DE202015104679U1 - Kinematics for an intracorporeally driven instrument of an endoscope - Google Patents

Abstract

Kinematics for an intracorporeally driven instrument of an endoscope, comprising at least one actuator of a drive motor and a gear and means for receiving and / or operating a diagnostic and / or surgical instrument, characterized in that at least one actuator in the distal (intracorporeal) end of Kinematics is located.

Description

The invention relates to a kinematics for an intracorporeally driven instrument, which is used in an endoscope application, according to the preamble of the first claim.

• • Starre Endoskope • Fixes Werkzeug im Schaft • Ausrichtbares Instrument in der Spitze – Ausrichtkinematik in Schaft oder Endstück – Schwenkprisma
• • Flexible Endoskope • Abwinkelbare Spitze • Flexibler Schaft • Ausrichtkinematik in Spitze
• • Kapselendoskope: PillCam

The innovative core of the invention lies in the kinematic implementation of the instrument alignment and -aktuation of the endoscope. Looking at the relevant state of the art, the variants can be divided into

• • Rigid endoscopes • Fixed tool in the shaft • Alignable instrument in the tip - Alignment kinematics in shaft or tail - Swivel prism
• • Flexible endoscopes • Angled tip • Flexible shaft • Alignment kinematics in tip
• • Capsule endoscopes: PillCam

The illustrated variants differ in the way in which the instrument carrier, referred to below as the examination head, feeds at the distal end. The distal (body facing away) end is referred to in endoscopy deviating from the conventional nomenclature from the direction of the surgeon. Thus, the proximal end of the surgeon is outside (extracorporeal) of the body.

Rigid endoscopes guide an examination head directly from the entrance opening - here usually as a wound - to the examination zone. Since the latter is usually not directly accessible, this requires the use of at least one Zuführwunde. The rigid arrangement allows for an arrangement of the instruments in the shaft, which allows a cheaper version especially in the optical rod lens systems. Such systems are typically fixed in their viewing direction to the angles 0 °, 30 °, 70 ° or 90 °, which requires a preselection or a change of the endoscope during the operation.

This is remedied by adjustable endoscopes whose effective direction can be changed by kinematics. These endoscopes use the space available through the rigid shaft, whereby an extracorporeal arrangement of the drive unit - manual to automated - is offered here. Disadvantages of rigid endoscopes are - in addition to the obvious limitation in terms of access - justified in the built-in rod optics. Classical lens constructions are highly sensitive to bending and prone to visual obstruction due to condensation on the lenses. These disadvantages are offset by the lower costs as an advantage.

Flexible endoscopes consist of a flexible shaft which can be distracted at the distal end by the orientation of the insertion direction. The remaining shaft can be rigid or according to the Hirschowitz flexoscope [ US 3,753,672 ] are deformable executed. If the examination head is to be aligned with the examination zone, either a kinematics in the shaft or at the tip is required. An essential advantage of flexible endoscopes is the easier delivery through a single wound (single port) or, ideally, through existing, natural orifice translumenal endoscopic surgery ("NOTES").

Capsule endoscopes are disposable cameras that are taken as (disposable) pills and transported through the peristalsis of the digestive organs to the examination site. The recordings are generated via radio to an extracorporeal evaluation unit. The obvious benefits of capsule endoscopy are the lack of shaft and natural transport of the capsule to the examination site. This eliminates perforation and bleeding risks as well as the need for anesthesia. Disadvantages arise from the long transport time of the capsule to the examination site (inflation of hollow organs only partially externally controllable, during this time ingested food impedes the investigation), the arbitrary orientation of the capsule (no detailed inspections or surgical procedures possible) and the restriction to investigations of the Digestive tract [ http://www.pillcam.ch ].

Swing prism systems are rigid rod lens systems in which the viewing direction is achieved by the alignment of a prism in the endoscope tip. For sterilization in an autoclave (water vapor saturated atmosphere at 2 bar overpressure 134 ° C) [ Oginski, S .: Development and construction of a novel assistance system for medical endoscopy. Dissertation 2013 ], the optical elements must be protected by a soldered metal housing. The resulting requirements can not be met by endoscopes for technical use. The only known system in the field of medical technology is the system EndoCAMeleon from Karl Storz. The EndoCAMeleon achieves a viewing angle of 0 ° -120 ° with a shaft length of 180 mm and a minimum diameter of 4 mm.

Tilt and Shift lenses (TSO) change the sharpness level and distortion of the captured image by panning (tilting) and shifting (shifting). Thus, different angles can be realized with a camera position, which in turn can be put together to form an overall picture. The strong distortion of the image requires a computation-intensive image correction along with an elaborate illumination of the surgical field. A current solution is given by the ORS Image Trac of Olympus.

• • LTF-VP EndoEYE (Olympus Europa Holding GmbH): Starres Endoskop mit abwinkelbarer Spitze. Durchmesser 5,4 mm mit 100° Abwinkelung in vier Richtungen. CCD-on-Tip-Optik.
• • [ Bühs, F.: Entwicklung eines Endoskops mit flexibler Endoskopspitze für die minimalinvasive Chirurgie. Dissertation 2011 ]: Starres Endoskop mit abwinkelbarer Spitze. 140° Abwinkelung in x- und y-Richtung. CCD-on-Tip-Optik. Fokussiermodul auf Basis eines Linearmotors. Kooperationsprojekt der TU Berlin mit der Karl Storz GmbH.
• • Silver Scope (Karl Storz): Videoendoskop mit flexibel abwinkelbarer Spitze.
• • Endochoice (RMS): Flexibles Endoskop. Durchmesser 8,9 mm. Maximale Abwinkelung 210° (Auf/ab) bzw. 120° (links/rechts).
• • FNS-2800 (emos technology): Flexibles Endoskop, Durchmesser 2,8 mm, Abwinkelung 150° (auf/ab).
• • ENF-34-300 (Endodoctor GmbH): Flexibles Endoskop, Durchmesser 3,4 mm, Abwinkelung 150° (je auf/ab).
• • Gastro 98 (Endo-Tech Hamburg): Flexibles Endoskop, Durchmesser 9,8 mm mit einen Arbeitskanal von 2,8 mm. Abwinkelung in vier Richtungen (oben 190°, unten, links, rechts jeweils 100°).
• • RS1 & RX1 (orlvision): Flexibles USB-Videoendoskop. Durchmesser 3,9 mm. Abwinkelung (auf/ab) um je 130°.
• • MEE050500 (Karlheinz Hinze Optoengineering GmbH): Flexible Glasfaser, Durchmesser 0,5 mm, Sichtbereich 70° (keine Abwinkelung des Kopfes).
• • invendoscopeTM SC20 (invendo medical): Durchmesser 18 mm, Elektrohydraulische Abwinkelung um 180° in jede Richtung.
• • 830 001 3118 (Henke-Sass, Wolf GmbH): Flexibles Videoendoskop. Durchmesser 3,2 mm, Abwinkelung (auf/ab) 130°.
• • EG-530 NP (FujiFilm): Flexibles Gastroskop, Durchmesser 4,9 mm, 210° oben, 120° unten.
• • EB-470 P (FujiFilm): Flexibles Bronchoskop, Außendurchmesser: 3,8 mm, Abwinkelung: 180° oben, 130° unten.
• • GIF-XP 190 N (Olympus): Flexibles Gastroskop. Außendurchmesser: 5,8 mm. Abwinkelung: 210° oben, 90° unten, 100° links/rechts.
• • BF-3C 160 (Olympus): Flexibles Bronchoskop. Außendurchmesser: 3,8 mm. Abwinkelung: 180° oben, 130° unten.
• • Anubis (Karl Storz): Flexibles Endoskop (NOTEScope) als Multifunktionsinstrument ohne Optik. Durchmesser 16 mm.
• • TransPort (USGI): Flexibles Multifunktionsendoskop mit vier Arbeitskanälen (für Endoskopie und/oder Instrumente).
• • EndoSamurai (Olympus): Flexibles Multifunktionsendoskop mit 15,7 mm.

