DE102010016538A1 - Surgical pipe shaft instrument for use during endoscopic surgical interventions, has positioning device formed such that no force is exerted on insulation shaft if insulation shaft occupies distal position relative to tubular shaft - Google Patents

Abstract

The instrument has a force transmitting member (44) moveably arranged in a tubular shaft (42), and tool elements (30, 32) moveably arranged at a distal end of the shaft. The force transmitting member is coupled moveably with a grip portion for transferring an operating force of the grip portion to the shaft. An insulation shaft positioning device holds an insulation shaft (108) in a distal position relative to the shaft. The positioning device is formed such that no force is exerted on the insulation shaft if the insulation shaft occupies the distal position relative to the shaft.

Description

The present invention relates to a surgical tubular shaft instrument having a handle part and a shaft part, which shaft part comprises a tubular shaft, a force transmission member movably mounted therein and at least one tool element movably mounted at a distal end of the shaft, which shaft is at least partially surrounded by a tubular isolation shaft and which power transmission member is movably coupled to the handle portion and to the at least one tool member for transmitting an actuating force from the handle portion to the at least one tool member for moving the same relative to the shaft.

Surgical tubular shaft instruments of the type described above are used in particular in endoscopic surgical procedures. If they are designed as reusable tubular shaft instruments, it is possible, depending on the construction of the instrument, in particular to completely separate the shaft, the insulation shaft and the force transmission member for cleaning the instrument. After cleaning, the instrument is reassembled and sterilized. If the insulation stem and stem are not made of the same materials, they will expand to different extents during the steam sterilization process. Therefore, the isolation shaft can not be firmly clamped to the shaft, otherwise it may be damaged by steam sterilization. The consequence of this is that the isolation shaft of a demountable instrument must be mounted with sufficient axial play on the shaft. This in turn has the disadvantage that arise between the shaft and the insulation shaft gaps in which body tissue and suture can be trapped or caught.

It is therefore an object of the present invention to improve a surgical tubular shaft instrument of the type described above so that, despite complete dismantling of the instrument for cleaning purposes, the risk of pinching suture or tissue in the gap between the isolation shaft and shaft is minimized.

This object is achieved according to the invention in a surgical tubular shaft instrument of the type described above in that an Isolationsschaftpositioniereinrichtung is provided, which holds the isolation shaft in a most distal position relative to the shaft.

Providing such Isolationsschaftpositioniereinrichtung has the advantage that the isolation shaft is held by her in its most distal position relative to the shaft. Depending on the design of the shaft and insulation shank can be achieved so that the isolation shaft abuts the distal side gap-free or substantially gap-free on the shaft. In this way, body tissue or sutures can be prevented from being pinched or caught in a gap between the isolation shaft and the shaft, which is a great danger in conventional collapsible surgical tubular shaft instruments since, as described, the isolation shaft is axially slack must be mounted on the shaft to prevent damage during the sterilization process. In other words, the isolation shaft positioning device makes it possible, if at all, to form a gap at the proximal end of the isolation shaft between it and the shaft, since such an end region of the isolation shaft is normally located outside the patient's body, and in particular even in the grip part of the instrument, so that the danger the pinching of body tissue or suture does not exist in a proximally formed gap between insulation stem and shaft. A length compensation, for example, by the Isolationsschaftpositioniereinrichtung done in a simple manner, in particular to compensate for manufacturing tolerances in the production of the insulation shank.

It is advantageous if a stop acting in the proximal direction is provided in the region of a distal end of the shaft and if the isolation shaft positioning device holds a distal end of the isolation shaft against the stop in a working position. This ensures that, in principle, no gap is formed between the insulating shaft and the stop, since the insulating shaft positioning device holds the insulating shaft against the stop in abutment. In particular, the abutment can be formed by a single or multistage recess at the distal end or at a distal end region of the shaft.

It is favorable if the isolation shaft positioning device is designed such that it exerts no force on the isolation shaft when it assumes its most distal position relative to the shaft. In this way, the isolation shaft is held force-free in its most distal position, so that potentially damaging forces acting on a distal end of the isolation shaft can be avoided.

According to a further preferred embodiment of the invention may further be provided that the Isolationsschaftpositioniereinrichtung is designed such that it exerts a biasing force on the isolation shaft when it assumes its most distal position relative to the shaft. This embodiment has the particular advantage that even if the tubular shaft instrument is inserted through a sealing element of a trocar or otherwise causes frictional forces on the isolation shaft, it is held in its most distal position due to the biasing force. The necessary biasing force can be adjusted individually by appropriate design of Isolationsschaftpositioniereinrichtung and take into account the frictional forces acting of Trochardichtungen during insertion and movement of the instrument.

Preferably, the isolation shaft is movable against a force action of the Isolationsschaftpositioniereinrichtung relative to the shaft in the proximal direction. In this way, it is possible that, in particular in a thermal expansion of the insulation shank, this can expand against the action of Isolationsschaftpositioniereinrichtung, without being damaged. Furthermore, the embodiment has the advantage that the isolation shaft positioning device can move the isolation shaft back into its most distal position as a result of a proximal deflection.

It is particularly favorable when the isolation shaft positioning device comprises a restoring device which exerts a restoring force acting in the distal direction on the isolation shaft when it is deflected in the proximal direction from its most distal position relative to the shaft. Optionally, the restoring device can also be designed such that even in the most distal position of the isolation shaft, a restoring force directed in the distal direction acts relative to the shaft. The restoring device makes it possible to deflect the isolation shaft from its most distal position relative to the shaft only by exerting a force acting in the proximal direction.

The structure of the restoring device can be made particularly simple if it comprises at least one restoring member which acts directly or indirectly on the shaft and acts in the distal direction. Optionally, it may also form part of the shaft or a portion thereof. The restoring member is preferably adapted to exert a force acting in the distal direction, in particular as a result of a deflection of the isolation shaft relative to the shaft from the most distal position in the proximal direction.

Particularly simple is the construction of the tubular shaft instrument, when the restoring device is arranged acting on a proximal end of the insulation shaft. In this way, complicated and possibly difficult to clean components of the surgical Rohrschaftinstruments can be arranged in the region of a proximal end of the insulation shaft and optionally optionally protected against contamination.

The restoring device preferably comprises a feed element resting against the proximal end of the insulation shank. The feed member itself need not necessarily be designed to exert itself a force acting in the distal direction of the insulation shaft. It may in particular be designed as a force transmission member to transmit a force exerted by a return member force on the insulation shank.

Conveniently, the at least one return member is located on the proximal side of the feed member. In this way, it can initiate a feed force pointing in the distal direction into the feed element, which in turn can transmit the feed force to the insulation shaft.

Preferably, the at least one return member is formed in the form of an elastic or spring-elastic element. Of course, two, three or more return members may be provided, which form part of Isolationsschaftpositioniereinrichtung. An elastic or resilient design of the return member makes it possible to increase a restoring force as a function of the deflection.

It can also be advantageous if the return member is designed in the form of an elastically resilient bellows. This can be integrated in particular in the isolation shaft or arranged or formed at one end thereof. In particular, it makes it possible to ensure that the entire section of the shaft to be covered by the insulation shaft can actually be covered. This is also possible in particular if immovable stops, that is to say stationary stops, are provided on the shaft, between which the insulation shaft is arranged and bears against them. In particular, the bellows can compensate for different length expansions of the shaft and insulation shaft, in particular when passing through a sterilization process.

Preferably, the at least one return member is relaxed and exerts no force on the isolation shaft when it assumes its most distal position relative to the shaft. It can thus be achieved that no forces are exerted on in particular a distal end of the isolation shaft when it assumes its most distal position relative to the shaft.

It may be favorable, however, if the at least one restoring member is biased in the distal direction and exerts a holding force on the isolation shaft, if this is its most distal Position relative to the shank occupies. This ensures that the isolation shaft maintains its most distal position even when the instrument is inserted with its shaft, for example, through a trocar of a trocar, which exerts frictional forces on the isolation shaft. In particular, an adaptation to different Trochardichtungen can be achieved by appropriate choice of the return member.

It is advantageous if the at least one return element is arranged laterally offset with respect to a longitudinal axis of the insulation shank. This at least theoretically makes it possible to retrofit existing tubular shaft instruments with an isolation shaft positioning device. Furthermore, the function of the same can also be decoupled from other elements which are arranged or formed coaxially with respect to a longitudinal axis of the shaft.

Conveniently, the Isolationsschaftpositioniereinrichtung is arranged on the handle part. In this way, already available on the market shafts with insulation shafts with such a handle part, which comprises a Isolationsschaftpositioniereinrichtung be coupled in order to achieve the above-described advantages of the invention.

