DE102010037758A1 - Surgical holding instrument for surgical clasp element in surgical equipment, has linkage assembly releasably connected with holding instrument corresponding to coupling device of surgical handling instrument for forming holding instrument - Google Patents

Abstract

The instrument (14) has a holding member moving relative to another holding member and a clasp element retainer for receiving a part of a clamping element (18) i.e. aneurysm clip (20). The former holding member is moved from one relative position to another relative position under deformation of the clamping element. A linkage assembly is releasably connected with the holding instrument corresponding to a coupling device of a surgical handling instrument (12) for forming the holding instrument. The clamping element is pre-assembled on the holding instrument.

Description

The invention relates to a surgical holding instrument for a surgical clamping element, comprising a first holding part and a movable relative to this second holding part, each having a clamping element receptacle for receiving at least a portion of the clamping element, wherein the first holding part and the second holding part under deformation of the clamping element of a first relative position in a second relative position can be transferred.

Moreover, the invention relates to a surgical instrument.

Furthermore, the invention relates to a surgical handling instrument.

By means of a holding instrument of the type mentioned, a surgical clamping element can be applied by the surgeon. This can be done by inserting the clamping element into the clamping element receptacles and inserting them into the interior of the body by means of the holding instrument. By relative movement, for example by pivoting, the holding parts to each other, the clamping element can be deformed and thereby clamped to a body part such as a blood vessel or an organ. The clamping element, also referred to as "clip", may in particular be an aneurysm clip for clamping an aneurysm, the mouth part of which is initially spread by transferring the holding parts from the first relative position to the second relative position and then by transferring the holding parts from the second Relative position in the first relative position to set the clip is closed again. It is also conceivable, however, a clamping element in the form of a ligature clip, which can be determined by transferring the holding parts of the first relative position in the second relative position directly clamping the body tissue.

Especially in the case of aneurysm clips, many different variants are available on the market, which differ, for example, from one another depending on the area of application, size, shape or closing force. For correct handling of the different clips a variety of holding instruments is required, which are each tailored to the properties of the clip. There is thus a risk that an operator erroneously uses a wrong holding instrument to apply the clip. This can result in damage to the clip, for example, by over-spreading it by means of an improper holding instrument, which can compromise a secure fit of the clip at the point of use and thus present a health risk to a patient.

Object of the present invention is to provide a holding instrument of the type mentioned, a surgical instrument and a handling instrument that can be handled in a user-friendly manner.

This object is achieved in a generic holding instrument according to the invention that the holding instrument comprises a connecting device which is designed for releasably connecting the holding instrument with a coupling device formed thereon corresponding to a surgical handling instrument for the holding instrument.

The holding instrument according to the invention comprises a connecting device, by means of which it can be releasably connected to a handling instrument for the holding instrument, which handling instrument in turn for this purpose a coupling device - in a sense, the connecting device of the handling instrument - includes. This makes it possible to design the holding instrument according to the properties of the clip in order to hold the clip, but to make the handling of the clip in the true sense but using a suitable for the holding instrument handling instrument, thus a Anlegeinstrumentes for the clip and operating instrument for the holding instrument. As a result, even for a variety of holding instruments, a universal handling instrument can be used, which can be detachably connected to each of the holding instruments. Using the holding instrument according to the invention, the risk of confusion by the surgeon can be reduced, in particular if a clamping element with a matched to this holding element already pre-assembled by the manufacturer. This considerably facilitates the handling of the holding instrument for the surgeon and at the same time reduces the risk of applying the clamping element with an unsuitable holding instrument. This also reduces a potential health risk for a patient.

Preferably, the holding instrument comprises a clamping element, on the properties of which, for example, the field of application, size, closing force or shape it is in particular tuned. This ensures that the clamping element is assigned a suitable for the application holding instrument, which simplifies the handling of the clamping element and the holding instrument and reduces the risk of incorrect handling. Even workflows in operation mode can be simplified. It is thus possible that clamping elements and holding instruments are supplied sterilized by the manufacturer and only the universal handling instrument has to be sterilized by the user. User can be thereby significantly reduce the sterilization effort. Furthermore, the trust in the sterility of the clamping element and the holding instrument is increased on the part of the user, for example, when they are prefabricated and delivered sterile together.

Advantageously, the clamping element is pre-mounted on the holding instrument. This further facilitates the handling of the clamping element and the holding instrument and makes it possible to reduce the risk of incorrect handling even more.

It has already been mentioned at the beginning that the clamping element can be an aneurysm clip. In the case of an aneurysm clip, the advantages of the holding instrument according to the invention come into play particularly when a multiplicity of different aneurysm clips can be applied by means of a universal manipulation instrument and holding instruments tuned to the properties of the respective aneurysm clips.

In particular, when the clamping element is an aneurysm clip, it can be provided that the first holding part can be transferred to the second holding part counter to a restoring force applied by the clamping element from the first relative position to the second relative position.

Preferably, the holding instrument comprises at least one adjustable stop element for limiting the movement of the first holding part and the second holding part relative to each other when transferring from the first relative position to the second relative position. The stopper makes it possible to limit the deformation of the clamping element by relative movement of the holding parts to each other. An excessive, possibly damaging deformation of the clamping element can thereby be avoided and a health risk for the patient can be reduced. Because the stop element is adjustable, for example, it can already be adapted by the manufacturer by skilled personnel to the requirements of the clamping element to be applied with the holding instrument. This makes it possible to match the holding instrument to the properties of a plurality of clamping elements, so that it proves to be very versatile. In the case of an aneurysm clips, for example, the opening width of the jaw part can be limited by means of the stop element. This makes it possible to ensure that, using even a universal handling instrument, the aneurysm clip is not excessively widened and thus the closing force set by the manufacturer can be ensured.

It is favorable if the at least one stop element is encompassed by a holding part or arranged thereon. This makes it possible to give the holding instrument a structurally simple design.

Advantageously, the at least one stop element is designed adjustable adjustable. This makes it possible to ensure that the range of movement of the holding parts relative to each other, once set, can not be changed. The determination of the at least one stop element is preferably also manufacturer and conveniently by the same trained specialist, which adjusts the stop element on the properties of the clamping element. For fixing the at least one stop element, the holding instrument may comprise, for example, a securing device with at least one securing member which, for example, seals access to the at least one stop element.

Preferably, the at least one stop element is manually adjustable, wherein "manually" as taking place by a person using hand tool is to be considered. This facilitates the adjustment of the at least one stop element and thereby the handling of the holding instrument.

It is advantageous if the at least one stop element is designed as a set screw or comprises an adjusting screw. This allows a structurally simple design of the holding instrument. The set screw is for example screwed in one of the holding parts, so that their distance to the other holding part can be changed. The end face, the screw can form a stop surface for the other holding part.

In the holding instrument according to the invention, the holding parts are designed to be movable relative to each other. Preferably, the holding instrument comprises at least one joint, on which the first holding part and the second holding part are hinged together. As a result, the first holding part and the second holding part can be moved relative to each other in a defined manner. This also makes it easier to deform the clamping element in a defined manner.

It is favorable if the at least one joint is a hinge joint defining a pivot axis about which pivot axis the first holding part and the second holding part are pivotable relative to each other. The hinge joint allows a structurally simple and at the same time reliably functioning articulated connection of the holding parts with each other. The pivot axis may, for example, be oriented perpendicular to a clamping element plane defined by the clamping element receptacles, in which different parts of the clamping element are deformed relative to one another by means of the holding instrument.

The clamping element receptacles are preferably arranged on a distal end of the holding instrument in order to facilitate the application of the clamping element to the surgeon. In the present case, "distal" and "proximal" are to be understood as referring to the surgeon inserting the holding instrument.

Conveniently, the connecting device is arranged at a proximal end of the holding instrument so that it can be connected to the handling instrument in a user-friendly manner.

The connecting device has at least one first connecting element arranged on the first holding part or encompassed by the latter and at least one second connecting element arranged on the second holding part or encompassed by the latter. By means of the connecting elements, the holding instrument can be detachably connected to a handling instrument, which may comprise, for example, coupling elements as part of the coupling device for this purpose.

