DE102014013076A1 - Medical endoscope with angled tool guide - Google Patents

Abstract

The invention relates to a medical endoscope (10) having an elongate shaft (12) for insertion into a human or animal body and a tool (14) with a tool section (16) extending between a distal region and a proximal region of the endoscope (10) ), wherein at least a part of the tool section (16) is guided in a curved channel (18) of a component (20) of the endoscope (10), and wherein the channel (18) is guided by a curved pipe section (20) arranged in the component (20). 22) is formed.

Description

The invention relates to an endoscope referred to in the preamble of claim 1 Art.

Such endoscopes are preferably used for cutting resection in the area of the bladder, in particular in the area of the prostate. Endoscopes for resecting tissue in the bladder and prostate area are commonly known as resectoscopes. However, resectoscopes can also be used in other surgical fields, for example when working in the uterus. They typically have a light source, a surgeon's vision channel, a fluid supply, and a working channel. Resectoscopes are usually transurethral with their shank, d. H. inserted through the urethra into the body.

For processing a treatment area located in the region of the distal end of the endoscope within the body, different tools may be provided on the endoscope. For high-frequency resectoscopy, a loop subjected to high-frequency alternating current is usually inserted at the distal end of the endoscope. The loop is contacted via at least one wire-like electrical conductor, the electrode carrier, at the proximal end of the endoscope at connection points with a high-frequency source. To perform a cutting movement of the electrode carrier is mounted longitudinally displaceable in a shaft of the endoscope. The longitudinal displacement of the electrode carrier is typically performed by the operation of a transporter in the proximal region of the endoscope.

In laser resectoscopy, instead of an electrode, a laser fiber is guided longitudinally displaceably in the shaft of the resectoscope, with the distal end of the fiber being exposed at the distal end of the endoscope in order to machine the surgical field with a laser light emerging there. For longitudinal displacement of a laser fiber or a high-frequency electrode, these tools are usually motion-coupled in the proximal region of the endoscope to a movable carriage, which can be moved back and forth relative to the shaft of the endoscope by finger movement of the surgeon.

The tool shanks, d. H. For example, the fiber body or the electrode carrier are guided over longer areas axially parallel to the endoscope shaft within an outer tube. In particular, in the proximal region of the endoscope, guidance of the tool shanks in angled channels is usually also provided. For example, a laser fiber is guided proximally outwardly in an angled passageway to connect to an external laser source. An unnecessary interruption of the fiber is avoided in order to prevent energy losses and to keep the component complexity of the endoscope as low as possible. A continuous straight guidance of the tools is often not possible because, for example, axially parallel an optic is guided in the endoscope, which opens into an eyepiece in the proximal region. Lateral or oblique feeds through curved channels are therefore already necessary for space-economic reasons.

Shafts of a high-frequency electrode or the proximal terminal areas of an electrode carrier are sometimes also guided in angled channels to be connected at suitable contact points via connecting lines to a high-frequency power source or the like. Angled channels are often also at the coupling points of Endoskopschäften, for example, between the main body of a conveyor and an outer shaft.

In addition to the usual use of laser fibers or high-frequency electrodes for cutting resection, optical fibers or biopsy forceps are inserted into the endoscope for illumination or removal of tissue samples and guided with the forceps body or the fiber body to the distal end of the endoscope. Even such tools or aids are often performed by angled channels of the endoscope.

The implementation or the introduction of elongated tool shanks in angled channels involves various risks. For example, upon insertion of the tool into the angled channel, shaft portions of the tool may scrape on the inner wall of the channel, thereby shedding material chips from the inner wall of the channel and transporting them into the patient's body. In addition, the tool shanks sometimes jam at kinks of the angled channel, which can lead to jerky movements of the instrument. On the walls of the channel hakelnde tool shanks complicate the operation of the endoscope and eroded material flakes can pose high health risks when entering the patient's body.

Against this background, the object of the present invention is to provide a medical endoscope of the type mentioned in the introduction, which allows improved operation and reduces the risk of material erosion in angled channels.

This object is achieved by an article having the features of claim 1. Advantageous embodiment are specified in the dependent claims.

