DE102021119509A1 - Joint mechanism for a medical instrument and medical instrument - Google Patents

Abstract

The invention relates to a joint mechanism for a medical instrument, in particular for a medical robot or for an endoscope, with a supporting joint arrangement with a joint body or several joint bodies for pivoting a distal end section, and a first steering element arranged on the joint arrangement and connected to the distal end section , so that the distal end section can be manipulated by means of the first steering element, the first steering element being designed in the form of a strip. Furthermore, the invention relates to a medical instrument, in particular a medical robot or a medical endoscope.

Description

The invention relates to a joint mechanism for a medical instrument, in particular for a medical robot or for an endoscope, with a supporting joint arrangement with a joint body or several joint bodies for pivoting a distal end section, and a first steering element arranged on the joint arrangement and connected to the distal end section , so that the distal end section can be manipulated by means of the first steering element. Furthermore, the invention relates to a medical instrument, in particular a medical robot or an endoscope with a joint mechanism.

Joint mechanisms of the type mentioned are used, in particular in medical instruments such as robots or endoscopes, to move, in particular pivot, a distal end section of such a robot or such an endoscope in one axis or in several axes. The distal end section can thus be precisely aligned with an observation space or a processing space by means of such a joint mechanism.

The U.S. 7,699,855 discloses an interface to attach instruments or other end effectors to a robotic arm. The drives for the functions of the instrument are located on the side of the robot, which means that the instrument remains inexpensive. The transmission of angles of rotation from drives to the instrument takes place by means of coupling discs in a common parting plane. Axes of the drives are therefore parallel and perpendicular to this plane.

The WO 00/2014004242 describes another interface for so-called axis-parallel drives for a gripper of a surgical instrument.

In the U.S. 10,105,128 a mechanism for aligning a swash plate by means of connecting rods with two axially parallel drives is described.

The object of the invention is to improve the prior art.

This object is achieved by a joint mechanism for a medical instrument, in particular for a medical robot or for an endoscope, with a supporting joint arrangement with a joint body or several joint bodies for pivoting a distal end section, and one arranged on the joint arrangement and connected to the distal end section first steering element, so that the distal end section can be manipulated by means of the first steering element, the first steering element being in the form of a strip.

By means of such a strip-shaped steering element, the respective steering element covers a region of a circumference of the joint mechanism and/or the joint arrangement arranged in the joint mechanism. The respective band-shaped steering element can thus offer protection for the joint arrangement. Furthermore, a strip-shaped steering element increases the torsional stiffness of a corresponding steering element, for example compared to a steering wire, for a corresponding joint mechanism and the torsional stiffness of the entire joint mechanism.

The following terms are explained here:

A "medical instrument" can be any mechanical or mechanical-electrical active unit that is suitable for medical treatment of a person or an animal, in particular a medical robot, an endoscope, an endoscope system or an endoscope shaft. these terms are also used synonymously here. For example, such a medical instrument can hold and move a cutting tool, a gripping tool, an optical system for examining a field of vision, a combined instrument from the various options listed, or another tool or instrument suitable for a medical treatment method.

A "medical robot" is a piece of technical equipment that is usually suitable for taking on recurring or defined mechanical work. Robots are known as both stationary and mobile machines and are controlled by appropriate software. Robots have drive motors, for example for driving different movement axes of a robot, so that corresponding forces can be applied to an end effector. In the present example, however, such a robot can also be a very small, delicately working technical unit, which supports medical interventions or the medical treatment of a person or an animal.

An “endoscope” is a technical and/or medical instrument that is used, for example, to visually inspect cavities or areas that are difficult to access and/or to use the endoscope to use manipulators or end effectors to perform a specific activity to be done in a workroom. For example, such an endoscope is equipped with a movable shaft in its head area, so that in addition to an optical inspection in a straight direction, the optical inspection of a corresponding area can also be carried out at an angle. Endoscopes are used, for example, to obtain a clear view of an area that is narrow or within a body during medical interventions, or else in technical areas to inspect or view technical machines and their poorly accessible areas.

A "hinge assembly" may be any mechanical assembly capable of pivoting in one or more axes. For example, such a joint arrangement is a sequence of “joint bodies” which each roll off one another and thus represent a diverse articulation of the joint arrangement.

A “distal end section” can be any area or section of the joint mechanism that is spaced apart and faces away from an actuator system or a body or other central assembly. For example, a distal end section has a movable and/or pivotable shaft.

