DE102021132427A1 - Deflection mechanism for an endoscopic instrument, endoscopic instrument and surgical system - Google Patents

Abstract

The present invention relates to a deflection mechanism for an endoscopic instrument, in particular for a surgical system, having: a first connection member and at least one second connection member which interacts with the first connection member for deflection; a plurality of steering wires coupling the connecting members to each other and extending through through holes provided off-center in the connecting members; and at least one electrical conductor which extends through the connecting members and is guided in conductor bushings provided eccentrically in the connecting members, the conductor bushings each being arranged in a region between two adjacent passage openings. The present invention also relates to an endoscopic instrument, in particular for a surgical system, and a corresponding surgical system.

Description

FIELD OF THE INVENTION

The present invention relates to a deflection mechanism for an endoscopic instrument, in particular for a surgical system, an endoscopic instrument, in particular for a surgical system, and a corresponding surgical system.

TECHNICAL BACKGROUND

A deflection mechanism for endoscopic instruments is used to deflect an accessory attached to it, in particular a handling device such as forceps, scissors or clamps.

For example, describes the DE 10 2019 121 034 A1 an endoscopic device provided for a surgical robotic system with a deflection mechanism and an end effector coupled thereto in the form of forceps.

Current surgical techniques, in particular the so-called HF surgery, use high-frequency electrical alternating current for electrotomy (also diathermy or electrocaustic) and coagulation (clotting). The thermal effect of high-frequency alternating current on tissue is used to cut through target tissue and/or stop bleeding. For this purpose, the surgical instruments have one or more (active) electrodes on their handling device, e.g. B. forceps, clamps, scissors or the like, via which the high-frequency alternating current is introduced into the target tissue of a patient. In order for the desired effect of electrotomy and/or coagulation to occur on the target tissue, a high current density is applied to the target tissue. For this reason, (active) electrodes generally have a small surface area and are designed, for example, in the form of needles or blades in order to introduce the applied high-frequency alternating current into the target tissue with the highest possible current density. The handling devices are designed to be correspondingly small.

In HF surgery, either monopolar or bipolar operated surgical instruments can be used. In the case of monopolarly operated surgical instruments, a single active electrode is arranged on the accessory of the surgical instrument, via which the high-frequency alternating current is introduced into the tissue of a patient. So that the current can be introduced into the tissue from the individual active electrodes, a large counter-electrode (neutral electrode) must be attached to the patient's body as the opposite pole. In the case of bipolarly operated surgical instruments, two electrodes (active electrode and neutral electrode) are arranged on the accessory of the surgical instrument. The high-frequency alternating current is introduced into the target tissue from a first electrode (active electrode) directly opposite the second electrode (neutral electrode).

With the previous systems, the alternating current was conducted to the accessory via electrically conductive structural elements of the surgical instrument, for example tension elements and shaft, that had to be insulated from one another. In this case, a deflection mechanism is designed to conduct current. On the one hand, this means a large number of transition points which can impair the electrical function due to their transition resistance. In addition, this places further demands on the insulation for electrical safety, so that these areas must again be insulated from the patient, with additional effort.

Alternatively, in previous systems, conductors routed centrally in the instrument are routed to the handling device. In this case, an actuation strand can be designed both for the transmission of tensile forces and for the transmission of current. However, this requires a design compromise, so neither of these properties can be maximized.

SUMMARY OF THE INVENTION

Against this background, the object of the present invention is to specify an improved deflection mechanism for an endoscopic instrument.

According to the invention, this object is achieved by a deflection mechanism having the features of patent claim 1 .

• - Eine Auslenkmechanik für ein endoskopisches Instrument, insbesondere für ein Chirurgiesystem, mit: einem ersten Verbindungsglied und wenigstens einem zu einer Auslenkung mit dem ersten Verbindungsglied zusammenwirkenden zweiten Verbindungsglied; einer Mehrzahl von die Verbindungsglieder miteinander koppelnden Lenkdrähten, welche sich durch außerzentrisch in den Verbindungsgliedern vorgesehene Durchtrittsöffnungen erstrecken; und zumindest einem sich durch die Verbindungsglieder erstreckenden elektrischen Leiter, welcher in außerzentrisch in den Verbindungsgliedern vorgesehenen Leiterdurchführungen geführt ist, wobei die Leiterdurchführungen jeweils in einem Bereich zwischen zwei benachbarten Durchtrittsöffnungen angeordnet sind.
• - Ein endoskopisches Instrument, insbesondere für ein Chirurgieystem, mit einer erfindungsgemäßen Auslenkmechanik.
• - Ein Chirurgiesystem, mit einem Chirurgieroboter und einem mit dem Chirurgieroboter gekoppelten erfindungsgemäßen endoskopischen Instrument.

Accordingly, it is provided:

• A deflection mechanism for an endoscopic instrument, in particular for a surgical system, having: a first connecting member and at least one second connecting member cooperating with the first connecting member for a deflection; a plurality of steering wires coupling the connecting members to each other and extending through through holes provided off-center in the connecting members; and at least one electrical conductor extending through the connecting members and guided in conductor bushings provided off-center in the connecting members, the conductor bushings are each arranged in a region between two adjacent passage openings.
• - An endoscopic instrument, in particular for a surgical system, with a deflection mechanism according to the invention.
• - A surgical system with a surgical robot and coupled to the surgical robot endoscopic instrument according to the invention.

The finding on which the present invention is based is that for a safe HF function that can be operated with high voltages, an off-center conduction of two potentials from a proximal end of a surgical instrument to the distal end is required.

