DE202010008674U1 - Surgical instrument - Google Patents

Abstract

The invention relates to a surgical instrument (20), comprising a pull/push element (2) guided in a sleeve (1) for transmitting a pulling/pushing force from an actuating device (3) disposed at one end of the sleeve (1) to a loop (4) disposed at the other end of the sleeve in order to move the loop (4) from a storage position, in which the loop (4) lies in an extended manner inside the sleeve (1), into a usage position, in which the expanded opening (5) of the loop (4) is located in front of the sleeve (1), and back into the storage position, wherein the loop (4) comprises two expansion limbs (6), which in the usage position are located partially in and in front of the sleeve (1) and together have an expanded V shape and which are more flexurally rigid at least in a direction that is transverse to the opening plane (5') than a loop arc (7) connecting the respective free ends (61) of the expansion limbs to each other, and wherein the pull/push element (2) is electrically conductive. For an advantageous development, at least one first longitudinal sub-section (21) of the loop arc (7), which in the storage position is located on the one longitudinal side of the loop (4), comprises an electrically insulating sheathing (23) or consists of an electrically insulating material, and at least one second longitudinal sub-section (22) of the loop arc (7), which in the storage position is located on the other longitudinal side of the loop (4), is electrically conductive, comprises no electrically insulating sheathing and is electrically conductively connected to the pull/push element (2) by means of at least one expansion limb (6).

Description

The present invention relates to a surgical instrument, preferably a radiofrequency surgical polypectomy snare, preferably for the removal of pathological tissue in hollow organs, comprising a pulling / pushing member carried in a sleeve for transmitting a pulling / pushing force from one located at one end of the sleeve Actuator on a arranged at the other end of the sleeve loop to the loop from a Verwahrstellung in which the loop is in an extended position in the sleeve, in a use position in which the spread opening of the loop in front of the sleeve, and back to shift, wherein the loop has two in the use position partially in and before the sleeve, spread together V-shaped expansion leg, which are more rigid than the respective free ends of the expansion leg mitei at least in one direction transverse to the opening plane spanned by the expansion legs nander connecting loop bow, and wherein the pull / push element is electrically conductive.

Such an instrument is known in the art DE 10 2005 030 159 A1 known. It is preferably used in the field of so-called flexible endoscopy, wherein, while the loop is still in the storage position, it can be inserted through a free working channel of an endoscope with its distal end into a hollow organ of a human or animal body. There, the sling can be moved into the position of use and placed around a limited, raised by an surrounding wall and to be removed tissue, such as. To a polyp. To separate the tissue, the loop is retracted to narrow its opening in the sleeve while at the same time by means of a connected high-frequency generator with high-frequency pulsating electric current (RF current) acted upon. The loop serves as an active electrode, which is traversed by an HF current. At another, generally remote location, the body to be treated can be connected to a so-called neutral electrode so that a potential difference to the surrounding tissue remains at the loop. With a sufficiently large potential difference, an electric arc is created between the active electrode and the adjacent tissue, whereby the desired cutting effect occurs by means of pyrolysis. If the loop is moved and in particular pulled back into the sleeve, the tissue area can be separated and removed. In view of this mode of operation, one should speak of a high frequency surgical instrument or cutter for the field of flexible endoscopy, which may, for example, find application in the gastrointestinal tract. A requirement of such instruments is that, based on the effective loop length, a sufficiently high current is available, otherwise the so-called lead delay and tissue damage may occur. Since the current intensity usually generated by HF surgical generators is limited, this also sets a certain upper limit for the effective loop length. In practice, an upper limit for the size of the tissue area to be removed with such an instrument is thereby often predetermined. To make matters worse, that at a mere increase in the electrically effective loop length and the so-called. Perforation risk, ie the risk of unwanted contacts and damage to healthy tissue increases.

Against this background, the invention has the object, advantageously further develop an instrument of the type mentioned, so that in particular the restrictions described above can be avoided as much as possible.

The object is achieved according to the invention first and substantially in conjunction with the features that at least a first length portion of the loop loop, which is in the storage position on one longitudinal side of the loop and preferably in position adjoins the local expansion limb, has an electrically insulating sheath or consists of electrically insulating material and that at least a second length portion of the loop loop, which is in the Verwahrstellung on the other longitudinal side of the loop and in particular positionally adjoins the local expansion limb, is electrically conductive, has no electrically insulating sheathing and by means of at least one Spreizschenkels is electrically conductively connected to the pull / push element. It follows that the loop loop is effective not cutting with its entire length, but only in one or more longitudinal sections. The amperage generated by a connected RF generator is thus available exclusively for the one or more limited, cutting effective length sections, while the length of the loop or the loop circumference can be further increased overall, including the non-cutting effective length sections. This makes it possible to wrap around larger tissue areas, in particular tissue areas with a diameter of more than 2 cm in diameter (for example, with a diameter of 3 or 4 cm or more) and by means of the one or more limited, cutting effective areas compared to previous instruments to separate the loop in toto. At the same time there is a higher current intensity at the limited cutting areas. Potential difference available, as would be the case if the entire loop would be formed as an active electrode. The cutting effective length can be dimensioned so that the risk of so-called bleed delay is limited or avoided. In addition, there is the advantage that the perforation risk can be reduced by the partially insulating coating. The instrument according to the invention can be used, for example, for the removal of polyps and, to that extent, also be referred to as HF-surgical polypectomy snares.

