DE102009055351A1 - Control of a tubular shaft of a surgical instrument - Google Patents

Abstract

The invention relates to a tubular shaft (30, 50, 80, 100) of a surgical instrument with a rigid section (31, 51, 81, 101), at the distal end of which a bendable area (32, 52, 82, 102) is connected wherein at least the rigid section (31, 51, 81, 101) and the bendable area (32, 52, 82, 102) are continuously traversed by bendable, tensile and pressure-resistant rods (7-10, 20, 57I-57IV) , of which several are arranged distributed over the circumference of the shaft (30, 50, 80, 100), wherein the rods (7-7, 80, 100) are positively guided, the support being a displacement of the rods (7-10, 20, 57I-57IV) allowed in the longitudinal direction of the shaft (30, 50, 80, 100) and prevented in the circumferential direction and in the radial direction, the rods (7-10, 20, 57I-57IV) at the distal end at a parallel to the axis of the Shaft (30, 50, 80, 100) guided end tube (12) are attached, as well as a surgical instrument with a corresponding shaft (30, 50, 80, 100) . The invention is characterized in that at least two rods (57I, 57III) are connected at a proximal end of the ung (41-43, 59-63I-IV, 88-92, 104a, 105-115), which is designed to bend the distal bendable area (32, 52, 82, 102), displace the rods (7-10, 20, 57I-57IV) longitudinally and axially without bending them in the proximal area.

Description

The invention relates to a tubular shaft of a surgical instrument having a rigid portion, at the distal end of which a bendable portion adjoins, wherein at least the rigid portion and the bendable portion are continuously traversed by bendable tensile and pressure-resistant rods, of which several over the circumference of the shaft are distributed, wherein the rods are forcibly guided on or in the shaft, the bearing allows a displacement of the rods in the longitudinal direction of the shaft and prevented in the circumferential direction and in the radial direction, the rods at the distal end to a parallel to the axis of Shaft-guided tailpipe are attached. The invention further relates to a surgical instrument with a corresponding shaft.

In WO 2009/098244 A2 is a surgical hand instrument with a controllable distal tip described. The hand instrument has a shaft with a proximal bendable region and a distal bendable region, which has a kinematic positive coupling via tensile and pressure-resistant rods mounted only longitudinally displaceably. A bend in the proximal area is automatically transmitted by the positive guide and the tension- and pressure-resistant rods into a bend in the distal area. The proximal end of such a shaft is understood to mean the end of the hand instrument that faces the surgeon, usually a surgeon, while the distal end is the end applied by the surgeon, which is inserted into a surgical field. Corresponding surgical hand instruments with a tubular shaft are used in particular in minimally invasive surgery.

Compared to conventional tubular shanks of surgical instruments, which are driven only with tensile ropes or traction cables, but which are not shear-proof or pressure-resistant, surgical instruments with tubular shafts with tensile and pressure-resistant rods have the advantage that smaller bending radii can be generated because a bend is created by two opposing rods, one pulled and the other pushed. In addition, in this solution is a larger interior for channels, tools, image guides and the like available.

The control by means of a proximal bendable region, which is reciprocal to the distal bendable region, is in some cases unfavorable, since in many cases the extracorporeally available working space in which the proximal region is controlled is limited.

In contrast, the invention has for its object to provide opportunities to allow the distal bend even with a very small extracorporeal work space available and a one-handed control of a tubular shaft.

This object of the invention is based on a tubular shaft of a surgical instrument having a rigid portion, at the distal end of which a bendable area adjoins, wherein at least the rigid portion and the bendable area are continuously traversed by bendable, tension- and pressure-resistant rods, a plurality of which are arranged distributed over the circumference of the shaft, wherein the rods are forcibly guided on or in the shaft, wherein the bearing allows a displacement of the rods in the longitudinal direction of the shaft and prevented in the circumferential direction and in the radial direction, wherein the rods at the distal end attached to a tail pipe guided parallel to the axis of the shaft, in which at least two rods are connected at a proximal end of the shaft to a control device adapted to displace the rods longitudinally axially without deflecting the distal bendable portion proximal ber to bend.

The invention is based on the idea that a proximal bendable region is completely omitted and replaced by a control device which acts directly on the bendable, tension and pressure resistant rods in the rigid section. In addition to the advantage that such a control device can be kept very small construction, actuating means, such as puller wires for arranged at the distal end of the surgical instrument tools, such as forceps or knives, can be led out proximally from the tube construction and controlled by handle lever among others.

According to the invention bendable tensile and pressure-resistant bars wires that are mounted in vollumschließenden channels only longitudinal axial displaceable, be, or in a preferred embodiment of the tubular shaft according to the invention such that the shaft comprises three concentric tubes arranged one inside the other, the middle tube at its proximal End forms the end tube and is divided by means along a portion of the length of the central tube slots or recesses in, in particular flat, rods, wherein the outer tube and the inner tube are rigid in the rigid portion and are formed bendable in the distal bendable region and along the length of the shaft together form a forced guidance for the middle tube. In the context of the invention means pressure-resistant in particular also shear resistant.

The positive guide for the middle tube forms in particular the positive guidance for the rods, which make up a part of the middle tube. This preferred construction is particularly simple and inexpensive to produce with little effort, since only three concentric tubes must be made, of which the central tube is divided along a portion of its longitudinal extent in the circumferential direction, while the outer and inner tubes in the respective bendable distal region a Structure that makes it bendable with respect to its longitudinal axis.

