DE202012100197U1 - TFT Koagulationssicherung - Google Patents

Abstract

Medical TFT instrument of the bipolar type with at least two electrodes (10, 16) held by relatively movable electrode carriers (6, 12), each of which can be supplied with HF current via a feed line, characterized by one in the area of at least one of the electrode carriers ( 6, 12), as well as in at least one of the supply lines interposed fuse switch mechanism (26, 28, 34), which is brought into an open or disconnected position when the at least one electrode carrier (12) is moved into the non-functional position or situation, whereby an HF Power supply to the electrode (16) assigned to the supply line is interrupted.

Description

The present invention relates to a TFT coagulation fuse, and more particularly to a TFT instrument having a hinged RF electrode for end-to-end anastomosis with integrated RF energy interruption according to the preamble of claim 1.

An end-to-end anastomosis is basically understood to mean an (artificial) anastomosis, in which two hollow organ sections (for example intestinal parts) are sewn together again at their open ends, so that a fluid-tight and continuous course is created. It is important here that the peripheral seam results in a completely fluid-tight and flexible and tear-resistant connection of the two hollow organ sections to be joined, which is designed in such a way that the surface of the hollow organ forms as smooth a surface as possible in order to guarantee trouble-free fluid flow within the hollow organ.

From the prior art staplers in the form of one-way instruments are known, as for example in the DE 43 27 233 A1 is disclosed. Accordingly, a stapler of this type has an endoscope shaft at the proximal end portion of which a handpiece for holding the device and for operating a stapling mechanism is disposed. The stapling mechanism consists of a distally fixed at Endokopschaft staple cartridge approximately in the form of a cylindrical cartridge case in which a number of circumferentially arranged circumferentially brackets are spring biased and a staple head or staple cap mushroom or umbrella style placed on the axially distal end of the cartridge case and by a fixed thereto style / pin is axially movably guided in the cartridge case. The stapling head is thus in the axial direction of the stapler of the cartridge case continuously spaced, thereby resulting between the stapling head and the cartridge case an adjustable, circumferential (annular) axial gap into which the two ends of the hollow organ to be joined can be clamped. The stapling head (or staple cap) as well as the cartridge case are operable via suitable transfer means within the endoscope shaft from the handpiece.

The problem of such staplers is basically to produce a fluid-tight and flexible and tear-resistant seam. For this purpose, in some staplers two spaced apart in the radial direction of the cartridge case staple rows are provided, the brackets overlap in their engagement areas. Although this improves the degree of tightness and the tear resistance, meanwhile, radially inwardly protruding tissue flaps or folds inevitably arise, as a result of which a fluid flow within the hollow organ can be hindered. For this reason, staplers of this genus have recently been replaced or supplemented by medical TFT instruments, preferably with bipolar electrode construction.

Also in this case, such a TFT instrument has an endoscope shaft with a proximal handpiece and an endoscope head, which is preferably mechanically and electrically connected to the handpiece via suitable transmission means within the endoscope shaft. The endoscope head consists essentially of a bearing sleeve, which is then attached axially fixed to the distal end portion of the endoscope shaft and at the distal end edge of a first circumferential electrode (electrode ring) is mounted and from a relatively movable electrode screen (electrode cap). The electrode shield has for this purpose an axial pin, which is axially displaceably guided in the bearing sleeve and coupled / coupled with a mechanical transmission means within the endoscope shaft for its actuation via the handpiece and a circumferential electrode rim, which is arranged at the distal end of the pin thereto. At the bearing sleeve facing the end face of the electrode ring this carries a second circumferential electrode (electrode ring), which cooperates with the first electrode.

In accordance with the staplers known per se, in the TFT instrument of this structure, by axially moving the electrode shield by means of the handpiece, an axial gap between the electrode ring and the bearing sleeve can be adjusted to sandwich tissue to be connected therebetween and to the electrodes by RF current application coagulate (weld or seal). This method creates a flexible and fluid-tight fabric seam without large tissue folds projecting into the interior of the hollow organ.

However, there is the problem with such TFT devices that at least the screen when pulling out of the device from the hollow organ must pass through the seam without sustainably injuring them. There is always the risk that the RF power supply is activated inadvertently, causing u. U. tissue can be damaged especially in the seam area.

In view of this, an object of the present invention is to develop a generic TFT device so that the risk of inadvertent tissue damage by RF exposure especially when removing the device from an organ (preferably hollow organ) is reduced.

This object is achieved by a TFT device having the features of claim 1. Advantageous embodiments of the invention are the subject of the dependent claims.

