WO1993005826A1

WO1993005826A1 - Surgical instrument

Info

Publication number: WO1993005826A1
Application number: PCT/EP1992/002152
Authority: WO
Inventors: Harald Heidmüller
Original assignee: Heidmueller Harald
Priority date: 1991-09-21
Filing date: 1992-09-18
Publication date: 1993-04-01
Also published as: DE4131495C1

Abstract

The surgical instrument (1) had a handgrip (2), a coaxial protective tube (4) in which there are suction and/or flushing channels having pipe connectors in the rear region and front apertures, and blocking means for the channels. It is essential, according to the invention, that the suction and/or flushing channels take the form of tubes (22, 23) arranged mutually parallel and can be pushed individually axially out of the protective tube (4) and that the blocking means (10) are contained in a controlling section (3) which is fitted at a point between the movable tubes (22, 23) and rear extensions of the suction and/or flushing channels and has an adjusting lever (13). This provides an instrument distinguished by high suction and/or flushing effects which is simple to handle.

Description

Surgical instrument

The invention relates to an instrument with a handle piece and a coaxial protective tube after the Oberbe handle of claim 1.

Such instruments are used in laparoscopic, gynecological and arthroscopic surgery. After insertion of the surgical instrument, it is for laparoscopic surgery, e.g. in the case of de-gallbladder removal, it is particularly important that secreted or released body fluid, in particular blood, is aspirated and, if necessary, the operating area can be rinsed and the rinsing fluid can be aspirated with the body fluid.

In a surgical instrument of the type mentioned known from US Pat. No. 4,950,278, the protective tube contains an inner annular channel and an outer annular channel, which concentrically surround one another and open out at the blunt front end of the protective tube. From the rear end of the two channels serving as suction or rinsing channels, radially outwardly directed line connections originate, each of which is provided with a shut-off element which carries its own actuating element. One annular channel is provided with a channel extension through which an instrument with a working part can be advanced over the level of the mouths of the channels. This Mündungs¬ level of the rinsing and suction channels is reset in relation to the working part of the instrument, so that a flushing or suction of the work area can only be achieved with increased fluid or suction pressures, which cannot be used in every operation. At lower pressures, the cleaning effect of the suction or rinsing forces, which are circular at a greater distance from the working area, is not satisfactory.

In the case of a surgical instrument according to DE 39 41 108 Cl, a concentric inner tube is immovably provided in a protective tube, by means of which tubular optics and probes can be displaced, which, depending on requirements, can be inserted into and out of the inner tube through the rear end be completely pulled out. The individual parts of the instrument set make this surgical instrument unwieldy. Simultaneous suction / rinsing and surgical treatment of a body cavity area are not possible.

DE 23 64 692 B2 describes a surgical instrument with a tube which can be axially advanced in an outer body. The outer body is a suction cup and the tube which can be pushed forward is designed as a puncture tube which is ground on the tip and through which a drainage hose runs. This instrument is intended for aspirating the liquid content of cyst-like tumors; the instrument is not suitable for flushing the work area during surgical interventions.

Coaxial tubes movable relative to each other are shown in a surgical suction device WO 81/03125 AI. An inner tube which is firmly connected to a handle and is connected to a line is provided at its tip with wall holes of different sizes. By pushing the closed jacket of an axially movable outer tube forward more or less res, the passage cross section of the wall holes of the inner tube can be regulated by release or covering and thus control the suction power of the device. When used as a rinsing device, this adjustability would have no discernible advantage, especially since fluid jets spraying radially from the inner tube could not specifically reach a working area lying in the axial direction of the tube. The only passageway limits the application to only one media flow direction.

The object of the invention is to provide an instru ment of the type mentioned, which is characterized by high suction and / or rinsing effectiveness and is easy to handle.

This object is achieved by the features of patent claim 1.