The invention also relates to a surgical instrument, preferably a radiofrequency surgical polypectomy snare, comprising a pull / push member carried in a sleeve for transmitting a pulling / pushing force from an actuator disposed at one end of the sleeve to an actuator disposed at the other end of the sleeve Sling to displace the sling from a storage position in which the sling is in an extended position in the sleeve to a use position in which the spread opening of the sling lies in front of the sleeve and back again displaced together with the sling , slidably mounted in the sleeve stop when moving the loop from its Verwahrstellung in its position of use against a sleeve-fixed counter-attack occurs to exert a spreading effect on the loop, the loop two in the use position partially in and before the sleeve lying V-shaped spread spreader leg l forms, whose free ends are connected to a loop loop, attacking at each of the free ends additional, substantially parallel to the expansion legs extending tension elements which are connected to the slidable relative to the expansion limbs stop, and wherein the pull / push element electrically is conductive.

Such an instrument is also out DE 10 2005 030 159 A1 known. Based on this, the object of the invention is again to advantageously develop such an instrument, so that in particular the restrictions described above can be avoided as far as possible.

The object is achieved according to the invention initially and essentially in conjunction with the features that at least a first longitudinal section of the loop loop, which is in the storage position on one longitudinal side of the loop and in particular positionally adjoins the local expansion limb, has an electrically insulating sheath or consists of electrically insulating material and that at least a second length portion of the loop loop, which is in the Verwahrstellung on the other longitudinal side of the loop and in particular positionally adjoins the local expansion limb, is electrically conductive, has no electrically insulating sheathing and by means of at least one Spreizschenkels is electrically conductively connected to the pull / push element. For the possible effects and advantages, reference is made to the preceding description.

According to the design of the sling with expansion legs, the sling can be pressed with its tip against the wall of a body cavity. In this case, the less rigid loop bow bends, so that the area in the direction from the end of the sleeve on the apex of the loop immediately after the free ends of the expansion legs is a region of greatest deflection. This area is at the same time the area of the largest opening width of the loop so that the splayed loop, which in the best case is bent at a right angle, can be lifted or pulled over the tissue area to be removed (eg a polyp).

Regarding the aforementioned instruments according to the invention there are many possibilities for the preferred development. At first, it is preferred that the first longitudinal section section and the second longitudinal section section each have half the length or each approximately half the length of the loop loop and / or in each case proceeding from a distal tip or vertex of the loop loop, preferably up to one of the two expansion legs, respectively. extend. It is thus preferable to use a loop loop which acts as a cutting electrode on one side or half side as a cutting electrode. In particular, in conjunction with the described possibility to bend the less rigid loop bow, this offers advantages in handling and observation by an endoscope. There is the possibility that the distal tip of the loop loop has an electrically insulating sheath or consists of electrically insulating material or that the distal tip of the loop loop is electrically conductive and has no electrically insulating sheath. Thus, the distal tip may optionally be formed as a cutting active electrode or not. The spreading elements adjoining the loop loop are likewise part of the loop and delimit with their opening cross-section. A preferred development is seen in that the expansion element adjoining the first longitudinal section of the loop loop at least partially, preferably in an adjacent to the first length portion of the loop loop portion of the longitudinal portion, or a total of electrically insulating sheath or consists of electrically insulating material and that the other Spreader is electrically conductive and has no electrically insulating sheath. The isolated Although spreading element may have an electrically conductive core, but also does not form an active electrode for the cutting process due to its external insulation. It is thus possible, for example, to completely isolate an entire loop half or loop side (relative to the feed direction or an imaginary longitudinal center line) and to completely form the second loop half or side as an active electrode. In addition, the cutting effective length or its length portion can be further reduced at the loop length by, for example, both spreading at least partially, preferably in a respective adjoining the loop bend length portion, an electrically insulating sheath. It would then be possible, for example, for only one or possibly several longitudinal sections of the loop loop to act as an active electrode. A development is also conceivable in that both tension elements at least partially, preferably in a respective adjacent to the associated expansion limb longitudinal part region, or in total have an electrically insulating sheath or consist of electrically insulating material.

The electrically insulating sheath preferably extends in its respective length region around the entire core cross-sectional circumference of the loop loop or optionally of the expansion limb and of the tension element. The electrically insulating sheath may be formed, for example, as a coating, which comprises, for example, aluminum carbonate or consists of aluminum carbonate, which is body and tissue friendly. However, other other electrically insulating sheathing or coatings are used. As appropriate for handling is considered when the electrically insulating coating roughened to the center of the loop towards peripheral portions of the loop loop and / or the expansion limbs and executed at the loop center away oriented peripheral portions of the loop loop and / or the expansion leg to comparatively smooth. A roughening can be given, for example, by small points, points, hooks or comparable microstructures. This facilitates grasping and holding or positioning the loop around tissue to be removed. With regard to the loop loop, there is the possibility that this is made, for example, of a monofilament, preferably elastically flexible, looped wire wire (for example of spring steel), the diameter of which, for example, being in the range of 0.3 to 0.5 mm (or even deviating). can amount. Alternatively, there is the possibility that the loop bow has, for example, a loop core of comparable overall diameter, which, however, is made of a plurality (for example from approximately 10 to 20) monofilaments twisted or twisted together of correspondingly smaller individual diameters. With regard to the expansion leg is preferably thought that these are formed of elastic strips of metal, which lie in the storage position with their broad side surfaces together. At least in areas which are to be used as an active electrode, the loop loop and the expansion leg (s) are preferably made of a metal, such as spring steel. There is the possibility that the loop loop in the region of its tip forms a bay of acute looped or parallel Schlingenbogenabschnitten.

