, ie the distance between the first and second peaks 16, 16 'substantially larger at the same opening angle (see. Fig. 9, right). In one embodiment, the length of the jaw parts 10, 10 behave 'to the distance of the longitudinal axis of the first jaw part 10 to the pivot axis approximately in the ratio 10: 1. While the outsourced fulcrum 1 is achieved for clarity of '-faceted perpendicular to the proximal ends of the jaw parts 10, 10 of the extensions in Fig. 9, in a preferred embodiment the fulcrum 1 is purely virtual. This virtual training is achieved by a sliding guide, as will be explained hereinafter with reference to FIGS. 3-8. Thus, as shown in Fig. 3, the second jaw member 10 'at its proximal end opposite the tip 16' has two curved articulation guide rails 41, 41 '. From a plan view viewed (see. Fig. 4), these articulation guide rails 41, 41 'is substantially parallel along the longitudinal axis of the second jaw member 10' from each other and spaced apart to form a channel.
From the side (see. Fig. 5) is considered, the second jaw member 10 'has a spoon-shaped profile. The proximal end of the second jaw member 10 ', in particular the joint guide rails 41, 41', that have on their upper side each has a concave portion 43, 43 ', which communicates with the first jaw part 10 in engagement. As reference to Fig. 6 can be seen for this purpose, the first jaw part 10 has two articulation guide pins 42, 42 ', which each have a convex structure section. In the opening and closing movement of the jaw members 10, 10 'thus slides, the concave portion 43 of the first hinge guide rail 41 to the adjacent convex portion of the first articulation guide pin 42 and the concave portion 43' of the second articulation guide rail 41 'to the adjacent convex portion of the second articulation guide pin 42 '. The curvature of the concave portions 43, 43 'of the two articulated guide rails 41, 41' and of the corresponding portions of the articulation guide pins 42, 42 'are decisive for the position of the virtual fulcrum 1. With a more pronounced curvature, the pivot axis is located 1 closer to the tool head 30 as with a weak curvature. Accordingly, strong and weak, the effects described with respect to FIG. 9 occur.
The guide mechanisms or joint 40 has opposite joints which have only a punktu- elle compound, further the advantage of high stability. By the convex and concave portions engage with each other, a large-area contact region is formed, and the hinge 40 can absorb significantly more power than a hinge with a single-point connection. For further stabilization of the joint 40, the first jaw member 10 includes a first link guide bearing 46 and a second articulation guide bearing 46 '. As the articulation guide pins 42, 42 'are the spherical bearings 46, 46' mutually attached to the inside of the side walls of the first jaw part 10th
The first link guide bearing 46 and the first guide pins 42 are spaced so that they take up in the space between them, the first articulation guide rail 41st The first link guide bearing 46 has a concave section, which communicates with a convex portion 44 of the first articulation guide rail 41 is engaged. When opening and closing of the tool head 30, the first articulation guide rail 41, guided by the first guide pin 42 and the first articulation guide bearing 46 about the fulcrum 1 rotates.
Likewise, rotating the second hinge guide rail 41 ', guided by the second guide pin 42' and the second articulation guide bearing 46 'about the pivot axis 1. For this, second articulation guide rail 41', the second articulation guide pins 42 ', a convex portion 44' of the second articulation guide rail 41 ' and the second articulation guide bearing 46 'symmetrically to the first pivot guide rail 41, the first joint guide pin 42, the convex portion 44 of the first articulation guide rail 41 and the first articulation guide bearing 46 formed and arranged.
As shown in Fig. 10, a tension strip 27 at the proximal end of the second jaw member 10 'to. More specifically, it is approximately centered at the convex portions 44, 44 'of the joint guide rails 41, 41' attached. For this purpose, 41 have the joint guide rails 41 'a profile for forming a joining edge 2 (Fig. 5). Preferably, this abutment edge 2 (see Fig., 19) does not run in a straight line parallel to the pivot axis 1, but is semicircular. Through this extended joining edge 2 along which the second jaw part 10 'and the tension belt 27 are welded, the introduction of force are homogenized in the pull tape 27, and the tensile and bending load capacity of the weld is significantly increased. form guide in alternative from acute welds or multiple serrations welds are conceivable that provide a comparable result. The tension belt 27 parallel to the fulcrum 1 has a substantially greater width than thickness. Thus an elasticity and bendability of the tension band 27 is ensured during the rotation of the second jaw member 10 '. However, 27 in the longitudinal direction of the tubular shaft instrument, the drawstring has a relatively high rigidity, so that thrust forces can be generated.
