DE19915061A1 - Surgical instrument - Google Patents
Surgical instrumentInfo
- Publication number
- DE19915061A1 DE19915061A1 DE1999115061 DE19915061A DE19915061A1 DE 19915061 A1 DE19915061 A1 DE 19915061A1 DE 1999115061 DE1999115061 DE 1999115061 DE 19915061 A DE19915061 A DE 19915061A DE 19915061 A1 DE19915061 A1 DE 19915061A1
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- DE
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- Prior art keywords
- distal
- surgical instrument
- hook
- section
- instrument according
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/295—Forceps for use in minimally invasive surgery combined with cutting implements
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00353—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery one mechanical instrument performing multiple functions, e.g. cutting and grasping
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2945—Curved jaws
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/30—Surgical pincettes without pivotal connections
- A61B2017/303—Surgical pincettes without pivotal connections with four or more legs
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00345—Vascular system
- A61B2018/00404—Blood vessels other than those in or around the heart
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00601—Cutting
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/1206—Generators therefor
- A61B2018/1246—Generators therefor characterised by the output polarity
- A61B2018/126—Generators therefor characterised by the output polarity bipolar
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/1412—Blade
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/1425—Needle
- A61B2018/1432—Needle curved
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B2018/145—Probes having pivoting end effectors, e.g. forceps wherein the effectors remain parallel during closing and opening
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
- A61B2018/1455—Probes having pivoting end effectors, e.g. forceps including means for cutting having a moving blade for cutting tissue grasped by the jaws
Abstract
Description
Die Erfindung betrifft ein chirurgisches Instrument nach dem Oberbegriff des Patentanspruches 1.The invention relates to a surgical instrument according to the Preamble of claim 1.
Die Präperation, Dissektion und Hämostase sind Arbeitsschritte einer Operation, die derzeit noch mit Hilfe zweier oder mehrerer verschiedener Instrumente durchgeführt werden. Dabei ist ein Instrumentenwechsel immer mit einem zeitlichen und organisatorischen Aufwand verbunden, der die Operationen erschwert und in die Länge zieht.The preparation, dissection and hemostasis are Work steps of an operation that is currently still using performed two or more different instruments become. An instrument change is always with one time and organizational effort associated with the Operations difficult and protracted.
Die Durchführung minimal invasiver Operationen erfordert durch die eingeschränkte Sicht auf das Operationsfeld im besonderen Maße geeignete Verfahren zur Dissektion gefäßführender Strukturen. Die Stillung eventuell auftretender Blutungen ist in der minimal invasiven Chriurgie wegen des indirekten Zuganges zum Operationsfeld deutlich schwieriger als in der offenen Chirurgie, so daß eine prophylaktische Hämostase um so wichtiger ist.Performing minimally invasive surgery requires due to the restricted view of the surgical field in the special measures suitable for dissection vascular structures. The breastfeeding may be bleeding occurs in minimally invasive chriurgy because of the indirect access to the operating field more difficult than in open surgery, so a prophylactic hemostasis is all the more important.
Die notwendige Energie für die thermische Hämostase kann mittels Laserstrahlung, Ultraschallvibration oder Hochfrequenzstrom ins Gewebe eingebracht werden.The energy required for thermal hemostasis can by means of laser radiation, ultrasonic vibration or High frequency current can be introduced into the tissue.
Die Lasertechnik ist bisher noch zu teuer und aufwendig und hat deshalb nur für spezielle Anwendungen wie zum Beispiel in der HNO- und Neurochirurgie Bedeutung erlangt. Up to now, laser technology has been too expensive and complex has therefore only for special applications such as in ENT and neurosurgery gained importance.
Ultraschalldisektoren werden in zunehmendem Maße bei Operationen eingesetzt und haben für eine Reihe von Anwendungen zu einer deutlichen Verbesserung der Operationstechnik geführt. Laser- und Ultraschallapplikatoren sind in der Anschaffung mit ganz erheblichen Kosten verbunden. Bei der Anwendung von Lasern müssen zudem noch eine Reihe von Sicherheitsmaßnahmen ergriffen werden.Ultrasound detectors are increasingly used Operations and have been used for a number of Applications to significantly improve the Surgical technique led. Laser and ultrasound applicators are very expensive to purchase connected. When using lasers you also have to a number of security measures are taken.