There is the possibility that the tension elements acting on the free or front ends of the expansion limbs are formed by wire ropes. There is also the possibility that the stop is formed by a tube piece slidably mounted in the sleeve, through which tube piece the expansion legs protrude. It is considered to be advantageous for the tension elements to extend along the wide side surfaces of the expansion limbs facing away from one another. There is the possibility that the free or front ends of the expansion limbs are in the direction of the apex of the loop in front of the region of the largest opening width of the loop.

A preferred development is also seen in that at least the loop bow has a plurality of spaced-apart local thickenings and / or spaced, loop-inwardly directed hooks. The thickenings or hooks can be arranged as needed in the effective as an active electrode length sections and / or the electrically insulated lengths. In order to feed an HF current to the loop or the length section (s) acting as the cutting electrode, it is considered appropriate that at least the corresponding loop sections in the area of the loop loop and the expansion leg and the pull / push element designed as a rope or band consist of an electric consist of conductive material and are electrically conductively connected to an electrical contact of the actuator. A generator selected for RF power can be connected to said electrical contact of the actuator.

The components or components of the loop, which are electrically conductive, together form an electrically conductive loop core. With regard to the described electrically insulating sheath, there is also the possibility, as also described, that it extends around the entire loop core circumference, ie, around the circumference, in a cross-section oriented transverse to the loop longitudinal or longitudinal direction. Alternatively, it would be conceivable, the electrically insulating To provide sheathing as an electrically insulating cover only in a limited peripheral region of the loop core or the sling core cross-section. It would thus be conceivable for the lateral surface of the loop core to be electrically conductively free at least circumferentially at least circumferentially with respect to a loop core cross section of the loop opening, and at least circumferentially at the circumference side remote from the loop opening to have an electrically insulating cover. In particular, it would be conceivable that the lateral surface of the loop core with respect to the loop core cross-section at the loop opening assigning circumferential half in the circumferential direction continuously exposed electrically conductive and on the side facing away from the loop opening peripheral half in the circumferential direction continuously carries an electrically insulating cover. This possible development relates on the one hand to the loop loop and the expansion leg, but can also be applied to the tension elements as needed.

Other possibilities of the preferred development is related to the DE 10 2005 030 159 A1 taken. The content of this document is hereby incorporated in full in the present application, also for the purpose of including features with claims.

The feature that at least a first length portion of the loop loop is in the storage position on the one longitudinal side of the loop, does not necessarily mean that the first length portion extends over the entire length of the loop loop on the one longitudinal side of the loop. Accordingly, the feature that a second length portion of the loop loop is in the custody position on the other longitudinal side of the loop, not necessary that the second length portion extends over the entire length of the loop loop on the other longitudinal side of the loop. Instead, these features determine only one layer of the respective length section. This means that, alternatively, in particular as an alternative to the preferred (ie unnecessary) development, exemplary embodiments also fall under the claimed invention, in which the first longitudinal section and / or the second longitudinal section of the loop loop are less than half the length extend the loop loop.

So there is z. For example, the possibility that the first length portion of the loop loop adjacent to a third length portion of the loop loop on the same longitudinal side of the loop, that the third length portion extends from the distal tip of the loop loop to the first length portion portion and that the third length portion is electrically conductive , Has no electrically insulating sheath and is electrically conductively connected by means of at least one spreader leg with the pull / push element. Thus, one side of the loop loop may be cuttingly effective in a forward or distal portion of its length due to its lack of insulation, while a proximal adjoining portion of the length of said side of the loop may not be cuttingly effective due to electrical insulation. With respect to the cutting effective longitudinal portion means (here and in the rest) the formulation that this is electrically conductively connected by at least one spreader leg with the pull / push element that in an electrical connection between the cutting active longitudinal section and the pull / push element at least one Expansion limb is electrically conductively integrated. In particular, in connection with the embodiment described above, only one preferred (i.e., not necessary) configuration is seen in that the second length portion of the loop loop extends continuously from the distal tip of the loop loop to the expansion leg disposed on the same longitudinal side of the loop. Alternatively, there is the possibility that the second longitudinal section of the loop loop extends from the distal tip of the loop loop only to a fourth longitudinal section of the loop loop disposed on the same longitudinal side of the loop, wherein the fourth longitudinal section of the loop loop comprises an electrically insulating sheath or electrically insulative material and preferably extends to the expansion limb on this longitudinal side.

Also preferred, d. H. not necessary, that the second length portion of the loop loop and the third length portion of the loop loop have the same length. In particular, it may be provided that the length of the second longitudinal section of the loop loop and the length of the third longitudinal section of the loop loop about 15% to 40%, more preferably about 20% to 30% and more preferably about 25% of the length of the loop loop in a range of the distal tip is up to a spreader leg.