In an advantageous development, at least one further rod at the proximal end of the shaft against displacement, in particular against a longitudinal displacement, secured. Such a further bar, in particular two opposing further bars secured against displacement or longitudinal displacement, causes the bends of the distal bendable area in the respective directions in which bars secured against displacement or longitudinal displacement are to be reduced or prevented , Thus, a direction selection on one for the bending in a simple manner possible and reduces the number of degrees of freedom for the surgeon, which facilitates handling.

In a preferred embodiment, a handle is provided at the proximal end of the shaft, which is in particular firmly connected to an outer tube of the shaft. The outer tube may be the outer tube of a three-pipe construction or the outer shell of another corresponding construction.

Preferably, when the handle has a coaxially arranged with the longitudinal axis of the shaft wheel, which is torsionally connected to the inner tube of the shaft or with a rotatable about the longitudinal axis tool at the distal end of the shaft, it is possible, the inner tube of a three-tube construction over the middle and the outer tube of the three-tube construction to rotate independently about the longitudinal axis of the shaft. Thus, it is possible, for example, to adapt the orientation of a knife or a gripping tool to the operational needs, without changing the bending direction of the bendable portion of the tubular shaft. Under torsionally rigid in this context is understood that rotation of the wheel leads to a corresponding rotation of the tool or the inner tube of the shaft.

Further preferably, the handle has an actuating element, in particular an actuating lever, for a tool at the distal end of the shaft. The actuating element is connected by means of a transmission means, for example a pull cable, a pull wire or a partially längsaxial displaceable inner tube of a three-tube construction, with the tool to operate it.

Advantageously, one or more through openings, in particular in the handle, are provided as access to one or more channels in the interior of the shaft. Thus, it is possible, for example, to insert and re-implement tools introduced during the operation during surgery, to aspirate liquids in the surgical field and to carry out further activities which require a material transport through a central opening in the tubular shaft.

In a preferred embodiment of the invention, the control device for the rods each have their own drive, in particular linear drives, piezoactuators, electromechanical, mechanical, pneumatic or hydraulic actuators or drives. In this case, each rod is individually controllable, so that with fine control different bends and Biegerungen can be generated.

For this purpose, it is preferably provided that a mechanical or electronic control unit is provided for the individual drives, which in particular has a control for controlling the bend or is connected to the control. For electrical or electronic actuators and drives, such as linear actuators or piezo actuators, the control unit is electronic and includes a control logic that converts in particular the movement of a control element into corresponding control signals for the individual drives or actuators for the rods. This is also possible by mechanical or hydraulic means. A control element may be formed, inter alia, but not exclusively, as a toggle switch, slide switch, joystick, trackball, touch-sensitive surface sensor in the context of the invention. Preferably, the control device is integrated in the handle.

In a further preferred embodiment of the invention, the control device is designed as a arranged on the handle, with the shaft concentrically arranged control ring having one or more internal threads or internal threads that engage in one or more external thread or external thread of at least two rods, the or the internal thread or internal thread and / or the external thread or external thread are formed in opposite directions. The handle itself is preferably in sections, especially at the place of Control ring, rotationally symmetrical about the longitudinal axis of the shaft formed.

The internal threads of the control ring engage external threads or external threads of the rods, counteracting the rotation of the control ring in one direction causing the various rods in opposite directions, corresponding to the counter orientation of the internal and / or external threads or partial threads be moved. A corresponding control ring is preferably formed with a non-slip surface, so that a rotation of the control ring is possible only with the thumb of the hand guiding the handle and the distal bendable portion is bent.

Advantageously, a plurality of control rings are provided one behind the other independently of each other, each cooperating with different rods or different pairs of rods, so that different bending directions can be actuated by means of the various control rings. A particularly simple preferred embodiment of this is that an internal thread or internal thread at least two at least partially in opposite directions spirally extending on an inner side of the control ring grooves, at least two rods as external thread or external thread each having a pin which engage in each of the grooves. The terms external thread and internal thread according to the invention thus also include pins that engage in long slots or grooves. The elongated slots or grooves may extend over part of the circumference of the control ring or may also have one or more spiral windings around the inside of the control ring.

Advantageously, the internal thread or internal thread has at least one threaded section which has no pitch relative to the longitudinal direction of the shaft and into which an external thread of at least one rod whose longitudinal axial position is fixed engages. Thus, the technical solution that one or more rods are not moved, also realized by a combination of correspondingly formed internal threads and external threads without pitch. No other fixation is necessary.

Preferably, a plurality of independently movable control rings are provided, each cooperating with different rods.

In a further preferred embodiment of the invention, a control disk with a central recess projecting radially outward from the shaft at the proximal end of the rigid portion of the shaft is formed, the rods being connected at their proximal end to the control disk along the edge of the central recess of the control disk are. A tilting of the control disk about a, in particular arbitrarily selectable, tilting axis which intersects the longitudinal axis of the shaft, then leads to a longitudinal displacement of the rods connected to the control disk, wherein the rods are pulled on one side of the tilting axis, while on the opposite side of the rods be pushed. This results in bending of the bendable distal portion of the shaft.

Preferably, the control disk is arranged in an outer ring made of an elastic material, which in particular has a non-slip surface, wherein a central recess of the outer ring has a, in particular elliptical or spitzelliptische, contour which at a tilt of the outer ring with the control disk in at least a tilting direction causes a clamping protection of the outer ring on the shaft. In this case, the control disk is arranged in the outer ring so that the control disk and the outer ring perform each tilt together. The contour clamping is performed such that is pressed by tilting the control disc with the outer ring of the elastic outer ring on the shaft and clamps there.

