DE10042606A1 - Medical instrument has two interfitting cannulas with curvature altered by twisting by means of cog wheels, or drive mechanism. - Google Patents

Medical instrument has two interfitting cannulas with curvature altered by twisting by means of cog wheels, or drive mechanism.

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Publication number
DE10042606A1
DE10042606A1 DE2000142606 DE10042606A DE10042606A1 DE 10042606 A1 DE10042606 A1 DE 10042606A1 DE 2000142606 DE2000142606 DE 2000142606 DE 10042606 A DE10042606 A DE 10042606A DE 10042606 A1 DE10042606 A1 DE 10042606A1
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DE
Germany
Prior art keywords
cannulas
cannula
medical device
another
curvature
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
DE2000142606
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German (de)
Inventor
Michael Loser
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Siemens AG
Original Assignee
Siemens AG
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Publication date
Application filed by Siemens AG filed Critical Siemens AG
Priority to DE2000142606 priority Critical patent/DE10042606A1/en
Publication of DE10042606A1 publication Critical patent/DE10042606A1/en
Ceased legal-status Critical Current

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02Instruments for taking cell samples or for biopsy
    • A61B10/0233Pointed or sharp biopsy instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34Trocars; Puncturing needles
    • A61B17/3403Needle locating or guiding means
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34Trocars; Puncturing needles
    • A61B17/3417Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421Cannulas
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/01Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/0105Steering means as part of the catheter or advancing means; Markers for positioning
    • A61M25/0133Tip steering devices
    • A61M25/0152Tip steering devices with pre-shaped mechanisms, e.g. pre-shaped stylets or pre-shaped outer tubes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003Steerable
    • A61B2017/00318Steering mechanisms
    • A61B2017/00331Steering mechanisms with preformed bends
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2901Details of shaft
    • A61B2017/2904Details of shaft curved, but rigid
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2927Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/01Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/0105Steering means as part of the catheter or advancing means; Markers for positioning

Abstract

The implement has two interlocking and curved cannulas (1,2) which can be relatively twisted so that the total curvature of the interlocked cannulas can be altered by twisting. The appliance for twisting the cannulas is in the form of at least one cog wheel (3,4) or drive mechanism (6,8). The cannulas are of a size to be used for a biopsy, invasive therapy, or endsoscope.

Description

Die Erfindung betrifft ein medizinisches Gerät, aufweisend zwei ineinander steckbare und gebogene Kanülen.The invention relates to a medical device, comprising two interlocking and curved cannulas.

Punktionen von Lebewesen, beispielsweise für eine Biopsie, eine Injektion oder eine Drainage, sind in der Medizin allge­ mein üblich. Bei einer Punktion führt ein Arzt eine Hohlnadel in den Körper eines Patienten ein, um beispielsweise eine Ge­ webeprobe zu entnehmen. Nachteilig bei der Punktion mit her­ kömmlichen Hohlnadeln ist, dass es nicht immer ohne Weiteres möglich ist, ein Punktionsziel genau zu treffen. Es ist bei­ spielsweise möglich, dass die Hohlnadel insbesondere bei ei­ nem relativ weit im Inneren des Patienten liegenden Punkti­ onszieles während der Punktion abdriften oder durch die At­ mung des Patienten von einer gewählten Punktionsbahn abwei­ chen und somit das Punktionsziel verfehlen kann. Wenn das Punktionsziel verfehlt wird, muss die Punktion wiederholt werden, was wiederum den Patienten zusätzlich belastet.Puncturing living organisms, for example for a biopsy, an injection or drainage is common in medicine my usual. In the event of a puncture, a doctor guides a hollow needle into a patient's body, for example, to get a Ge see web sample. A disadvantage with the puncture Conventional hollow needles is that it is not always easy it is possible to hit a puncture target exactly. It is at possible for example that the hollow needle, in particular with egg Point relatively far inside the patient target during the puncture or through the at deviate from a selected puncture pathway chen and can therefore miss the puncture target. If that If the puncture target is missed, the puncture must be repeated become, which in turn puts additional strain on the patient.

Die Verwendung von Endoskopen ist in der Medizin ebenfalls allgemein üblich. Endoskope werden beispielsweise verwendet, um Bilder eines Untersuchungsobjektes aus dem Inneren eines Patienten zu erhalten oder Gewebeproben aus dem Inneren eines Patienten zu entnehmen. Nachteilig an starren Endoskopen ist insbesondere die Schwierigkeit das Endoskop an schwer zugäng­ lichen Untersuchungsobjekten, die beispielsweise durch Kno­ chen verdeckt sind, heranzuführen.The use of endoscopes is also in medicine common practice. Endoscopes are used for example for images of an examination object from inside a Get patient or tissue samples from inside a patient Remove patients. A disadvantage of rigid endoscopes especially the difficulty of finding the endoscope difficult to access Lichen examination objects, for example by Kno Chen are covered.

