DE202007005510U1 - Surgical instrument e.g. bipolar-combination instrument, for use as e.g. tubular shaft instrument, has cutting and clamping units, where units are brought into cleaning position in which clamping unit releases cutting unit - Google Patents

Abstract

The instrument has a clamping device (12) for holding a thread (156), and a cutting device (14) for cutting of the thread, where the clamping device has two clamping units (68, 92) that are movably arranged relative to each other. The cutting device has a cutting unit (48) and the clamping unit (68), which are movable relative to each other and are brought into a cutting position for cutting the thread. The cutting unit (48) and the clamping unit (92) are brought into a cleaning position, where the clamping unit (92) completely releases the cutting unit (48) in the cleaning position.

Description

The The present invention relates to a surgical instrument having a clamping device for holding and / or clamping tissue, a Separating device for cutting tissue and a handling device to operate the clamping device and / or the separating device, wherein the clamping device a first and a second clamping member which are relative to each other are movably mounted, wherein the separating device, the first clamping member and a partition member which is movable relative to each other and for cutting tissue in a release position in plant brought are or interact with each other, whereby in a working position, in which tissue is clamped and / or held with the instrument and / or can be severed, the second clamping member, the separating member at least partially surrounds.

A surgical instrument of the type described above, for example, from the US 6,743,230 B2 known. It is an instrument that combines the functions of a clamp and a pair of scissors. The configuration that the second clamping member at least partially surrounds the separating member has the advantage that only short actuating paths for moving the separating member relative to the second clamping member are required. However, this advantage is due to the disadvantage that, during a surgical procedure, tissue or other deposits may accumulate in the region between the separating member and the first clamping member and may even carbonize there. In the course of a surgical procedure, continuous tissue deposition can even lead to complete failure of the instrument. It must then be exchanged for another instrument or cleaned consuming.

It is therefore an object of the present invention, a surgical Instrument of the type described above to improve so that possible functional failures avoided and its manageability are improved.

These Task is in a surgical instrument of the type described above Type according to the invention thereby solved, that the separating member and the second clamping member, without the instrument to disassemble, can be brought into a cleaning position, in which the second clamping member completely releases the isolator.

These Design allows it, even in the course of a surgical procedure, especially then, For example, if the instrument is not needed for a short time, to transfer the instrument in the cleaning position, so that, for example an assistant of the surgeon the instrument in the area of the isolator and the first clamping member can clean, for example, by simple Removal of tissue deposited on the two limbs. The instrument Consequently, it can also be used without longer replacement, even during prolonged surgical procedures Interventions without major Effort to be kept operational. It is also not As with other known instruments, the instrument is required disassemble. For example, it is conceivable to design the instrument in such a way that that all parts of the same in the cleaning position together held or interconnected.

Advantageous it is when the second clamping member has an opening and if the separating member in the working position at least partially dips into the opening and in the cleaning position the Breakthrough completely releases. The opening on the second clamping member has to provide the advantage that a particularly compact design of the instrument possible is. It is thus particularly suitable for minimally invasive surgical procedures. for example, if it is in the form of an endoscopic instrument is trained. Furthermore, the arrangement of the isolator has at least partially in the opening or in the area of the opening the advantage that only a short actuation path is required, to move the separating member relative to the second clamping member, so that it can be brought into abutment with the first clamping member in the disconnected position is. The instrument lets also very easy to clean, and that by the fact that the opening is easily accessible in the cleaning position. So can not be attached Tissue directly fall out of the opening or yourself release from the isolator, if this completely clears the opening.

Preferably is the second clamping member for transferring the Instruments from the working position to the cleaning position of Separator away in the direction of the second clamping member movable. It is not mandatory that the isolator for transferring the Instruments from the working position to the cleaning position of first clamping member is moved away. For example, in one Working position, the separating member moves away from the first clamping member and then by moving the second clamping member away from the partition member in the direction of the first clamping member towards the instrument are transferred to the cleaning position. Depending on which viewpoint the relative movement is viewed from, can also be a relative movement of the separating member of the second clamping member Watch away, with a distance between the separator and the first clamping member remain the same, become smaller, but also in particular grow can.

Around in particular, cut tissue particularly easily and effectively to be able to It is advantageous if the separating member in the disconnected position in the direction over to the first clamping member the second clamping member protrudes. This also serves the separator as a kind of clamping member until complete cutting of the tissue, because if the separator over the second clamping member protrudes, is a distance between the separating member and the first clamping member is smaller than a distance between the two Clamping members.

Especially simply the construction of the surgical instrument, if that first and the second clamping member relative to each other about a first pivot axis are pivotally mounted. This allows both training of the instrument as an endoscopic instrument, for example as Pipe shank instrument, or as a conventional instrument with two or three relatively movable branches.

Further simplify the structure of the instrument when the first clamping member and the Separator pivotally relative to each other about a second pivot axis are stored.

Around to achieve a particularly compact design of the instrument is it is advantageous if the first and the second pivot axis parallel to each other. this makes possible it, that the separating member and the second clamping member in the same direction of movement can be moved to the first clamping member, for clamping or holding and / or for severing tissue.