The basic idea of the invention is, in principle, to guide the HF power supply to at least one of the electrodes of a bipolar TFT device according to the invention, preferably of the one-way type, via a distal safety switch mechanism (in addition to a main switch in the region of the handpiece) one of the electrode support is arranged (integrated) and automatically when transferring the TFT device or the one electrode carrier in functional position / function situation (ie automatically by the movement of the at least one electrode carrier) in the on position and when transferring the electrode carrier in non-functional position / non-functional situation is switched off / brought in, whereby an RF power supply is inevitably interrupted (regardless of the main switch operation). By this separation of the RF supply line to the electrode carrier unwanted tissue damage can no longer occur, even if accidentally an RF activation is triggered for example by appropriate operation on the handle.

In the specific case, the TFT device is an end-to-end anastomosis HF instrument with an endoscope shaft, at the distal end of which a substantially annular first electrode (or electrode row) is placed on the front side and an electrode shield or electrode cap attached to a tube-shaped) pin or style is mounted end, which is mounted axially displaceable in the distal end portion (bearing sleeve) of the endoscope shaft. The electrode cap forms a kind of annular electrode carrier, which carries on a side facing the end piece a second, substantially annular electrode (or electrode row), which cooperates with the first electrode.

Preferably, the coronary electrode carrier, hinged or pivotally mounted on the (tubular) pin (hinged) centric. The pivoting or folding of the annular electrode carrier with respect to the pin by means of a pin mounted in / on the actuating rod (needle), which is articulated via at least one lever with the annular electrode carrier, whereby an axial movement of the actuating rod along the pin in a pivoting or folding movement of the coronal electrode carrier is transferred around the pin. The actuating rod is electrically connected to the electrode (electrode row) held by the electrode carrier and thus constitutes a section of the HF supply line. The (tubular) pin preferably made of electrically nonconducting material is a (single) contact contact, for example in the form of a sliding contact. fixed (arranged / formed), which comes only at / from a predetermined axial position of the actuating rod relative to the pin, in which the coronary electrode support is folded out or swung substantially in working position, with the operating rod or a contact provided thereto in electrical contact closure and thus the HF supply line produces. As a result, the RF lead is disconnected outside the predetermined axial position of the actuator rod with respect to the stylus. The actuating rod and the contact on the side of the pin thus form the safety switching mechanism according to the invention.

Alternatively, of course, it is also possible, in particular in the case of a non-hinged / pivotable electrode cap, to provide the safety switch mechanism between endoscope shaft end piece (bearing sleeve) and cap pin. In this alternative, the supply of RF current to the cap side second electrode (electrode row) via a supply line which is over the endoscope end piece (bearing sleeve) and the cap pin is performed and only at / from a predetermined axial distance between the electrode cap and Electrode and endoscope end piece is closed. If this predetermined axial distance (range) is exceeded and / or undershot, the supply line between the pin and the end piece is disconnected.

In summary, therefore, the safety switching mechanism is coupled to a mechanical function of the HF instrument, with which at least two RF electrodes are movable relative to each other in order to be brought into a functional and / or non-functional position.

Another alternative according to the invention provides for releasably locking, clipping or jamming the electrode cap or the annular electrode carrier with the pin, wherein an electrical contact closure to the electrode on the electrode side is simultaneously produced by this mechanical connection. Ie. the latch / Verclippung / clamping at the same time also represents the safety switch mechanism according to the invention. In this case, the electrode carrier (electrode cap) is preferably connected via an electrically insulated or insulating thread to the pin. When the instrument is removed / withdrawn from the organ, the electrode cap is mechanically stripped from the pin (ie, the catch), at the same time completely disconnecting the electrical lead at the catch. The electrode cap is then dragged over the electrically insulated / insulating thread quasi. In this way, the electrode cap can be relatively easily pulled through the previously prepared seam, with the thereto arranged electrode is no longer acted upon by RF power.

The invention will be explained below with reference to preferred embodiments with reference to the accompanying figures.

1 Fig. 3 shows a medical bipolar TFT instrument preferably of the end-to-end anastomosis type with a number of alternative axially displaceable electrode caps according to the invention,

2a - 2d show a first variant of an axially displaceable electrode cap according to the invention in functional and non-functional position in detail and

3a to 3c show a second variant of an axially displaceable electrode cap according to the invention in functional and non-functional position in detail.

In the 1 For example, a bipolar medical instrument preferably of the end-to-end anastomosis type is basically illustrated. It should be noted, however, that the basic principle of the present invention, as has already been explained above, is also applicable to other types of medical instruments such as forceps-type coagulation instruments or scissors-shaped cutting instruments in which at least two electrodes are movable towards each other to come into a functional position / functional situation.