A "guiding element" can be a rope, a tape, a wire or a strand, for example. Such a steering element can be any mechanical element which is suitable for absorbing tensile forces or compressive forces or primarily tensile forces and small compressive forces. In particular, such a steering element can also absorb compressive forces, so that pressure can also be exerted by means of the steering element.

“Strip-shaped” describes in particular a flattened shape of a cross-section of such a strip or other steering element compared to a round shape of a so-called steering wire. In particular, such a strip-shaped steering element is designed in such a way that a width of the steering element is greater or significantly greater than a thickness of the steering element.

In order to be able to move or pivot the joint mechanism in different directions or spatially differentiated, the joint mechanism has a second steering element or further steering elements.

A respective steering element can thus be assigned to a specific pivoting direction or a specific articulation of the joint mechanism, so that the desired direction of pivoting of the joint mechanism is achieved by pulling on a respective steering element.

In one embodiment, the first steering element, the second steering element or the further steering elements is or are rectangular or essentially rectangular or else oval.

Such a rectangular or substantially rectangular steering element is particularly suitable for protecting the joint arrangement or other components arranged within the joint mechanism from external influences, since the relatively larger width compared to the relatively smaller thickness means that an area of a circumference of the joint mechanism or the joint arrangement can be covered takes place and thus a local protection, for example against penetrating dust and / or against mechanical influences is formed.

Furthermore, by means of a rectangular or essentially rectangular steering element, the torsional rigidity of the respective steering element and thus also the torsional rigidity of the joint mechanism is greatly increased compared to other geometric designs of the steering element or steering elements.

In order to cover or protect the joint mechanism or, for example, the joint arrangement arranged within the joint mechanism, the first steering element, the second steering element and/or the further steering elements have a ratio of a width to a thickness of more than 3/1, in particular more than 4/1 or more than 5/1, up.

In a further embodiment, the first steering element, the second steering element and/or the further steering elements is or are a belt and/or belt, in particular a fiber-reinforced belt or a fiber-reinforced belt, and/or made of steel strip, in particular steel, stainless steel and/or a nitinol.

Such a belt and/or belt can be designed to be particularly stable and resistant to tension. In particular, this is realized by a fiber reinforcement in a belt or belt designed as a fiber-reinforced belt or belt, since the fibers of the fiber reinforcement can be designed in particular for the tensile and compressive forces to be absorbed. A high tensile strength and compressive strength of the belt and/or the belt can thus be achieved with a low weight. A corresponding matrix as a support material for the fibers of the fiber reinforcement, however, can be particularly elastic or applied to the fibers as abrasion protection, so that overall the Life of the belt and / or the belt is increased.

A "belt" is, for example, a braided or woven base body that forms a steering element.

A “belt” is, for example, a mostly flat or band-shaped steering element provided with tension bands and/or pressure bands and equipped with a matrix surrounding the tension bands and/or pressure bands. The drawstrings and/or pressure bands within the belt are thus covered, held and protected by the matrix, whereas the drawstrings can absorb the tensile forces.

A "strip steel" can, for example, be a rolled or drawn strand made of steel, in particular made of a stainless steel or a nitinol. A high-grade steel can here for example be a high-grade steel of the quality 1.4310 or also 1.4401. "Nitinol" is a so-called shape memory alloy, in particular a nickel-titanium alloy, which consists, for example, of about 55% nickel and another part of about 35% to 45% titanium and other corresponding alloy components.

In order to protect a round or curved joint mechanism in particular from external influences by means of the steering element or by means of the several steering elements, the first steering element, the second steering element and/or the further steering elements is or are curved along a circumference of the joint mechanism, in particular in an installed position educated.

Such a curved shape adapts to a round and/or elliptical base body of a joint mechanism, for example, so that the steering element, the second steering element and/or the additional steering elements provide geometrically adapted protection for an interior area and/or the joint arrangement and/or others, inside of the steering elements or systems arranged behind a steering element.

An "installation position" describes the position or arrangement in which the steering element is in a usable configuration of the joint mechanism. For example, an originally rectangular steering element can be guided and/or held in a curved shape by installation and appropriate guide means.

In one embodiment, the first steering element, the second steering element and/or the further steering elements has or have a surface coating, in particular made of an elastomer and/or a plastic.

Such a surface coating protects the steering element from external influences and can also be designed with a correspondingly low coefficient of friction or a low coefficient of friction. This reduces the frictional forces of the steering element on other components of the joint mechanism and thus simplifies the use of the joint mechanism.