Due to the suction and / or rinsing tubes which can be pushed independently of one another via the front opening of the protective tube, the suction and / or the rinsing can be applied directly to the operation site without moving the protective tube, as a result of which both processes proceed effectively. A flushing liquid can, for example, be flushed into the operating area with pressure and then suctioned off, the pipes with connected flexible pressure or suction lines being connected in a simple manner via the shut-off elements of the operating part in a centrally controlled manner or being blocked against them. One of the tubes can be used to insert an instrument for surgery into a body cavity from the rear and the other tube can be pushed forward from the protective tube into the operating area in order to specifically perform its suction or irrigation function, depending on the line connected. Advantageous embodiments of the invention are characterized in the subordinate claims. Two suction and rinsing tubes, which can be pushed independently of one another, are inserted into the protective tube and can be connected centrally or simultaneously to connecting lines or blocked against them via the shut-off elements in the operating part. At least one of the channels is straight throughout so that an additional instrument can be inserted. This makes it possible for the surgeon to perform an operation with the instrument through one of the channels, while at the same time the operation area can be flushed or suctioned through the other tube pushed forward. The front opening of the flushing tube is preferably configured in the form of a nozzle in order to flush the flushing liquid with pressure into the operating area. The axially movable suction and rinsing tubes have the essential advantage that the instrument can be firmly positioned and the suction and / or rinsing tube can subsequently be moved forward for suction or rinsing.

As actuating elements for the displacement of the suction and / or rinsing tubes, semicircular sliding buttons arranged laterally on the protective tube or handle and guided in longitudinal slots can be used, which can be slid on the outside on the protective tube or the handle. Each slide button sits on a pin that is connected to the tubes and protrudes through the longitudinal slot. In addition, locking means can be provided to fix the axial positions of the individual tubes.

The surgical instruct can be used to lift or push away individual organs, such as the liver, and thus to enlarge the operating area. ment can be equipped with at least one further axially insertable instrument insert, which is designed similarly to the instrument according to DE 37 09 706 C2 and is mounted in a protective tube axially parallel. It can be moved by means of an actuating element protruding from the protective tube or the handle. The actuating element can correspond to the actuating elements of the individually sliding tubes. This instrument insert is defined in claims 9 to 13. E emerges to the front from the end face or lateral surface of the protective tube and consists of several biegsa men wires, which emerge like a fan from the individual outlet openings in the protective tube. To avoid injuries to the internal organs, the wires at the front end each have a thickening. The instrument and the fan-like emergent wires need to be positioned only once because the suction and the rinsing tube are axially displaceable, so that no displacement of the entire instrument has to take place.

For better cleaning of the instrument it is provided that the handle and the protective tube are preferably releasably attached to the central operating part via radial stud screws, threaded pieces or a bayonet lock.

The invention is explained in more detail using an exemplary embodiment shown in FIGS. 1 to 5. It shows:

1 shows a longitudinal section through the surgical instrument with suction rinsing,

2 is a plan view of the instrument,

3 shows a cross section along the line III-III in FIG. 1,

Fig. 4 shows a cross section along the line IV-IV in Figure 1 and

5A-5D the different possibilities of adjusting the shut-off elements of the upper and lower suction and / or rinsing channels.

A surgical instrument 1 is shown in FIGS. 1 to 3, which can be used for operations, for example on the liver, and enables flushing and suctioning of the operating area. The surgical instrument 1 consists of a circular cylindrical handle 2, which is connected to a preferably rectangular operating part 3 and a circular cylindrical protective tube 4, which is fastened diametrically opposite to the handle 2 on the operating part 3. The handle 2 is screwed into a connection socket 14 with an internal thread of the operating part 3 and fixed by means of suitable fuses, such as a radial stud screw. A bayonet lock can also be selected as a screw connection. The protective tube 4 is also screwed into a connecting socket 19 of the operating part 3 and, like the handle piece 2, is attached.

In the handle 2, two axially parallel pipe end pieces 15, 16 are inserted, the front openings of which are sealingly connected to bores 5 _r 6 of the operating part 3 and the rear ends of which are connected via a rear one Step forward on the end face 17 of the handle piece 2, the lower pipe end piece 16 running straight and the upper pipe end piece 15 running upwards in a quarter curve. At the outer ends of the pipe end pieces 15, a flange 15a, 16a for connection v, not shown, flexible lines are provided which are connected to a fluid source or a suction source.