The invention will be further described below with reference to the accompanying figures, which show preferred embodiments of the invention. It shows:

1a the first, the loop end having a first embodiment of the instrument according to the invention in an enlarged view, wherein the loop is currently in the storage position;

1b the other end of this embodiment with actuator;

2a a representation according to 1a wherein the sling is displaced to a position of use;

2 B a representation according to 1b but in the position of use;

3a a representation according to 2a wherein the loop is displaced in an expanded position;

3b a representation according to 2 B but in the spread position;

4 the in 2a with IV designated area in an enlarged view;

5 the in 3a with V designated area in an enlarged view;

6 a perspective view of a according to 3 splayed loop in which, according to a vertical pressure of the loop on a base of the loop bow portion is splayed approximately at right angles to the sleeve, with an opening of the width D adjusts;

7 the loop of a second embodiment of the instrument according to the invention in a Aufspreizstellung about how 3a ;

8th the loop of a third embodiment of the instrument according to the invention in a representation like 7 ;

9 an enlarged cross-sectional view of the loop loop in an electrically insulated longitudinal section in the direction of view IX-IX according to 3a ;

10 perspective enlargement of a longitudinal section of an electrically insulated loop loop, according to another preferred embodiment;

11 in enlargement an alternative embodiment to the detail XI 3a ;

12 an alternative to the in 11 embodiment shown;

13a . 13b the two ends of the instrument according to the invention according to a further preferred embodiment,

14a . 14b the two ends of the instrument according to the invention according to a still further preferred embodiment,

15a . 15b the two ends of the instrument according to the invention according to yet another preferred embodiment and

16a . 16b the two ends of the instrument according to the invention according to yet another preferred embodiment.

The elements of the surgical instrument 20 or cutting device of the embodiments consist of materials that are able to withstand the temperatures occurring during sterilization of the device. The sleeve 1 consists of a plastic, such as PTFT. The sleeve 1 is about positive locking elements, essentially via connectors with an actuator 3 connected. This has a guide rail 16 , which has at its end a Durchgriffsauge for a finger, in particular the thumb of the surgeon. On the guide rail 16 , the thrust and tensile with the sleeve 1 is connected, sits a train-push piece 17 which has two opposing recessed grips to the train-push piece 17 to be able to hold between two fingers of the surgeon.

Inside the sleeve 1 is located throughout an electrically conductive train-push element 2 , which is formed in the embodiment as a metal core, in particular in the form of a rope or a flat strip. Will that be with the pull / push element 2 connected train-push piece 17 shifted, so the train-push element shifts 2 inside the sleeve 1 , The train-push piece 17 also carries an electrical contact 14 , which can be connected to a terminal of a high-frequency current generator, with which the pull / push element 2 and those with the reference number 4 designated snare of the cutting device can be energized in order to be able to separate in the known manner, for example, polyps from the tissue carrying them by means of a coagulation current. In the 1a . 1b are the two longitudinal ends of the instrument according to the invention 20 according to a first preferred embodiment, wherein the intermediate longitudinal region in which the pull / push element 2 through the sleeve 1 extends, is not shown for clarity. Also for better illustration is the in 1a end shown in comparison to the in 1b enlarged end of the instrument ( consequently also with a comparatively larger diameter).

The actuating device 3 also has a flush opening 15 on, by means of a rinsing liquid or a gas in the sleeve 1 can be initiated.

The end of the train push element 2 goes in two, in the in 1a shown storage position in which the loop 4 in the sleeve 1 rests, substantially parallel to each other extending expansion legs 6 above. In the expansion legs 6 These are each flat, resilient metal strips, which lie with their broad side surfaces together. The two expansion legs 6 are spring-loaded and have a kink 18 so that when you move out of the sleeve 1 V-shape, as it is the 2a shows. When relocating the sling 4 from the sleeve 1 from the in 1a shown deposit position in which the loop 4 in a stretched position completely rests in the sleeve, into the in 2a shown use position in which the kinks 18 outside before the end of the sleeve 1 The two spreader legs spread apart 6 V-shaped, so that the loop loop 7 , with regard to the vertex attached to it 11 also as a loop vertex arch 7 can be designated and with the free ends 6 ' the expansion leg 6 are connected, spreading. Also, the space between the spread spreader legs 6 forms an area of the loop opening 5 with an opening plane 5 ' , The loop opening 5 gets through the loop crest arc 7 closed, which consists of a metallic wire rope and less rigid than the two expansion legs 6 , In this sense, the loop loop form 7 and the two expansion legs 6 the loop 4 or overrun the loop opening 5 ,

The vertex 11 of the loop vertex arch 7 forms a narrowing in the form of a bay, the two sections 11 ' this bay at an acute angle to each other. Also the respective area of the loop vertex arch 7 that is adjacent to the free end 6 ' of the spreading leg 6 lies, forms a bulge 19 outwards. Again 6 it can be seen, are the two bulges 19 substantially diametrically opposite and forming the area of largest diameter D of the loop.

At the free ends 6 ' the expansion leg 6 are also each traction elements 10 attached. These tension elements 10 consist of thin wire ropes and protrude together with the expansion legs 6 a tubular counter-attack 9 that is inside the sleeve 1 arranged shear-resistant at the end. The tension elements 10 are with their other or proximal ends on a stop tube piece forming a stop 8th attached. This stop tube piece is slidable longitudinally in the sleeve on the in the sleeve 1 lying sections of the expansion leg 6 stored. When moving the sling 4 between the storage position and a first open position slides this stop pipe piece 8th inside the sleeve 1 , It has for this purpose a smaller diameter than the counter stop pipe piece 9 or as the sleeve hollow section. The tension elements 10 run outside the loop opening 5 essentially parallel to the expansion legs 6 , Following the kinks 18 lie the tension elements 10 but slightly spaced apart from the expansion legs 6 ,

Will the noose 4 from the in 1a Deposit position shown in the 2a displaced illustrated first open position, so spread the spreader leg 6 according to their spring bias from each other from V-shaped. In this position, the stop pipe piece is located 8th from the back of the counter-stop pipe piece forming a counter-stop 9 at.

