ES2364380T3 - DEVICE FOR CUTTING AND REMOVING TISSUE CYLINDERS FROM A FABRIC, AND ITS USE. - Google Patents

Abstract

Device for trimming and removing tissue cylinders from a fabric that is inside a body cavity or joint and / or in or next to a wall area of these, comprising two cutting devices (12, 12 ') each with a hollow cylindrical base body (14, 14'), a distal hole (18, 18 ') at a distal end (16, 16') of the base body (14, 14 ') and a cutting element (20, 20 ') surrounding the distal orifice (18, 18'), arranged one inside the other and made so that they can rotate relatively with each other, and a transmission (30) housed in a housing (32) that by means of a coupling device (88) can be coupled with at least one drive device (22) to rotate the respective base body (14, 14 ') of the two cutting devices (12, 12') around their axes longitudinal (24, 24 ') in reciprocal coupling, the transmission (30) corresponding to an output gear (42) assigned to the drive device (22), as well as two drive gears (44, 46) that are engaging with it an output gear (42), each corresponding to one of the two cutting devices (12, 12 '), characterized because the output gear (42) and the two drive gears (44, 46) of the transmission (30) are made as bevel gears, the output gear (42) being releasably fixed on a support member (56 ) which is supported with the possibility of rotation in the transmission housing (42) (30), the support element (56) being able to be connected with the torsion-proof drive device (22) by means of a transmission element ( 64) in the shape of a spike, with a profile of rectangular, square, hexagonal or other polygonal, elliptical, trapezoidal, parallel-shaped or semi-circular profile.

Description

The invention relates to a device for trimming and removing tissue cylinders from a tissue that is inside a body cavity or a joint and / or in or near an area of the wall thereof.

These kinds of devices are general knowledge. Accordingly, these devices serve for example in the medical field of gynecology, by the simultaneous use of a trocar and a trocar sheath, to remove tissues from a matrix, or a matrix as a whole, or for the treatment of fibroids, etc. A device of this class is known for example from EP 0 522 125 B1. This class of devices also finds application in medicine in numerous fields, partly very diverse, for example in the case of surgical interventions in the abdominal cavity, in the stomach and for cholecystectomy or appendectomy. However, such devices in practice have been partly affected by various drawbacks. Thus, for example, this class of devices all have a cutting device with a hollow cylindrical base body, a distal hole at a distal end of the base body and a cutting element that surrounds the distal hole. The hollow cylindrical base body with the cutting element is imparted a turning movement to trim or punch the tissue cylinder. Due to this rotation of the hollow cylindrical base body, however, the tissue from which the tissue cylinder is cut or stamped is deformed at the same time, or even an auto-rotation movement is imparted thereto. In order to be able to proceed with a controlled intervention in the tissue, additional medical instruments are required, for example, pressing instruments such as a clamp clamp to deform or fix the tissue accordingly. As a consequence of all this, the handling of such devices is as a whole complex, not very careful for the patient and requiring a lot of time.

The invention starts from US-PS 4,306,570 as the closest state of the art, where a device according to the preamble of claim 1 is described.

The invention therefore aims to provide a device for trimming and removing tissue cylinders from a fabric, where it is allowed to make a simple, quick and therefore economical replacement of the driven gear when it is worn or when it is necessary to perform Some other repair.

This objective is surprisingly simple resolved by the identifying characteristics of claim 1.

Thus, a simple, compact and firm construction of the device assembly can be achieved by carrying out the device according to the invention according to claim 1. The device according to the invention, which can also be designated as a morceller, has the important advantage that when cutting or punching a tissue cylinder the device does not require any additional instrument, in particular any clamping instrument such as a clamp of claws or similar to deform or hold the tissue. Due to the realization of the device according to the invention with a minimum of two, in particular two, of such cutting elements, however, the deformation or self-authorization of the tissue from which it is cut or punched a cylinder of tissue that has been cut is excluded of fragmenting One of the results of this and not the least important is the remarkably simple and very careful handling of the device as a whole and above all it requires little time. Finally, with the device according to the invention, remarkably improved and increased safety can be achieved for the patient.

Other advantageous details of the device according to the invention are described in claims 2 to 19.

Within the scope of the invention is that the inner cutting device is coaxially housed in the adjacent outer cutting device of the two cutting devices according to claim 2.

The inner cutting device is conveniently housed with a reduced clearance in the adjacent outer cutting device of the two cutting devices.

Alternatively, the inner cutting device is housed in the adjacent outer cutting device of the two cutting devices according to claim 3 with a larger clearance, being disposed between the base bodies of the inner cutting device and the outer adjacent cutting device by At least one centering element and / or guide. By means of this centering and / or guide element, a coaxial alignment of the base bodies of the adjacent cutting devices is therefore achieved.

It is also within the scope of the invention that the two cutting devices can be moved by means of the drive device rotating in the opposite direction to each other and / or in the same direction. In this regard, it is of great importance mainly the embodiment according to the invention of a drive of the at least two cutting devices by means of the drive device in the opposite direction from each other. And it is that due to a drive with rotation in the opposite direction, it can be additionally achieved that the tissue from which the tissue cylinder is cut or punched does not undergo any deformation or even self-rotation due to the application of the cutting device. By turning the at least two, in particular two, cutting devices in a relative direction opposite each other, the forces and pairs acting on the tissue are largely nullified by trimming or punching the tissue cylinder.

For this purpose, the transmission housed in a housing is advantageously located between the two cutting devices and the drive device.

To simplify the design of the device according to the invention, the two drive gears that each correspond to one of the two cutting devices, engage simultaneously with the driven gear corresponding to the drive device. The axes of rotation of the two drive gears coincide. The axes of rotation of the two drive gears are instead offset ± 90º with respect to the axis of rotation of the driven gear. With such an embodiment, it is easily achieved that the at least two cutting devices can be operated with rotation in opposite directions to each other. The drive can also be carried out by means of a single drive device.