It is advantageous if the at least one first connecting element and / or the at least one second connecting element are designed for positive and / or non-positive cooperation with coupling elements of the coupling device of the handling instrument. This makes it possible to connect the holding instrument positively and / or non-positively releasably connected to the handling instrument.

In a structurally simple embodiment of the holding instrument, it is advantageous if the at least one first connecting element and / or the at least one second connecting element are clamping members.

A positive and non-positive connection of the holding instrument and the handling instrument can be effected, for example, by the at least one first connection element on the first holding part and / or if the at least one second connection element formed on the second holding part recesses for receiving projections formed on the handling instrument. The recesses may be blind holes, for example, in the pin-like projections on the handling instrument positively and non-positively engage and can be jammed therein. It is also conceivable that the recesses are slot-shaped, engage positively and non-positively in the disc-shaped projections of the handling instrument and can be jammed therein.

It can also be provided in the reverse manner that the at least one first connecting element and / or the at least one second connecting element are projections for introducing recesses formed on the handling instrument. However, it is for reasons of user-side sterilizability of advantage if the recesses are arranged on the holding instrument and the projections on the handling instrument.

Furthermore, it can be provided that the at least one first connecting element and / or the at least one second connecting element are latching members. This can also be done a structurally simple connection of the holding instrument with the handling instrument.

Preferably, the at least one first connecting element and / or the at least one second connecting element for forming a rigid connection of the holding instrument and the handling instrument are formed with each other. An operating force exerted by the surgeon on the handling instrument can thereby be reliably transmitted to the holding members to move relative to each other.

In a different embodiment of the holding instrument according to the invention, it is advantageous if the at least one first connecting element and / or the at least one second connecting element for forming an articulated connection of the holding instrument and the handling instrument are formed with each other. By means of the connecting device and the coupling device can be formed by a joint, for example, a scissors joint. This makes it possible in practice to guide tool parts of the handling instrument, which are each connected to a holding part of the holding instrument, relative to these in a clearly defined manner in order to facilitate the handling of the holding instrument to an operator.

Preferably, the at least one first connecting element and / or the at least one second connecting element each define a pivot axis, in order to allow the formation of a hinge joint between the holding instrument and a handling instrument. For example, the first and / or the second connecting element are formed in the form of pegs or in the form of bearing bushes for receiving bearing journals on the handling instrument.

A structurally simple embodiment of the holding instrument can be achieved if the at least one first connecting element and the at least one second connecting element are identical. In addition, this gives the possibility of a handling instrument in more than one way with the Holding instrument to connect, provided that cooperating with the connecting elements Ankoppelelemente the handling instrument are also identical.

Preferably, the holding instrument comprises at least one blocking element for blocking a movement of the first holding part and the second holding part relative to each other. This can ensure that the holding parts can be transferred from the first relative position to the second relative position under deformation of the clamping element only when an operator deliberately removes the at least one blocking element from the holding instrument. An erroneous and unconscious deformation of the clamping element, which may possibly be damaged, can be largely avoided as a result. The at least one blocking element can, for example, be mounted by the manufacturer on the holding instrument, in particular if this is prefabricated and specially pre-assembled with the clamping element.

It is expedient if the at least one blocking element on the first holding part and on the second holding part includes or forms engageable stop members in order to block a movement of the holding parts relative to one another.

In a structurally simple embodiment of the holding instrument, it is advantageous if the at least one blocking element is wedge-shaped, for example in the form of a form-fitting engaging wedge between the holding parts.

Preferably, the at least one blocking element is manually detachable from the holding instrument, wherein "manually" in this context means "tool-free". This facilitates the handling of the holding instrument for the surgeon.

It is expedient if the at least one blocking element comprises at least one material weakening section yielding when the handling instrument is connected to the holding instrument. This makes it possible to design the at least one blocking element in such a way that, after the yielding of the at least one material weakening section, it is to a certain extent "automatic" d. H. further intervention of the surgeon, released from the holding instrument. This simplifies the handling of the holding instrument. The at least one material weakening section is suitably a predetermined breaking section.

It is advantageous if the holding instrument comprises at least one securing element for securing the holding instrument against connection to the handling instrument. This can ensure that the holding instrument is not inadvertently or mistakenly connected to a handling instrument. This also reduces the risk that the holding parts are moved inadvertently or erroneously with deformation of the clamping element relative to each other.

It is advantageous, at least one blocking element of the holding instrument that includes or forms at least one securing element to allow a structurally simple design of the holding instrument while achieving the advantages that can be provided by the blocking element and by the securing element. The blocking element and the at least one securing element are conveniently integrally connected to each other.

It is advantageous if the at least one securing element is a cover which at least partially covers the connecting device. This makes it possible in a structurally simple and effective way to prevent a connection of a handling instrument with the holding instrument.

In a corresponding manner as in the case of the at least one blocking element, it can be provided that the at least one securing element can be released manually (without tools) from the holding instrument.

Advantageously, the holding instrument has a marking device comprising data relating to a clamping element accommodated on the holding instrument. This is particularly advantageous if the holding instrument is delivered pre-assembled with a clamping element. After implantation of the clamping element, the holding instrument can be added to a patient file. On the basis of the patient record a tracing of the clamping element after insertion is possible. The data may include, for example, the manufacturer name, type and size of the clamping element, article number, serial number, batch number or the like. The data may be stored in physical form or in electronic form. Furthermore, the data can be read without contact, for example using optical means. A machine-readable identification device is also an advantage.

As mentioned above, the invention also relates to a surgical instrument. A surgical instrumentation according to the invention solves the object stated at the outset by comprising at least one holding instrument of the type described above and a surgical manipulation instrument, comprising a first handling part, a second handling part movable relative to this and a second handling part Coupling device, which is designed for releasably connecting the handling instrument with the connecting device of the at least one holding instrument.

With the instrumentation according to the invention, the advantages already mentioned in connection with the explanation of the holding instrument according to the invention and optionally the advantages mentioned in connection with the explanation of advantageous embodiments of the holding instrument according to the invention can be achieved.

It is advantageous if the instrument has a plurality of holding instruments with identical connection means. As a result, the handling instrument proves to be universally applicable, because it can be connected to each of the holding instruments for applying the respective clamping element, the holding instruments can be formed completely different from the respective connection device, for example because they are adapted to the respective clamping element.

It is advantageous if the handling instrument comprises at least one joint on which the first handling part and the second handling part are hinged together. This makes it possible to move the handling parts in a defined manner relative to each other.

For example, the at least one joint may be a hinge joint defining a pivot axis about which pivot axis the first handling part and the second handling part can be pivoted relative to one another. This makes it possible to pivot the holding parts of the holding instrument relative to each other.

Preferably, the coupling device is arranged at a distal end of the handling instrument to facilitate the surgeon connecting it to the holding instrument.

The coupling device advantageously has at least one first coupling element arranged on the first handling part or encompassed by the same, and at least one second coupling element arranged on or covered by the second handling part. The coupling elements can be releasably connected to correspondingly designed connecting elements of the holding instrument.

The at least one first and / or the at least one second coupling element may be formed in ways described below, wherein they are formed corresponding to at least one first and / or at least one second connecting element of the handling instrument.

With reference to the above statements on the at least one first connecting element and / or the at least one second connecting element, it is therefore advantageous if the at least one first coupling element and / or the at least one second coupling element for interlocking and / or frictional interaction with connecting elements of Connecting means of the holding instrument are formed.

It is likewise advantageous if the at least one first coupling element and / or the at least one second coupling element are clamping members.

It is also advantageous if the at least one first coupling element on the first handling part and / or if the at least one second coupling element formed on the second handling part are projections which are receivable by recesses formed on the holding instrument.

It is further preferred if the at least one first coupling element and / or the at least one second coupling element are latching members.

In an advantageous embodiment of the surgical instrumentation, it is favorable if the at least one first coupling element and / or the at least one second coupling element are designed to form a rigid connection of the holding instrument and the handling instrument with each other.

In a different embodiment of the surgical instrumentation according to the invention, the at least one first coupling element and / or the at least one second coupling element are advantageously designed to form an articulated connection of the holding instrument and the handling instrument with each other.