The idea on which the present invention is based is to guide at least one electrical conductor through conductor bushings additionally provided in the connecting members of a deflection mechanism, which are arranged eccentrically in the connecting members between the passage openings provided in the connecting members for steering wires. In this way, for the first time, conductors can be guided through the deflection mechanism without the space in the central passage of the connecting members or a special actuating strand of the surgical instrument with integrated conductors being required. An actuating cord is usually provided as a pulling element for mechanically actuating an accessory, in particular a handling device such as pliers, scissors or clamps. According to the invention, a design of the actuating train that is optimized for this tensile load can be provided without considering electrical aspects. The present invention thus enables the transmission of mechanical actuation forces and electrical potentials to be decoupled. Much less consideration needs to be given to mechanical requirements when routing the conductors. The electrical aspects, in particular with regard to insulation of the conductor designed for higher operating voltages, can thus be implemented in a significantly more pronounced manner and in a manner that is easier to produce and therefore more cost-effective.

The arrangement of the conductor bushings according to the invention enables gentle conductor or cable routing, which automatically follows the movements of the deflection mechanism, especially the connecting links. In this way, an even distribution of mechanical stresses is made possible, so that the conductor is better protected against damage.

A single conductor or a plurality of conductors may be provided. In the case of a plurality of conductors, individual conductor bushings are preferably provided in the connecting links, in particular in each connecting link, for each conductor.

An off-center arrangement of the conductor bushing is to be understood, in particular, as a positioning spaced radially from a central axis, similar to the positioning of the passage openings provided for the steering wires. The arrangement in a region between two adjacent passage openings is to be understood in particular as positioning tangentially between them. This does not necessarily mean an identical or similar radial distance from the central axis, rather a radial offset of the conductor bushing can also be provided. Furthermore, the conductor bushing can differ in its dimensions and/or shape from the passage openings. In particular, the dimension and/or shape can be adapted to the electrical requirements of an endoscopic instrument.

The conductor bushing can in particular be specially designed for the function of moving a conductor. For example, the conductor bushing can be designed with rounded edges for this purpose, in order not to damage an insulation of the conductor, for example an insulating sleeve or a jacket, when the deflection mechanism moves. Furthermore, the conductor bushing can be lined with a grommet or with a coating for the purpose of moving the conductor guide, for example in order to provide improved sliding properties and/or additional insulation.

The connecting members can be designed, for example, in a previously known manner as so-called cup washers, which are coupled to one another via intermediate pieces, so-called swivel olives, which allow deflection. An interaction of the connecting members for deflection is realized by means of the steering wires coupling the connecting members together radially outside of the vertebral olives, which can be displaced in a coordinated manner relative to one another, in particular pulled and/or pushed, so that the deflection mechanism is loaded in tension in one to one steering wire-pointing direction or against a direction pointing to a pressure-loaded or relaxed steering wire deflects.

Different configurations of the deflection mechanism with different numbers of steering wires are possible. A typical number of 8 to 10 steering wires is often employed to provide a smooth round deflection with no preferred directions. But this does not represent any Theoretically, depending on the degree of miniaturization of the deflection mechanism or the type and design of the steering wires, other numbers would also be conceivable, for example a reduced number of only 6 or an increased number of 12 or more steering wires. In particular, according to the invention, there can be a reduction in the number of steering wires compared to a conventional deflection mechanism with comparable dimensions, for example from ten to eight steering wires with a dimensioning of the deflection mechanism with a diameter in the range of 10 mm. In this way, space is created for the conductor bushings, so that at least one conductor, in particular two conductors, can be routed through the deflection mechanism. Further miniaturization down to small diameters of 3-4 mm are conceivable. Larger dimensions are of course also possible.

Steering wires are to be understood as meaning strands that are suitable for steering the connecting links by means of tensile force transmission and are elastically deformable when bent, and are made of a biocompatible material. A design made of metal, in particular stainless steel, is provided in an advantageous embodiment. However, the use of other biocompatible, tensile materials and/or structures, for example multi-fiber strands and/or composite strands, would also be conceivable.

Advantageous refinements and developments result from the further dependent claims and from the description with reference to the figures of the drawing.

According to one embodiment, the passage openings are arranged on a concentric hole circle of the respective connecting members. The conductor bushings are arranged in the area of the bolt circle. A circle of holes is to be understood as meaning a common circle on which the centers of the passage openings are arranged. The passage openings are preferably distributed uniformly on the concentric circle of holes, that is to say at equal angular distances from one another. A center point of the conductor bushing lies within such an angular distance, but does not necessarily have to lie on the circle of holes. A radial offset of the conductor bushing relative to the circle of holes can also be provided, but this is preferably designed to be smaller than a radius of the passage openings. In particular, the center point of the conductor bushing can be arranged in the middle of the angular spacing of the passage openings.

According to one embodiment, a cross section of the conductor bushing intersects the circle of holes. Thus, a radial offset of the conductor bushing to the circle of holes is less than half the diameter of the conductor bushing. In this way, the material section present between the through-openings can be advantageously used for conductor feedthrough.

According to one embodiment, an even number of steering wires distributed evenly over the hole circle and a corresponding even number of through-openings in the connecting links are provided. In this way, a symmetrical arrangement of the through-openings and consequently also of the conductor bushings arranged between two through-openings is made possible.

According to one embodiment, the conductor bushings are designed with inlet and outlet radii. In this way it is avoided that an insulation of the conductor is damaged during the deflection. In particular, jamming between the connecting members is prevented. Furthermore, the bending radii of the conductors at the transition between the connecting links are reduced, so that the conductors can be guided gently. Overall, the conductor is thus protected against damage when the deflection mechanism is deflected.

According to one embodiment, the steering wires are anchored in a head member that can be coupled to a handling device. The at least one electrical conductor is guided through a conductor bushing provided in the head member up to one end of the head member. In this way, an electrical supply for an accessory, in particular a handling device, is provided via the at least one conductor. In particular, HF current with a comparatively high operating voltage can thus be transmitted to the handling device or a contact section of the handling device.

