DE102009022867A1 - Minimal-invasive medical tool for removing kidney stone, has cores movably arranged opposite to each other, and force limiter provided on operating element for limiting force that is transmitted during engagement process - Google Patents

Abstract

The tool (1) has an operating element engaged with a non-reinforced covering pipe (3) and another operating element (2b) engaged with cores (4) moving through the non-reinforced covering pipe, where the cores are movably arranged opposite to each other. A force limiter (6) is provided on one of the operating elements for limiting the force that is transmitted during engagement process. The cores are made of nitinol and provided with a sling tool and foreign body gripper, and the operating elements are fixed opposite to each other.

Description

The The present invention relates to the term claimed above and thus relates to the field of minimally invasive medicine.

In Minimally invasive medicine becomes an intervention inside the body a patient with instruments performed by a small, natural, or about an incision created body opening to the site, that is the intervention site to be advanced. At the for this used medical instruments are made high demands. In addition to the physiological compatibility of the used In particular, it is necessary materials very small and flexible To create instruments, with the same incision deeper into the body to be able to penetrate certain places in the body at all to achieve simultaneous use of multiple instruments, etc.

Even though the minimally invasive medical instruments as delicate as possible designed to be an intervention deep inside the body to allow trouble-free and in particular a sufficient detergent flow to allow the instrument around, the instrument must easy and safe to use, a fast, no long Anesthesia requiring surgery without complications also by yet to allow inexperienced surgeons.

So It has become possible in the field of urology, for example Endoscopes to remove kidney stones and the like. This will be a endoscopic catheter introduced, which is an optical transmission of images from the inside of the body allowed and at least has a clear opening through which one or more Medical instruments can be introduced and through which the situs can be rinsed.

When Medical instrument that can be used endoluminally in such a way then a so-called Steinfangkörbchen is introduced. This consists of an outer tube and one in this back and forth moving soul, at whose in the body to be introduced The end is a wire crossing itself at at least one place formed catching basket is located. The collecting basket opens itself, if inside the body the soul from the envelope is pushed out. The collecting basket can then go to one Kidney stone or the like can be laid. When retiring The wires are laid in the sheath of the soul around the stone and the stone can then, together with the sheath, be removed through the clear tube of the endoscope.

at conventional minimally invasive Steinfangkörbchen There is a problem in that often when retiring the soul of a stone trap with the stone caught the envelope tube end located in the interior of the body so much force is exercised that the sheath starts to buckle, meandering, etc. This is especially with regard to the obstruction of the flushing agent flow unacceptable.

Therefore, already wire-reinforced microcatheter are known, see for example US-PS 7,507,229 B2 , In this, a multi-layer catheter is provided for introduction to in-body locations with a cladding layer, a reinforcing layer and an inner liner, whereby a core or the like may be advanced through the inner region. The flexibility at the distal end, that is the end of the medical instrument which is inserted deep into the body and in which contact between the medical tool and the site to be treated, can be increased by removing the sheath or the like, as required by medical professionals Deflectability by at least 270 ° with narrow radius of curvature guaranteed. Such instruments are available on the market, but expensive to manufacture and undesirably large due to the wire insert in the buffer tube.

A method for adjusting the rigidity of a microtube and for producing such tubes is otherwise from the U.S. Patent 6,841,214 B1 known.

The Prior art arrangements are due to their reinforcement Too high wall thickness too thick and inflexible and also limit the purge stream.

This also applies to other uses of endoluminal or other minimally invasive medical instruments, such as urology, of gastrology, in the field of ear, nose and throat medicine, for arthroscopy and / or bronchoscopy. To call are here In addition to Steinfangkörbchen in particular other foreign body gripper, Polypenschlingen, vascular cups, etc. In the area of nonendoluminal Minimally invasive medicine is about the treatment of breast tissue mentioned by milk channels. Even with such devices So there are similar problems.

It is desirable, a minimally invasive medical instrument inexpensive to produce, which is easy is operable and allows a trouble-free operation.

The The object of the present invention is to provide news for to provide the commercial application.

The Solution of this task is in independent form claimed. Preferred embodiments can be found in the dependent claims.

To A first aspect of the present invention thus becomes a minimally invasive Suggested medical instrument, at its operator a first Operating element in engagement with a buffer tube and a second control element in engagement with a through the hose movable soul are arranged against each other movable, wherein on at least one operating element, a force limiter for limiting the force transmitted during the intervention is provided.