Alternatively, it may also be advantageous if the Isolationsschaftpositioniereinrichtung is arranged or formed on the isolation shaft. Of course, it is also possible to provide Isolationsschaftpositioniereinrichtungen, which are arranged or formed both on the insulating shank and on the handle part. Providing the isolation shaft positioning means on the isolation shaft has the advantage that only the isolation shaft needs to be replaced in order to equip conventional collapsible tubular shaft instruments with an isolation shaft positioning device in order to achieve the advantages described above.

The preparation of the Isolationsschaftpositioniereinrichtung is particularly simple when it is integrally formed with the insulating shank. For example, a portion of the insulation shaft may be formed as a bellows or any other resilient or elastic element. Integrally formed does not necessarily mean that the insulation shaft is made only of a material. In particular, it may be made in sections of different materials, which may also have different elastic properties. In particular, individual sections of the insulation shank can be made of resilient or elastic material, for example of an elastomer.

The insulating shaft positioning device can be produced particularly easily if it comprises or forms a shaft section extending in the longitudinal direction of the insulating shaft. For example, the Isolationsschaftpositioniereinrichtung may be formed by a formed of an elastomer shaft portion of the insulation shaft.

The insulating shaft positioning device can be made particularly compact if the at least one return element forms the shaft section.

According to a further preferred embodiment of the invention, it may be provided that the insulation shank is made of an insulation shank material, that the shank portion is made of a shank portion material and that the shank portion material has a smaller thermal expansion coefficient than the sheath material. This design makes it possible to compensate for different expansion coefficients between shaft and insulation shank, so that destruction of the insulation shank is avoided when going through a sterilization process.

The tubular shaft instrument can be produced in a particularly simple and cost-effective manner if the insulating shaft material and / or the shaft section material is a plastic. In particular, the plastic is preferably electrically non-conductive and suitable to form an electrical insulation of the shaft.

Preferably, the distal end of the insulation shank is flat or substantially flat against the stop. In this way it can be prevented that forms a gap between the distal end of the insulation shaft and the stop of the shaft, in which body tissue or material can be caught or pinched.

It is advantageous if the distal end of the insulation shank rests against the stop without a gap or substantially gap-free. By such a gap-free system can be prevented that body tissue or suture can be caught or pinched in a gap between the distal end of the insulation shaft and the stop.

The tubular shaft instrument can be designed to be particularly stable if the stop is formed integrally with the shaft. In particular, the stop can be made of the same material as the shaft. Furthermore, it can be permanently connected permanently to the shaft, for example by gluing, soldering or welding.

It is advantageous if the stop has a stop surface pointing in the proximal direction includes. This abutment surface can serve, in particular, to define the most distal position of the isolation shaft relative to the shaft, for example as the position in which the distal end of the isolation shaft bears against the abutment surface. The stop can be produced in a particularly simple manner if the stop surface is designed in the form of an annular surface or at least part of an annular surface. In particular, a tubular insulating shaft with a distal end, which comprises a ring surface pointing in the distal direction, can create a particularly good surface and gap-free on the stop surface.

In order to avoid that suture or body tissue between the distal end of the insulation shank and the stop can be caught or pinched, it is advantageous if a distal end surface of the insulation shank rests flat and / or gap-free on the stop surface. This in turn prevents a gap between the end surface and the stop surface is formed, in which suture or body tissue can be caught or trapped.

The insulating shaft can be produced particularly easily if a distal end surface thereof is designed in the form of an annular surface or a part of an annular surface. Thus, it is possible to produce the insulation shank by cutting off a tubular or tubular endless material.

In principle, it would be possible to form the tubular shaft instrument with one or more tool elements, which are displaceable relative to the shaft parallel and / or transversely to its longitudinal axis. A drum or cutting tool can be formed particularly easily if the at least one tool element is mounted so as to be pivotable relative to the shaft about a pivot axis extending transversely to a longitudinal axis of the shaft.

In order to optimally protect in particular a mechanism for the articulation of the at least one tool element by means of the force transmission member, it is advantageous if the isolation shaft extends in the distal direction beyond the pivot axis. The insulation shaft can thus extend beyond a pivot point of the at least one tool element and in particular completely cover a coupling point or even a coupling piece for movably coupling the power transmission element and the at least one tool element. Thus, the risk of contamination of the instrument in particularly sensitive areas of a movable mounting of the at least one tool element can be minimized.

According to a preferred embodiment it can be provided, in particular also in the case of a surgical tubular shaft instrument of the type described in the introduction, that the shaft is made of a shaft material, that the insulation shaft is made of an insulation shank material and that the shaft material has a thermal expansion coefficient which corresponds to the thermal expansion coefficient of the shaft Insulating material corresponds or substantially corresponds. Such a design of the tubular shaft instrument ensures that even during a sterilization process, no forces act on the insulation shaft and thus a damage-free sterilization in the mounted state of the tubular shaft instrument is possible.

Furthermore, it may be favorable if the surgical tubular shaft instrument comprises at least one RF connection contact on the grip part, which is electrically conductively connected to the at least one tool element. When providing an RF connection contact, for example, a monopolar instrument can be formed. A bipolar instrument preferably requires two RF terminal contacts electrically isolated from one another, which are then electrically conductively connected to two tool elements at the distal end of the shaft, the two tool elements being electrically insulated from each other or designed to avoid short circuits. Such a tubular shaft instrument thus enables in particular a coagulation of body tissue when grasping and / or severing it.

It when the tubular shaft instrument comprises two relatively movable tool elements is particularly advantageous. It is conceivable to make both tool elements movable relative to the shaft. However, it is also possible to make only one movable relative to the shaft, so that both, however, are relatively movable as a result. Thus, in particular barrel instruments such as forceps or needle holder can be formed or cutting instruments such as endoscopic scissors in particular.

In order to improve the cleanability of the tubular shaft instrument, it is advantageous if the shaft and the grip part are detachably connectable to one another. To clean the tubular shaft instrument after a surgical procedure, the handle part can thus be separated from the shaft.

Thus, the shaft can be optimally cleaned, it is advantageous if the shaft, the insulating shaft and the power transmission member are releasably connectable to each other. Such a configuration makes it possible to clean the instrument, in particular the three parts mentioned, as Unit defining a shaft portion, to remove from each other, for example, to rid them of dirt in an instrument dishwasher. For sterilization purposes, the three parts mentioned can then be reconnected or coupled together, optionally also with a handle part. The dismountability of the shaft is particularly important because the outer diameter of the shafts can be in a range of less than 2 mm. If dirt is not completely removed between the insulation shaft and the shaft or even inside the shaft during the cleaning thereof, it or the germs present in it can pass into the body of a patient in the course of the use following a cleaning. This health risk for the patient can be avoided by the dismantling of the shaft part. Furthermore, can be replaced by the dismantling of the shaft part in a simple way, for example, a damaged insulation shank. A repair of a damaged insulation shank in a non-collapsible instrument can usually only be performed by the manufacturer or an external service provider, resulting in a temporary failure of the instrument. This usually involves higher repair costs. The dismantling thus allows easy replacement of the insulation shaft after damage by the user.

It is advantageous if the tubular shaft instrument comprises a coupling device for direct or indirect coupling of the force transmission member and the at least one tool element. The coupling device makes it possible to separate the power transmission member in a simple manner from at least one tool element or a Ankekeinheit in the form of a disposed between the power transmission member and the at least one tool element coupling element or corresponding coupling piece.

It is also favorable if the force transmission member and a handle member movably mounted on the actuating member are formed releasably connectable to each other. Thus, the power transmission member can be solved in particular for cleaning purposes of the handle part. Furthermore, the force transmission member can be moved relative to the shaft in the desired manner with the actuating member movably mounted on the handle part.

Furthermore, it is advantageous if the insulation shank and the grip part are detachably connectable to one another. For example, the insulation shaft can be detached from the grip part for cleaning purposes.

In order to improve handling of the tubular shaft instrument and to allow the greatest possible universal use thereof, it is expedient for the shaft and the grip part to be rotatable relative to each other about a longitudinal axis of the shaft. Thus, for example, in a cutting instrument, a cutting plane defined by the at least one tool element can be selectively rotated about the longitudinal axis of the shaft.

Preferably, the surgical tubing instrument is in the form of a monopolar or bipolar instrument. This allows a surgeon to coagulate body tissue, especially during holding, grasping or severing, by means of a radio frequency (RF) current to quench bleeding.