In order to the structure of the instrument can be further simplified is it cheap when the first and second pivot axes are identical. These Design allows in particular a pivot bearing for the clamping members and to provide the isolator relative to each other, which is only a single one Bearing shaft or the like required.

According to one preferred embodiment of Invention can be provided that in the working position with Exception of the separation position a distance between the first and the second clamping member is smaller than a distance between the separating member and the first clamping member. So it can be ensured the tissue, for example in the form of blood vessels, first can be clamped between the clamping members before it cuts becomes. So a surgeon, for example, tissue only in the desired Wise way and under circumstances let go again without running the risk of having the separator the tissue in unwanted Way is injured.

The Handling of the instrument becomes especially useful for a surgeon easy if the handling device two relative to each other movable actuators includes, which are coupled to the separating device and the clamping device. This results in for the operator a handling as in a clamp or scissors, independently of whether the instrument as an endoscopic instrument, preferably as a tubular shaft instrument, or in the form of a surgical instrument formed with two pivotally mounted to each other industries is.

The Handling device becomes particularly simple in its construction, though the two actuators relative to each other pivotally mounted about a third pivot axis are. For example, an actuator on a shaft an endoscopic tubular instrument fixedly arranged be, the other actuator can be pivoted relative to the fixed actuator be arranged.

Of the Structure of the instrument simplifies further, if the third Pivoting axis parallel to the first and / or second pivot axis.

Preferably are the third pivot axis and the first and / or second pivot axis identical. In particular, if all three pivot axes identical are, that is can coincide the actuators, the clamping members and the separating member on a single common bearing shaft be stored.

conveniently, is a first actuator rigid or direct with the first clamping member and a second actuator rigid or directly connected to the separator. Such an instrument is particularly easy to handle and has a particularly good tactility, because a surgeon can directly control the action of the separator over the Actuate handling device and feel their effect.

The Handling of the instrument is improved when the handling device is arranged at a proximal end of the instrument.

Further is it cheap when the clamping device and / or the separating device on a distal end of the instrument are arranged. For example, these can introduced into a patient's body in an endoscopic instrument and with a handling device which is located outside the body, actuated become.

According to a preferred embodiment of the invention can be provided that the Instru comprises two pivotally mounted rigid branches, each having a proximal and a distal end, that the actuators at the proximal ends and that the first clamping member and the separating member are respectively provided at one of the distal ends. Such a structure is particularly simple. The instrument would thus have, for example, the shape of a conventional pair of scissors if the first clamping member were likewise designed in the form of a separating member. Rigid means in the present case directly connected, possibly in one piece. A certain elasticity of the compound, for example an industry, should not be excluded.

Advantageous it is when the first clamping member at a distal end of a order the first and / or the second pivot axis pivotally mounted first Levers is arranged. Such an instrument is easy to construct and manufacture. In particular, the first lever may be part of a Industry.

Preferably is the second clamping member at a distal end of one around the first and / or the second pivot axis pivotally mounted second Levers arranged. So lets the second clamping member in a simple manner relative to the first clamping member arrange movably. Furthermore, it is also advantageous if the separating member at a distal end of one about the first and / or the second pivot axis is arranged pivotably mounted third lever. For example The third lever can also be part of an industry of the instrument. The Arrangement of the clamping members and the separating member each at one Lever allows in particular a simple structure of the instrument, in particular even if it is designed in the form of a tubular shaft instrument.

Preferably is a common bearing wave for the first, the second and / or the third lever provided which defines the first and second pivot axes. Of course that can Instrument should also be designed so that the common bearing shaft also defines the third pivot axis, creating a structure of the instrument even further simplified.

Advantageous it is when the first and / or the second and / or the third Lever in the proximal direction over extend the first and / or the second pivot axis addition. This elevated for a stability of the instrument. For another so the lever in a particularly simple way with the actuator be coupled. Especially in the training of an endoscopic Instruments in the form of a tubular shaft instrument can the over the first and / or the second pivot axis beyond the ends Linkages for connection to one or more power transmission links, which in an elongated U-shaped shank of the instrument movably mounted and connected to the actuators, be articulated.

In order to the instrument is not inadvertently removed from the working position be transferred to the cleaning position can, is it cheap, if a safety device is provided for securing the second Clamping member in the working position. So it is possible with the safety device ensure that the second clamping member and the isolator the maintained relative position required, they in the working position taking.

One a particularly simple construction of the safety device can be in that they achieve a first and a second securing member includes, which are engaged in the working position and in the cleaning position except Engage. To transfer the Instrument is from the working position to the cleaning position it thus only necessary, the first and the second securing member except To interfere. The one for this required forces can vary depending on the configuration of the safety device. A unintentional deactivation of the safety device can be all the more better avoid, the higher a dissolving power is that for separating the first and the second securing member is required from each other. In particular, the security members in the working position non-positively and / or positively engaged.

On simple way, the safety device can be arranged and a compact design of the instrument obtained when the first securing member on the second lever and when the second securing member on the third Levers are arranged. Thus, in particular, a relative position of the second clamping member and the separating member in the working position can be secured directly in a simple way, if the mentioned links are arranged on the second and on the third lever.

Around the securing device of the clamping members and the separating member spatial preferably to separate it is convenient when the first and / or the second securing member on the proximal side of first and / or second pivot axis are arranged. So can the Clamping members and the separating member are formed in the desired manner, regardless to have to take on the design of the safety device.