It is also provided in accordance with the invention that the support element of the driven gear is rotatably supported according to claim 4 advantageously in the housing cover, within a recess. By means of such an embodiment of the gear driven in two parts, it is possible that the support element, which in general is subjected by the drive device of non-negligible forces and / or torques for the transmission of the turning movement, It may eventually be made of a material more resistant to wear. Due to a bipartite embodiment of this kind of driven gear, it is possible to make a simple, quick and therefore cheaper replacement of this in the case of wear.

In order to simplify the assembly and / or repair, the driven gear and / or the support element are advantageously connected to each other according to claim 5 in an advantageous manner by means of an interlocking or elastic coupling joint or a joint threaded Additional insurance can be made through pins, etc.

It is also within the framework of the invention that the two drive gears are each housed in drive bushings, each corresponding to one of the two cutting devices. By means of a bipartite embodiment of this class, it is also possible to choose different materials for the drive gears and for the drive bushings, depending on the respective request. In this way, the replacement of the drive gears for repair purposes can also be carried out simply, quickly and economically.

The two drive gears according to claim 6 are conveniently fixed by means of a threaded joint or an interlocking or elastic coupling joint. Without being represented in detail, an independent insurance can be provided, for example by means of pins, etc.

The drive bushings conveniently penetrate through the transmission housing to facilitate a constructive connection between the drive gears and the respective at least two corresponding cutting devices.

It is also within the scope of the invention that the drive device according to claim 7 can be controlled and / or regulated by a control and / or regulation device, especially electronic, so that the two cutting devices can be operated by the drive device respectively at intervals in opposite directions of rotation. In this way it is ensured that two cutting devices adjacent to each other can be operated optionally by a right and left turn and / or also reversibly and also optionally with a left or right turn.

In this regard, it is advantageous if the time intervals for the operation of the two cutting devices in the opposite direction of the drive can be adjusted and / or optionally preset for the operation of the two cutting devices in the opposite direction in accordance with claim 8 by means of the control and / or regulation device, in particular electronic.

According to the features of claim 9, the two cutting devices are each provided at the proximal end and / or in the area of the base body oriented towards the proximal end of coupling elements that are inseparably connected with the respective base body

The constructive measures of claim 10 are of particular interest. According to these, the two cutting devices and the drive device can be torsionally connected to the transmission, each through a coupling device. The coupling device can be operated in a particularly simple way by the respective user thanks to its constructive embodiment.

For this purpose, the coupling device is made according to claim 11 as a plug, interlock or elastic coupling device. An elastic plug, interlocking or coupling device of this kind is especially advantageous, since during the operative intervention it makes it possible to make a particularly fast and simple connection of the at least two cutting devices and the drive device with the transmission, or the subsequent separation of the union, in certain circumstances and even by a single hand of the user.

In this regard, it is especially advantageous for the coupling device according to claim 12 to have a tilting lever which is located respectively in the drive bushings and in the transmission housing, with the possibility of turning around an axis of rotation, held in a end to the force of a spring and comprising at the ends opposite the first end a pin, bolt or projection arranged in radial direction to fit in a hole or recess correspondingly in the coupling element of the at least two devices of cut or drive device respectively.

In addition to this, it is within the scope of the invention that the coupling element that the interior / interior of the two cutting devices according to claim 13 be made as a sealing device for closing or opening a proximal hole at the proximal end of the base body.

Advantageously, the sealing device has, according to the features of claim 14, a bipartite housing and is essentially in the form of a bowl, with a housing element fixed on the base body and a closure element in the form of a cap or cap that can be fix on the housing element.

In order to achieve a simple, fast and safe manufacturing and assembly, but above all economical, the housing element and the housing closing element can be joined together in a releasable or non-releasable manner by means of a threaded joint or a interlocking or elastic coupling union. The constructive embodiment of providing a releasable or non-releasable connection between the housing element and the housing closing element depends essentially on the kind of use and destination of the device according to the invention, that is to say if the device is to be provided. for single use or for multiple use. This in turn, as well as the other way around, has a considerable impact on the realization of the device as a whole or on the choice of the materials of which the different components of the device according to the invention consist.

If, for example, the device is intended for single use only, that is, if it is completely removed after use, the housing element and the housing closing element can be inseparably connected to each other, preferably by inserting a adhesive, in particular a silicone adhesive or by ultrasonic welding.

On the other hand for repeated use, the housing element and the housing closing element, which are then surely also made of metal, are joined together by, for example, a screwed connection.

As an alternative to the screw connection, an interlocking or elastic coupling joint can be provided in which the housing element and the housing closing element are connected to each other by means of at least one locking projection or a shoulder of similar interlocking located in the housing element and by another interlocking projection or similar interlocking projection located in the closure element, which act together and which can be coupled together. It is also possible to make a kinematic inversion of this, where at least one locking projection or a similar locking projection is provided in the closing element and at least one interlocking recess or the like in the housing element. Instead of at least one other interlocking projection, at least one interlocking recess or the like can also be provided that acts in conjunction with the at least one interlocking projection.

For a single-use version, the device according to the invention is advantageously made in this respect such that the at least one similar locking interlocking or projection is made in the housing element or in the closing element and that the at least one additional locking projection or similar locking projection is / are made in the closing element or in the housing element such that the housing element and the housing closing element are joined together or on the one hand after the coupling of the at least one interlocking projection or similar interlocking projection and the at least one other interlocking projection or interlocking projection or the like inseparably to each other or that on the other hand cannot be re- join each other after the subsequent decoupling of at least one interlocking projection or similar interlocking projection and the at least one other or interlocking projection or similar interlocking projection. In this last embodiment, it can be imagined, for example, that one of the two interlocking projections or similar interlocking projections is provided with a controlled breaking point, such that this interlocking projection or similar interlocking projection is broken from the housing element or of the closing element when subjected to a certain tensile force. Instead of at least one additional interlocking projection, at least one interlocking recess or the like can be provided that acts in conjunction with the at least one interlocking projection.