The exemplary instrument of the end-to-end anastomosis type according to the 1 has a preferably rigid (ie, more rigid than the surrounding organ tissue and thus the hollow organ shape does not adapt) endoscope shaft 1 , at the proximal end of a handpiece 2 is arranged. At the distal end of the endocopy shaft 1 is an endoscope head 4 provided essentially consisting of one at the endoscope shaft 1 axially fixed or formed thereon bearing sleeve 6 and one in the bearing sleeve 6 axially movable electrode cap (electrode shield) 8th , At the distal end of the bearing sleeve 6 is a first electrode ring (or circumferential electrode row) 10 used, which has one in the endoscope 1 laid electrical supply line (not shown) with a proximal main switch (also not shown) in the region of the handpiece 2 connected is.

The electrode cap 8th consists of a coronal electrode holder 12 that is central to a pen 14 is coupled, such that the annular electrode holder 12 either completely from the pen 14 separated, or opposite the pin 14 can be pivoted or folded, as will be described in more detail below. The pencil 14 is in turn axially displaceable in the distal endoscope bearing sleeve 6 used or usable. For actuating the pivoting / folding / separating mechanism as well as for axial displacement of the pin 14 within the distal bearing sleeve 6 are in the endoscope 1 a number of push / pull rods or trains laid (not shown), the distal to the electrode cap 8th and proximal to the handpiece 2 or to predetermined handling of the handpiece 2 are coupled. Finally, on the coronal electrode holder 12 on the bearing sleeve 6 facing end face a second electrode ring (or circumferential electrode row) 16 mounted, via a preferably separate supply line within the endoscope shaft 1 also electrically connected to the main switch / is connectable.

The hand piece 2 exists according to the 1 from an ergonomically shaped handle 18 and a relatively movable / pivotable lever or trigger (first handle) 20 via which the integrated (not shown) main switch for RF power to the electrodes 10 . 16 is operable. Furthermore, on the handpiece 2 a number of setting wheels or buttons (second and third handle) 22 . 24 for activating the push / pull rods for an axial displacement of the electrode cap 8th with respect to the bearing sleeve 6 and for actuating the pivoting / folding mechanism of the annular electrode holder 12 appropriate.

The general structural design of the TFT device according to the invention for the mechanical coupling of the electrode cap to the endoscope shaft and the electrical connection of the electrodes to the main switch are well known in the prior art, so that at this point can be dispensed with a more detailed description. In the following, essentially the individual variants of the electrode caps according to the invention will be described with reference to FIGS 1 to 3 described in more detail.

As also from the 1 can be seen, the TFT device according to the invention in the present case in the form of end-to-end anastomosis instrument with differently shaped electrode caps 8th be fitted. Basically, every electrode cap has 8th the previously mentioned annular electrode holder 12 as well as the perpendicular to this extending pen 14 which is in the bearing sleeve 6 insertable and with an actuator at least for axial displacement of the electrode cap 8th can be coupled. Depending on the variant, the electrode holder 12 concerning the pin 14 (hinged) pivotally mounted or the electrode holder 12 is more divided, with each part relating to the pin 14 can be folded. Alternatively, the pen 14 be formed at its distal end portion with a latching or plug-in mechanism, with which the annular electrode holder 12 can be brought into latching engagement. This locking / insertion mechanism is formed so that its release direction substantially axially to the endoscope shaft 1 is aligned and the necessary release force for disengagement is so dimensioned or adjustable, that upon retraction of the device from the hollow organ of the annular electrode holder 12 from the pen 14 or stripped from the locking / insertion mechanism.

The 2a to 2d now show an electrode cap 8th This invention according to a first preferred embodiment in functional as well as in non-functional position / situation.

In the 2a is the electrode cap 8th shown in partial longitudinal section as well as in functional position. Accordingly, the pen exists 14 from a tube of preferably non-conductive or electrically insulated material, at its distal end of the annular electrode holder 12 is centrally hinged, such that this with respect to the tubular pin 14 can tilt / tilt, like this in the 2 B and 2c is shown. At a proximal end portion of the tubular pin 14 is an outer contact ring 26 fixed from electrically conductive material, preferably in the interior of the tube 14 projects in certain areas. In the tube 14 inserted axially displaceable an actuating rod or needle 28 , which at the distal end of the tube 14 protrudes and at its protruding, distal end of a toggle 30 hinged, in turn, with the coronary electrode carrier 12 is connected at the edge and hinged (see in particular 2c ). Consequently, the actuating rod 28 axially in the tube 14 shifted, this movement is transferred to the electrode carrier 12 , this with respect to the tube 14 tilted.