The handling of the instrument can be improved in a simple manner, that the first and the second securing member are formed in the form of locking members. By the vanguard hen of locking members, the instrument can be converted in a simple manner by latching the same from the cleaning position to the working position. In addition, no further tools or instruments are required both for releasing and for connecting the locking members, which allows an operator, even during a surgical procedure, the instrument briefly transferred from the working position to the cleaning position to roughly clean the clamping members and the separating member and then return the instrument to the working position.

Of the Structure of the security device will be particularly easy if that first locking member a recess and when the second locking member has a corresponding Advantage includes. Of course can the securing members also be formed correspondingly reversed.

Especially good results when cutting through tissue can be achieved when the partition member comprises a cutting edge. In particular, can the cutting edge may be arranged and configured to be such both in the working position and in the disconnected position towards points to the first clamping member. Preferably, it is in the release position on her whole length on the first clamping member.

According to one preferred embodiment of Invention may provide an electrical connection device be, which with the first and / or second clamping member and / or the isolator is electrically connected. So can be without huge Training monopolar or bipolar instruments. For example For constructing a monopolar instrument, the first clamping member be electrically connected to the connection device. This allows a monopolar clamping device and at the same time a monopolar separator are formed. For training bipolar Subfunctions of the instrument can additionally also the separating member and / or the second clamping member electrically conductive be connected to the connection device.

Around to improve the handling of the instrument, it is advantageous if the electrical connection device in the region of a proximal end of the instrument is arranged. For example, the connection device via plug connections be connected with a connecting cable, which in turn with a high-frequency generator can be connected to, for example, a for one To provide coagulation of tissue required electricity.

Cheap is it, if the electrical connection device three connection contacts each of which is electrically conductive with the first Clamping member, the second clamping member and the separating member connected is, which are electrically isolated from each other. This embodiment allows the construction of a quasi double bipolar instrument, namely a Instruments with a bipolar clamping device and a bipolar Separator.

Cheap is it, when the second clamping member and the separating member against the effect a reset device are movable toward each other such that when adjacent to each other Clamping members the separating member against the action of the return device in the direction of the first clamping member is movable. This embodiment In particular, in an instrument of the type described above Art be provided in which it also not mandatory is that the second clamping member, the separating member at least partially surrounds. By the development of the invention Is it possible, an instrument with a separating device and a clamping device form, both devices are actuated with a handling device, which only two relatively movable actuators includes. The second clamping member and the separating member can thus together actuated are ensured, whereby ensured by the arrangement of the return device is that first Tissue between the two clamping members can be held before the separator operable is.

Especially The surgical instrument is simple in construction when the resetting device is proximal the first and / or second pivot axis is provided. For example can the reset device be arranged in the field of safety device or even to be combined with this. The proximal-sided arrangement of the restoring device also ensures optimal spatial Separation of the clamping members and the separator.

Cheap is it if the reset device at least a return member includes, which on the one hand directly or indirectly on the second Clamping member and which, on the other hand, directly or indirectly on the separating member supported. So can with increasing operating force the second clamping member and the separating member moves relative to each other until the instrument assumes the release position.

Of the Construction of the instrument becomes particularly easy if that at least a reset member supported on the one hand on the second lever and on the other hand on the third lever.

It can also be advantageous if the at least one return member on the one hand on the La gerwelle and on the other hand supported on the second and / or third lever. Thus, in particular a particularly compact design of the restoring device and thus also of the entire instrument can be achieved.

Especially economical and easy to manufacture will be the instrument if that at least a reset member in the form of an elastic sleeve or an elastic ring is formed. For example, can be so the at least one return member Arrange directly on a bearing shaft, allowing a relative movement of mounted on the bearing shaft levers relative to the bearing shaft and possible to each other is.

Advantageous it may also be, if the at least one return member comprises the second lever, which distal side of the first and / or second pivot axis at least comprises an elastically resilient region. This allows the restoring device almost integrate into the second lever. Other components for training the return device are not required in this case. In particular, the second Lever along its entire length be formed elastic, whereby a total of stability of the instrument elevated can be, because so lets a deformation per unit length compared to a short springy section of the lever clearly reduce.

Especially economical and just under construction the reset device, if the at least one return member is formed in the form of a mechanical spring. The spring can in particular a coil spring, a leaf spring or a plate spring be.

According to one preferred embodiment of Invention, the instrument may further comprise an instrument grip, which comprises the handling device.

Around To improve the cleanability of the instrument, it is beneficial if the instrument handle with the separator and / or the clamping device solvable is connectable. For example, you can so endoscopic instruments, in particular tubular instruments, be formed, in which the shank of the instrument, to which the separating device and / or the clamping device arranged could be, can be separated from the handle. So For example, an instrument handle can be used multiple times, the tubular shaft with the separator and / or the clamping device For example, it can also be provided as a disposable item. Of course But it is also conceivable that the entire instrument as a disposable item Herge is independent of whether an instrument handle is provided or not.

Around to be able to coagulate tissue already held with the instrument before it is severed, it is advantageous if the clamping device is formed in the form of a bipolar clamping device. For example can the two clamping members two electrical poles of the bipolar clamping device form.