Die Aufgabe der Erfindung ist daher, ein medizinisches Gerät der oben genannten Arten derart auszubilden, dass die Voraus­ setzungen dafür getroffen sind, eine Behandlung eines Patien­ ten flexibler und weniger belastend durchzuführen. The object of the invention is therefore a medical device train the above types so that the advance conditions are met for treatment of a patient more flexible and less stressful.  

Nach der Erfindung wird diese Aufgabe gelöst durch ein medi­ zinisches Gerät, aufweisend zwei ineinander steckbare und ge­ bogene Kanülen, wobei die ineinander gesteckten Kanülen rela­ tiv zueinander verdrehbar sind, so dass bei der Verdrehung eine Gesamtkrümmung der ineinander gesteckten Kanülen verän­ derbar ist. Folglich kann beispielsweise bei der Verwendung der Erfindung für die Punktion bei einem Abdriften der inein­ ander gesteckten Kanülen die Gesamtkrümmung der ineinander gesteckten Kanülen verändert und somit das Abdriften korri­ giert werden.According to the invention, this object is achieved by a medi cinical device, comprising two pluggable and ge curved needles, the inserted needles rela tiv are rotatable relative to each other, so that when twisting change the total curvature of the inserted cannulae is derbar. Consequently, for example, in use of the invention for the puncture when drifting into one another the total curvature of the one inside the other inserted cannula changed and thus the drift corri be greeded.

Eine Variante der Erfindung sieht vor, dass bei dem medizini­ schen Gerät die Kanülen derart gebogen sind, dass bei der Verdrehung die Kanülen derart relativ zueinander ausrichtbar sind, dass die ineinander gesteckten Kanülen keine Gesamt­ krümmung aufweisen. Somit kann die Erfindung beispielsweise bei der Verwendung zur Punktion auch gerade Punktionsbahnen durchdringen.A variant of the invention provides that in the medical device, the cannulas are bent in such a way that Twist the cannulas can be aligned relative to one another in this way are that the nested cannulas are not a total have curvature. Thus, for example, the invention when used for puncture also straight puncture lanes penetrate.

Wenn nach einer Ausführungsform der Erfindung das medizini­ sche Gerät eine Einrichtung zum Verdrehen der Kanülen relativ zueinander aufweist, kann die Gesamtkrümmung der ineinander gesteckten Kanülen einfacher verändert werden.If according to one embodiment of the invention the medicinal cal device a device for rotating the cannulas relative to each other, the total curvature of one another inserted needles can be changed more easily.

Eine weitere Variante der Erfindung sieht vor, dass die Ein­ richtung zur Verdrehung wenigstens ein Zahnrad aufweist.Another variant of the invention provides that the one Direction for rotation has at least one gear.

Eine weitere Ausführungsform der Erfindung sieht vor, dass die Kanülen mittels wenigstens eines Antriebes verdrehbar sind. Dadurch ist eine besonders feinfühlige Einstellung der Gesamtkrümmung der ineinander gesteckten Kanülen erreichbar.Another embodiment of the invention provides that the cannulas can be rotated by means of at least one drive are. This is a particularly sensitive setting of the Total curvature of the inserted cannulas can be reached.

Eine weitere Ausführungsform der Erfindung sieht vor, dass die Verdrehung mittels eines Roboters steuerbar ist. Dadurch kann eine Behandlung mit der Erfindung automatisiert werden. Another embodiment of the invention provides that the rotation can be controlled by a robot. Thereby Treatment with the invention can be automated.  

Weitere Ausführungsformen der Erfindung sehen vor, dass die Kanülen derart dimensioniert sind, dass das medizinische Ge­ rät für eine Biopsie oder für eine minimal invasive Therapie verwendbar ist.Further embodiments of the invention provide that the Cannulas are dimensioned such that the medical Ge advises for a biopsy or for minimally invasive therapy is usable.

Eine weitere Ausführungsform der Erfindung sieht vor, dass die Kanülen derart dimensioniert sind, dass das medizinische Gerät für ein Endoskop verwendbar ist. Aufgrund der veränder­ baren Gesamtkrümmung der ineinander gesteckten Kanülen kann solch ein Endoskop vielseitiger als ein starres Endoskop ein­ gesetzt werden.Another embodiment of the invention provides that the cannulas are dimensioned such that the medical Device can be used for an endoscope. Because of the change total curvature of the inserted cannulae such an endoscope is more versatile than a rigid endoscope be set.

