DE102009037045A1 - Tubular shaft for surgical instrument, particularly morcellator, shaver or reamer, has rigid section and longitudinally extended tubular element, which has opposite longitudinally movable sections - Google Patents

Abstract

The tubular shaft (1) has a rigid section and a longitudinally extended tubular element, which has opposite longitudinally movable sections. The longitudinally movable sections are fixed at the distal ends of the tubular element in a longitudinal axial manner. The shaft has a rotating tool at its distal ends.

Description

The invention relates to a tubular shaft of a surgical instrument with bendable areas. Such constructions are known from flexible endoscopes and also from endoscopic or laparoscopic instruments. As an example of a bendable endoscope shaft is the EP 1 681 013 A1 cited.

The bendable areas of such bendable Endoskopschäfte are about complicated control equipment steerable and require a tremendous technical Effort.

For simpler shanks of surgical instruments such. B. For laparoscopic forceps such constructions are due the high design effort and the complicated operation not suitable.

It however, it is increasingly common with sheaths of surgical instruments the need for shafts that are simple and inexpensive Way are partially bendable to z. B. the distal end portions individually to be able to adapt to the current work situation, or to work through with multiple laparoscopic instruments a single port to mitigate the collision problems. It exists also a need for surgical stems Instruments, these with rotatable tools, in particular cutting tools and milling tools to equip.

The Object of the present invention is therefore a shaft to create a surgical instrument that is simpler Operation and low cost is controlled in certain areas, taking the surgical instrument in a safe and flexible way suitable for making cuts or sampling should be.

These The object is achieved with the features of claim 1.

According to the invention a tubular shaft of a surgical instrument provided with an at least substantially rigid portion, at the distal end of which a bendable area adjoins, wherein the shaft is an elongate tubular Element having the longitudinally displaceable against each other Has sections, wherein the longitudinally displaceable sections longitudinally axial at the distal end of the tubular member are fixed, which is further developed by the fact that the shaft has a rotating tool at its distal end.

With This training makes it possible for the first time, a tubular Shaft with bendable distal tip and rotating tool for Whereas in the prior art known corresponding surgical instruments, for example Morcellators, shavers or reamers the shaft was always rigid. Known shafts with controllable by cable bendable distal end areas do not have the necessary flexural rigidity and fixability on, to work safely with a rotating To ensure tool.

In an embodiment of the invention has the Shaft has two bendable areas that extend beyond the perimeter distributed arranged rods are passed longitudinally. bends One of the two bendable areas, so one or more these rods shortened in this area and others in this area Extended range. The rods are circumferentially and only mounted longitudinally displaceable on the shaft, so can do not dodge. You must be of the bend-operated Range extending through shortening or lengthening the range of bending movements resulting from longitudinal displacement transferred to the other bendable area. Because the rods attached to the ends of axially parallel tailpipes are and thus their length between the tailpipes rigid is predetermined and not corrected by lateral evasion can not be left to the poles, than to shorten in the second bendable area so or to extend that the second bendable area in a forced movement in a different direction than the bending-actuated Area is bent.

It thus results in a shaft with two bendable areas and one intermediate rigid section. You can do this shaft on hold rigid section and at one of the bendable areas in bend in any direction. It then bends forcibly other area in reverse bending direction. Here then stand the Ends the two bendable areas always parallel, so that through Actuating the bending actuated area the second bendable area very easy and clearly controllable is. The technical effort to do so is extremely low. The shaft may be formed as a hollow tube in which z. B. surgical work channels, image guides, light guides, Pull cable, electric cables and the like can be laid. At one end of the shank according to the invention can, for example a handle and be arranged at the other end of a forceps jaw.

The construction of the invention is already functional with only three or four rods and can be very simple in this way. However, the rods must be stored multiple times and very precisely over their length in order to avoid lateral avoidance. Only then does the description described be sufficiently precise Zwangsverbiegung.