According to one embodiment, the deflection mechanism has two electrical conductors extending through the connecting members. The two conductors are each guided in conductor bushings provided eccentrically in the connecting members. The conductor bushings are each arranged in a region between two adjacent passage openings. In this way, an independent guidance of two electrical potentials through the deflection mechanism is advantageously made possible, in particular for the bipolar operation of an HF instrument. Alternatively, the two conductors can be charged with the same electrical potential for monopolar operation. In other embodiments would also more than two, for example three, four or more electrical conductors extending through the connecting members are conceivable. A maximum number of conductors corresponds in particular to the number of steering wires.

According to one embodiment, the two conductor bushings are arranged opposite one another in the connecting members. In particular, they are arranged on a common radial connecting line. In this way, a symmetrical design of the connecting members is made possible, so that the deflection mechanism is advantageously designed in a balanced manner.

According to a further development, the connecting members are each designed to be axially symmetrical in cross section with respect to a transverse axis which is normal to a connecting line of the conductor bushings.

According to one embodiment of an endoscopic instrument, a handling device coupled to the deflection mechanism is provided. A contact section of the handling device, which is designed in particular for electrosurgical contacting of biological tissue, is preferably electrically coupled to the at least one conductor. In this way, it is possible to apply HF current to the contact section via the conductor.

According to one embodiment of the endoscopic instrument, the guide wires are anchored in a head member that can be coupled to a handling device, with the at least one electrical conductor being guided through a conductor bushing provided in the head member to one end of the head member, and the handling device having a joint mechanism that is mounted in the head member .

According to one embodiment of the endoscopic instrument, the deflection mechanism has two electrical conductors extending through the connecting members, both conductors being guided in conductor bushings provided eccentrically in the connecting members and the conductor bushings being arranged in a region between two adjacent passage openings. The handling device is designed here for bipolar high-frequency treatment. Thus, in each case a contact section of the handling device, which is designed in particular for electrosurgical contacting of biological tissue, is electrically coupled to a respective conductor, for example welded or soldered. In this way, two electrical potentials can be applied to the two contact sections independently of one another, so that bipolar HF operation is made possible. Due to the structurally independent and separately insulated conductors, comparatively high operating voltages can advantageously be applied without the risk of current flashover.

According to one embodiment, the handling device has two levers that can be moved for manipulation, with a respective contact section being mechanically coupled to the levers in an electrically insulated manner. Preferably, the two levers can be actuated synchronously, in particular via an actuating strand that is guided centrally through the deflection mechanism. The contact sections are each connected to one of the conductors and are designed for bipolar electrosurgical contacting of biological tissue. In this way, two electrical potentials can be applied to the two contact sections independently of one another, so that bipolar operation is made possible.

The above configurations and developments can be combined with one another as desired, insofar as this makes sense. Further possible configurations, developments and implementations of the invention also include combinations of features of the invention described above or below with regard to the exemplary embodiments that are not explicitly mentioned. In particular, the person skilled in the art will also add individual aspects as improvements or additions to the respective basic form of the present invention.

character list

• 1 eine schematische Längsschnittansicht einer Handhabungsvorrichtung;
• 2 eine Explosionsdarstellung einer Handhabungsvorrichtung gemäß einer weiteren Ausführungsform;
• 3 eine Seitenansicht der Handhabungsvorrichtung gemäß 2 im montierten Zustand;
• 4 eine Längsschnittansicht der Handhabungsvorrichtung gemäß 3;
• 5 eine Draufsicht der Handhabungsvorrichtung gemäß 2 bis 4;
• 6 eine Querschnittansicht der Handhabungsvorrichtung gemäß 5 im Bereich A-A;
• 7 eine Querschnittansicht der Handhabungsvorrichtung gemäß 5 im Bereich B-B;
• 8 eine perspektivische Ansicht einer Handhabungsvorrichtung gemäß einer Ausführungsform mit zwei Hebeln;
• 9 eine Seitenansicht eines zur Handbetätigung ausgebildeten chirurgischen Instruments;
• 10 eine schematische Darstellung eines Chirurgiesystems;
• 11 eine Draufsicht auf eine Auslenkmechanik für ein endoskopisches Instrument;
• 12 eine Draufsicht auf eine Auslenkmechanik gemäß einer weiteren Ausführungsform;
• 13 eine Querschnittansicht einer Auslenkmechanik gemäß 12 im Bereich eines Verbindungsglieds;
• 14 eine perspektivische Ansicht eines endoskopischen Instruments; und
• 15 eine Längsschnittansicht des endoskopischen Instruments gemäß 14.

The present invention is explained in more detail below with reference to the exemplary embodiments given in the schematic figures of the drawing. They show:

• 1 a schematic longitudinal sectional view of a handling device;
• 2 an exploded view of a handling device according to a further embodiment;
• 3 a side view of the handling device according to FIG 2 in assembled condition;
• 4 a longitudinal sectional view of the handling device according to FIG 3 ;
• 5 a plan view of the handling device according to FIG 2 until 4 ;
• 6 a cross-sectional view of the handling device according to FIG 5 in area AA;
• 7 a cross-sectional view of the handling device according to FIG 5 in the BB area;
• 8th a perspective view of a handling device according to an embodiment with two levers;
• 9 a side view of a surgical instrument designed for manual operation;
• 10 a schematic representation of a surgical system;
• 11 a plan view of a deflection mechanism for an endoscopic instrument;
• 12 a plan view of a deflection mechanism according to a further embodiment;
• 13 a cross-sectional view of a deflection mechanism according to FIG 12 in the area of a connecting link;
• 14 a perspective view of an endoscopic instrument; and
• 15 a longitudinal sectional view of the endoscopic instrument according to FIG 14 .