Advantageously, a tilting axis is provided, which connects the control disk at two opposite points with the shaft, wherein the control disk is tiltable about the tilting axis relative to the shaft. The same applies in the case that the control disk is connected to an outer ring. By means of the tilting axis, the tilt about the tilting axis is fixed, so that only bending of the distal bendable region in two opposite directions is possible. This in turn facilitates the handling of the instrument.

In a preferred embodiment, an inner ring is provided, which is connected at two opposite points with the tilting axis, wherein the control disc relative to the inner ring tiltable about the tilt axis and in particular about a longitudinal axis of the shaft is rotatable, wherein the inner ring with the proximal end a relation to the rods inner tube of the shaft is torsionally connected. This is particularly advantageous in a three-pipe design with three concentric nested tubes, because by means of the inner ring which is connected to the inner tube, the inner tube and optionally connected to the inner tube tools at the distal tip of the instrument are rotatable independently of the bend of the distal bendable portion of the instrument.

Another according to the invention corresponding tubular shaft has as a control device at the proximal end of the rigid portion of the shaft radially from the shaft outwardly projecting handle with central recess, wherein in the recess at least one finger performed radially inwardly through an opening in the outer tube of the shaft or is feasible and connected to at least one rod of the middle tube or connectable. This refers to a three-pipe construction in which a rod-containing middle pipe is supported between an inner and an outer pipe and constrained. The central recess is such that the operating element is seated concentrically on the shaft. In this case, the operating element is preferably arranged linearly movable on the shaft with respect to a longitudinal axis of the shaft. By means of the linear movement of the operating element, a linear movement of the bending element is transmitted via the pin in the central recess onto a rod of the central tube, whereby it is displaced longitudinally linearly and a bending is caused in the distal bendable region. This can be both a push and a pull movement.

If advantageously the operating element is arranged rotatably on the shaft about a longitudinal axis of the shaft, wherein the at least one finger is arranged retractable in a receptacle in the operating element, in particular the finger pressure is at least a finger or a finger actuator for retracting and extending the at least one finger is provided , it is possible to select at a control element with only one finger on which rod the finger should engage, d. H. in which direction the distal bendable region should be bent. The rotation of the flexure about the longitudinal axis of the shaft to select a rod other than the previously moved one can be done by one or two fingers of the surgeon and is very easy to handle.

For this case, an advantageous development is that openings in the outer tube of the shaft for receiving a finger of the operating element in the circumferential direction at a distance of 36 °, 45 °, 60 ° or 90 ° from each other are arranged, wherein the rods at the same distances from each other are arranged in the circumferential direction below the openings. The mentioned degrees correspond to a uniform arrangement of 10, 8, 6 or 4 rods which are to be moved. Within the scope of the invention, there may also be an irregular distribution of the rods and correspondingly irregular distributions of openings for the finger.

In order to facilitate the operator preferably the orientation in which direction a movement of the operating element causes a bending of the distal bendable region, it is preferably provided that the operating element is provided with symbols indicating a bending direction, wherein a relation to the shaft rotationally fixed arranged housing for the operating element is provided which has at least one window which is aligned with the operating element in each position of the bending element so that a symbol can be seen in at least one window which indicates the direction of the bending of the distal bendable region in the current rotational state of the operating element.

The housing may be arranged with the operating element linearly displaceable on the shaft, but is secured against rotation about the longitudinal axis of the shaft. The combination of symbol on the control element and window, each aligned with a symbol, allows a reliable assessment of the direction in which a linear movement the control element will bend the distal bendable area and therefore leads to an easy handling while high operational safety.

The object underlying the invention is also achieved by a surgical instrument having a tubular shaft according to the invention, as has been described above.

The invention will be described below without limiting the general inventive idea by means of embodiments with reference to the drawings, reference being expressly made to the drawings with respect to all in the text unspecified details of the invention. Show it:

1 a schematic representation of an embodiment of a known tubular shaft with bendable distal and proximal region,

2 a schematic cross-sectional view through a shaft according to 1 .

3 a schematic representation of a variant of the shaft according to 1 .

4 a schematic cross-sectional view of a three-tube construction of a known tubular shaft,

5 a schematic sectional view of the three-tube construction according to 4 .

6 an outer tube according to 4 in a schematic side view,

7 a middle pipe according to 4 in a schematic side view,

8th an inner tube according to 4 in a schematic side view,

9 a schematic side view of an embodiment of the invention,

10 a schematic side view of a second embodiment of the invention,

11 a schematic detail of 10 .

12 a schematic representation of a variant of a surgical instrument according to 10 in detail,

13 a detailed representation of another solution according to the invention,

14 a schematic representation of a variant of a solution according to the invention to 13 .

15 a perspective schematic representation of a device according to 14 .

16 a schematic cross-sectional view through a shaft according to the invention according to 13 .

17 a schematic side view of another operating device according to the invention for a tubular shaft and

18 schematic representations of in 17 shown control element.

In the drawings, the same or similar elements and / or parts are provided with the same reference numerals, so that apart from a new idea each.

1 shows a first embodiment of a known tubular shaft 1 with both distal bendable region and proximal bendable region. 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 rigid and in adjoining the ends bendable areas 4 and 5 is formed bendable. To the bendable areas 4 and 5 can have rigid end areas 6 and 6 be scheduled.

From the in 2 shown in the inner circumference of the shaft 1 distributed tensile and shear resistant rods 7 to 10 are in 1 two bars 7 and 9 shown. These pass through the bends in the bendable areas 4 . 5 always parallel to the wall of the pipe 2 , At the ends 6 . 6 ' are the rods 7 to 10 at tailpipes 12 . 12 ' attached, the axis-parallel in the shaft 1 are guided. The construction may also have only about three circumferentially spaced rods or more than four.