According to the invention, a medical endoscope is provided with an elongate shaft for insertion into a human or animal body and a tool having a tool section extending between a distal section and a proximal section of the endoscope, at least a portion of the tool section being in a curved channel of a component of the endoscope is guided, and wherein the channel is formed by a bent pipe piece arranged in the component.

Tools that are guided through the curved channel, can be introduced into the endoscope with low friction and with the use of only low shear forces. This not only prevents the risk of material abrasion on the inner surfaces of the curved or angled channel, but also facilitates the operation of the endoscope.

In endoscopes of conventional design, curved channels are typically formed by two angularly aligned bores that meet in their end regions. In thus formed angled channels arise in the meeting of the holes kinks and irregularities on the inner wall of the channel. These irregularities lead to blockages of tools. The tools must be pushed with excessive force and the risk of material abrasion on the inner wall of such channels increases. In the invention, it is contemplated that the curved channel in the component of the endoscope is a portion between two straight portions of a channel and that at least the portion with the curvature of a bent pipe piece is formed. Preferably, the entire channel of the component is formed by the pipe section. It is also conceivable that the channel is curved over its entire longitudinal extent.

For the formation of the channel can be provided that the pipe piece is inserted into an angled extending bore of the component. The bend of the pipe section may be incorporated prior to insertion into the pipe section. Alternatively, it can be provided that the bend adjusts when inserting into the angled bore or that a preset bend continues to bend as a result of the insertion or changes approaching the course of the angled bore.

For fixing the pipe section can be provided that the pipe section is clamped in the angled bore. For this purpose, it is conceivable that the pipe section rests with its outer wall at least partially clamping on one or more areas of the bore inner wall. Alternatively or additionally, it can be provided that the pipe section is held outside the angled bore on the component. For this purpose, the pipe section may for example have a flange which can be fastened to the component, in particular can be screwed to the component. For fixing the pipe section can also be provided that the pipe piece is at least partially bonded to the component.

In a first conceivable variant it can be provided that the curved channel is formed as a blind hole. Blind holes are preferably used to contact pads of electrodes at junctions in the proximal region of the endoscope.

In a second variant, it is conceivable that the curved channel is formed as a continuous, open at two points of the component channel. Through-passages of this type are preferably used to introduce tools from the outside into the endoscope. Feedthroughs are used, for example, for laser electrodes, biopsy forceps, optical fibers, or the like.

In a preferred embodiment it is provided that the pipe section consists of a metal. Due to good biocompatibility, the metal may in particular be a stainless steel. The stainless steels commonly used in medical endoscopes are durable and dimensionally stable and are well suited for forming a curved channel within the endoscope. If the component having the channel also consists of a metal or at least partially has metallic surfaces, the tube piece can be welded to the component and / or soldered. Alternatively, the pipe section can also be made of a suitable plastic, in particular a heat-resistant and / or an abrasion-resistant plastic. Preferably, the pipe section is made of an autoclavable material. The component having the channel is preferably made of a plastic.

A piece of tubing made of metal to form the channel helps prevent material abrasion. For this purpose, metals such as stainless steels with suitable hardness can be selected.

A particularly cost-effective and flexible production of the component is supported by the fact that the component is an injection molded part. Injection molded parts are particularly advantageous for the production of large quantities. Complicated or complex component shapes can be implemented quickly and easily with injection molding. Alternatively it can be provided to manufacture the component from a solid material. Regardless of the design of the component made of a solid material or as an injection molded part, a passage or a recess for receiving the curved pipe section, for example, be machined by machining in the material of the component.

In the embodiment of the component as an injection molded part, a simple integration of the bent pipe section into the component is possible. For this purpose, it may be provided that holes are formed in the molded component, which form a curved bore channel and the pipe section is inserted into the drill channel. The pipe section may be held by clamping and / or by means of screwing and / or adhesive bonding in the bore of the component. Regardless of whether the component is manufactured as an injection molded part, it can also be provided that the curved pipe section traverses a cavity of the component and thus forms a defined channel within the cavity. For this purpose, the pipe section can be fixed in a fixing manner, for example, at one or more points of opening of the component

To reduce the component complexity and / or to reduce the work steps necessary when assembling the endoscope, it is envisaged that the tube piece is incorporated as an insert in the component embodied as an injection-molded part. In particular, in a piece of pipe made of metal, such as stainless steel, the piece of pipe in the manufacture of the component can be easily injected with injection molding compound. When using a pipe section of a metal or other suitable material deformations or material changes can be avoided by hot injection molding compound.

