DE202007009317U1 - Surgical instrument e.g. shear, for minimal invasive surgery, has tool unit connected with force transmission unit over flexible drive unit in sections for transmitting actuating force from force transmission unit to tool unit - Google Patents

Abstract

The surgical instrument (10) has an end effector (14) defining a longitudinal axis and comprising a movably supported tool unit (18). A force transmission unit (22) is movably supported in a shaft (12) in distal and proximal direction for transmitting actuating force, which is induced at a proximal end of the instrument, to the end effector for moving the tool unit. The tool unit is connected with the force transmission unit over a flexible drive unit in sections for transmitting the actuating force from the force transmission unit to the tool unit.

Description

The The present invention relates to a surgical instrument a shaft, comprising at least one movably mounted tool element, a longitudinal axis defining end effector and one in the shaft in distal and proximal Direction movably mounted power transmission member for transmitting an actuating force introduced at a proximal end of the instrument on the end effector for moving the at least one tool element from a first to a second tool element position and / or vice versa, wherein the at least one tool element on an am Shaft held bearing shaft is pivotally mounted.

surgical Instruments of the type described above are available in numerous Variants in the form of so-called tubular shaft instruments in the used minamalinvasive surgery. It is known that swiveling stored tool elements over pivotally mounted on the tool element and the power transmission member Handlebars to connect and actuation forces to Move the tool elements to transfer. Another alternative is the provision of so-called "slotted cam guides", either on the tool element or on the force transmission member one a guideway defining recess and on the other part one in the guideway engaging projection is formed to due to a relative movement of the power transmission member and the shaft to move the projection in the guideway and so on to cause a movement of the at least one tool element.

adversely in all known articulations of the instruments available on the market However, they are a result of inevitable manufacturing tolerances occurring Game and due to the articulation occurring friction losses. These disadvantages lead in particular to the fact that the known instruments are not in the desired Miniaturized while maintaining their stability and functionality can be. Shank diameters significantly smaller than 10 mm are with conventional power transmission mechanisms not realizable in practice.

It is therefore an object of the present invention, a surgical Instrument of the type described above to improve so that the end effector can be made significantly smaller than at usual Instruments.

These Task is in a surgical instrument of the type described above Type according to the invention thereby solved, that the at least one tool element over at least one at least partially flexible link with the power transmission section connected to transmit the operating force from the power transmission member on the at least one tool element.

The Link, of course, too Completely, that means about his whole length, may be flexible, allows for a movement of at least a tool element required deformation, so that known Anlenkungsvarianten, such as "slot-cam guides" or swivel Linkages of small links between the at least one tool element and the transmission member, can be waived. By providing at least one Anlenkglieds in the manner described are thus compared to the solutions known from the prior art, the friction losses minimized. To which is proposed according to the invention articulation of the at least one tool element extremely low backlash, depending on the design even practically free of play. Because of complicated linkages between the Power transmission member and the at least one tool element can be dispensed with, it is possible with such a Anlenkglied, a size of the end effector significantly reduce, that is in particular Diameter of end effectors to realize, which is also smaller than 2 mm can be. In order to is the proposed inventions Instrument excellent for Use in neurosurgical procedures or minimally invasive Interventions in children.

Especially play and friction is the end effector, if that at least an articulation member insoluble is connected to the at least one tool element. Furthermore, can it also prevents parts from becoming very small Release end effectors and in the body of a patient can be lost.

Especially simply manufactured and equipped with sufficient stability can be a surgical instrument if that at least one articulating member one piece is formed with the at least one tool element.

Preferably the at least one articulation member is permanently connected to the power transmission member. So can also in the field of power transmission from the power transmission member minimized friction losses on the link and the linkage be formed without play.

The stability of the end effector can be further increased be when the at least one link integral with the power transmission member is trained.

Especially it is advantageous if the at least one articulation member is a solid-state joint between the power transmission member and forms the at least one tool element. By providing a solid-state joint can dispense with any other form of interlocking parts be a force from the force transmitting member to transfer to the at least one tool element. Solid joints enable thus a practically backlash transmission and also have with a maximum miniaturization still sufficient stability for a desired function of Instruments on.

Around the at least one tool element in particular by transfer a tensile force from the longitudinal axis to be able to pan away is it cheap when the at least one link is on one of the longitudinal axis pointing away outside acts on at least one tool element.

Cheap can However, it should also be if the at least one link on one on the longitudinal axis indicative inner side or inner section at least attacks a tool element. This embodiment makes it possible the at least one tool element in particular by applying the Anlenkglieds with a tensile force in the direction of the longitudinal axis to move. With two provided tool elements, these can as a result of an exercised Traction be closed.

A stability of the instrument as a whole can be further increased thereby a proximal end of the end effector fixed to the force transmitting member connected is.

Preferably a proximal end of the end effector is integral with the force transmitting member educated. This may result in manufacturing at one complex Connection between the end effector and the transmission member be dispensed with, which also limit the stability of the instrument can.

According to one preferred embodiment of Invention may be provided that the end effector in a distal and proximal direction movable power transmission section comprises, which with the power transmission member is connected to or abuts against this, and a distal end portion of the power transmission member forms, and that a proximal end of the at least one Anlenkglieds with the power transmission section connected is. By providing the power transmission section can the end effector as an independent entity be formed, in particular also in one piece. This has manufacturing technology Advantages, especially when the end effector is very miniaturized shall be. The power transmission member and the end effector can be made separately. The power transmission to the at least a tool element then takes place starting from the power transmission section via the Connecting member on the moving tool element.

One particularly compact design of the end effector can be characterized in particular achieve that the at least one articulation member integral with the Power transmission section is trained.

one The end effectors described above can be particularly simple Way in conjunction with conventional Instruments when the force transmitting member has a thrust and drawbar. In particular, the power transmission member even be designed as a push and pull rod.

Advantageous it is also when the power transmission member at least one displaceably mounted in the shaft and a piston from the at least one piston separated by a sealing element fluid portion comprising, which is filled with a fluid, which by pressurization pressed against the sealing element is for moving the voltage applied to the sealing element at least one Piston parallel to the longitudinal axis of the shaft. Providing such a fluid section makes it possible to a shaft flexible or curved train and still a desired power transmission starting from a proximal end of the instrument to at least to ensure a tool element. In addition, a fluidic power transmission very low backlash, usually even virtually free of play, and almost no friction losses.

The Instrument leaves form a particularly compact, if the at least one piston the Power transmission section includes. In particular, the piston may form the power transmission section.

Around to be able to train a closed fluidic transmission is it cheap, when the power transmission member comprises two pistons, which between them by the piston through in each case one sealing element separate fluid section on the distal side and limit on the proximal side.

Around Losses of a filled in the fluid section fluid, in which it is preferably a biocompatible liquid such as a physiological saline solution, to prevent is it cheap when the fluid portion comprises a fluid space which is completely closed and is sealed.

A optimum sealing of the fluid section with the sealing element can be achieved in particular by the fact that the sealing element flexible and inelastic. This prevents it as a result of a pressure increase in the fluid a shell of the fluid portion may burst.

Easy in production, easily connectable with a shaft and also long displacement paths can be granted a sealing element be if it is designed in the form of a bellows or a bellows is.

Around to prevent the power transmission section and / or the power transmission member relative to the shaft about its longitudinal axis can twist, it is advantageous if the instrument has a guide device for guiding a movement the power transmission section and / or of the power transmission member in the shaft parallel to the longitudinal axis having.

conveniently, forms the guiding device an anti-rotation device for preventing rotation of the at least a piston about the longitudinal axis. This can in particular a jamming of the end effector in the shaft or the at least one tool element on the bearing shaft safely prevented.

Especially simply the structure of the guide device, if this comprises first and second cooperating guide members, of one of the power transmission section and another is disposed on the shaft, and when the first guide member in the form of a leadership lead and the second guide member in the form of a guide recess is trained.

A Longitudinal guide can be form in a simple manner in that the guide recess in the form of a parallel to the longitudinal axis extending guide groove is trained. In this leadership In particular, a corresponding leadership projection parallel to longitudinal axis move.