For example, the at least one first coupling element and / or the at least one second coupling element each define a pivot axis. Depending on a holding part of the holding instrument and a handling part of the handling instrument can be pivotally connected to each other about one of the pivot axes. As a result, the instrumentation forms, for example, a scissors joint, which simplifies the handling of the same for the surgeon.

Furthermore, it can be provided that the at least one first coupling element and the at least one second coupling element are formed identically.

The invention also relates to a surgical manipulation instrument for a surgical instrument of the aforementioned type. A manipulation instrument according to the invention comprises a first handling part, a second handling part movable relative thereto and a coupling device for releasably connecting the manipulation instrument to the connection device of a holding instrument of the above is formed type mentioned. The handling instrument according to the invention serves for applying the clamping element and for actuating the holding instrument. It may also have the features of the handling instrument of any surgical instrumentation of the aforementioned types and be used, for example, as a universal manipulation instrument for a plurality of holding instruments with preferably identical connection means.

• 1. Chirurgisches Halteinstrument für ein chirurgisches Klemmelement (18), umfassend ein erstes Halteteil (42) und ein relativ zu diesem bewegliches zweites Halteteil (43), welche jeweils eine Klemmelementaufnahme (44, 45) zur Aufnahme mindestens eines Teils des Klemmelementes (18) aufweisen, wobei das erste Halteteil (42) und das zweite Halteteil (43) unter Verformung des Klemmelementes (18) von einer ersten Relativstellung in eine zweite Relativstellung überführbar sind, dadurch gekennzeichnet, dass das Halteinstrument (14; 104; 154) eine Verbindungseinrichtung (49; 163) umfasst, die zum lösbaren Verbinden des Halteinstrumentes (14; 104; 154) mit einer korrespondierend zu ihr ausgebildeten Ankoppeleinrichtung (35; 158) eines chirurgischen Handhabungsinstrumentes (12; 102; 152) für das Halteinstrument (14; 104; 154) ausgebildet ist.
• 2. Halteinstrument nach Satz 1, dadurch gekennzeichnet, dass das Halteinstrument (14; 104; 154) ein Klemmelement (18) umfasst.
• 3. Halteinstrument nach Satz 2, dadurch gekennzeichnet, dass das Klemmelement (18) am Halteinstrument (14; 104; 154) vormontiert ist.
• 4. Halteinstrument nach Satz 2 oder 3, dadurch gekennzeichnet, dass das Klemmelement (18) ein Aneurysmen-Clip (20) ist.
• 5. Halteinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass das erste Halteteil (42) und das zweite Halteteil (43) entgegen einer vom Klemmelement (18) aufgebrachten Rückstellkraft von der ersten Relativstellung in die zweite Relativstellung überführbar sind.
• 6. Halteinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass das Halteinstrument (14; 104; 154) mindestens ein verstellbares Anschlagelement (65) zum Begrenzen der Bewegung des ersten Halteteils (42) und des zweiten Halteteils (43) relativ zueinander beim Überführen von der ersten Relativstellung in die zweite Relativstellung umfasst.
• 7. Halteinstrument nach Satz 6, dadurch gekennzeichnet, dass das mindestens eine Anschlagelement (65) von einem Halteteil (42) umfasst wird oder daran angeordnet ist.
• 8. Halteinstrument nach Satz 6 oder 7, dadurch gekennzeichnet, dass das mindestens eine Anschlagelement (65) festlegbar verstellbar ausgebildet ist.
• 9. Halteinstrument nach einem der Sätze 6 bis 8, dadurch gekennzeichnet, dass das mindestens eine Anschlagelement (65) manuell verstellbar ist.
• 10. Halteinstrument nach einem der Sätze 6 bis 9, dadurch gekennzeichnet, dass das mindestens eine Anschlagelement (65) als Stellschraube (66) ausgebildet ist oder eine Stellschraube (66) umfasst.
• 11. Halteinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass das Halteinstrument (104; 154) mindestens ein Gelenk (33; 156) umfasst, an dem das erste Halteteil (42) und das zweite Halteteil (43) gelenkig miteinander verbunden sind.
• 12. Halteinstrument nach Satz 11, dadurch gekennzeichnet, dass das mindestens eine Gelenk (33; 156) ein eine Schwenkachse (34; 157) definierendes Scharniergelenk ist, um welche Schwenkachse (34; 157) das erste Halteteil (42) und das zweite Halteteil (43) relativ zueinander verschwenkbar sind.
• 13. Halteinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass die Verbindungseinrichtung (49; 163) an einem proximalen Ende (40) des Halteinstrumentes (14; 104; 154) angeordnet ist.
• 14. Halteinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass die Verbindungseinrichtung (49; 163) mindestens ein am ersten Halteteil (42) angeordnetes oder von diesem umfasstes erstes Verbindungselement (50; 164) sowie mindestens ein am zweiten Halteteil (43) angeordnetes oder von diesem umfasstes zweites Verbindungselement (51; 165) aufweist.
• 15. Halteinstrument nach Satz 14, dadurch gekennzeichnet, dass das mindestens eine erste Verbindungselement (50; 164) und/oder das mindestens eine zweite Verbindungselement (51; 165) zum formschlüssigen und/oder zum kraftschlüssigen Zusammenwirken mit Ankoppelelementen (36, 37; 159, 160) der Ankoppeleinrichtung (35; 158) des Handhabungsinstrumentes (12; 102; 152) ausgebildet sind.
• 16. Halteinstrument nach Satz 14 oder 15, dadurch gekennzeichnet, dass das mindestens eine erste Verbindungselement (50; 164) und/oder das mindestens eine zweite Verbindungselement (51; 165) Klemmglieder sind.
• 17. Halteinstrument nach einem der Sätze 14 bis 16, dadurch gekennzeichnet, dass das mindestens eine erste Verbindungselement (50) am ersten Halteteil (42) und/oder dass das mindestens eine zweite Verbindungselement (51) am zweiten Halteteil (43) gebildete Ausnehmungen (52, 53) zur Aufnahme von am Handhabungsinstrument (12; 102) gebildeten Vorsprüngen (38, 39) sind.
• 18. Halteinstrument nach einem der Sätze 14 bis 17, dadurch gekennzeichnet, dass das mindestens eine erste Verbindungselement (164) und/oder das mindestens eine zweite Verbindungselement (165) Rastglieder sind.
• 19. Halteinstrument nach einem der Sätze 14 bis 18, dadurch gekennzeichnet, dass das mindestens eine erste Verbindungselement (50) und/oder das mindestens eine zweite Verbindungselement (51) zum Ausbilden einer starren Verbindung des Halteinstrumentes (14; 104) und des Handhabungsinstrumentes (12; 102) miteinander ausgebildet sind.
• 20. Halteinstrument nach einem der Sätze 14 bis 18, dadurch gekennzeichnet, dass das mindestens eine erste Verbindungselement (164) und/oder das mindestens eine zweite Verbindungselement (165) zum Ausbilden einer gelenkigen Verbindung des Halteinstrumentes (14; 104) und des Handhabungsinstrumentes (12; 152) miteinander ausgebildet sind.