Alternatively, the second jaw member 10 ', as shown in FIGS. 20 and 21, a Zugbandzapfen 47, extending radially substantially toward the fulcrum 1. This Zugbandzapfen 47 is centered between the convex portions 44, 44 'of the joint guide rails 41, 41' arranged and is received in a bore of the tension band 27th Thus, a permanent connection between jaw member 10 ', and 27 and tying is made. An additional welding increases the stability of the compound.
By the attachment of a first end of the tension band 27 at the convex portions 44, 44 'of the joint guide rails 41, 41' ensures that the pulling force exerted by means of the tension cord 27, is always substantially tangential to the circular motion of the curved joint guide rails 41, 41 'about fulcrum first Thus a uniform independent of the opening angle of force transmission is ensured. A second end of the tension band 27 is engaged with the handle 110 in operative connection and can be moved by means of an opening provided in this control device. Because of the virtual pivot axis 1, which, as already explained itself, located outside and above the jaw parts 10, 10 ', the distance between the pivot axis 1 and the first end of the tension band 27 is substantially greater than the distance which is obtained in conventional joints , Therefore, the off-described guide has a form of tubular shaft instrument a much greater leverage by means of the second jaw part 10 'on the tie rod 27 can be moved.
For fixing of the fabric 10, 10 have the two jaw parts 'are each a clamping surface 12, 12'. The first jaw member 10 thus has an upwardly facing first clamping surface 12 at a distal portion. This first clamping surface 12 is formed substantially transverse to the longitudinal axis of the first jaw part 10 concave. In the closed state of the tool head 30, the convex second clamping surface 12 'of the second jaw member 10' is substantially parallel to said first clamping surface 12th
In the described embodiment, these clamping surfaces 12, 12 'not only adapted to securely fix the later tissue to be cut, but also form the electrodes for a coagulation process. For this purpose, portions of the clamping surfaces 12, 12 'electrically conductive and connected via conductor tracks to an RF power source, which is likewise controllable via the handle 110th Thus, prior to cutting the tissue gripped, can be as strong desolate that separation is possible without bleeding. Preferably, at least portions of the jaw members 10, 10 'made of ceramic injection molding. Thus, the guide elements, in particular the joint guide rails 41, 41 'and the pivot guide pin 42, 42' of the joint 40 is easily formed. The joint 40 of ceramic which provides electrical insulation between the jaw parts 10, 10 ', in particular between the electrodes for coagulation.
After the coagulation is carried out in the present embodiment, the actual mechanical cutting operation. For this purpose, parallel to a fixing plane xy (see. Fig. 11), which is determined by the clamping surfaces 12, 12 ', a cutting device 50 moves. This cutting device 50 comprises a blade 51 for severing the tissue, and a guide wire 52 by means of which a movement of the blade 51 in the longitudinal direction of the tubular shaft instrument (x axis) is possible.
Before the cutting operation, the blade 51 is withdrawn so far to the tubular shaft 24 out that premature damage to the tissue is not possible. Preferably, the cutting edge is in the first jaw member 10 at the height of the joint guide pins 42, 42 '. From this starting position, the cutting edge 51 is a second in the mouth part 10 'integrated ramp 55 (Fig. 4, see FIG. Thereto) supplied to the fixing plane xy. This ramp 55 is located between the two joint guide rails 41, 41 '. For the movement of the cutting blade 51 and represents the second jaw member 10 'provides a blade guide 53rd This blade guide 53 is an elongated opening extending along the longitudinal axis of the second jaw member 10 '. To keep the blade 51 perpendicular to the fixing plane xy, the second jaw member 10 'in its central region, side panels 60, 60' which are arranged parallel to each other to form a longitudinally extending channel. In this channel, the blade 51 or blade is guided.