The formation of the pipe section as a depositor in the component designed as an injection molded part is advantageous because the pipe section is firmly connected to the component and no further fastening means for holding the pipe section must be provided on the component. For this purpose, the pipe section may have structured outer surfaces which allow a firm hold in the solidified injection molding compound. For example, at least in some areas elevations and / or depressions, corrugations, edges, webs or the like may be provided on the outer surface of the pipe section.

For a modular construction of the endoscope, to simplify maintenance work and to improve the cleanability of individual elements of the endoscope, it is proposed that the component be detachably fastened to the endoscope. A releasable attachment to the endoscope can be realized for example by clamping or screwing. Alternatively or additionally, it can also be provided that the component is latched on the endoscope. A detachable attachment facilitates the replacement or the maintenance or cleaning-related disassembly of such parts.

In the component additional channels can be provided for the passage of other tools or components without further notice. For example, the component may also include a straight channel for performing optics. Furthermore, it can be provided that in the component connection points and / or contact points for the introduction and forwarding of high-frequency current to high-frequency tools of the endoscope, such as cutting electrodes, are incorporated.

In a preferred embodiment it is provided that the component for attachment to the endoscope has at least two holes for receiving fastening bolts. The holes can be designed as through holes or blind holes. In particular, in the execution of a blind bore, an internal thread may be provided in the holes for the positive retention of bolts.

In the drawings, embodiments of the invention are shown very schematically. Show it:

1 an inventive endoscope axially cut endoscope,

2 a component with a curved channel in a first variant, and

3 a component with a curved channel in a second variant.

1 shows in its right part in section the distal end of a tubular shaft 12 in which an optic parallel to the axis 36 is arranged. The viewing direction of the optics 36 is slightly oblique to the axis of the shaft 12 educated. The optics 36 is in one, extending from the proximal region to the distal end of the endoscope, optical channel 34 guided.

On the optical channel 34 is with a partially tubular guide piece 40 a pipe 42 guided, that for guiding a shaft area or a section 16 a tool 14 serves. The pipe 42 takes the tool 14 with the tool section 16 longitudinally displaceable and guides the shank region of the tool or the tool section 16 at least partially parallel to the longitudinal axis of the shaft 12 , In conceivable variants, the tube 42 in the longitudinal direction immovably on the optical channel 34 be attached.

As shown, the tool can 14 an optical fiber or a laser fiber for illumination or for processing an operating area (not shown). The tool 14 can at its distal end easily too Pliers industries and / or cutting industries have (not shown). In particular, when using electrodes for a transurethral resection can at the distal end of the tool 14 be provided with electric current act on wire loops (not shown).

On the left side shows 1 the proximal end of the illustrated endoscope 10 , The shaft 12 is with its proximal end on a main body 44 attached. At the attachment area of the shaft 12 Rinse water inlets and outlets may be provided (not shown).

Proximal beyond the main body 44 is a conveyor with a carriage 30 arranged. The sled 30 is - as schematically indicated - preferably on the optical channel 34 slidably mounted. As shown, it is for observing the area of operation and / or for observing the distal end of the tool 14 an optic 36 in the optical channel 34 inserted. The optics 36 opens proximally in an eyepiece 38 ,

To operate the transporter is on the carriage 30 a thumb ring 28 and at the main body 44 a pair of finger devices 26 arranged. The thumb ring 28 and the main body 44 are by means of a spring bridge 32 spaced spring-loaded apart. Through a movement of the thumb ring 28 in the direction of the fingers 26 against the spring bridge 32 Applied spring force can the operator of the endoscope 10 the sled 30 opposite the main body 44 move. The sled 30 is preferably on the optical channel 34 sliding shifted.

When moving the carriage 30 in the distal direction of the endoscope 10 becomes the tool section 16 and the distal end of the tool 14 opposite the shaft 12 moved longitudinally. That's what the tool can do 14 forcibly guided by the carriage 30 be coupled, for example by means of clamping (not shown).