Ausführungsbeispiele der Erfindung sind in den beigelegten schematischen Zeichnungen dargestellt. Es zeigen:Embodiments of the invention are in the accompanying shown schematic drawings. Show it:

Fig. 1 in teilweise geschnittener Darstellung eine Seitenansicht eines erfindungsgemäßen medizini­ schen Gerätes, Fig. 1 in partial cross section a side view of the invention's Medical Intern device,

Fig. 2 und 3 Schaubilder zur Verdeutlichung der Funktions­ weise des erfindungsgemäßen medizinischen Gerä­ tes, Fig. 2 and 3 are diagrams for explaining the function example of the medical Gerä invention tes,

Fig. 4 ein erfindungsgemäßes medizinisches Gerät, wel­ ches an einem Roboter angeordnet ist, und Fig. 4 shows an inventive medical device, which is arranged on a robot, and

Fig. 5 in teilweise geschnittener Darstellung ein En­ doskop. Fig. 5 shows a partially sectioned En doskop.

Das in der Fig. 1 dargestellte erfindungsgemäße medizinische Gerät MG umfasst zwei ineinander steckbare, gebogene und hohlzylinderförmige Kanülen 1, 2. Im Falle des vorliegenden Ausführungsbeispieles ist die Kanüle 2, deren äußerer Durch­ messer wenig kleiner als der innere Durchmesser der Kanüle 1 ist, in die Kanüle 1 gesteckt. The medical device MG according to the invention shown in FIG. 1 comprises two mutually pluggable, curved and hollow cylindrical cannulas 1 , 2 . In the case of the present exemplary embodiment, the cannula 2 , whose outer diameter is slightly smaller than the inner diameter of the cannula 1, is inserted into the cannula 1 .

Im Falle des vorliegenden Ausführungsbeispieles ist an einem Ende der Kanüle 1 ein Zahnrad 3 und an der Kanüle 2 ein Zahn­ rad 4 angeordnet. Ferner ist das Zahnrad 3 derart mit einer Welle 5 eines Elektromotors 6, das Zahnrad 4 derart mit einer Welle 7 eines Elektromotors 8 und die Zahnräder 3 und 9 der­ art miteinander verbunden, dass die Kanülen 1 und 2 mittels der Elektromotoren 6 und 8 relativ zueinander verdreht werden können. Es ist aber auch eine Ausführungsform ohne Elektromo­ toren möglich, bei der die Kanülen 1, 2 per Hand, beispiels­ weise mittels der Zahnräder 4, 5, verdreht werden können. Es sind aber auch Ausführungsformen ohne Zahnräder 3, 4 denkbar. Andere Antriebe als Elektromotoren 6, 8, wie beispielsweise hydraulische Antriebe, sind auch möglich.In the case of the present exemplary embodiment, a toothed wheel 3 and a toothed wheel 4 are arranged on the cannula 2 at one end of the cannula 1 . Furthermore, the gear 3 is connected to a shaft 5 of an electric motor 6 , the gear 4 is connected to a shaft 7 of an electric motor 8, and the gears 3 and 9 are connected to one another such that the cannulas 1 and 2 are relative to one another by means of the electric motors 6 and 8 can be twisted. But it is also an embodiment without electromotors possible, in which the cannulas 1 , 2 can be rotated by hand, for example by means of the gears 4 , 5 . However, embodiments without gears 3 , 4 are also conceivable. Drives other than electric motors 6 , 8 , such as hydraulic drives, are also possible.

Im Falle des vorliegenden Ausführungsbeispieles sind die Elektromotoren 6 und 8 mit einem Schutzgehäuse 9 umgeben und an dem Schutzgehäuse 9 mit nicht dargestellten Haltern ange­ ordnet und können mittels in der Fig. 1 nicht dargestellte Bedienelemente gesteuert werden. Das Schutzgehäuse 9 kann beispielsweise auch als Griff zur besseren Handhabung des me­ dizinischen Gerätes MG verwendet werden.In the case of the present exemplary embodiment, the electric motors 6 and 8 are surrounded by a protective housing 9 and are arranged on the protective housing 9 with holders (not shown) and can be controlled by means of control elements (not shown in FIG. 1). The protective housing 9 can, for example, also be used as a handle for better handling of the medical device MG.