In addition, the constructive measures of claim 14 are of great importance, according to which the sealing system comprises two sealing elements which are arranged adjacent to each other in the housing on the longitudinal axis of the base body of the cutting device, and which They act together.

Accordingly, it is provided in accordance with the invention that one of the two sealing elements of the sealing device is made according to claim 15 essentially in a conical shape, with a cone trunk, a bowl, a cap or the like, comprising a hole in groove shape arranged in a plane displaced with respect to a plane that passes through the base surface of the sealing element in a direction towards the distal end of the base body of the cutting device, and having a peripheral section that for fixing in the housing extends radially outward in the plane that passes through the base surface of the sealing element. Thus, due to its shape and arrangement in the housing, one of the two sealing elements is forced and held in its closed position in the opposite direction to the effect of an artificially created overpressure inside a body cavity or a joint, for example by insufflation of CO2. In this way the sealing element is compressed on the outer side against another instrument or against its rod, for example against a handle or other cutting instrument, in particular a clamp clamp or a myoma drill, performing a complete sealing. After this it is ensured that in any case the overpressure that is required to operate is maintained, that is to say, to trim or punch a tissue cylinder from a tissue and during the subsequent removal of the trimmed or die cut tissue cylinder from the operating area. . Therefore, a gas leak, such as CO2 or similar, is excluded from the body cavity or from the joint cavity of the operating area, and thus acts against an obstacle to the unwrapping process or a traumatization of the surrounding tissue during unwrapping.

It is especially within the framework of the invention that one of the two sealing elements has at least two sealing lips which, in order to close and open the slot hole, are in mutual active engagement.

In addition to this, another of the two sealing elements of the sealing device is made according to claim 16 in the form of a disk, and has a central, substantially circular recess, through which another instrument can be passed, in particular an instrument presser or other cutting element, preferably a clamp clamp or a myomas drill.

The approximately circular central recess of the other of the two sealing elements is preferably made with an inside diameter that is less than or equal to an outside diameter of the other instrument.

It is also within the scope of the invention that the other of the two sealing elements is arranged in accordance with the constructional embodiment in the housing on the longitudinal axis of the base body of the cutting device, between the proximal end of the base body and one of the two sealing elements, in particular adjacent to the plane that passes through the base surface of one of the two sealing elements. In this way a reciprocal joint action of the two sealing elements is achieved, whereby the sealing can be further improved.

To improve the sealing effect, the at least one, in particular the two sealing element / s of the sealing device are made of a flexible plastic, in particular silicone.

Of particular interest are the features of claim 17. According to these, the cutting elements of the two cutting systems surrounding the distal orifice are essentially tapered or inclined away from the distal orifice and / or oriented towards the outside. the interior extending towards the distal hole.

In this regard, the cutting elements of the two cutting devices have, according to claim 18, advantageously a very sharp or continuous or discontinuous peripheral edge, smooth, wavy or jagged, which during a turning movement of the base body causes a very precise driving of the cut in the tissue without traumatizing the remaining tissue too much. In this way, the tissue can be devaled without deforming the surrounding tissue during the process.

The cutting elements of the two cutting devices are made at the leading end edge of the distal hole, preferably with a wavy edge. With this embodiment of the invention a plurality of circle arc sections distributed along the perimeter are obtained with wave valleys set back in the axial direction and wave ridges protruding in the axial direction. For example, in the case of four wave protrusions and four wave valleys located between them, slightly retracted in an axial direction on the peripheral surface, sections of circle arcs of an approximate field of 40 to 45 ° would be formed. The wavy edge may be continuous or peripheral, that is, be present throughout the perimeter of the distal orifice. conveniently the sharpening zone can be made especially sharp between the wave valley and the wave shoulder, so that firstly an axial fixation of the tissue is carried out and only then, by means of the rotation movement of the base body, the fragmentation of tissue cylinders or tissue bushings. However, the wavy edge may also eventually be discontinuous as a scale-like arrangement around the perimeter of the envelope in the distal orifice.

The same applies to the alternative embodiment of the invention, according to which the cutting elements of the two cutting devices have a serrated edge with teeth distributed along the perimeter with tooth recesses recessed in the axial direction and tips of tooth protruding in axial direction. Depending on the desired application, a peripheral or continuous or discontinuous toothed edge can be imagined.

In order to punch or desvainate tissue, the rotational movement can be applied to the base body by means of a motor that can have an electric drive, by means of battery, pneumatic or hydraulic.

In a particularly advantageous manner, the transmission housing and / or the centering or guide element or the driven gear and / or the two drive gears and / or the support element and / or the drive bushings and / or The coupling elements and / or the sealing device and / or the housing element and / or the closing element of the housing and / or the clamping disc may be made of plastic, in particular of polyoxymethylene, polyester, polyphenylsulfon, ABS, acryl, polycarbonate, tetrafluoroethylene or Impax, duroplast elastomers with or without fiberglass reinforcement, or a combination of these. The device according to the invention is of a particularly light construction and can be manufactured manifestly economically.

As an alternative to all of the above, it is also within the scope of the invention that the base bodies of the two cutting devices and / or the transmission housing, and / or the centering element and / or the guide element and / or the gear driven and / or the two drive gears and / or the support element and / or the drive bushings and / or the coupling elements and / or the sealing device and / or the coupling device and / or the housing element and / or the housing closing element and / or the clamping disc are made of metal, in particular steel (stainless), alloy steel, aluminum, brass, zinc, red cast iron alloys or an alloy of previous.