In another embodiment (not shown) can be provided that the carriage 30 with the fingers 26 motion coupled to the endoscope 10 , preferably on the optical channel 34 sliding, arranged. It can be provided that the carriage 30 by means of the spring bridge 32 against one, with the optical channel 34 in the longitudinal direction of the endoscope 10 motion-coupled thumb ring 28 , spring-biased. At the movement of the fingers 26 in the direction of the thumb ring 28 the operator of the endoscope can slide 30 move in the proximal direction of the endoscope and so the distal end of the tool 14 at least partially in the shaft 12 involve.

In the variants described, in particular in the 1 variant shown, is the component 20 with the channel formed therein 18 in one to the longitudinal axis of the endoscope 10 sliding carriage 30 arranged. Instead of one on the endoscope 10 longitudinally displaceable mounted component 20 can also be provided, the channel 18 in an immovable to the shaft 12 to arrange located area. For example, the channel 18 in the main body 44 be arranged. It can also be provided the component 20 in with the endoscope 10 couplable intermediate pieces, such as in a so-called bridge to arrange (not shown). Preference is given by immovable to the main body 44 arranged channels used to introduce biopsy forceps.

How strongly schematized in 1 and more exactly but also schematized in the 2 and 3 shown is a component 20 provided in which an angled channel 18 is arranged. The tool 14 is with a section 16 in the channel 18 guided. As shown, the channel can 18 be designed as a passage with two openings, the tool 14 the channel 18 with the section 16 passes. Alternatively it can be provided that the channel 18 is formed as a blind channel with at least one curvature (not shown), for example, for receiving a proximal end of an electrode.

As in the 2 and 3 clarifies, is the channel 18 through a piece of pipe 22 educated. 2 shows the component 20 in a first variant, in which the pipe section 22 in an angled bore hole 23 of the component 20 is used. The pipe piece 22 can do that in the bore hole 23 be inserted. As can be clearly seen, the pipe section 22 one the course of the bore channel 23 in the component 20 following rounding up. The rounding of the pipe section 22 facilitates the insertion and pushing through of a section 16 a tool 14 , The risk of the formation of material chips removed by inserted tools and their entry into the human or animal body is thereby considerably reduced.

3 shows a further variant for the design of the channel 18 , Here is the component 20 manufactured as an injection molded part, wherein the pipe section 22 as depositor in the manufacture of the component 20 is injection molded with injection molding material. The component 20 can - as in the 1 to 3 shown - holes 24 have, which are designed to receive bolts to secure the component to the endoscope. The holes 24 can be designed as through holes or blind hole. In particular, it can be provided that at least some of the holes 24 have an internal thread for screwing with a bolt (not shown).

LIST OF REFERENCE NUMBERS

10

endoscope

12

endoscope shaft

14

Tool

16

Shank area of the tool

18

angled channel

20

Component with angled channel

22

pipe section

23

drilling

24

mounting holes

26

finger plants

28

thumb ring

30

carriage

32

Spring joint bridge

34

optical channel

36

optics

38

eyepiece

40

guide piece

42

pipe

44

main body

Claims (6)

Medical endoscope ( 10 ) with an elongated shaft ( 12 ) for introduction into a human or animal body and a tool ( 14 ) with a between a distal portion and a proximal portion of the endoscope ( 10 ) extending tool section ( 16 ), wherein at least a part of the tool section ( 16 ) in a curved channel ( 18 ) of a component ( 20 ) of the endoscope ( 10 ), characterized in that the channel ( 18 ) of one in the component ( 20 ) arranged bent pipe section ( 22 ) is trained. Medical endoscope according to claim 1, characterized in that the tube piece ( 22 ) consists of a metal. Medical endoscope according to one of claims 1 or 2, characterized in that the component ( 20 ) is an injection molded part. Medical endoscope according to claim 3, characterized in that the pipe section ( 22 ) as an insert in the executed as an injection molded part ( 20 ) is incorporated. Medical endoscope according to one of the preceding claims, characterized in that the component ( 20 ) releasably attached to the endoscope ( 20 ) is attached. Medical endoscope according to claim 5, characterized in that the component ( 20 ) for attachment to the endoscope at least two holes ( 24 ) for receiving bolts.

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