Bei der Hämostase mittels Hochfrequenzstrom kann der Hochfrequenzstrom sowohl monopolar als auch bipolar angekoppelt werden. Die monopolare Anwendung hat den Nachteil, daß der Strom vom Applikator durch den Patienten bis zur Neutralelektrode fließt und auf diese Weise thermische Schäden an Geweben entstehen können, an denen eigentlich kein Energieeintrag beabsichtigt war.In the case of hemostasis using high-frequency current, the High frequency current both monopolar and bipolar be coupled. The monopolar application has that Disadvantage that the current from the applicator through the patient flows to the neutral electrode and in this way thermal Damage to tissues can occur, on which actually none Energy input was intended.
Für die bipolare Applikation werden Scheren oder Zangen benutzt, wobei der Strom auf das Gewebe zwischen den beiden Elektroden begrenzt ist. Ein solches Gerät ist beispielsweise aus der DE 44 21 822 C1 bekannt, wobei zum Durchtrennen von Gewebe ein Messer vorgesehen ist. Sowohl der Aufbau als auch die Handhabung des bekanntlich chirurgischen Instrumentes sind aufwendig. Ein Präparieren von Gewebe mittels des Instrumentes ist fast nicht möglich.Scissors or forceps are used for bipolar application used, the current on the tissue between the two Electrodes is limited. Such a device is for example known from DE 44 21 822 C1, whereby for severing Tissue a knife is provided. Both the structure as well the handling of the known surgical instrument are expensive. A tissue preparation using the Instrumentes are almost impossible.
Der Erfindung liegt die Aufgabe zugrunde, mit möglichst einfachen Mitteln eine Kombination der Funktionen Präparation, Dissektion und Hämostase zu ermöglichen.The invention is based, with as possible a simple combination of functions Allow preparation, dissection and hemostasis.
Diese Aufgabe wird durch ein chirurgisches Instrument nach dem Patentanspruch 1 gelöst.This task is performed by a surgical instrument solved the claim 1.
Ein erster wesentlicher Punkt der Erfindung liegt darin, daß ein stumpfes Präparieren mittels eines hakenförmigen Instrumentes sowie ein Aufspreizen von Gewebe mit diesem einen Instrument in einfacher Weise ermöglicht wird. Dadurch wird eine erhebliche Erleichterung bei Operationen erzielt. Vorzugsweise ist mindestens eine Andruckeinrichtung vorgesehen, die mit der Betätigungseinrichtung verbunden ist und ein, an einem Haltelement befestigtes Andruckelement umfaßt, welches in einer Bewegung im wesentlichen senkrecht zur Spreizebene, an mindestens einem der distalen Teilabschnitte zum Festklammern von Gewebe oder dergleichen andrückbar ist. Dadurch wird eine weitere Präparationsmöglichkeit geschaffen. Hierbei sind vorzugsweise zwei Andruckeinrichtungen mit jeweils einem Andruckelement vorgesehen, die jeweils an einen distalen Teilabschnitt andrückbar sind. Vorzugsweise sind hierbei die Andruckeinrichtungen zum gleichzeitigen Andrücken der zwei Andruckelemente an die distalen Teilabschnitte ausgebildet, was die Handhabung des Instrumentes erleichtert.A first essential point of the invention is that a blunt dissection using a hook-shaped Instruments as well as a spreading of tissue with this an instrument is made possible in a simple manner. Thereby surgery is greatly facilitated. At least one pressure device is preferred provided, which is connected to the actuator and a pressure element fastened to a holding element which is substantially perpendicular in one movement to the spreading plane, on at least one of the distal ones Sections for clamping tissue or the like is pressable. This will make another one Preparation possibility created. Here are preferred two pressure devices, each with a pressure element provided, each on a distal section are pressable. Here are preferably Pressure devices for pressing the two simultaneously Pressure elements formed on the distal sections, which makes handling the instrument easier.
Die Andruckelemente sind vorzugsweise derart komplementär, vorzugsweise schalenförmig ausgebildet, daß sie flächig an die distalen Teilabschnitte andrückbar sind. Auf diese Weise ist trotz geringer Flächenpressung eine hohe Haltekraft sichergestellt.The pressure elements are preferably complementary, preferably bowl-shaped that they are flat the distal sections can be pressed on. In this way is a high holding force despite the low surface pressure ensured.
Vorzugsweise ist eine mit der Befestigungseinrichtung verbundene Schneidvorrichtung vorgesehen, die zwischen den distalen Teilabschnitten derart hindurchführbar ist, daß auf den gespreizten Teilhaken aufliegendes Gewebe durchtrennbar ist. Man kann also mit dem Instrument zunächst präparieren, dann das Gewebe ergreifen und auseinanderziehen und dann durchtrennen.One is preferably with the fastening device connected cutting device provided between the distal sections can be passed through such that the spreading partial hook of tissue lying on it can be severed is. So you can prepare with the instrument first, then grab the tissue and pull it apart and then cut through.