As 2 shows are the rods 7 to 10 in guides 11 stored and secured against lateral deflections on the pipe 2 are attached. As they also on 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.

In 1 are the bendable areas 4 respectively. 5 defined as distal or proximal regions. The proximal area 5 is located towards an operator, the distal area away from the surgeon. A bend of the proximal area 5 in the direction of the arrow 14 in this case leads to a bending of the distal area 4 in the direction of the arrow 13 because the pole 7 towards the distal area 4 pushed back while the rod 9 towards the proximal end 5 pulled out. This opposite movement results in the distal area 4 to a corresponding bend. At the other two rods 8th . 10 , in the case of bending according to 1 no shift. 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 an embodiment variant for 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. The embodiments differ in that the rods 7 . 9 in 3 in the rigid section 3 of the shaft 1 run crosswise. This is achieved in a simple way by the rods 7 to 10 in their guides 11 in the rigid section 3 the circumference of the pipe 2 follow on a helix by 180 °. The resulting direction of bending 13 is to in 1 shown bend 13 opposed. Would here the screw twisting of the rods 7 to 10 over z. B. 90 °, as would result in the bending of the proximal region 5 of the 3 in the manner shown, a movement of the distal bendable area 4 upwards out of the drawing plane.

The 4 to 8th show a second embodiment of the shaft 1 , again, as far as possible, the previous reference numbers are used. The shaft 1 is tubular formed of three closely nested tubes, namely an outer tube 15 , a middle tube 16 and an inner tube 17 ,

4 shows the composite shaft 1 in cross section. 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 side view in the 6 to 8th schematically illustrated 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 each have a rigid middle section 3 on, on the both sides bendable areas 4 and 5 and rigid end sections 6 . 6 ' connect. The bendable areas 4 and 5 are with wide slots running across the tube axis 18 Mistake. These are in 4 with dashed areas of the pipes 15 and 17 indicated. The slots 18 are alternately arranged angularly offset by 90 ° in the axial direction and result in a structure that is bendable in all directions, while always maintaining their circumferential length.

The middle tube 16 whose essential details are given in 7 as in 5 are shown is 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 together. The rods are supported laterally close to each other in the circumference 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 to 8th the shaft reacts 1 in bending as well as in the embodiment of 1 , These are the three tubes 15 . 16 and 17 pushed into each other. The middle tube 16 lies with the tailpipes 12 in the rigid end areas 6 . 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 dodge sideways due to their tight abutment. 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 to 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 bars 7 to 10 respectively. 20 should 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 abutting surfaces z. B. polished, lubricated, coated or designed to reduce friction other.

9 shows a schematic side view of a first embodiment of a tubular shaft according to the invention 30 with a rigid section 31 and a distal bendable area 32 , which at the top of a pair of pliers 33 having. The shaft 30 is a three-pipe construction with an outer pipe 34 , a middle tube 35 and an inner tube 36 , which are arranged concentrically in one another, constructed. The middle tube 35 is circumferentially segmented into individual rods, which at the top in a common tailpipe, as in 7 shown, but with a proximal tailpipe 12 out 7 at the shaft 30 according to 9 is missing.

The forceps 33 is by means of a pull wire 37 with a lever 39 a handle 38 connected to the operation of the pliers 33 serves. The handle 38 has a housing 40 on, the linear drives 41 . 41 ' , For example, piezo actuators, each having a linear drive 41 . 41 ' with a rod of the middle tube 35 is connected and this in the longitudinal axial direction of the shaft 30 pushes or pulls. In 9 a situation is shown in which, marked with arrows, the linear actuator 40 the corresponding rod pulls while the linear actuator 41 ' the corresponding rod pushes, causing a bend of the distal bendable area 32 upwards.

The linear drives 41 . 41 ' are with a control module 42 connected, that with a control element 43 which is used to control the bending of the distal bendable area 32 of the shaft 30 serves. Exemplary possible directions of movement are as arrows on the control 43 in 9 shown. At the control 43 it may be a toggle switch or a joystick or similar suitable controls. The control module 42 translates the signals it receives from the control element 43 receives, in control signals for the linear drives 41 . 41 ' ,

The control device may also be formed mechanically or hydraulically, wherein a control element 43 then via a mechanical or hydraulic control module 42 corresponding mechanical or hydraulic drives 41 . 41 ' drives.

With the in 9 shown tubular shaft 30 with a control module that works like in 9 As illustrated, it is possible for the surgeon to operate the entire surgical instrument with one hand and both the absolute positioning of the instrument and the bending of the distal bendable region 32 as well as the operation of the pliers 33 with one hand.

In 10 is an alternative embodiment of a surgical instrument with a shaft 50 that a rigid section 51 , a distal bendable area 52 and a distal end portion 53 has shown. At the proximal end of the rigid section 51 this is with a handle 58 connected to a control ring 59 which is concentric with the longitudinal axis of the shaft 50 is arranged.

How out 11 it can be seen that a detail cross-section of the surgical instrument according to 10 from which it can be seen that it is a construction of an outer tube 54 and a middle tube 55 is. An inner tube is in 11 not shown. The middle tube 55 has slots 56 . 56 ' on, in the longitudinal axial direction of the shaft 50 run and the middle tube 55 subdivided into individual rods, which are independently longitudinally displaceable.