The operating rod 28 is made of an electrically conductive material (or has an electrical line) and is electrically connected to the electrode ring (circumferential row of electrodes) 16 on the electrode holder 12 connected. The operating rod 28 or the conduit mounted thereon is shaped so that it / they at a certain axial position with respect to the tube 14 , in which the electrode carrier 12 essentially assumes its functional position (see 2a and 2d ), with the outer contact ring 26 comes into contact and thus a contact closure with the endoscope 1 installed electrical wiring. Finally, the operating rod protrudes 28 also at the proximal end of the tube 14 before and forms at its proximal end an engaging portion 32 that with a corresponding actuating mechanism in the endoscope shaft 1 can be coupled.

Will therefore the operating rod 28 from the axial position (corresponds to the functional position) according to the 2a or 2 B , in which the electrode carrier 12 essentially parallel to the distal end face of the bearing sleeve 6 is aligned, in an axial position (corresponds to the non-functional position) according to the 2 B or 2c shifted, in which the electrode carrier 12 an angle> O ° with respect to the distal end face of the bearing sleeve 6 takes, simultaneously becomes the electrical contact between the outer contact ring 26 and the actuating rod 28 (automatically) separated so that the cap-side electrode 16 no longer can be acted upon by an RF power. Even if in this position, the main switch on the hand / handle 2 (unintentionally) should be actuated, the cap-side electrode 16 not be activated. Damage to the surrounding tissue can be safely avoided.

At this point it should be noted that the pivotal mounting of the annular electrode holder 12 can also be replaced by a folding storage, as shown schematically in the 1 is indicated in a variant shown there. In this case, the electrode holder 12 be divided into two, with the two parts are hinged together. Each part is via its own articulated lever with the operating rod 28 operatively connected, so that the two parts in axial displacement of the actuating rod 28 similar to a screen unfolded / can be clamped.

It is also possible in principle, the electrode cap 8th form without pivoting or folding mechanism, in which case the annular electrode holder 12 stuck with the pen 14 (without actuating rod / needle) is connected. In such a construction, it is conceivable, the pin 14 from an electrically conductive material (whereas the electrode carrier 12 is non-conductive) and with the cap-side electrode 16 electrically connect. The contact ring 26 would be in the bearing sleeve 6 used, such that they at a certain axial position of the electrode cap 8th with respect to the distal end face of the bearing sleeve 6 (corresponds to a certain gap measurement range) with the pen 14 comes in electrical contact or separates the electrical contact.

Finally, let me turn to another variant for an electrode cap 8th according to the invention, as shown in the 3a to 3c is shown.

In this alternative embodiment, the cap pin is 14 according to the 3c tongue or platelet-shaped, where it is at its distal end portion to two resilient prongs 34 forked. Every tine 34 forms an undercut or indentation, which each represents a latching engagement, in the spreading direction of the respective prongs 34 has. The coronal or cup-shaped electrode holder 12 has a longitudinal slot in its central area 36 , which acts as an engagement slot for the spring-loaded tines 34 is provided. Furthermore, on the electrode holder 12 a thread 38 made of electrically non-conductive material fixed, in turn, on the cap pin 14 is attached.

The capstick 14 is at least partially electrically conductive, with an electrical line 40 from the cap side electrode 12 leads out to the longitudinal slot in the (electrically non-conductive) electrode carrier, as in particular in the 3a is shown. In functional position according to the 3a is the pen 14 over his two springy tines 34 in the longitudinal slot 36 of the electrode carrier 12 engaged so that the electrode carrier 12 fixed with predefined locking force with the pin 14 connected is. At the same time the pen has 14 over the springy tines 34 an electrical contact to the cap side electrode 16 , The string 38 is in this state between the tines 34 wound up, as in particular in the 3a is shown.

From the 3b in combination with the 1 can be seen that the electrode carrier 12 in the locked state substantially parallel to the distal end face of the bearing sleeve 6 aligns, resulting in between the opposing electrodes 10 . 16 (circumferential electrode rows) forms an axial gap. About a through hole 42 at the proximal end of the pen 14 is the electrode cap 8th with an actuating mechanism not shown further for an axial displacement of the electrode cap 8th in the bearing sleeve 6 coupled, so that the axial gap is adjustable to a certain gap size.