Die Kanülen 1, 2 sind im Falle des vorliegenden Ausführungs­ beispieles derart gebogen, dass bei einer geeigneten Verdre­ hung der Kanülen 1, 2 relativ zueinander die ineinander gesteckten Kanülen 1, 2 keine Gesamtkrümmung aufweisen (dies ist in Fig. 1 strichliert dargestellt). Bei einer Verdrehung der Kanülen 1, 2 relativ zueinander kann außerdem die Gesamt­ krümmung der ineinander gesteckten Kanülen 1, 2 verändert werden. Die Richtung der Gesamtkrümmung ist ebenfalls beein­ flussbar. Es sind aber auch Ausführungsformen denkbar, bei der die Kanülen 1, 2 derart gebogen sind, dass bei jeder Ver­ drehung der ineinander gesteckten Kanülen 1, 2 die ineinander gesteckten Kanülen 1, 2 eine Gesamtkrümmung aufweisen.The cannulas 1 , 2 are bent in the case of the present embodiment, for example, such that when the cannulas 1 , 2 are suitably rotated relative to one another, the cannulas 1 , 2 inserted one into the other have no overall curvature (this is shown in dashed lines in FIG. 1). When the cannulas 1 , 2 are rotated relative to one another, the total curvature of the cannulas 1 , 2 inserted into one another can also be changed. The direction of the total curvature can also be influenced. However, embodiments are also conceivable in which the cannulas 1 , 2 are bent such that with each rotation of the nested cannulas 1 , 2 the nested cannulas 1 , 2 have an overall curvature.

Das in der Fig. 1 gezeigte erfindungsgemäße Gerät MG kann bei geeignet dimensionierten Kanülen 1, 2 beispielsweise für eine Biopsie oder für eine minimal invasive Therapie, beispiels­ weise für eine Drainage oder eine Injektion, verwendet wer­ den. Bei der Verwendung für eine Punktion kann beispielsweise die Gesamtkrümmung der ineinander gesteckten Kanülen 1, 2 beim Abdriften der Kanülen 1, 2 während der Punktion gezielt verändert und somit das Punktionsziel besser getroffen wer­ den. Somit können Fehlversuche vermieden und zu behandelnde Patienten geschont werden. Ferner können beispielsweise durch eine gezielte Veränderung der Gesamtkrümmung der ineinander gesteckten Kanülen 1, 2 während der Punktion auch schwer zu­ gängliche Punktionsziele erreicht werden, die beispielsweise durch Knochen oder sensible Strukturen, wie beispielsweise Nerven oder Blutgefäße, verdeckt sind.The device MG according to the invention shown in FIG. 1 can be used with suitably dimensioned cannulas 1 , 2 , for example for a biopsy or for minimally invasive therapy, for example for drainage or injection. When used for a puncture, for example, the overall curvature of the cannulas 1 , 2 inserted one into the other when the cannulas 1 , 2 drift during the puncture can be specifically changed and thus the puncture target can be better met. In this way, incorrect attempts can be avoided and patients to be treated can be spared. Furthermore, for example, a targeted change in the overall curvature of the cannulas 1 , 2 inserted into one another during the puncture can also achieve difficult-to-reach puncture targets that are hidden, for example, by bones or sensitive structures, such as nerves or blood vessels.

Bei einer Verwendung des erfindungsgemäßen medizinischen Ge­ rätes MG für eine minimal invasive Therapie erleichtert das erfindungsgemäße medizinische Gerät MG den Zugang zum Punkti­ onsziel. Die eigentliche Therapie kann dann beispielsweise über Katheter oder feine Nadeln, die durch die ineinander gesteckten Kanülen 1, 2 geschoben werden können, erfolgen.When using the medical device MG according to the invention for minimally invasive therapy, the medical device MG according to the invention facilitates access to the targeting point. The actual therapy can then be carried out, for example, via catheters or fine needles which can be pushed through the cannulas 1 , 2 inserted into one another.