In the handle 58 the rods have an external thread 60 or external thread 60 on, which is complementary to an internal thread 61 the control ring 59 are. A rotation of the control ring 59 due to the different configuration of the internal thread and the external thread in an independent displacement of the individual rods of the middle tube 55 ,

In 12 is another embodiment of a female threaded external thread mechanism in a surgical instrument according to 10 shown schematically. The 12 represents an unrolling of a middle tube 55 ' with four bars 57I to 57IV dar. On the schematically unrolled to a surface rods 57I to 57IV is a dashed line a control ring 59 ' indicated, the several elongated grooves 63I to 63IV has, in the circumferential direction in each case the width of about 1½ bars 57I to 57IV span. The bars 57I to 57IV each have a guide pin 621 to 62IV on, each with a groove 63I to 63IV cooperates and intervenes in these.

The extension of the grooves in the circumferential direction allows rotation of the control ring 59 ' by 135 °, namely 3/8 of a full turn. With the rotation of 135 ° it is possible to use the rod 57I longitudinal axial in one direction and the rod 57III in the opposite direction by the same amount. The grooves 63II and 63IV have no slope, so the rods 57II and 57IV , their guide pins 62II and 62IV with the grooves 63II and 63IV interact, are fixed longitudinally axially. The guide groove 63IV runs over the bars 57IV to 57I , what in 12 in the illustrated unrolling results in being shown in two parts, although it is in the tubular central tube 55 ' is actually connected.

Analogous to the embodiment of 12 can also be provided two different successively arranged guide rings, each having only two guide grooves for the guide pins of two rods, such as the rods 57I and 57III on the one hand and the bars, on the other 57II and 57IV on the other hand. This allows a bend of the corresponding distal bendable area 52 by the two control rings in different directions, such as horizontal and vertical, are set independently.

In the 13 to 16 a further embodiment of a surgical instrument according to the invention with a distal bendable tip and a control device is shown schematically. It is an embodiment with a control disc at the proximal end with the rods of a middle tube 85 a three-pipe construction of outer pipe 84 , middle tube 85 and inner tube 86 connected is.

The shaft 80 with its middle section 81 is in 16 shown. The middle tube 85 ends in the circumferential direction with a control disk 88 with whom she is connected. The control disc 88 is at its outer periphery in an outer ring 89 mounted, which consists of an elastic material, such as rubber, in particular with a non-slip surface or comprises such a material. The solid lines show a neutral position of the control disk 88 in which there is no tilting of the control disc relative to the shaft 80 is present, so that an unillustrated distal end region is present straight and without bending.

Dashed lines represent a situation in which the control disk 88 ' and the outer ring 89 ' tilted together with a tilt axis in the image plane through the shaft 80 runs. After tilting is the upper pole of the middle tube 85 shifted to the left, which is represented by a dashed line indicated contour on the left edge of the drawing, while in the lower part of the rod of the middle tube 85 pulled to the right, which is indicated by a dashed contour on the left side of the 16 , as well as by a dashed continuation of the middle tube 85 up to the tilted control disc 88 ' is shown. The illustrated tilting results in an unillustrated bending of the distal bendable portion downwardly.

In 13 is for clarity a schematic cross-sectional view through the end portion of the shaft 80 out 16 shown. From the shaft 80 is the outer tube 84 represented, to which the outer ring 89 followed. The control disc 88 ' is not shown separately. Through the outer ring 89 runs a mechanical tilting axis 91 , which at two opposite points with the outer tube 84 is connected and a tilt of the outer ring 89 and the control disk, not shown 88 only around this tilt axis 91 allowed. The central opening of the outer ring 89 has a spitzellipsenförmige contour 90 on. This spitzellipsenförmige contour 90 ensures that when tilted the outer ring 89 around the tilt axis 91 the elastic material of the outer ring 89 on the shaft 80 clamps, as the narrowing contour on the outer tube 84 is pressed. This causes a clamping and thus a fixation of the bend of the distal bendable portion of the surgical instrument.

In 14 is an alternative to the embodiment according to 13 shown, with an additional inner ring 92 is formed, with the inner tube 86 the three-pipe construction of the shaft 80 or is rotatably connected to a further inside inner tube. The inner ring 92 is opposite the tilt axis 91 rotatably mounted, so that the inner tube of the shaft 80 is rotatable about its longitudinal axis separately and independently of the set bend of the distal bendable portion of the surgical instrument. In 15 is a perspective view of the embodiment according to 14 shown schematically.

In the 17 and 18 is a further embodiment of a control device according to the invention of a tubular shaft according to the invention 100 shown schematically. The shaft 100 has a rigid section 101 with a distal bendable area 102 on. The distal tip includes pliers 103 as a tool. The forceps 103 is together with the inner tube, which is in 17 not shown, independent of the longitudinal axis of the shaft 100 rotatably connected. A central pull wire for the tool is in an interrupted area of the shaft 100 indicated.

At the proximal end of the shaft 100 sits on the outer tube 104 of the rigid section 101 a bending operator 106 on, that on the outer tube 104 arranged longitudinally displaceable axially. By means of the bending operation element 106 , the finger hollows 110 for example, an index finger 116 and a middle finger 117 a hand of an operator, is by retracting or advancing the bending operation element 106 the tip of the shaft 100 with the distal bendable area 102 bent in a predetermined direction.

It is also a case 113 for the bending operator element 106 provided, which may also be longitudinally displaceable on the outer tube 101 of the shaft 100 is arranged, wherein the bending operation element 106 around the longitudinal axis of the shaft 100 is rotatable, the housing 113 However not. The housing 113 has a window 114 on its back, which shows an icon representing the currently set direction of bending. A corresponding window 115 is on the side surface of the case 113 appropriate. The bending operator element 106 is in the case 113 around the longitudinal axis of the shaft 100 rotatably arranged around. The linear movement of the bending actuator 106 for actuating the distal bendable area 102 is with a double arrow 121 characterized.