• 1. Chirurgisches Rohrschaftinstrument (10) mit einem Griffteil (12) und einem Schaftteil (14; 14'), welcher Schaftteil (14; 14') einen rohrförmigen Schaft (42), ein in diesem bewegbar gelagertes Kraftübertragungsglied (44) und mindestens ein an einem distalen Ende des Schafts (42) bewegbar gelagertes Werkzeugelement (32; 30', 32') umfasst, welcher Schaft (42) mindestens teilweise von einem rohrförmigen Isolationsschaft (108; 108'; 108''; 108''') umgeben ist und welches Kraftübertragungsglied (44) zum einen mit dem Griffteil (12) und zum anderen mit dem mindestens einen Werkzeugelement (32; 30', 32') bewegbar gekoppelt ist zum Übertragen einer Betätigungskraft vom Griffteil (12) auf das mindestens eine Werkzeugelement (32; 30', 32') zum Bewegen desselben relativ zum Schaft (42), dadurch gekennzeichnet, dass eine Isolationsschaftpositioniereinrichtung (116; 116'; 166''; 116''') vorgesehen ist, welche den Isolationsschaft (108; 108'; 108''; 108''') in einer distalsten Stellung relativ zum Schaft (42) hält.
• 2. Chirurgisches Rohrschaftinstrument nach Satz 1, dadurch gekennzeichnet, dass im Bereich eines distalen Endes (66; 66') des Schafts (42) ein in proximaler Richtung wirkender Anschlag (114) vorgesehen ist und dass die Isolationsschaftpositioniereinrichtung (116; 166'; 116''; 116''') in einer Arbeitsstellung ein distales Ende (110; 110'; 110''; 110''') des Isolationsschafts (108; 108'; 108''; 108''') am Anschlag (114) in Anlage hält.
• 3. Chirurgisches Rohrschaftinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass die Isolationsschaftpositioniereinrichtung (116; 116'; 166''; 116''') derart ausgebildet ist, dass sie keine Kraft auf den Isolationsschaft (108; 108'; 108''; 108''') ausübt, wenn er seine distalste Stellung relativ zum Schaft (42) einnimmt.
• 4. Chirurgisches Rohrschaftinstrument nach einem der Sätze 1 bis 3, dadurch gekennzeichnet, dass die Isolationsschaftpositioniereinrichtung (116; 116'; 166''; 116''') derart ausgebildet ist, dass sie eine vorspannende Kraft auf den Isolationsschaft (108; 108'; 108''; 108''') ausübt, wenn er seine distalste Stellung relativ zum Schaft (42) einnimmt.
• 5. Chirurgisches Rohrschaftinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass der Isolationsschaft (108; 108'; 108''; 108''') entgegen einer Kraftwirkung der Isolationsschaftpositioniereinrichtung (116; 116'; 166''; 116''') relativ zum Schaft (42) in proximaler Richtung bewegbar ist.
• 6. Chirurgisches Rohrschaftinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass die Isolationsschaftpositioniereinrichtung (116; 116'; 116'') eine Rückstelleinrichtung (164; 164'; 164'') umfasst, welche auf den Isolationsschaft (108; 108'; 108'') eine in distaler Richtung wirkende Rückstellkraft ausübt, wenn er in proximaler Richtung aus seiner distalsten Stellung relativ zum Schaft (42) ausgelenkt ist.
• 7. Chirurgisches Rohrschaftinstrument nach Satz 6, dadurch gekennzeichnet, dass die Rückstelleinrichtung (164; 164'; 164'') mindestens ein Rückstellglied (166; 166'; 166'') umfasst, welches direkt oder indirekt am Isolationsschaft (108; 108'; 108'') angreift und in distaler Richtung wirkt.
• 8. Chirurgisches Rohrschaftinstrument nach Satz 6 oder 7, dadurch gekennzeichnet, dass die Rückstellrichtung (164; 164') auf ein proximales Ende (140; 140') des Isolationsschafts (108; 108') wirkend angeordnet ist.
• 9. Chirurgisches Rohrschaftinstrument nach einem der Sätze 6 bis 8, dadurch gekennzeichnet, dass die Rückstellrichtung (164) ein am proximalen Ende des Isolationsschafts (108) anliegendes Vorschubglied (120) umfasst.
• 10. Chirurgisches Rohrschaftinstrument nach Satz 9, dadurch gekennzeichnet, dass das mindestens eine Rückstellglied (166) proximalseitig am Vorschubglied (120) anliegt.
• 11. Chirurgisches Rohrschaftinstrument nach einem der Sätze 7 bis 10, dadurch gekennzeichnet, dass das mindestens eine Rückstellglied (166; 166'; 166'') in Form eines elastischen oder federelastischen Elements ausgebildet ist.
• 12. Chirurgisches Rohrschaftinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass das Rückstellglied (166'; 166'') in Form eines elastisch federnden Faltenbalgs (162; 162') ausgebildet ist.
• 13. Chirurgisches Rohrschaftinstrument nach einem der Sätze 7 bis 12, dadurch gekennzeichnet, dass das mindestens eine Rückstellglied (166; 166'; 166'') entspannt ist und keine Kraft auf den Isolationsschaft (108; 108'; 108''; 108''') ausübt, wenn dieser seine distalste Stellung relativ zum Schaft (42) einnimmt.
• 14. Chirurgisches Rohrschaftinstrument nach einem der Sätze 7 bis 13, dadurch gekennzeichnet, dass das mindestens eine Rückstellglied (166; 166'; 166'') in distaler Richtung wirkend vorgespannt ist und eine Haltekraft auf den Isolationsschaft (108; 108'; 108'') ausübt, wenn dieser seine distalste Stellung relativ zum Schaft (42) einnimmt.
• 15. Chirurgisches Rohrschaftinstrument nach einem der Sätze 7 bis 14, dadurch gekennzeichnet, dass das mindestens eine Rückstellglied (166) seitlich versetzt bezogen auf eine Längsachse (18) des Isolationsschafts (108) angeordnet ist.
• 16. Chirurgisches Rohrschaftinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass die Isolationsschaftpositioniereinrichtung (116) am Griffteil (12) angeordnet oder ausgebildet ist.
• 17. Chirurgisches Rohrschaftinstrument nach einem der Sätze 1 bis 16, dadurch gekennzeichnet, dass die Isolationsschaftpositioniereinrichtung (116'; 116''; 166''') am Isolationsschaft (108'; 108''; 108''') angeordnet oder ausgebildet ist.
• 18. Chirurgisches Rohrschaftinstrument nach Satz 17, dadurch gekennzeichnet, dass das die Isolationsschaftpositioniereinrichtung (116'; 116''; 116''') einstückig mit dem Isolationsschaft (108'; 108''; 108''') ausgebildet ist.
• 19. Chirurgisches Rohrschaftinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass die Isolationsschaftpositioniereinrichtung (116'; 116''; 116''') einen sich in Längsrichtung (18) des Isolationsschafts (108'; 108''; 108''') erstreckenden Schaftabschnitt (160; 160'; 160'') desselben umfasst oder bildet.
• 20. Chirurgisches Rohrschaftinstrument nach Satz 19, dadurch gekennzeichnet, dass das mindestens eine Rückstellglied (166'; 166'') den Schaftabschnitt (160; 160') bildet.
• 21. Chirurgisches Rohrschaftinstrument nach Satz 19 oder 20, dadurch gekennzeichnet, dass der Isolationsschaft (108'; 108''; 108''') aus einem Isolationsschaftmaterial hergestellt ist, dass der Schaftabschnitt (160; 160'; 160'') aus einem Schaftabschnittmaterial hergestellt ist und dass das Schaftabschnittmaterial einen kleineren thermischen Ausdehnungskoeffizienten aufweist als das Isolationsschaftmaterial.
• 22. Chirurgisches Rohrschaftinstrument nach Satz 21, dadurch gekennzeichnet, dass das Isolationsschaftmaterial und/oder das Schaftabschnittmaterial ein Kunststoff ist.
• 23. Chirurgisches Rohrschaftinstrument nach einem der Sätze 2 bis 22, dadurch gekennzeichnet, dass das distale Ende (110; 110'; 110''; 110''') des Isolationsschafts (108; 108'; 108''; 108''') flächig oder im Wesentlichen flächig am Anschlag (114) anliegt.
• 24. Chirurgisches Rohrschaftinstrument nach einem der Sätze 2 bis 23, dadurch gekennzeichnet, dass das distale Ende (110; 110'; 110''; 110''') des Isolationsschafts spaltfrei oder im Wesentlichen spaltfrei am Anschlag (114) anliegt.
• 25. Chirurgisches Rohrschaftinstrument nach einem der Sätze 2 bis 24, dadurch gekennzeichnet, dass der Anschlag (114) einstückig mit dem Schaft (42) ausgebildet ist.
• 26. Chirurgisches Rohrschaftinstrument nach einem der Sätze 2 bis 25, dadurch gekennzeichnet, dass der Anschlag (114) eine in proximaler Richtung weisende Anschlagfläche (70) umfasst.
• 27. Chirurgisches Rohrschaftinstrument nach Satz 26, dadurch gekennzeichnet, dass die Anschlagfläche (70) in Form einer Ringfläche oder mindestens eines Teils einer Ringfläche ausgebildet ist.
• 28. Chirurgisches Rohrschaftinstrument nach Satz 26 oder 27, dadurch gekennzeichnet, dass eine distale Endfläche (112; 112'; 112''; 112''') des Isolationsschafts (108) flächig und/oder spaltfrei an der Anschlagfläche (70) anliegt.
• 29. Chirurgisches Rohrschaftinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass eine distale Endfläche (112; 112'; 112''; 112''') des Isolationsschafts in Form einer Ringfläche oder eines Teils einer Ringfläche ausgebildet ist.
• 30. Chirurgisches Rohrschaftinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass das mindestens eine Werkzeugelement (32; 30', 32') um eine quer zu einer Längsachse (18) des Schafts (42) verlaufende Schwenkachse (76) relativ zum Schaft (18) verschwenkbar gelagert ist.
• 31. Chirurgisches Rohrschaftinstrument nach Satz 30, dadurch gekennzeichnet, dass sich der Isolationsschaft (108; 108'; 109''; 108''') in distaler Richtung über die Schwenkachse (76) hinaus erstreckt.
• 32. Chirurgisches Rohrschaftinstrument nach einem der voranstehenden Sätze, insbesondere nach dem Oberbegriff des Satzes 1, dadurch gekennzeichnet, dass der Schaft (42) aus einem Schaftmaterial hergestellt ist, dass der Isolationsschaft (108''') aus einem Isolationsschaftmaterial hergestellt ist und dass das Schaftmaterial einen thermischen Ausdehnungskoeffizienten aufweist, welcher dem thermischen Ausdehnungskoeffizienten des Isolationsschaftmaterials entspricht oder im Wesentlichen entspricht.
• 33. Chirurgisches Rohrschaftinstrument nach einem der voranstehenden Sätze, gekennzeichnet durch mindestens einen HF-Anschlusskontakt (28) am Griffteil (12), welcher elektrisch leitend mit dem mindestens einen Werkzeugelement (30, 32; 30', 32') in Verbindung steht.
• 34. Chirurgisches Rohrschaftinstrument nach einem der voranstehenden Sätze, gekennzeichnet durch zwei relativ zueinander bewegbare Werkzeugelemente (30, 32; 30', 32').
• 35. Chirurgisches Rohrschaftinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass der Schaft (42) und der Griffteil (12) miteinander lösbar verbindbar ausgebildet sind.
• 36. Chirurgisches Rohrschaftinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass der Schaft (42), der Isolationsschaft (108; 108'; 108''; 108''') und das Kraftübertragungsglied (44) miteinander lösbar verbindbar sind.
• 37. Chirurgisches Rohrschaftinstrument nach einem der voranstehenden Sätze, gekennzeichnet durch eine Kopplungseinrichtung (38) zum direkten oder indirekten Koppeln des Kraftübertragungsglieds (44) und des mindestens einen Werkzeugelements (30, 32; 30', 32').
• 38. Chirurgisches Rohrschaftinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass das Kraftübertragungsglied (44) und ein am Griffteil (12) bewegbar gelagertes Betätigungsglied (22) miteinander lösbar verbindbar ausgebildet sind.
• 39. Chirurgisches Rohrschaftinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass der Isolationsschaft (108; 108'; 108''; 108''') und der Griffteil (12) miteinander lösbar verbindbar ausgebildet sind.
• 40. Chirurgisches Rohrschaftinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass der Schaft (42) und der Griffteil (12) um eine Längsachse (18) des Schafts (42) relativ zueinander verdrehbar ausgebildet sind.
• 41. Chirurgisches Rohrschaftinstrument nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass es in Form eines Monopolar- oder Bipolarinstruments (10) ausgebildet ist.