The preferred construction, in which the stem of three concentric and tightly slidable into one another with intermeshing tubes consists, with the inner tube and the outer Pipe in the rigid section rigid and in the bendable areas without significant change in the circumferential length bendable are formed and wherein the middle tube at its ends the End pipes forms and in the area between these with narrow longitudinal slots in slidably adjoining rods is divided, can thereby be advantageous and in particular because of their lower technical Expenditure. In this construction, three tubes are inserted into each other, the z. B. are formed as thin metal tubes. The pipes are sliding closely together, so that the middle tube through the inner and the outer tube against evasive movements protected inside or outside. The middle one Pipe forms the rods, preferably in large Number in the perimeter closely juxtaposed so that they are mutually exclusive support and prevent evasion in the circumferential direction.

Preferably the shaft has an outer tube, which is the tubular Sliding inside of the element with close play. Further Preferably, the shaft has an inner tube inside slidably disposed in the tubular element with close play is. These two variants taken together give the aforementioned preferred construction.

Preferably are longitudinally displaceable sections in longitudinal axial Direction tensile and pressure resistant. Thus they form the previously described Rods, even if the longitudinally displaceable sections are not necessarily are cylindrical but any other shape can have.

The middle pipe is, for example, as a metal pipe with longitudinal slots educated. Preferably, the inner tube and / or the outer Tube formed as metal tubes, which at the bendable areas with longitudinally arranged one behind the other wide Transverse slots are provided, alternately in the circumferential direction are offset.

Preferably the inner tube projects into the bendable section or passes through this. This allows the inner tube in a bendable section a develop a stabilizing effect. For this purpose, the inner tube is preferably formed bendable in the bendable region, in particular by means of bendable, but torsion-resistant structures.

Such Torsion strip structures can, for example, in the circumferential direction be sections formed incisions, for example, a diamond pattern, whereby the inner tube is bendable, but against a twist over the bendable area is stabilized.

Around the lumen inside the inner tube in the bendable region of the inner tube To protect, the inner tube has at least in the bendable Area a flexible and continuous interior coating on. This may be, for example, a shaft tube.

A similar Coating may also be on the outside of the shaft at least in the bendable area.

For the drive of the rotating tool is preferably provided that the rotating tool by a central rotating shaft, which in the Inside the shaft is arranged, is driven. At the central Rotary shaft can be a conventional rotary shaft or around a hollow shaft. This is in a particularly preferred Embodiment designed the inner tube as a rotary shaft. In that case, that the inner tube is designed as a rotary shaft, there is an advantageous Development in that the inner tube at the distal end as a rotating tool is trained. The rotating tool is in particular a circular Blade like a morcellator. The blade and the hollow shaft trained inner tube thus form a channel through which a gripping tool can be guided to the cut tissue by the Hollow channel of the shaft to remove. The blade can also be wavy or toothed.

In an advantageous development is the inner tube opposite the shaft so far axially movable that the rotating tool on distal end is fully retractable into the shaft and partially or completely pushed out of the shaft is. Thus, the rotating tool is retracted, for example Condition safely in an operating position in a to-be-operated Body insertable without healthy tissue parts too violate and only at the place of removal or processing Tissue can be brought into a working position.

A Alternative to this or an addition to this is advantageously in that the shaft has a protective cover in its distal end for the rotating tool, wherein the protective cover in particular axially movable so that in different positions the protective cover the tool completely or partially sunk or exposed.

The rotating tool is advantageously a morcellator, a shaver or a reamer.

The object underlying the invention is also achieved by the use of a Shaft according to the invention described above in a surgical instrument, in particular a morcellator, a shaver or a reamer, as well as by a surgical instrument, in particular morcellator, shaver or reamer, with a shaft according to the invention described above.

The Invention will hereinafter be understood without limitation of the general Erfindungsgedankenens with reference to embodiments below Referring to the drawings, wherein respect all not explained in detail in the text invention Details specifically referred to the drawings becomes. Show it:

1 a schematic side view of a shaft according to the invention in a first embodiment,

2 a highly schematic enlarged section along line 2-2 in 1 transverse to the axis of the shaft,

3 a view according to 1 by an embodiment variant of the first embodiment with a different bending characteristic,

4 a highly schematic section across the axis of a shaft of a second embodiment,

5 an enlarged real representation of the section V from 4 .

6 a side view of the outer tube of the construction of 4 .

7 a side view of the middle tube of the construction of 4 .

8th a side view of the inner tube of the construction of 4 .