Of Further, it can be cheap be when the separator in the form of a bipolar separator is trained. In particular, tissue during the Cut through are coagulated, allowing bleeding, for example when cutting through blood vessels, effective can be avoided.

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

1 a perspective view of a surgical instrument in the working position with open clamping device;

2 : a perspective view of the instrument 1 in the release position with closed clamping device;

3 : a perspective view of the instrument 1 in the cleaning position;

4 : another perspective view of the instrument 3 in the cleaning position;

5 : An enlarged and partially sectioned partial view of a distal part of the instrument 3 ;

6 a perspective view of the instrument when cutting through a vessel;

7 a sectional view taken along line 7-7 in 1 in an alternative embodiment of the instrument;

8th : a sectional view analog 7 in an alternative embodiment of the instrument; and

9 a sectional view taken along line 9-9 in FIG 1 ,

In the 1 to 6 is a total with the reference numeral 10 provided surgical instrument in the form of a bipolar instrument cluster. It comprises a clamping device formed at a distal end 12 , a separator also formed at the distal end 14 and a proximal end of the instrument 10 forming handling device 16 , which are described in detail below.

The instrument 10 includes two elongated branches 18 and 20 which are about a common pivot axis 22 are mounted pivotally to each other.

The pivot axis 22 is defined by a longitudinal axis of a bearing sleeve 24 which has a sleeve section 26 , which with an internal thread 28 is provided and a sleeve section 26 one-sided closing head 30 includes. Furthermore, there is a locking screw 32 provided, which one to the internal thread 28 corresponding external thread section 34 with a head 36 having. To the sleeve section 26 and the male threaded portion 34 adjacent head areas 38 and 40 are parallel to each other and face each other when the bearing sleeve 24 with the end screw 32 is screwed.

The industry 20 is substantially elongated and rod-shaped and has for storage on the bearing sleeve 24 a coaxial to the pivot axis 22 oriented transverse bore 42 on. A section of the industry 20 which is from the final area 44 in which the industry 48 on the bearing shaft defining a bearing sleeve 24 is stored, both somewhat extending in the proximal and in the distal direction, defines a third lever in the sense of the claims 46 , which at its distal end a separating member 48 carries, which is essentially a perpendicular to the pivot axis 22 defined running level. From the industry 20 pointing away is a front edge of the separator 48 in the form of a sharp edge 50 educated. The isolator 48 is preferably made of an electrically conductive material or provided with an electrically conductive coating. In the final area 44 is the industry 20 in the form of an elongated, cuboidal section 52 formed, which two to each other and to the top surfaces 38 and 40 parallel and facing away from each other side surfaces 54 and 56 has, wherein the side surface 54 towards the head area 40 and the side surface 56 towards the head area 38 clues.

To the section 52 closes on the proximal side a round rod section 48 which tangentially into a finger ring 60 passes. The finger ring 60 defines a plane which is substantially parallel to the side surfaces 54 and 56 is oriented. He is also in the same direction as the industry 20 pointing away like the divider 48 , In the opposite direction, so from the finger ring 60 pointing away, stands by the industry 20 a first locking member 62 a total with the reference numeral 64 provided lock. One to the locking member 62 corresponding further locking member 66 is in the industry 18 arranged. The locking members 62 and 66 can be engaged with each other to move proximal ends of the branches 18 and 20 away from each other. The lock can also according to the in the DE 202 18 311 U1 be described barrier, which is hereby incorporated with its entire disclosure content in the present application.

A distal end to the industry 18 forms a first clamping member 68 in the form of a jaw with a flat clamping surface 70 , which with an electrically conductive coating 72 is provided. The clamping surface 70 points in the direction of the isolator 48 out. The first clamping member 68 is also with an elongated slot 74 provided, so that a total of an elongated, annular clamping surface 70 is trained. The slot 74 is sized so that the cutting edge 50 in the slot 74 can dive.

Proximalseitig of the first clamping member 68 joins this in the sense of the claims first lever 76 which is something about the final area 44 extends in the proximal direction. The first lever comprises two elongated, mutually parallel, flat rectangular lever arms 78 which are spaced from each other, which is a width of the section 52 between the side surfaces 54 and 56 equivalent. Between the two lever arms 78 So is an elongated cuboid slot 80 defines which of the industry 20 is measured, with its section 52 , The two lever arms 78 are also each with a hole 82 provided, whose longitudinal axes coaxial with the pivot axis 22 extend and which have an inner diameter which is connected to an outer diameter of the sleeve portion 26 is adjusted. The first lever 76 is thus also on the bearing sleeve 24 around the pivot axis 22 pivoted. Interior surfaces facing each other 84 the lever arms 78 lie in the closing area on the side surfaces 54 and 56 at.

Proximal side of the slot 80 continues the industry 18 in the form of a round bar section 86 which is on the proximal side in a finger ring 88 which defines a ring plane parallel to one of the slot 80 defined plane, ie perpendicular to the pivot axis 22 extending, extending. In the area of the finger ring 88 is from the round bar section 86 towards the industry 20 pointing the locking member 66 arranged distantly.