A “surface coating” can be any coating applied to a surface or an external area of a steering element. In particular, this can be sprayed on, rolled up, rubbed on or applied in some other way.

“Elastomer” can be any elastic, in particular flexible, material. In particular, such an elastomer is a natural or man-made rubber or other rubber product which forms an elastomer.

A "plastic" can be any artificially produced, duroplastic, thermoplastic or partially elastic material, which is, for example, a polypropylene, a polyethylene, a polyamide, a polyimide or an acetyl butadiene styrene (ABS).

In order to make the joint mechanism particularly easy to move and easy to operate, the first steering element, the second steering element and/or the further steering elements is/are movably guided by means of a guide or a plurality of respective guides on a respective joint body along a pulling direction or along a pushing direction.

A "guide" describes a mechanical element that guides or picks up a body or an object within a specified path. For example, such a guide is a linear guide, which movably guides the respective steering element on a respective base body along the direction of pull.

A “direction of pull” or a “direction of pressure” describes, for example, a path or path along which a respective steering element is movably arranged within the joint mechanism. In particular, such a pulling direction or such a pushing direction is located along a longitudinal axis of the articulated joint mechanism, which can also be curved. Tensile forces or compressive forces are then applied or directed along the tensile direction or along the compressive direction.

In a further embodiment, the guide or the respective guide is designed as a sliding guide and/or a roller guide.

A sliding guide and/or a roller guide makes it possible in a particularly simple manner for the respective steering element to be guided easily and simply.

A "sliding guide", which is also called "plain bearing", guides a respective component with direct contact. The component, for example a steering element, slides on the sliding bearing or the sliding guide. A frictional resistance can be kept low by means of an appropriate pairing of materials between the sliding guide and the steering element and/or by means of lubrication.

A “roller guide” is, for example, a roller bearing or a guide cage equipped with guide rollers for a respective steering element. In a roller guide, the force required to move the guided component, for example the steering element, is achieved by rotating a rolling element or rolling body about an axis.

In order to be able to articulate different areas within the joint mechanism at different distances from a proximal or distal end area, the first steering element, the second steering element and/or the further steering elements are mechanically connected to a respective joint body in a pulling direction with the respective joint body.

For example, a defined number of steering elements of a respective joint body can be mechanically connected to the respective joint body at a respective distance from a distal end region, so that a differentiated movement and/or a differentiated pivoting of a respective joint body within the joint mechanism is made possible.

In a further embodiment, the first steering element, the second steering element and/or the further steering elements is/are connected to the distal end section and/or the respective articulated body by means of screws, clamps and/or adhesives. Alternatively or additionally, welding, soldering or another material-to-material method can also be used.

In particular, the forms of connection mentioned, namely screws, clamps and/or adhesives, make it possible to connect a respective steering element to the respective joint body in a very confined space. For example, clamping by means of a screw, namely by means of a clamping screw, can also be implemented for the respective steering element. The same applies to welding and/or soldering.

In order to be able to steer the joint mechanism safely and reliably, the first steering element, the second steering element and/or the further steering elements is/are guided by means of a swash plate, with the respective steering element or the respective steering elements being mechanically connected to the Swashplate is connected or are.

In this way, for example, the swash plate can be used as an intermediate element for forwarding a corresponding articulation for the joint mechanism.

For example, the swash plate is the articulation element for the joint mechanism.

A "swash plate" is in particular a stationary, but pivotable, mostly round component which can be inclined relative to a main axis or longitudinal axis, for example the joint mechanism. Such a swash plate can have attachment points or connection points for the steering elements arranged symmetrically around its circumference.

In a further embodiment, the first steering element and the second steering element and/or the first steering element and the further steering elements are arranged radially, in particular radially symmetrically, around a longitudinal axis of the joint mechanism.

Such a radial, in particular radially symmetrical, arrangement makes it possible, by means of the steering elements, to realize protection for the joint arrangement which is as complete as possible or else complete.

A “longitudinal axis” is, for example, a geometric or otherwise defined axis that runs along the joint mechanism, in particular along a longitudinal extension of the joint mechanism. In this case, the longitudinal axis does not have to follow a geometrically or mathematically exact axis alignment, for example through a line of gravity or a geometric center line.