Angled tips can bend and realign the entire endoscope tip based on a mostly rigid shaft. This requires a gap sufficient for the bend. The following systems are available and documented:

• • LTF-VP EndoEYE (Olympus Europe Holding GmbH): Rigid endoscope with angled tip. Diameter 5.4 mm with 100 ° bend in four directions. CCD-on-tip optics.
• • [ Bühs, F .: Development of an endoscope with flexible endoscope tip for minimally invasive surgery. Dissertation 2011 ]: Rigid endoscope with angled tip. 140 ° bend in x and y direction. CCD-on-tip optics. Focusing module based on a linear motor. Cooperation project of the TU Berlin with the Karl Storz GmbH.
• • Silver Scope (Karl Storz): Video endoscope with flexibly angled tip.
• • Endochoice (RMS): Flexible endoscope. Diameter 8.9 mm. Maximum angulation 210 ° (up / down) or 120 ° (left / right).
• • FNS-2800 (emos technology): Flexible endoscope, diameter 2.8 mm, angulation 150 ° (up / down).
• • ENF-34-300 (Endodoctor GmbH): Flexible endoscope, diameter 3.4 mm, angulation 150 ° (each up / down).
• • Gastro 98 (Endo-Tech Hamburg): Flexible endoscope, diameter 9.8 mm with a working channel of 2.8 mm. Bending in four directions (top 190 °, bottom, left, right 100 ° each).
• • RS1 & RX1 (orlvision): Flexible USB video endoscope. Diameter 3.9 mm. Angulation (up / down) by 130 ° each.
• • MEE050500 (Karlheinz Hinze Optoengineering GmbH): Flexible glass fiber, diameter 0.5 mm, viewing range 70 ° (no bending of the head).
• • invendoscopeTM SC20 (invendo medical): diameter 18 mm, electro-hydraulic bending by 180 ° in each direction.
• • 830 001 3118 (Henke-Sass, Wolf GmbH): Flexible video endoscope. Diameter 3.2 mm, angulation (up / down) 130 °.
• • EG-530 NP (FujiFilm): flexible gastroscope, diameter 4.9 mm, 210 ° top, 120 ° bottom.
• • EB-470 P (FujiFilm): Flexible bronchoscope, outer diameter: 3.8 mm, angulation: 180 ° top, 130 ° bottom.
• • GIF-XP 190 N (Olympus): flexible gastroscope. Outer diameter: 5.8 mm. Angulation: 210 ° top, 90 ° bottom, 100 ° left / right.
• • BF-3C 160 (Olympus): flexible bronchoscope. Outer diameter: 3.8 mm. Angulation: 180 ° at the top, 130 ° at the bottom.
• • Anubis (Karl Storz): Flexible endoscope (NOTEScope) as a multifunctional instrument without optics. Diameter 16 mm.
• • TransPort (USGI): Flexible multifunction endoscope with four working channels (for endoscopy and / or instruments).
• • EndoSamurai (Olympus): flexible multifunction endoscope with 15.7 mm.