• 21. Halteinstrument nach Satz 20, dadurch gekennzeichnet, dass das mindestens eine erste Verbindungselement (164) und/oder das mindestens eine zweite Verbindungselement (165) je eine Schwenkachse (168, 169) definieren.
• 22. Halteinstrument nach einem der Sätze 14 bis 21, dadurch gekennzeichnet, dass das mindestens eine erste Verbindungselement (50; 164) und das mindestens eine zweite Verbindungselement (51; 165) identisch ausgebildet sind.
• 23. Halteinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass das Halteinstrument (14; 104; 154) mindestens ein Blockierelement (58; 106; 174) zum Blockieren einer Bewegung des ersten Halteteils (42) und des zweiten Halteteils (43) relativ zueinander umfasst.
• 24. Halteinstrument nach Satz 23, dadurch gekennzeichnet, dass das mindestens eine Blockierelement (58; 106; 174) am ersten Halteteil (42) und am zweiten Halteteil (43) anlegbare Anschlagglieder (59, 60; 113, 114) umfasst oder ausbildet.
• 25. Halteinstrument nach Satz 23 oder 24, dadurch gekennzeichnet, dass das mindestens eine Blockierelement (58; 106; 174) keilförmig ausgebildet ist.
• 26. Halteinstrument nach einem der Sätze 23 bis 25, dadurch gekennzeichnet, dass das mindestens eine Blockierelement (58; 106; 174) manuell vom Halteinstrument (14; 104; 154) lösbar ist.
• 27. Halteinstrument nach einem der Sätze 23 bis 26, dadurch gekennzeichnet, dass das mindestens eine Blockierelement (106) mindestens einen bei Verbinden des Handhabungsinstrumentes (102) mit dem Halteinstrument (104) nachgebenden Materialschwächungsabschnitt (120) umfasst.
• 28. Halteinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass das Halteinstrument (14; 104; 154) mindestens ein Sicherungselement (54; 106; 174) zum Sichern des Halteinstrumentes (14; 104; 154) gegen Verbinden mit dem Handhabungsinstrument (12; 102; 152) umfasst.
• 29. Halteinstrument nach Satz 28, dadurch gekennzeichnet, dass mindestens ein Blockierelement (106; 174) des Halteinstrumentes (104; 154) das mindestens eine Sicherungselement (106; 174) umfasst oder ausbildet.
• 30. Halteinstrument nach Satz 28 oder 29, dadurch gekennzeichnet, dass das mindestens eine Sicherungselement (54; 106; 174) eine die Verbindungseinrichtung (49; 163) zumindest teilweise abdeckende Abdeckung (55) ist.
• 31. Halteinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass das Halteinstrument (14; 104; 154) eine Kennzeichnungseinrichtung (71) umfassend Daten betreffend ein am Halteinstrument (14; 104; 154) aufgenommenes Klemmelement (18) aufweist.
• 32. Chirurgisches Instrumentarium, umfassend mindestens ein Halteinstrument (14; 104; 154) nach einem der voranstehenden Sätze sowie ein chirurgisches Handhabungsinstrument (12; 102; 152), umfassend ein erstes Handhabungsteil (28), ein relativ zu diesem bewegliches zweites Handhabungsteil (29) sowie eine Ankoppeleinrichtung (35; 158), die zum lösbaren Verbinden des Handhabungsinstrumentes (12; 102; 152) mit der Verbindungseinrichtung (49; 163) des mindestens einen Halteinstrumentes (14; 104; 154) ausgebildet ist.
• 33. Instrumentarium nach Satz 32, dadurch gekennzeichnet, dass das Instrumentarium (10; 100; 150) eine Mehrzahl von Halteinstrumenten (14; 104; 154) mit identischen Verbindungseinrichtungen (49; 163) aufweist.
• 34. Instrumentarium nach Satz 32 oder 33, dadurch gekennzeichnet, dass das Handhabungsinstrument (12; 102; 152) mindestens ein Gelenk (33) umfasst, an dem das erste Handhabungsteil (28) und das zweite Handhabungsteil (29) gelenkig miteinander verbunden sind.
• 35. Instrumentarium nach Satz 34, dadurch gekennzeichnet, dass das mindestens eine Gelenk (33) ein eine Schwenkachse (34) definierendes Scharniergelenk ist, um welche Schwenkachse (34) das erste Handhabungsteil (28) und das zweite Handhabungsteil (29) relativ zueinander verschwenkbar sind.
• 36. Instrumentarium nach einem der Sätze 32 bis 35, dadurch gekennzeichnet, dass die Ankoppeleinrichtung (35; 158) an einem distalen Ende (26) des Handhabungsinstrumentes (12; 102; 152) angeordnet ist.
• 37. Instrumentarium nach einem der Sätze 32 bis 36, dadurch gekennzeichnet, dass die Ankoppeleinrichtung (35; 158) mindestens ein am ersten Handhabungsteil (28) angeordnetes oder von diesem umfasstes erstes Ankoppelelement (36; 159) sowie mindestens ein am zweiten Handhabungsteil (29) angeordnetes oder von diesem umfasstes zweites Ankoppelelement (37; 160) aufweist.
• 38. Instrumentarium nach Satz 37, dadurch gekennzeichnet, dass das mindestens eine erste Ankoppelelement (36; 159) und/oder das mindestens eine zweite Ankoppelelement (37; 160) zum formschlüssigen und/oder zum kraftschlüssigen Zusammenwirken mit Verbindungselementen (50, 51; 164, 165) der Verbindungseinrichtung (49; 163) des Halteinstrumentes (14; 104; 154) ausgebildet sind.
• 39. Instrumentarium nach Satz 37 oder 38, dadurch gekennzeichnet, dass das mindestens eine erste Ankoppelelement (36) und/oder das mindestens eine zweite Ankoppelelement (37) Klemmglieder sind.
• 40. Instrumentarium nach einem der Sätze 37 bis 39, dadurch gekennzeichnet, dass das mindestens eine erste Ankoppelelement (36) am ersten Handhabungsteil (28) und/oder dass das mindestens eine zweite Ankoppelelement (37) am zweiten Handhabungsteil (29) gebildete Vorsprünge (38, 39) sind, die von am Halteinstrument (14; 104; 154) gebildeten Ausnehmungen (52, 53) aufnehmbar sind.
• 41. Instrumentarium nach einem der Sätze 37 bis 40, dadurch gekennzeichnet, dass das mindestens eine erste Ankoppelelement (159) und/oder das mindestens eine zweite Ankoppelelement (160) Rastglieder sind.
• 42. Instrumentarium nach einem der Sätze 37 bis 41, dadurch gekennzeichnet, dass das mindestens eine erste Ankoppelelement (36) und/oder das mindestens eine zweite Ankoppelelement (37) zum Ausbilden einer starren Verbindung des Halteinstrumentes (14; 104) und des Handhabungsinstrumentes (12; 102) miteinander ausgebildet sind.
• 43. Instrumentarium nach einem der Sätze 37 bis 41, dadurch gekennzeichnet, dass das mindestens eine erste Ankoppelelement (159) und/oder das mindestens eine zweite Ankoppelelement (160) zum Ausbilden einer gelenkigen Verbindung des Halteinstrumentes (154) und des Handhabungsinstrumentes (152) miteinander ausgebildet sind.
• 44. Instrumentarium nach Satz 43, dadurch gekennzeichnet, dass das mindestens eine erste Ankoppelelement (159) und/oder das mindestens eine zweite Ankoppelelement (160) je eine Schwenkachse (161, 162) definieren.
• 45. Instrumentarium nach einem der Sätze 37 bis 44, dadurch gekennzeichnet, dass das mindestens eine erste Ankoppelelement (36, 159) und das mindestens eine zweite Ankoppelelement (37, 160) identisch ausgebildet sind.