Die Fig. 2 und 3 zeigen Schaubilder zur Verdeutlichung der Funktionsweise des in Fig. 1 dargestellten erfindungsgemäßen medizinischen Gerätes MG. Die Fig. 2 zeigt exemplarisch eine Krümmungslinie w1,0(x)<0 der gebogenen Kanüle 1, wenn die Ka­ nülen 1, 2 nicht ineinander gesteckt sind. Das Koordinaten­ system 20 ist im Falle des vorliegenden Ausführungsbeispieles derart gewählt, dass die Krümmungslinie w1,0(x) nur eine z- Komponente hat. Wird die Kanüle 2 in die Kanüle 2 gesteckt, wirkt auf die Kanüle 1 eine von der ebenfalls gebogenen Ka­ nüle 2 ausgeübte Lastverteilung q1(x), die eine Biegelinie w1(x) der Kanüle 1 hervorruft. Sind die Kanüle 1, 2 derart relativ zueinander verdreht, dass die Biegelinie w1(x) eben­ falls nur eine z-Komponente hat, lässt sich die Biegelinie w1(x) approximieren als:
Figs. 2 and 3 show diagrams to illustrate the operation of the illustrated in Fig. 1 MG medical device according to the invention. Fig. 2 shows an example of a line of curvature w 1.0 (x) <0 of the curved cannula 1 when the cannula 1 , 2 are not inserted into each other. The coordinate system 20 is selected in the case of the present exemplary embodiment in such a way that the line of curvature w 1.0 (x) has only one z component. When the cannula 2 into the cannula 2 inserted, acts on the cannula 1 a of the also bent Ka Nuele 2 load distribution exerted q 1 (x), the w a bending line 1 causes (x) of the cannula. 1 If the cannulas 1 , 2 are rotated relative to one another in such a way that the bending line w 1 (x) also has only a z component, the bending line w 1 (x) can be approximated as:

wobei E1 ein materialspezifisches Elastizitätsmodul, I1 ein axiales Trägheitsmoment der Kanüle 1 und f1(x) eine eine in Fig. 1 nur exemplarisch dargestellte Lastverteilung q1(x) entlang der Kanüle 1 umfassende Funktion sind.where E 1 is a material-specific modulus of elasticity, I 1 is an axial moment of inertia of the cannula 1 and f 1 (x) is a function comprising a load distribution q 1 (x) along the cannula 1 which is only shown by way of example in FIG. 1.

Der Term
The term

lässt sich zumindest näherungsweise aus der Balkenbiegungslehre ableiten.can at least be approximated derive the beam bending gauge.

Die gebogene Kanüle 2 weist auch eine Krümmungslinie w2,0(x)<0 auf, wenn die Kanülen 1, 2 nicht ineinander gesteckt sind und die in Fig. 2 zusammen mit der in Fig. 1 dargestellten Krüm­ mungslinie w1,0(x) der Kanüle 1 dargestellt ist. Die Kanüle 2 ist derart zur Kanüle 1 angeordnet, dass die Krümmungslinie w2,0(x) ebenfalls nur eine z-Komponente aufweist und die Krüm­ mungslinien w1,0(x), w2,0(x) relativ zueinander auseinander laufen. Bei ineinander gesteckten Kanülen 1, 2 übt die Kanüle 1 ebenfalls eine in der Fig. 3 nicht dargestellte Lastvertei­ lung q2(x) auf die Kanüle 2 aus, die eine Biegelinie w2(x) der Kanüle 2 bewirkt. Die Biegelinie w2(x) lässt sich appro­ ximieren als
The curved cannula 2 also has a curvature line w 2.0 (x) <0 if the cannulas 1 , 2 are not inserted into one another and the curvature line w 1.0 (in FIG. 2 together with the curvature line shown in FIG. x) the cannula 1 is shown. The cannula 2 is arranged in relation to the cannula 1 in such a way that the line of curvature w 2.0 (x) likewise has only a z component and the lines of curvature w 1.0 (x), w 2.0 (x) diverge relative to one another . When cannulas 1 , 2 are inserted into one another, the cannula 1 also exerts a load distribution q 2 (x) (not shown in FIG. 3) on the cannula 2 , which causes a bending line w 2 (x) of the cannula 2 . The bending line w 2 (x) can be approved as

wobei E2 ein materialspezifisches Elastizitätsmodul, I2 ein axiales Trägheitsmoment der Kanüle 2 und f2(x) eine die Last­ verteilung q2(x) entlang der Kanüle 2 umfassende Funktion sind.where E 2 is a material-specific modulus of elasticity, I 2 is an axial moment of inertia of the cannula 2 and f 2 (x) is a function comprising the load distribution q 2 (x) along the cannula 2 .

Der Term
The term

lässt sich ebenfalls zumindest näherungs­ weise aus der Balkenbiegungslehre ableiten. can also be approximated at least derive wisely from the beam bending gauge.  

Bei ineinander gesteckten Kanülen 1, 2 sind die Biegelinien w1(x) und w2(x) wenigstens im Wesentlichen gleich.With cannulas 1 , 2 inserted one into the other, the bending lines w 1 (x) and w 2 (x) are at least substantially the same.