• 1. [ DE 10 2012 202 552 B3 ]: Ein Videoendoskop mit verstellbarer Blickrichtung, dessen flexibles distales Ende über einen verstellbares Innenskelett ausgelenkt wird. Das Innenskelett besteht aus ringförmigen magnetischen Aktorelementen, die sich bei Anlegen eines Stroms relativ zueinander verkippen. Nachteilig erweist sich hier der resultierende große Krümmungsradius.
• 2. [ DE 10 2010 009 003 A1 ]: Eine Matrix aus elektroaktiven Polymeren, welche sich bei entsprechender Ansteuerung der Einzelelemente in verschiedene Richtungen auslenken lässt. Ebenfalls nachteilig ist der resultierende große Krümmungsradius.
• 3. [ DE 699 240 82 T2 ]: Die Endoskopspitze ist als elastische Hülle mit einer eingelegten Feder aus einer Formgedächtnislegierung ausgeführt. Diese Feder wird mittels lokaler induktiver Erwärmung ausgelenkt.
• 4. [ EP 2 073 058 A1 ]: Aus dem nicht-medizinischen Bereich wird eine Inspektionskamera für Rohre und Kanäle beschrieben, deren „distales“ Ende aus mehreren motorisch angetriebenen Gelenken besteht. Ein Glied dieser kinematischen Kette besteht aus zwei Gelenkelementen mit jeweils einem Rotationsfreiheitsgrad senkrecht zur proximalen Achse sowie zum vorangehenden Gelenk. Jedes Gelenk wird über einen Riementrieb angetrieben, dessen Abtrieb das kugelförmige Gelenkelement umschlingt. Durch eine kinematische Kette mehrerer Gelenkelemente sind Schwenkbereiche > 90° realisierbar.
• 5. [ EP 1 759 629 B1 ]: Dieses Patent beschreibt einen distal starren Schaft, welcher zwei hintereinander angeordnete Motoren enthält. Diese Motoren leiten die Bewegung entweder über lange Wellen oder Hebelmechanismen zum distalen Ende, welches zwei parallele Schwenkachsen aufweist. Das erste Gelenk schwenkt die Endoskopspitze um ca. 90° aus der Schaftachse, während das zweite Gelenk die Endoskopspitze weiter, in eine rückwärtige Ausrichtung zu schwenken vermag. Der Schaft lässt sich axial durch einen proximal integrierten Getriebemotor drehen, dessen Ritzel an eine Innenverzahnung im Schaft eingreift.
• 6. [ EP 1 332 710 B1 ]: Ein Endoskop mit motorisch verstellbarer Seitenblickoptik. Der Motor ist distal direkt hinter einen axial drehbaren Hohlzylinder angeordnet, welcher ein Kamerasystem nebst Spiegel enthält. Der Spiegel ist in 45° zur axialen Kamerablickrichtung zusammen mit der Kamera im Hohlzylinder angeordnet, so dass bei einer Drehung des Zylinders ein Blickfeld von 360° radial zur Drehachse zur Verfügung steht. Der Motor überträgt das Drehmoment über ein Reibrad. Eine weitere Ausführung positioniert den Motor proximal und leitet die Bewegung über eine biegsame Welle zum Hohlzylinder.
• 7. [ DE 10 2011 089 132 A1 ]: Wie auch in [ EP 1 332 710 B1 ], beschreibt diese Offenlegung ein seitlich blickendes Videoendoskop, bei dem eine axial drehbare Optik elektromotorisch vor einem feststehenden Bildsensor verstellt wird. Die Optik ist ebenfalls in einem, im Endoskopschaft gelagerten Hohlzylinder untergebracht.
• 8. [ DE 10 2011 077 273 A1 ]: Diese Offenlegung beschreibt ein optisches Endoskop mit distalen Kugelgelenk. Die Kugelpfanne enthält Elektromagnete, welche die Kugel durch einen, in der Kugel des Gelenks befindlichen, Permanentmagnet ausrichten.
• 9. [ WO 2009/058 350 A1 ]: Das hier beschriebene „Columbia Imaging Device“ besteht aus einer intrakorporal schwenkbaren Schaft, die zwei elektrische Antriebe enthält. Während ein Motor eine axiale Drehbewegung realisiert, treibt der zweite Motor über eine Schnecken- und Stirnrad-Getriebestufe eine Zahnstange an, welche den Kopf um 90° schwenken kann. Letzterer ist ein Geräteträger für Kamerasysteme. Der Schwenkmechanismus mittels Zahnstange wird bereits in [ US 2003/032 863 A1 ] offenbart.
• 10. [ DE 10 2006 003 548 B4 ]: Dieses „Zangen- oder Schereninstrument mit Getriebeverbindung“ verfügt über ein Kegelradgetriebe zur synchronen Bewegung von Zangenbacken. Die Getriebewelle besteht hierbei aus einer Stange die vom proximalen Ende her angetrieben wird. Diese Erfindung benötigt somit ein starres Endoskop mit einem Antrieb außerhalb des Körpers.
• 11. [ WO 2003/086 179 A1 ]: Die Anmeldung beschreibt ein optisches Endoskop, dessen distales Ende senkrecht aus der Endoskopachse schwenken kann. Die Schwenkbewegung wird über eine Schubstange von einem proximalen bzw. im Endoskopschaft befindlichen Aktuator bereitgestellt.
• 12. [ US 2003 0032 863 A1 ]: Es wird eine optisches Endoskop offenbart, welches das distale Ende senkrecht zur Endoskopachse schwenken kann. Die Schwenkbewegung wird über eine Schubstange, Zahnstange oder Seilzug von einem proximal liegenden Aktuator zum Gelenk geführt.
• 13. [ US 8 771 169 B2 ]: Eine Klammer- oder Zangenkinematik wird über zwei distale Motoren angetrieben. Die Motoren sind proximal zu einem Schwenkgelenk um die Schaftachse positioniert. Die Rotation wird über ein Kegelradgetriebe über das Gelenk an ein distal liegendes Getriebe übertragen. Eine Motorbewegung wird im Folgenden mittels einer Getriebespindel und einer Kulisse in eine Öffnungsbewegung einer Zangenbacke übertragen, während die andere, stillstehende Backe ein Klammerwerkzeug beinhaltet. Dieses wird in ähnlicher Weise vom zweiten Motor angetrieben, welcher ebenfalls die Rotation in eine Translation wandelt um damit die Klammerung auszulösen. Während dieses Patent die Anwendung von Getriebemotoren nahe am distalen Gelenk beschreibt, dienen diese rein zur Aktuation der Werkzeuge.
• 14. [ EP 1830461 ]: Weiterhin gegeben ist der in [ EP 1830461 ] beschriebene Servomotor (MSD), welcher eine konzeptionelle Basis für die geplanten Entwicklungen darstellt.
• 15. [ DE 10 2012 212 094 A1 ]: Ein endoskopisches Instrument bekannt, welches einen langgestreckten Schaft und einen distalen Instrumentenkopf aufweist der vom proximalen Instrumentenende aus steuerbar ist. Es ist ein Gelenk im Schaft oder zwischen dem distalen Schaftende und dem Instrumentenkopf vorgesehen sowie Mittel zum Schwenken eines distalen Gelenkteils in Bezug auf einen proximalen Gelenkteil. Es sind weiter Getriebemittel zur Übertragung von mindestens einer Steuerfunktion vom proximalen Instrumentenende zum Instrumentenkopf vorgesehen. Die Getriebemittel weisen mindestens ein Umlaufgetriebe auf, dessen zentrale Achse mit der Gelenkachse zusammenfällt. Die Getriebemittel sind dabei in Form einer Übertragungskinematik aus hintereinander geschalteten Planetengetriebestufen ausgebildet und übertragen eine Bewegung auf Zug- und Druckstangen. Der entscheidende Nachteil dieser Lösung besteht darin, dass die Eingangsgröße eine translatorische Bewegung bildet, die in eine rotierende Bewegung gewandelt werden muss, wofür ein relativ hoher konstruktiver Aufwand erforderlich ist. Die Verwendung von Stangen ist weiterhin nur für ein starres Endoskop nutzbar, wodurch eine Eintrittswunde unabdingbar ist. Bevorzugt werden jedoch Lösungen für Flexible Endoskope unter Zuhilfenahme natürlicher Körperöffnungen (NOTES; NOTES ist das Akronym für Natural Orifice Transluminal Endoscopic Surgery).
• 16. [ DE 10 2004 058 929 A1 ]: Ein Endoskop mit rotierbarem distalen Endoskopkopf. Dieser verfügt über ein abwinkelbares Endstück mit einem Endoskopschaft zu einem rohrförmigen Bauteil verbunden ist. Erfindungsgemäß ist zwischen dem Endoskopschaft und dem abwinkelbaren Endstück ein zusätzliches Rotationselement zur Rotation des abwinkelbaren Endstücks um die Längsachse des Endoskopschafts eingefügt. Dafür wird ein Untersetzungsgetriebe in Form eines koaxialen Getriebes, insbesondere eines Planetengetriebes oder ein sog. "Harmonic Drive" mit hoher Untersetzung und somit als selbsthemmendes Getriebe verwendet. Dieses Getriebe ist in der Getriebekammer untergebracht, welche ebenfalls vom Mittenabschnitt des Gehäuses des Rotationselements umschlossen ist. Durch das selbsthemmende Getriebe ergibt sich ein schlechter Gesamtwirkungsgrad. Weiterhin besteht ein großer Nachteil um dem großen benötigten axialen Bauraum und der geringen Zahl von Freiheitsgraden.
• 17. [ DE 11 2008 000 121 T5 ] offenbart einen Motor und einen Endoskopkopf, in dem der Motor verwendet wird. Ein Untersetzungsgetriebekopf wird von dem Motor angetrieben, wobei der Untersetzungsgetriebekopf ein Planeten-Untersetzungsgetriebe aufweist. Die grundsätzliche Struktur des Planeten-Untersetzungsgetriebemechanismus beinhaltet zwei Sätze voneinander unabhängiger Trageelemente, die hintereinander von der Seite des Motors zu der Seite der Abtriebswelle angeordnet sind, und einen Satz von Trageelementen, der am Basisende der Abtriebswelle angeordnet ist. Dieser Endoskopkopf verfügt über nur einen Freiheitsgrad, der für viele Anwendungsfälle ein zu geringes Bewegungsspektrum zur Verfügung stellt. Besonders nachteilig ist, dass keine Schwenkbewegung realisiert werden kann.