The above description thus includes in particular the embodiments of a surgical tubular shaft instrument defined below in the form of numbered sets:

• 1. Surgical tubular shaft instrument ( 10 ) with a handle part ( 12 ) and a shank part ( 14 ; 14 ' ), which shaft part ( 14 ; 14 ' ) a tubular shaft ( 42 ), in this movably mounted force transmission member ( 44 ) and at least one at a distal end of the shaft ( 42 ) movably mounted tool element ( 32 ; 30 ' . 32 ' ), which shaft ( 42 ) at least partially from a tubular insulation shank ( 108 ; 108 '; 108 ''; 108 ''' ) is surrounded and which force transmission member ( 44 ) on the one hand with the handle part ( 12 ) and on the other hand with the at least one tool element ( 32 ; 30 ' . 32 ' ) is movably coupled to transmit an actuating force from the handle part ( 12 ) on the at least one tool element ( 32 ; 30 ' . 32 ' ) for moving the same relative to the shaft ( 42 ), characterized in that an isolation shaft positioning device ( 116 ; 116 '; 166 ''; 116 ''' ) is provided, which the isolation shaft ( 108 ; 108 '; 108 ''; 108 ''' ) in a most distal position relative to the shaft ( 42 ) holds.
• 2. Surgical tubular shaft instrument by set 1 , characterized in that in the region of a distal end ( 66 ; 66 ' ) of the shaft ( 42 ) a stop acting in the proximal direction ( 114 ) and that the isolation shaft positioning device ( 116 ; 166 '; 116 ''; 116 ''' ) in a working position a distal end ( 110 ; 110 '; 110 ''; 110 ''' ) of the isolation shaft ( 108 ; 108 '; 108 ''; 108 ''' ) at the stop ( 114 ) holds in plant.
• 3. Surgical tubular shaft instrument according to one of the preceding sentences, characterized in that the Isolationsschaftpositioniereinrichtung ( 116 ; 116 '; 166 ''; 116 ''' ) is designed such that it does not exert any force on the insulation shaft ( 108 ; 108 '; 108 ''; 108 ''' ) when it is in its most distal position relative to the shaft ( 42 ) occupies.
• 4. Surgical tubular shaft instrument according to one of the sentences 1 to 3, characterized in that the Isolationsschaftpositioniereinrichtung ( 116 ; 116 '; 166 ''; 116 ''' ) is designed such that it has a prestressing force on the insulation shaft ( 108 ; 108 '; 108 ''; 108 ''' ) when it is in its most distal position relative to the shaft ( 42 ) occupies.
• 5. Surgical tubular shaft instrument according to one of the preceding sentences, characterized in that the isolation shaft ( 108 ; 108 '; 108 ''; 108 ''' ) against a force effect of the isolation shaft positioning device ( 116 ; 116 '; 166 ''; 116 ''' ) relative to the shaft ( 42 ) is movable in the proximal direction.
• 6. Surgical tubular shaft instrument according to one of the preceding sentences, characterized in that the Isolationsschaftpositioniereinrichtung ( 116 ; 116 '; 116 '' ) a reset device ( 164 ; 164 '; 164 '' ), which on the isolation shaft ( 108 ; 108 '; 108 '' ) exerts a distally acting restoring force when it moves in the proximal direction from its most distal position relative to the shaft ( 42 ) is deflected.
• 7. Surgical tubular shaft instrument according to sentence 6, characterized in that the restoring device ( 164 ; 164 '; 164 '' ) at least one reset member ( 166 ; 166 '; 166 '' ), which directly or indirectly at the isolation shaft ( 108 ; 108 '; 108 '' ) and acts in the distal direction.
• 8. Surgical tubular shaft instrument according to sentence 6 or 7, characterized in that the return direction ( 164 ; 164 ' ) to a proximal end ( 140 ; 140 ' ) of the isolation shaft ( 108 ; 108 ' ) is arranged acting.
• 9. Surgical tubular shaft instrument according to one of the sentences 6 to 8, characterized in that the return direction ( 164 ) at the proximal end of the isolation shaft ( 108 ) adjacent feed member ( 120 ).
• 10. Surgical tubular shaft instrument according to sentence 9, characterized in that the at least one return member ( 166 ) proximally on the feed member ( 120 ) is present.
• 11. Surgical tubular shaft instrument according to one of the sentences 7 to 10, characterized in that the at least one return member ( 166 ; 166 '; 166 '' ) is formed in the form of an elastic or spring-elastic element.
• 12. Surgical tubular shaft instrument according to one of the preceding sentences, characterized in that the return member ( 166 '; 166 '' ) in the form of an elastically resilient bellows ( 162 ; 162 ' ) is trained.
• 13. Surgical tubular shaft instrument according to one of the sentences 7 to 12 , characterized in that the at least one return member ( 166 ; 166 '; 166 '' ) is relaxed and no force on the isolation ( 108 ; 108 '; 108 ''; 108 ''' ), when this is its most distal position relative to the shaft ( 42 ) occupies.
• 14. Surgical tubular shaft instrument according to one of the sentences 7 to 13, characterized in that the at least one return member ( 166 ; 166 '; 166 '' ) is biased acting in the distal direction and a holding force on the isolation shaft ( 108 ; 108 '; 108 '' ), when this is its most distal position relative to the shaft ( 42 ) occupies.
• 15. Surgical tubular shaft instrument according to one of the sentences 7 to 14, characterized in that the at least one return member ( 166 ) offset laterally relative to a longitudinal axis ( 18 ) of the isolation shaft ( 108 ) is arranged.
• 16. Surgical tubular shaft instrument according to one of the preceding sentences, characterized in that the Isolationsschaftpositioniereinrichtung ( 116 ) on the handle part ( 12 ) is arranged or formed.
• 17. Surgical tubular shaft instrument according to one of the sentences 1 to 16, characterized in that the Isolationsschaftpositioniereinrichtung ( 116 '; 116 ''; 166 ''' ) at the isolation shaft ( 108 '; 108 ''; 108 ''' ) is arranged or formed.
• 18. Surgical tubular shaft instrument according to sentence 17, characterized in that the Isolationsschaftpositioniereinrichtung ( 116 '; 116 ''; 116 ''' ) in one piece with the insulation shank ( 108 '; 108 ''; 108 ''' ) is trained.
• 19. Surgical tubular shaft instrument according to one of the preceding sentences, characterized in that the Isolationsschaftpositioniereinrichtung ( 116 '; 116 ''; 116 ''' ) in the longitudinal direction ( 18 ) of the isolation shaft ( 108 '; 108 ''; 108 ''' ) extending shank portion ( 160 ; 160 '; 160 '' ) of the same includes or forms.
• 20. Surgical tubular shaft instrument set 19 , characterized in that the at least one return member ( 166 '; 166 '' ) the shank portion ( 160 ; 160 ' ).