After closing the jaw parts 10, 10 'to slide the blade 51 so from its home position on the ramp 55 in the said channel and can be pulled or in distal and proximal direction over the fabric pushed there. To ensure that this displacement stepwise severing of the tissue, the blade 51 is biased xy relation to fixing. A biasing means exerts a force perpendicular to the fixing plane xy, which pushes the blade 51 against the plane. This force is built up on the elasticity of the guide wire 52 and its deflection. As seen from Fig. 12, the guide wire 52 is in the plane spanned by the cutting edge 51 plane perpendicular to the fixing xy, curved. In a front portion of the guide wire 52 is a bead 56. The bead 56 is integrated in such a way in the guide wire 52, that when fully extended condition of the cutter 50, that is, when the cutting edge 52 is located at the distal end of the jaw parts 10, 10 ' , the bead in the tubular shaft 24 is also at the distal end thereof. The bead 56 serves to deliver at least part of the force exerted by the curvature of the guide wire 52 perpendicular to the fixing plane xy to the tubular shaft 24 and has corresponding contact points on. The bending of the guide wire 52 is such that in a parallel running of the proximal end of the guidewire, the distal end of the free guide wire is bent 52 downward to the tubular shaft 24 and the blade 51 is located at least partially below the fixing plane xy. The guide wire 52 is engaged with the handle 110 in operative connection that can be back and forth in the tool head 30 by means of this the cutting 51st
With regard to the design of the blade 51 a variety of embodiments are conceivable. These are described below with reference to FIGS. 13, 14 and 15. An idea of ​​the invention is that the cutting edge 52 has at least one portion that is substantially parallel to the fixing plane xy, and thus runs parallel to the fixed tissue. Thus, the cutting edge 51 slides during the cutting operation so long across the tissue, until it is completely severed. Unlike conventional cutting operations so it can be ensured that even with blunt cutting edge 51 the fabric is cut and is not crushed due to the mechanical stress. The formed parallel to the fixing plane xy section of the cutting blade also has the advantage that the blade 51 rests not only selectively on the fabric, but usually for a longer range. Thus a punctual wearing of blade 51 is avoided. Fig. 13 shows a semi-circular blade 51, which has a convex curvature. The blade 51 is arranged on the underside of the guide wire 52nd It has a blade curvature 54 in the distal and proximal to the tubular shaft instrument.
Fig. 14 shows a blade 51, which consists of two successively arranged respective semicircles.
Fig. 15 shows a blade 51 having a blade curvature in the distal direction 54, and a vertical portion 52 to the guide wire in the proximal direction.
Preferably, the cutting edge 51 to a total of a micro-toothing.
In an alternative embodiment (see. E.g., Fig. 10) is on the guide wire 52 to a rail. The rail may be formed such that it has the same functionality as the guidewire 52nd The bias relative to the fixing plane xy can be achieved by the inherent elasticity of the rail or by a separate device (for example, a spring).
The advantageous cutting device 50 of the invention has been described in connection with the advantageous articulation shape. Both inventions can also be run separately from each other.
For example, FIGS. 17 and 18 show the cutting device 50 in a tool head 30, wherein the second jaw member 10 'is not in operative connection via a slotted guide with the first jaw member 10. The axis of rotation 1 here lies substantially on the longitudinal axis of the jaw parts 10, 10 '.
In one embodiment of the invention the tubular shaft instrument further comprises an interface control device. This determines when the tissue between the two clamping surfaces 12, 12 'is completely separated. In the exemplary embodiment, blade 51 rests at completely transected tissue on the first clamping surface 12th Since the clamping surface 12 includes an electrode for coagulation, it is at least partially electrically conductive. According to the invention at least a portion of the cutting edge 51, the separating surface mechanically contacted when the tissue 12, also formed of electrically conductive material. By means of an interface control device of the electrical contact between the blade 51 and the clamping surface 12 is determined. The gripped tissue is considered to be completely severed, if up to the ramp 55 is at a complete cutting movement of the tip 16 'of the second jaw member 10' a continuous electrical contact between blade 51 and clamping surface 12th As shown in Fig. 16 can be seen, the interface control device for determining and displaying the progress of the cutting operation comprises a processing device 100, a display device 101, a switch 103 and a displacement sensor 102. The displacement sensor 102 position or the movement of the blade 51 and helps thus determines to define an observation interval, which preferably comprises a complete cutting movement. The switch 103 is formed in the simplest case by the electrically conductive blade 51 and the first clamping surface 12th Since the tissue to be cut has a certain electrical conductivity, the electrical switch 103 is only deemed to be closed when a low impedance connection between the clamping surface 12 and the blade 51 is made. A corresponding device is connected upstream of the processing apparatus 100. FIG. Represents the processing device 100 determines that during a complete observation period, a continuous low-impedance contact between blade 51 and clamping surface 12, it indicates to the user via the display device 101 that the gripped tissue is completely severed. Thus, the cutting device 50 is protected, since the movement of the blade 51 without intervening tissue damages them on the clamping surface 12th
Alternatively, the user may also be displayed continuously, whether a direct mechanical contact between blade 51 and clamping surface 12 is present. Since the movement of the cutting is carried out manually by the user 51, he can pull independently conclusions whether the tissue is sufficiently severed.