The device can therefore be sterilized as a whole by a thermal and / or chemical process and can be reused without problems for multiple use.

Of particular interest are the constructive measures of claim 19. According to these, the transmission that is located between the two cutting devices and the drive device is made and can be assembled with its various components in a modular manner. The transmission and therefore the whole device can be assembled in this way on a modular basis by the operator or by the service personnel. On the one hand, additional assembly costs can be saved by the manufacturer. On the other hand, the device according to the invention can thus be disassembled and then reassembled for new use in a simple and fast as well as safe manner, for example for the purpose of disinfection or the like.

In this respect it is of great advantage if the transmission housing or the housing element and the housing cover and / or the driven gear and / or the two drive gears and / or the support element are made and can be assembled modularly.

Other features, advantages and details of the invention are deduced from the following description of a preferred embodiment of the invention as well as the drawings. These show:

fig. 1 a front perspective view of an embodiment of a device according to the invention for trimming and removing tissue cylinders from a fabric, without the carcass,

fig. 2 a partially open sectional perspective view of the embodiment of the device made according to the invention according to detail II of fig. 1, in an enlarged representation,

fig. 3A to 3F a side view, a front view, another side view, a front view, a rear view and a plan view of the embodiment of the device made according to the invention, according to fig. 1 and 2,

fig. 4 a partially open sectional side view of the embodiment of the device made according to the invention according to fig. 3C, in an enlarged representation,

fig. 5A and 5B a front view and a sectional view through the embodiment of the device made according to the invention along the line VB-VB of fig. 5A, with housing, in enlarged representation,

fig. 6A and 6B seen in schematic section through the embodiment of the device made according to the invention along the VIA-VIA line of fig. 5B, in the closed position and in the open position,

fig. 7A and 7B schematic sectional views through the embodiment of the device made according to the invention along the VIIA-VIIA line of fig. 5B, in the closed position and in the open position,

fig. 8 a schematic perspective view, in open section of cutting elements of the embodiment of the device made according to the invention according to fig. 1 to 7B, in an augmented representation.

The device 10 according to the invention is provided for trimming and removing tissue cylinders from a fabric that is inside a body cavity or a joint cavity and / or in or next to a wall area thereof. In the following description of an embodiment of the device 10 according to the invention, the same components that correspond to each other are each provided with identical reference figures.

The device 10 according to the invention is suitable in the broadest sense to operate, in particular to remove an organic tissue, preferably myomas, tumescences, ulcers, carcinomas etc. or an inorganic body such as gallstones and vesicular stones or similar agglomerations, which are at least partially housed and / or surrounded by a body cavity or joint cavity or an organic cavity of a human or animal body, and / or in or next to a wall area of it.

In fig. 1 to 7B is a preferred embodiment of a device of this class 10 according to the invention.

The device 10 comprises at least two cutting devices 12, 12 ', each with a hollow cylindrical base body 14, 14'. At the distal end 16, 16 'of each base body 14, 14' is each located a distal hole 18, 18 '. Each distal hole 18, 18 'is surrounded by a cutting element 20, 20'.

In the device shown in fig. 1 to 7B, two such cutting devices 12, 12 'are provided, which corresponds to an especially advantageous embodiment of the invention. However, without being represented in detail, three or even a larger number of cutting devices 12, 12 'may also be provided.

The two cutting devices 12 and 12 'are arranged inside each other. That is to say that the inner cutting element 20 is housed in the outer cutting element 20 '. The two cutting elements 20, 20 'are also made with the possibility of relative rotation with each other.

The inner cutting device 12 is therefore coaxially housed in the adjacent outer cutting device 12 'of the two cutting devices 12, 12'. Between the inner cutting device 12 and the adjacent outer cutting device 12 'there is preferably only a reduced clearance. Therefore, the outer diameter of the base body 14 of the cutting device 12 is slightly smaller than the inner diameter of the base body 14 'of the cutting device 12', and vice versa. The clearance between the inner cutting device 12 and the adjacent outer cutting device 12 'must be chosen such that the cutting devices 12, 12' can easily rotate relative to each other, but at the same time allow obtaining Exact driving with each other. In addition, the passage of blood, body fluids or gas, etc. should be avoided as much as possible. between the outer diameter of the base body 14 of the cutting device 12 and the inner diameter of the base body 14 'of the cutting device 12'.

Alternatively, it would be possible, without this being shown in detail, that the inner cutting device 12 is housed in the adjacent outer cutting device 12 'also with an upper clearance. In such an embodiment, however, one or more centering and / or conduction elements (not shown) are arranged between the base bodies 14, 14 'of the inner cutting device 12 with respect to the adjacent outer cutting device 12 '. This / these centering and / or conduction elements must especially prevent the tilting and / or a hardness of operation during the relative rotation of the inner cutting device 12 with respect to the adjacent outer cutting device 12 'as well as the passage of blood, liquids body or gas, etc.

To rotate the respective base body 14, 14 'of the two cutting devices 12, 12' around their respective longitudinal axis 24, 24 ', the device 10' is provided with at least one drive device 22. In the present example The device 10 provides only one of such drive devices 22 (shown schematically). The drive device 22 may be located at a proximal end 26 of one of the base bodies 14, 14 '. Alternatively, or as depicted in the present embodiment, the drive device 22 may also be located in an area 28 of the base body 14 that is simply oriented towards the proximal end 26 and / or adjacent thereto. The drive device 22 is made as a motor, which can have, for example, an electric drive, by battery, pneumatic or hydraulic.