Wenn die Kanülen 1, 2 derart zueinander angeordnet sind, dass bei ineinander gesteckten Kanülen 1, 2 keine Gesamtkrümmung der ineinander gesteckten Kanülen 1, 2 auftritt, sind die Be­ träge der Lastverteilungen q1(x) und q2(x), die durch die Flächenpressung zwischen den Kanülen 1, 2 hervorgerufen wer­ den, gleich. Insbesondere gilt
If the cannulas 1 , 2 are arranged in such a way that when cannulas 1 , 2 are inserted into one another, there is no overall curvature of the cannulas 1 , 2 inserted into one another, the amounts of the load distributions q 1 (x) and q 2 (x) are given by the surface pressure between the cannulas 1 , 2 caused who the same. The following applies in particular

q1(x) = -q2(x) (3)q 1 (x) = -q 2 (x) (3)

Somit gilt auch
So also applies

f1(X) = -f2(x) (4)f 1 (X) = -f 2 (x) (4)

Wenn die ineinander gesteckten Kanüle 1, 2 keine Gesamtkrüm­ mung aufweisen, gilt ferner
If the inserted cannula 1 , 2 do not have a total curvature, the following also applies

w1(x) = w2(x) = 0 (5)
w 1 (x) = w 2 (x) = 0 (5)

und somit
and thus

E1I1.w1,0(x) = E2I2.w2,0(x) = E2I2.kw1,0(x) (6)E 1 I 1 .w 1.0 (x) = E 2 I 2 .w 2.0 (x) = E 2 I 2 .kw 1.0 (x) (6)

Für eine einfachere Verdeutlichung der Funktionsweise der ineinander gesteckten Kanülen 1, 2 werden gleiche Materialien der Kanülen 1, 2 angenommen. Somit ist E1 = E2 = E das Elastizi­ tätsmodul der Kanülen 1, 2. Somit folgt aus (6):
The same materials of the cannulas 1 , 2 are assumed for a simpler illustration of the functioning of the cannulas 1 , 2 inserted into one another. Thus E 1 = E 2 = E is the elasticity module of the cannulas 1 , 2 . It follows from ( 6 ):

wobei k ein reeller Faktor ist.where k is a real factor.

Die axialen Flächenträgheitsmomente I1, I2 der hohlzylinder­ förmigen Kanülen 1, 2 können bestimmt werden als
The axial moments of inertia I 1 , I 2 of the hollow cylindrical cannulas 1 , 2 can be determined as

wobei D1,2 die Außendurchmesser und d1,2 die Innendurchmesser der Kanüle 1 bzw. der Kanüle 2 sind.where D 1.2 are the outer diameter and d 1.2 are the inner diameter of the cannula 1 and the cannula 2 , respectively.

Somit kann beispielsweise durch geeignet gebogene Kanülen 1, 2, (7) erfüllt und bei einer geeigneten Verdrehung der inein­ ander gesteckten Kanülen 1, 2 relativ zueinander erreicht werden, dass die ineinander gesteckten Kanülen 1, 2 keine Ge­ samtkrümmung aufweisen.Thus, for example, by means of suitably curved cannulas 1 , 2 , ( 7 ), and with a suitable rotation of the cannulas 1 , 2 inserted one into the other relative to one another, it can be achieved that the cannulas 1 , 2 inserted into one another have no overall curvature.

Bei einer Verdrehung der Kanülen 1, 2 relativ zueinander kann ferner die Gesamtkrümmung der ineinander gesteckten Kanülen 1, 2 verändert werden.When the cannulas 1 , 2 are rotated relative to one another, the overall curvature of the cannulas 1 , 2 inserted into one another can also be changed.

Bei unterschiedlichen Elastizitätsmodulen E1, E2 der Kanülen 1, 2 können ebenfalls die Kanülen 1, 2 geeignet gebogen und deren axiale Flächenträgheitsmomente I1, I2 derart gewählt werden, dass bei einer geeigneten Verdrehung der ineinander gesteckten Kanüle 1, 2 relativ zueinander erreicht wird, dass die ineinander gesteckten Kanülen 1, 2 keine Gesamtkrümmung aufweisen.In different elastic moduli E 1, E 2 of the needles 1, 2 may also be the needles 1, 2 suitably bent and the axial surface moment of inertia I 1, I 2 are selected such that achieved relatively at a suitable rotation of the nested cannula 1, 2 to each other becomes that the inserted cannulas 1 , 2 have no overall curvature.