The instrument 10 furthermore comprises a second lever in the sense of the claims 90 , whose distal end in the form of a second clamping member 92 is trained. The second clamping member 92 which has a clamping jaw with a clamping surface pointing in the direction of the first clamping member 94 defined, which with an electrically conductive coating 96 is provided, is also with a slot-like opening 98 provided, in which the separating member 48 completely submerge. A height of the second clamping member is dimensioned such that a distal end of the branch 20 and a part of the isolator 48 completely from the second clamping member 92 is surrounded when the cutting edge 50 over the clamping surface 94 from the second clamping member 92 protrudes.

The second lever 90 includes two lever arms 100 , which are in the form of elongated, flat cuboid sections. They define between them an elongated rectangular slit 102 and sit in the proximal direction something over the final area 44 gone on. The lever arms 100 are one-sided with a connecting portion from their proximal end to about one quarter of their entire length 104 connected so that along the entire length of the connecting section 104 the second lever 90 having a cross-sectionally U-shaped profile, wherein the two lever arms 100 two parallel legs of the U-shaped profile and the connecting portion 104 define a crosspiece of the U-shaped profile.

In the final area are the lever arms 100 each with a hole 106 provided, whose longitudinal axes coaxial with the pivot axis 22 are oriented. An inner diameter of the holes 106 is slightly larger than an outer diameter of the sleeve portion 26 , In each of the holes 106 is a rubber sleeve 108 used, which has an outer diameter, the inner diameter of the bore 106 corresponds, and the inner diameter of an outer diameter of the sleeve portion 26 equivalent. Interior surfaces facing each other 110 the lever arms 100 lie in the final area 44 flat on facing away from each other outer surfaces 112 the lever arms 78 at. Furthermore, the lever arms 100 so dimensioned that faces away from each other outer surfaces 114 the same flat on the head surfaces 38 and 40 issue. It thus results in the final area 44 an arrangement as exemplified in 7 is shown.

The round bar section 58 is about halfway between the final area 44 and the finger ring 60 further with a transverse bore 116 provided, whose longitudinal axis parallel to the pivot axis 22 runs. In the cross hole 116 used is a rubber sleeve 118 whose outer diameter corresponds to an inner diameter of the transverse bore 116 equivalent. In a parallel to the pivot axis 22 extending aperture 120 the rubber sleeve 118 is a first securing member 122 a total with the reference numeral 124 provided safety device used. Free ends of the first securing member, which is in the form of a cylindrical pin, are on both sides of the round rod portion 58 before, and on a length which corresponds to a width of the lever arms 100 corresponds parallel to the pivot axis. Second security links 126 the safety device 124 make up of the connecting section 104 pointing away slots in the lever arms 100 , which are arranged so that the first securing member 122 can engage in this when the connecting section 104 with a rounded inner surface 128 at the round bar section 58 is applied. The first securing member 122 is thus in the form of a projection, the second securing member 126 formed in the form of a recess. The two security members 122 and 126 may in particular also be designed in the form of latching members, that is to the second securing members 126 forming recesses may be provided small latching lugs, whereby an undercut on the second securing members 126 is formed, so that the small locking lug, the first securing member 122 something can surround if this in one of the second securing member 126 is introduced.

Alternatively to the equipment with the rubber sleeve 118 can the cross hole 116 also be sized so that they break 120 equivalent. The first securing member 122 is then inelastic at the round bar section 58 stored.

Further, on the instrument 10 an electrical connection device 130 provided, which via connecting lines 132 . 134 and 136 can be connected to a high frequency generator, not shown in the figures, for providing a high frequency current for coagulating tissue. The connection device 130 includes three on the instrument 10 trained connection contacts 138 . 140 and 142 , where the connection contacts 138 and 132 at proximal ends of the branches 18 and 20 are arranged and connected to the connecting lines 132 and 136 can be connected. Optionally, it can also be provided that the connection lines 132 and 136 unsolvable with the connection contacts 138 and 142 are connected. The connection contacts 138 . 140 and 142 are by means of cables 144 . 146 and 148 which are along the branches 18 and 20 and the third lever 46 are guided, with the coating 72 , the isolator 48 and the coating 96 connected. This arrangement optionally allows coagulation flow between the first clamping member 68 and the second clamping member 92 flow or between the isolator 48 and the first clamping member 68 , Overall, it becomes such an instrument 10 formed, which combines two bipolar instruments, namely a bipolar clamp and a bipolar scissors.

At the instrument 10 Furthermore, an electrical actuating device may be provided with which at least one coagulation circuit can be closed and / or opened. The electrical actuator may be a button or a switch. The electrical actuator can, for example, insoluble in one of the branches 18 and or 20 arranged or be detachably connectable with these. Preferably if they are permanent and indissoluble on the instrument 10 is arranged, the electrical actuating device is preferably arranged and formed such that it is between the terminal contacts 138 . 140 . 142 and the clamping members 68 and 92 or the separating member 48 is switched to a current flow through the wires 144 . 146 and or 148 permit or prohibit. By operating the electric actuator, a surgeon can selectively flow a coagulation current, depending on the embodiment of the two clamping members 68 and 92 and / or via the first clamping member 68 and the isolator 48 , The electrical actuator can be used both on an instrument 10 , which is designed as a monopolar instrument, as well as an instrument 10 which is designed as a bipolar instrument, for example in the form of a double bipolar instrument, as described above.