Vorzugsweise sind mindestens an den distalen Teilabschnitten elektrische Elektrodeneinrichtungen vorgesehen, die mit einer steuerbaren Stromquelle so verbunden sind, daß ein Koagulationsstrom auf dem Haken aufliegendem Gewebe zuführbar ist. Dadurch kann eine Hämostase bewirkt werden.Preferably, at least on the distal sections electrical electrode devices provided with a controllable power source are connected so that a Coagulation current can be supplied to tissue lying on the hook is. This can cause hemostasis.
Wenn Andruckelemente vorgesehen sind, so sind sowohl an diesen Andruckelementen als auch an den Haken Elektrodeneinrichtungen vorgesehen, die mit einer steuerbaren Stromquelle verbunden sind, so daß ein Koagulationsstrom vorzugsweise bei gespreiztem Haken jeweils zwischen einem distalen Teilabschnitt und einem Andruckelement zur Koagulation von zwischen dem distalen Teilabschnitt und dem Andruckelement eingeklemmten Gewebeabschnitten zuführbar ist. Es kann damit aufgenommenes Gewebe bzw. ein Blutgefäß an zwei voneinander beabstandeten Stellen gleichzeitig koaguliert werden. Nach einer solchen Koagulation kann eine Durchtrennung zwischen den Koagulationsstellen ohne Gefahr der Blutung durchgeführt werden. Damit sind nun die wichtigsten Funktionen wie stumpfes Präparieren, prophylaktische und akute Blutstillung, Koagulation und Durchtrennung in einem Instrument vereint. Dies ermöglicht ein kontinuierliches Arbeiten, ohne Instrumente wechseln zu müssen. Die Verwendung von Hochfrequenzstrom als Energiequelle und dessen Zuführung über bipolare Elektroden hat verschiedene Vorteile. Zum einen sind Hochfrequenzgeneratoren in allen gut ausgerüsteten Operationssälen standardmäßig vorhanden. Der Energieeintrag ist weiterhin auf das zwischen den Elektroden befindliche Gewebe begrenzt. Schließlich läßt sich der Koagulationserfolg durch Erfassung und Bewertung der elektrischen Parameter Strom und Spannung und der daraus abgeleiteten Impedanz des Gewebes beurteilen und entsprechend steuern.If pressure elements are provided, both are on these pressure elements as well as on the hook Electrode devices provided with a controllable Power source are connected so that a coagulation current preferably with the hook spread between each distal section and a pressure element for Coagulation of between the distal section and the Pressure element clamped tissue sections can be fed. Tissue or a blood vessel can thus be applied to two spaced from each other coagulated at the same time become. After such coagulation, a Cutting between the coagulation points without danger bleeding. So now that is most important functions like blunt dissection, prophylactic and acute hemostasis, coagulation and Separation united in one instrument. this makes possible a continuous work without changing instruments have to. The use of high frequency current as Energy source and its supply via bipolar electrodes has several advantages. For one are High frequency generators in all well equipped Operating theaters are standard. The energy input is still on the one between the electrodes Tissue limited. Finally, the coagulation success can be by recording and evaluating the electrical parameters Current and voltage and the derived impedance of the Assess tissue and control accordingly.
Vorzugsweise sind die distalen Teilabschnitte derart spiegelsymmetrisch mit abgerundeten Flächen an ihren voneinander abgewandten Seiten ausgebildet, daß mindestens der distale Abschnitt des Hakens im ungespreizten Zustand glatte Außenflächen aufweist. Dadurch läßt sich mit dem. Instrument Gewebe besonders sicher, ohne die Gefahr Läsionen zu setzen, stumpf präparieren. Nach dem Präparieren wird eine Portion des Gewebes auf den Haken aufgeladen und aufgespannt bzw. gespreizt, danach bipolar koaguliert und schließlich durchtrennt. Zielsetzung ist es hierbei, die Koagulation nur so lange dauern zu lassen, bis die in dem aufgeladenen Gewebe enthaltenen Gefäße verschlossen sind. Dabei sollten Effekte (wie Karbonisierung), die bei übermäßiger Erwärmung des Gefäßes auftreten vermieden werden. Dies wird durch eine entsprechend kontrollierte bzw. gesteuerte (oder beispielsweise über die Impedanz geregelte) Unterbrechung der Energiezufuhr durch den Generator vor der endgültigen Austrocknung des Gewebes erreicht. Weiterhin wird durch die Konstruktion eine Blutstillung an Gefäßstümpfen und bei kleineren flächenhaften Blutungen ermöglicht.The distal sections are preferably such mirror-symmetrical with rounded surfaces on their sides facing away from each other that at least the distal section of the hook in the unexpanded state has smooth outer surfaces. This allows the. Instrument tissue particularly safe without the risk of lesions to put, prepare blunt. After preparation, one Portion of the tissue loaded on the hook and stretched or spread, then bipolar coagulated and finally severed. The aim here is to only coagulate to let take so long in the charged tissue contained vessels are closed. Effects should (like carbonization), which is caused by excessive heating of the Vascular occurrence can be avoided. This is done by a appropriately controlled or controlled (or for example regulated via the impedance) interruption of the Energy supplied by the generator before the final one Drying of the tissue reached. Furthermore, the Construction of hemostasis on stumps and at allows smaller areal bleeding.