9a a schematic three-dimensional representation of an elongate tubular element,

9b a schematic three-dimensional representation of the elongated tubular element 9a in which the bendable sections or bendable sections are bent accordingly,

10 a schematic representation of a morcellator according to the invention,

11 a schematic cross-sectional view through a Morcellator invention and

12 a schematic detail view of a shaver according to the invention.

1 shows a first embodiment of a tubular shaft according to the invention 1 , The shaft is in 2 shown in section and shows in the highly schematic representations of 1 and 2 a pipe 2 in a rigid section 3 is rigid and in subsequent thereto at the ends of bendable areas 4 and 5 is formed bendable. To the bendable areas 4 and 5 In turn, additional areas can be applied at the ends, such as rigid end regions in the example shown 6 and 6 ' ,

As 2 shows, the shaft is 1 of four bars 7 . 8th . 9 and 10 run through. Of these are in 1 only two, namely the rods 7 and 9 , shown in dashed lines. As 2 shows are the rods 7 - 10 in guides 11 stored on the pipe 2 are attached. The bars 7 - 10 are thus secured in the guides against lateral deflections, but can move longitudinally in the guides.

As 1 shows, the rods are lost 7 and 9 thus by the bends in the bendable areas 4 . 5 always parallel to the wall of the pipe 2 , At the ends are the rods 7 - 10 at tailpipes 12 . 12 ' attached in 1 also shown in dashed lines. The tailpipes 12 . 12 ' are axially parallel in the shaft 1 guided in the embodiment in the rigid end regions 6 and 6 ' ,

In 1 are from the four bars 7 - 10 For the sake of clarity, only the two rods 7 and 9 shown. The construction of the 1 and 2 can also z. B. have only three distributed over the circumference arranged rods, or more than four.

Because the rods 7 - 10 in the guides 11 secured against lateral evasion and since they are at the ends of the tailpipes 12 . 12 ' are fixed and thus their ends always on a plane transverse to the axis of the shaft 1 are held, there is a forced movement, which will be explained below.

Is according to 1 the bendable area 4 in the direction of the arrow 13 bent, so shortens in this area 4 the pole 9 while the pole 7 must extend. Since the rods are longitudinally displaceable in the guides 11 are stored, the rods move accordingly in the rigid area 1 , At the other two rods 8th . 10 , in the case of bending according to 1 no shift.

Because the length of the rods 7 . 9 between tailpipes 12 is constant and lateral deflection is nowhere possible except at the second bendable area 5 , this one must be in 1 represented sense in the direction of the arrow 14 bend, in which case within the bendable range 5 the bars 9 extended and the rod 7 is shortened.

If the bending of the one bendable area 4 in another direction, z. B. perpendicular to the plane of the drawing, so the bendable area bends 5 in a corresponding manner perpendicular to the plane of the drawing.

3 shows a variant in illustration according to 1 , As far as possible, the same reference numbers are used. On average according to 2 agrees the construction of 3 with the 1 match.

Different in the construction of the 3 it's just that the rods 7 . 9 in the rigid section 3 of the shaft 1 run crosswise. This is achieved simply by being in this area, ie in the rigid section 3 , the circumference of the pipe 2 Follow on a helix, by appropriate arrangement and training of the guides 11 is predetermined.

It turns out that when bending the bendable area 4 the construction of the 3 in the direction of the arrow 13 in the same sense as in the presentation of the 1 , the second bendable area 5 is again forcibly bent, but in the opposite sense as in the construction of the 5 ,

So it is possible, according to the design variants of 1 and 3 shafts 1 in such a way that when the one section is bent in one direction, the other section is forcibly bent in either one direction or the other.

In the construction of the 3 are the rods 7 . 9 in the rigid section 3 circumferentially offset by 180 ° between the ends of this section. Would here the screw twisting of the rods 7 - 10 not over 180 °, but only over z. B. 90 °, as would result in the movement of the area 4 of the 3 in the manner shown a movement of the other bendable area 5 upwards out of the drawing plane.