Das in der Fig. 1 dargestellte und obenstehend beschriebene erfindungsgemäße medizinische Gerät MG kann auch mittels ei­ nes in der Fig. 4 teilweise schematisch dargestellten Robo­ ters 40 bedient werden. Dabei kann der Roboter 40 mittels ei­ ner in Fig. 4 nicht gezeigten Regeleinrichtung und mittels eines Durchleuchtungsgerätes 41, z. B. eines Röntgengerätes, mittels dessen beispielsweise eine Punktionsbahn der ineinan­ der gesteckten Kanülen 1, 2 während der Punktion kontrolliert werden kann, die Gesamtkrümmung der ineinander gesteckten Ka­ nülen 1, 2 derart verändern, dass ein vorbestimmtes Punkti­ onsziel 42 innerhalb eines Patienten P relativ genau getrof­ fen wird. Im Falle des vorliegenden Ausführungsbeispiels liegt der Patient P auf einen von in Fig. 4 nicht dargestell­ ten Halterungsvorrichtung getragenen Tisch T.The medical device MG according to the invention shown in FIG. 1 and described above can also be operated by means of robots 40 , which is shown schematically in FIG. 4. The robot 40 can by means of egg ner control device not shown in Fig. 4 and by means of a fluoroscopic device 41 , z. B. an X-ray device, by means of which, for example, a puncture pathway of the inserted cannulas 1 , 2 can be checked during the puncture, change the overall curvature of the inserted cannulas 1 , 2 such that a predetermined puncture target 42 within a patient P is relatively accurate is hit. In the case of the present exemplary embodiment, the patient P lies on a table T carried by a holding device (not shown in FIG. 4) .

Das in den Fig. 1 bis 4 dargestellte und vorstehend beschrie­ bene erfindungsgemäße Gerät MG kann, wenn die Kanülen 1, 2 geeignet dimensioniert sind, auch für ein Endoskop EP verwen­ det werden. Ein Ausführungsbeispiel ist in Fig. 5 schematisch gezeigt.The device MG according to the invention shown in FIGS . 1 to 4 and described above can, if the cannulas 1 , 2 are suitably dimensioned, also be used for an endoscope EP. An exemplary embodiment is shown schematically in FIG. 5.

Die Fig. 5 zeigt schematisch und Ausschnittsweise zwei inein­ ander gesteckte und gebogene Kanülen 50, 51, die für ein En­ doskop EP verwendet werden. Bei einer Verdrehung der Kanülen 50, 51 relativ zueinander lässt sich die Gesamtkrümmung der ineinander gesteckten Kanülen 50, 51 verändern. Fig. 5 shows schematically and in sections two interlocking and curved cannulas 50 , 51 , which are used for an En doskop EP. When the cannulas 50 , 51 are rotated relative to one another, the overall curvature of the cannulas 50 , 51 inserted into one another can be changed.

Im Falle des vorliegenden Ausführungsbeispieles ist an dem Ende der ineinander gesteckten Kanülen 50, 51, welches bei­ spielsweise für eine Behandlung eines Patienten in das Innere des Patienten eingeführt wird, ein Linsensystem 52 angeord­ net. Das Linsensystems 52 ist mit einem im Inneren der Kanüle 51 verlaufenden Glasfaserstranges 53 verbunden, welcher bei­ spielsweise mit einer in der Fig. 5 nicht dargestellten Kop­ peleinrichtung verbunden sein kann, Welche wiederum an eine ebenfalls in der Fig. 5 nicht gezeigten Video-Kamera ange­ schlossen sein kann. Somit können Bilder aus dem Inneren des Patienten aufgenommen werden. Für die Bildaufnahme notwendi­ ges Licht kann beispielsweise mittels eines Glasfaserstranges 54 von einer in der Fig. 5 ebenfalls nicht gezeigten Licht­ quelle an das in das Innere des Patienten geführten Ende der Kanülen 50, 51 transportiert werden.In the case of the present exemplary embodiment, a lens system 52 is arranged at the end of the cannulas 50 , 51 which are inserted into one another and which is inserted into the interior of the patient, for example for treating a patient. The lens system 52 is connected to a glass fiber strand 53 running inside the cannula 51, which can be connected, for example, to a coupling device (not shown in FIG. 5), which in turn is connected to a video camera, also not shown in FIG. 5 can be closed. This allows images to be taken from inside the patient. For the image acquisition necessary light can be transported, for example, by means of a glass fiber strand 54 from a light source also not shown in FIG. 5 to the end of the cannulas 50 , 51 guided into the interior of the patient.

Ferner können im Inneren der Kanüle 51 in der Fig. 5 nicht, dargestellte Spül-, Absaug- oder weitere Behandlungskanäle angeordnet sein.Furthermore, irrigation, suction or further treatment channels, not shown, can be arranged in the interior of the cannula 51 in FIG. 5.