The The present invention has thus recognized that it is possible is the forces acting between enveloping tube and soul not directly where they interact, but rather, at a place not affected by size problems outside the body, so proximal to the surgeon. The realization can be exploited, that despite very fragile Design of minimally invasive medical instruments one not insignificant stability against kinks at the end of engagement thereby given that the two parts are largely frictionless can move against each other. The training with force limiters to limit the forces transmitted during the intervention thus makes reinforcements and the like largely unnecessary, because a risk of buckling between the inside of the body Elements is no longer given.

It is possible with the invention and also preferred if Both controls are each detachable on the outer tube or the soul are arranged. The solvability the controls is advantageous, for example, if at a Stone catching a captured stone is so great that he does not pass through the clear opening of the endoscope, with which The minimally invasive medical instrument used is removed can and sometimes no longer be possible is to release the captured stone again. In such a case the controls must be removed, the endoscope over the minimally invasive medical instrument remaining inside the body and next to the minimally invasive medical instrument reintroduced who the. Then you can with a second minimally invasive medical instrument the stone will be destroyed or the like. The solvability The controls make it easy to take such a step quickly and preferably without tools to make.

The Soul is made in a preferred variant of nitinol and may further preferably at its end at least one of the tools Loop, stone catcher or foreign body gripper include. That manufacture other minimally invasive medical instruments from nitinol are, should be mentioned. Also with other instruments can one Force limitation may be preferred.

The minimally invasive medical instrument of the present invention with a less stable sleeve than in the stand known to the art. It is possible to use non-armored encasing tubes too use and in particular hoses from a to use very thin material. It is also Therefore - preferred if at least one of shell or soul on the extracorporeal operator, so proximal, reinforced is. The preferred power relief allows in particular, hoses from cheaper materials, for example Teflon or polyurethane, to use. On the one hand, this reduces the costs of the minimally invasive On the other hand, enables the minimally invasive To produce a smaller diameter medical instrument than in other materials.

At least one of shell or soul becomes the extracorporeal operator Be strengthened, for example, by one around the soul crimped (capillary) tubular reinforcement around and / or one around the soul or its tubular Reinforcement placed around shrink tube assembly can be done. The reinforcement contributes to the controls better attached to the sleeve or the soul so that both the assembly and the possibly required separation from the controls during an operation is facilitated.

It is further preferred when the first and second controls can be fixed relative to each other. This can be done by clamping or a magnetic mechanism happen, in particular by clamping together. If the elements are not in any position against each other are fixable, which is clearly preferred, so is a fixation at least in either the withdrawn or the complete extended position be desirable. The fixation allows, for example, a once captured stone safely with the instrument without releasing it again or about by rinsing liquid from the collecting basket is released. The clamping is done by the force limiting means favors the present invention, since it is not to be feared that during setting a kink occurs because about sleeve and soul (when clamping) still in excess against each other move.

In a particularly preferred variant, the first and second operating elements can be designed to be rotatable relative to one another, whereby preferably the core is also rotated relative to the enveloping hose can be, and preferably so far that the intervention tool is aligned in the interior of the body accordingly. The rotatability of the controls alone, even without the engagement tool is rotated inside the body, be advantageous if in the vicinity of the endoscope or the like, a plurality of instruments to be operated is present, so that the operation of individual instruments is affected by others.

In In a particularly preferred variant, the controls are as Handles, in particular ring-shaped handles, in a surgeon can insert his fingers.

Prefers limits the force limiter at least those forces that when the soul is withdrawn, that is, the outward movement the soul, transferred to the Hüllschlauchende become. It should be noted, however, that in the same way in addition and / or alternatively the one of the soul forward, that is when moved into the body inside Forces can be limited. This is particularly advantageous if otherwise the injury of very delicate tissue. Further It should be noted that it is also possible, the sheath over to push the soul instead of the soul into the sheath to pull back; in both cases it can without the measures proposed by the invention to a Kinking of the enveloping tube come; by the invention However, design is also used in a minimally invasive instrument, in which the soul (relative to a place in the body, for example) is wholly or partially immovable, and instead and / or additionally the sheath moves and in particular over the soul is moved (back), a kink or the like prevented. For this reason, no distinction is made in the further between a movement of the soul in the outer tube and a Movement of the enveloping tube relative to the soul.

The Force limitation is preferably chosen so that at best no matter how great a force is transmitted between the soul and the shell can be that the sheath hose is not kinked becomes. This ensures that a captive stone or the like can still be fixed as securely as possible while he is removed from the inside of the body.

Of the Force limiter can with a spring means, preferably a prestressed and by retracting the soul compressible spring be formed. The training of the force limiter with a prestressed Spring allows it in a particularly simple way, namely by selecting the spring constant and the permitted displacement, to limit the transmitted power.