The 4 - 8th show a fundamentally different second embodiment of the shaft 1 , again as far as possible, the previous reference numerals are used. The shaft 1 is formed tubular from three tightly inserted tubes, namely an outer tube 15 , a middle tube 16 and an inner tube 17 ,

4 shows the interlocking arrangement of these three tubes in section perpendicular to the tube axis. A section V of the section of the 4 is in 5 magnified and shown in real terms, however, to simplify the drawing without showing the curvature of the pipe. The pipes are in side view in the 6 - 8th shown.

The pipes 15 . 16 and 17 exist in the embodiment of metal and z. B. cut with lasers in their special shape. 5 shows that the pipes 15 . 16 and 17 very close together, so are arranged as possible without a gap, so that the inner tube 17 and the outer tube 15 the middle tube 16 include tightly between themselves. As material for the pipes 15 . 16 and 17 is z. B. spring steel suitable.

The outer tube 15 and the inner tube 17 are very similar. You point when you're with 1 compares the rigid section 3 on, at the side of the bendable areas 4 and 5 connect, in turn, which the rigid end sections 6 connect.

In the exemplary embodiment, the bendable areas 4 and 5 with wide slots running across the tube axis 18 Mistake. These are also in 4 with dashed areas of the pipes 15 and 17 indicated. The slots 18 are like that 6 and 8th show in the axial direction one behind the other alternately arranged at 90 ° angularly offset and give a structure that is bendable in all directions, while always maintaining their circumferential length.

In alternative, but less simple training, could be used for the bendable areas and a joint construction, as in EP 1 681 013 A1 is described.

The middle tube 16 whose essential details are given in 7 as in 5 are shown, as these figures show, at the ends with closed end pipes 12 and 12 ' Mistake. In the intermediate area is the pipe 16 longitudinally slotted with longitudinal slots 19 with which the pipe in this area in bars 20 is divided, which at the very narrow longitudinal slots 19 close to each other, like 5 in the enlarged view shows. The rods are therefore based in the periphery laterally close to each other and can not avoid pressure and tensile load, so are as safe against lateral evasion as the rods 7 - 10 in the construction of 1 and 2 in the guides 11 ,

In the embodiment of the 4 - 8th the shaft reacts 1 in bending as well as in the embodiment of 1 , To do this, the three must Tube 15 . 16 and 17 be pushed over each other in a relative longitudinal position, as they are characterized by the superposition of the 6 - 8th in the drawing results. The middle tube 16 So lies with the tailpipes 12 in the rigid end areas 6 and 6 ' the inside and outside adjacent pipes 15 and 17 , The tailpipes 12 and 12 ' be through their leadership between the two pipes 15 and 17 held parallel to the tube axis. The bars 20 of the middle tube 16 can not escape laterally due to their close juxtaposition. Bends in this construction the one bendable area 4 so must the other bendable area 5 follow with a forced bend, as in the case of 1 was explained. Also in the embodiment of the 4 - 8th can the variant of the 3 be realized. This requires the rods 20 of the middle tube 16 in the rigid area 3 that is, between the bendable areas 4 and 5 be helically wound trained.

The shaft according to the invention 1 can be used as a shaft of a surgical instrument. For example, it can form the shaft of an endoscope, wherein in the interior of the tubular shaft 1 the facilities of an endoscope are laid, such. As image guide, light guide, working channel, electrical cables, etc. At one end, a window may be provided through which a lens looks, while at the other end are arranged manual control devices. Likewise, the shaft of the invention can also be used as a shaft, z. B. a laparoscopic instrument, such. As a pair of pliers are used. Then at one end a handle and at the other end a forceps jaw is arranged.

For required rotational actuations over the length of the shank z. B. in the embodiment of 4 - 8th the pipes 15 and 17 be twisted against each other, which is also possible in the bent state. Relative longitudinal displacements are also possible.

The bars 7 - 10 respectively. 20 must be well slidably formed or arranged on all sides, so that there is a proper, precise forced bend in the shaft according to the invention. For this purpose, the rods, or the adjacent surfaces z. B. polished, lubricated, coated or designed to reduce friction other.