Da sich die Gesamtkrümmung der ineinander gesteckten Kanülen 50, 51 verändern lässt, sind Voraussetzungen gegeben, das in der Fig. 5 gezeigte und die Kanülen 50, 51 umfassende Endo­ skop EP flexibler als ein starres, seine Krümmung unveränder­ bares Endoskop einzusetzen.Since the total curvature of the cannulas 50 , 51 inserted into one another can be changed, there are prerequisites for using the endoscope EP shown in FIG. 5 and the cannulas 50 , 51 more flexibly than a rigid endoscope whose curvature cannot be changed.

Es sind auch andere Ausführungsformen eines Endoskops als die in der Fig. 5 dargestellte möglich.Other embodiments of an endoscope than the one shown in FIG. 5 are also possible.

Die oben stehend beschriebenen Ausführungsbeispiele sind im Übrigen nur exemplarisch zu verstehen.The exemplary embodiments described above are in the To understand the rest only as an example.

Claims (9)

1. Medizinisches Gerät, aufweisend zwei ineinander steckbare und gebogene Kanülen (1, 2, 50, 51), wobei die ineinander gesteckten Kanülen (1, 2, 50, 51) relativ zueinander verdreh­ bar sind, so dass bei der Verdrehung eine Gesamtkrümmung der ineinander gesteckten Kanülen (1, 2, 50, 51) veränderbar ist.1. Medical device, comprising two interlocking and curved cannulas ( 1 , 2 , 50 , 51 ), the intermeshing cannulas ( 1 , 2 , 50 , 51 ) being rotatable relative to one another, so that an overall curvature of the cannulas ( 1 , 2 , 50 , 51 ) inserted into one another can be changed. 2. Medizinisches Gerät nach Anspruch 1, bei welchem die Kanü­ len (1, 2, 50, 51) derart gebogen sind, dass bei der Verdre­ hung die Kanülen (1, 2, 50, 51) derart relativ zueinander ausrichtbar sind, dass die ineinander gesteckten Kanülen (1, 2, 50, 51) keine Gesamtkrümmung aufweisen.2. Medical device according to claim 1, wherein the cannula len ( 1 , 2 , 50 , 51 ) are bent such that the cannula ( 1 , 2 , 50 , 51 ) can be aligned relative to one another in such a way that the cannulas ( 1 , 2 , 50 , 51 ) inserted into each other have no overall curvature. 3. Medizinisches Gerät nach einem der Ansprüche 1 oder 2, welches eine Einrichtung zum Verdrehen der Kanülen (1, 2, 50, 51) relativ zueinander aufweist.3. Medical device according to one of claims 1 or 2, which has a device for rotating the cannulas ( 1 , 2 , 50 , 51 ) relative to each other. 4. Medizinisches Gerät nach Anspruch 3, bei welchem die Ein­ richtung zur Verdrehung wenigstens ein Zahnrad (3, 4) auf­ weist.4. Medical device according to claim 3, wherein the direction for rotation has at least one gear ( 3 , 4 ). 5. Medizinisches Gerät nach einem der Ansprüche 1 bis 4, bei welchem die Kanülen (1, 2, 50, 51) mittels wenigstens eines Antriebes (6, 8) verdrehbar sind.5. Medical device according to one of claims 1 to 4, in which the cannulas ( 1 , 2 , 50 , 51 ) can be rotated by means of at least one drive ( 6 , 8 ). 6. Medizinisches Gerät nach einem der Ansprüche 1 bis 5, bei welchem die Verdrehung mittels eines Roboters (40) steuerbar ist.6. Medical device according to one of claims 1 to 5, in which the rotation is controllable by means of a robot ( 40 ). 7. Medizinisches Gerät nach einem der Ansprüche 1 bis 6, des­ sen Kanülen (1, 2, 50, 51) derart dimensioniert sind, dass es für eine Biopsie verwendbar ist.7. Medical device according to one of claims 1 to 6, the sen cannulas ( 1 , 2 , 50 , 51 ) are dimensioned such that it can be used for a biopsy. 8. Medizinisches Gerät nach einem der Ansprüche 1 bis 6, des­ sen Kanülen (1, 2, 50, 51) derart dimensioniert sind, das es für eine minimal invasive Therapie verwendbar ist. 8. Medical device according to one of claims 1 to 6, the sen cannulas ( 1 , 2 , 50 , 51 ) are dimensioned such that it can be used for minimally invasive therapy. 9. Medizinisches Gerät nach einem der Ansprüche 1 bis 6, des­ sen Kanülen (1, 2, 50, 51) derart dimensioniert sind, dass es für ein Endoskop (EP) verwendbar ist.9. Medical device according to one of claims 1 to 6, the sen cannulas ( 1 , 2 , 50 , 51 ) are dimensioned such that it can be used for an endoscope (EP).
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