Various cordless, electromotive adjusting devices for the orientation of the distal end are known from the prior art:

• 1. [ DE 10 2012 202 552 B3 ]: A video endoscope with adjustable viewing direction, whose flexible distal end is deflected by an adjustable inner skeleton. The inner skeleton consists of annular magnetic actuator elements that tilt relative to each other when a current is applied. The disadvantage here proves to be the resulting large radius of curvature.
• 2. [ DE 10 2010 009 003 A1 ]: A matrix of electroactive polymers, which can be deflected in different directions with appropriate control of the individual elements. Another disadvantage is the resulting large radius of curvature.
• 3. [ DE 699 240 82 T2 ]: The endoscope tip is designed as an elastic shell with an inserted spring made of a shape memory alloy. This spring is deflected by means of local inductive heating.
• 4. [ EP 2 073 058 A1 ]: From the non-medical field, an inspection camera for tubes and channels is described, whose "distal" end consists of several motor-driven joints. One member of this kinematic chain consists of two joint elements, each with a rotational degree of freedom perpendicular to the proximal axis and to the preceding joint. Each joint is driven by a belt drive whose output wraps around the spherical joint element. By a kinematic chain of several joint elements pivoting ranges> 90 ° can be realized.
• 5. [ EP 1 759 629 B1 ]: This patent describes a distally rigid shaft which contains two motors arranged one behind the other. These motors conduct the movement either to the distal end via long shafts or lever mechanisms, which has two parallel pivot axes. The first joint pivots the endoscope tip about 90 ° out of the shaft axis, while the second joint continues to pivot the endoscope tip in a rearward orientation. The shaft can be rotated axially by a proximally integrated gear motor whose Pinion engages an internal toothing in the shaft.
• 6. [ EP 1 332 710 B1 ]: An endoscope with motorized side view optics. The motor is located distally directly behind an axially rotatable hollow cylinder, which contains a camera system together with mirrors. The mirror is arranged in 45 ° to the axial camera viewing direction together with the camera in the hollow cylinder, so that upon rotation of the cylinder a field of view of 360 ° is radially available to the rotation axis. The motor transmits the torque via a friction wheel. Another embodiment positions the motor proximally and directs the movement via a flexible shaft to the hollow cylinder.
• 7. [ DE 10 2011 089 132 A1 ]: As in [ EP 1 332 710 B1 ], this disclosure describes a side-looking video endoscope in which an axially rotatable optics is adjusted by an electric motor in front of a fixed image sensor. The optics are also housed in a hollow cylinder mounted in the endoscope shaft.
• 8th. [ DE 10 2011 077 273 A1 ]: This disclosure describes an optical endoscope with distal ball joint. The ball socket contains electromagnets which align the ball with a permanent magnet located in the ball of the joint.
• 9. [ WO 2009/058 350 A1 ]: The "Columbia Imaging Device" described here consists of an intracorporally pivotable shaft, which contains two electric drives. While a motor realizes an axial rotational movement, the second motor drives a toothed rack via a worm and spur gear stage, which can pivot the head through 90 °. The latter is a device carrier for camera systems. The swivel mechanism using a rack is already described in [ US 2003/032863 A1 ] disclosed.
• 10. [ DE 10 2006 003 548 B4 ]: This "pliers or scissors instrument with gearbox connection" has a bevel gearbox for synchronous movement of pliers jaws. The gear shaft here consists of a rod which is driven from the proximal end. This invention thus requires a rigid endoscope with a drive outside the body.
• 11. [ WO 2003/086 179 A1 ]: The application describes an optical endoscope whose distal end can pivot vertically out of the endoscope axis. The pivoting movement is provided via a push rod from a proximal or endoscope shaft located actuator.
• 12. [ US 2003 0032 863 A1 ]: An optical endoscope is disclosed which can pivot the distal end perpendicular to the endoscope axis. The pivoting movement is guided via a push rod, rack or cable from a proximal actuator to the joint.
• 13. [ US 8,771,169 B2 ]: Clamp or forceps kinematics are driven by two distal motors. The motors are positioned proximal to a pivot around the shaft axis. The rotation is transmitted via a bevel gear via the joint to a distal gear. A motor movement is transmitted in the following by means of a gear spindle and a link in an opening movement of a jaw, while the other, stationary jaw includes a stapling tool. This is similarly driven by the second motor, which also converts the rotation into a translation to trigger the stapling. While this patent describes the use of geared motors near the distal joint, these serve purely to actuate the tools.
• 14. [ EP 1830461 ]: Furthermore, the one given in [ EP 1830461 ] described servomotor (MSD), which provides a conceptual basis for the planned developments.
• 15. [ DE 10 2012 212 094 A1 ]: An endoscopic instrument is known, which has an elongated shaft and a distal instrument head which is controllable from the proximal end of the instrument. There is provided a hinge in the shaft or between the distal shaft end and the instrument head and means for pivoting a distal hinge part with respect to a proximal hinge part. There are further provided transmission means for transmitting at least one control function from the proximal end of the instrument to the instrument head. The transmission means have at least one planetary gear, the central axis coincides with the hinge axis. The transmission means are formed in the form of a transmission kinematics of successively connected planetary gear stages and transmit a movement on pull and push rods. The decisive disadvantage of this solution is that the input variable forms a translatory movement, which must be converted into a rotating movement, for which a relatively high design effort is required. The use of rods is still available only for a rigid endoscope, making an entry wound is essential. However, solutions for flexible endoscopes with the aid of natural body openings (NOTES, NOTES is the acronym for Natural Orifice Transluminal Endoscopic Surgery) are preferred.
• 16. [ DE 10 2004 058 929 A1 ]: An endoscope with rotatable distal endoscope head. This has a bendable end piece with an endoscope shaft connected to a tubular member. According to the invention, an additional rotation element for rotation of the endoscope shaft and the bendable end piece bendable end piece inserted about the longitudinal axis of the endoscope shaft. For a reduction gear in the form of a coaxial transmission, in particular a planetary gear or a so-called. "Harmonic Drive" with high reduction and thus used as a self-locking gear. This gear is housed in the gear chamber, which is also enclosed by the center portion of the housing of the rotary member. Due to the self-locking gear results in a poor overall efficiency. Furthermore, there is a major disadvantage to the large required axial space and the small number of degrees of freedom.
• 17. [ DE 11 2008 000 121 T5 ] discloses a motor and an endoscope head in which the motor is used. A reduction gear head is driven by the engine, the reduction gear head having a planetary reduction gear. The basic structure of the planetary reduction gear mechanism includes two sets of mutually independent support members arranged in series from the motor side to the output shaft side, and a set of support members disposed at the base end of the output shaft. This endoscope head has only one degree of freedom, which provides a too small range of motion for many applications. A particular disadvantage is that no pivoting movement can be realized.