In order to achieve as complete protection as possible for the joint arrangement, the first steering element and the second steering element and/or the first steering element and the further steering elements are arranged adjacent to and/or adjacent to one another.

In order to protect the joint arrangement even when the joint mechanism moves and/or shifts, the first steering element and the second steering element and/or the first steering element and the further steering elements are arranged in an overlapping manner.

In a further embodiment, the first steering element and the second steering element and/or the first steering element and the further steering elements partially or completely surround a working channel of the joint arrangement, so that in particular by means of the respective steering elements a protective cover is formed which locally or completely encloses the working channel of the joint arrangement.

Further functions or functional elements can then be provided in the joint mechanism within such a working channel, which require special protection. For example, an optical or mechanical arrangement or a combination of an optical and a mechanical arrangement is guided in such a working channel, which extends in particular along the longitudinal axis within the joint mechanism, so that corresponding manipulations in a working area of the medical robot or the endoscope can be carried out through the working channel can be made. In particular, an optical waveguide, a mechanical drive shaft or a combination of such arrangements is or are guided in such a working channel.

A “protective cover” is, for example, a cover that protectively encloses the inner area or the working channel of the joint mechanism, which in particular is designed to completely enclose it.

In a further aspect, the object is achieved by a shank, in particular a shank of an instrument, with a joint mechanism according to one or more of the described embodiments.

In a further aspect, the object is achieved by a medical instrument, in particular a medical robot or an endoscope, with a joint mechanism according to one or more of the described embodiments.

Such a shank or such a medical instrument is or are particularly torsionally rigid due to the design of the joint mechanism, is easy to use and particularly easy to clean and/or close, in particular when a protective cover or other protection for an inner area of the joint mechanism is formed by several steering elements or one steering element disinfect. If, for example, a shaft of an endoscope is designed as a consumable, appropriate protection can be guaranteed for a single use.

• 1 eine schematische Darstellung einer Gelenkmechanik in einer isometrischen Ansicht,
• 2 eine schematische Darstellung einer weiteren Gelenkmechanik in isometrischer Ansicht,
• 3 eine schematische Darstellung einer Anordnung von Lenkbändern für eine Gelenkmechanik,
• 4 eine schematische Darstellung einer Taumelscheibe für eine Gelenkmechanik in einer Draufsicht,
• 5 eine schematische Darstellung eines Endoskopes in isometrischer Ansicht, sowie
• 6 eine schematische Darstellung eines medizinischen Roboters in einer Seitenansicht.

The invention is explained in more detail below using exemplary embodiments. Show it

• 1 a schematic representation of a joint mechanism in an isometric view,
• 2 a schematic representation of another joint mechanism in an isometric view,
• 3 a schematic representation of an arrangement of steering strips for a joint mechanism,
• 4 a schematic representation of a swash plate for a joint mechanism in a plan view,
• 5 a schematic representation of an endoscope in an isometric view, and
• 6 a schematic representation of a medical robot in a side view.

A joint mechanism 101 has a distal end area 103 and a proximal end area 105 . A shaft 107 runs from the proximal end area 105 to the distal end area 103 inside the joint mechanism 101 and is connected to a shaft 117 by means of a joint 108 . At the proximal end area 105 the shaft 117 is connected to further shafts by means of a ball joint 118 . The shaft 107 and the shaft 117 are used to drive an end effector that can be connected to the distal end area 103 of the joint mechanism 101 .

A guide ring 109 is arranged around the shaft 107 at the distal end area 103 . A swash plate 111 with a steering ring 113 is arranged around the shaft 117 and the ball joint 118 at the proximal end region 105 . The swash plate 111 slides on the ball joint 118 and is mounted on this ball joint 118 so that it can pivot in several axes.

A plurality of steering strips 131 made of stainless steel are arranged on a circumference of the joint mechanism 101, namely radially around an axis 181, which depicts the longitudinal axis of the joint mechanism 101, evenly distributed around the circumference. The steering belts 131 are fastened to the guide ring 109; for this purpose, the respective steering belts 131 are fastened in the guide ring 109 with a crimped connection.

The steering straps 131 pass through respective openings 114 in the swash plate 111 and steering ring 113. The steering straps 131 are rectangular are formed and arranged so that the width, which is significantly larger than the thickness of a rectangular cross section, is arranged along a circumference of the hinge mechanism 101 . The steering bands 131 thus stiffen the joint mechanism 101 in the direction of torsion.