If now the TFT instrument is removed from the hollow organ (not shown), ie withdrawn, the electrode holder strikes 12 from the forked prongs 34 like this in the 3c is shown symbolically. In this case also becomes the electrical contact between the pin 14 and the cap-side electrode 16 interrupted / disconnected. The electrode holder 12 now only hangs over the electrically non-conductive thread 38 at the pin 14 and is thus dragged by the endoscope.

In summary, a medical TFT instrument of the bipolar type is disclosed with at least two of relatively movable electrode carriers 6 . 12 held electrodes 10 . 16 , Which can be acted upon by a respective supply line with RF power. According to the invention, one is in the region of the electrode carrier 6 . 12 arranged, as well as additionally provided in at least one of the leads between circuit breaker mechanism, which upon transfer at least one of the electrode carrier 12 is brought in non-functional position / situation in an off or disconnected position, whereby an RF power supply to the electrode associated with this supply line is interrupted.

QUOTES INCLUDE IN THE DESCRIPTION

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Cited patent literature

• DE 4327233 A1 [0003]

Claims (9)

Medical TFT instrument of the bipolar type with at least two of relatively movable electrode carriers ( 6 . 12 ) held electrodes ( 10 . 16 ), which can be acted upon by a respective supply line with HF current, characterized by a in the range of at least one of the electrode carrier ( 6 . 12 ), as well as interposed in at least one of the leads fuse switch mechanism ( 26 . 28 . 34 ), which upon transfer of the at least one electrode carrier ( 12 ) is brought into an off or disconnected position in the inoperative position or situation, whereby an HF power supply to the electrode assigned to the feed line ( 16 ) is interrupted. A medical TFT instrument according to claim 1, characterized in that it is an end-to-end anastomosis HF instrument, preferably of the one-way type. Medical TFT instrument according to claim 1 or 2, characterized by a preferably rigid endoscope shaft ( 1 ), at its distal end ( 6 ) a substantially annular first electrode ( 10 ) is placed on the front side and an electrode cap ( 8th ) with a pen ( 14 ) located in the distal end piece ( 6 ) of the endoscope shaft ( 1 ) is mounted axially displaceable, wherein the electrode cap ( 8th ) at one end piece ( 6 ) side facing a second, substantially annular electrode ( 16 ), which with the first electrode ( 10 ) cooperates. Medical TFT instrument according to claim 3, characterized in that the electrode cap ( 8th ) from a coronary electrode carrier ( 12 ), which hingedly on the now tubular pin ( 14 ) is mounted centrally in order to move into a functional position essentially parallel to the end face of the distal shaft end piece ( 6 ) and in an inoperative position at an angle greater than 0 ° to the end face of the distal end of the shaft ( 6 ) to be panned. Medical TFT instrument according to claim 4, characterized in that the safety switch mechanism ( 26 . 28 . 34 ) mechanically with the electrode cap ( 8th ) and in particular with its pin ( 14 ) is coupled such that at a position of the coronal electrode carrier ( 12 ) outside its functional position the at least one supply line to that of the coronary electrode carrier ( 12 ) held electrode ( 16 ) is interrupted. Medical TFT instrument according to claim 5, characterized in that the pivoting of the coronal electrode carrier ( 12 ) concerning the pen ( 14 ) by means of a pen ( 14 ) axially movably mounted actuating rod ( 28 ), which via a toggle lever ( 30 ) with the coronal electrode carrier ( 12 ) is coupled to an axial movement of the actuating rod ( 28 ) along the pin ( 14 ) in a pivoting movement of the coronal electrode carrier ( 12 ) around the pen ( 14 ) to transfer. Medical TFT instrument according to claim 6, characterized in that the actuating rod ( 28 ) electrically with that of the electrode carrier ( 12 ) held electrode ( 16 ) and thus represents a portion of the RF lead, wherein the tubular pin ( 14 ) a contact contact, preferably in the form of a sliding contact ( 26 ) arranged at a predetermined axial position of the actuating rod ( 28 ) concerning the pen ( 14 ), in which the coronal electrode carrier ( 12 ) is unfolded in functional position, with the operating rod ( 28 ) or an intended contact in electrical contact closure comes. Medical TFT instrument according to one of claims 1 to 3, characterized in that the pin ( 14 ) at its distal end a safety switch mechanism ( 34 ) forming snap-action or latching device which is provided with a coronal electrode carrier ( 12 ) of the electrode cap ( 8th ) is mechanically latched to simultaneously electrical contact between the pin ( 14 ) or an attached supply line ( 40 ) with the electrode ( 16 ) on the side of the electrode cap ( 8th ). Medical TFT instrument according to claim 8, characterized in that the electrode carrier ( 12 ) via an electrically non-conductive thread ( 38 ) is connected to the pen.

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