The aforementioned modern endoscopes are severely limited in your line of sight.

By a movable form of optics a more precise inspection of the investigation site is possible. Therefore, the working range of endoscopic manipulators is severely limited. The positioning of the intracorporeal endoscope end takes place by mechanical action outside the body. This burdens the entrance wound of the endoscope into the body very strongly. Miniaturized kinematics in microinvasive surgery are only known as extracorporeal design in rigid endoscopes [ Oginski, 2013: http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:83-opus-39014 ]. This always requires access through a surgical wound. Flexible endoscopes can be delivered to the treatment site via regular orifices in most applications. All patents describe housing the motors in a rigid shaft, the movement having to be directed through a kinematics (rack, lever, etc.) through the shaft to the joint. The previous actuation of the distal instruments is primarily via cables or rods, which - especially in open instruments as in the case of the DaVinci system - offer high potential for nucleation and contamination in the hard to reach areas of kinematics or in the gap between the wires of a strand. Intracorporeal electromotive applications are provided so far only in optical endoscopy due to the low torque of micro motors. Haptic feedback on the resistance of the operated tissue requires additional sensors in the tip [ Haßelbeck, CF: Experimental Evaluation of Haptics in Telemanipulator-Assisted Cardiac Surgery [Electronic Resource]; Munich, Techn. Univ., Diss., 2009 ]. This in turn requires additional data and power lines.

The object of the invention is therefore to provide a kinematics for an intracorporeally driven instrument of an endoscope with a significantly expanded field of vision and action when used as an endoscopic surgical instrument, so that the effective range of endoscopic treatments is not limited to the subterminal zone (in front of the endoscope tip) and which, on the other hand, reduces or shifts the mechanical action on the delivery wound, given by the handling of the endoscope by the operators, to a noncritical region.

This object is achieved by the characterizing features of the first patent claim.

Advantageous embodiments emerge from the subclaims.

The innovative core of the invention lies in the kinematic implementation of the instrument alignment and -aktuation of the endoscope.

The kinematics for the intracorporeally driven instrument of an endoscope according to the invention comprises at least one actuator of a drive motor and a transmission and means recording and / or operation of diagnostic and / or surgical instruments, wherein the actuator is according to the invention in the distal (intracorporeal) end of the endoscope kinematics , Distally driven endoscopic kinematics eliminate the problem of the limited scope of action of the endoscope.

In this case, the actuator consists essentially of an electric motor and a planetary gear, with which the forces required for the biopsy are applied.

The problem of too low engine forces is solved by the use of an electric motor in the form of a micro-geared motor. The transmission is arranged in a transmission housing, so that according to the prior art existing problem of contamination of the cables is eliminated. It is possible after the procedure, a simple cleaning, which is avoided by the transmission housing contamination of the transmission.

Advantageously, the load on the instrument is determined by measuring the electrical characteristic values currently present at the engine. The reaction force determined on the instrument is preferably reported back to the operator as force or resistance, so that the operator receives a haptic feedback by means of a motor current control.

The planetary gear has several gear stages, wherein at least two stages of the planetary gear form a bevel gear.

Preferably, a pivoting degree of freedom (pitch or yaw) is determined by the transmission. The pivoting angles are preferably defined by indirect stops, since the volume of the element to be pivoted would be at an angle of 180 ° to the axis of the preceding element in the latter. In this respect, the kinematic chain itself forms implicit stops. It is possible that the controller detects the stop (s) via the motor current. Accurate detection makes sense, for example, via an incremental encoder and zero reference. The homing then takes place extracorporeally. The axial rotational movement (rolling rotational movement about the longitudinal axis) still requires an explicitly executed stop, otherwise theoretically the continuing lines or external flexible sheaths could be twisted to damage.

The endoscope kinematics has a distal tool holder for the instruments and is formed by a combination of at least one of the kinematics described below. The control signals and / or the power supply are passed through the mechanical structure of the kinematics for at least one actuator. This can be achieved, for example, by producing an electrically conductive skeleton and electrically conductive joints which are encapsulated to the environment. In this case, one uses, for example, the frequency modulation of the skeleton-guided drive current as a control signal. For this purpose, for example, the electrically conductive skeleton or lines integrated in the casing can be connected to the joints via flexible bridging (cable, or electrically conductive polymers). For this purpose, the lines of the control signals and / or the power supply for at least one actuator are preferably conducted through a flexible envelope surrounding the mechanical structure of the kinematics. This envelope, designed in the manner of a housing, is autoclavable and thus autoclavable / disinfectable and protects the coated parts from the environmental influences of the environment of use. The conductive elements of the endoscopic element are preferably made of electrically conductive polymers to conduct electrical energy and / or signals above. The gear stage is, if necessary, executed several times for a joint. The respective gear stages are preferably individually switchable and designed such that the degrees of freedom of the individual joints are also switchable. Advantageously, all joints are driven by a common drive train. An end effector of the endoscopic instrument records orientation-dependent environmental sensor data by means of a camera whose orientation is determined by an inverse kinematic calculation of the axis angles. As a result, the orientation of the image is correctable. This is of considerable importance, as the camera of the effector rotates arbitrarily in space and it can become the operating doctor through the image orientation evil or dizzy. By measuring the axis angle of each axis, the orientation of the end point of the kinematics (i.e., the camera) can be calculated. Accordingly, you can now rotate the image so that the image is always oriented in the same direction, preferably to the ground. The end effector has a plurality of degrees of freedom, which are both individually and jointly movable by a transmission kinematics.