To the bending control element 106 closes proximally a handle 124 with several other controls on. At the front end of the handle 124 is a pull lever 122 provided by means of which the surgeon pliers 103 can serve. The pull lever 122 has finger hollows for an index finger and a middle finger 117 as well as openings for a ring finger 118 and a little finger 119 on. The surgeon can thus with a lot of force the pliers 103 serve.

Behind the pull lever 122 is a thumbwheel 123 for operation by means of a thumb 120 provided with an in 17 Inner tube, not shown, of the three-tube construction of the shaft 100 is torsionally rigid or torsionally connected, so that a rotation of the thumbwheel 123 around the longitudinal axis of the shaft 100 to a corresponding rotation of the inner tube and the tool 103 around the longitudinal axis of the shaft 100 leads. This rotation is independent of which bend of the distal bendable area 102 is set.

The bending operator element 106 is so adjacent to the pull lever 123 arranged that the surgeon can operate both controls by one hand. For this the surgeon uses his index finger 116 and middle finger 117 for the bending operator element 106 while the ring finger 118 and the little finger 119 the pull lever 122 and with it the tool 103 actuate. At the same time he can with his thumb 120 the thumbwheel 123 and thus the orientation of the tool 103 Taxes.

At the back end of the handle 124 is a thumb ring 125 or thumb hole provided by means of which the surgical instrument can be stored on the thumb. Also in this position can with the thumb the thumbwheel 123 be operated.

Also shown is the handle 124 via an RF connection 126 and an RF control unit 127 has, via which the tool at the tip of the surgical instrument can be supplied with an RF power.

In 18 is the bending control element 106 shown in detail in different views. 18 a) shows a frontal view of a cross-shaped bending operating element 106 with four arms and a central circular recess 107 on the outer tube 104 of the shaft 100 is deferred. In the central recess 107 is a retractable pen in one place 108 arranged, for example, spring-loaded in a receptacle 109 is retractable. With dashed lines are finger hollows 110 at the four arms 120 the cross-shaped bending operation element 106 shown. Likewise are symbols 111 shown on the respective arms indicate the currently set bending direction for the distal bendable area. The icons are arranged so that they have windows 114 of in 17 illustrated housing 113 aligned. There is only one icon at a time.

In 18 b) is the bending actuator 106 out 18 a) shown schematically from above. It is shown that the arms 112 also on the top a symbol 112 can have.

In 18 c) is shown schematically as the bending actuator 106 with the rods of the middle tube 105 the three-pipe construction cooperates. For this purpose, the bending operation element 106 with its central recess 107 on the outer tube 104 of the shaft 100 placed. The outer tube 104 points along its circumference with the rods of the middle tube 105 aligned oblong holes 104a in which the retractable pin 108 of the bending operation element 106 intervenes.

The rods of the middle tube 105 have appropriate recordings for the pen 108 on, so if the flexing element 106 is brought into the appropriate position, the pin through a slot 104a of the outer tube 104 in the corresponding receptacle of the rod of the middle tube 105 intervenes. When the engagement is warped, the rod can flex with the flexing element 106 be moved longitudinally axially, resulting in a bend of the distal bendable portion of the shaft 100 leads.

To a rotation of the bending operation element 106 around the longitudinal axis of the shaft 100 to enable are the pen 108 and the sides of the slot 104a of the outer tube is formed obliquely or curved in the circumferential direction, so that a rotation of the bending operation element 106 is possible. It slides the pin 108 in his recording back and hinders the rotation of the bending operation element 106 around the longitudinal axis of the shaft 100 Not. As soon as the next slot 104a is reached, moves the spring-loaded pin 108 in the slot 104a and the corresponding receptacle of the rod of the middle tube 105 into it. This leads to a clearly perceptible to the surgeon, ie audible and / or tactile clicking sound or snapping. Thus, the surgeon by means of a finger, for example, the index finger, the bending operation element 106 around the longitudinal axis of the shaft 100 turns, very exactly set the desired bending direction.

With all embodiments, a very simple and one-handed handling of a tubular shaft of a surgical instrument according to the invention is made possible.

All mentioned features, including the drawings alone to be taken as well as individual features that are disclosed in combination with other features are considered alone and in combination as essential to the invention. Embodiments of the invention may be accomplished by individual features or a combination of several features.

LIST OF REFERENCE NUMBERS

1

shaft

3

middle section

4

bendable area

5

bendable area

6

proximal end region

6 '

distal end region

7-10

pole

11

guide

12

proximal tailpipe

12 '

distal tailpipe

15

outer tube

16

middle tube

17

inner tube

18

slot

19

longitudinal slot

20

pole

30

shaft

31

rigid section

32

distal bendable area

33

tongs

34

outer tube

35

middle tube

36

inner tube

37

pull wire

38

handle

39

lever

40

casing

41, 41 '

linear actuator

42

control module

43

operating element

50

shaft

51

rigid section

52

distal bendable area

53

distal end region

54

outer tube

55, 55 '

middle tube

56, 56 '

slot

57 ^I- 57 ^IV

pole

58, 58 '

handle

59, 59 '

control ring

60

inner thread

61

external thread

62 ^I -62 ^IV

guide pin

63 ^I -63 ^IV

guide

80

shaft

81

rigid section

84

outer tube

85

middle tube

86

inner tube

88, 88 '

control disc

89, 89 '

outer ring

90

inner contour

91

axis

92

inner ring

100

shaft

101

rigid section

102

distal bendable area

103

tongs

104

outer tube

104a

Long hole

105

middle tube

106

Bending control element

107

central recess

108

retractable pin

109

admission

110

finger recess

111

direction icon

112

poor

113

casing

114-115

window

116

index finger

117

middle finger

118

ring finger

119

pinkie finger

120

thumb

121

movement direction

122

pull lever

123

thumbwheel

124

handle

125

thumb ring

126

RF connector

127

RF control unit

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• WO 2009/098244 A2 [0002]