By applying another push by means of the pull-push piece 17 on the pull-push element 2 become the expansion legs 6 slightly further from the sleeve 1 shifts out. Since the tension elements 10 according to the counter-attack 9 kicked stop 8th not further from the sleeve 1 can shift, this leads to a deflection of the expansion limbs 6 , which causes the kinks 18 further from the tension elements 10 remove and move towards each other, as in the 3a is shown. This will remove the free ends 6 ' from each other, and the noose 4 spreads further on. When doing the kinks 18 push against each other, this spreading is even reinforced.

Will the noose 4 Pressed vertically against a surface, so the loop bend bends 7 as it is in the 6 is shown. There is the loop of the loop 7 substantially perpendicular to a plane 5 ' , which of the V-shaped expansion legs 6 is clamped, bent at right angles. This is a consequence of the greater flexural stiffness of the expansion legs 6 especially in the direction transverse to the loop opening 5 or level 5 ' which is a consequence of the orientation of the slender leaf springs, of which the expansion limbs 6 be formed. For clarification are in the 6 the three mutually perpendicular spatial directions with X, Y, Z denotes. The sleeve 1 extends there parallel to the Z direction. The loop vertex arch 7 has turned into a plane that corresponds to the XY plane. Again 6 it can be seen, the loop bends 4 in the area of the bulges 19 through, ie in an area immediately adjacent to the free ends 6 ' the expansion leg 6 is adjacent. This is the area with the largest opening width of the sling 4 which can be placed over the polyp or the like when using the device as a surgical cutter. Is the noose 4 put over a polyp, so on the pull-push piece 17 exercised a move, so that the noose 4 contracted to closely embrace the polyp especially on his neck. Then, in the known manner, the separation of the polyp through the over the electrode 14 initiated electricity.

To better keep the severed polyp in the sling 4 to be able to hold, are in the in the 7 shown second embodiment thickenings 12 in the area of the unilateral loop vertex arc 7 intended. In the in the 8th illustrated embodiment are unilaterally loop inwardly directed hooks 13 provided, the holder of the separated polyp in the loop 4 serve.

The cross-sectional shape of the expansion leg 6 is chosen so that it is within the level 5 ' the loop opening 5 bend more easily than in the transverse direction. For this purpose, have the expansion leg 6 preferably a rectangular cross-section, wherein the rectangular edges, which are the broad side surfaces of the expansion limbs 6 form, are many times longer than the perpendicular thereto narrow edges, in the plane of the loop opening 5 lie. Not only in the storage position, but also in the position of use, the broad side surfaces of the expansion limb 6 towards each other. They are in the storage position at least partially in touching contact.

In the above-described embodiments of the instrument 20 are each the pull / push element 2 , the spreader legs 6 , the loop of the bow 7 and the tension elements 10 made of metal. At the ends 6 ' there is a firm and electrically conductive connection between the respective expansion leg 6 and the subsequent loop loop 7 , as well as to the tension element 10 , Likewise, in the 4 . 5 shown enlarged solid connection between the two expansion legs 6 and the pulling / pushing element 2 electrically conductive formed. The pull / push element 2 in turn is in electrically conductive connection to the electrical contact 14 , Thus, also stands the loop loop 7 in electrically conductive connection with the contact 14 to which an RF generator, which is not shown in the drawings, can be connected to the power supply.

In the embodiment of the instrument 20 according to 1 to 6 is provided that a so-called. First longitudinal section 21 the loop of the loop 7 an electrically insulating sheath 23 having the cross section of the loop loop 7 completely encloses at the periphery (see. 9 ). In this case, this length portion extends 21 from the end 6 ' of the adjacent expansion limb 6 to the top 11 located at the distal tip of the sling 4 located. The loop of the loop 7 is thus on one of two long sides of the loop 4 isolated. On the opposite side of the longitudinal center line labeled M extends from the apex 11 starting a so-called second longitudinal section 22 the loop of the loop 7 until the end 6 ' of the arranged on this side of the center line M Spreizschenkels 6 , This second length section 22 has no electrically insulating sheath and thus also has an exposed, electrically conductive surface. Although both length sections 21 . 22 electrically conductive with the contact 14 connected, acts due to the insulating sheath 23 on the loop of the loop 7 only the second length section 22 as a cutting active electrode. In the first longitudinal section 21 forms due to the sheath 23 no potential gradient to the adjacent tissue, so there is no effective cutting area. Nevertheless, in the example, the two longitudinal sections are 21 and 22 formed from only one piece of continuous metal wire, ie, the second longitudinal portion portion has an electrically conductive core, so that the first length portion 21 by means of both expansion legs 6 electrically conductive with the pull / push element 2 connected is. Alternatively, it would also be conceivable, the loop loop 7 in the region of the first longitudinal section 21 made of an electrically non-conductive material.