The object of the invention can be achieved by the use of the features of the first claim. The actuator consisting of electro-drive and transmission preferably has a miniaturized servo drive, which is arranged in the equipment carrier of the endoscope.

After the conventional coarse positioning of the endoscope near the examination site (for example in the stomach), the operators align the optics located in the equipment carrier with the help of the - also in the equipment carrier mounted - servo-controlled adjusting device.

Working in narrow cavities will be much easier, since the invention does not require a range of action for bending, which is not fulfilled by current flexible endoscopes.

Since the viewing direction of the invention can be arbitrarily and continuously changed, it has significant advantages over swing prisms.

The substitution of the cables by the miniaturized servomotors significantly increases the degrees of freedom of the instruments and manipulators.

By appropriate encapsulation and a durable plastic surface that can Endoscope can be automatically treated in disinfection and cleaning equipment.

In this case, many instruments can be successively introduced through an access into the body cavity. Each instrument only needs a thin cable.

The instruments do not have to be finely positioned from the outside. After coarse positioning to the place of use, the instruments move within themselves.

Since the forces are generated by the drives, one is independent of the cable length. The surgical device can thus be placed anywhere in the operating room.

The instruments generate a defined controllable force, independent of the cable turn.

The endoscopic instruments are more variable than previously positioned; especially in several levels ("around the corner"). By additional degrees of freedom of moving through the adjusting device carrier the working space and the visible examination area are significantly increased.

The operation is independent of the cable system as ergonomic and haptic optimized solution feasible; for example by means of joystick, eye movement, movement mirroring (also with defined force feedback), voice control, gesture control or data glove.

Operation can be done from different operating points or online. Thus, technically a nationwide micro-invasive primary care can be realized. In the case of mobile applications - e.g. in disaster control or defense - the specialist does not have to go into danger on the ground.

Since no mechanical alignment takes place from the outside, there are no reaction loads in the feed wound and thus no further loading of the same.

Finally, the measurement of the motor current can be used to determine the reaction force prevailing on the instrument and make it available to the operators as haptic feedback.

The functions envelope structure, torque transmission and torque conversion are realized by a planetary gear whose ring gear is provided by a sprocket in the shell of the following member, i. the axial rotational degree of freedom (rolling movement - rotational movement about the longitudinal axis of the actuator) is determined by a geared motor with planetary gear whose ring gear is received or formed by the rotating about the longitudinal axis structure. The functions of torque conversion and changing the direction of movement are realized by the combination of a planetary gear with a bevel gear. This is used to implement a pivoting movement, or in claim 9 of further increasing the degrees of freedom, since the distal tool holder is formed by a combination of at least one of each of the two kinematics.

Further functions of the endoscope kinematics are integrated into the casing surrounding the kinematics, since the control signals or the signal supply and / or the energy supply are conducted through the mechanical structure of the kinematics and preferably lead through the casing surrounding the kinematics. The sheath, in turn, seals the kinematics and the internal components of the endoscope from environmental influences, wherein the sheath can be treated in an autoclave and thus can be easily disinfected / sterilized.

 The outer skin of the shell is preferably made of conductive polymers and is formed for example in the manner of a rubber hose or polymer tube.

multiple execution of the gear stage for a joint, which are individually switchable and the degrees of freedom of the individual joints are separately switchable, extends the kinematics to a kinematic chain with appropriate combination options for the corresponding gear. This includes the combination of several gear stages as a basis for the thus enabled switching ability of the same and the individual setting of individual joints. Thus, it becomes possible to sequentially move each joint to the desired position with only one drive. It is also possible to drive all joints on a common drive train and possibly provide a switchable flexible shaft.

The end effector (the last element of the kinematic chain) of the endoscope kinematics advantageously accommodates orientation-dependent sensor data of the environment. Thus, its orientation can be determined by an inverse-kinematic calculation of the axis angles and subsequently corrected. By using servomotors, it is possible to detect the position of the shaft and thus the resulting position of the joint. From the kinematic calculation results in the orientation of the end effector. This can be compared with the starting position - or calibrated by reference measurements - so that the operators always have referenced measured values available. An application would be an optical sensor (camera), the indicates a misaligned image when the orientation is misaligned. This can lead to nausea for operating personnel.

The end effector preferably contains a plurality of degrees of freedom, which can be moved both individually and jointly by a transmission kinematics, whereby, for example, a clamp, scissors or forceps can be aligned for an actuation.

embodiments

The invention will be explained in more detail with reference to embodiments and accompanying drawings. Show it:

1 a solution for the axial rotational degree of freedom actuation by a motor with planetary gear at the distal end,

2 a solution for the actuation of the pivoting degree of freedom by bevel gear planetary gear at the distal end,

3 a gear diagram for the simultaneous and individual actuation of individual jaws by means of planetary gears,

4 a constructive solution for the simultaneous and individual actuation of individual jaws by means of planetary gears,

5 the principle of a distal end of an endoscope endoscopes with a first actuator and a second actuator and an instrument with two jaws in a partial longitudinal section,

6 the schematic diagram of the distal end of an endoscope with two first actuators and two arranged between these second actuators and a distal instrument with two jaws,

7 1 is a schematic diagram of the distal end of an endoscope with a first actuator and two second actuators whose output shafts are arranged parallel to one another, in a partial longitudinal section;

8th the schematic diagram of the distal end of an endoscope with two first actuators, between which a second actuator is arranged, in a partial longitudinal section. According to 1 the actuation of the axial rotational degree of freedom of the kinematics, ie the realization of a rotational movement about a first longitudinal axis A1 of the first actuator 1 by a first electric motor 16 and with a first planetary gear P1 at the distal end.

The first electric motor 16 is in the proximal end 11 fixed and its drive shaft 16.1 is with the sun wheel 14 the first planetary gear P1 rotatably connected. The sun wheel 17 combs with at least one planetary gear 15 that is rotatable about its own, non-designated axis of rotation but with respect to the longitudinal axis A1 in a planet carrier 17 is fixed. The planet carrier 17 is here formed in the manner of a plate having a number of planetary gears corresponding number of recesses 18 where the planets are 15 are rotatably mounted. The planetary gear (s) 15 combing with a ring gear 13 , The electric motor 16 drives over its drive shaft 16.1 the sun wheel 14 directly to. The movement is via one (or more) with respect to the longitudinal axis A1 fixed but rotatable about its own axis in the planet carrier 17 stored planetary gear 15 to the ring gear 13 transmitted, which also forms a distal recording. The planet carrier 17 absorbs axial forces in the distal direction.