Die Betätigungseinrichtung umfaßt vorzugsweise einen distalen hohlstabförmigen Abschnitt mit im wesentlichen glatter Außenfläche, in welchem mindestens ein proximaler Teilabschnitt beweglich gelagert ist. Ein solcher Aufbau kann mit geringen Dimensionen gefertigt werden.The actuator preferably includes a distal one hollow rod-shaped section with a substantially smoother Outer surface in which at least one proximal Section is movably mounted. Such a structure can be made with small dimensions.
Wenn Andruckelemente vorgesehen sind, so umfaßt die Betätigungseinrichtung ebenfalls einen distalen hohlstabförmigen Abschnitt mit im wesentlichen glatter Außenfläche, in welchem zum einen mindestens ein proximaler Teilabschnitt und zum anderen die Halteelemente der Andruckelemente beweglich gelagert sind. Der Aufbau wird dann besonders einfach, wenn einer der beiden proximalen. Teilabschnitte fest am hohlstabförmigen Abschnitt angebracht ist, während der andere Teilabschnitt hierzu bewegbar ist. Die Halteelemente sind vorzugsweise derart im hohlstabförmigen Abschnitt axial zu diesem verschiebbar angebracht, daß die Andruckelemente bis zum hohlstabförmigen Abschnitt oder gar in diesen hinein zurückziehbar sind. Dadurch wird ein besonders gut zum Präparieren geeignetes Hakeninstrument geschaffen.If pressure elements are provided, the Actuator also a distal hollow rod-shaped section with a substantially smoother Outer surface in which on the one hand at least one proximal Section and the other the holding elements of the Pressure elements are movably mounted. The build will then particularly easy if one of the two proximal. Sections firmly attached to the hollow rod-shaped section is, while the other section is movable for this purpose. The holding elements are preferably such hollow rod-shaped section axially displaceable to this attached that the pressure elements up to the hollow rod Section or even retractable into this. This makes it particularly suitable for preparation Hook instrument created.
Die Hakenelemente sind vorzugsweise derart relativ zu dem proximalen Teilabschnitten geführt, daß mindestens bei gespreiztem Haken die Andruckelemente bei axialem Verschieben in Richtung auf die distalen Teilabschnitte an diesen in Anlage kommen. Durch diese zwangsläufige Verbindung der Bewegungen entstehen somit zwei zangenartige Instrumente, mittels derer Gewebe sicher ergriffen (und koaguliert) werden kann.The hook elements are preferably relative to that proximal sections that at least spread the hook the pressure elements when moving axially towards the distal sections at these in Plant come. Through this inevitable connection of the Movements result in two pliers-like instruments, by means of which tissues are gripped (and coagulated) safely can.
Bevorzugte Ausführungsformen der Erfindung ergeben sich aus den Unteransprüchen.Preferred embodiments of the invention result from the subclaims.
Nachfolgend wird die Erfindung anhand eines Ausführungsbeispieles näher erläutert, das anhand der beiliegenden Abbildungen beschrieben wird. Hierbei zeigenThe invention is based on a Embodiment explained in more detail using the enclosed pictures is described. Show here
Fig. 1 eine Ausführungsform der Erfindung bei geschlossenem Haken, Fig. 1 shows an embodiment of the invention in a closed hook,
Fig. 2 die Anordnung nach Fig. 1 mit gespreiztem Haken Fig. 3 die Ausführungsform nach den Fig. 1 und 2 mit an die Teilhaken angelegten Andruckeinrichtungen und Fig. 2 shows the arrangement according to Fig. 1 with the hook spread . Fig. 3 shows the embodiment according to Figs. 1 and 2 with the partial hooks and pressure devices
Fig. 4 die Anordnung nach den Fig. 1 bis 3 mit ausgefahrener Schneidvorrichtung zum Durchtrennen von Gewebe. Fig. 4 shows the arrangement of FIGS. 1 to 3 with the cutting device extended for severing tissue.