In a particularly advantageous formula, the two cutting devices 12, 12 'can be operated by means of the drive device 22 with opposite directions of movement. In this way, it can be achieved additionally and in a particularly simple and therefore also economical way, that the tissue (not shown) of which the corresponding tissue cylinder is cut and / or stamped, is not deformed or authorized during the operative intervention by means of the device according to the invention 10 inside the body or joint cavity and / or in or next to the wall area thereof. Due to the rotation in opposite directions of the two cutting devices 12, 12 ', the forces and / or possible pairs acting on the tissue are canceled out due to the corresponding cutting elements 20, 20'. The consequence of this is that during the operative intervention by means of the device 10 according to the invention the tissue remains without deforming or in a certain position without any movement of its own.

Without being represented in detail, the drive device 22 can be controllable and / or adjustable by means of a control and / or regulation device (not shown), especially electronic, so that the two cutting devices 12, 12 'can be operate by the drive device 22 each at intervals in the opposite direction. The modification of the direction of operation of the two cutting devices 12, 12 'which are changing, for example, in an oscillating or similar way, is independent of their relative turning movement. In other words, a drive of the two drive devices 12, 12 'can take place in opposite directions of drive without thereby canceling their relative drive with each other in the opposite direction and / or in the same direction. In this way it is ensured that the two cutting devices 12, 12 'respectively adjacent to each other can optionally be operated with a right turn and / or a reversible turn to this and also optionally with a right turn / left.

For this purpose it is especially advantageous that the time intervals for the actuation of the two drive devices 12, 12 'in the opposite direction of the drive can be adjusted and / or preset at will in the direction of the opposite drive by the control and regulation device, especially electronic In this respect the time intervals can be chosen of the same duration or of different duration, adapting exactly to the area of operation that is individually in each case or can be formed stochastically, etc.

To achieve the drive of the two cutting devices 12, 12 'by means of the driving device 22, in the opposite direction to each other and / or in the same direction, there is a transmission 30 interleaved between the two cutting devices 12, 12' and the drive device 22, which is housed in a housing 32. For this purpose the housing 32 consists of a housing element 34, which is shown only in fig. 5A and 5B and a housing cover 36 that can be deduced from all figs. 1 to 7B. The housing element 34 and the housing cover 36 are conventionally connected to each other by means of screws 38 that pass through the corresponding holes or recesses in the housing element 34 (not shown) and which can be fixed in the corresponding holes 40 or recesses of the housing cover 36.

The transmission 30 comprises for the opposite direction an output gear 42 corresponding to the drive device 22. In addition to this, the transmission 30 has two drive gears 44, 46 that engage with the output gear 42 and corresponding each one of the two cutting devices 12, 12 '.

The output gear 42 and the two drive gears 42, 46 of the transmission 30 are each made as bevel gears in the exemplary embodiment of the device 10 according to the invention represented in fig. 1st 7B.

In the embodiment of the device 10 shown in fig. 1 to 7B, the two drive gears 44 and 46 respectively that each correspond to one of the cutting devices 12 or 12 'respectively, are simultaneously engaging with the output gear 42 corresponding to the drive device 22. In the In this embodiment, the rotation shafts 48, 48 'of the two drive gears 44.46 coincide. The rotation shafts 48, 48 'of the two drive gears 44, 46 corresponding respectively to one of the two cutting devices 12 and 12' respectively, engage simultaneously with the output gear 42 corresponding to the drive device 22 In the present embodiment, the rotation shafts 48, 48 'of the two drive gears 44, 46 coincide. The rotation shafts 48, 48' of the two drive gears 44, 46 are also identical to the longitudinal shafts. 24, 24 'of the base bodies 14, 14'. On the other hand, the rotation axes 48, 98 'of the two drive gears 44, 46 are offset with respect to the rotation axis 50 of the output gear 42, once at + 90 ° and once at -90 °. Thanks to such a constructive embodiment, a simultaneous, uniform but opposite direction of the two drive gears 44, 46 according to the arrows 52, 52 'is achieved when the output gear 42 rotates according to the arrow 54. On the other hand, if the output gear 42 rotates in the opposite direction to the arrow 54, the direction of rotation of the two drive gears 44, 46 according to the arrows 52, 52 '(not shown) is also reversed.

As is especially apparent from fig. 2 and 5B, the output gear 42 is also releasably fixed on a support member 56 that is approximately disk-shaped. For this purpose, the output gear 44 and the support member 56 are releasably connected to each other by means of an interlocking or elastic coupling joint. In addition, pins 60 or bolts or the like are provided in order to prevent relative movement between the output gear 42 and the support member 56.

The disk-shaped support member 56 rests on the cover 36 of the casing 32 of the rotating transmission 30. For example, the support element 5.6 is placed in a round recess 61. The support element 56 is further provided with a recess 62 arranged in a centered position in which a spike-shaped transmission element 64 penetrates torsionally. of the drive device 22. The recess 62 arranged centrally and the transmission element 64 are made so that they correspond to each other. Thus, the transmission element 64 can be provided, for example, with a profile with a rectangular, square, hexagonal or other polygonal, elliptical, trapezoidal shape, as a parallelogram or as a semicircle.

The two-part construction of the output gear 42 and the support element 56 allows, for example, the use of different materials with different properties. In the present embodiment of the device 10, the output gear 42 is formed for example of polyoxymethylene (POM), while the support element 56 is of polyphenylsulfone (PPSU). As is known, polyphenylsulfone is considerably more stress-resistant and wear-resistant than many other plastics when high stresses and / or large torques arise, acting from the drive device 22 through the transmission element 64 on the transmission element. support 56. On the other hand, a construction embodiment of this kind allows a simple, fast and therefore economical replacement of the output gear 42 in case of wear or other repairs.