In order to the power transmission member for an operator in a simple and secure manner parallel to the longitudinal axis, preferably in the distal and proximal direction, can be moved is conveniently an actuator at the proximal end of the instrument for moving the power transmission member parallel to the longitudinal axis intended.

A Handling of the instrument can preferably be improved by that the actuating device comprises at least one movable grip element, which with the Power transmission member articulated is connected.

Under an articulated connection is to be understood in particular also in that the grip element bears against a proximal end of the force transmission member and can move it distally.

In order to The instrument can be easily cleaned, it is advantageous when the actuator detachably connectable to the shaft and / or the power transmission member is. In addition, would be it is also conceivable to form the shaft with the end effector as a unit, which as a disposable product for single use with a reusable actuator can be used.

In order to an operator an orientation of the end effector, in particular the at least one tool element, directly to a position of actuator can recognize, it is favorable, though the shaft is fixed relative to the actuating device is arranged.

Around to allow an operator to to comfortably hold the instrument in a comfortable position and the at least one tool element nevertheless inside a Patient body to execution a surgical procedure in the required manner to be able to it is advantageous if the shaft and / or the force transmission member relative to the actuator around the longitudinal axis are rotatable.

Cheap is it, if the at least one articulating member in a tool element position, which defines a basic position, is undeformed. Especially an instrument with two tool elements can be designed that the two tool elements in the basic position closed or spread are. Thus, in the basic position, the at least one articulation member no powers on the at least one tool element or the force transmission member exercise.

According to one another preferred embodiment The invention may be provided that the at least one articulation member in any of a basic position in which it is undeformed is, deviating working position of the at least one tool element is deformed. The job position is the same to a tool element position, which does not match the basic position. This embodiment of the instrument has the advantage that by Deformation of the linkage energy can be stored to the at least one tool element in whole or in part from the deflected working position back to the basic position. The Connecting member can thus simultaneously as a return member of a return device serve.

Around one possible slim and compact design of the instrument, in particular its end effector, to enable is it cheap when the at least one articulation member is parallel or substantially parallel to the longitudinal axis extends both proximal and distal of the bearing shaft. Furthermore, by a corresponding length of the Anlenkglieds also a desired opening angle or pivot angle of the at least one tool element achieved become. A gift movement of the at least one tool element let yourself optional also over a corresponding limit on the actuator or by corresponding limitation of a displacement path of the power transmission member in the shaft.

Of the End effector can be made very compact, if the at least one articulation member on the proximal and distal sides of the Bearing shaft in each case the same or approximately the same extent. So can in particular all the necessary parts for the articulation of at least a tool element arranged in the direction of the longitudinal axis one behind the other which gives an outside diameter of the shaft or an outer diameter of the end effector reduce significantly.

Especially simply the structure of the end effector, if that is at least one Connecting link in the form of a thin Bridge is formed. In particular, a thickness of the preferably stripe Footbridge be much smaller than a width of the same. Here can relationships 1:10 or even less than 1:20.

Around To form a particularly small end effector, it is beneficial if the link, especially if it is in the form of a web is, has a thickness in a range of about 50 microns to 700 microns. The thickness is preferably 100 μm to 200 μm.

In order to the at least one tool element, which from a basic position is deflected, again automatically be transferred back to this can if no operating force on the power transmission member exercised is, it is advantageous if a restoring device provided is to transfer the at least one tool element from any deflected Tool element position back into a basic position.

Of the Structure of the reset device becomes particularly easy if this at least one return member comprises, on the one hand on at least one tool element and on the other hand on the power transmission member supported. In particular, the return member can also on the power transmission section support the end effector, if this, for example, a distal end of the power transmission member forms.

A Restoring force can in particular easily by the at least one return member thereby exercised when it is resilient. As a result of deformation of the return member stored energy can then turn for transferring the at least one tool element from a deflected tool element position to the basic position back be used.

Of the Construction of the instrument, in particular the end effector, can be particularly be made compact, when the at least one link member, the return member forms. The articulation member exercises thus a double function. On a separate return member can complete in this case be waived.

Of the The structure of the instrument is simplified and thus, in particular its manufacture when the distal end of the instrument is mirror-symmetrical is formed to at least one plane of symmetry. In particular even with the provision of two or more tool elements a symmetrical activity the same already be given by the structure of the end effector.

Of the End effector leaves Particularly easy to train and manufacture when the power transmission section is formed in two parts and two essentially by a longitudinal axis containing level comprises separate section halves. For example may be an overall substantially cylindrically shaped power transmission section through two cylinder halves be formed.

The Instrument leaves in a simple way in the form of scissors, tweezers or form a forceps if it comprises two tool elements.

The Production of the end effector can be simplified in particular thereby when it is formed in two parts and comprises two Endeffektorteile. This can be particularly complicated shapes on the Implement tool elements easier, for example by milling, wire or Laser eroding.

to Formation of a symmetrical or substantially symmetrical End effector it is convenient when each end effector part comprises a tool element.

Furthermore, manufacturing can be simplified and the stability of each end effector part increased if each end effector part has a portion half of the power transmission section comprises.

In order to only one type or type of end effector parts are made In order to form a two-piece end effector, it is beneficial if the end effector from two identical, firmly connected Endeffektorteilen is formed, which is arranged rotated relative to each other by 180 ° about the longitudinal axis are. Two identical effector parts can then be composed in this way that they form a single end effector.

According to one another preferred embodiment The invention can be provided that the two tool elements are formed mutually penetrating or crossing each other. This is to be understood in particular that on a tool element an aperture or recess may be provided through which the other tool element, for example a distal end thereof, through or introduced is. A penetrating or crossing formation of the tool elements allows in particular a pivoting of the same to each other by applying the Anlenkglieds with a tensile force. In particular, scissors, Grasping forceps and tweezers are formed, which are open in a basic position and by exercising a tensile force on the power transmission member can be closed.

Preferably a connecting device is provided for connecting the Endeffektorteile each other. The end effector parts can made separately, connected together and then into the shaft of the instrument. Of course, they can optionally also be glued together or welded become.

Especially simply the structure of the end effector and thus of the instrument, if the connecting device at least a first and at least comprises a second connecting element, which in a connec tion position engaged with each other, and if that at least a first and the at least one second connecting element in each case at one Endeffektorteil are arranged. Two end effector parts can do so be easily connected by the fact that the at least one first and second connecting elements with each other be engaged so that they are the connection position taking.

Of the Structure of the connection device is particularly simple if the at least one first connecting element in the form of a projection and if the at least one second connecting element in the form of a formed to projection corresponding receptacle. Projections and recesses can be produced very easily. In addition, they can also as mutual attacks serve to connect a relative position of each other End effector parts in the desired Pretending to be able to pretend.

Preferably These are at least a first and the at least one second connecting element in a direction transverse or substantially transverse to the longitudinal axis oriented. For example, they may be from one end effector part projecting in the direction of the other end effector part be formed, and that transverse to the longitudinal axis. This prevents that due to a movement of the force transmission member in parallel to the longitudinal axis the End effector parts can be moved apart.

A Connecting two end effector parts becomes particularly easy when the at least one first and the at least one second connecting element in a direction parallel or substantially parallel to the longitudinal axis extend. For example, you can the fasteners in the form of Nu th and form-fitting in these engaging projections be formed, although transversely to the longitudinal axis of each one Endeffektorteil point away, however, in a direction parallel to the longitudinal axis extend. Alternative would be It is also conceivable that a groove extends transversely to the longitudinal axis and forms a connecting element. The interlocking fasteners can in particular be designed so that they are clamping and / or latching engaged with each other in the connection position. optional can one, in particular limited, relative mobility of the both Endeffektorteile in the connection position for adjustment purposes desirable be.

Around To be able to build the end effector very compact, it is advantageous if the connecting device arranged on the power transmission section is for connecting the section halves. This disturbs the connection device spatial the at least one tool element, in particular a movement same, not.

According to one preferred embodiment of Invention may be provided that the end effector is formed is that the at least one tool element as a result of a movement of the power transmission member can be pivoted in the proximal direction in the direction of the longitudinal axis is and vice versa. With such an end effector can be for example, form a forceps, which closes on train.