In der nachfolgenden Beschreibung werden für gleiche und gleichwirkende Teile die selben Bezugsziffern verwendet. In the following description, the same and equivalent parts used the same reference numerals.
Wie in Fig. 1 gezeigt, umfaßt die Ausführunsform des chirurgischen Instruments gemäß der vorliegenden Erfindung einen hohlstabförmigen Abschnitt 40, der zu hier nicht gezeigten Halte- und Betätigungselementen an einem proximalen Abschnitt führt.As shown in FIG. 1, the embodiment of the surgical instrument according to the present invention comprises a hollow rod-shaped section 40 which leads to holding and actuating elements on a proximal section, not shown here.
Aus dem hier in den Abbildungen gezeigten distalen Ende des hohlstabförmigen Abschnittes 30 ragt ein hakenförmiger Abschnitt 10, der eine proximalen Abschnitt 12 und einen von diesem senkrecht nach oben ragenden distalen Abschnitt 11 umfaßt, der ein freies Ende 13 hat. Der hakenförmige Abschnitt 10 besteht aus einem ersten Teilhaken 10' und einem zweiten Teilhaken 10", wobei dies Teilhaken 10', 10" jeweils im wesentlichen gleich geformte distale Teilabschnitte 11', 11" bzw. proximale Teilabschnitte 12', 12" aufweisen. Die distalen Teilabschnitte 11', 11" sind bei der hier gezeigten Ausführungsform als Halb-Kegelstümpfe ausgebildet, wobei die außenliegenden Flächen 14', 14" zur Bildung dieses Kegelstumpfes abgerundet sind. Der so ausgebildete Haken ist (in der in Fig. 1 gezeigten Position) zum stumpfen Präparieren wie ein "normaler" Präparationshaken geeignet.From the distal end of the hollow rod-shaped section 30 shown here in the figures, a hook-shaped section 10 protrudes, which comprises a proximal section 12 and a distal section 11 projecting vertically upwards therefrom, which has a free end 13 . The hook-shaped section 10 consists of a first partial hook 10 'and a second partial hook 10 ", these partial hooks 10 ', 10 " each having essentially identical distal partial sections 11 ', 11 "or proximal partial sections 12 ', 12 ". In the embodiment shown here, the distal sections 11 ', 11 "are designed as half-truncated cones, the outer surfaces 14 ', 14 " being rounded off to form this truncated cone. The hook designed in this way (in the position shown in FIG. 1) is suitable for blunt dissection like a "normal" preparation hook.
Bei der hier gezeigten Ausführunsform ist einer der proximalen Teilabschnitte 12' des ersten Teilhakens 10' fest mit dem hohlstabförmigen Abschnitt. 40 verbunden, während der andere proximale Teilabschnitt 12" des zweiten Teilhakens 10" gegenüber dem ersten proximalen Teilabschnitt 12' bzw. gegenüber dem ersten Teilhaken 10' derart verschwenkbar ist, daß die distalen Teilabschnitte 11', 11" aus der in Fig. 1 gezeigten zusammengelegten Position in eine in den Fig. 2-4 gezeigte gespreizte Position auseinanderbewegt werden können. In the embodiment shown here, one of the proximal partial sections 12 'of the first partial hook 10 ' is fixed to the hollow rod-shaped section. 40 connected, while the other proximal section 12 "of the second partial hook 10 " is pivotable relative to the first proximal partial section 12 'or relative to the first partial hook 10 ' such that the distal partial sections 11 ', 11 "from that shown in FIG. 1 folded position can be moved apart into a spread position shown in Figs. 2-4.