The accompanying drawing figures are intended to provide a further understanding of embodiments of the invention. They illustrate embodiments and, together with the description, serve to explain principles and concepts of the invention. Other embodiments and many of the foregoing advantages will become apparent by reference to the drawings. The elements of the drawings are not necessarily shown to scale with respect to one another.

In the figures of the drawing, elements, features and components that are the same, have the same function and have the same effect--unless stated otherwise--are each provided with the same reference symbols.

DESCRIPTION OF EXEMPLARY EMBODIMENTS

1 shows a schematic longitudinal sectional view of a handling device 1.

It is a movable handling device 1 for electrosurgical instruments, which can be coupled to a corresponding instrument or its head member, operating strand and electrical conductor.

The handling device has an articulated mechanism 2, which can be mounted in a head member of an electrosurgical instrument and coupled to an operating string. The joint mechanism 2 has at least one lever 3 on the handling side, which can be moved, in particular rotated, for manipulation by the joint mechanism 2 . In addition, the joint mechanism 2 can have a counter-member, not shown here, for absorbing reaction forces of the lever 3, or a second lever, not shown here (see Fig 8th ) exhibit. In the installed state, the lever 3 can be adjusted in rotation by the joint mechanism 2 and can transmit forces, in particular in a closing direction.

The lever 3 is firmly coupled to a lever extension 4 designed as an electrical insulator. Furthermore, an electrically conductive contact section 5 coupled firmly to the lever extension 4 is provided. The lever extension 4 electrically decouples the articulation mechanism 2 together with the lever 3 from the contact section 5 , but establishes a fixed mechanical connection between the articulation mechanism 2 and the contact section 5 . The lever extension 4 is also designed to transmit force in the closing direction and is subjected to pressure, among other things, when the handling device 1 is in operation. In the illustrated embodiment, the lever extension 4 additionally lengthens the lever 3 and is thus also subjected to a moment or, depending on the point at which a reaction force is applied, a bending load.

The contact section 5 is arranged on a side 6 of the lever extension 4 that can be acted upon by a force, in particular the closing force, via the joint mechanism 2 . For example, the handling device 1 can be a jaw part of a forceps instrument. In the case of pliers, the side 6 that can be subjected to force represents an inside of the lever 3, for example.

The contact section 5 is made of an electrically conductive, biocompatible material and has a non-slip and narrow surface contour, which is shown here as an example with a corrugation. In this way, the contact section 5 is designed for electrosurgical contacting of biological tissue. The contact section can also be contacted directly with a conductor, not shown here, which can extend in particular through the lever extension 4 and be electrically conductively connected thereto on a rear side of the contact section 5 facing the lever extension 4 .

2 shows an exploded view of a handling device 1 according to a further embodiment.

The regarding 1 features explained are transferrable to this embodiment. In addition, the lever extension 4 is positively connected to the lever 3 here. Furthermore, the contact section 5 is also connected to the lever extension 4 in a form-fitting manner. In the illustrated embodiment, there is a peripheral tongue and groove connection 13, 14 by means of so-called T-grooves, which engage in one another. For this purpose, a circumferential form-fitting engagement of the tongue and groove connection 13 by a handling lateral end 7 of the lever 3 is produced by pushing on a corresponding mounting section 8 of the lever extension 4 . Similarly, a circumferential form-fitting engagement of the tongue and groove connection 14 around an end 10 of the lever extension 4 on the handling side is produced by pushing on a corresponding assembly section 11 of the contact section 5 . Of course, other types of geometries of the form-fitting connection are also conceivable in further embodiments, for example with dovetail grooves or the like.

Both the respective components and their contact surfaces taper towards the handling side or towards a distal end, so that the complete form fit is achieved when the device is pushed on completely. The tongue and groove connections 13, 14 are each secured in this position with an additional lock 9, 12. Between the lever 3 and the lever extension 4 there is a securing element 9 that can be connected to the lever 3 in a materially bonded manner is. The connection between the contact section 5 and the lever extension 4 is fixed with a securing element 12 which can be connected to the contact section 5 in a materially bonded manner, which is designed here by way of example as a securing plate which is designed with an extension and is attached over the entire area from the inner side 6 .

Due to the fact that the lever extension 4 designed as an electrical insulator largely encloses the lever 3, the lever 3 or the joint mechanism 2 and the contact section 5 are separated from one another with sufficient creepage distances. With direct contacting of the contact section 5 with a conductor (17, see 8th ) The joint mechanism 2 can thus advantageously be made of steel without itself acting as a conductor. Thus there is no risk of accidental flashover.

3 shows a side view of the handling device according to FIG 2 in assembled condition.

For assembly, the components are preferably glued together over the entire surface in addition to the form-fitting connection. In this way, on the one hand, the strength of the connection is further increased and, on the other hand, joints between the components are filled and completely sealed.

4 shows a longitudinal sectional view of the handling device according to FIG 3 .

In this view, the two tongue and groove connections 13, 14 can be seen clearly, which are each designed with flat tongues and grooves, for example. In the case of the tongue and groove connection 13 , a tongue 22 that is one piece with the lever 3 and is comparatively long is accommodated in a groove 23 provided in the mounting section 8 of the lever extension 4 . In the case of the tongue and groove connection 14 between the contact section 5 and the lever extension 4, on the other hand, springs 24, 25 that are provided on the handling-side end 10 and also on the mounting section 11 and are designed to correspond to one another and have a hook-like extension and which result from the hook-like shape resulting directly to the springs 24, 25 subsequent grooves into each other.