It is also advantageous if the end effector is designed such that the at least one tool element as a result of movement of the force transmission member in the distal direction in the direction can be pivoted on the longitudinal axis and vice versa. For example, it is possible to form a surgical instrument, for example scissors or forceps, which can be closed as a result of a pressure acting on the force transmission member in the distal direction.

Cheap can it may be further when the end effector comprises two tool elements and is formed such that distal ends of the tool elements as a result of transferable with the power transmission member Thrust on each other are pivoted. So, for example With a forceps tissue can be grasped and held by the power transmission member is applied in the distal direction with a thrust.

Especially to form a pair of scissors, it is advantageous if the end effector comprises two tool elements and is designed such that distal Ends of the tool elements due to a transferable with the power transmission member tensile force are pivotable towards each other. Such an embodiment can especially excellent for training a forceps suitable.

Around the at least one tool element in a defined manner on the Store bearing shaft, it is advantageous if a proximal end of the at least one Tool element formed in the form of at least one bearing jaw is, which is a bearing shaft corresponding to the bearing shaft receiving having.

Especially Easy to manufacture and build up will be the end effector if the at least one bearing jaws formed substantially cuboid or cube-shaped is. Preferably, the at least one bearing jaws of the power transmission member spaced. The distance corresponds to at least one extension the bearing jaw parallel to the longitudinal axis, however, it can be two or three times larger.

Preferably the at least one bearing jaw has an outer surface which adjoins an inner contour of the shaft is adjusted. In an elongated sleeve-shaped or tubular shaft is the outer surface of the Bearing jaw preferably in the form of a spherical surface portion educated. this makes possible a pivoting of the tool element even if the outer surface of the at least one bearing jaw directly in an inner wall of the tubular shaft is applied.

Preferably is a width of the at least one bearing jaw in one direction parallel to a swivel axis defined by the bearing shaft half as big as an inner diameter of the shaft. This allows two bearing jaws store next to each other on the bearing shaft, for example, a End effector with two relatively pivotable tool elements train.

According to one another preferred embodiment The invention can be provided that a first tool element has two first bearing jaws which transverse to the longitudinal axis spaced from each other, and that a second tool element Having a second bearing jaws, which between the two first Bearing jaws is mounted on the bearing shaft. That's how it works Overall, a mirror-symmetrical arrangement of two tool elements reach, in which in particular the second tool element the first tool element penetrating or in a recess thereof can be mounted engaging on the bearing shaft. For this purpose points the first tool element optionally an opening or a corresponding slot for the second tool element or a tool end of the same.

advantageously, the at least one tool element has a tool end in shape a cutting edge or in the form of a jaw. Leave it Endeffectors in the form of cutting, clamping or catching devices form.

Around to be able to train a particularly small instrument it is favorable if the tool end a material thickness in a range of 300 μm to 700 microns has. In particular, the material thickness define the thickness of a cutting edge.

Preferably the tool end extends distally from a connection region between the at least one articulation member and the at least one tool element. Thus, the at least one tool element free of for a function the instrument are held in a disadvantageous way.

body tissues let yourself in particular easily cut thereby, grab or hold when the surgical instrument in the form of a pair of scissors, a Forceps or tweezers is formed.

In principle, it is conceivable to manufacture the surgical instrument from any materials suitable for the manufacture of surgical instruments. However, the end effector is preferably made of a metal or a plastic. The preparation of a plastic, for example polyetheretherketone (PEEK), in principle makes it possible to produce the end effector by a thermoforming process, such as injection molding. The end effector, which consists of a Metal is made, for example, a tool steel, can be made very stable and therefore very small.

Preferably lies an outer diameter of the Shaft in a range of 1.5 mm to 8 mm.

Cheap is if it is in a range of 1.5 mm to 4 mm. Preferably it is smaller than 3 mm. Especially with the smallest mentioned outer shaft diameters can Minimally invasive surgical procedures on the head or in small ones Children while avoiding major trauma be made.

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

1 a partially broken perspective overall view of a surgical instrument;

2 : A perspective enlarged view of the area A from 1 ;

3 : A perspective view of an end effector of the 1 and 2 illustrated instrument in a connection position;

4 : an exploded view of the end effector 3 ;

5 a partially broken side view of an alternative embodiment of a surgical instrument;

6 a perspective view of another embodiment of an end effector;

7 : a longitudinal sectional view of the end effector 6 ;

8th : an exploded view of the end effector 6 seen from above;

9 : an exploded view of the end effector 6 seen from below;

10 a perspective view of another, designed in the form of a cutting tool end effector;

11 : an exploded view of the end effector 10 seen from above; and

12 : an exploded view of the end effector 10 seen from below.

In 1 is a total with the reference numeral 10 provided surgical instrument comprising an elongated tubular shaft 12 , an end effector disposed at the distal end thereof 14 with two relative to each other about a pivot axis 16 pivotable tool elements 18 in the form of jaw-shaped jaw parts and one at the proximal end of the instrument 10 arranged actuator 20 for initiating and transmitting an actuating force to a generally numeral 22 provided with force transmission member for transmitting the actuating force to the end effector 14 for moving the tool elements 18 ,

The actuating device 20 includes a substantially transverse to one of the shaft 12 defined longitudinal axis 24 protruding handle 26 , on which a handle element 28 around one of the longitudinal axis 24 spaced but perpendicular to this pivot axis is pivotally mounted. A proximal end of the shaft 12 is in a distal direction from the handle part 26 projecting and coaxial with the longitudinal axis 24 arranged guide sleeve 32 held. The shaft 12 Can be fixed to the guide sleeve 32 or releasably connected to it.

In the proximal end region 34 of the shaft 12 is a first piston 36 parallel to the longitudinal axis 24 slidably mounted. It comprises a first piston section 38 , whose outer diameter to an inner diameter of the shaft 12 is adjusted. From the first piston section 38 is in the direction of the distal end facing a second piston section 40 coaxial to the longitudinal axis 24 from whose outer diameter is slightly smaller than the inner diameter of the shaft 12 so that the second piston section 40 surrounding annulus 42 is trained. One at the level of the longitudinal axis 24 trained and from the handle element 28 Distally facing pressure surface 44 is located on a pointing in the proximal direction end face of the piston 36 and can by pivoting the handle element 28 around the pivot axis 30 the piston 36 move in the distal direction. Thus, in particular, a hinged connection of the actuating device 20 and the piston 36 of the power transmission member 22 realized. Optionally, on the actuator 20 a non-illustrated restoring element may be provided which the handle element 28 transferred to a basic position when no pressure force is exerted on this, wherein in the normal position, the pressure surface 44 preferably occupies its most proximal position, which at the same time means that the furthest from the longitudinal axis 24 protruding operating range 46 of the handle element 28 protrudes maximally far in the distal direction and points in this.

The power transmission element 22 is designed in several parts and includes, inter alia, the piston 36 , Furthermore, the power transmission element comprises 22 another piston 48 , which is a distal end of the power transmission member 22 Are defined. The piston 48 , which is a power transmission section 49 forms, with the power transmission member 22 is connected and forms a distal end thereof, is substantially identical to the piston 36 constructed and includes a first cylindrical piston portion 50 which has an outer diameter which corresponds to an inner diameter of the shaft 12 corresponds, so that the piston 48 essentially free of play in the shaft parallel to the longitudinal axis 24 is movably mounted. From a pointing in the proximal direction end face 52 of the first piston portion 50 is a second piston section 54 coaxial to the longitudinal axis 24 pointing in the proximal direction. The length of the second piston section 54 is about one third of the length of the first piston section 50 , The second piston section 54 surrounding is an annulus 56 educated. An end face pointing in the proximal direction 58 of the second piston portion 54 defines a printing area. Edges of the cylindrical second piston portion 54 are rounded.

Between the two pistons 36 and 48 a total extends with the reference numeral 60 provided fluid section. It includes an an inner wall 62 of the stem substantially between the second piston portions 40 and 54 lining hose 64 whose free proximal and distal ends 66 each with an identically formed sealing element 68 are closed. Below is therefore limited to the description of the coupling of the piston 36 and 48 to the fluid section 60 on the coupling of the piston 48 to the fluid section 60 , which define a so-called piston-seal element arrangement.