The above description therefore comprises in particular the embodiments of a holding instrument according to the invention and an instrument according to the invention defined below in the form of numbered sets:

• 1. Surgical holding instrument for a surgical clamping element ( 18 ), comprising a first holding part ( 42 ) and a relative to this movable second holding part ( 43 ), which each have a clamping element receptacle ( 44 . 45 ) for receiving at least a part of the clamping element ( 18 ), wherein the first holding part ( 42 ) and the second holding part ( 43 ) under deformation of the clamping element ( 18 ) can be transferred from a first relative position to a second relative position, characterized in that the holding instrument ( 14 ; 104 ; 154 ) a connection device ( 49 ; 163 ), for releasably connecting the holding instrument ( 14 ; 104 ; 154 ) with a coupling device (corresponding to it) ( 35 ; 158 ) of a surgical manipulation instrument ( 12 ; 102 ; 152 ) for the holding instrument ( 14 ; 104 ; 154 ) is trained.
• 2. Holding instrument after sentence 1 , characterized in that the holding instrument ( 14 ; 104 ; 154 ) a clamping element ( 18 ).
• 3. Holding instrument after sentence 2 , characterized in that the clamping element ( 18 ) on the holding instrument ( 14 ; 104 ; 154 ) is pre-assembled.
• 4. Holding instrument by sentence 2 or 3 , characterized in that the clamping element ( 18 ) an aneurysm clip ( 20 ).
• 5. Holding instrument according to one of the preceding sentences, characterized in that the first holding part ( 42 ) and the second holding part ( 43 ) against one of the clamping element ( 18 ) applied restoring force of the first relative position in the second relative position can be transferred.
• 6. Holding instrument according to one of the preceding sentences, characterized in that the holding instrument ( 14 ; 104 ; 154 ) at least one adjustable stop element ( 65 ) for limiting the movement of the first holding part ( 42 ) and the second holding part ( 43 ) relative to one another when transferring from the first relative position to the second relative position.
• 7. Holding instrument after sentence 6 , characterized in that the at least one stop element ( 65 ) of a holding part ( 42 ) or arranged thereon.
• 8. Holding instrument by sentence 6 or 7 , characterized in that the at least one stop element ( 65 ) is formed adjustably adjustable.
• 9. Holding instrument according to one of the sentences 6 to 8th , characterized in that the at least one stop element ( 65 ) is manually adjustable.
• 10. Holding instrument according to one of the sentences 6 to 9 , characterized in that the at least one stop element ( 65 ) as a set screw ( 66 ) is formed or a set screw ( 66 ).
• 11. Holding instrument according to one of the preceding sentences, characterized in that the holding instrument ( 104 ; 154 ) at least one joint ( 33 ; 156 ), on which the first holding part ( 42 ) and the second holding part ( 43 ) are hinged together.
• 12. Holding instrument by sentence 11 , characterized in that the at least one joint ( 33 ; 156 ) a pivot axis ( 34 ; 157 ) hinge joint is about which pivot axis ( 34 ; 157 ) the first holding part ( 42 ) and the second holding part ( 43 ) are pivotable relative to each other.
• 13. Holding instrument according to one of the preceding sentences, characterized in that the connecting device ( 49 ; 163 ) at a proximal end ( 40 ) of the holding instrument ( 14 ; 104 ; 154 ) is arranged.
• 14. Holding instrument according to one of the preceding sentences, characterized in that the connecting device ( 49 ; 163 ) at least one on the first holding part ( 42 ) arranged or covered by this first connecting element ( 50 ; 164 ) and at least one on the second holding part ( 43 ) arranged or covered by this second connecting element ( 51 ; 165 ) having.
• 15. Holding instrument by sentence 14 , characterized in that the at least one first connection element ( 50 ; 164 ) and / or the at least one second connecting element ( 51 ; 165 ) for the positive and / or frictional interaction with coupling elements ( 36 . 37 ; 159 . 160 ) of the coupling device ( 35 ; 158 ) of the handling instrument ( 12 ; 102 ; 152 ) are formed.
• 16. Holding instrument after sentence 14 or 15 , characterized in that the at least one first connecting element ( 50 ; 164 ) and / or the at least one second connecting element ( 51 ; 165 ) Are clamping members.
• 17. Holding instrument according to one of the sentences 14 to 16 , characterized in that the at least one first connecting element ( 50 ) on the first holding part ( 42 ) and / or that the at least one second connecting element ( 51 ) on the second holding part ( 43 ) formed recesses ( 52 . 53 ) for inclusion on the handling instrument ( 12 ; 102 ) formed protrusions ( 38 . 39 ) are.
• 18. Holding instrument according to one of the sentences 14 to 17 , characterized in that the at least one first connecting element ( 164 ) and / or the at least one second connecting element ( 165 ) Locking members are.
• 19. Holding instrument according to one of the sentences 14 to 18 , characterized in that the at least one first connecting element ( 50 ) and / or the at least one second connecting element ( 51 ) for forming a rigid connection of the holding instrument ( 14 ; 104 ) and the handling instrument ( 12 ; 102 ) are formed with each other.
• 20. Holding instrument according to one of the sentences 14 to 18 , characterized in that the at least one first connecting element ( 164 ) and / or the at least one second connecting element ( 165 ) for forming a hinged connection of the holding instrument ( 14 ; 104 ) and the handling instrument ( 12 ; 152 ) are formed with each other.
• 21. Holding instrument by sentence 20 , characterized in that the at least one first connecting element ( 164 ) and / or the at least one second connecting element ( 165 ) each a pivot axis ( 168 . 169 ) define.
• 22. Holding instrument according to one of the sentences 14 to 21 , characterized in that the at least one first connecting element ( 50 ; 164 ) and the at least one second connecting element ( 51 ; 165 ) are formed identically.
• 23. Holding instrument according to one of the preceding sentences, characterized in that the holding instrument ( 14 ; 104 ; 154 ) at least one blocking element ( 58 ; 106 ; 174 ) for blocking a movement of the first holding part ( 42 ) and the second holding part ( 43 ) relative to each other.
• 24. Holding instrument after sentence 23 , characterized in that the at least one blocking element ( 58 ; 106 ; 174 ) on the first holding part ( 42 ) and at the second holding part ( 43 ) attachable stop members ( 59 . 60 ; 113 . 114 ) or trains.
• 25. Holding instrument by sentence 23 or 24 , characterized in that the at least one blocking element ( 58 ; 106 ; 174 ) is wedge-shaped.
• 26. Holding instrument according to one of the sentences 23 to 25 , characterized in that the at least one blocking element ( 58 ; 106 ; 174 ) manually from the holding instrument ( 14 ; 104 ; 154 ) is solvable.
• 27. Holding instrument according to one of the sentences 23 to 26 , characterized in that the at least one blocking element ( 106 ) at least one when connecting the handling instrument ( 102 ) with the holding instrument ( 104 ) yielding material weakening section ( 120 ).
• 28. Holding instrument according to one of the preceding sentences, characterized in that the holding instrument ( 14 ; 104 ; 154 ) at least one security element ( 54 ; 106 ; 174 ) for securing the holding instrument ( 14 ; 104 ; 154 ) against connection with the handling instrument ( 12 ; 102 ; 152 ).
• 29. Holding instrument by sentence 28 , characterized in that at least one blocking element ( 106 ; 174 ) of the holding instrument ( 104 ; 154 ) the at least one security element ( 106 ; 174 ) or trains.
• 30. Holding instrument by sentence 28 or 29 , characterized in that the at least one securing element ( 54 ; 106 ; 174 ) a connecting device ( 49 ; 163 ) at least partially covering cover ( 55 ).
• 31. Holding instrument according to one of the preceding sentences, characterized in that the holding instrument ( 14 ; 104 ; 154 ) a marking device ( 71 ) comprising data concerning a holding instrument ( 14 ; 104 ; 154 ) received clamping element ( 18 ) having.
• 32. Surgical instrumentation comprising at least one holding instrument ( 14 ; 104 ; 154 ) according to one of the preceding sentences and a surgical handling instrument ( 12 ; 102 ; 152 ), comprising a first handling part ( 28 ), a relative to this movable second handling part ( 29 ) and a coupling device ( 35 ; 158 ) for releasably connecting the handling instrument ( 12 ; 102 ; 152 ) with the connection device ( 49 ; 163 ) of the at least one holding instrument ( 14 ; 104 ; 154 ) is trained.
• 33. Instrumentarium by sentence 32 , characterized in that the instrumentation ( 10 ; 100 ; 150 ) a plurality of holding instruments ( 14 ; 104 ; 154 ) with identical connecting devices ( 49 ; 163 ) having.
• 34. Instrumentarium by sentence 32 or 33 , characterized in that the handling instrument ( 12 ; 102 ; 152 ) at least one joint ( 33 ), on which the first handling part ( 28 ) and the second handling part ( 29 ) are hinged together.
• 35. Instrumentarium by sentence 34 , characterized in that the at least one joint ( 33 ) a pivot axis ( 34 ) hinge joint is about which pivot axis ( 34 ) the first handling part ( 28 ) and the second handling part ( 29 ) are pivotable relative to each other.
• 36. Instrumentation according to one of the sentences 32 to 35 , characterized in that the coupling device ( 35 ; 158 ) at a distal end ( 26 ) of the handling instrument ( 12 ; 102 ; 152 ) is arranged.
• 37. Instrumentation according to one of the sentences 32 to 36 , characterized in that the coupling device ( 35 ; 158 ) at least one on the first handling part ( 28 ) arranged or covered by this first coupling element ( 36 ; 159 ) and at least one on the second handling part ( 29 ) arranged or covered by this second coupling element ( 37 ; 160 ) having.
• 38. Instrumentarium by sentence 37 , characterized in that the at least one first coupling element ( 36 ; 159 ) and / or the at least one second coupling element ( 37 ; 160 ) for the positive and / or non-positive interaction with connecting elements ( 50 . 51 ; 164 . 165 ) of the connection device ( 49 ; 163 ) of the holding instrument ( 14 ; 104 ; 154 ) are formed.
• 39. Instrumentarium by sentence 37 or 38 , characterized in that the at least one first coupling element ( 36 ) and / or the at least one second coupling element ( 37 ) Are clamping members.
• 40th Instrumentarium after one of the sentences 37 to 39 , characterized in that the at least one first coupling element ( 36 ) on the first handling part ( 28 ) and / or that the at least one second coupling element ( 37 ) on the second handling part ( 29 ) formed projections ( 38 . 39 ) of the holding instrument ( 14 ; 104 ; 154 ) recesses ( 52 . 53 ) are receivable.
• 41. Instrumentation according to one of the sentences 37 to 40 , characterized in that the at least one first coupling element ( 159 ) and / or the at least one second coupling element ( 160 ) Locking members are.
• 42. Instrumentation according to one of the sentences 37 to 41 , characterized in that the at least one first coupling element ( 36 ) and / or the at least one second coupling element ( 37 ) for forming a rigid connection of the holding instrument ( 14 ; 104 ) and the handling instrument ( 12 ; 102 ) are formed with each other.
• 43. Instrumentation according to one of the sentences 37 to 41 , characterized in that the at least one first coupling element ( 159 ) and / or the at least one second coupling element ( 160 ) for forming a hinged connection of the holding instrument ( 154 ) and the handling instrument ( 152 ) are formed with each other.
• 44. Instrumentarium by sentence 43 , characterized in that the at least one first coupling element ( 159 ) and / or the at least one second coupling element ( 160 ) each a pivot axis ( 161 . 162 ) define.
• 45. Instrumentation according to one of the sentences 37 to 44 , characterized in that the at least one first coupling element ( 36 . 159 ) and the at least one second coupling element ( 37 . 160 ) are formed identically.