• 21. Surgical tubular shaft instrument according to sentence 19 or 20, characterized in that the isolation shaft ( 108 '; 108 ''; 108 ''' ) is made of an insulation material, that the shaft portion ( 160 ; 160 '; 160 '' ) is made of a shank portion material and that the shank portion material has a smaller coefficient of thermal expansion than the insulating sheath material.
• 22. Surgical tubular shaft instrument according to sentence 21, characterized in that the insulation shank material and / or the shank portion material is a plastic.
• 23. Surgical tubular shaft instrument according to one of the sentences 2 to 22, characterized in that the distal end ( 110 ; 110 '; 110 ''; 110 ''' ) of the isolation shaft ( 108 ; 108 '; 108 ''; 108 ''' ) flat or substantially flat at the stop ( 114 ) is present.
• 24. Surgical tubular shaft instrument according to one of the sentences 2 to 23, characterized in that the distal end ( 110 ; 110 '; 110 ''; 110 ''' ) of the isolation shaft gap-free or substantially gap-free at the stop ( 114 ) is present.
• 25. Surgical tubular shaft instrument according to one of the sentences 2 to 24, characterized in that the stop ( 114 ) in one piece with the shaft ( 42 ) is trained.
• 26. Surgical tubular shaft instrument according to one of the sentences 2 to 25, characterized in that the stop ( 114 ) a stop surface pointing in the proximal direction ( 70 ).
• 27. Surgical tubular shaft instrument according to sentence 26, characterized in that the stop surface ( 70 ) is formed in the form of an annular surface or at least a part of an annular surface.
• 28. Surgical tubular shaft instrument according to sentence 26 or 27, characterized in that a distal end surface ( 112 ; 112 '; 112 ''; 112 ''' ) of the isolation shaft ( 108 ) flat and / or gap-free at the stop surface ( 70 ) is present.
• 29. Surgical tubular shaft instrument according to one of the preceding sentences, characterized in that a distal end surface ( 112 ; 112 '; 112 ''; 112 ''' ) of the insulation shank in the form of an annular surface or a part of an annular surface is formed.
• 30. Surgical tubular shaft instrument according to one of the preceding sentences, characterized in that the at least one tool element ( 32 ; 30 ' . 32 ' ) about a longitudinal axis ( 18 ) of the shaft ( 42 ) running pivot axis ( 76 ) relative to the shaft ( 18 ) is pivotally mounted.
• 31. Surgical tubular shaft instrument according to sentence 30, characterized in that the isolation shaft ( 108 ; 108 '; 109 ''; 108 ''' ) in the distal direction over the pivot axis ( 76 ) extends.
• 32. A surgical tubular shaft instrument according to one of the preceding sentences, in particular according to the preamble of the sentence 1, characterized in that the shaft ( 42 ) is made of a shank material that the insulation shank ( 108 ''' ) is made of an insulating sheath material and that the shank material has a thermal expansion coefficient which corresponds to the thermal expansion coefficient of the insulating shank material or substantially corresponds.
• 33. Surgical tubular shaft instrument according to one of the preceding sentences, characterized by at least one RF connection contact ( 28 ) on the handle part ( 12 ), which is electrically conductive with the at least one tool element ( 30 . 32 ; 30 ' . 32 ' ).
• 34. Surgical tubular shaft instrument according to one of the preceding sentences, characterized by two relatively movable tool elements ( 30 . 32 ; 30 ' . 32 ' ).
• 35. Surgical tubular shaft instrument according to one of the preceding sentences, characterized in that the shaft ( 42 ) and the handle part ( 12 ) are formed releasably connectable to each other.
• 36. Surgical tubular shaft instrument according to one of the preceding sentences, characterized in that the shaft ( 42 ), the isolation ( 108 ; 108 '; 108 ''; 108 ''' ) and the force transmission member ( 44 ) are releasably connectable to each other.
• 37. Surgical tubular shaft instrument according to one of the preceding sentences, characterized by a coupling device ( 38 ) for direct or indirect coupling of the power transmission member ( 44 ) and the at least one tool element ( 30 . 32 ; 30 ' . 32 ' ).
• 38. Surgical tubular shaft instrument according to one of the preceding sentences, characterized in that the force transmission member ( 44 ) and on the handle part ( 12 ) movably mounted actuator ( 22 ) are formed releasably connectable to each other.
• 39. Surgical tubular shaft instrument according to one of the preceding sentences, characterized in that the isolation shaft ( 108 ; 108 '; 108 ''; 108 ''' ) and the handle part ( 12 ) are formed releasably connectable to each other.
• 40. Surgical tubular shaft instrument according to one of the preceding sentences, characterized in that the shaft ( 42 ) and the handle part ( 12 ) about a longitudinal axis ( 18 ) of the shaft ( 42 ) are formed rotatable relative to each other.
• 41. Surgical tubular shaft instrument according to one of the preceding sentences, characterized in that it is in the form of a monopolar or bipolar instrument ( 10 ) is trained.

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

1 : An overall perspective view of a first embodiment of a surgical tubular shaft instrument;

2 FIG. 4 is a partially broken perspective view of a distal end portion of the in FIG 1 shown tubular shaft instruments;

3 : an exploded view of the distal end portion of the in 1 shown tubular shaft instruments;

4A FIG. 2 is a partially broken sectional view of the distal end portion of the tubular shaft instrument in FIG 1 illustrated closed position of the tool elements;

4B : a view analog 4A in an open position of the tool elements;

5 FIG. 2 is a partially sectioned view of a proximal end portion of the in FIG 1 illustrated pipe sheep instruments;

6 a sectional view taken along line 6-6 in 1 ;

7 : a view analog 2 a second embodiment of a surgical Rohrschaftinstruments;

8th : an exploded view of the distal end portion of the in 8th illustrated second embodiment;

9A FIG. 2 is a partially broken longitudinal sectional view of the distal end portion of FIG 8th illustrated embodiment in a closed position of the tool elements;

9B : a view analog 10A in an open position of the tool elements;

10A a longitudinal sectional view of another embodiment of an insulation shank;

10B a longitudinal sectional view of another embodiment of an insulation shank; and

10C a longitudinal sectional view of yet another embodiment of an isolation shaft.