Weiterhin sind bei der hier gezeigten Ausführungsform aus dem hohlstabförmigen Abschnitt 40 hervorragende Andruckeinrichtungen 20', 20" entlang der Achse des hohlstabförmigen Abschnittes 40 verschiebbar angeordnet. Die Andruckeinrichtungen 20', 20" umfassen ein aus dem hohlstabförmigen Abschnitt 40 hervorragendes Halteelement 21', 21" sowie an deren Ende jeweils ein Andruckelement 22', 22". Die Andruckelemente 22', 22" weisen an Ihren, den Teilhaken 10', 10" zugewandten Seiten abgerundete Flächen auf, die derart geformt sind, daß sie bei einem Verschieben der Andruckelemente 20', 20" aus dem hohlstabförmigen Abschnitt 40 heraus in Richtung auf den hakenförmigen Abschnitt 10 in Anlage an die distalen Teilabschnitte 11', 11" gelangen, wie dies insbesondere in den Fig. 3 und 4 gezeigt ist.Furthermore, in the embodiment shown here, from the hollow rod portion 40 superior compression means 20 ', 20 "slidably disposed along the axis of the hollow-rod-shaped section 40th The pressing means 20', 20" include an outstanding from the hollow-rod-shaped section 40 of support member 21 ', 21 " and at the end of each a pressure element 22 ', 22 ". The pressure elements 22 ', 22 "have rounded surfaces on their sides facing the partial hooks 10 ', 10 ", which are shaped in such a way that when the pressure elements 20 ', 20 "are moved out of the hollow rod-shaped section 40 in the direction of the hook-shaped section 10 comes into contact with the distal sections 11 ', 11 ", as is shown in particular in FIGS. 3 and 4.
Zwischen den Teilhaken 10', 10" bzw. deren proximalen Teilabschnitten 12', 12" und den Andruckeinrichtungen 20', 20" ist eine Schneidvorrichtung 30 im hohlstabförmigen Abschnitt 40 längsverschieblich (parallel zu dessen Achse) angeordnet, wie dies insbesondere in den Fig. 3 und 4 gezeigt ist. Das Maß, um welches die Schneidvorrichtung 30 aus dem hohlstabförmigen Abschnitt 40 herausgezogen werden kann, ist derart, daß in jedem Fall die Ebene zwischen den hakenförmigen Abschnitten 10 und den Andruckeinrichtungen 20', 20" "durchbrochen" wird.Between the partial hooks 10 ', 10 "or their proximal partial sections 12 ', 12 " and the pressure devices 20 ', 20 ", a cutting device 30 is arranged in the hollow rod-shaped section 40 so as to be longitudinally displaceable (parallel to its axis), as is shown in particular in FIGS. 3 and 4. The extent to which the cutting device 30 can be pulled out of the hollow rod-shaped section 40 is such that in each case the plane between the hook-shaped sections 10 and the pressing devices 20 ', 20 is "" broken through "".
Aus der obigen Beschreibung in Zusammenhang mit den Fig. I bis 4 wird klar, daß mit der gezeigten Ausführungsform des chirurgischen Instrumentes Gewebe (nach stumpfer Präparation) auf den Haken aufgenommen und durch Auseinanderbewegung der Teilhaken 10', 10" gespreizt werden kann. Danach kann man den aufgenommenen Gewebeabschnitt durch Herausfahren der Andruckeinrichtung 20', 20" festklemmen (Fig. 3). Durch Herausfahren der Schneidvorrichtung 30 kann dann das aufgenommene und festgehaltene Gewebestück leicht durchtrennt werden.From the above description in connection with FIGS. I to 4 it becomes clear that with the embodiment of the surgical instrument shown tissue (after blunt preparation) tissue can be picked up on the hook and spread apart by moving the partial hooks 10 ', 10 " the clamped tissue section is clamped by moving the pressure device 20 ', 20 "out ( FIG. 3). By moving the cutting device 30 out, the piece of tissue that is picked up and held in place can then be easily severed.