The same applies to the two drive gears 44, 46 as in the present embodiment of the device 10 which is represented in fig. 1 to 7B, they are also made in two parts. Accordingly, the two drive gears 44, 46 are each housed in drive bushings 66, 66 ', which are each assigned respectively to one of the two cutting devices 12, 12'.

According to fig. 5B, the two drive gears 44, 46 are each fixed in the drive bushings 66, 66 'in the device shown 10 by means of a threaded joint. For greater safety, discs 66, 68 '(washers or friction discs) are provided, in which the drive gears 44, 46 can be immobilized. Additionally, it can be imagined to secure the drive gears 44, 46 by pins or bolts. (not shown) or by inserting a glue, preferably a silicone glue or by means of ultrasonic welding, although additional insurance of this type could hinder the speed of assembly or disassembly for repair purposes. As you can clearly see in fig. 5B, the drive bushings 66, 66 'extend through the housing 32 of the transmission 30.

As can also be deduced in fig. 5B, the at least two cutting devices 12, 12 'are provided with couplings 70, 70' which are inseparably connected with the respective base body 14, 14 'of the cutting devices 12, 12'. For this, the coupling elements 70, 70 'may be located at the proximal end 26, 26'. Alternatively or cumulatively, the coupling elements 70, 70 'are arranged, as in the illustrated embodiment, in a zone 28, 28' of the base body 14, 14 'that is oriented towards the proximal end 26, 26' .

The two cutting devices 12, 12 'and the driving device 22 can also be torsionally connected to the transmission 30, respectively by a coupling device 72. The coupling device 72 is made as a plug-in, interlocking device or elastic coupling.

The coupling device 72 has for this purpose a tilting lever 74. The tilting lever 74 is arranged respectively in the actuating bushings 66, 66 'and in the casing 32 of the transmission 38 in a tilting manner about an axis of rotation 76. At one end 78, the rocker lever 74 is subjected to the elastic force of a spring 80. At one end 82, which is opposite the end 78, there is provided a pin 84, a bolt or a projection that acts together with a hole 86 or recess made correspondingly in the respective coupling element 70, 70 'of the two cutting devices 12, 12' or of the drive device 22 (not shown). The pin 84, bolt or projection and the corresponding hole 86 or recess each run approximately radially with respect to the longitudinal axes 24, 24 'of the base bodies 14, 14' of the device 10.

The spring 80 is arranged such that the rocker lever 74 is permanently maintained in the closed position of the coupling device 72. In the closed position shown in fig. 6A and 7A, the pin 84, the bolt or projection that passes in the radial direction is coupled with the hole 86 or with the recess. The respective cutting device 12,12 'or the driving device 22 are therefore connected to the transmission torque test 30.

In the open position of the device 72, which is achieved by pressing down the rocker lever 64 the force of the spring 80, the rocker lever 74 is instead turned, with the pin 84 or the bolt or the projection radially outward. Due to this, the pin 84, the bolt or projection is no longer coupled with the hole 86 or with the recess in the open position that is represented in fig. 6B and 7B. The cutting devices 12, 12 'or drive devices 22 can therefore be easily separated from the transmission 30.

In the embodiment of the device 10 according to the invention, which are represented in fig. 1 to 7B, the coupling element 70 that is assigned to the inner cutting device 12 of the two cutting devices 12, 12 'is realized as a sealing device 88.

The sealing device 88 serves to close and open a proximal hole 90 located at the proximal end 26 of the base body 14. The sealing device 88 comprises a housing 92 and at least one sealing element 94, 94 'which is it can be housed in the housing 92. As can be seen from Figures 1 to 7B, a total of two sealing elements 94, 94 'are provided in the illustrated embodiment of the device 10 according to the invention. Without being represented in detail, it is perfectly possible to imagine only a single sealing element, for example as an integral component of the two sealing elements 94, 94 ', or also a number greater than two such sealing elements 94, 94' .

The housing 92 is formed by a housing element 96 and a closure element 98.

The housing element 96 is essentially in the form of a bowl, the at least one gasket member 94,94 'is housed therein and is inseparably disposed on the base body 14. The at least one gasket member 94,94 'extends at least in part into a chamber 100 that is enclosed and therefore formed by the housing element 96 of the housing 92.

The closure element 98 is made in the form of a cap or cap. The closure element 98 is provided with a hole 92 or similar central recess, approximately circular in shape. Another instrument (not shown) can be passed through the hole 102, in particular a clamping element or other cutting element, preferably a clamp clamp or a myoma drill, specifically through the hole 102 through the proximal hole 90 of the body base 14, through the sealing device 88 located at the proximal end of the base body 14, through the same base body 14 towards the distal end 16 of the base body 14, through the distal hole 16 finally to the (cylinder) of the tissue which is about withdrawing in the area of the operation. The closing element 98 in turn can be fixed to the housing element 96.

For this purpose, the housing elements 96 and the closing element 98 of the housing 92 may be connected to each other by means of a bolted joint or an elastic interlocking or coupling joint 104, either releasable or inseparable. The realization of a releasable or inseparable connection between the housing element 96 and the closure element 98 depends on the kind of application and destination of the device 10, in the form of a single-time use or a multiple use, of the realization of the device 10 or of the choice of the materials of which the different components of the device 10 according to the invention are composed, of the wishes of the users, etc.

In the case of a single use of the device 10, the housing element 96 and the closure element 98 are inseparably connected to each other by means of the screwed joint or interlocking or elastic coupling joint 104, intercalating an adhesive, preferably a silicone glue, or by ultrasonic welding. In this way, thermal or chemical sterilization of device 10 and any repeated or additional use of device 10 is excluded.