In a further embodiment of the displacement sensor 102 includes two electrical contact areas on the distal and proximal end of the blade guide 53, which are formed such that a contact between the blade 51 and the distal contact portion and between the edge 51 and the proximal contact area can be determined. The processing device 100 can thus detect the start and end of an observation interval.
Fig. 22 shows a schematic detail view of the handle 110 of FIG. 1. The handle 110 includes a handle body 117, on the underside, a first gripping lever is integrally formed 122nd This handle lever 122 has an opening for receiving a plurality of fingers, preferably the middle, ring and little finger on. A second handle lever 122 'is rotatably connected near the first handle lever 122 to the handle body 117th By a movement of the second handle lever 122 'relative to the first handle lever 122 in proximal and distal direction, leave the mouth parts 10, 10' of the "tool head to open and close the 30th, the handle lever 122, 122 'form a manual trigger 120, and can thus in accommodate the user's hand, that the entire tubular shaft instrument can be performed with one hand. For this purpose the hand encloses portions of the handle lever 122, 122 '. at the handle body 117 facing away from the end of the second handle arm 122' is a projection which engages in a toothed rack 124 . This rack 124 is attached at a right angle to the longitudinal axis of the first handle lever 122 to which the handle body 117 facing away from the end. the dentition of the rack 24 is formed such that the second handle lever 122 can gradually move towards the first handle lever 122 'and the corresponding holds set position without constant application of force. To this Fixie tion of the handle lever 122, 122 'to solve each other is so pushed, the rack 124 of the extension 125 that they are no longer in engagement.
Furthermore, the handle 110 has a finger trigger 130, which is also rotatably attached to the handle body 117th By actuating the finger trigger 130, the cutting device 50, in particular blade 51 can be moved in the distal direction. An unshown spring element in the interior of the handle body 117 brings the finger trigger 130 after the actuation returns to its starting position, whereby the cutting device is moved in the proximal direction 50th The finger trigger 130 is distally disposed before the first handle lever 122 such that is operable in a gripping of the handle lever 122, 122 'of the finger trigger 130 with the index finger. The handle 110 has a push-button switch 116 on the proximal side of the handle body 117, which is used to control the coagulation. In an alternative embodiment, a control device can be used with a plurality of actuators provided in place of the pushbutton switch 116, by means of which a plurality may be selected by coagulation modes and carried out. It is likewise conceivable to provide the display device 101 on the handle body 117th
In an invention disclosed embodiment, the tubular shaft 24 and handle 110 are formed such that the tubular shaft 24 may be detachably inserted into the handle 110th To this end, located on the side of the handle 110 has a receiving opening 112, which can be closed by a cover.
Before the operation, so a sterile disposable tubular shaft 24 is inserted with an appropriate tool head 30 and cutter 50 in the reusable handle 110 and is locked there. A re-use of the tubular shaft 24 and the associated apparatus is not provided here. For mechanical connection of the tool head 30, the cutting device 51 and the tube stem 24 117 has the handle body having a first coupling member 114 and coupling element, a second coupling element 114 'and coupling member and a third coupling element 114 "or coupling member. In the third coupling element 114 'engages 24 ring provided at the proximal end of the tubular shaft in such a that the tubular shaft is rigidly connected to the handle body 117th in the first coupling element 114, with the second handle lever 122' is in operative connection, engages a first inner tube adapter 22 by means of a likewise arranged at the proximal end ring a. the movement of the second handle lever 122 'is transmitted through a disposed within the handle body 117 mechanics to the first coupling element 114 and transmits it in turn to the first inner pipe adapter 22. this is directly or indirectly on the tension belt 27 having the second griped il 10 'in mechanical connection. A longitudinal displacement of the first inner tube adapter 22 relative to the tubular shaft 24 thus causes the opening and closing of the jaw members 10, 10 '.