The hose 64 is preferably fixed to the shaft 12 connected and relative to this about the longitudinal axis 24 non-rotatable. He can even form a shaft when on the shaft 12 is waived. The sealing element 68 is directly to the hose 64 molded or firmly connected to this and connects directly to the respective end 66 at. The sealing element 68 includes a first, substantially sleeve-shaped portion 70 , which is almost twice as long as a length of the second piston portion 54 parallel to the longitudinal axis 24 , A free, from the end 66 wayward end of the section 70 is through a second section 74 of the sealing element 68 locked. The section 74 extends substantially transverse to the longitudinal axis 24 and defines a surface area that is substantially the size of an inner free cross-sectional area of the stem 12 equivalent. The sealing element 68 is flexible, but inelastic and formed overall in the form of a fluid-tight membrane, which forms a so-called rolling bellows. It has an annular edge facing away from the respective piston 76 on, in the present case, stuck with the end 66 of the hose 64 and thus indirectly fixed to the inner wall 62 connected is.

The hose 64 with the sealing elements formed on both sides 68 defines a fluid space 78 which is with a fluid 80 , preferably an incompressible liquid, is filled. The fluid space 78 is preferably filled gas-free, which means that in particular no air bubbles or gas bubbles in the fluid space 78 are included. In any case, this is the fluid 80 permanently in the fluid space 78 , which is preferably free of leakage, filled. A volume of the fluid 80 roughly corresponds to one of the hose 64 defined volume, that is the volume which is defined by the product of the inner cross-sectional area of the hose 64 and its length.

The second sections 74 the sealing elements 68 can optionally with the second piston sections 40 and 54 be connected, for example, with the face 58 of the second piston portion 54 , The sealing element 68 has a wall thickness that is less than 0.5 mm, preferably less than 0.1 mm, and depending on the choice of material may be less than 0.05 mm. The ratio between a length of the first section 70 and a diameter of the second section 74 is in the illustrated in the figures Darge embodiment about 2. However, it may be less than 1, in particular less than 0.5 or 0.2.

The sealing element 68 is formed such that the second section 74 evertable is under education one from the edge 76 pointing away and in one of the edge 76 pointing away closed double-layered rolled sealing section 82 , This means that the first section 70 in the direction of the longitudinal axis 24 folded back on itself or turned over, leaving a first part of the first section 70 on the shaft 12 is a second part of the first section 70 on an outer surface of the second piston portion 54 , Overall, the sealing section emerges 82 in the annulus 56 without jamming. This allows the second section 74 parallel to itself in the direction of the longitudinal axis 24 is movable, both in the distal and in the proximal direction. During a movement of the second section 74 for example, in the distal direction, the partially turned first section rolls 70 and can be in a distal position of the piston 48 be completely unrolled and the inner wall 62 in the form of a cylindrical portion of the sealing element 68 line. Conversely, the second section 74 to the edge 76 be moved, the first section 70 then turned over so that the sealing portion 82 in about half the length of the first section 70 having. In principle, it is conceivable to choose the dimensions of the parts relative to one another such that the second section 74 in the proximal direction over the edge 76 towards the actuator 20 can be postponed. This is possible in principle until the first section 70 is completely unrolled again. This theoretically results in a maximum displacement of the piston 48 which is twice the length of the first section 70 equivalent.

The described arrangement of pistons 48 and sealing element 68 is analogous to the piston 36 intended. This is in 1 indicated schematically by dashed lines. The pistons 36 and 48 are preferably arranged so that in a basic position of the fluid portion 60 the second piston sections 40 and 54 at the second sections 74 abut, both at about the level of the edges 76 are arranged. The fluid space 78 is then, as described, bubble-free with the fluid 80 filled, which in particular also the annular space-like sections in the region of the sealing sections 82 fills.

Will the operating area 46 from the handle element 28 pivoted in the proximal direction, then the pressure surface 44 moves in the distal direction and pushes the piston 36 also in the distal direction. At the same time the second piston section 40 adjacent second section 74 of the sealing element 68 moved in the distal direction, and that on the distal side of the edge 76 , Due to the incompressibility of the fluid 80 is due to the movement of the piston 36 The piston 48 moved in the distal direction. The sealing section rolls 82 off, on the inside wall 62 of the shaft 12 fitting and supporting part of the sealing portion 82 is getting longer and the second piston section 54 fitting and supporting part of the sealing portion 82 gets shorter and shorter until the first section 70 is completely unrolled and the second section 74 a distal end of the sealing element 68 forms. In the opposite way leads a movement of the piston 48 in the proximal direction to a movement of the Kol ben 36 also in the proximal direction. Are the sections 74 with the respective second piston sections 40 and 54 connected by a movement of the piston 36 in the proximal direction of the piston 48 also be pulled in the proximal direction.

The end effector 14 is at the instrument 10 directly on the piston 48 formed. Basically it would be possible to use the piston 48 and the end effector 14 with the tool elements 18 to train in one piece. The end effector will be easier to produce 14 in conjunction with the piston 48 however, when two identical parts are formed by means of a pivot axis 16 and a bearing shaft 84 defining pin are held on the shaft, which, for example, in coaxial with the pivot axis 16 oriented holes in a wall of the shaft 12 is stored. On the bearing shaft 84 are stored proximal end portions 86 the tool elements, which are essentially cube-shaped bearing jaws 87 form and with a corresponding to the bearing shaft 84 trained and arranged bore 88 are provided. The two end sections 86 the tool elements 18 are side by side on the bearing shaft 84 arranged. Outwardly facing outer surfaces 89 the bearing jaws 87 are convexly curved and preferably define spherical surfaces having a radius which is a radius of the shaft 12 equivalent.

With the respective end section 86 rigidly connected is a tool end 90 of the respective tool element 18 , The bearing jaws 87 are about half as wide as a proximal end of the tool end 90 , so when the tool ends 90 cover, the bearing jaws 87 next to each other on the bearing shaft 84 are pivotally mounted.

In the present instrument 10 are tool elements 90 in the form of jaws 91 formed, which are about as wide as a diameter of the shaft 12 and their mutually facing inner surfaces, as in the 3 and 4 shown, optionally with a cross-toothing 110 may be provided, which may have a Verzahnungshöhe in a range of 50 microns to 400 microns, preferably 200 microns to 300 microns. Approximately in the middle between the distal end of the tool end 90 and the pivot axis 16 is through a gap 92 an outer surface of the tool element 18 defining, flat elongated bridge 94 formed, the proximal end of which is integral with the piston 48 is trained. The jetty 94 is flexible and elastically bendable and forms a link 95 in the form of a solid-state joint 96 out. The jetty 94 extends approximately equally in the distal and in the proximal direction with respect to the pivot axis 16 , Thus, an opening is further defined, which is limited on the distal side by the bearing jaws 87 , proximal of the first piston portion 50 and in the radial direction of the opposing hinge members 95 , A distance between a proximal end of the bearing jaws 87 and a distal end of the first piston portion 50 is about two to three times as large as an extension of the bearing jaws 87 in a direction parallel to the longitudinal axis 24 , For optimal mobility of the tool elements 18 to achieve and jamming the same on the bearing shaft 84 to prevent These are proximal ends of the tool ends 90 through a narrow gap from the bearing jaw 87 the other tool element 18 separated.

The production of both the piston 48 as well as the end effector 14 is simplified when two identical Endeffektorteile 102 be formed, which can be converted into each other by rotation about the longitudinal axis 24 ,

For this purpose, the piston 48 from two piston halves 98 , each one section half 99 of the power transmission section 49 form, composed, the longitudinal axis 24 containing connection surfaces 100 define that parallel to the webs 94 run and the piston 48 with its first and second piston sections 50 and 54 cut lengthwise in half. For connecting the two Endeffektorteile 102 serves a total with the reference numeral 104 provided connecting device, each having two connecting elements 106 and 108 wear. The connecting element 106 is in the form of an elongated, parallel to the longitudinal axis 24 formed extending projection. The other connection element 108 is formed in the form of a projection corresponding to the recess into which the connecting element 106 can intervene positively. The connecting elements 106 and 108 are on the connection surfaces 100 each arranged so that the two section halves 99 in a connection position the power transmission section 49 form. The piston halves 98 are optionally firmly connected to each other, for example by gluing or welding.