The lever extension 4 mechanically lengthens the lever 3 starting from the joint mechanism 2 or an axis of rotation symbolized purely schematically here by dashed lines, so that a mechanically extended region 15 of the lever extension 4 extending beyond the lever 3 is provided. In this way, the contact section 5 is nevertheless arranged in a force-transmitting manner in the mechanically extended region 15, in which the lever 3 does not extend, or at least not completely.

An axis of rotation, symbolized here schematically by dashed lines, runs in the joint mechanism 2 when the handling device 1 is mounted on an electrosurgical instrument. The joint mechanism 2 is designed as a non-protruding joint mechanism, so that the lever 3 can be rotationally manipulated without displacement.

Also clearly visible in this view is the form fit produced by means of the securing elements 9, 12 that block the respective tongue and groove connection against loosening. For this purpose, both the pin 9 through the lever 3 and the extension of the plate 12 through the contact section 5 engage in the lever extension 4 designed as an electrical insulator.

5 shows a plan view of the handling device 1 according to FIG 2 until 4 .

In this view it can be seen that the illustrated embodiment of the handling device 1 is a jaw part of surgical forceps. The jaw part has a contour that tapers distally and also curves by about 30°. Also marked are two intersection lines A-A and B-B.

6 shows a cross-sectional view of the handling device 1 according to FIG 5 in the AA area.

The section line A-A runs transversely through the securing element 9 and illustrates the T-shaped cross-section of the spring 22 of the lever 3 and the groove 23 of the lever extension 4 Passage of an electrical conductor 17 to the contact section 5 for high-frequency control of the contact section 5 is formed.

7 shows a cross-sectional view of the handling device 1 according to FIG 5 in the BB area.

The section line B-B runs through the lever 3, the lever extension 4 and the contact section 5. The tongue and groove connection 13 between the lever and the lever extension is also designed with a T-shaped cross section here, while there is still no tongue and groove connection 14 in this area between lever extension 4 and contact section 5 is present. This is formed further distally closer to the end 10 on the handling side.

8th shows a perspective view of a handling device 1 according to an embodiment with two levers 3, 18.

The joint mechanism 2 accordingly has a second lever 18 which can be moved, in particular rotated, in the same way as the first lever 3 for manipulation. The second lever 18 can also be coupled to the actuating strand of an electrosurgical instrument via the joint mechanism 2 . In this case, the two levers 3, 18 function together, preferably synchronously, for power transmission. Thus, biological tissue can be clamped in between or separated.

Furthermore, in the same way as the first lever 3 , the second lever 18 is firmly coupled to a second lever extension 19 designed as an electrical insulator, which in turn is coupled to an electrically conductive second contact section 20 . The two contact sections 5, 20 are arranged corresponding to one another on an inner side of the lever extensions 4, 19 and can each be electrically contacted independently of one another with a conductor 17.

The lever extensions 4, 19 designed as electrical insulators enclose the respective lever 3, 18 and electrically separate the respective contact section 5, 20 from it, so that there are sufficient creepage distances for electrical insulation. Each contact section 5 , 20 can thus be acted upon independently by an electrical potential via the conductor 17 . The conductors are routed proximally and can be connected to an HF generator there. The connection of the conductors 17 to the contact sections 5, 20 is realized, for example, by a welded connection. In this way, a bipolar operation of the handling device 1 is made possible when two electric potentials are applied to it with alternating current.

Such a handling device 1 for bipolar HF surgery can be used both with manually operated surgical instruments and with surgical or endoscopic instruments for a surgical system, in particular for operation via a surgical robot.

9 shows a side view of a surgical instrument 21 designed for manual operation.

It is therefore a hand-guided and hand-operated surgical instrument 21, which is designed here as a forceps instrument, for example. The surgical instrument includes an actuating strand running in a tubular shaft 26 as a pulling element (not shown here). The handling device 1 according to 8th is mounted here as an accessory or tool at the distal end (facing away from a user/surgeon) of the tubular shaft 26 in a head member 27 of the surgical instrument 21 . At the proximal end (facing a user/surgeon) there is a handle 28 and a handle limb 29 that can be moved to actuate the operating string.

The surgical instrument 21 is designed for bipolar high-frequency treatment and for this purpose has a bipolar power connection 30, for example for a coaxial cable. For contacting from the bipolar power connection to the contact sections 5, 20, for example, two conductors 17 extending in or over the tubular shaft 11 to the contact sections 5, 20 of the handling device 1 can be provided. In further embodiments, other contacts are also conceivable, at least from the power connection to the head member, for example directly via the tubular shaft 26 and/or the actuating strand.

10 shows a schematic representation of a surgical system 60.

The surgical system 60 has a surgical robot 61 and a corresponding elec rosurgical instrument, which is designed as an endoscopic instrument 50.

The endoscopic instrument 50 is guided by an arm 64 of the surgical robot 61 and has a handling device 1 that can also be actuated by the surgical robot 61 both mechanically and electrically, preferably in a bipolar manner.

The surgical system 60 also includes a control unit 62 connected to the surgical robot 61 via a data link 63 . The control unit 62 is set up to control the surgical robot 61 . In particular, the control unit 62 has a man-machine interface 65 via which user inputs or control commands can be entered.

The endoscopic instrument 50 can be detachably connected to the robotic arm 64, for example in order to exchange, modify, sterilize or the like this.

In the embodiment shown, the surgical robot 61 has, by way of example, a plurality of robot arms. Of course, a single robot arm or another plurality of robot arms can be provided in further embodiments. Furthermore, several surgical robots and/or several control devices can also be provided.