A second inner tube adapter 22 'is disposed opposite to the first inner tube adapter 22 to move freely in the interior thereof. This inner tube adapter 22 'is in Wirkver- bond with the guide wire 52 and moving the cutter 51. By the insertion of the tubular shaft 24 in the handle body 117 engages the proximal ring at the end of the second inner tube adapter 22' in the second coupling member 114 'and transfers the movement or the force exerted by the finger trigger 130 to the cutting device 50th
In order to facilitate the insertion of the disposable tubular shaft 24, a removable fixing is provided on this, which holds the inner pipe adapter 22, 22 'relative to the tubular shaft 24 in a predetermined position, which is configured such that the rings easily in the coupling elements 114, 114 ', 114 "can be used.
The coupling elements 114, 114 '114' are formed such that the tubular shaft 24 may be rotated relative to the handle 110. Thus, the alignment of the tool head 30 relative to handle 110 can be freely set. During rotation, the rings of the inner pipe adapter 22 rotate, 22 'and the pipe shaft 24 in the coupling elements 114, 114', 114 "and thus form a pivot joint.
10, 10 'jaw part
12, 12 'clamping surface
16, 16 'peak
22, 22 'the inner tube adapter
27 tieback
40 articulated
41, 41 'articulation guide rail
42, 42 'pivot guide pin 43, 43' rail concave portion of the articulated guide
rail 44, 44 'convex portion of the articulated guide
46, 46 'articulation guide bearing
51 cutting edge
52 guidewire
56 bead
60, 60 'lateral part
100 proce eitungs device
102 displacement sensor
112 ff voltage nahmeö
114, 114 ', 114 "coupling element
116 key switch
122, 122 'Handle
124 rack
X x axis y y-axis
1. A tubular-shaft instrument, in particular electrosurgical tubular shaft instrument, for gripping and / or coagulating and / or cutting of tissue comprising a tubular shaft (24),
- a first and a second jaw part (10, 10 ') at a distal end of the tubular shaft (24) with at least one clamping surface (12, 12'),
- at least one hinge (40) for rotatably supporting the jaw parts (10, 10 ') such that the jaw parts (10, 10' can be brought) from an open position to a closed position around the tissue with the clamping surfaces (12, 12 ' to fix), characterized in that the joint (40) is formed such that the axis of rotation (1) of the joint (40) outside of the jaw parts (10, 10 '), and the distal end of at least one jaw part (10, 10' ) can be moved away on opening of the distal end of the tubular shaft (24).
2. Tubular shaft instrument according to claim 1, characterized in that the joint (40) comprises a link guide.
3. A tubular-shaft instrument according to one of the preceding claims, characterized in that the joint (40) a hinge guide (42, 42 ', 46, 46') on one of the two jaw parts (10, 10 ') and at least one rail (41, 41 ') or groove on the other of the two jaw parts (10, 10' includes).
4. A tubular-shaft instrument according to one of the preceding claims, characterized by at least two part-joints (40, 40 ') leading to the formation of a, preferably centrally between the partial joints (40, 40' arranged) passageway are spaced from each other.
5. A tubular-shaft instrument according to one of the preceding claims, characterized by a cutting edge (51) for severing the fixed tissue.
6. A tubular-shaft instrument according to one of the preceding claims, characterized in that at least one jaw part (10, 10 ') comprises a blade guide (53).
7. A tubular-shaft instrument according to one of the preceding claims, characterized in that one of the two jaw parts (10) rigidly connected to the tubular shaft (24) is connected.
8. A tubular-shaft instrument according to one of the preceding claims, characterized in that 'a substantially linearbewegbares band is provided with an elastic end portion on to moving jaw part (10 for opening and closing a to moving jaw part (10)' is fixed).
9. A tubular-shaft instrument according to one of the preceding claims, in particular according to claim 8, characterized in that the band is designed as a tension band (27), in particular made of spring steel, of which
End portion fixedly connected to the jaw parts (10 ') is connected.
10. A tubular-shaft instrument according to one of the preceding claims, in particular according to claim 8 or 9, characterized in that attached the tape by welding at the jaw part (10 '), said weld preferably extends un-rectangular and / or curved to a longitudinal axis of the belt ,
11. A tubular-shaft instrument according to one of the preceding claims, characterized in that at least one of the clamping surfaces (10, 10 ') comprises an electrode for coagulation of the fixed tissue.