The housing 92 of the sealing device 88 and in particular the closing element 98 of the housing 92 are provided by their perimeter with a profile 105 for manually activating and turning the base body 14.

The sealing device 88 comprises, as already mentioned, in the embodiment of Figures 1 to 7B, two joint elements 94, 94 'which are arranged adjacent to each other in the housing 92 on the longitudinal axis 24 of the base body 14 of the cutting device 12, and acting together.

One 94 of the two joint elements 94, 94 'of the sealing device 88 is essentially made in the shape of a cone trunk, bowl, cap or the like. The sealing member 94 comprises a slot-shaped hole 106 that is disposed in a plane 108 (perpendicular to the plane of the paper), which is disposed relative to a plane 112 (perpendicular to the plane of the paper) that passes through the base surface 110 of the sealing element 94 displaced in the direction of the distal end 16 of the base body 14. The sealing element 94 therefore extends with the part essentially formed in the form of a cone, cone trunk, bowl, cap or the like in the direction towards the distal end 16 of the base body 14 and penetrates the chamber 100 of the housing 92. The sealing element 94 also has a peripheral section 114 extending radially outward, which is located in the plane 112 formed by the base surface 110 of the joint member 94, and which is used for fixing in the housing 92.

The sealing element 94 has at least two sealing lips 116, 116 'which are in reciprocal engagement to close and open the slot-shaped hole 106. Due to the shape and arrangement of the two sealing lips 116, 116 'of the joint member 94 in the housing 92 in the opposite direction to the effect of an artificially created overpressure, for example by insufflation of CO2, inside a body cavity or a joint, the joint lips 116, 116' are they are attached to another instrument (not shown), for example to a clamping instrument or to another cutting element, in particular to a clamp clamp or to a myoma drill, on the outer side of this and specifically performing a total seal. In this way a wedging of the sealing lips 116, 116 'takes place. The sealing lips 116, 116 'are compressed against the other instrument and remain in this position until the overpressure has been suppressed in a regulated manner. In this way it is ensured that the overpressure required to operate is maintained permanently, that is to say to cut or punch a tissue cylinder from a tissue and the subsequent removal of the trimmed or die cut tissue cylinder outside the area of operation. . It is effectively avoided that a gas leakage, such as CO2 or the like outside the body cavity or joint, can occur from the area of the operation.

The other 94 'of the two sealing elements 94, 94' of the sealing device 88 is made in the form of a disk and is provided with a central recess 118 approximately circular in shape. Through the recess 118 of the sealing element 94 ', the other instrument already mentioned (not shown) can be passed, in particular a clamping instrument or other cutting instrument, preferably a clamp clamp or a myoma drill. The central recess 118 of approximately circular shape has an inside diameter that is less than or equal to an outside diameter of the other instrument.

As can be seen from Figure 5B, the other sealing element 94 'is located in the housing 92 on the longitudinal axis 94 of the base body 14 between the proximal end 26 of the base body 14 and one of the sealing elements 94. In particular, the other sealing element 94 'is disposed (immediately) adjacent to the plane 112, formed by the base surface 110 of one of the sealing elements 94.

The two sealing elements 94, 94 'of the sealing device 88 can be fixed to each other in the housing by a pressure disk 120 or the like.

According to fig. 1 and 8, the cutting elements 20, 20 'of the cutting devices 12, 12' are essentially chamfered, conical or cone-shaped or obliquely moving from the distal hole 18, 18 'outwards and / or approximately towards the distal hole 18, extending inwards. In the embodiment of the device 10 which is represented in fig. 8 the cutting element 20 of the cutting device 12 is essentially chamfered, has a cone shape and is tapered or inclined towards the distal hole 18, extending inwards. On the other hand, the cutting element 20 'of the cutting device 12' is essentially chamfered, cone-shaped, being tapered or inclined away from the distal hole 18 ', extending outwards. Without being represented in detail, any other constructive embodiments or arrangements of the cutting elements 20, 20 'can also be fitted together.

The cutting elements 20, 20 'can respectively have a continuous or discontinuous smooth sharpening, a wavy sharpening or a serrated sharpening. In the embodiment of the device 10, as is mainly deduced from fig. 8, the two cutting elements 20, 20 'are provided with a serrated sharpening which has teeth distributed along the perimeter with tooth bottoms set in the axial direction and tooth tips protruding in the axial direction. Without being represented in detail, any other combinations can also be made in this regard. Thus, for example, the cutting elements 20.20 'of the two cutting devices 12, 12' can be made, for example, with a wavy edge that has circular arc sections distributed along the perimeter, with wave valleys set back in axial direction and wave crests protruding in axial direction.

The at least one, and in particular the two sealing elements 94, 94 'of the sealing device 88 are made of flexible plastic, in particular silicone.

The housing 32 of the transmission 30 and / or the centering and / or guide element and / or the output gear 42 and / or the two drive gears 44, 46 and / or the support element 56 and / or the drive bushings 66, 66 'and / or the coupling elements 70, 70' and / or the sealing device 88 and / or the housing element 86 and / or the closing element 98 of the housing 92 and / or pressure disc 120, is / are made of plastic, in particular polyoxymethylene, polyester, polyphenylsulfone, ABS, acryl, polycarbonate, tetrafluoroethylene or Impax, duroplast elastomers, with or without fiberglass reinforcement or a combination thereof.

Instead, the transmission housing 32 and / or the centering and / or guiding element and / or the output gear 42 and / or the two drive gears 44, 46 and / or the element of support 56 and / or the drive bushings 66, 66 'and / or the coupling elements 70, 70' and / or the sealing device 88 and / or the housing elements 96 and / or the closing element 98 of the housing 92 and / or the clamping disk 120 may be made alternatively and / or cumulatively of metal, in particular of (stainless) alloy steel, aluminum, brass, zinc, red cast iron alloys or an alloy of the previous. In contrast, the base bodies 14, 14 'of the cutting devices 12, 12' and / or the coupling device 72 are preferably generally made of metal, in particular steel (stainless), alloy steel, aluminum, brass , zinc, red cast iron alloys or an alloy of these.