In 1 is an example of a surgical instrument 10 represented in the form of a collapsible tubular shaft instrument. It includes a handle part 12 and a detachable with this connectable shaft part 14 , at the distal end of a tool 16 is arranged.

The handle part 12 includes a transverse to a longitudinal axis 18 of the shaft part 14 protruding holding elements 20 and a proximal side of the same and movably mounted relative to this actuator 22 , The holding element 20 and the actuator 22 are each with a finger ring 24 respectively 26 equipped, which are also called eyes. An operator can do so with two fingers of one hand the instrument 10 hold and use.

The instrument 10 can be designed as a monopolar or as a bipolar and includes for this purpose a connection contact 28 , which from the handle part 12 protruding substantially in the proximal direction and can be connected to a connecting cable to the instrument 10 to connect to a high frequency generator, not shown. In a manner not shown is the terminal contact 28 with the tool 16 electrically connected.

To form a Bipolarinstruments are optionally also two terminals 28 providable, which are then each electrically isolated from each other and each with a tool element 30 respectively 32 of the tool 16 are electrically connected.

Pointing in the distal direction is on the handle part 12 a so-called turning star 34 around the longitudinal axis 18 kept rotatable. The rotary star 34 forms, inter alia, an outer housing for a total of three coupling devices 36 . 38 and 40 to the handle part 12 and a shaft part 14 to pair. The coupling devices 36 . 38 and 40 will be described in detail below.

The shaft part 14 includes a carrying function performing shaft 42 which is coaxial with the longitudinal axis 18 extends and is tubular. Inside the shaft 42 is parallel to the longitudinal axis 18 slidably a power transmission member 44 stored in the form of a push and pull rod. The power transmission element 44 has a spherical proximal end 46 on which in a corresponding admission 48 of the actuating element 22 is held movable. The spherical end 46 and the recording 48 form the coupling device 38 for coupling the power transmission member 44 with the handle part 12 ,

The shaft 42 is a total of two parts and comprises a tubular portion 50 and a tool section 52 , An inside diameter of the section 50 extends slightly spaced from its distal end 54 With its inner diameter pointing in the distal direction in one stage and thus forms a distal-facing annular surface 56 out. The tool section 52 is formed substantially in the form of a short sleeve whose outer diameter tapers in a single stage towards its proximal end and an annular surface pointing in the proximal direction 58 Are defined. Proximalseitig of the ring surface 58 forms the tool section 52 a coupling section 60 coming from distally in the section 50 is insertable until the annular surface 58 at the end 54 strikes.

The tool section 52 is with a longitudinal slot 62 provided which extends from a proximal end 64 to a distal end 66 the same extends. On one side of the longitudinal slot 62 is from the distal end 66 protruding a stationary tool element 30 formed, which is a cutting edge 68 Are defined. Something proximal to the distal end 66 an outer diameter of the tool section expands 52 again in one stage, so that an annular or an open ring portion having, pointing in the proximal direction stop surface 70 is formed, which is a stop level 72 defined perpendicular to the longitudinal axis 18 is oriented.

Somewhat proximal side of the stop surface 72 passes through a transverse bore 74 the tool section 52 and defines a pivot axis 76 , In the cross hole 74 used is a cylindrical bearing pin 78 which is a transverse bore 80 of the second tool element 32 interspersed. The bearing pin 78 is in the cross hole 74 at the tool section 52 set and the cross hole 80 such that the tool element 32 around the pivot axis 76 relative to the tool element 30 and thus also relative to the shaft 42 is pivotable.

The relative to the shaft 42 movable tool element 32 is indirect with the transmission element 44 coupled. A substantially cuboid coupling piece 82 is in the longitudinal slot 62 parallel to the longitudinal axis 18 slidably guided in the proximal and distal directions, but against rotation about the longitudinal axis 18 secured.

Starting from a proximal end 84 of the coupling piece 82 is a substantially cuboid blind hole 86 educated. Transverse to the longitudinal axis 18 is the coupling piece 82 spaced from the proximal end 84 with a rectangular cross-section opening 88 Mistake. The blind hole 86 and the opening 88 define a coupling receptacle 90 for one from a distal end 92 of the power transmission member 44 protruding coupling member 94 , The coupling member 94 is formed substantially parallelepiped-shaped and wedge-shaped tapering in the distal direction, so that two sliding surfaces 96 are defined, which are inclined relative to each other approximately at an angle of 45 °. The coupling member 94 is from the distal end 92 a little bit apart. A cross-sectional area of the blind hole 86 transverse to the longitudinal axis 18 substantially corresponds to a cross-sectional area of the coupling member 94 transverse to the longitudinal axis 18 so that the coupling member 94 coming from the proximal end into the blind hole 86 can be inserted until it is on a pointing in the proximal direction ground 98 of the same strikes. The opening 88 is dimensioned so that now the force transmission member 44 90 ° around the longitudinal axis 18 relative to the coupling piece 82 can be rotated, and so a coupling between the power transmission member 44 and the coupling piece 82 is achieved by the coupling member lateral boundaries of the blind hole 86 engages behind. In this coupling position, which is schematically in 3 can be clearly seen, shear and tensile forces from the power transmission element 44 on the coupling piece 82 be transferred to move it in the distal or proximal direction.

On the coupling piece 82 is from the longitudinal axis 18 pointing away one at an angle of about 45 ° relative to this laterally open guide 100 formed in which one in a direction transverse to the longitudinal axis 18 from a proximal end 104 of the tool element 32 protruding guide projection 102 intervenes. The guide groove 100 and the leadership lead 102 together define a type of slotted cam guide for axial movement of the power transmission member 44 in the shaft 42 in a pivoting movement of the tool element 32 implement.

At the in 3 illustrated embodiment, the tool elements 30 and 32 designed such that the tool 16 in the 4A schematically shown closed position assumes when the power transmission member 44 assumes its most proximal position. To open the tool 16 becomes the actuator 22 in the direction of the holding element 20 moved or pivoted and while the power transmission member 44 moved in the distal direction. Due to the forced guidance of the guide projection 102 in the guide groove 100 of the coupling piece 82 becomes the tool element 32 around the pivot axis 76 from the tool element 30 pivoted away, leaving the tool 16 opens. The tool element 32 further includes a cutting edge 106 that with the cutting edge 68 cooperates so as to form a total of a cutting tool in the form of an endoscopic scissors.

To ensure that live sections of the instrument 10 can not inadvertently come into contact with body tissue or other instruments, is an isolation shaft 108 provided in the form of an elongated, thin plastic tube. A distal end 110 it defines a distally facing annular surface 112 , An inner diameter of the insulation shaft 108 is at the outside diameter of the section 50 adapted and can be pushed over this. The stop surface 70 forms part of one through the tool section 52 defined stop 114 of the shaft 42 , which acts in the proximal direction. The ring surface 112 is at the stop 114 on, on the stop surface 70 preferably flat and / or gap-free, if the insulation shaft 108 its most distal position relative to the shaft 42 occupies. The distal end 110 thus also extends over the pivot axis 76 of the tool element 32 in addition and conceals the coupling piece 82 Completely. It simultaneously closes the longitudinal slot 62 and thus prevents the ingress of dirt, especially of blood, in these. The longitudinal slot 62 is thus only the distal side of the stop surface 70 opened, but this essentially by the movable tool element 32 closed is.

To the isolation shaft 108 to hold in a defined position, namely in its most distal position relative to the shaft 42 , is a total by the reference 116 provided Isolationsschaftpositioniereinrichtung provided. It includes two identical coil springs 118 and a plate-shaped feed member 120 , The coil springs 118 are parallel with their longitudinal axis, but offset laterally to the longitudinal axis 18 , but symmetrical to this and rotated by 180 °, so mirror-symmetrical to a longitudinal axis 18 containing mirror plane arranged. Proximal ends 122 the coil springs 118 each based on a pointing in the distal direction ground 124 a blind hole 126 from, which in a rotationally symmetrical outer contour bearing body 128 is trained. The bearing body 128 has a central hole 130 coaxial to the longitudinal axis 18 on whose inner diameter to an outer diameter of the shaft 40 adjusted so that this into the hole 130 can be inserted from distal coming. The blind holes 126 are starting from a distally facing annular surface 132 in the bearing body 128 brought in.

The coil springs 118 form in the manner described return members 166 a reset device 164 pointing to the isolation shaft 108 exerts a distally acting restoring force when moving proximally from its most distal position relative to the shaft 42 is distracted.