The joint mechanism 101 can be pivoted about the joint 108 and the joint 118 in different axes by means of different tension on the respective steering bands 131. To do this, the joint mechanism 101 is pivoted in the direction in which a steering band 131 loaded with a tensile force is also arranged. The joint mechanism 101 can therefore be freely controlled by means of the steering belts 131 .

A joint mechanism 201 has a head piece 203 and a guide ring 205 , a guide ring 207 and a guide ring 209 . The head piece 203 is arranged on a distal end area 202, a guide ring 211 on a proximal end area 204. Guide bands 231, which are fixed in the head piece 203, run through the guide ring 211 and the guide rings 205, 207 and 209. The steering belts 231 are guided in openings 214 in the respective guide rings and the steering ring 211 . The head piece 203 can thus be pivoted and moved by means of the steering belts 231 analogously to the example shown above for the articulated mechanism 101 at the distal end area 202 of the articulated mechanism 201 . The steering belts 214 are arranged radially symmetrically on a circumference of the joint mechanism 201 about an axis 191 which depicts the longitudinal axis of the joint mechanism 201 .

A steering arrangement 301, which can be used within a joint mechanism, has a number of steering belts 331. The steering bands 331 are rectangular and curved along a circumference due to the mounting in the steering assembly 301 . The steering straps 331 are arranged so that they overlap with one another at overlaps 333, so that all of the steering straps 331 form a tubular structure.

As a result, a working channel 335 is formed within the steering bands 331 . Drive shafts, optical systems, optical waveguides and other arrangements, for example, can then be inserted within the working channel 335 in corresponding joint mechanisms. A sleeve 336 formed in this way from the steering bands 331 protects the systems arranged inside the working channel 335 from mechanical influences.

An outside 337 of the cover 336 is easy to clean, so that a joint mechanism equipped with a corresponding steering arrangement 301 can be easily cleaned or disinfected.

An alternative swash plate 411 which can be used in the joint arrangement 101, for example, has a guide surface 412 which can be arranged on the ball joint 118. The respective steering belts 114 can then be accommodated in receptacles 421 . The respective steering bands 114 are then fixed by means of grub screws screwed into threaded bores 423 (grub screws not shown).

An endoscope 501 has an objective 507 at one end 506 of a distal end area 502 . By means of the lens 507, an observation area can be viewed with the endoscope 501, for example inside a human body.

The joint mechanism 101 is arranged in the head 503 of the endoscope 501 for moving the end 506 and for aligning the lens 507 to a viewing area. By means of this joint mechanism 101, the head 503 of the endoscope 501 can be pivoted freely in different directions (indicated by the curvature of the head 503). A shaft 505 of the endoscope 501 is arranged at a proximal area 504 and connects to the head 503 . The endoscope can be guided on this proximal area 504 and the shaft 505, for example with one hand.

A robot 601 has a foot 603 and an arm 605 articulated by means of joints 607 . An end effector 611 is arranged at one end 609 of the arm 605 . The end effector 611 has the joint mechanism 201 in its end region 612 for the fine alignment of the end effector 611 . The end effector 611 is designed as a gripper.

The robot 601 is a medical robot for supporting a surgical intervention by gripping and holding human or animal tissue by means of the end effector 611 so that an operator can carry out the actual surgical intervention.

Reference List

101

joint mechanics

103

distal end area

105

proximal end area

107

Wave

108

joint

109

conductive ring

111

swashplate

113

steering ring

114

opening

117

Wave

118

ball joint

131

steering tape

181

axis

191

axis

201

joint mechanics

202

distal end area

203

headpiece

204

proximal end area

205

conductive ring

207

conductive ring

209

conductive ring

211

steering ring

214

opening

231

steering tape

301

steering assembly

331

steering tape

333

overlap

335

working channel

336

Covering

337

outside

411

swashplate

412

guide surface

421

Recording

423

threaded hole

501

endoscope

502

distal end area

503

Head

504

proximal area

505

shaft

506

End

507

lens

601

robot

603

Foot

605

poor

607

joint

609

End

611

end effector

612

end area

QUOTES INCLUDED IN DESCRIPTION

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

Patent Literature Cited

• US7699855 [0003]
• WO 002014004242 [0004]
• US10105128 [0005]

Claims (17)