The following description of preferred embodiments of the invention is used in conjunction with the drawings for a more detailed explanation of the invention. Show it:

1 a perspective view of an instrument according to the invention, comprising a handling instrument according to the invention and an inventive holding instrument in the interconnected state;

2 a partially sectioned schematic side view of a proximal part of the instrument from 1 ;

3 : a representation accordingly 2 before connecting the handling instrument to the holding instrument;

4 1 is a partially sectioned schematic side view of a proximal part of a second preferred embodiment of a surgical instrumentation according to the invention, comprising a second manipulation instrument and a second holding instrument in the interconnected state;

5 : a representation accordingly 4 (partial) before connecting the handling instrument with the holding instrument;

6 : A plan view of a blocking and securing element of the instrument from 4 ;

7 FIG. 2: a partially sectioned schematic side view of a proximal part of a third embodiment of a surgical instrumentation according to the invention with a third manipulation instrument and a third holding instrument in the connected state, and FIG

8th : a representation accordingly 7 before connecting the handling instrument with the holding instrument.

1 shows a perspective view of a first preferred embodiment of a surgical instrumentation according to the invention 10 , which is a first preferred embodiment of a Handling instrument according to the invention 12 and a first preferred embodiment of a holding instrument according to the invention 14 includes. The holding instrument 14 , subsequently jaw part 16 , Includes a surgical clamping element 18 in the form of a clip 20 , which in this case is an aneurysm clip.

The handling instrument 12 , below applying forceps 22 , has a proximal end 24 and a distal end 26 on. "Proximal" and "distal" are present as on the instrumentation 10 to refer to the operating surgeon.

Starting from the distal end 26 extend two handling parts 28 and 29 the applying forceps 22 in the distal-poximal direction. The handling parts 28 and 29 are near the proximal end 24 by means of an arcuate band spring 30 resiliently connected. Furthermore, the handling parts form 28 and 29 handle elements 31 respectively. 32 supplied by an operator with an actuating force for applying the clip 20 (this will be discussed later) can be applied.

Near the distal end 26 are the handling parts 28 and 29 by means of a joint 33 hinged together. The joint 33 is a hinged joint that is perpendicular to each, from the handling parts 28 and 29 defined directions aligned pivot axis 34 defined to which the handling parts 28 and 29 can be pivoted relative to each other.

At the distal end 26 includes the application forceps 22 one below as a coupling device 35 designated connecting means for releasably connecting the applying forceps 22 with the jaw part 16 ( 3 ). The coupling device 35 has two coupling elements 36 and 37 on the handling part 28 or on the handling part 29 on. The coupling elements 36 and 37 are identical, as a pin-shaped projections 38 respectively. 39 attached to the handling parts 28 respectively. 29 are formed otherwise. In from the handling parts 28 and 29 pioneering directions, the projections taper 38 respectively. 39 conical.

The jaw part 16 has a proximal end 40 and a distal end 41 on. It includes two each from the proximal end 40 to the distal end 41 extending holding parts 42 and 43 , At the distal end 41 include the holding parts 42 and 43 Clamping element receptacles 44 respectively. 45 into which the clip 20 in a manner known per se is releasably inserted, so that it by means of the jaw part 16 can be held.

The holding parts 42 and 43 are movable relative to each other, but not hinged together. The degrees of freedom of movement of the holding parts 42 and 43 relative to each other are restricted by a guide means 46 approximately midway between the proximal end 40 and the distal end 41 , The management device 46 includes a first guide member 47 of the holding part 42 in the form of a blind hole-like recess for a second guide member 48 of the holding part 43 in the form of an engaging in the recess guide pin. The guide members 47 and 48 each have a circular arc-shaped curvature with respect to the pivot axis 34 on, based on a connected state of the jaw part 16 and the applying forceps 22 together ( 2 ).

At the proximal end 40 includes the jaw part 16 a connection device 49 for interaction with the coupling device 35 , The connection device 49 has two identical fasteners 50 on the holding part 42 such as 51 on the holding part 43 on. Both fasteners 50 and 51 are blind-hole-like, from the proximal end 40 towards the distal end 41 conically tapering recesses 52 respectively. 53 ,

As mentioned, the jaw part 16 with the applying forceps 22 be detachably connected. For this purpose, the projections 38 and 39 in the recesses 52 respectively. 53 introduce. This leads to jamming of the holding part 42 with the handling part 28 and the holding part 43 with the handling part 29 ie the projections 38 and 39 and the recesses 52 and 53 are clamping members for clamping connection of the jaw part 16 with the applying forceps 22 , This allows a (clamping) non-positive connection of jaw part 16 and applying forceps 22 , Due to the positive engagement of the projections 38 and 39 and the recess 52 respectively. 53 the connection is also form-fitting.

A connection of the jaw part 16 with the applying forceps 22 However, this can only be done when a fuse element 54 in the form of the recesses 52 and 53 covering cover 55 previously removed by the surgeon. The cover 55 has engagement elements 56 and 57 on that in the recesses 52 and 53 can engage, so the cover 55 on the jaw part 16 is anchored. The cover 55 is supplied by the manufacturer during delivery to the jaw part 16 attached and prevents the applying forceps 22 unintentionally with the jaw part 16 is connected.

Furthermore, the jaw part comprises 16 a manufacturer mounted blocking element 58 which is near the proximal end between the holding parts 42 and 43 is wedged. The blocking element 58 includes stop surfaces 59 respectively. 60 for the holding parts 42 respectively. 43 as well as protruding ribs 61 and 62 in corresponding grooves 63 respectively. 64 on the holding part 42 or on the holding part 43 can intervene. Even if the applying forceps 22 with the jaw part 16 connected, the holding parts 42 and 43 are not moved relative to each other, without first the blocking element 58 has been removed by the surgeon.

In addition, the jaw part includes 16 an adjustable stop element 65 in the form of a holding part 42 included set screw 66 , For receiving the set screw 66 is in the holding part 42 a tubular opening 67 formed with not shown in the drawing internal thread, with a not shown in the drawing external thread of the screw 66 can interact. Towards the holding part 43 enters the set screw 66 from the opening 67 on, and the holding part 43 facing it has an end face stop surface 68 on.