Distal ends 134 the coil springs 118 lie on from the longitudinal axis 18 pointing away, flat, wing-like projections 136 of the rest of a circular disk-shaped basic shape having feed member 120 from. The feed member 120 is with a hole 138 provided, the inner diameter of the shaft 42 is adjusted so that the feed member 120 can be moved relative to the shaft in the proximal or distal direction. The flat feed link 120 defines a plane perpendicular to the longitudinal axis 18 is oriented. By choosing the inner diameter of the hole 138 forms the feed member 120 a proximal stop for a proximal end 140 of isolation shaft 108 , The coupling device 40 thus comprises the Isolationsschaftpositioniereinrichtung 116 in conjunction with the proximal end 140 the isolation shaft 108 ,

To prevent the feed member 120 from the handle part 12 can fall off is a distal end 142 of the rotary star 34 with a rotationally symmetrical closure element 144 locked. This has a coaxial with the longitudinal axis 18 extending longitudinal bore 146 on, whose inner diameter is just so large that even the insulation shaft 108 in the longitudinal bore 146 parallel to the longitudinal axis 18 can be moved. A pointing in the proximal direction, in the form of an annular surface 148 formed end surface of the closure element 144 defines a stop acting in the proximal direction for the feed member 120 ,

Depending on a length of the insulation shaft 108 as well as the coil springs 118 , both in terms of their length and their spring constant, can be used for each instrument 10 be adjusted individually, whether the distal end 110 of isolation shaft 108 in a basic or working position with or without preload on the stop surface 70 is applied. By appropriate choice of coil springs 118 especially if the isolation shaft 108 under tension in abutment against stop 114 is kept, for example, when inserting the sheep part 14 through a trocar seal of the insulation shaft 108 due to the friction acting during insertion and movement of the shaft part 14 in the trocar seal not from its most distal position, as exemplified in the 1 and 2 is shown, can be deflected in the proximal direction. This will prevent it from getting between the ring surface 112 and the stop surface 70 may form a gap where body tissue or suture may become entangled or trapped therein.

On the bearing body 128 is also the coupling device 36 arranged for releasably connecting the handle part 12 with the shaft 42 , It comprises two mirror symmetry to the longitudinal axis 18 on the shaft 42 Flats formed in the region of its proximal end 150 which define conically tapering outer surfaces in the proximal direction. A locking element 152 in the form of a substantially L-shaped lever is on a bearing pin 154 pivoted. The bearing pin 154 is in a bore of the bearing body 128 used and defines a longitudinal axis, which is perpendicular to the longitudinal axis 18 , but laterally offset from this runs. In a schematic in 6 shown coupling position engages a short leg of the locking element 152 in one of the two flats 150 on the shaft 42 and thus forms a stop for the shaft 42 , In this way, a movement of the shaft 42 prevented in the distal direction. For decoupling the shaft 42 from the handle part 12 must be the locking element 152 only around the pivot axis 156 to be slightly tilted until the flattening 150 is released. Then the shaft can 42 in the distal direction of the handle 12 be pulled out.

The exact structural design of the handle 12 and in particular the coupling devices 36 and 38 is of minor importance to the present invention, so that the rest of the construction of the handle part 12 does not need to be described in detail.

The isolation shaft positioning device 116 is thus suitable, a different longitudinal expansion of the shaft 42 and the isolation shaft 108 in the assembled state of the instrument 10 in the course of a superheated steam sterilization. Since the insulating shaft preferably made of a plastic 108 when heated, it expands more than the shaft 42 , is when the instrument warms up 10 the feed member 120 against the action of the coil springs 118 from the isolation shaft 108 pressed in the proximal direction. Would be the feed member 120 immovable on the handle 12 arranged and the isolation shaft 108 between the feed member 120 and the stop surface 70 clamped gap-free on both sides at room temperature, could in a superheated steam sterilization due to the different thermal expansion coefficients of the insulation shank 108 and the shaft 42 the isolation shaft 108 to be damaged.

As the Isolationsschaftpositioniereinrichtung 116 at the instrument 10 on the handle part 12 can be arranged, by simply replacing conventional handle parts by the handle part 12 already existing on the market shaft parts 14 without difficulty, the advantages of Isolationsschaftpositioniereinrichtung 116 use.

In the 7 . 8th , and 9A such as 9B is an alternative embodiment of a shaft part 14 ' shown schematically. The shaft part 14 ' is in the manner described above according to the shaft part 14 with the handle part 12 coupled. Below are essentially only the differences between the shaft parts 14 and 14 ' briefly explained, with identical parts of the shaft parts 14 and 14 ' with identical reference numerals, similar parts in the shaft part 14 ' additionally provided with a simple coat of paint.

The tool 16 ' of the shaft part 14 ' includes two around those of the bearing pin 78 defined pivot axis 76 swiveling tool elements 30 ' and 32 ' , Therefore, the tool section is different 52 ' from the tool section 52 in that it is mirror-symmetrical to one of the longitudinal axis 18 formed mirror plane is formed. Again, a longitudinal slot extends 62 ' to a distal end 66 ' of the tool section 52 ' in the shaft 42 is used.

The longitudinal slot 62 ' However, it is open on both sides, so that two free, pointing in the distal direction legs are formed. That in the longitudinal slot 62 ' sliding coupling piece 82 ' is identical to the coupling piece in the area of its proximal end 82 trained and can therefore in the manner described above with the power transmission member 44 be coupled. Unlike the coupling piece 82 are at the coupling piece 82 ' on facing away from each other side surfaces of the same two each about 45 ° relative to the longitudinal axis 18 inclined guide groove 100 ' and 101 ' designed for receiving and guiding guide projections 102 ' and 103 ' attached to proximal ends of the tool elements 30 ' and 32 ' in a direction transverse to the longitudinal axis 18 are formed projecting serve.

Also with the shaft part 14 ' covers the isolation shaft 108 the coupling piece 82 essentially complete. His distal end 110 extends over the pivot axis 76 out and lies in a basic position at the pointing in the proximal direction stop surface 70 of the stop 114 of the tool section 52 flat and / or gap-free. In this way is also the shaft part 14 ' the entire mechanism for moving the jaws 30 ' and 32 ' through the isolation shaft 108 protected. This is done by the Isolationsschaftpositioniereinrichtung 116 at the stop 114 in the manner described above in investment.

In 10A is an alternative embodiment of an isolation shaft 108 ' shown schematically. It covers almost the entire length of the insulation shaft 108 ' extending envelope section 158 from an insulation stock material. A proximal end region of the isolation shaft 108 ' defines a short shaft section 160 which is in the form of a bellows 162 is trained. The shaft section 160 forms at the isolation shaft 108 ' an isolation shaft positioning device 116 ' , The bellows 162 defines an elastically resilient element, which ensures that even with a longitudinal expansion of the insulation shaft 108 ' , which is larger than that of the shaft 42 , damage to the insulation shaft 108 ' can be prevented. This is achieved by a compressibility of the shaft portion 160 ,

The isolation shaft 108 ' can be combined in particular with conventional handle parts. The top of the handle part 12 provided Isolationsschaftpositioniereinrichtung 116 is not absolutely necessary because of the shaft 108 ' already the Isolationsschaftpositioniereinrichtung 116 ' includes.

Of course, the isolation shaft 108 ' the other way around on the shaft 12 to be assembled. This means that the bellows 162 ' not in the area of the grip part 12 must be arranged, but alternatively pointing in the distal direction on the shaft 42 can be mounted. The shaft section 162 is then in the area of the tool section 52 , the end being 146 ' then at the stop 114 respectively 114 ' is applied.

The schematic in 10B illustrated isolation shaft 108 '' is different from isolationism 108 ' only in that the shaft section 160 ' not directly adjacent to one end of the isolation shaft 108 '' is arranged, but in any area between the distal end 110 '' and the proximal end 140 '' of isolation shaft 108 '' arranged or formed. In its function, it otherwise corresponds to the shaft section 160 ,

In 10C is a schematic view of another embodiment of an isolation shaft with the reference numeral 108 ''' Mistake. The shaft section 160 '' is not going through a bellows 162 but formed by a tubular portion which is made of a different material than the rest of the insulating shaft. Preferably, the shaft portion 160 '' formed of an elastomeric material, so that a length compensation between the distal end 110 ''' and the proximal end 140 ''' of isolation shaft 108 ''' allows, even if the ends 110 ''' and 140 ''' relative to the shaft 42 are immovably positioned, as is the case with conventional shaft parts in the rule. Alternatively, the shaft portion 160 '' also be formed of a material which has a smaller coefficient of thermal expansion than the remaining part of the insulation shank 108 ''' to give a different longitudinal extension of the insulation shaft 108 ''' and the shaft 42 to balance when passing through a superheated steam sterilization process.