One Minimally invasive medical instrument according to the present Invention can be used for a variety of different medical Applications and moreover in both the human and the used in veterinary medicine. In addition to the application for urology in Steinfangkörbchen be about any other endoluminal or catheter-based applications. Mention should be made of urological, gastroenterological, ear, nose and throat medicine, bronchoscopic surgery, arthroscopy and the like. That it is not necessarily an endoluminal or catheter-based one Instrument must act, but be mentioned.

The Invention will be described below only by way of example with reference to the drawing described. In this is represented by

1 a schematic diagram of a minimally invasive medical instrument according to the present invention, wherein I and II illustrate different positions of the operator,

2 a perspective view of a minimally invasive medical instrument according to the present invention,

3 a sectional view through the operator of a minimally invasive medical instrument according to the present invention,

4 a sectional view accordingly 3 with different details in different position of the soul-operator,

5 a distal end of a minimally invasive medical instrument according to the invention with a foreign body located in the stone catcher basket,

6 a minimally invasive instrument according to the prior art, wherein I and II illustrate different positions of the operator end.

To 1 includes a only schematically indicated and generally with 1 designated minimally invasive medical instrument 1 an operator 2 with a first operating element 2a in engagement with a buffer tube 3 and a second control 2 B engaged with one through the buffer tube 3 mobile soul 4 , which is formed here from Nitinol, wherein the first and the second control element 2a . 2 B against each other are arranged to move back and forth, as indicated by arrow 5 indicated. At the first operating element 2a in engagement with the buffer tube 3 is a force limiter 6 provided in a minimally invasive medical procedure that of the soul 4 on the buffer tube 6 at the distal end 7 limited transmitted power.

The first control 2a points in the Darge example presented each exemplary a passage ring 2a1 for the ring finger and for the index finger of one hand (cf. 2a2 ) while operating element 2 B Here, for example, a ring opening for the passage of the thumb of a surgeon, so that by opposing movement of these fingers, the soul 4 in the outer tube 3 can be moved back and forth; the execution with other controls instead of ring openings is explicitly mentioned; For example, force limitation is also possible with actuator-actuated minimally invasive devices, although it is particularly preferred in manual instruments.

The operating element 2 B is directly connected to the soul in the present embodiment and is thereby engaged with this. The first control 2a is over the spring 6 , which is biased and serves as a force limiter, as well as a connector 8th firmly connected to the buffer tube. In the embodiment shown only schematically here is a solubility of the controls of Hüllschlauch or soul is not given; How this can be realized on a practical, actually built device will be described with reference to FIGS 2 to 5 will be described below.

At the distal end of actuation to be introduced into the body of a patient in the use of the minimally invasive medical instrument 7 is a stone catcher 9 arranged, the stones and the like, for example, when used in urology kidney stones catch.

Of the Envelope is dimensioned so that it endoluminal can be used.

If with the minimally invasive instrument a kidney stone or the like with the catcher 9 is caught and the operating element 2 B away from the control 2a according to the force arrow 10 is moved, first moves the soul 4 with the captured stone 9 on the distal, ie body-inner envelope end 3 to. Once the catcher 9 with the stone at the end of the sleeve 3 is present, is in the axial direction of the Hüllschlauches, see arrow 11 , Force applied to the sheath. This leads by appropriate power transmission in turn to a compression of the force limiter 6 so that when retiring the soul 4 through the sheath 3 on the buffer tube 4 acting force is limited. The spring constant of the spring 6 is chosen so that the enveloping tube 4 can not kink.

6 shows in comparison to the situation with a minimally invasive medical instrument according to the prior art without force limiter 6 , Too much pulling back the soul is pulled with such great force against the Hüllschlauchende that the Hüllschlauchende kinks or is severely deformed in other ways.

While that in 1 As illustrated embodiment greatly facilitates the understanding of the invention, it will be appreciated that a practical embodiment of the minimally invasive medical instrument will have a different, advantageous embodiment thereof.

An actual minimally invasive medical instrument 1 is therefore, using largely the same reference numerals, in 2 It should be noted that in a typical application, the buffer tube 3 will have a much greater length and, moreover, the thickness of the Hüllschlauchs and the soul is exaggerated in the figures for reasons of better representability.

In the perspective view of 2 is the force limiter element 6 in the top of the control 2 hidden. It is therefore referred to below 4 , in which 4a essentially the same section shows how 3 , However, a different Ausschubstellung the soul is shown from the Hüllschlauch. In 3 Incidentally, the inclusion of reference numerals has been omitted for reasons of clarity.

In 4 are represented by reference numerals 3 and 4 again the sheath and the soul. The feather 6 the Kraftbegrenzermittels is in a spring sleeve 13 taken up, which has a clear opening for a penholder 14 having. In the clear opening, the pen holder 14 against which the spring 6 to lean, to slide back and forth.