The distal end 11 can record further kinematics, eg as in the following 5 to 8th described. According to 2 takes place at a second actuator 2 the actuation of a pivoting degree of freedom by the combination of a second electric motor 28 with a second planetary gear P2, by the design of the second planetary gear P2 in the form of a bevel gear planetary gear at the distal end 11 , The drive shaft 28.1 of the second electric motor 28 is rotatable with the sun gear 27 connected and drivable about the second longitudinal axis A2. With the sun wheel 27 mesh one or more planetary gears, for example, at least a first bevel gear 24 , The second electric motor 28 and the planetary shafts rotatable about their own unspecified axis 25 of the planetary gears (bevel gears 24 ) are in the housing at the proximal end 12 by means of an indicated holder 21 fixed. The first bevel gear designed as a planetary gear 24 meshes with a second bevel gear 23 whose wave 22 an axis of rotation AA2.1 (or a pivot axis) which forms the longitudinal axis A2 of the second actuator 2 here offset by 90 °.

The wave 22 of the second bevel gear 23 can according to the 5 to 8th Record kinematics or an end effector, not shown.

The second electric motor 28 drives the sun wheel 27 directly to. The movement is via the fixed relative to the second longitudinal axis A2 but about its own axis fixed first bevel gear 24 laterally diverted and to a pseudo ring gear in the form of the second bevel gear 23 transfer. This also forms a distal recording. The end of the second actor 2 is over a lid 26 encapsulated or sealed by a shrink tube, not shown, for further cable management.

Out 3 is the gear diagram for the simultaneous and individual actuation of individual jaws of the endoscopic instrument 3 can be seen by means of planetary gear with two planetary stages, which can be combined for example with a first and / or second actuator and in 4 the three-dimensional representation of a corresponding instrument 3 with pliers jaws 37 ,

At the left and right wheel 35 is gem. 3 each a pliers jaw, not shown on an attachment point 36 attached and swiveled in the pivot axis A3.1. A jetty 31 and the wheels 32 left and right are each driven by a rack, not shown.

Will the bridge 31 powered and the wheels 32 held, both pincers simultaneously pivot about the pivot axis A3.1. Will the bridge 31 held, can not be seen here pliers jaws on the wheels 32 be moved / swung individually.

The wheels 33 . 34 Due to their different diameters, they only realize one more translation stage.

The wheels 25 and 35 each form a sun gear and the wheels 33 and 34 , with the respective sun gear combing planet, in which case a ring gear is not required.

Furthermore, the drive motors for separate drive each jaw 37 not shown. The two pliers jaws 37 extend gem. 4 in the direction of the longitudinal axis A3 of the instrument 3 , The pivot axes A3 of the jaws 37 are aligned with each other and are to the longitudinal axis A3 of the instrument 3 arranged offset by 90 °.

• a. Die Zangenbacken 37 aufeinander zu schwenken und die Zange (das Instrument) schließen,
• b. die Zangenbacken 37 von einander weg schwenken und die Zange damit öffnen,
• c. eine Zangenbacke 37 festhalten und die andere Zangenbacke darauf zu oder weg schwenken, und
• d. die Ausrichtung beider Zangenbacken bei einer fixen Position der Backen zueinander – z.B. bei einem gegriffenen Objekt – verändern kann.

In 4 is the three-dimensional representation of the intracorporeally driven endoscopic instrument gem. 3 shown. It can be seen that each on the left and right wheels 35 one jaw each 37 is appropriate. The jetty 31 and two-sided wheels 32 For example, each driven via a rack, not shown here by the not apparent here electric motor. When driving the bridge 31 driven and held the wheels 32 , both pincers simultaneously pivot 37 in the same direction. Will the bridge 31 held, the jaws can 37 be moved individually on the wheels a32, ie rotate in different directions In detail, this means that one:

• a. The pliers jaws 37 to pivot on each other and close the pliers (the instrument),
• b. the pliers jaws 37 swing away from each other and open the pliers,
• c. a pliers jaw 37 hold the other pincers on or off, and
• d. The alignment of both jaws at a fixed position of the jaws to each other - for example, in a gripped object - change.

5 shows the schematic diagram of a distal end of an endoscope with a first actuator 1 according to 1 to which a second actor 2 according to 2 coupled to the second actuator 2 an instrument 3 with two forceps jaws gem. 3 and 4 followed.

In the initial state illustrated here, the longitudinal axes A1, A2, A3 of the first and second actuators are aligned 1 . 2 and the instrument 3 ,

Will actor 1 operated, perform actor 2 and the instrument rotates about its longitudinal axes A2, A3. If actor 2 is pressed, the instrument becomes 3 pivoted about the axis A2.1. Each of the two pliers jaws 37 , of which here in the partial section only one pliers jaw 37 is shown, can be pivoted about the pivot axis A3.1 by means of a separate drive motor M3.

The instrument 3 is therefore rotatable about the axis A3 and additionally pivotable about the axis A2.1.

6 shows a schematic diagram of a side view of a kinematics according to the invention, in which two first and two second actuators 1 . 2 with an instrument 3 with two jaws 37 combined (two actuators 1 , two actors 2 and the instrument 3 are indicated by dashed lines). This kinematics is of a flexible shell 40 sheathed, from which only the two jaws 37 protrude.

• – Ein erster Aktor 1, dessen Antriebswelle 16.1 um die Längsachse A1 rotiert,
• – ein zweiter Aktor 2, dessen Antriebswelle 22 ausgangsseitig quer zu dessen Längsachse A2 abgehend angeordnet ist und um die Achse A2.1 rotiert,
• – ein gehäuseseitig mit der Antriebswelle 22 verbundener weiterer zweiter Aktor 2, der jedoch mit seiner Antriebswelle 22 um 90° versetzt zur Antriebswelle 22 des vorherigen zweiten Aktors 2 angeordnet ist, wodurch die Antriebswelle eine um 90° versetzte Achse A2.1 aufweist,
• – einen ersten Aktor 1, der gehäuseseitig mit der Antriebswelle 22 des weiteren zweiten Aktors 6 verbunden ist,
• – ein Instrument 3, das mit der Antriebswelle 16.1 des weiteren ersten Aktors 1 verbunden ist und dessen Zangenbacken 37 um die Schwenkachse A3.1 mittels zweier separater Antriebsmotoren M3 schwenkbar sind.