The link 95 has a material thickness which depends on the diameter of the power transmission section 49 in a range of about 50 microns to 700 microns. At an inner diameter of the shaft 12 of about 2 mm is the thickness of the web 94 about 100 μm.

The operation of the end effector 14 will be explained in more detail below.

In the 1 and 2 is the end effector 14 presented in a basic position. The tool ends 90 are slightly spread apart and define an opening angle between them 112 of about 30 °. The bridges 94 run in the normal position parallel to the longitudinal axis 24 , Will the piston 48 moving in the proximal direction, the webs become 94 also pulled in the proximal direction. Because the tool elements 90 rigidly pivotable about the bearing shaft 84 are stored, deforms the bridge 94 and thus the solid-state joint 96 so that the tool ends 90 from the longitudinal axis 24 be swung away to the outside. This allows the opening angle 112 enlarging what the grasping of tissue with the end effector 14 simplified. By appropriate manufacturing, it is also possible in a basic position the web 94 to deform something, so without over the piston 48 initiated forces the respective tool elements 90 are pivoted further apart.

Will the piston 48 moving in the distal direction, also becomes the bridge 94 shifted in the distal direction. Because the tool ends 90 have no other possibility of movement than to be pivoted toward each other, this is done under appropriate deformation, that is, elastic deflection of the web 94 and thus the solid-state joint 96 , A displacement of the piston 48 is limited by the tool ends 90 whose inner surfaces in a closed position, which is not shown in the figures, abut each other or substantially abut each other.

The solid joints 96 allow a virtually backlash-free storage and power transmission from the power transmission element 22 on the tool elements 18 for moving the same, that is in the present case for pivoting about the pivot axis 16 ,

To move the piston 48 in the distal and proximal directions, as described above, the piston 36 be provided. Optionally you can on the piston 36 with associated sealing element 68 also refrain if an alternative fluid supply device 114 , for example in the form of an external fluid pump, which via a supply line 116 with a proximal end of the shaft 12 of the tube arranged therein 64 is provided fluid-tight, is provided. With the fluid supply 114 can the fluid 80 in the proximal end of the shaft 12 pressed and thus the piston 48 be moved in the distal direction. Removing or reducing the pressure in the fluid 80 then leads due to the elastically resilient solid joints 96 to a Rückverschwenkung the tool elements 18 in its basic position and connected by the connection of the piston 48 over the footbridges 94 with the tool elements 18 , to a return movement of the piston 48 in the proximal direction.

An actuation of the fluid supply device 114 can for example via the pivotally mounted handle element 28 be realized, wherein preferably an electrical, electronic or electro-mechanical circuit element for actuating the fluid supply 114 due to a pivoting movement of the handle element 28 is provided, for example in the form of a switch, buttons or electronic switching element, such as an optical sensor or an inductive or capacitive proximity sensor, not shown, which on the actuating device 20 is arranged to detect a movement of the handle member 28 relative to the handle part 26 ,

In 5 an alternative embodiment of a surgical microtubular shaft instrument is shown. It includes an elongated tubular shaft 122 , at the distal end of the instrument 10 known end effector described above 14 is mounted so as to give details regarding the structure of the end effector 14 Reference may be made to the above description.

A proximal end of the shaft 122 is approximately at right angles to a longitudinal axis 124 of the shaft 122 angled and forms a first handle part 126 an actuating device 128 , To one transverse to the longitudinal axis 124 oriented, but spaced from this pivot axis 130 is relative to the handle part 126 a second handle part 132 pivoted. Free ends of the handle parts 126 and 132 are each with a finger ring 134 provided by an operator can push through one or more fingers.

In the shaft parallel to the longitudinal axis 124 slidably mounted, is a power transmission member in the form of a push and pull rod 136 whose distal end 138 fixed to the power transmission section 49 of the end effector 14 connected is. A proximal end of the push and pull rod 136 is in the form of a ball head 140 formed, which in a corresponding receptacle 142 one over the pivot axis 130 protruding portion of the handle part 132 is stored to form a ball joint connection of the push and pull member 136 with the handle part 132 , By pivoting the handle part 132 relative to the handle part 126 can the push and pull rod 136 move in the distal direction to close the tool elements 18 and in the proximal direction to open the tool elements 18 ,

This in 5 illustrated instrument 120 serves as an example that it is possible that related to the instrument 10 described end effector 14 , as well as all other end effectors described below, to combine with so-called conventional tubular shaft instruments, that is, with instruments that use a rod-shaped push and pull rod as power transmission member 136 or the like. The bearing shaft 84 is in corresponding blind holes or holes of the shaft 122 held.

Another embodiment of an end effector, which on both the instrument 10 as well as on the instrument 120 can be provided is exemplary in the 6 to 9 represented and in total by the reference numeral 214 Mistake.

The end effector 214 comprises two pivot axis defined about a bearing shaft, not shown and supported on a shaft 216 against each other pivotally mounted tool elements 218 , Overall, the end effector 214 formed in two parts and includes a first Endeffektorteil 220 and a second end effector part 222 , The two end effector parts 220 and 222 are, unlike the end effector parts 102 , not identical. Rather, each end effector part considered individually is also different than the end effector parts 102 , formed symmetrically to a mirror plane, which is perpendicular to the pivot axis 216 runs and the longitudinal axis 224 of the end effector 214 contains. A sectional view of the end effector 214 along this mirror plane is in 7 shown.

The end effector part 220 includes a cylindrical power transmission section 249 , which can also be referred to as a piston. A proximal end thereof is analogous to the piston 48 shaped for use in an instrument 10 or is with a push and pull rod 136 like the instrument 120 connected. The power transmission section 249 defines a distal facing end face 226 , From the power transmission section 249 there is a bridge in the distal direction 294 starting, which is a flexible link 295 to form a solid-state joint 296 Are defined. One from the longitudinal axis 224 wayward outer surface 228 the web forms a continuation of a cylindrical outer surface of the power transmission section 249 , One in the direction of the longitudinal axis 224 facing inner surface 230 of the footbridge 294 is just.

The link 295 is to a cylindrical Zugabschnitt 232 of the tool element 218 formed. A parallel to the jetty 294 extending gap separates this from two bearing jaws, which in turn through a gap 234 spaced apart from each other. The bearing jaws 287 point in the proximal direction and are coaxial with the pivot axis 216 provided with a bore through which a pin-shaped bearing shaft can be pushed through to the tool element 218 the end effector part 220 to store pivotally on a shaft. Slightly distal to a connecting area between the bridge 294 and the train section 232 is the train section 232 with an opening 238 which is symmetrical to the plane of symmetry and transverse to the longitudinal axis 224 the train section 232 breaks approximately cuboid, and a distal-facing end face of the tensile section 232 opened. The gap 234 and the opening 238 are connected. The gap 234 separates the two bearing jaws 287 not completely, but ends just before a proximal end thereof, so that pointing in the proximal direction, the bearing jaws 287 connecting connecting web 242 is trained. From the train section 232 is in the distal direction a tool end 290 in such a way that a virtual extension of the same in the proximal direction of the web 294 would be diametrically opposed. A in the direction of the longitudinal axis facing clamping surface 244 is with a cross-toothing 246 provided, which may have a height in a range between 20 microns and 100 microns.

For connecting the end effector part 220 with the end effector part 222 serves a connection device 248 with a first connecting element 252 , which at the power transmission section 249 is formed, in the form of a parallelepiped-shaped recess which is open in a direction away from the longitudinal axis radial direction. From a floor 253 the recess is an elongated cuboid bar 254 starting in a direction parallel to the longitudinal axis 224 slightly shorter than the recess but flush with the face 226 concludes. A width transverse to the longitudinal axis 224 of the connecting element 252 corresponds to a width of the opening 238 as well as the gap 234 ,

The connection device 248 comprises a second connecting element 256 , which is shaped such that it from the connecting element 252 completely filled recess. It is therefore generally approximately cuboid and has an outer surface portion, which the power transmission section 249 added to the cylinder. To take the bar 254 is a groove 258 on the connecting element 256 formed, which is closed on the proximal side. So can the bar 254 in the groove 258 engage, a relative movement of the two connecting element 252 and 256 relative to each other parallel to the longitudinal axis 224 but is prevented.