Joint mechanism (101, 201) for a medical instrument, in particular for a medical robot (601) or for an endoscope (501), with a supporting joint arrangement (117, 118) with a joint body (118) or several joint bodies (118) for pivoting a distal end section (103, 202), and a first steering element (114, 214) arranged on the joint arrangement (117, 118) and connected to the distal end section (103, 202), so that by means of the first steering element (114, 214) the distal end section (103, 202) can be manipulated, characterized in that the first steering element (114, 214) is in the form of a strip. Joint mechanics according to claim 1 , characterized in that the joint mechanism has a second steering element (114, 214) or further steering elements (114, 214). Joint mechanics according to claim 1 or 2 , characterized in that the first steering element (114, 214), the second steering element (114, 214) or the further steering elements (114, 214) is rectangular or essentially rectangular and/or oval. Joint mechanism according to one of the preceding claims, characterized in that the first steering element (114, 214), the second steering element (114, 214) and/or the further steering elements (114, 214) have a ratio of a width to a thickness of more than 3/1, in particular more than 4/1 or more than 5/1. Joint mechanism according to one of the preceding claims, characterized in that the first steering element (114, 214), the second steering element (114, 214) and/or the further steering elements (114, 214) as a belt and/or belt, in particular as a fiber-reinforced belt or a belt and/or a strip steel, in particular made of a steel, a stainless steel and/or a nitinol. Joint mechanism according to one of the preceding claims, characterized in that the first steering element (114, 214), the second steering element (114, 214) and/or the further steering elements (114, 214), in particular in an installed position, are curved along a circumference of the Joint mechanism is formed or are. Joint mechanism according to one of the preceding claims, characterized in that the first steering element (114, 214), the second steering element (114, 214) and/or the further steering elements (114, 214) have a surface coating, in particular made of an elastomer and/or of a plastic, has or have. Joint mechanism according to one of the preceding claims, characterized in that the first steering element (114, 214), the second steering element (114, 214) and/or the further steering elements (114, 214) by means of a guide (421) or a plurality of respective guides ( 421) is or are movably guided on a respective joint body (118) along a pulling direction and/or along a pushing direction. Joint mechanics according to claim 8 , characterized in that the guide (421) or the respective guide (421) is designed as a sliding guide and/or a roller guide. Joint mechanism according to one of the preceding claims, characterized in that the first steering element (114, 214), the second steering element (114, 214) and/or the further steering elements (114, 214) on a respective joint body (118) in a pulling direction and /or is or are mechanically connected to the respective articulated body (118) in a pressure direction. Joint mechanism according to one of the preceding claims, characterized in that the first steering element (114, 214), the second steering element (114, 214) and/or the further steering elements (114, 214) are connected to the distal end section (103, 202) and/or or is or are connected to the respective articulated body (118) in a frictionally, positively and/or cohesive manner, in particular by means of screws, clamps and/or gluing, welding and/or soldering. Joint mechanism according to one of the preceding claims, characterized in that the first steering element (114, 214), the second steering element (114, 214) and/or the further steering elements (114, 214) is or are guided by means of a swash plate (111), wherein the respective steering element (114, 214) or the respective steering elements (114, 214) is or are mechanically connected to the swash plate (111), in particular in a pulling direction and/or in a pushing direction. Joint mechanism according to one of claims 2 until 12 , characterized in that the first steering element (114, 214) and the second steering element (114, 214) and / or the first steering element (114, 214) and the further steering elements (114, 214) radially, in particular radially symmetrically to a Longitudinal axis (181, 191) of the joint mechanism are arranged around. Joint mechanism according to one of claims 2 until 13 , characterized in that the the first steering element (114, 214) and the second steering element (114, 214) and/or the first steering element (114, 214) and the further steering elements (114, 214) are arranged adjacent to and/or adjacent to one another. Joint mechanism according to one of claims 2 until 14 , characterized in that the first steering element (114, 214, 331) and the second steering element (114, 214, 331) and/or the first steering element (114, 214, 331) and the further steering elements (114, 214, 331) are arranged overlapping (333). Joint mechanism according to one of claims 2 until 15 , characterized in that the first steering element (114, 214, 331) and the second steering element (114, 214, 331) and/or the first steering element (114, 214, 331) and the further steering elements (114, 214, 331) partially or completely enclose a working channel (335) of the joint arrangement, so that in particular by means of the respective steering elements (114, 214, 331) a protective cover (336) locally or completely enclosing the working channel (335) of the joint arrangement is formed. Medical instrument, in particular medical robot (601) or endoscope (501), with a joint mechanism (101, 201) according to one of Claims 1 until 16 .

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