In which to the 1 - 6 described embodiment ends the insulating sheath 23 at the distal tip 24 , According to 11 Alternatively, there is the possibility that the electrically insulating sheath 23 until just above the vertex 11 or the distal tip 24 Beyond the side of the sling opposite the center line M. 4 extends. Another, not graphically reproduced alternative may be that the electrically insulating sheath 23 on the isolated loop side not all the way to the top 11 extends, leaving the distal tip 24 even cutting can be effective. In 12 is shown as yet another alternative that the loop loop 7 from two initially separate loops bow sections 7 . 7 ' may be formed, the free ends each fixed to a common tip body 25 are embedded from an electrically insulating material, up to which the sheath 23 extends.

With reference to the 9 and 10 is shown schematically simplified that an electrically insulating sheath 23 as a coating Aluminum carbonate is carried out, with each coating to the center of the loop 4 indicative (cf the cutting direction of 9 in 3a ) Peripheral areas of the loop loop 7 along the approximately half cross-sectional circumference a roughening in the form of many individual peaks 26 has. At the remaining, from the loop opening 5 remote half of the circumference has the coating or sheath 23 a smooth surface. The roughening allows a secure embrace of the tissue, while the smooth outer side, the retraction and extension of the loop in / out of the sleeve 1 facilitated. The difference in the 9 . 10 shown variants is that in 9 the loop of the loop 7 has a monofilament loop wire, while the loop wire cross section in 10 was formed from a plurality of relatively smaller, each monofilament wires by means of twisting.

In the in the 13a . 13b shown alternative embodiment of an instrument 20 it is envisaged that this also applies to the first longitudinal section 21 the loop of the loop 7 subsequent expansion element 6 partly an electrically insulating sheath 23 (Simplified is the reference number for the electrically insulating sheath uniform 23 used) extending from the end 6 ' over the kink 18 extends to one end, which in the position of use shown still in the front end of the sleeve 1 located. This electrically insulated encased longitudinal part region of the expansion limb is in 13a with the reference number 27 designated. In the example shown, the second expansion leg arranged on the opposite side of the center line M has 6 , which is also made of a flat metal band, no electrically insulating sheath. This means that in 13a the second longitudinal part section located above the center line M. 22 the loop of the loop 7 together with the expansion limb adjacent to it 6 form an electrode suitable for cutting that extends entirely from the distal tip 24 the noose 4 up to its proximal end in the region of the kinks 18 extends, while the opposite loop half along this length portion an electrically continuous insulating coating 23 has. In the example in 13a also has the tension element located on the insulated loop side 10 a corresponding sheath 23 ,

Deviating is in the in the 14a . 14b shown embodiment provided that both expansion legs 6 and both tension elements 10 each in one on the loop loop 7 adjacent longitudinal portion of an electrically insulating sheath 23 exhibit. Also both tension elements 10 own in a respective, to the associated expansion leg 6 adjacent longitudinal portion of an electrically insulating sheath 23 , At the in 14a shown embodiment is thus only the so-called. Second longitudinal section 22 the loop of the loop 7 formed as a cutting electrode due to its electrically conductive surface, wherein the length portion of the loop circumference in the example is about a quarter. In the 1 - 14 is the electrically insulating sheath 23 or coating illustrated for illustrative purposes with exaggerated thickness. It goes without saying that the thickness of the sheathing must be chosen so that the loop as a whole also easily by the counter-attack 9 moving pipe section forward and back.

That in the 15a . 15b shown further embodiment of the instrument according to the invention 20 differs from the embodiment of 3a . 3b in that the first longitudinal section 21 the loop of the loop 7 not over its entire one side, that does not extend over its half length. Instead, it is envisaged that starting from the distal tip 24 in the proximal direction, a third longitudinal section 28 the loop of the loop 7 extending over the length approximately L, wherein the third length portion 28 is electrically conductive and has no electrically insulating sheath. Only starting from or adjacent to this third length section 28 extends the so-called. First longitudinal section 21 , the electrically insulating sheath 23 carries, to the proximal adjacent spreader leg 6 , In this embodiment extends on the opposite longitudinal side of the loop 4 the so-called second longitudinal section 22 from the distal tip 24 proceeding continuously up to the arranged on this other longitudinal side expansion leg 6 , ie in terms of location.

The 16a . 16b show yet another preferred embodiment. With respect to the first and third longitudinal sections 21 . 28 this corresponds to the design according to 15a . 15b , Deviating from but provided that the second longitudinal section 22 the loop of the loop 7 from the distal tip 24 the loop of the loop 7 starting only up to one on the same longitudinal side of the loop 4 arranged so-called. Fourth longitudinal section 29 the loop of the loop 7 extends, wherein the fourth length portion 29 the loop of the loop 7 an electrically insulating sheath 23 and / or consists of electrically insulating material and in turn on the lying on the same longitudinal side expansion leg 6 followed. In this respect, a center-symmetrical configuration is selected with respect to the center line M, in which on both longitudinal sides of the loop 4 in the area of the loop loop 7 only one each limited anterior, to the distal tip 24 adjacent and this enclosing length section 22 . 28 cutting is effective while attaching to both sides of the sling 4 in the proximal direction in each case an electrically insulating coated longitudinal part section 23 . 29 the loop of the loop 7 followed. By way of example, ie not necessary, it is provided that the second longitudinal section 22 and the third length portion 28 have the same length L. In the chosen embodiment, the length L is about a quarter of the one longitudinal side of the loop 4 attributable partial length of the loop loop 7 ,

All disclosed features are essential to the invention. The disclosure of the associated / attached priority documents (copy of the prior application) is hereby also incorporated in full in the disclosure of the application, also for the purpose of including features of these documents in claims of the present application. The subclaims characterize in their optional sibling version independent inventive development of the prior art, in particular to make on the basis of these claims divisional applications.