The instrument 10 further comprises a reset device 150 , which is formed such that the second clamping member 92 and the isolator 48 against the action of the return device 150 are movable toward each other such that when adjacent clamping members 68 and 92 the isolator 48 against the action of the return device 150 in the direction of the first clamping member 68 is movable. The reset device 150 includes a return member 152 which in a first embodiment, the second lever 90 includes. Is the second lever 90 proximal to the final area 144 at the round bar 58 and is the safety device 124 active, that is the first securing member 122 and the second securing member 126 can engage with each other by moving the two branches 18 and 20 relative to each other, the clamping surfaces 70 and 94 be planted. The isolator 48 is then, such as in 1 to see, almost completely from the second clamping member 92 surround. The cutting edge 50 is so through the second clamping member 92 protected and is not in the direction of the first clamping member 68 pointing away from the second clamping member 92 in front. Will the finger rings 60 and 88 moved closer to each other, approach the second separator 48 and the first clamping member 68 which are rigid with the finger rings 60 and 88 connected to each other. This is made possible by the second lever 90 which extends substantially along its entire length between the pivot axis 22 and the second clamping member 92 an elastically resilient area 154 includes. The clamping surfaces 70 and 94 thus remain attached to each other, the isolator 48 is then through the opening 98 continue on the first clamping member 68 moves with simultaneous elastic deformation of the area 154 so the cutting edge 50 finally in the slot 74 can dive.

With the instrument 10 can thus by moving the finger rings 60 and 88 on top of each other first tissue, for example, a schematic in 6 illustrated vessel 156 to be clamped. The separator 14 is only activated when the clamping device 12 counteracting, exerted by the tissue to be clamped counter-force of a restoring force of the return member 152 equivalent. If the clamping force of the instrument further increases, the second lever 90 deformed in the manner described and the separator 14 can the vessel 156 cut. Already when clamping the vessel 156 by applying the two clamping surfaces 70 and 94 be coagulated with a high frequency current. In the same way, a coagulation stream when severing the vessel with the separator 14 flow, from the isolator 48 to the clamping surface 70 or the other way around. This makes it possible both while clamping tissue, such as the vessel 156 , as well as at the same time bleeding the same bleeding by coagulation to breastfeed.

As stated above, can on the rubber sleeve 118 be omitted in the manner described. The reset device 150 of the instrument 10 then includes only the return member 152 in the form of the elastically resilient region 154 , However, the rubber sleeve 118 provided, the second lever can 90 be formed completely inelastic. A restoring force is then passed through the return device 150 which the rubber sleeve 118 includes, from the rubber sleeve 118 about the second locking member mounted in this 126 on the second lever 90 exercised. This means concretely that with increasing clamping force of the second lever 90 relative to the separator 48 can be moved, in which case a bottom of the U-shaped recess, which the second securing member 126 forms, the first securing member 122 against the effect of the rubber sleeve 118 in one direction by the industry 18 push away. In this embodiment, as well as in the elastically resilient region 154 Can on the rubber sleeve described above 108 be waived. In this case, then the hole 106 so dimensioned that they are related to an inside diameter 7 described rubber sleeve 108 corresponds, that is, an outer diameter of the sleeve portion 26 ,

In a further variant of the return device 150 may alternatively or additionally the rubber sleeve described above 108 form a return member.

A restoring force of the return device 150 can then directly through the rubber sleeve 108 be exercised, which is a relative movement of the second lever 90 and the industry 20 allows each other. It can optionally also the elastically resilient area 154 and / or the rubber sleeve 118 for the formation of the return device 150 be provided.

In a further alternative embodiment, the restoring device 150 Alternatively, a rubber sleeve 108a provide, which has an inner diameter which an outer diameter of the sleeve portion 26 equivalent. The rubber sleeve 108a is in a cross hole 42a of the section 52 used, the inner diameter of an outer diameter of the rubber sleeve 108a equivalent. This is exemplary in 8th shown. In this variant can then on the rubber sleeve 108 optionally dispensed, which means that an inner diameter of the bore 106a to an outer diameter of the sleeve portion 26 is adjusted. The rubber sleeve 108a also allows a relative movement of the second lever 90 and the isolator 48 relative to each other, because by increasing the on the instrument 10 in the field of finger rings 60 and 88 initiated clamping force can be achieved by deformation of the rubber sleeve 108a the cutting edge 50 from the opening 98 emerge to sever tissue. Again, it should be noted that optional the rubber sleeve 108 could also be provided, if desired, combined with the rubber sleeve forming a return member 118 and / or the elastic region 154 ,

The instrument 10 can be made entirely of a plastic except for the electrically conductive elements. The industries 18 and 20 as well as the second lever 90 can then be cast in a simple manner by injection molding. The coatings 72 and 96 can then optionally apply after injection molding or molding in the form of electrically conductive platelets directly during injection molding. The second isolator 48 can also be injected directly. The final screw 32 can optionally be made of a metal. Instead of the end screw 32 Optionally, a rivet can be provided. The second lever 90 and the two industries 18 and 20 may also be colored differently for easier recognizability.