Instead of the term "rods" used so far in the context of the description, the term "longitudinally displaceable section" can also generally be used. To illustrate this is as another embodiment according to the 9a and 9b a pipe 16 or an elongated tubular element 16 shown, which preferably as the elongate tubular member 16 or pipe 16 out 7 tight between an outside pipe 15 and an inner tube 17 can be formed plugged. The longitudinally displaceable sections 120 ' and 120 that in the 9a and 9b are shown are at a gap 19 mounted longitudinally displaceable. The longitudinally displaceable sections 120 . 120 ' go to the tailpipes 12 respectively. 12 ' through tapered sections 21 . 21 ' above. As a result, an improved bendability of the bendable areas 4 . 5 the elongated tubular element 16 given. By providing tapered sections 21 . 21 ' result in longitudinal axial apertures 22 to 25 in the bending area 4 and 5 , In the figures, due to the three-dimensional schematic representation, only two longitudinally displaceable sections 120 . 120 ' provided with reference numbers. However, there are two more longitudinally displaceable sections available.

In 9a is the tubular element 16 shown in an undeflected or curved shape and in 9b in a deflected or curved form. With regard to this inventive design of the tubular element 16 in particular, reference is made to the patent application PCT / EP2009 / 051294 from 05.02.2009 resp. WO 2009/098244 A2 , The further embodiments of the corresponding tubular elements as well as the controllable tubes, which in this patent application ( PCT / EP2009 / 051294 ) are intended to be incorporated in full in the disclosure of this patent application.

The embodiments of the tubular shafts according to the invention have hitherto been formed substantially symmetrically. However, it is also possible, only at the distal end of a bendable area 4 and at the proximal end instead of the bendable area 5 a control region by means of which the corresponding desired movements can be generated on the longitudinally displaceable sections.

In 10 a morcellator according to the invention is shown schematically, which by means of a trocar 32 through an abdominal wall 31 is inserted into an abdominal cavity. The distal end area 6 ' with the blade 33 ' is in front of a tissue 30 arranged to be cut and removed by means not shown gripping tool from the abdominal cavity.

The middle, rigid section 3 penetrates the trocar 32 , On the outside of the patient is the rigid section 3 by means of a holder 34 at a fixed point 35 is fixed, held, so that an axial displacement is not or not unintentionally possible. Also shown are the bendable areas 4 and 5 at the distal or proximal end of the shaft. At the proximal end is a drive 36 provided, the inner tube, as a hollow wave is formed and that at its distal end a blade 33 ' has, drives. The drive also has a lumen, shown in phantom 37 or an opening 37 which runs through the entire instrument, and through which a gripping tool or tissue parts can be passed.

In 11 is a schematic sectional view through a Morcellator 33 shown. As a result, it can be seen in particular that in the rigid section 3 the structure of outer tube 15 , middle tube 16 and inner tube 17 is present, with the inner tube 17 the hollow drive shaft for the blade 33 ' forms. Dashed lines are the slots 18 in the bendable areas of the inner tube and the outer tube. For the inner tube 17 are the slots like, for example, in 8th shown executed, which ensures a flexibility with sufficient torsional stiffness. Furthermore, in 11 inner and outer panels 38 and 39 shown, the slotted areas of the inner tube 17 or the outer tube 15 cover and thus prevent damage by touching the slits with tissue on the inside or the outside.

In 12 is schematically the head of a shaver 40 shown. This is a milling instrument. The shank, on which the shaver head rests, is designed according to the invention with an inner tube 17 , middle tube 16 and outer tube 15 , The drive of the milling head 42 , the parallel ridges 43 for milling, via a central rotary shaft 41 , unlike in the embodiment according to 10 and 11 is not designed as a hollow shaft. Not shown are working channels that serve, for example, the removal of milling fragments or the supply of rinsing liquid. The head of the shaver 40 is a partial enclosure of the milling head 42 with a window or an opening 44 with a serrated edge. With the window open to one side or the opening 44 can be milled at a tissue site, such as a bone or cartilage surface, without affecting adjacent tissue parts.

In order to is it possible according to the invention for the first time Milling heads or Morcellator heads not solely on rigid shafts, but to provide bendable shafts.

All mentioned features, including the drawings alone to be taken as well as individual characteristics, in combination with other characteristics are disclosed alone and in combination. as essential to the invention considered. Embodiments of the invention can be due to individual characteristics or a combination of several characteristics be fulfilled.