In the protective tube 4 two achspa parallel parallel cylindrical channels are formed, in each di a shorter piece of pipe 20, 21 is inserted so that the rear openings are sealingly connected to coaxial bores 5, 6 of the control panel 3, di aligned with the pipe end pieces 15, 16 . The outer diameter of the pipe sections 20, 21 is smaller than the inner diameter of the channels in the protective tube 4 to form an annular gap. A coaxially arranged pipe 22, 23 is pushed over each pipe section 20, 2 and lies sealingly on the respective pipe section 20, 21 and is displaceable on this in the axial direction of the surgical's instrument 1 so that it can practice a front end face 24 of the protective tube 4. The lower tube 23 according to FIG. 1 has a constant inner and outer diameter over the entire length, while the upper tube 22 tapers conically at the front, so that a nozzle 18 is formed. The upper tube 22 can be used, for example, as a flushing tube and the lower tube 23 serve as a suction pipe. Furthermore, can be inserted through the lower straight tube 23 ei instrument, such as a biopsy instrument, into a body cavity when the connected line is disconnected and the bore 5 of the operating parts 3 is open. A radial pin 28 or 29 is connected to each tube 22, 23 and carries a semicircular sliding button 25 or 26 on the outside. The pins 28, 29 are guided in the longitudinal slots 30 of the protective tube 4 and the sliding buttons 25, 26 slide along its outer surface when the tubes 22, 23 are axially displaced. The sliding buttons 25, 26 are designed such that they can be locked via locking means, so that the tubes 22, 23 can be locked in the desired feed positions.

In the alignment of the channels, the control part 3 has two bores 5, 6 running in the axial direction of the surgical instrument 1, each with a circular extension and a through bore 9 arranged perpendicular to the parallel extensions with respect to one another Bearing an axis 12 is used. In each of the extensions, a shut-off element 7, 8 is fitted, but rotatably, which is coupled to the axis 12 and can be moved by means of a lever 13 connected to it. The shut-off element 7 has on its underside a polygon 40 which engages in a fit 41 on the top of the shut-off element 8. This releasable connection between the two shut-off elements 7 and 8 enables the shut-off elements in the operating part 3 to be mounted more easily. Each shut-off element 7, 8 is in the form of a parallel, flat disk which has intersecting bores 10, 11 (shut-off element 7), 110 , 111 (shut-off device 8). The bores 10, 11 run at right angles to one another, while the bores 110, 111 are oriented in an X-shape. FIGS. 5A-5D show the four positions of the shut-off elements 7, 8, which can result when the adjusting lever 13 rotates. In position I (FIG. 2) of the adjusting lever 13, the shut-off elements 7 and 8 of the operating part 3 have the positions shown in FIG. 5A, in which the upper one Channel 22, 6, 15 and the lower channel 23, 5, 16 are open.

In position II of the adjusting lever 13, the shut-off elements 7 and 8 are in the positions shown in FIG. 5B, in which the upper channel 22, 6, 15 and the channel 23, 5, 16 are closed.

In position III of the adjusting lever 13, the positions of the shut-off elements 7 and 8 illustrated in FIG. 5C result, in which the upper channel 22, 6, 1 is open and the lower channel 23, 5, 16 is closed.

In position IV of the adjusting lever 13, the shut-off elements are oriented as shown in FIG. 5D and the upper channel 22, 6, 15 is closed, while the lower channel 23, 5, 16 is open.