At the proximal (surgeon's) end is the spring sleeve 13 in a handle cap 15 releasably inserted, compare reference number 13a putting it in a groove in the handle cap 15 latching end piece of the spring sleeve 13 illustrated. In the handle body 15 is a spacer 16 received, in turn, a clear opening for the implementation of the soul 4 has. spring sleeve 13 , Grip cap 15 and spacers 16 have it as well as penholder 14 clear openings, which are coaxial with the correct arrangement of the parts to each other.

The soul 4 is with a thumbscrew 17 on a handle slider 18 arranged, here two gripping rings 2b1 . 2b2 wearing. While the force limiter spring 6 and the soul 4 as well as the knurled screw 17 may be formed of metal, the other parts described above, as preferred and possible, are made of plastic. It should be noted that the Ausführungsfor from 1 and 2 differ insofar as the operating element for the soul 4 to 1 has a single gripping ring for the thumb while the soul 4 to 2 is operated with the two handle rings having slider.

Next is in the area of the operator 2 First, the hose with a reinforcement 3a wrapped, which facilitates the placement of the spring holder and the hose stiffened at the operator end, but this is not critical for the use of the minimally invasive instrument and in particular the flexibility in the interior of the body. Furthermore, the typical very thin Nitinol-wires, which forms the soul, crimped operator end side with a capillary tube for reinforcement.

The illustrated embodiment allows a simple separation of the controls of Hüllschlauch and soul, by first the thumbscrew 17 dissolved and then the spring sleeve 13 ' from the handle cap 15 is pulled.

The Arrangement of the present invention is with only slight changes can be used compared to conventional arrangements and allows it in particular, despite very small envelope hose diameter and thus very good purge flow through a given endoluminal Lumen sufficient security against buckling of the sheath guarantee.

QUOTES INCLUDE IN THE DESCRIPTION

This list The documents listed by the applicant have been automated generated and is solely for better information recorded by the reader. The list is not part of the German Patent or utility model application. The DPMA takes over no liability for any errors or omissions.

Cited patent literature

• - US 7507229 B2 [0007]
• US 6841214 B1 [0008]

Claims (12)

Minimally invasive medical instrument, at the operator end a first control element in engagement with a Hüllschlauch and a second control element are arranged movable against one another movable through the envelope tube soul, characterized in that provided on at least one operating element, a force limiter for limiting the force transmitted during the intervention is. Minimally invasive medical instrument after the previous one Claim, characterized in that at least one of the operating elements, prefers both controls, in releasable engagement with Covering tube or soul stand. Minimally invasive medical instrument after one of the preceding claims, wherein the core is made of nitinol is and preferred at its end at least one of the tools loop, stone catcher, Foreign body gripper includes. Minimally invasive medical instrument after one of the preceding claims, characterized in that the sheath a non-armored sheath is, preferably a non-armored Teflon or polyurethane sheath. Minimally invasive medical instrument after one of the preceding claims, characterized in that at least one of shell and / or soul on the extracorporeal Operator is reinforced, especially with one around the Soul arranged, preferably with it crimped, preferably tubular Reinforcement and / or one around the soul or its crimped or otherwise attached reinforcement laid hose assembly. Minimally invasive medical instrument after one of the preceding claims, characterized in that the first and second operating elements can be fixed relative to one another, preferably by clamping and / or a magnetic mechanism, in particular preferably in the fully retracted position and / or any position. Minimally invasive medical instrument after one of the preceding claims, characterized in that the first and second operating elements are rotatable relative to one another, preferably with rotation of the soul relative to the envelope tube, preferably sufficient for engagement tool alignment Angle of rotation. Minimally invasive medical instrument after one of the preceding claims, characterized in that the first and second operating elements are designed as handles. Minimally invasive medical instrument after one of the preceding claims, characterized in that the force limiter for limiting the retraction the soul and / or when moving the Hüllschlauchs over the soul transferable to the Hüllschlauchende Force is provided. Minimally invasive medical instrument after the previous one Claim, characterized in that the force limiter for limiting the force transmissible between the soul and the envelope limited to the envelope non-kinking forces is. Minimally invasive medical instrument after one of the preceding claims, characterized in that the force limiter with a spring means, preferably a prestressed, formed upon retraction of the soul compressible spring is. Minimally invasive medical instrument after one of the preceding claims, for a catheter-based and / or endoluminal and / or urological and / or gastroenterological and / or Ear, nose and throat and / or arthroscopic and / or bronchoscopic Intervention is formed.