LIST OF REFERENCE NUMBERS

1

shaft

3

middle section

4

bendable Area

5

bendable Area

6

proximal end

6 '

distal end

7-10

pole

11

guide

12

proximal tailpipe

12 '

distal tailpipe

15

outer pipe

16

average pipe

17

inner pipe

18

slot

19

longitudinal slot

20

pole

21 21 '

tapered section

22-25

longitudinal axial aperture

30

tissue

31

abdominal wall

32

trocar

33

morcellator

33 '

blade

34

bracket

35

fixation

36

drive

37

lumen

38

Inner paneling

39

Outer paneling

40

Shaver

41

rotary shaft

42

milling head

43

Bone

44

opening with serrated edge

120 120 '

longitudinally displaceable section

QUOTES INCLUDE IN THE DESCRIPTION

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

Cited patent literature

• - EP 1681013 A1 [0001, 0057]
• - EP 2009/051294 [0064, 0064]
• WO 2009/098244 A2 [0064]

Claims (15)

Tubular shaft ( 1 ) of a surgical instrument having an at least substantially rigid portion ( 3 ), at its distal end ( 6 ' ) a bendable area ( 4 ), whereby the shaft ( 1 ) an elongated tubular element ( 16 ), the mutually longitudinally displaceable sections ( 7 - 10 . 20 . 120 . 120 ' ), wherein the longitudinally displaceable sections ( 7 - 10 . 20 . 120 . 120 ' ) at the distal end ( 6 ' ) of the tubular element ( 16 ) are longitudinally fixed axially, characterized in that the shaft ( 1 ) has a rotating tool at its distal end. Shank ( 1 ) according to claim 1, characterized in that the shaft ( 1 ) an outer tube ( 15 ) having the tubular element ( 16 ) slidingly accommodates in its interior with close play. Shank ( 1 ) according to claim 1 or 2, characterized in that the shaft ( 1 ) an inner tube ( 17 ), which in the interior of the tubular element ( 16 ) is slidably disposed with close play. Shank ( 1 ) according to one of claims 1 to 3, characterized in that the longitudinally displaceable sections ( 7 - 10 . 20 . 120 . 120 ' ) are tensile and pressure resistant in the longitudinal axial direction. Shank ( 1 ) according to claim 3, characterized in that the inner tube ( 17 ) in the bendable section ( 4 ) protrudes or interspersed. Shank ( 1 ) according to one of claims 3 to 5, characterized in that the inner tube ( 17 ) in the bendable area ( 4 ) is formed bendable, in particular by means of flexible, but torsionally rigid structures. Shank ( 1 ) according to one of claims 3 to 6, characterized in that the inner tube ( 17 ) at least in the bendable range ( 4 ) has a flexible and continuous inner coating. Shank ( 1 ) according to one of claims 1 to 7, characterized in that the rotating tool by a central rotating shaft, which in the interior of the shaft ( 1 ) is arranged, is driven. Shank ( 1 ) according to claim 8, characterized in that the inner tube ( 17 ) is designed as a rotary shaft. Shank ( 1 ) according to claim 9, characterized in that the inner tube ( 17 ) at the distal end as a rotating tool, in particular with a circular blade ( 33 ' ), is trained. Shank ( 1 ) according to claim 10, characterized in that the inner tube ( 17 ) opposite the shaft ( 1 ) is axially movable so that the rotating tool at the distal end completely in the shaft ( 1 ) is retractable and partially or completely from the shaft ( 1 ) is pushed out. Shank ( 1 ) according to one of claims 1 to 11, characterized in that the shaft ( 1 ) has at its distal end a protective cover for the rotating tool, wherein the protective cover in particular is axially movable so that in different position of the protective cover, the tool is completely or partially recessed and / or exposed. Shank ( 1 ) according to one of claims 1 to 12, characterized in that the rotating tool is a morcellator, a shaver or a reamer. Use of a shaft ( 1 ) according to one of claims 1 to 13 in a surgical instrument, in particular a morcellator, a shaver or a reamer. Surgical instrument, in particular morcellator, shaver or reamer, with a shaft ( 1 ) according to one of claims 1 to 13.

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