For the sake of clarity, only the robot arm 64 of the robot arms is provided with a reference number. In the same way, the surgical system 60 in the illustrated embodiment comprises a plurality of endoscopic devices, which can be of the same or different type as the endoscopic instrument 50 , which is also provided with a reference number for the sake of clarity.

The surgical robot 64 has, purely by way of example, one endoscopic device per robot arm. The plurality of endoscopic devices can be configured differently from one another, at least in part, and differ, for example, by a type of end effector and/or a mode of operation. Of course, one skilled in the art would readily provide and/or adapt the multiple endoscopic devices for various surgical applications in accordance with their skill in the art.

For additional mobility of the handling device 1 , the endoscopic instrument 50 has a deflection mechanism 31 between the robot arm 64 and the handling device 1 .

11 shows a plan view of a deflection mechanism 31 for an endoscopic instrument 50.

The deflection mechanism 31 has a first connecting member 32 and a second connecting member 33 which interacts with the first connecting member 32 for a deflection. In further embodiments, more such connecting members can also be provided.

In particular, the connecting members are toroid-like or ring-shaped in cross-section around a central axis 45 with a central recess for an actuating strand of an endoscopic instrument. A toroidal shape is to be understood broadly, it can be a ring or an annular disk with a variety of longitudinal sectional geometries, in particular also with a lateral surface that is straight in sections and/or a longitudinal sectional contour that tapers conically from the inside to the outside.

The links 32, 33 are coupled to each other by a plurality of steering wires 34. As shown in FIG. In addition, movable coupling elements (48, see Fig 15 ) be provided. The steering wires 34 are guided through passage openings 35 of the connecting members 32,33, which are provided eccentrically in the connecting members 32,33. Preferably, the passage openings 35 are distributed at a uniform distance from one another around the center of the connecting members 32, 33.

An electrical conductor 36 is arranged in a region between two adjacent steering wires 24 and also extends, in particular parallel to the steering wires 34, through the connecting members 32, 33. For this purpose, the electrical conductor 36 is guided through conductor bushings 37 which are additionally provided in the connecting members 32, 33 between two adjacent passage openings 35 and are also arranged eccentrically.

The steering wires 34 are anchored at a distal end 43 of the deflection mechanism 31 in an element distally adjoining the connecting members 32, 33 and can be subjected to tensile and/or compressive loads at a proximal end 44 of the deflection mechanism 31, for example by an actuator provided in a robot arm . By applying a tensile load to a steering wire 34, the deflection mechanism 31 is bent toward the steering wire 34 that is under tension. This way will the distal end 43 is deflected relative to the proximal end 44 in a radial direction, ie transverse to a central axis 45 of the connecting links 32,33.

The at least one conductor 36 moves automatically with the deflection mechanism 31 and is thus curved comparatively gently in a manner similar to the steering wires 340 . In addition, the conductor bushings 37 can be formed with inlet and outlet radii in order to avoid edge contact of the at least one conductor 36 and thus in particular not to damage an insulation of the conductor 36 . Furthermore, certain compensating volumes can be provided when the conductor 36 is compressed or stretched, and the radii of a curvature or deformation of the conductor can be kept as large as possible. In this way, despite the free mobility of the deflection mechanism 31 in all spatial directions, a gentle conductor guidance that places little mechanical stress on the at least one conductor 36 is always made possible.

12 shows a plan view of a deflection mechanism 31 according to a further embodiment.

The deflection mechanism 31 also has the reference 11 features described, the steering wires 34 here in one with a handling device 1 (see 14 ) coupleable head member 39 are anchored, which is provided at the distal end 43 of the deflection mechanism 31.

Furthermore, the deflection mechanism 31 here has two electrical conductors 36a, 36b which extend through the connecting members 32, 33 and are guided in parallel through the connecting members 32, 33. Same as the conductor 36 in 11 Both conductors 36a, 36b are each guided in conductor bushings 37a, 37b provided eccentrically in the connecting members 32, 33 and the conductor bushings 37a, 37b are each arranged in a region between two adjacent passage openings 35. In the region of the head member, the conductors 36a, 36b are guided through a conductor bushing 40 provided in the head member 39 to one end 41 of the head member and can thus be coupled to a handling device 1. At the end 41 of the head member, the conductors 36a, 36b are guided past the joint mechanism 2 laterally through the conductor bushings 40. The conductor bushings 40 open in a funnel-like manner towards the distal end, so that there is enough space for the conductors 36a, 36b to move, so that the conductors 36a, 36b can move with them when the levers 3, 18 are opened and closed.

At the proximal end 44 of the deflection mechanism there is a foot member 46 that can be coupled, for example, via a tubular shaft or directly to a robot arm, which foot member has passage openings for the steering wires 34 and conductor bushings for the conductors 36a, 36b arranged in the same way as in the connecting members 32, 33.

13 shows a cross-sectional view of a deflection mechanism 31 according to FIG 12 in the area of a connecting link 32.

An example is in 12 a section line drawn through the first connecting member 32, in which the cross section is arranged. Equally, however, the cross section of the second connecting link 33 can also be of the same design.

In the sectional view, the passage openings 35 are arranged here on a concentric circle of holes 38 of the connecting members 32, 33. Advantageously, for reasons of symmetry, an even number of guide wires 34, eight in the illustrated embodiment, distributed evenly over the lock circuit 38, and a corresponding even number, eight in this case, through-openings 35 are advantageously provided. With an even number, which is in particular at least eight, a uniform, round deflection of the deflection mechanism is made possible without preferred directions, ie in all directions equally. The connecting members 32 , 34 are accordingly designed to be axially symmetrical in cross section with respect to a transverse axis 42 .