QUOTES INCLUDE IN THE DESCRIPTION

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

Cited patent literature

• DE 102005030159 A1 [0002, 0006, 0014]

Claims (20)

Surgical instrument ( 20 ), in particular radiofrequency surgical polypectomy snares, in particular for the removal of pathological tissue in hollow organs, with one in a sleeve ( 1 ) guided pulling / pushing element ( 2 ) for transmitting a pulling / pushing force from one at the one end of the sleeve ( 1 ) arranged actuating device ( 3 ) on a arranged at the other end of the sleeve loop ( 4 ) to the sling ( 4 ) of a storage position in which the sling ( 4 ) in an extended position in the sleeve ( 1 ) rests, in a position of use, in which the spread-open ( 5 ) of the sling ( 4 ) in front of the sleeve ( 1 ), and to shift back, whereby the loop ( 4 ) two in the position of use partially in and in front of the sleeve ( 1 ) lying, together in a V-shaped spread expansion limbs ( 6 ), which are at least in one direction transverse to the opening plane ( 5 ' ) are more rigid than the respective free ends ( 6 ' ) of the expansion leg interconnecting loop loop ( 7 ), and wherein the pull / push element ( 2 ) is electrically conductive, characterized in that at least a first longitudinal section ( 21 ) of the loop loop ( 7 ), which is in the storage position on one longitudinal side of the loop ( 4 ), an electrically insulating sheath ( 23 ) or consists of electrically insulating material and that at least a second longitudinal section ( 22 ) of the loop loop ( 7 ), which is in the storage position on the other longitudinal side of the loop ( 4 ) is electrically conductive, has no electrically insulating sheath and by means of at least one spreader leg ( 6 ) electrically conductive with the pull / push element ( 2 ) connected is. Surgical instrument ( 20 ), in particular radiofrequency surgical polypectomy snares, with one in a sleeve ( 1 ) guided pulling / pushing element ( 2 ) for transmitting a pulling / pushing force from one at the one end of the sleeve ( 1 ) arranged actuating device ( 3 ) to one at the other end of the sleeve ( 1 ) arranged loop ( 4 ) to the sling ( 4 ) of a storage position in which the sling ( 4 ) in an extended position in the sleeve ( 1 ) rests, in a position of use, in which the spread-open ( 5 ) of the sling ( 4 ) in front of the sleeve ( 1 ), and again to shift back, whereby one together with the noose ( 4 ) displaceable, sliding in the sleeve ( 1 ) mounted stop ( 8th ) when moving the loop ( 4 ) from its storage position in its position of use against a sleeve-fixed counter-attack ( 9 ) occurs to a spreading effect on the loop ( 4 ), wherein the sling two partially in the position of use in and in front of the sleeve ( 1 ) lying V-shaped spread spreader legs ( 6 ) whose free ends ( 6 ' ) with a loop ( 7 ) are connected, wherein at each of the free ends ( 6 ' ) additional, substantially parallel to the expansion legs ( 6 ) extending tension elements ( 10 ) attack with the opposite of the expansion legs ( 6 ) slidable stop ( 8th ) and wherein the pull / push element ( 2 ) is electrically conductive, characterized in that at least a first longitudinal section ( 21 ) of the loop loop ( 7 ), which is in the storage position on one longitudinal side of the loop ( 4 ), an electrically insulating sheath ( 23 ) or consists of electrically insulating material and that at least a second longitudinal section ( 22 ) of the loop loop ( 7 ), which is in the storage position on the other longitudinal side of the loop ( 4 ) is electrically conductive, has no electrically insulating sheath and by means of at least one spreader leg ( 6 ) electrically conductive with the pull / push element ( 2 ) connected is. Instrument ( 20 ) according to claim 1 or in particular according thereto, characterized in that at each free end ( 6 ' ) of the spreader leg ( 6 ) additional, substantially parallel to the expansion legs ( 6 ) extending tension elements ( 10 attack) with one together with the sling ( 4 ) displaceable, sliding in the sleeve ( 1 ) and opposite the expansion legs ( 6 ) slidable stop ( 8th ), which stop ( 8th ) when moving the loop ( 4 ) from its storage position in its position of use against a sleeve-fixed counter-attack ( 9 ) occurs to a spreading effect on the loop ( 4 ) exercise. Instrument ( 20 ) according to claim 2 or in particular according thereto, characterized in that the V-shaped spread expansion limbs ( 6 ) at least in the direction transverse to that of the expansion limbs ( 6 ) opening plane ( 5 ' ) are more rigid than the loop loop ( 7 ). Instrument ( 20 ) according to one or both of claims 1, 2 or in particular according thereto, characterized in that the first longitudinal section ( 21 ), which is in the storage position on one longitudinal side of the loop ( 4 ), in terms of location at the local expansion legs ( 6 ) and that the second longitudinal section ( 22 ), which is in the storage position on the other longitudinal side of the loop ( 4 ), in terms of location at the local expansion legs ( 6 ). Instrument ( 20 ) according to one or more of the preceding claims or in particular according thereto, characterized in that the first longitudinal section ( 21 ) and the second longitudinal section ( 22 ) each half the length or each about half the length of the loop loop ( 7 ) and / or each starting from a distal tip ( 24 ) of the loop loop ( 7 ), especially until in each case to one of the expansion limbs ( 6 ). Instrument ( 20 ) according to one or more of the preceding