The insulation shafts 108 ' . 108 '' and 108 ''' can be exchanged in particular against insulation shafts conventional shaft parts, so as to retrofit a Isolationsschaftpositioniereinrichtung in a simple manner.

Further, a material for the insulation shank can be chosen so that it has the same or almost the same coefficient of thermal expansion as the material from which the shaft 42 is made. In this case, the shaft will stretch 42 and such isolation shaft in hot steam sterilization is the same, so that the problem of different linear expansion, as described above, by providing isolation shaft positioning means 116 . 116 ' and 116 '' or 116 ''' is resolved, does not occur. The isolation shaft positioning devices 116 ' and 116 '' thus also include reset facilities 164 ' and 164 '' , which on the respective isolation shaft 108 ' respectively 108 '' exert a restoring force acting in the distal direction, when this in the proximal direction from its most distal position relative to the shaft 42 is deflected.

Claims (25)

Surgical tubular shaft instrument ( 10 ) with a handle part ( 12 ) and a shank part ( 14 ; 14 ' ), which shaft part ( 14 ; 14 ' ) a tubular shaft ( 42 ), in this movably mounted force transmission member ( 44 ) and at least one at a distal end of the shaft ( 42 ) movably mounted tool element ( 32 ; 30 ' . 32 ' ), which shaft ( 42 ) at least partially from a tubular insulation shank ( 108 ; 108 '; 108 ''; 108 ''' ) is surrounded and which force transmission member ( 44 ) on the one hand with the handle part ( 12 ) and on the other hand with the at least one tool element ( 32 ; 30 ' . 32 ' ) is movably coupled to transmit an actuating force from the handle part ( 12 ) on the at least one tool element ( 32 ; 30 ' . 32 ' ) for moving the same relative to the shaft ( 42 ), characterized in that an isolation shaft positioning device ( 116 ; 116 '; 166 ''; 116 ''' ) is provided, which the isolation shaft ( 108 ; 108 '; 108 ''; 108 ''' ) in a most distal position relative to the shaft ( 42 ) holds. Surgical tubular shaft instrument according to claim 1, characterized in that in the region of a distal end ( 66 ; 66 ' ) of the shaft ( 42 ) a stop acting in the proximal direction ( 114 ) and that the isolation shaft positioning device ( 116 ; 166 '; 116 ''; 116 ''' ) in a working position a distal end ( 110 ; 110 '; 110 ''; 110 ''' ) of the isolation shaft ( 108 ; 108 '; 108 ''; 108 ''' ) at the stop ( 114 ) holds in plant. Surgical tubular shaft instrument according to one of the preceding claims, characterized in that the isolation shaft positioning device ( 116 ; 116 '; 166 ''; 116 ''' ) is designed such that it does not exert any force on the insulation shaft ( 108 ; 108 '; 108 ''; 108 ''' ) when it is in its most distal position relative to the shaft ( 42 ) occupies. Surgical tubular shaft instrument according to one of claims 1 to 3, characterized in that the Isolationsschaftpositioniereinrichtung ( 116 ; 116 '; 166 ''; 116 ''' ) is designed such that it has a prestressing force on the insulation shaft ( 108 ; 108 '; 108 ''; 108 ''' ) when it is in its most distal position relative to the shaft ( 42 ) occupies. Surgical tubular shaft instrument according to one of the preceding claims, characterized in that the insulating shaft ( 108 ; 108 '; 108 ''; 108 ''' ) against a force effect of the isolation shaft positioning device ( 116 ; 116 '; 166 ''; 116 ''' ) relative to the shaft ( 42 ) is movable in the proximal direction. Surgical tubular shaft instrument according to one of the preceding claims, characterized in that the isolation shaft positioning device ( 116 ; 116 '; 116 '' ) a reset device ( 164 ; 164 '; 164 '' ), which on the isolation shaft ( 108 ; 108 '; 108 '' ) exerts a distally acting restoring force when it moves in the proximal direction from its most distal position relative to the shaft ( 42 ) is deflected. Surgical tubular shaft instrument according to claim 6, characterized in that the restoring device ( 164 ; 164 '; 164 '' ) at least one reset member ( 166 ; 166 '; 166 '' ), which directly or indirectly at the isolation shaft ( 108 ; 108 '; 108 '' ) and acts in the distal direction. Surgical tubular shaft instrument according to claim 6 or 7, characterized in that the return direction ( 164 ; 164 ' ) to a proximal end ( 140 ; 140 ' ) of the isolation shaft ( 108 ; 108 ' ) is arranged acting. Surgical tubular shaft instrument according to one of claims 6 to 8, characterized in that the return direction ( 164 ) at the proximal end of the isolation shaft ( 108 ) adjacent feed member ( 120 ). Surgical tubular shaft instrument according to one of the preceding claims, characterized in that the restoring member ( 166 '; 166 '' ) in the form of an elastically resilient bellows ( 162 ; 162 ' ) is trained. Surgical tubular shaft instrument according to one of claims 7 to 10, characterized in that the at least one return member ( 166 ) offset laterally relative to a longitudinal axis ( 18 ) of the isolation shaft ( 108 ) is arranged. Surgical tubular shaft instrument according to one of the preceding claims, characterized in that the isolation shaft positioning device ( 116 ) on the handle part ( 12 ) is arranged or formed. Surgical tubular shaft instrument according to one of claims 1 to 12, characterized in that the Isolationsschaftpositioniereinrichtung ( 116 '; 116 ''; 166 ''' ) at the isolation shaft ( 108 '; 108 ''; 108 ''' ) is arranged or formed. Surgical tubular shaft instrument according to one of the preceding claims, characterized in that the isolation shaft positioning device ( 116 '; 116 ''; 116 ''' ) in the longitudinal direction ( 18 ) of the isolation shaft ( 108 '; 108 ''; 108 ''' ) extending shank portion ( 160 ; 160 '; 160 '' ) of the same includes or forms. Surgical tubular shaft instrument according to claim 14, characterized in that the at least one return member ( 166 '; 166 '' ) the shank portion ( 160 ; 160 ' ). Surgical tubular shaft instrument according to claim 14 or 15, characterized in that the isolation shaft ( 108 '; 108 ''; 108 ''' ) is made of an insulation material, that the shaft portion ( 160 ; 160 '; 160 '' ) is made of a shank portion material and that the shank portion material has a smaller coefficient of thermal expansion than the insulating sheath material. Surgical tubular shaft instrument according to one of claims 2 to 16, characterized in that the distal end ( 110 ; 110 '; 110 ''; 110 ''' ) of the isolation shaft ( 108 ; 108 '; 108 ''; 108 ''' ) flat or substantially flat at the stop ( 114 ) and / or that the distal end ( 110 ; 110 '; 110 ''; 110 ''' ) of the isolation shaft gap-free or substantially gap-free at the stop ( 114 ) is present. Surgical tubular shaft instrument according to one of claims 2 to 17, characterized in that the stop ( 114 ) a stop surface pointing in the proximal direction ( 70 ). Surgical tubular shaft instrument according to claim 18, characterized in that the abutment surface ( 70 ) is formed in the form of an annular surface or at least a part of an annular surface. Surgical tubular shaft instrument according to claim 18 or 19, characterized in that a distal end surface ( 112 ; 112 '; 112 ''; 112 ''' ) of the isolation shaft ( 108 ) flat and / or gap-free at the stop surface ( 70 ) is present. Surgical tubular shaft instrument according to one of the preceding claims, characterized in that the at least one tool element ( 32 ; 30 ' . 32 ' ) about a longitudinal axis ( 18 ) of the shaft ( 42 ) running pivot axis ( 76 ) relative to the shaft ( 18 ) is pivotally mounted. Surgical tubular shaft instrument according to claim 21, characterized in that the insulating shaft ( 108 ; 108 '; 109 ''; 108 ''' ) in the distal direction over the pivot axis ( 76 ) extends. Surgical tubular shaft instrument according to one of the preceding claims, in particular according to the preamble of claim 1, characterized in that the shaft ( 42 ) is made of a shank material that the insulation shank ( 108 ''' ) is made of an insulating sheath material and that the shank material has a thermal expansion coefficient which corresponds to the thermal expansion coefficient of the insulating shank material or substantially corresponds. Surgical tubular shaft instrument according to one of the preceding claims, characterized in that the shaft ( 42 ), the isolation ( 108 ; 108 '; 108 ''; 108 ''' ) and the force transmission member ( 44 ) are releasably connectable to each other. Surgical tubular shaft instrument according to one of the preceding claims, characterized in that the insulating shaft ( 108 ; 108 '; 108 ''; 108 ''' ) and the handle part ( 12 ) are formed releasably connectable to each other.

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