The adjusting screw 66 can be adjusted by trained personnel by the manufacturer such that the range of motion of the holding parts 42 and 43 relative to each other is limited to an extent which is an application of the clip 20 allowed, but avoids their unintentional damage. Once set, the set screw can 66 by means of a securing member 69 in the form of a plug in the opening 67 be fixed.

The following is the application of the clip 20 by means of the instruments 10 and the associated benefits explained:
The jaw part 16 is the manufacturer with the clip 20 pre-assembled, this on the clamping element recordings 44 and 45 is pre-assembled. As mentioned, the set screw 66 adjusted so that the holding parts 42 and 43 only so far can be moved relative to each other, that the clip 20 not overly using the applying forceps 22 is widened. Pre-assembling the clip 20 on the jaw part 16 has the advantage that the jaw part 16 in terms of its size, dimensions and in particular the adjustment of the set screw 66 on the properties of the clip 20 can be individually tailored.

Manufacturer side are on the jaw part 16 also the fuse element 54 and the blocking element 58 assembled. The delivery of the jaw part 16 takes place in the sterilized state and, for example, packed separately, wherein a magizinierte packaging of a plurality of jaw parts 16 with pre-assembled clips 20 is possible.

Should the clip 20 It is necessary for the surgeon to first apply the cover 55 from the jaw part 16 to solve. This can be done manually. Subsequently, the surgeon brings the coupling device 35 and the connection device 49 engaged with each other. Furthermore, the blocking element 58 between the holding parts 42 and 43 This can also be done manually. Then the instruments take the in 2 schematically illustrated a configuration.

To apply the clip, the grip elements 31 and 32 acted upon with mutually facing actuating forces, so that the handling parts 28 and 29 and thus the holding parts 42 and 43 relative to each other about the pivot axis 34 be pivoted. The holding parts 42 and 43 be characterized by a first relative position in which a mouth end 70 of the clip 20 closed is ( 2 ), under deformation of the clip 20 converted into a second relative position, in which the mouth end 70 is open (not shown).

The adjusting screw 66 arrives at the holding part 43 with the stop surface 68 to stop and limits the widening of the mouth end 70 , This will ensure that the clip 20 not widened excessively. This is particularly important in aneurysm clips of particular importance, as an excessive widening to a deterioration of the clip 20 can lead such that the manufacturer-specified closing force and the actual closing force of the clip 20 can fall apart. This drawback, which is a potential risk of injury to the patient due to a slipping clip 20 in itself, can by the adjustable stop element 65 be avoided, the factory already on the properties of the clip 20 adjusted and by means of the securing member 69 can be fixed.

With open mouth end 70 can the clip 20 be applied in a known manner to be suppressed aneurysm by the operating force on the handle elements 31 and 32 is lowered and the holding parts 42 and 43 be transferred back to the first relative position.

In that the surgeon the securing element 54 and the blocking element 58 before applying the clip 20 aware of the jaw part 16 In addition, it will largely avoid the clip 20 is spread repeatedly. Also a repeated spreading of the clip 20 may result in an impairment of the manufacturer's set closing force. Lack the security element 54 and the blocking element 58 on the jaw part 16 , this may include the clip 20 be safely discarded by the surgeon, because the surgeon must expect that the clip 20 at least once has been spread. Thus, the presence or absence of the security element provides 54 and the blocking element 58 An additional control option for the surgeon that can reduce the risk of injury to the patient.

The adjustable set screw 66 In addition, offers the option of the jaw part 16 instead of the clip 20 to use a different clip, for example, with different closing force, without the jaw part 16 otherwise it has to be exchanged. Thus, the jaw part prove 16 and with it the instruments 10 as versatile.

The instrumentation 10 further includes the jaw part 16 including clip 20 In addition, a plurality of jaws with each held clip, their connection means identical to the connecting device 49 are formed (not shown). This allows the applying forceps 22 to use with each of the jaws. Therefore, the user is only the application forceps 22 Provide even to create clips of all kinds professionally.

This is justified by the fact that the adaptation of the instruments 10 takes place at the respective clip by means of the respective jaw part, so for example on size, shape, field of application or closing force of the respective clip. This facilitates a surgeon's handling of the instruments 10 not only significantly, but it also reduces the risk that clips are mistakenly applied with a not-for-use applying forceps and affected by it.

A labeling area 71 with marking device on the holding part 43 includes the clip 20 relevant data, e.g. In physical form. A sticker with an optically readable barcode or a wirelessly readable RFID tag is also conceivable. Based on the data, a trace of the clip 20 be made when the jaw part 16 remains in the patient record after implantation.

The 4 and 5 show in sections a second preferred embodiment of a surgical instrumentation according to the invention 100 with second preferred embodiments of a handling instrument 102 or a holding instrument 104 , For the same or equivalent components or features of the instruments 10 and 100 identical reference numerals are used. The ones with the instruments 10 achievable benefits can be achieved with the instrumentation 100 also be achieved.

The instrumentation 100 is different from the instrumentarium 10 essentially in that, unlike this, the jaw part 16 the joint 33 includes, but not the application forceps 22 , which is shown only in sections in the drawing. This means that the holding parts 42 and 43 pivotable about the pivot axis 34 are stored. Furthermore, the instrumentation 100 the management facility 46 at the application forceps 22 and not on the jaw part 16 arranged so that the handling parts 28 and 29 by means of the guide device 46 can be performed relative to each other.

In addition, comes in place of the fuse element 54 and the blocking element 58 at the instrumentarium 100 a combined locking and locking element 106 for use. The locking and locking element 106 is integrally formed, and it includes a securing portion 107 and a blocking section 108 , The security section 107 forms a cover 109 for the connection device 49 , By means of a border area 112 can the locking and locking element 106 on the jaw part 16 be releasably clamped.

The blocking section 108 is wedge-shaped and includes stop surfaces 113 and 114 for the holding parts 42 respectively. 43 to prevent relative movement of each other as long as the securing and blocking element 106 on the jaw part 16 is held.

Unlike the fuse element 44 is by means of the securing section 107 a connection of the jaw part 16 with the applying forceps 22 not completely prevented, but at least more difficult. At the security section 107 are circular openings 115 and 116 educated ( 6 ), whose respective diameter is slightly larger than that of the projections 38 and 39 , This diameter is in 6 the breakthroughs 115 and 116 shown concentrically surrounded by dashes. Between the openings 115 and 116 is a rectangular opening 117 of the locking and blocking element 106 arranged.

From a first edge 118 up to a second edge 119 runs a material weakening section 120 of the locking and blocking element 106 passing through the breakthroughs 115 to 117 is interrupted. The material weakening section 120 is a predetermined breaking section, on which two halves 121 and 122 of the locking and blocking element 106 connected to each other.

Should the application forceps 22 with the jaw part 16 are connected, the projections 38 and 39 at the openings 115 and 116 to arrange. Because the diameter of the protrusions 38 and 39 those of the openings 115 and 116 exceeds, the weakly formed material weakening section gives 120 after, when the applying forceps 22 with one on the jaw part 16 directed force is applied. This leads to the fact that the locking and blocking element to a certain extent "automatically" when connecting the applying forceps 22 with the jaw part 16 from the connection device 49 Will get removed. This makes it easier for the surgeon to handle the instruments 100 ,

A third preferred embodiment of a surgical instrumentation according to the invention 150 in the 7 and 8th shown in sections, and it includes in each case third preferred embodiments of a handling instrument according to the invention 152 or a holding instrument 154 , Features and components of the instruments 150 and 10 , which are the same or the same acting, are assigned with identical reference numerals. The ones with the instruments 10 achievable benefits can be achieved with the instrumentation 150 also be achieved.

From the instrumentarium 10 the instrumentation differs 150 essentially by having both the jaw part 16 as well as the applying forceps 22 Have joints and that the jaw part 16 and the applying forceps 22 are hinged together:
As with the instruments 10 indicates the application forceps 22 at the instrumentarium 150 the joint 33 on. The jaw part 16 like the instrumentation 100 one the holding parts 42 and 43 hingedly interconnecting joint on, subsequently as a joint 156 designated. At the joint 156 , a hinge joint, are the holding parts 42 and 43 around a pivot axis 157 pivoted relative to each other.