The isolator 48 and the second clamping member 92 can without the instrument 10 to be disassembled, brought into a cleaning position, in which the second clamping member 92 the isolator 48 completely releases. This cleaning position is exemplary in the 3 to 5 shown. For transferring the instrument from the working position, in which the securing members 122 and 126 the safety device 124 engage and a proximal end of the second lever 90 at the round bar section 58 is applied, in the cleaning position, the securing members 122 and 126 disengaged and the proximal end of the second lever from the round rod portion 58 away in the direction of the round bar section 86 pivoted out. By the pivotable mounting of the second lever on the sleeve portion 26 relative to the two industries 18 and 20 thus becomes the second clamping member 92 from the isolator 48 away in the direction of the first clamping member 68 pivoted. The isolator 48 then gives the breakthrough 98 completely free. This allows easy cleaning of both the separator 48 as well as the opening 98 where tissue can accumulate and interfere with a function of the instrument. In reverse, the instrument can 10 be transferred from the cleaning position back into the working position by a pivoting movement of the second lever relative to the industry 20 until the fuse links 122 and 126 engage again with each other.

Claims (44)

Surgical instrument ( 10 ) with a clamping device ( 12 ) for holding and / or clamping tissue ( 156 ), a separating device ( 14 ) for cutting tissue ( 156 ) and a handling device ( 16 ) for actuating the clamping device ( 12 ) and / or the separating device ( 14 ), wherein the clamping device ( 12 ) a first and a second clamping member ( 68 . 92 ) which are mounted so as to be movable relative to one another, wherein the separating device ( 14 ) the first clamping member ( 68 ) and a separator ( 48 ) movable relative to one another and for severing tissue ( 156 ) are engageable in a disconnected position or cooperate with each other, wherein in a working position, in which with the instrument ( 10 ) Tissue ( 156 ) can be clamped and / or held and / or cut, the second clamping member ( 92 ) the isolator ( 48 ) at least partially, characterized in that the separating member ( 48 ) and the second clamping member ( 92 ), without the instrument ( 10 ), in a cleaning position can be brought, in which the second clamping member ( 92 ) the isolator ( 48 ) completely releases. Surgical instrument according to claim 1, characterized in that the second clamping member ( 92 ) an opening ( 98 ) and that the isolator ( 48 ) in the working position at least partially into the opening ( 98 ) and in the cleaning position the opening ( 98 ) completely releases. Surgical instrument according to one of the preceding claims, characterized in that the second clamping member ( 92 ) for transferring the instrument ( 10 ) from the working position into the cleaning position of the separating member ( 48 ) away in the direction of the first clamping member ( 68 ) is movable towards. Surgical instrument according to one of the preceding claims, characterized in that the separating member ( 48 ) in the disconnected position in the direction of the first clamping member ( 68 ) over the second clamping member ( 92 ) protrudes. Surgical instrument according to one of the preceding claims, characterized in that the first and the second clamping member ( 68 . 92 ) relative to each other about a first pivot axis ( 22 ) are pivotally mounted. Surgical instrument according to one of the preceding claims, characterized in that the first clamping member ( 68 ) and the isolator ( 48 ) relative to each other about a second pivot axis ( 22 ) are pivotally mounted. Surgical instrument according to claim 6, characterized in that the first and the second pivot axis ( 22 ) parallel to each other. Surgical instrument according to claim 6 or 7, characterized in that the first and the second pivot axis ( 22 ) are identical. Surgical instrument according to one of the preceding claims, characterized in that in the working position with the exception of the separating position, a distance between the first and the second clamping member ( 68 . 92 ) is smaller than a distance between the isolator ( 48 ) and the first clamping member ( 68 ). Surgical instrument according to one of the preceding claims, characterized in that the handling device ( 16 ) two relatively movable actuators ( 88 . 86 . 60 . 58 ) which is connected to the separating device ( 14 ) and the clamping device ( 12 ) are coupled. Surgical instrument according to claim 10, characterized in that the two actuators ( 88 . 86 . 60 . 58 ) relative to each other about a third pivot axis ( 22 ) are pivotally mounted. Surgical instrument according to claim 11, characterized in that the third pivot axis ( 22 ) parallel to the first and / or second pivot axis ( 22 ) runs. Surgical instrument according to claim 11 or 12, characterized in that the third pivot axis ( 22 ) and the first and / or second pivot axis ( 22 ) are identical. Surgical instrument according to one of claims 10 to 13, characterized in that a first actuator ( 88 . 86 ) rigidly with the first clamping member ( 68 ) and that a second actuator ( 60 . 58 ) rigidly with the isolator ( 48 ) connected is. Surgical instrument according to one of the preceding claims, characterized in that the handling device ( 16 ) at a proximal end of the instrument ( 10 ) is arranged. Surgical instrument according to one of the preceding claims, characterized in that the clamping device ( 12 ) and / or the separating device ( 14 ) at a distal end of the instrument ( 10 ) are arranged. Surgical instrument according to one of claims 10 to 16, characterized in that the instrument ( 10 ) two rigidly mounted rigid branches ( 18 . 20 ), each having a proximal and a distal end, that the actuators ( 88 . 86 . 60 . 