12. A tubular-shaft instrument according to one of the preceding claims, characterized in that at least one of the jaw parts (10, 10 ') consists at least in the region of the joint of electrically insulating material, in particular ceramic.
13. A tubular-shaft instrument according to one of the preceding claims, characterized in that the jaw parts (10, 10 ') for fixating tissue in a fixing plane (xy) are formed, wherein a cutting means (50) having a cutting edge (51) for cutting the fixed fabric is moved by means of an actuating device in a sectional direction (x), wherein the cutting edge (51) substantially to the fixing parallel (xy) is movably guided by a biasing means (56) is biased during cutting against the fixing plane (xy).
14. A tubular-shaft instrument according to one of the preceding claims, in particular according to claim 13, characterized in that the biasing means (56) has an elastic guide wire comprises (52) having a bend, wherein the guide wire (52) with the cutting edge (51) substantially rigidly and such in the tubular shaft (24) is performed such that the cutting edge (51) relative to the tubular shaft (24) towards the fixing plane (xy) is biased towards.
15. A tubular-shaft instrument according to one of the preceding claims, in particular according to claim 13 or 14, characterized in that the biasing means (56) comprises a bead in such a way in the guide wire (52) is arranged to at pushed forward cutting edge (51) near the distal is the end of the tubular shaft (24).
16. A tubular-shaft instrument according to one of the preceding claims, characterized in that one of the two jaw parts (10, 10 ') has a cut along the direction (x) includes extending blade guide (53).
17. A tubular-shaft instrument according to one of the preceding claims, in particular according to any one of claims 13-16, characterized by an in particular ramp-shaped blade guide (53) and is designed and arranged such that the cutter (51) from one to the fixing plane (xy) spaced-Deten initial position by a movement in the cutting direction (x) on the fixing plane (xy) feeds.
18. A tubular-shaft instrument according to one of the preceding claims, in particular according to any one of claims 13-17, characterized in that the blade guide (53) is designed such that the cutting edge (51) (in a starting position near the axis of rotation of the jaw members 10, 10 ' ) can be brought.
19. A tubular-shaft instrument according to one of the preceding claims, characterized in that by the clamping surface (12, 12 '), the fabric in a fixing plane (xy) can be fixed, wherein a cutting device (50) having a cutting edge (51) for cutting tissue against is one of the jaw parts (10, 10 ') arranged and substantially parallel to the fixing (xy) over a predeterminable cutting path movable; and a first electrode and a second electrode disposed on the cutting device (50) and / or the clamping surface (12) are arranged such that a mechanical contacting of between the cutting edge (51) and clamping surface (by means of a connected to the electrodes processing means (100) 12) is detectable.
20. A medical instrument according to any one of the preceding claims, in particular according to claim 19, characterized in that the cutting edge (51), the first electrode, the clamping surface (12) of the second electrode and the processing means (100) comprises means for determining an electrical resistance between comprise the electrodes.
21. A medical instrument according to any one of the preceding claims, in particular according to claim 20, characterized in that the processing means (100) is formed such that a curve of the
Resistance can be detected during the cutting path.
22. A medical instrument according to any one of the preceding claims, in particular according to one of claims 19-21, characterized in that the processing means (100) comprises a displacement sensor (102) and / or an electrical switch for detecting the movement of the cutting edge (51) parallel to the clamping surface (12).
PCT/EP2007/008386 2006-10-05 2007-09-26 Tubular shaft instrument WO2008040483A1 (en)
WO2008040483A1 true WO2008040483A1 (en) 2008-04-10
WO2018054575A1 (en) * 2016-09-20 2018-03-29 Epflex Feinwerktechnik Gmbh Tubular shaft instrument with a distal, rotatable functional part
AU2010201369B8 (en) * 2009-04-07 2014-03-20 Covidien Lp Vessel sealer and divider with blade deployment alarm
AU2010201369A8 (en) * 2009-04-07 2014-03-20 Covidien Lp Vessel sealer and divider with blade deployment alarm
AU2010201369B2 (en) * 2009-04-07 2014-03-06 Covidien Lp Vessel sealer and divider with blade deployment alarm
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