The conductor bushings 37 are also arranged symmetrically, here opposite one another, in the area of the lock circuit 38 . In the illustrated embodiment, the center point of the conductor bushing 37 is not arranged exactly on the circle of holes 38 but offset radially thereto. Of course, other arrangements lying in the area of the circle of holes are also conceivable, with a cross section of the conductor bushing 37 preferably intersecting the circle of holes 38 .

The recess 47 for the passage of an actuation strand is arranged centrally in the cross section.

14 shows a perspective view of an endoscopic instrument 50.

The endoscopic instrument 50 is for a surgical system 60 according to 10 provided and has a deflection mechanism 31 according to 12 and a handling device according to FIG 8th on, which is coupled to the deflection mechanism 31. For coupling, the joint mechanism 2 is the handle exercise device 1 is mounted in the head member 39 and can be actuated with an actuating strand that can be inserted through the center of the deflection mechanism 31 .

The handling device 1 has two levers 3, 18 that can be moved synchronously for manipulation. A contact section 5, 20 is mechanically coupled to each of the levers 3, 18 in an electrically insulated manner. Furthermore, the conductors 36a, 36b are electrically connected to one of the contact sections 5, 20 independently of one another, so that the surgical instrument 50 is designed for bipolar high-frequency treatment when two different electrical potentials are applied, as in relation to FIG 8th described. Each contact section 5, 20 can thus be acted upon independently by an electrical potential via the conductors 36a, 36b. For this purpose, the conductors 36a, 36b are guided proximally through the head member 39 and the deflection mechanism 31 and can be connected there to an HF generator.

The endoscopic instrument 50 is accordingly designed for bipolar electrosurgical contacting of biological tissue. When applying the same electrical potential to the conductors 36a, 36b, however, monopolar operation is also possible, which is particularly the case with respect to FIG 1 and 2 set forth electrical insulation of the contact sections 5, 20 to the joint mechanism 2 is made possible with a sufficient creepage distance.

15 FIG. 5 shows a longitudinal sectional view of the endoscopic instrument 50 according to FIG 14 .

In this view, the coupling elements 48 can also be seen, which are designed as so-called swivel olives. These have a spherical or spherical shape on their lateral surface. A corresponding recess or socket in the shape of a segment of a sphere has associated receptacles 51 of the connecting members 32, 33, which are shaped here as socket washers, and of the head member 39 and the foot member 46 at their axial ends. The first connecting member 32 and the second connecting member 33 thus interact in the manner of a ball joint and/or in the manner of vertebral bodies. In this way, the coupling elements 48 and connecting members 32, 33 can be rotated relative to one another to a certain extent, which enables the deflection mechanism 31 to be deflected.

The coupling elements 48 are also formed with a central recess 52 for the implementation of an actuation strand. An actuating string can be fastened in an eyelet 49 anchored in the joint mechanism, so that the two levers 3, 18 can be rotated and subjected to a closing force by pulling the actuating string. For example, the eyelet 49 can have an internal thread and the actuation strand can have a corresponding external thread at its tip. Of course, other, preferably detachable, fastening means for coupling the actuating strand are also possible.

Also clearly visible in the longitudinal section are the inlet and outlet radii 53 provided in the conductor bushings 37, which keep the radii of a curvature or deformation of the conductor as large as possible when the deflection mechanism 31 is deflected.

In addition, the passage openings 16 for the conductors 36a, 36b through the electrically insulated sections, in particular a lever extension 4, from the joint mechanism 2 to the contact sections 5, 20 can also be seen here.

Although the present invention has been fully described above on the basis of preferred exemplary embodiments, it is not restricted to them, but rather can be modified in a variety of ways.

In particular, the handling device 1 can also have a different configuration as an alternative to a jaw part of a forceps instrument. In particular, a lever extension 4 does not necessarily have to lengthen the lever 3; it could also simply continue the lever 3 in the direction of force transmission.

Furthermore, it would also be conceivable to form a base of the handling device in one piece as a joint mechanism 2 and a lever extension 3 made of an insulating material, so that the joint mechanism is made of the insulating material. However, it is preferably a three-part construction with an electrically neutral joint mechanism 2 as the base, a lever extension 4 as the insulator and a contact section 5 as the electrically active contact surface.

The joint mechanism 2 and the head member 39 supporting the joint mechanism 2 can be made of a metallic material, but are not used to conduct electricity. An electrical potential on the contact surfaces is carried exclusively by conductors 36 or cables, which conduct the current directly to the contact surface.

All connections of the individual parts, in particular miniaturized T-slots and safety pins or pins, can also be connected by an adhesive connection. The form-fitting connection is therefore a form-fitting securing of the glued connections.

Known jaw parts, for example according to EP 2 026 705 B1 , can be modified by division in the manner of the invention. In particular, the joint mechanics of the non-exiting joints can remain in place. The contact surface of the jaw part formed with the contact cut 5 is electrically decoupled from the base or joint mechanism 2 by the lever extension 4 . The contact surface of the contact section 5 thus forms the active gripping surface of the pliers. This structure is analogous to that on the other jaw part. The rest of the instrument forms an electrically neutral frame that realizes the movements. The lever extension, which is designed as an electrical insulator, is mainly subjected to pressure and therefore does not offer any mechanical weak points. Securing the form fit by materially connected, in particular welded, locking pins ensures that the individual parts can no longer fall apart.

The deflection mechanism 31 can include different numbers of steering wires 34 . In particular, there can be a reduction in the steering wires 34 compared to a comparably dimensioned deflection mechanism, for example from 10 to 8 steering wires with a dimensioning of the deflection mechanism with a diameter of 10 mm.