Claims (25)

Tubular shaft ( 30 . 50 . 80 . 100 ) of a surgical instrument with a rigid section ( 31 . 51 . 81 . 101 ), at whose distal end a bendable area ( 32 . 52 . 82 . 102 ), wherein at least the rigid section ( 31 . 51 . 81 . 101 ) and the bendable area ( 32 . 52 . 82 . 102 ) of bendable, tension and pressure resistant rods ( 7 - 10 . 20 . 57I - 57IV ), several of which extend beyond the circumference of the shaft ( 30 . 50 . 80 . 100 ) are arranged, wherein the rods ( 7 - 10 . 20 . 57I - 57IV ) on or in the shaft ( 30 . 50 . 80 . 100 ) are mounted positively guided, wherein the storage a displacement of the rods ( 7 - 10 . 20 . 57I - 57IV ) in the longitudinal direction of the shaft ( 30 . 50 . 80 . 100 ) and prevented in the circumferential direction and in the radial direction, wherein the rods ( 7 - 10 . 20 . 57I - 57IV ) at the distal end on a parallel to the axis of the shaft ( 30 . 50 . 80 . 100 ) guided tailpipe ( 12 ), characterized in that at least two rods ( 57I . 57III ) at a proximal end of the shaft ( 30 . 50 . 80 . 100 ) with a control device ( 41 - 43 . 59 - 63I-IV . 88 - 92 . 104a . 105 - 115 ), which is designed to bend the distal bendable region (FIG. 32 . 52 . 82 . 102 ) the rods ( 7 - 10 . 20 . 57I - 57IV ) longitudinally without bending in the proximal region. Tubular shaft ( 30 . 50 . 80 . 100 ) according to claim 1, characterized in that the shaft ( 30 . 50 . 80 . 100 ) three concentrically nested tubes ( 34 - 36 . 54 - 56 . 84 - 86 . 104 - 106 ), wherein the middle tube ( 35 . 55 . 85 . 105 ) forms at its proximal end the tailpipe and by means of along a portion of the length of the central tube ( 35 . 55 . 85 . 105 ) extending slots ( 56 . 56 ' ) or recesses in the rods ( 20 . 57I - 57IV ), wherein the outer tube ( 34 . 54 . 84 . 104 ) and the inner tube ( 36 . 56 . 86 . 106 ) in the rigid section ( 31 . 51 . 81 . 101 ) are rigid and in the distal bendable region ( 32 . 52 . 82 . 102 ) are formed bendable and along the length of the shaft ( 30 . 50 . 80 . 100 ) together a positive guide for the middle tube ( 35 . 55 . 85 . 105 ) form. Tubular shaft ( 30 . 50 . 80 . 100 ) according to claim 1 or 2, characterized in that at least one further rod ( 57II . 57IV ) at the proximal end of the shaft ( 30 . 50 . 80 . 100 ) against displacement, in particular against a longitudinal displacement, is secured. Tubular shaft ( 30 . 50 . 80 . 100 ) according to one of claims 1 to 3, characterized in that at the proximal end of the shaft ( 30 . 50 . 80 . 100 ) a handle ( 38 . 48 . 58 . 89 . 89 ' . 124 ), in particular with an outer tube ( 34 . 54 . 84 . 104 ) of the shaft ( 30 . 50 . 80 . 100 ) is firmly connected. Tubular shaft ( 30 . 50 . 80 . 100 ) according to claim 4, characterized in that the handle ( 38 . 48 . 58 . 89 . 89 ' . 124 ) coaxial with the longitudinal axis of the shaft ( 30 . 50 . 80 . 100 ) arranged wheel ( 92 . 123 ), which is connected to the inner tube of the shaft ( 30 . 50 . 80 . 100 ) or with a rotatable tool about the longitudinal axis ( 33 . 103 ) at the distal end of the shaft ( 30 . 50 . 80 . 100 ) is torsionally connected. Tubular shaft ( 30 . 50 . 80 . 100 ) according to claim 4 or 5, characterized in that the handle ( 38 . 48 . 58 . 89 . 89 ' . 124 ) an actuating element ( 39 . 122 ), in particular an actuating lever, for a tool ( 33 . 103 ) at the distal end of the shaft ( 30 . 50 . 80 . 100 ) having. Tubular shaft ( 30 . 50 . 80 . 100 ) according to one of claims 1 to 6, characterized in that one or more through openings, in particular in the handle ( 38 . 48 . 58 . 89 . 89 ' . 124 ) as access to one or more channels inside the shaft ( 30 . 50 . 80 . 100 ) are provided Tubular shaft ( 30 ) according to one of claims 1 to 7, characterized in that the control device ( 41 - 43 ) for the rods ( 7 - 10 . 20 . 57I - 57IV ) each have their own drive ( 41 . 41 ' ), in particular linear drives, piezoactuators, electromechanical, mechanical, pneumatic or hydraulic actuators or drives. Tubular shaft ( 30 ) according to claim 8, characterized in that a mechanical or electronic control unit ( 42 . 43 ) for the individual drives ( 41 . 41 ' ), in particular a control element ( 43 ) for controlling the bend or with a control ( 43 ) connected is. Tubular shaft ( 30 ) according to claim 8 or 9, characterized in that the control device ( 41 - 43 ) in the handle ( 38 ) is integrated. Tubular shaft ( 50 ) according to one of claims 1 to 7, characterized in that the control device as a on the handle ( 58 ), with the shaft ( 50 ) concentrically arranged control ring ( 59 . 59 ' ) is formed, the one or more internal thread ( 61 ) or internal thread ( 62I - 62IV ), which in one or more External thread ( 60 ) or external thread ( 63I - 63IV ) of at least two rods ( 57I - 57IV ), wherein the internal thread or threads ( 61 ) or internal thread ( 62I - 62IV ) and / or the male thread or threads ( 60 ) or external thread ( 63I - 63IV ) are formed in opposite directions. Tubular shaft ( 50 ) according to claim 11, characterized in that an internal thread ( 61 ) or internal thread ( 62I - 62IV ) at least two at least partially in opposite directions spirally on an inner side of the control ring ( 59 . 