Vorzugsweise sind nun an den distalen Teilabschnitten 11', 11" und den Andruckelementen 22', 22" ebenso wie an dem distalen Ende (an der Schneide) der Schneidvorrichtung 30 Elektroden vorgesehen, die mit hier nicht gezeigten Hochfrequenzgeneratoreinrichtungen verbunden sind. Wenn also der oben beschriebene Vorgang durchgeführt wurde und ein Gewebeabschnitt oder ein Gefäß auf den Haken aufgenommen und in der in Fig. 3 gezeigten Position des chirurgischen Instrumentes zwischen den Andruckelementen 22', 22" und den dazu gehörigen distalen Teilabschnitten 11', 11" der Teilhaken 10', 10" festgeklemmt ist, werden die Generatoren derart angesteuert, daß jeweils zwischen einem Andruckelement 21' bzw. 22' und der dazu gehörigen Gegenelektrode am distalen Teilabschnitt 11', 11" ein Koagulationsstrom fließt, der das Gewebe an dieser Stelle koaguliert. Es handelt sich hier also um zwei bipolare Koagulationseinrichtungen, die elektrisch derart geschaltet sind, daß das Gewebe, welches zwischen den Teilhaken 10' und 10" aufgespannt ist, nicht von Strom durchflossen wird. Bei einer anderen Ausführungsform der Erfindung wird hier jedoch ein gezielter Stromfluß eingestellt, der ebenfalls eine Koagulation dieses Gewebeabschnittes bewirkt.Preferably, electrodes are now provided on the distal sections 11 ', 11 "and the pressure elements 22 ', 22 " as well as on the distal end (on the cutting edge) of the cutting device 30 , which electrodes are connected to high-frequency generator devices (not shown here). Thus, when the above-described process has been carried out and a tissue section or a vessel is picked up on the hook and in the position of the surgical instrument shown in FIG. 3 between the pressure elements 22 ', 22 "and the associated distal sections 11 ', 11 " of the Partial hook 10 ', 10 "is clamped, the generators are controlled such that a coagulation current flows between a pressure element 21 ' or 22 'and the associated counter electrode at the distal portion 11 ', 11 ", which coagulates the tissue at this point . These are therefore two bipolar coagulation devices which are electrically connected in such a way that the tissue which is stretched between the partial hooks 10 'and 10 "is not flowed through by electricity. In another embodiment of the invention, however, a specific flow of current is used here set, which also causes a coagulation of this tissue section.
In obigen Ausführungen war von Elektrodeneinrichtunge die Rede. Es sei hier aber ausdrücklich betont, daß in vorteilhafter Weise die hakenförmigen Abschnitte 10 und die Andruckeinrichtung 20', 20" aus elektrisch leitendem Material, insbesondere aus Metall gefertigt sein können, die jedoch derart an ihren Außenflächen isoliert sind, daß ein Stromfluß ins Gewebe lediglich an den Kontaktstellen zwischen den Andruckelementen 22', 22" und den distalen Teilabschnitten 11', 11" stattfinden kann. Weiterhin sei darauf hingewiesen, daß die gezeigten Teile, insbesondere der hakenförmige Abschnitt 10 mit einer anti-klebe Schicht beschichtet sind, was das Präparieren erleichtert.In the above, electrode devices were mentioned. However, it should be expressly emphasized here that the hook-shaped sections 10 and the pressure device 20 ′, 20 ″ can advantageously be made of electrically conductive material, in particular of metal, but which are insulated on their outer surfaces in such a way that only a current flow into the tissue at the contact points between the pressure elements 22 ', 22 "and the distal sections 11 ', 11 ". Furthermore, it should be pointed out that the parts shown, in particular the hook-shaped section 10, are coated with an anti-adhesive layer, which means that the preparation facilitated.
Die Schneidvorrichtung 30 ist ebenfalls vorzugsweise als HF chirurgisches Instrument ausgebildet, weist also eine als Elektrode ausgebildete Schneide auf, die mit einem (hier nicht gezeigten) HF-Generator verbunden ist. Der andere Pol des HF-Generators ist mit mindestens einem der anderen Instrumentteile, nämlich einem der distalen Teilabschnitte 11', 11" oder einem Andruckelement 22', 22" verbunden, so daß ein HF-Schneidestrom zwischen der Schneide der Schneidvorrichtung 30 und diesem anderen Pol fließen kann. Durch geeignete Schaltungsmaßnahmen ist es möglich, die genannten Teile 11, 11', 22, 22' während des Schneidvorgangs parallel zu schalten.The cutting device 30 is also preferably designed as an HF surgical instrument, that is to say has a cutting edge designed as an electrode, which is connected to an HF generator (not shown here). The other pole of the HF generator is connected to at least one of the other instrument parts, namely one of the distal sections 11 ', 11 "or a pressure element 22 ', 22 ", so that an HF cutting current between the cutting edge of the cutting device 30 and this other Pole can flow. Suitable circuit measures make it possible to connect the parts 11 , 11 ', 22 , 22 ' mentioned in parallel during the cutting process.
Weiterhin ist es möglich, die distalen Teilabschnitte 11', 11" bzw. die daran befindlichen Elektrodeneinrichtungen derart zu gestalten, daß sie als (bipolares) Koagulationsinstrument verwendbar sind. In diesem Fall können auch (gegebenenfalls zusätzliche) Elektroden an den dem hohlstabförmigen Abschnitt 40 abgewandten Seiten der distalen Teilabschnitte 11', 11" vorgesehen sein, um eine insbesondere flächige Koagulation vornehmen zu können.Furthermore, it is possible to design the distal sections 11 ′, 11 ″ or the electrode devices located thereon in such a way that they can be used as a (bipolar) coagulation instrument. In this case, (optionally additional) electrodes can also be attached to the section 40 facing away from the hollow rod Sides of the distal sections 11 ', 11 "may be provided in order to be able to carry out coagulation, in particular over a large area.