The conductor bushings 37 can be arranged, for example, as cable-carrying channels, radially like the steering wires 34 around the central axis 45 . This offers the advantage that the cables can follow any movements that are forced by the steering wires 34. Furthermore, the conductor bushing 40 provided in the head member 39 up to a head member end 41 and also the passage openings 16 for the conductors 36a, 36b through the electrically insulated sections of the joint mechanism 2 up to the contact sections 5, 20 are arranged in such a way that the cables can pass through the Head member 39 can be routed directly to the contact sections 5, 20.

The refinements and developments described here can be combined with one another as desired, insofar as this makes sense. Further possible configurations, developments and implementations of the invention also include combinations of features of the invention described above or below with regard to the exemplary embodiments that are not explicitly mentioned. In particular, the person skilled in the art will also add individual aspects as improvements or additions to the respective basic form of the present invention.

The present invention relates to a deflection mechanism for an endoscopic instrument, in particular for a surgical system, having: a first connection member and at least one second connection member which interacts with the first connection member for deflection; a plurality of steering wires coupling the connecting members to each other and extending through through holes provided off-center in the connecting members; and at least one electrical conductor which extends through the connecting members and is guided in conductor bushings provided eccentrically in the connecting members, the conductor bushings each being arranged in a region between two adjacent passage openings. The present invention also relates to an endoscopic instrument, in particular for a surgical system, and a corresponding surgical system.

Reference List

1

handling device

2

joint mechanics

3

lever

4

lever extension

5

contact section

6

Page

7

handling end

8th

assembly section

9

fuse element

10

handling end

11

assembly section

12

fuse element

13

tongue and groove connection

14

tongue and groove connection

15

mechanically extended range

16

passage opening

17

electrical conductor

18

second lever

19

second lever extension

20

second contact section

21

electrosurgical instrument

22

Feather

23

groove

24

Feather

25

Feather

26

tubular shaft

27

head limb

28

handle

29

handle shanks

30

power connection

31

deflection mechanism

32

link

33

link

34

steering wire

35

passage opening

36

Director

36a, b

Director

37

conductor bushing

38

lock circle

39

head limb

40

conductor bushing

41

head limb end

42

transverse axis

43

distal end

44

proximal end

45

central axis

46

foot phalanx

47

central recess

48

coupling element

49

eyelet

50

endoscopic instrument

51

Recording

52

recess

53

inlet and outlet radii

60

surgical system

61

surgical robot

62

control unit

63

Data Connection

64

robotic arm

65

human-machine interface

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

• DE 102019121034 A1 [0003]
• EP 2026705 B1 [0107]

Claims (15)

Deflection mechanism (31) for an endoscopic instrument (50), in particular for a surgical system (60), with: a first link (32) and at least one second link (33) cooperating for deflection with the first link (32); a plurality of steering wires (34) coupling the connecting members (32, 33) to each other and extending through through openings (35) provided eccentrically in the connecting members (32, 33); and at least one electrical conductor (36) extending through the connecting members (32, 33), which is guided through conductor bushings (37) provided eccentrically in the connecting members (32, 33), the conductor bushings (37) each being in a region between two adjacent Passage openings (35) of the steering wires (34) are arranged. deflection mechanism claim 1 , characterized in that the passage openings (35) are arranged on a concentric circle of holes (38) of the respective connecting members (32, 33), the conductor bushings (37) being arranged in the area of the circle of holes (38). deflection mechanism claim 2 , characterized in that a cross section of the conductor bushing (37) intersects the circle of holes (38). deflection mechanism claim 2 or 3 , characterized in that an even number of steering wires (34) distributed uniformly over the hole circle (38) and a corresponding even number of through-openings (35) are provided in the connecting members (32, 33). Deflection mechanism according to one of the preceding claims, characterized in that the conductor bushings (37) are formed with inlet and outlet radii (53). Deflection mechanism according to one of the preceding claims, characterized in that the steering wires (34) are anchored in a head member (39) which can be coupled to a handling device, the at least one electrical conductor (36) being routed through a conductor bushing (40 ) is guided to a head link end (41). Deflection mechanism according to one of the preceding claims, characterized in that the deflection mechanism (30) has two electrical conductors (36a, 36b) extending through the connecting members (32, 33), both conductors (36a, 36b) being eccentric in the connecting members (32, 33) provided conductor bushings (37a, 37b) and the conductor bushings (37a, 37b) are each arranged in a region between two adjacent passage openings (35). deflection mechanism claim 7 , characterized in that the two conductor bushings (37a, 37b) in the connecting members (32, 33) are each arranged opposite one another, in particular symmetrically about a center point. deflection mechanism claim 8 , characterized in that the connecting members (32, 34) are each formed axially symmetrically in cross-section with respect to a transverse axis (42) which is normal to a connecting line of the conductor bushings. Endoscopic instrument (50), in particular for a surgical system (60), with a deflection mechanism (31) according to one of the preceding claims. endoscopic instrument claim 10 , characterized in that a handling device (1) coupled to the deflection mechanism (31) is provided. endoscopic instrument claim 11 , characterized in that the deflection mechanism (31) after claim 6 is formed and the handling device (1) has a joint mechanism (2) which is mounted in the head member (39). Endoscopic instrument according to one of Claims 11 or 12 , characterized in that the deflection mechanism (31) according to one of Claims 7 until 9 formed and the handling device (1) is formed for bipolar high-frequency treatment. endoscopic instrument Claim 13 , characterized in that the handling device (1) has two movable levers (3, 18) for manipulation, with each of the levers (3, 18) having a contact section (5; 20) mechanically coupled in an electrically insulated manner, the contact sections (5, 20) are each connected to one of the conductors (36a, 36b) and are designed for bipolar electrosurgical contacting of biological tissue. Surgical system (60), with a surgical robot (61) and one with the surgical robot (61) coupled endoscopic instrument (50) according to any one of Claims 10 until 14 .

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