59 ' ) running grooves ( 63I - 63IV ), wherein at least two rods ( 57I - 57IV ) as external thread or external thread each have a pin ( 62I - 62IV ) which in each case one of the grooves ( 63I - 63IV ) intervene. Tubular shaft ( 50 ) according to claim 11 or 12, characterized in that the internal thread ( 61 ) or internal thread ( 63I - 63IV ) at least one threaded section ( 63II . 63IV ), which relative to the longitudinal direction of the shaft ( 50 ) has no pitch and into which an external thread ( 62II - 62IV ) at least one rod ( 57II - 57IV ), whose longitudinal axial position is fixed. Tubular shaft ( 50 ) according to one of claims 11 to 13, characterized in that a plurality of independently movable control rings ( 59 . 59 ' ) are provided, each with different rods ( 57I - 57IV ) work together. Tubular shaft ( 80 ) according to one of claims 1 to 7, characterized in that as a control device ( 88 - 92 ) one at the proximal end of the rigid section ( 81 ) of the shaft ( 80 ) radially from the shaft ( 80 ) outwardly projecting control disk ( 88 ) is formed with a central recess, wherein the rods at its proximal end with the control disc ( 88 ) along the edge of the central recess of the control disk ( 88 ) are connected. Tubular shaft ( 80 ) according to claim 15, characterized in that the control disk ( 88 ) in an outer ring ( 89 ) is arranged from an elastic material, which in particular has a non-slip surface, wherein a central recess of the outer ring one, in particular elliptical or spitzelliptische contour ( 90 ), which at a tilt of the outer ring ( 89 ' ) with the control disk ( 88 ' ) in at least one tilting direction a clamping protection of the outer ring ( 89 ' ) on the shaft ( 80 ) causes. Tubular shaft ( 80 ) according to claim 15 or 16, characterized in that a tilting axis ( 91 ) is provided, which the control disc ( 88 ) at two opposite points with the shaft ( 80 ), whereby the control disk ( 88 ) about the tilt axis ( 91 ) opposite the shaft ( 80 ) is tiltable. Tubular shaft ( 80 ) according to claim 17, characterized in that an inner ring ( 92 ) provided at two opposite points with the tilting axis ( 91 ), the control disk ( 88 ) opposite the inner ring ( 92 ) about the tilt axis ( 91 ) and in particular about a longitudinal axis of the shaft ( 80 ) is rotatable, wherein the inner ring ( 92 ) is torsionally connected to the proximal end of a tube of the shaft lying opposite the rods. Tubular shaft ( 100 ) according to one of claims 2 to 7, characterized in that as a control device ( 104a . 105 - 115 ) at the proximal end of the rigid section ( 101 ) of the shaft ( 100 ) radially from the shaft ( 100 ) outwardly projecting control element ( 106 ) with central recess ( 107 ) is formed, wherein in the recess ( 107 ) at least one finger ( 108 ) radially inwardly through an opening ( 104a ) in the outer tube ( 104 ) of the shaft ( 100 ) or is feasible and with at least one rod of the middle tube ( 105 ) is connected or connectable. Tubular shaft ( 100 ) according to claim 19, characterized in that the operating element ( 106 ) on the shaft ( 100 ) with respect to a longitudinal axis of the shaft ( 100 ) Is arranged linearly movable. Tubular shaft ( 100 ) according to claim 19 or 20, characterized in that the operating element ( 106 ) on the shaft ( 100 ) about a longitudinal axis of the shaft ( 100 ) is rotatably arranged, wherein the at least one finger ( 108 ) in a recording ( 109 ) in the control element ( 106 ) is arranged retractable. Tubular shaft ( 100 ) according to claim 21, characterized in that the at least one finger ( 108 ) is spring preloaded or a finger actuation element for retracting and extending the at least one finger ( 108 ) is provided. Tubular shaft ( 100 ) according to claim 21 or 22, characterized in that openings ( 104a ) in the outer tube of the shaft ( 100 ) for receiving a finger ( 108 ) of the operating element ( 106 ) in the circumferential direction at a distance of 36 °, 45 °, 60 ° or 90 ° from each other, wherein the rods at the same distances from each other in the circumferential direction below the openings ( 104a ) are arranged. Tubular shaft ( 100 ) according to one of claims 21 to 23, characterized in that the operating element ( 106 ) with symbols ( 111 ), which indicate a bending direction, wherein a relative to the shaft ( 100 ) rotationally fixed housing ( 113 ) for the operating element ( 106 ) is provided, the at least one window ( 114 . 115 ), which in each position of the operating element ( 106 ) so with the control ( 106 ) that a symbol ( 111 ) in at least one window ( 114 . 115 ), which shows the direction of the bend of the distal bendable region (FIG. 102 ) in the current state of rotation of the operating element ( 106 ). Surgical instrument with a tubular shaft ( 30 . 50 . 80 . 100 ) according to any one of claims 1 to 24.

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