The jetty 294 diametrically opposite extends from the connecting element 256 a footbridge 280 in the distal direction, which is a link 281 defines which is a solid-state joint 282 for transmitting pushing and pulling forces from the power transmission section 249 on the second end effector part 222 included tool elements 218 allows. The jetty 280 ends at a jaw-shaped train section 260 from the proximal direction and obliquely to the longitudinal axis 224 pointing out a stock baking 285 protrudes, which with a hole 283 is provided. The bearing jaws 285 is by a short, slightly distally over the pivot axis 216 also extending gap 262 from the jetty 280 separated. The train section 260 , the bridge 280 and the bearing jaws 285 are all the same width, their width being one width of the connecting element 256 and thus a width of the opening 238 equivalent. This makes it possible to assemble the end effector 214 the separately manufactured Endeffektorteile 220 and 222 to build together so that, as in the 8th and 9 shown, separated Endeffektorteile by inserting the connecting element 256 in the opening 238 Coming from above, that is in the direction of the clamping surface 244 and the longitudinal axis 244 pointing, is the connecting element 256 through the opening 238 can be pushed through until it protrudes on the other side. Then the end effector parts 220 and 222 pivoted relative to each other such that the connecting element 256 in the connecting element 252 can intervene. The holes 283 and 288 are then aligned and one from the train section 260 distal end of the tool 290 , which then occupies a basic position, as in the 6 and 7 is symmetrical and the other end of the tool 290 arranged opposite. The end effector 214 can then be set with a bearing shaft is not provided on a shaft of the instrument. Optionally, the end effector parts 220 and 222 in the area of the connection device 248 glued and / or welded. Will the power transmission section 249 guided in a sleeve-shaped shaft, this prevents separation of the two parts, so that a bond or welding is not mandatory.

The end effector 214 is due to the penetrating or sweeping arrangement of the tool elements 218 formed such that a tensile force introduced by a force transmission member leads to a closing movement of the end effector, that is, the clamping surfaces 244 are pivoted against each other. A movement of the power transmission section 249 in the distal direction leads to a pivoting of the tool elements 218 from the longitudinal axis 224 away, leaving an opening angle between the clamping surfaces 244 the tool elements 218 can enlarge again. The described closing movement to train the tool elements 218 is made possible in particular because the points of attack of the coupling links 281 and 295 each based on the pivot axis 216 lie on other sides than the connecting areas of the tool ends 290 at the train sections 232 respectively 260 ,

Another embodiment of a trained in the form of a cutting end effector is in the 10 to 12 illustrated by way of example and overall with the reference numeral 314 Mistake. The construction of the end effector 314 is essentially realized by a combination of the embodiments of the end effectors 14 and 214 , Also the end effector 314 is constructed in two parts and includes two not identically formed Endeffek gate parts 320 and 322 , Distal ends of the same who that formed by tool ends 390 in the form of mutually sliding cutting edges, which may have a material thickness in a range of 200 microns to 800 microns.

The power transmission section 349 is cylindrical as a whole and comprises two identically designed section halves 399 , These are like the section halves 99 at the end effector 14 , by means of a connecting device 348 connected with each other. This covers on each interface 400 the section halves 399 , which bear against each other in the assembled state, a first connecting element 352 in the form of a parallel to the longitudinal axis 324 extending projection, which in the direction of the connecting surface of the respective other section half 399 protrudes. Parallel to the connecting element 352 is another connecting element 356 in each section half 399 formed, in the form of a recess corresponding to the projection. Be the section halves 399 connected to each other, each engages a connecting element 352 positively in the other connection element 356 the other half of the section 399 a, so that the total of the cylindrical power transmission section 349 is trained.

From each section half 399 A narrow web extends in the distal direction, in each case from the end effector part 220 a footbridge 394 and the end effector part 322 a footbridge 380 , The bridges 394 and 380 each form strip-shaped coupling members 395 respectively 381 for the formation of solid joints 396 respectively 382 , The bridges 394 and 380 each go into a train section 332 over that in both end effector parts 320 and 322 are identical. The approximately semi-cylindrical addition sections 332 with the molded tool ends 390 can be converted into each other by rotation about the longitudinal axis 324 around 180 °. The tool ends 390 are at the train sections 332 arranged so that they are arranged approximately parallel to each other and for cutting devices in the usual manner sliding off each other cutting edges 370 define.

For pivotable mounting of the tool elements 318 on a, not shown, mounted on a shaft and a pivot axis 316 transverse to the longitudinal axis 324 defining bearing shaft are through a parallel to the web 394 extending gap 392 two bearing jaws 387 formed in the direction of the pivot axis 316 from each other through a gap 334 are spaced. Proximalseitig are the bearing jaws 387 like the bearing jaws 287 through a connecting bridge 342 connected with each other.

At the train section 332 the end effector part 322 is a single bearing baking 385 arranged in the proximal direction projecting and by a parallel to the web 380 extending gap 362 separated. A width of the bearing jaw 385 corresponds to a width of the gap 334 , so that the bearing jaws 385 between the bearing jaws 387 can intervene. The bearing jaws 385 and 387 are each coaxial with the pivot axis 316 aligned holes 383 respectively 388 Mistake.

Except for the training of the respective bearing jaws 385 respectively 387 are the end effector parts 320 and 322 formed identically and can by rotation about the longitudinal axis 324 be converted by 180 ° into each other. The arrangement of the bearing jaws 385 and 387 is mirror-symmetrical to a pivot axis 316 perpendicularly intersecting and the longitudinal axis 324 containing mirror plane. The train sections 332 are each formed by a short semi-cylindrical section, wherein lines of intersection of abutting cut surfaces of the tensile sections in inner surfaces 344 the tool ends 390 go over, whose free edges are the cutting edges 370 form.

For cutting with the end effector 314 must the power transmission section 349 be moved in the proximal direction. A cutting process can thus be effected by transmitting a tensile force.

The end effectors 14 . 214 and 314 , in particular their end effector parts 102 . 220 and 222 such as 320 and 322 can be made of a metal, in particular a tool steel, or a plastic. For metals, machining processes such as grinding, milling, wire eroding or laser cutting are particularly suitable. For the processing of plastics in particular thermoforming processes are applicable, such as deep drawing, hot blasting, embossing or injection molding. Suitable plastic materials are in particular polyetheretherketone (PEEK), polyethylene (PE), polyurethane (PU), polyethylene terephthalate (PET), polycarbonate (PC) or polypropylene (PP). In particular made of plastic end effectors make it possible to produce the shaft and the end effector together as a cost-effective disposable component, which can be disposed of after a surgical procedure. In particular, due to the possible in the described end effectors small dimensions, in particular outer diameter smaller than 2 mm are possible, a reprocessing of the end effectors is not easy and may involve the risk that no sterility can be guaranteed.

The described end effectors merely represent examples of end effectors, the tool elements pivotally mounted on a bearing shaft te, which can be acted upon by a flexible link in the form of a solid-state joint of a power transmission member with a pushing and / or pulling force.

A provision of a deflected tool element position of the tool elements in a basic position back, in which the respective solid joints 96 . 296 and 396 are undeformed, can by means of a return device 164 . 264 respectively 364 respectively. This each comprises a return member in the form of the flexible webs 94 . 280 and 294 respectively 380 and 394 , Due to a deformation of the webs stored energy can be used to return the tool elements to their normal position. Therefore, the end effectors described are also optionally usable so that only pulling or pushing forces must always be initiated to actuate the same.