Axial parallels to the tubes 22, 23 are arranged in the protective tube 4 as an additional auxiliary element egg axially movable instrument insert 32. According to Figure 1 e is above the upper tube 22 in an elongated recess 33 from the protective tube 4 out. The instrument insert 32 consists of a lamella 38, which carries a front end a plurality of wires 34, which can emerge in a fan-like manner, spread out in a fan-like manner, through five circumferentially distributed outlet openings 37 in the protective tube wall at the front end of the protective tube 4. A vertically projecting pin 36 is connected to the rear end of the lamella 38 and protrudes through a longitudinal slot 27 of the protective tube 4 and has an outer slide button 35 which serves as an actuating element for the instrument insert 32. To avoid injuries, the wires 34 have thickenings 39 at their front ends. In the pushed-forward position of the sliding button 35, the Wires 34 pushed the most out of the protective tube 4, while in the rear position of the push button 35 are completely pulled into the protective tube 4, so that the thickenings 39 are sunk into the protective tube circumference. To fix a certain position, locking means similar to the tubes 22, 23 can be used.

Claims

PATENT CLAIMS

1. Surgical instrument (1) with a handle (2), a coaxial protective tube (4) in which suction and or rinsing channels are provided, which are provided in the rear area with line connections and have front openings and openings and shut-off devices for the Channels, characterized in that the suction and / or rinsing channels are formed as tubes (22, 23), which are arranged parallel next to one another and can be axially pushed forward individually from the protective tube (4), and that the shut-off elements (10) are in a control unit ( 3 are summarized, which is arranged at a point between the advancing tubes (22, 23) and rear continuations of the suction and / or rinsing channels and has an adjusting lever (13).

2. Instrument according to claim 1, d a d u r c h g e k e n n z e i c h n e t that the protective tube (4) and the handle (2) are diametrically opposed to each other in connection sockets (14,19 of the control panel (3) attached.

3. Instrument according to claim 2, d a d u r c h g e k e n n z e i c h n e t that a radial pin screw, a threaded piece or a bayonet fitting is provided for fastening the handle piece (2) and the protective tube (4) to the operating part (3).

4. Instrument according to one of claims 1 to 3, characterized in that two tubes (22,23) in the protective tube (4) are provided. that actuating elements (25, 26, 28, 29) are laterally arranged a protective tube (4) or handle (2) and i longitudinal slots (27) and that each actuating element has a semicircular push button on the outside of the protective tube (4) or Handle (2) is slidable.

5. Instrument according to claim 4, so that the actuating elements (25, 26, 28, 29) can be locked in relation to the protective tube (4) or the handle (2).

6. Instrument according to one of claims 1 to 5, characterized in that the rear extensions of the suction and / or irrigation channels extend axially through the handle (2) and that from the rear end of the handle (2) the suction and / or pipe end pieces (15, 16) assigned to rinsing channels, which have the line connections (18) for flexible connecting lines and at least one of which is straight.

7. Instrument according to one of claims 1 to 6, so that the front opening of the flushing tube (22) is formed in a nozzle shape and that the suction tube (23) has the same overall inner diameter.

8. Instrument according to one of claims 1 to 7, characterized in that the shut-off elements (7, 8) of the suction and / or rinsing channels are coupled to one another and to the adjusting lever (13) in such a way that they jointly have a blocking position or can assume a flow position for both channels or a flow position for one or the other channel.

9. Instrument according to one of claims 1 to 8, characterized in that in the protective tube (4) at least one further axially in front of pushable instrument insert (32) is accommodated by means of a protruding from the protective tube (4) or de handle (2) actuating elements ( 35,36) is displaceable.

10. Instrument according to claim 9, d a d u r c h g e k e n n z e i c h n e t that the instrument insert (32) can be pushed out like a fan to the front from the protective tube (4) and consists of several flexible wires (34).

11. Instrument according to claim 10, characterized in that the wires (34) together in a recess (33) of a lateral surface (38) of the protective tube (4) or de handle (2) are guided and that the actuating element through a longitudinal slot (27 ) in the protective tube (4) or handle (2) has a radially projecting pin (36), which is connected on the inside to the instrument insert (32) and on the outside with a slide button (35).

12. Instrument according to claim 10 or 11, so that the wires (34) guided in the protective tube (4) emerge from individual outlet openings (37) in the wall of the protective tube (4).

13. Instrument according to one of claims 10 to 12, characterized in that the wires (34) each have a protective cap or thickened portion (39) at the front end.