claims or in particular according thereto, characterized in that the distal tip ( 24 ) of the loop loop ( 7 ) an electrically insulating sheath ( 23 ) or consists of electrically insulating material or that the distal tip ( 24 ) of the loop loop ( 7 ) is electrically conductive and has no electrically insulating sheath. Instrument ( 20 ) according to one or more of the preceding claims or in particular according thereto, characterized in that the first part of the length ( 21 ) of the loop loop ( 7 ) subsequent spreading element ( 6 ) at least partially, in particular in one of the first longitudinal section ( 21 ) adjacent longitudinal portion ( 27 ), or altogether an electrically insulating sheath ( 23 ) or consists of electrically insulating material and that the other expansion element ( 6 ) is electrically conductive and has no electrically insulating sheath. Instrument ( 20 ) according to one or more of the preceding claims or in particular according thereto, characterized in that both spreading elements ( 6 ) at least partially, in particular in a respective loop on the loop ( 7 ) adjacent longitudinal section ( 27 ), an electrically insulating sheath ( 23 ) exhibit. Instrument ( 20 ) according to one or more of the preceding claims or in particular according thereto, characterized in that both tension elements ( 10 ) at least partially, in particular in a respective at the associated expansion leg ( 6 ) adjacent longitudinal section ( 27 ), or altogether an electrically insulating sheath ( 23 ) or consist of electrically insulating material. Instrument ( 20 ) according to one or more of the preceding claims or in particular according thereto, characterized in that the electrically insulating sheath ( 23 ) is formed as a coating which comprises aluminum carbonate or consists of aluminum carbonate. Instrument ( 20 ) according to one or more of the preceding claims or in particular according thereto, characterized in that the electrically insulating coating at the middle of the loop oriented circumferential regions of the loop loop ( 7 ) and / or the expansion leg ( 6 roughened and oriented away from the middle of the loop edge regions of the loop loop ( 7 ) and / or the expansion leg ( 6 ) is performed comparatively smooth. Instrument ( 20 ) according to one or more of the preceding claims or in particular according thereto, characterized in that the loop loop ( 7 ) has a monofilament, in particular elastically flexible, looped wire wire, in particular with a diameter in the range of 0.3 to 0.5 mm, or that the loop loop ( 7 ) has a loop core in the range of 0.3 to 0.5 mm, comprising a plurality, in particular 10 to 20, monofilaments twisted together. Instrument ( 20 ) according to one or more of the preceding claims or in particular according thereto, characterized in that the expansion limbs ( 6 ) are formed by elastic flat strips which lie in the storage position with their broad side surfaces together. Instrument ( 20 ) according to one or more of the preceding claims or in particular according thereto, characterized in that the loop loop ( 7 ) in the area of its tip ( 24 ) a bay ( 11 ) from acute-angled or parallel looping loop sections (US Pat. 11 ' ) trains. Instrument ( 20 ) according to one or more of the preceding claims or in particular according thereto, characterized in that the first longitudinal section ( 21 ) of the loop loop ( 7 ) to a third longitudinal section ( 28 ) of the loop loop ( 7 ) on the same longitudinal side of the loop ( 4 ) adjoins the third longitudinal section ( 28 ) from the distal tip ( 24 ) of the loop loop ( 7 ) up to the first longitudinal section ( 21 ) and that the third longitudinal section ( 28 ) is electrically conductive, has no electrically insulating sheath and by means of at least one spreader leg ( 6 ) electrically conductive with the pull / push element ( 2 ) connected is. Instrument ( 20 ) according to one or more of the preceding claims or in particular according thereto, characterized in that the second longitudinal part section ( 22 ) of the loop loop ( 7 ) from the distal tip ( 24 ) of the loop loop ( 7 ) up to that on the same longitudinal side of the loop ( 4 ) arranged expansion limbs ( 6 ). Instrument ( 20 ) according to one or more of the preceding claims or in particular according thereto, characterized in that the second longitudinal part section ( 22 ) of the loop loop ( 7 ) from the distal tip ( 24 ) of the loop loop ( 7 ) up to one on the same longitudinal side of the loop ( 4 ) arranged fourth longitudinal portion section ( 29 ) of the loop loop ( 7 ), the fourth longitudinal section ( 29 ) of the loop loop ( 7 ) an electrically insulating sheath ( 23 ) or consists of electrically insulating material. Instrument ( 20 ) according to one or more of the preceding claims or in particular according thereto, characterized in that the second longitudinal part section ( 22 ) of the loop loop ( 7 ) and the third longitudinal section ( 28 ) of the loop loop ( 7 ) have the same length (L). Instrument ( 20 ) according to one or more of the preceding claims or in particular according thereto, characterized in that the length (L) of the second longitudinal section ( 22 ) of the loop loop ( 7 ) and / or the length (L) of the third longitudinal section ( 28 ) of the loop loop ( 7 ) about 20 to 30 percent, in particular about 25 percent, of the length of loop loop ( 7 ) in a region on a longitudinal side of the distal tip ( 24 ) to a spreader leg ( 6 ) is.

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