Claims (69)

Surgical instrument ( 10 ; 120 ) with a shaft ( 12 ; 122 ), at least one movably mounted tool element ( 18 ; 218 ; 318 ), a longitudinal axis ( 24 ; 124 ; 224 ; 324 ) defining end effector ( 14 ; 214 ; 314 ) and one in the shaft ( 12 ; 122 ) in the distal and proximal direction movably mounted force transmission member ( 22 ; 136 ) for transmitting one at a proximal end of the instrument ( 12 ; 120 ) actuated force on the end effector ( 14 ; 214 ; 314 ) for moving the at least one tool element ( 18 ; 218 ; 318 ) from a first to a second tool element position and / or vice versa, wherein the at least one tool element ( 18 ; 218 ; 318 ) on one on the shaft ( 12 ; 122 ) bearing shaft ( 84 ; 184 ) is pivotally mounted, characterized in that the at least one tool element ( 18 ; 218 ; 318 ) via at least one at least partially flexible connecting link ( 95 ; 295 ; 395 ) with the force transmission member ( 22 ; 136 ) is connected to transmit the actuating force from the force transmission member ( 22 ; 136 ) on the at least one tool element ( 18 ; 218 ; 318 ). Surgical instrument according to claim 1, characterized in that the at least one articulating member ( 95 ; 295 ; 395 ) indissoluble with the at least one tool element ( 18 ; 218 ; 318 ) connected is. Surgical instrument according to claim 1 or 2, characterized in that the at least one articulating member ( 95 ; 295 ; 395 ) in one piece with the at least one tool element ( 18 ; 218 ; 318 ) is trained. Surgical instrument according to one of the preceding claims, characterized in that the at least one articulating member ( 95 ; 295 ; 395 ) indissoluble with the force transmission member ( 22 ; 136 ) connected is. Surgical instrument according to one of the preceding claims, characterized in that the at least one articulating member ( 95 ; 295 ; 395 ) integral with the force transmitting member ( 22 ; 136 ) is trained. Surgical instrument according to one of the preceding claims, characterized in that the at least one articulating member ( 95 ; 295 ; 395 ) a solid-state joint ( 96 ; 296 ; 396 ) between the force transmitting member ( 22 ; 136 ) and the at least one tool element ( 18 ; 218 ; 318 ). Surgical instrument according to one of the preceding claims, characterized in that the at least one articulating member ( 95 ) on one of the longitudinal axis ( 24 ) facing away from the outside at least one tool element ( 18 ) attacks. Surgical instrument according to one of claims 1 to 6, characterized in that the at least one articulating member ( 295 ; 395 ) on one to the longitudinal axis ( 224 ; 324 ) facing inside or an inner portion of at least one tool element ( 218 ; 318 ) attacks. Surgical instrument according to one of the preceding claims, characterized in that the at least one articulating member ( 95 ; 295 ; 395 ) distal side of the bearing shaft ( 84 ; 184 ) on at least one tool element ( 18 ; 218 ; 318 ) attacks. Surgical instrument according to one of the preceding claims, characterized in that a proximal end of the end effector ( 14 ; 214 ; 314 ) fixed to the force transmitting member ( 22 ; 136 ) connected is. Surgical instrument according to one of claims 1 to 9, characterized in that a proximal end of the end effector ( 14 ; 214 ; 314 ) integral with the force transmitting member ( 22 ; 136 ) is trained. Surgical instrument according to one of the preceding claims, characterized in that the end effector ( 14 ; 214 ; 314 ) a movable in the distal and proximal direction of the power transmission section ( 49 ; 249 ; 349 ) associated with the force transmitting member ( 22 ; 136 ), or abuts against a distal end region of the force transmission member (FIG. 22 ; 136 ), and that a proximal end of the at least one articulation member ( 95 ; 295 ; 395 ) with the power transmission section ( 49 ; 249 ; 349 ) connected is. Surgical instrument according to claim 12, characterized in that the at least one articulating member ( 95 ; 295 ; 395 ) in one piece with the power transmission section ( 49 ; 249 ; 349 ) is trained. Surgical instrument according to one of the preceding claims, characterized in that the force transmission member ( 136 ) a push and pull rod ( 136 ). Surgical instrument according to one of the preceding claims, characterized in that the force transmission member ( 22 ) at least one in the shaft ( 12 ) displaceably mounted pistons ( 36 . 48 ) and one of the at least one piston ( 36 . 48 ) by a sealing element ( 68 ) separate fluid section ( 60 ), which is filled with a fluid ( 80 ), which by pressurization against the sealing element ( 68 ) is depressible for moving the sealing element ( 68 ) adjacent at least one piston ( 36 . 48 ) parallel to the longitudinal axis ( 24 ) of the shaft ( 12 ). Surgical instrument according to claim 15, characterized in that the at least one piston ( 48 ) the power transmission section ( 49 ). Surgical instrument according to claim 15 or 16, characterized in that the force transmission member ( 22 ) two pistons ( 36 . 48 ), which between them that of the piston ( 36 . 48 ) by a respective sealing element ( 68 ) separate fluid section ( 60 ) on the distal and proximal sides. Surgical instrument according to one of claims 15 to 17, characterized in that the fluid section ( 60 ) a fluid space ( 78 ), which is completely closed and sealed. Surgical instrument according to one of claims 15 to 18, characterized in that the sealing element ( 68 ) is flexible and inelastic. Surgical instrument according to claim 8, characterized in that the sealing element ( 68 ) in the form of a bellows ( 68 ) or a rolling bellows ( 68 ) is trained. Surgical instrument according to one of the preceding claims, characterized by a guide device for guiding a movement of the force transmission section (FIG. 49 ; 249 ; 349 ) and / or the power transmission element ( 22 ; 136 ) in the shaft ( 12 ; 122 ) parallel to the longitudinal axis ( 24 ; 124 ). Surgical instrument according to claim 21, characterized in that the guide device forms an anti-rotation device for preventing a rotation of the at least one piston ( 36 . 48 ) about the longitudinal axis ( 24 ). Surgical instrument according to claim 21 or 22, characterized in that the guide means comprises first and second cooperating guide members, one of which on the force transmission over tragungsabschnitt ( 49 ; 249 ; 349 ) and another on the shaft ( 12 ; 122 ) is arranged, and that the first guide member in the form of a guide projection and the second guide member is formed in the form of a guide recess. Surgical instrument according to claim 23, characterized in that the guide recess in the form of a parallel to the longitudinal axis ( 24 ; 124 ) extending guide groove is formed. Surgical instrument according to one of the preceding claims, characterized by an actuating device ( 20 ; 128 ) at the proximal end of the instrument ( 10 ; 120 ) for moving the power transmission member ( 22 ; 136 ) parallel to the longitudinal axis ( 24 ; 124 ). Surgical instrument according to claim 25, characterized in that the actuating device ( 20 ; 128 ) at least one movable grip element ( 28 ; 132 ), which with the force transmission member ( 22 ; 136 ) is hinged. Surgical instrument according to one of claims 25 to 26, characterized in that the actuating device ( 20 ; 128 ) with the shaft ( 12 ; 122 ) and / or the force transmission member ( 22 ; 136 ) is releasably connectable. Surgical instrument according to one of claims 25 to 27, characterized in that the shaft ( 12 ; 122 ) relative to the actuator ( 20 ; 128 ) is fixed. Surgical instrument according to one of claims 25 to 28, characterized in that the shaft ( 12 ; 122 ) and / or the force transmission member ( 22 ; 136 ) relative to the actuator ( 20 ; 128 ) about the longitudinal axis ( 24 ; 124 ) are rotatable. Surgical instrument according to one of the preceding claims, characterized in that the at least one articulating member ( 95 ; 295 ; 395 ) in a tool element position, which defines a basic position, is undeformed. Surgical instrument according to one of the preceding claims, characterized in that the at least one articulating member ( 95 ; 295 ; 395 ) in any of a basic position in which it is undeformed, deviating working position the at least one tool element ( 18 ; 218 ; 318 ) is deformed. Surgical instrument according to one of the preceding claims, characterized in that the at least one articulating member ( 95 ; 295 ; 395 ) parallel or substantially parallel to the longitudinal axis ( 24 ; 124 ; 224 ; 324 ) both proximal and distal of the bearing shaft ( 84 ; 184 ). Surgical instrument according to claim 32, characterized in that the at least one articulating member ( 95 ; 295 ; 395 ) on the proximal and distal sides