Instead of the coupling device 35 includes the application forceps 22 at the instrumentarium 150 a coupling device 158 with coupling elements 159 and 160 at the distal end 26 , The coupling elements 159 and 160 are identically formed as a respective pivot axis 161 respectively. 162 defining bushings 170 respectively. 171 ,

The jaw part 16 includes instead of the connection device 49 at the instrumentarium 150 a connection device 163 , The connection device 163 includes two identical fasteners 164 and 165 at the proximal end 40 in the form of bearing journals 166 respectively. 167 , The journals 166 and 167 each define a pivot axis 168 respectively. 169 ,

The applying forceps 22 and the jaw part 16 can be connected together by the bearing bushes 170 and 171 positive fit on the journals 166 respectively. 167 be snapped 7 ). The pivot axes 161 and 168 such as 162 and 169 coincide thereby, whereby, moreover, the pivot axes 161 . 162 . 168 . 169 . 157 such as 34 are each aligned parallel to each other. As a result, the handling part 28 and the holding part 42 and the handling part 29 and the holding part 43 each by means of a joint 172 respectively. 173 articulated and in particular pivotally connected to each other. In this way, form the handling parts 28 and 29 as well as the holding parts 42 and 43 one due to the joints 33 . 156 . 172 such as 173 deformable joint polygon. This articulated polygon has particularly good guiding properties for the holding parts 42 and 43 on when by the surgeon on the handle elements 31 and 32 an actuating force is exerted. Thus, the instrumentation proves 150 as particularly reliable in handling.

In a similar way as the instrumentation 100 includes the instruments 150 a combined, one-piece locking and locking element 174 with a manufacturer mounted, detachable, the connecting device 163 covering securing section 175 and one between the holding parts 42 and 43 wedged blocking section 176 ,

Claims (25)

Surgical holding instrument for a surgical clamping element ( 18 ), comprising a first holding part ( 42 ) and a relative to this movable second holding part ( 43 ), which each have a clamping element receptacle ( 44 . 45 ) for receiving at least a part of the clamping element ( 18 ), wherein the first holding part ( 42 ) and the second holding part ( 43 ) under deformation of the clamping element ( 18 ) can be transferred from a first relative position to a second relative position, characterized in that the holding instrument ( 14 ; 104 ; 154 ) a connection device ( 49 ; 163 ), for releasably connecting the holding instrument ( 14 ; 104 ; 154 ) with a coupling device (corresponding to it) ( 35 ; 158 ) of a surgical manipulation instrument ( 12 ; 102 ; 152 ) for the holding instrument ( 14 ; 104 ; 154 ) is trained. Holding instrument according to claim 1, characterized in that the holding instrument ( 14 ; 104 ; 154 ) a clamping element ( 18 ). Holding instrument according to claim 2, characterized in that the clamping element ( 18 ) on the holding instrument ( 14 ; 104 ; 154 ) is pre-assembled. Holding instrument according to claim 2 or 3, characterized in that the clamping element ( 18 ) an aneurysm clip ( 20 ). Holding instrument according to one of the preceding claims, characterized in that the holding instrument ( 14 ; 104 ; 154 ) at least one adjustable stop element ( 65 ) for limiting the movement of the first holding part ( 42 ) and the second holding part ( 43 ) relative to one another when transferring from the first relative position to the second relative position. Holding instrument according to claim 5, characterized in that the at least one stop element ( 65 ) of a holding part ( 42 ) or arranged thereon. Holding instrument according to claim 5 or 6, characterized in that the at least one stop element ( 65 ) is formed adjustably adjustable. Holding instrument according to one of claims 5 to 7, characterized in that the at least one stop element ( 65 ) is manually adjustable. Holding instrument according to one of claims 5 to 8, characterized in that the at least one stop element ( 65 ) as a set screw ( 66 ) is formed or a set screw ( 66 ). Holding instrument according to one of the preceding claims, characterized in that the holding instrument ( 104 ; 154 ) at least one joint ( 33 ; 156 ), on which the first holding part ( 42 ) and the second holding part ( 43 ) are hinged together. Holding instrument according to one of the preceding claims, characterized in that the connecting device ( 49 ; 163 ) at a proximal end ( 40 ) of the holding instrument ( 14 ; 104 ; 154 ) is arranged. Holding instrument according to one of the preceding claims, characterized in that the connecting device ( 49 ; 163 ) at least one on the first holding part ( 42 ) arranged or covered by this first connecting element ( 50 ; 164 ) and at least one on the second holding part ( 43 ) arranged or covered by this second connecting element ( 51 ; 165 ) having. Holding instrument according to claim 12, characterized in that the at least one first connecting element ( 50 ; 164 ) and / or the at least one second connecting element ( 51 ; 165 ) for the positive and / or frictional interaction with coupling elements ( 36 . 37 ; 159 . 160 ) of the coupling device ( 35 ; 158 ) of the handling instrument ( 12 ; 102 ; 152 ) are formed. Holding instrument according to claim 12 or 13, characterized in that the at least one first connecting element ( 50 ; 164 ) and / or the at least one second connecting element ( 51 ; 165 ) Are clamping members. Holding instrument according to one of claims 12 to 14, characterized in that the at least one first connecting element ( 164 ) and / or the at least one second connecting element ( 165 ) for forming a hinged connection of the holding instrument ( 14 ; 104 ) and the handling instrument ( 12 ; 152 ) are formed with each other. Holding instrument according to claim 15, characterized in that the at least one first connecting element ( 164 ) and / or the at least one second connecting element ( 165 ) each a pivot axis ( 168 . 169 ) define. Holding instrument according to one of the preceding claims, characterized in that the holding instrument ( 14 ; 104 ; 154 ) at least one blocking element ( 58 ; 106 ; 174 ) for blocking a movement of the first holding part ( 42 ) and the second holding part ( 43 ) relative to each other. Holding instrument according to claim 17, characterized in that the at least one blocking element ( 58 ; 106 ; 174 ) manually from the holding instrument ( 14 ; 104 ; 154 ) is solvable. Holding instrument according to claim 17 or 18, characterized in that the at least one blocking element ( 106 ) at least one when connecting the handling instrument ( 102 ) with the holding instrument ( 104 ) yielding material weakening section ( 120 ). Holding instrument according to one of the preceding claims, characterized in that the holding instrument ( 14 ; 104 ; 154 ) at least one security element ( 54 ; 106 ; 174 ) for securing the holding instrument ( 14 ; 104 ; 154 ) against connection with the handling instrument ( 12 ; 102 ; 152 ). Holding instrument according to claim 20, characterized in that the at least one securing element ( 54 ; 106 ; 174 ) a connecting device ( 49 ; 163 ) at least partially covering cover ( 55 ). Holding instrument according to one of the preceding claims, characterized in that the holding instrument ( 14 ; 104 ; 154 ) a marking device ( 71 ) comprising data concerning a holding instrument ( 14 ; 104 ; 154 ) received clamping element ( 18 ) having. Surgical instrumentation comprising at least one holding instrument ( 14 ; 104 ; 154 ) according to one of the preceding claims as well as a surgical handling instrument ( 12 ; 102 ; 152 ), comprising a first handling part ( 28 ), a relative to this movable second handling part ( 29 ) and a coupling device ( 35 ; 158 ) for releasably connecting the handling instrument ( 12 ; 102 ; 152 ) with the Connection device ( 49 ; 163 ) of the at least one holding instrument ( 14 ; 104 ; 154 ) is trained. Instrumentarium according to claim 23, characterized in that the instrumentation ( 10 ; 100 ; 150 ) a plurality of holding instruments ( 14 ; 104 ; 154 ) with identical connecting devices ( 49 ; 163 ) having. Instrumentarium according to claim 23 or 24, characterized in that the handling instrument ( 12 ; 102 ; 152 ) at least one joint ( 33 ), on which the first handling part ( 28 ) and the second handling part ( 29 ) are hinged together.

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