58 ) at the proximal ends and that the first clamping member ( 68 ) and the isolator ( 48 ) are each provided at one of the distal ends. Surgical instrument according to one of claims 5 to 17, characterized in that the first clamping member ( 68 ) at a distal end of one of the first and / or the second pivot axis ( 22 ) pivotally mounted first lever ( 76 ) is arranged. Surgical instrument according to one of claims 5 to 18, characterized in that the second clamping member ( 92 ) at a distal end of one of the first and / or the second pivot axis ( 22 ) pivotally mounted second lever ( 90 ) is arranged. Surgical instrument according to one of claims 5 to 19, characterized in that the separating member ( 48 ) at a distal end of one of the first and / or the second pivot axis ( 22 ) pivotally mounted third lever ( 46 ) is arranged. Surgical instrument according to claim 20, characterized in that a common bearing shaft ( 26 ) for the first, second and / or third lever ( 76 . 90 . 46 ) is provided, which the first and the second pivot axis ( 22 ) Are defined. Surgical instrument according to claim 20 or 21, characterized in that the first and / or the second and / or the third lever ( 76 . 90 . 46 ) in the proximal direction via the first and / or the second pivot axis (FIG. 22 ). Surgical instrument according to one of the preceding claims, characterized in that a safety device ( 124 ) is provided for securing the second clamping member ( 92 ) in the working position. Surgical instrument according to claim 23, characterized in that the securing device ( 124 ) a first and a second securing member ( 122 . 126 ) which engage in the operative position and are disengaged in the cleaning position. Surgical instrument according to claim 23 or 24, characterized in that the first securing member ( 126 ) on the second lever ( 90 ) and that the second securing member ( 122 ) on the third lever ( 46 ) are arranged. Surgical instrument according to one of claims 24 or 25, characterized in that the first and / or the second securing member ( 122 . 126 ) proximal of the first and / or second pivot axis ( 22 ) are arranged. Surgical instrument according to one of Claims 24 to 26, characterized in that the first and second securing members ( 122 . 126 ) in the form of locking members ( 122 . 126 ) are formed. Surgical instrument according to one of claims 24 to 27, characterized in that the first locking member ( 126 ) a recess ( 126 ) and that the second locking member ( 122 ) a corresponding projection ( 122 ). Surgical instrument according to one of the preceding claims, characterized in that the separating member ( 48 ) a cutting edge ( 50 ). Surgical instrument according to one of the preceding claims, characterized in that an electrical connection device ( 130 ) is provided, which with the first and / or second clamping member ( 68 . 92 ) and / or the isolator ( 48 ) is electrically connected. Surgical instrument according to claim 30, characterized in that the electrical connection device ( 130 ) in the region of a proximal end of the instrument ( 10 ) is arranged. Surgical instrument according to claim 30 or 31, characterized in that the electrical connection device ( 130 ) three connection contacts ( 138 . 140 . 142 ), of which in each case an electrically conductive with the first clamping member ( 68 ), the second clamping member ( 92 ) and the isolator ( 48 ), which are electrically isolated from each other. Surgical instrument according to one of the preceding claims or according to the preamble of claim 1, characterized in that the second clamping member ( 92 ) and the isolator ( 48 ) against the action of a restoring device ( 150 ) are movable towards each other such that when adjoining clamping members ( 68 . 92 ) the isolator ( 48 ) against the action of the restoring device ( 150 ) in the direction of the first clamping member ( 68 ) is movable towards. Surgical instrument according to claim 33, characterized in that the restoring device ( 150 ) proximal of the first and / or second pivot axis ( 22 ) is provided. Surgical instrument according to claim 33 or 34, characterized in that the restoring device ( 150 ) at least one reset member ( 108 . 108a . 118 ), which on the one hand directly or indirectly on the second clamping member ( 92 ) and which on the other hand directly or indirectly on the isolator ( 48 ) is supported. Surgical instrument according to claim 35, characterized in that the at least one restoring member ( 108 . 108a . 118 ) on the one hand on the second lever ( 90 ) and on the other hand at the third lever ( 46 ) is supported. Surgical instrument according to claim 35 or 36, characterized in that the at least one return member ( 108 . 108a ) on the one hand on the bearing shaft ( 26 ) and on the other hand at the second and / or third lever ( 90 . 46 ) is supported. Surgical instrument according to one of claims 35 to 37, characterized in that the at least one return member ( 108 . 108a . 118 ) in the form of an elastic sleeve ( 108 . 108a . 118 ) or an elastic ring is formed. Surgical instrument according to claim 35, characterized in that the at least one return member ( 152 ) the second lever ( 90 ), which distal side of the first and / or second Pivot axis ( 22 ) at least one elastically resilient area ( 154 ). Surgical instrument according to claim 35, characterized in that the at least one return member ( 152 ) is formed in the form of a mechanical spring. Surgical instrument according to one of the preceding claims, characterized by an instrument grip which holds the handling device ( 16 ). Surgical instrument according to claim 41, characterized in that the instrument grip with the separating device ( 14 ) and / or the clamping device ( 12 ) is releasably connectable. Surgical instrument according to one of the preceding claims, characterized in that the clamping device ( 12 ) in the form of a bipolar clamping device ( 12 ) is trained. Surgical instrument according to one of the preceding claims, characterized in that the separating device ( 14 ) in the form of a bipolar separator ( 14 ) is trained.