According to 6 the following components are provided from left to right:

• - A first actor 1 , its drive shaft 16.1 rotated about the longitudinal axis A1,
• - a second actor 2 , its drive shaft 22 on the output side is arranged transversely to the longitudinal axis A2 outgoing and rotated about the axis A2.1,
• - A housing side with the drive shaft 22 connected another second actuator 2 but with its drive shaft 22 offset by 90 ° to the drive shaft 22 of the previous second actor 2 is arranged, whereby the drive shaft has a 90 ° offset axis A2.1,
• - a first actor 1 , the housing side with the drive shaft 22 the second actor 6 connected is,
• - an instrument 3 that with the drive shaft 16.1 the other first actor 1 is connected and its jaws 37 can be pivoted about the pivot axis A3.1 by means of two separate drive motors M3.

The distal instrument 3 is thereby rotatable about its longitudinal axis A3 and about each longitudinal axis A1 and in two different pivot directions about the two axes A2.1 of the two rotated by 90 ° to each other second actuators.

In 7 the partial longitudinal section of a kinematics is shown, in which (here from left to right) on a first actuator 1 two second actors 2 consequences. The right second actor can be further components such as another actuator, an instrument 3 record etc. With this solution, an axial rotation is a swing and a further pivoting in the same direction possible.

8th shows the schematic diagram of the distal end of an endoscope with two first actuators 1 between which a second actor 2 is arranged, in a partial longitudinal section. The distal second actuator shown on the right can also accommodate another component, such as an instrument 3 , With this kinematics axial rotation can be realized with a swing alternately.

In addition to the embodiments described above, a plurality of further combinations of one or more first actuators with one or more second actuators and an instrument can be realized.

Preferably, the actuators are detachably connectable to each other and to the instrument (s) via suitable interfaces or coupling points, e.g. by known quick connections.

LIST OF REFERENCE NUMBERS

1

first actor

2

second actor

11

Distal end; Recording gearmotor, fix

12

Proximal end, rotatable about axial axis of rotation (rolling motion)

13

ring gear

14

sun

15

planet

16

first electric motor

16.1

drive shaft

17

Axial bearing plate

18

motor bearings

21

Bracket engine ( 28 ) and planetary wave ( 25 ) in proximal end

22

Shaft Pivoting axis (pitch / yaw) to outer swivel mount

23

bevel gear; corresponds to (pseudo-) ring gear in transmission

24

bevel gear; corresponds planetary gear in gearbox

25

Planet shaft, fixed to motor and housing

26

cover

27

sun

28

second electric motor

28.1

drive shaft

31

web

32

Wheel a

33

Wheel b

34

Wheel b '

35

Wheel c

36

Attachment point pliers jaw

37

jaw

40

 Flexible shell

A1

first longitudinal axis

A2

second longitudinal axis

A3

Axis of rotation / pivoting axis

P1

first planetary gear

P2

second planetary gear

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

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Cited non-patent literature

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Claims (22)

 Kinematics for an intracorporeally driven instrument of an endoscope, comprising at least one actuator of a drive motor and a gear and means for receiving and / or operating a diagnostic and / or surgical instrument, characterized in that at least one actuator in the distal (intracorporeal) end of Kinematics is located. Kinematics according to claim 1, characterized in that at least one actuator consists of an electric motor with planetary gear. Kinematics according to claim 1 or 2, characterized in that at least one degree of freedom of the distally mounted instruments with at least one actuator is driven. Kinematics according to claim 3, characterized in that a load on the instrument can be determined by a measurement of electrical parameters currently present on the electric motor. Kinematics according to claim 4, characterized in that a determined on the instrument reaction force as force or resistance to the operator is displayed. Kinematics according to one of claims 1 to 5, characterized in that a first actuator has an axial first rotational degree of freedom (rolling motion) in the form of an output-side rotational movement about a first longitudinal axis (A1) of the first actuator. Kinematics according to claim 6, characterized in that the first actuator comprises a first electric motor ( 16 ) and a first planetary gear (P1), wherein one with a first drive shaft ( 16.1 ) of the first electric motor ( 16 rotatably connected first sun gear ( 14 ) with at least one first planet ( 15 ) meshes, which in turn with a first ring gear ( 13 ) of the first planetary gear meshes and the output-side rotational movement about the longitudinal axis (A1) to a proximal end ( 12 ) transmits the kinematics or the proximal end ( 12 ) of kinematics forms. Kinematics according to one of claims 1 to 5, characterized in that the second actuator has an angle to its longitudinal axis (A2) inclined second rotational degree of freedom in the form of an output-side rotational movement about a longitudinal axis (A2) inclined axis of rotation (A3). Kinematics according to claim 8, characterized in that the second actuator has a second electric motor and a second planetary gear and that at least two stages of the second planetary gear form a bevel gear. Kinematics according to claim 9, characterized in that one with a second drive shaft ( 28.1 ) of the second electric motor ( 16 rotatably connected second sun gear ( 27 ) with at least one bevel gear formed as a second planet ( 25 ) meshes, which in turn with a trained as a bevel gear pseudo ring gear ( 33 ) of the second planetary gear meshes, wherein the pseudo ring gear ( 33 ) provides the output-side rotational movement about the axis of rotation (A3) to a proximal end ( 12 ) transmits the kinematics or the proximal end ( 12 ) of kinematics forms. Kinematics according to claim 8, characterized in that at least one pivoting degree of freedom (pitch or Yaw) of the second actuator is determined by the second planetary gear. Kinematics according to claim 1, characterized in that the means for receiving and / or operating diagnostic and / or surgical instruments, in the form of a distal tool holder are formed, which is formed by a combination of at least a first actuator and at least one second actuator. Kinematics according to claim 12, characterized in that the control signals and / or power supply for at least one actuator are passed through the mechanical structure of the kinematics. Kinematics according to claim 13, characterized in that the control signals and / or power supply for at least one actuator by a flexible, the mechanical structure of the kinematics surrounding envelope are passed. Kinematics according to claim 14, characterized in that the shell is autoclavable and protects the enveloped parts from the environmental influences of the environment of use.  Kinematics according to claim 13 or 14, characterized in that the conductive elements consist of electrically conductive polymers. Kinematics according to one of claims 1 to 16, characterized in that the gear stage is executed several times for a joint. Kinematics according to one of claims 2 to 17, characterized in that the individual gear stages are designed to be switchable. Kinematics according to claim 17 or 18, characterized in that the degrees of freedom of the individual joints are designed to be switchable. Kinematics according to one of claims 17 to 19, characterized in that the joints are drivable via a common drive train. Kinematics according to one of claims 1 to 20, characterized in that the kinematics k has an end effector which receives orientation-dependent sensor data of the environment whose orientation is determined by an inverse-kinematic calculation of the axis angle and corrected subsequent.  Kinematics according to claim 21, characterized in that the end effector contains a plurality of degrees of freedom which are both individually and jointly movable by a transmission kinematics.

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