of the bearing shaft ( 84 ; 184 ) in each case the same or approximately the same extent. Surgical instrument according to one of the preceding claims, characterized in that the at least one articulating member ( 95 ; 295 ; 395 ) in the form of a thin web ( 94 ; 294 ; 394 ) is trained. Surgical instrument according to one of the preceding claims, characterized in that the articulation member ( 95 ; 295 ; 395 ) has a thickness in a range of about 50 μm to 700 μm. Surgical instrument according to one of the preceding claims, characterized in that a restoring device ( 164 ; 264 ; 364 ) is provided for transferring the at least one tool element ( 18 ; 218 ; 318 ) From any deflected tool element position back to a basic position. Surgical instrument according to claim 36, characterized in that the restoring device ( 164 ; 264 ; 364 ) at least one reset member ( 95 ; 295 ; 395 ), which on the one hand on at least one tool element ( 18 ; 218 ; 318 ) and on the other hand on the power transmission element ( 22 ; 136 ) is supported Surgical instrument according to claim 37, characterized in that the at least one return member ( 95 ; 295 ; 395 ) is resilient. Surgical instrument according to claim 37 or 38, characterized in that the at least one articulating member ( 95 ; 295 ; 395 ) the reset member ( 95 ; 295 ; 395 ). Surgical instrument according to one of the preceding claims, characterized in that the distal end of the instrument ( 10 ; 120 ) is formed mirror-symmetrically to at least one plane of symmetry Surgical instrument according to one of claims 12 to 40, characterized in that the force transmission section ( 49 ; 349 ) is formed in two parts and two substantially by a longitudinal axis ( 24 ; 324 ) contain separate section halves ( 99 ; 399 ). Surgical instrument according to one of the preceding claims, characterized by two tool elements ( 18 ; 218 ; 318 ). Surgical instrument according to one of the preceding claims, characterized in that the end effector ( 14 ; 214 ; 314 ) is formed in two parts and two end effector parts ( 102 ; 220 . 222 ; 320 . 322 ). Surgical instrument according to claim 43, characterized in that each end effector part ( 102 ; 220 . 222 ; 320 . 322 ) a tool element ( 18 ; 218 ; 318 ). Surgical instrument according to claim 43 or 44, characterized in that each end effector part ( 102 ; 220 . 222 ; 320 . 322 ) a section half ( 99 ; 299 ; 399 ). Surgical instrument according to Claims 43 to 45, characterized in that the end effector ( 14 ) of two identical, firmly connected Endeffektorteilen ( 102 ), which are relative to each other by 180 ° about the longitudinal axis ( 24 ) are arranged twisted. Surgical instrument according to one of the preceding claims, characterized in that the two tool elements ( 218 ; 318 ) are formed mutually penetrating or crossing each other. Surgical instrument according to one of Claims 43 to 47, characterized in that a connecting device ( 104 ; 248 ; 348 ) is provided for connecting the Endeffektorteile ( 102 ; 220 . 222 ; 320 . 322 ) together. Surgical instrument according to claim 48, characterized in that the connecting device ( 104 ; 248 ; 348 ) at least a first and at least one second connecting element ( 106 . 108 ; 252 . 256 ; 352 . 356 ) which are engaged with each other in a connecting position, and that the at least one first and the at least one second connecting element ( 106 . 108 ; 252 . 256 ; 352 . 356 ) in each case on an end effector part ( 102 ; 220 . 222 ; 320 . 322 ) are arranged. Surgical instrument according to claim 49, characterized in that the at least one first connecting element ( 106 ; 256 ; 352 ) in the form of egg nes projection ( 106 ; 256 ; 352 ) and that the at least one second connecting element ( 108 ; 252 ; 356 ) in the form of a lead ( 106 ; 256 ; 352 ) corresponding recording ( 108 ; 252 ; 356 ) are formed. Surgical instrument according to claim 49 or 50, characterized in that the at least one first and the at least one second connecting element ( 106 . 108 ; 252 . 256 ; 352 . 356 ) in a direction transverse or substantially transverse to the longitudinal axis ( 24 ; 124 ; 224 ; 324 ) are orientated. Surgical instrument according to one of claims 49 to 51, characterized in that the at least one first and the at least one second connecting element ( 106 . 108 ; 252 . 256 ; 352 . 356 ) in a direction parallel or substantially parallel to the longitudinal axis ( 24 ; 124 ; 224 ; 324 ). Surgical instrument according to one of Claims 49 to 52, characterized in that the connecting device ( 164 ; 264 ; 364 ) at the power transmission section ( 49 ; 249 ; 349 ) is arranged for connecting the section halves ( 99 ; 299 ). Surgical instrument according to one of the preceding claims, characterized in that the end effector ( 214 ; 314 ) is formed such that the at least one tool element ( 218 ; 318 ) due to a movement of the force transmitting member ( 22 ; 136 ) in the proximal direction in the direction of the longitudinal axis ( 24 ; 124 ; 224 ; 324 ) and vice versa. Surgical instrument according to one of the preceding claims, characterized in that the end effector ( 14 ) is formed such that the at least one tool element ( 18 ) due to a movement of the force transmitting member ( 22 ; 136 ) in the distal direction in the direction of the longitudinal axis ( 24 ; 124 ) and vice versa. Surgical instrument according to one of the preceding claims, characterized in that the end effector ( 14 ) two tool elements ( 18 ) and is designed such that distal ends ( 90 ) of the tool elements ( 18 ) as a result of one with the force transmitting member ( 22 ; 136 ) Transmittable thrust to each other are pivotable. Surgical instrument according to one of claims 1 to 56, characterized in that the end effector ( 214 ; 314 ) two tool elements ( 218 ; 318 ) and is designed such that distal ends ( 290 ; 390 ) of the tool elements ( 218 ; 318 ) are pivotable towards each other as a result of a transmissible with the force transmission member tensile force. Surgical instrument according to one of the preceding claims, characterized in that a proximal end of the at least one tool element ( 18 ; 218 ; 318 ) in the form of at least one bearing jaw ( 87 ; 285 . 287 ; 385 . 387 ) is formed, which one to the bearing shaft ( 84 ; 184 ) correspondingly formed bearing shaft receptacle ( 88 ; 283 . 288 ; 383 . 388 ) having. Surgical instrument according to claim 58, characterized in that the at least one bearing jaw ( 87 ; 285 . 287 ; 385 . 387 ) is formed substantially cuboid or cube-shaped. Surgical instrument according to claim 58 or 59, characterized in that the at least one bearing jaw ( 87 ) an outer surface ( 89 ), which on an inner contour of the shaft ( 12 ; 122 ) is adjusted. Surgical instrument according to one of claims 58 to 60, characterized in that a width of the at least one bearing jaw ( 87 ) in a direction parallel to one of the bearing shaft ( 84 ; 184 ) defined pivot axis ( 16 ; 116 ) is about half as large as an inner diameter of the shaft ( 12 ; 122 ). Surgical instrument according to one of Claims 58 to 61, characterized in that a first tool element ( 218 ; 318 ) two first bearing jaws ( 287 ; 387 ), which transverse to the longitudinal axis ( 24 ; 124 ; 224 ; 324 ) are spaced from each other, and that a second tool element ( 218 ; 318 ) a second bearing jaw ( 285 ; 385 ), which between the two first bearing jaws ( 287 ; 387 ) on the bearing shaft ( 84 ; 184 ) is stored. Surgical instrument according to one of the preceding claims, characterized in that the at least one tool element ( 18 ; 218 ; 318 ) a tool end ( 90 ; 290 ; 390 ) in the form of a cutting edge ( 390 ) or in the form of a jaw ( 90 ; 290 ) having. Surgical instrument according to claim 63, characterized in that the tool end ( 90 ; 290 ; 390 ) has a material thickness in a range of 300 microns to 700 microns. Surgical instrument according to claim 63 or 64, characterized in that the tool end ( 290 ; 390 ) distally from a connecting region ( 236 ) between the at least one articulating member ( 295 ; 395 ) and the at least one tool element ( 218 ; 318 ). Surgical instrument according to one of the preceding claims, characterized in that the surgical instrument ( 10 ; 120 ) is in the form of a pair of scissors, a forceps or tweezers. Surgical instrument according to one of the preceding claims, characterized in that the end effector ( 14 ; 214 ; 314 ) is made of a metal or a plastic. Surgical instrument according to one of the preceding claims, characterized in that an outer diameter of the shaft ( 12 ; 122 ) is in a range of 1.5 mm to 8 mm. Surgical instrument according to claim 68, characterized in that an outer diameter of the shaft ( 12 ; 122 ) is in a range of 1.5 mm to 4 mm.