Die (hier nicht gezeigten) Betätigungseinrichtungen für den (beweglichen) Teilhaken 10" bzw. die Andruckeinrichtungen 20', 20" sind vorzugsweise derart ausgebildet, daß definierte Andruckkräfte aufgebracht werden können. Derartige Andruckkräfte können auch bei einer Bewegung der Teilhacken 10', 10" aus der in Fig. 2 gezeigten Position zurück in die in Fig. 1 gezeigte Position zwischen den distalen Teilabschnitten 11', 11" wirken, so daß die Teilhaken 10', 10" nicht nur zum Spreizen sondern auch zum Zangenförmigen festhalten von Gewebe dienen können. Um Gewebe, welches zwischen den distalen Teilabschnitten 11', 11" gehalten ist, koagulieren zu können, können die einander zugewandten Flächen der distalen Teilabschnitte 11', 11" wiederum als Elektroden ausgebildet sein bzw. solche mitumfassen, so daß dann eine bipolare Koagulation von Gewebe möglich wird, welches zwischen den Teilhaken 10', 10" eingeklemmt wird.The actuating devices (not shown here) for the (movable) partial hook 10 "or the pressing devices 20 ', 20 " are preferably designed in such a way that defined pressing forces can be applied. Such pressing forces can also act when the partial hooks 10 ', 10 "move from the position shown in FIG. 2 back to the position shown in FIG. 1 between the distal partial sections 11 ', 11 ", so that the partial hooks 10 ', 10 "not only for spreading but also for holding forceps-like tissue. In order to be able to coagulate tissue which is held between the distal sections 11 ', 11 ", the mutually facing surfaces of the distal sections 11 ', 11 "can in turn be used as Electrodes are formed or include them, so that bipolar coagulation of tissue is then possible, which is clamped between the partial hooks 10 ', 10 ".
Der hohlstabförmige Abschnitt 40, der zur Aufnahmen und. (beweglichen) Führung des hakenförmigen Abschnittes 10, der Andruckeinrichtung 20', 20" und der Schneidvorrichtung 30 dient, kann zusätzlich zum Zuführen einer Spülflüssigkeit oder auch zum Absaugen von Spül- bzw. Körperflüssigkeit dienen.The hollow rod-shaped section 40 , which is used for recording and. (Movable) guidance of the hook-shaped section 10 , the pressure device 20 ', 20 "and the cutting device 30 is used, in addition, can be used to supply a rinsing fluid or also to suction rinsing or body fluid.
1010th
Hakenförmiger Abschnitt
Hook-shaped section
1010th
', ',
1010th
" Teilhaken
"Partial hook
1111
distaler Abschnitt
distal section
1111
', ',
1111
" distale Teilabschnitte
"distal sections
1212th
proximaler Abschnitt
proximal section
1212th
', ',
1212th
" proximale Teilabschnitte
"proximal sections
1313
freies Ende
free end
1414
', ',
1414
" abgerundete Flächen
"rounded surfaces
2020th
', ',
2020th
" Andruckeinrichtung
"Pressure device
2121
', ',
2121
" Halteelement
"Holding element
2222
', ',
2222
" Andruckelement
"Pressure element
3030th
Schneidvorrichtung
Cutting device
4040
hohlstabförmiger Abschnitt
hollow rod-shaped section
Claims (16)
Priority Applications (2)
Application Number | Priority Date | Filing Date | Title |
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DE1999115061 DE19915061A1 (en) | 1999-04-01 | 1999-04-01 | Surgical instrument |
PCT/EP2000/002908 WO2000059392A1 (en) | 1999-04-01 | 2000-03-31 | Surgical instrument |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
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DE1999115061 DE19915061A1 (en) | 1999-04-01 | 1999-04-01 | Surgical instrument |
Publications (1)
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DE19915061A1 true DE19915061A1 (en) | 2000-10-26 |
Family
ID=7903375
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DE1999115061 Withdrawn DE19915061A1 (en) | 1999-04-01 | 1999-04-01 | Surgical instrument |
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DE (1) | DE19915061A1 (en) |
WO (1) | WO2000059392A1 (en) |
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