Without being shown in detail, the transmission 30 which is located between two at least two cutting devices 12, 12 'and the driving device 22, can be made and can be assembled with their various components in a modular way. The transmission 30 and therefore the assembly of the device 10 can thus be assembled in a modular manner by the operator or by the service personnel. On the one hand, additional assembly costs can be saved by the manufacturer. On the other hand, the device according to the invention can thus be disassembled and then reassembled for new use in a simple and fast as well as safe manner, for example for disinfection or similar purposes. In this case it is advantageous that the transmission housing 32 or the housing element 34 and the housing cover 36 and / or the output gear 42 and / or the two drive gears 44, 46 and / or the support element 56 is made and can be assembled in a modular way.

The invention is not limited to the embodiments of the invention 10 in accordance with Figures 1 to 8. Therefore, there is no further possibility of operating the at least two cutting devices 12, 12 'of the embodiment example of the device according to the invention 10 which is represented, not or not exclusively with rotation in opposite directions, but alternatively or cumulatively with synchronized operation, in the event that an operative intervention necessitated a synchronized drive of this kind. Without being represented in detail, in this case it is general knowledge to take additional constructive provisions in relation to the

transmission 30, with anticipation of switching possibilities for transmission 30, etc. In addition, instead of a bolted joint, an interlocking or elastic coupling joint (not shown in detail) can also be provided for mutual fastening between the housing element 96 and the closure element 98. In this case, the sealing element housing 96 and the closure element 98 are connected to each other by at least one interlocking projection 5 or interlocking shoulder or the like in the housing element 96 or the closure element 98, and at least one other interlocking projection in the closure element 98, or in the housing element 96. The two similar locking projections or interlocking projections act together and can be mutually coupled. Preferably, the at least one interlocking projection or similar interlocking projection and / or the at least one other interlocking projection or similar interlocking projection can be made in this respect in such a way that the housing element 96 and the element closure 98 of the housing 92 are inseparably connected to each other after they have been coupled, or which cannot be joined together after subsequent disassembly. For example, one or both interlocking projections or similar interlocking projections may be provided with a controlled breaking point in order to permanently damage the device 10 after disassembly, thereby rendering it unusable for a new use. He

Device 10 according to the invention is equally suitable for one-time use or multiple use.

Claims (19)

1. Device for trimming and removing tissue cylinders from a fabric that is inside a body cavity or joint and / or in or next to a wall area of these, comprising two cutting devices (12 , 12 ') each with a hollow cylindrical base body (14, 14'), a distal hole (18, 18 ') at a distal end (16, 16') of the base body (14, 14 ') and an element cutting (20, 20 ') surrounding the distal orifice (18, 18'), arranged inside each other and made so that they can rotate relative to each other, and a transmission (30) housed in a housing (32) that by means of a coupling device (88) it can be coupled with at least one drive device (22) to rotate the respective base body (14, 14 ') of the two cutting devices (12, 12') around its longitudinal axes (24, 24 ') in reciprocal coupling, corresponding to the transmission (30) an output gear (42) assigned to the drive device (22), as well as two drive gears (44, 46) that are engaging with it an output gear (42), each corresponding to one of the two cutting devices (12, 12 '), characterized in that the output gear (42) and the two drive gears (44, 46) of the transmission (30) are made as bevel gears, the output gear being (42) releasably fixed on a support element (56) that is supported with the possibility of rotation in the transmission housing (42) (30), the support element (56) being able to be connected with the drive device ( 22) Torsion-proof by means of a spike-shaped transmission element (64), with a profile of rectangular, square, hexagonal or other polygonal, elliptical, trapezoidal, parallelogram-shaped or semi-circular profile.

2.

Device according to claim 1, characterized in that the inner cutting device (12) is coaxially housed, in particular with a reduced clearance, in the adjacent outer cutting device (12 ') of the two cutting devices (12, 12 ').

3.

Device according to claim 1 or 2, characterized in that the inner cutting device (12) is housed in the adjacent outer cutting device (12 ') of the two cutting devices (12, 12') with a larger clearance, being arranged at least one centering and / or guide element between the base bodies (14,14 ') of the inner cutting device (12) and the adjacent outer cutting device (12').

Four.

Device according to one of claims 1 to 3, characterized in that the support element (56) of the output gear (42) is supported with the possibility of rotation in the housing cover (36) of the housing (32), within a recess (61).

5.

Device according to one of claims 1 to 4, characterized in that the output gear (44) and the support element (56) are releasably connected to each other by means of an interlocking or elastic coupling joint or by means of a screw connection.

6.

Device according to one of claims 1 to 5, characterized in that the two drive gears (44, 46) are respectively fixed to drive bushings (66, 68), in particular by means of a threaded joint or an interlocking joint or Elastic coupling

7.

Device according to one of claims 1 to 6, characterized in that the drive device (22) can be controlled and / or regulated by means of a control and / or regulation device, especially electronic, such that the two cutting devices (12, 12 ') can be operated by means of the drive device

(22) each at intervals in opposite directions of operation.

8.

Device according to claim 7, characterized in that the time intervals for the operation of the two cutting devices (12, 12 ') in opposite directions of operation can be adjusted and / or preset at will by means of the control and / or regulation device , especially electronic.

9.

Device according to one of claims 1 to 8, characterized in that the two cutting devices (12, 12 ') are each provided at the proximal end (26, 26') and / or in the area (28, 28 ') oriented towards the proximal end (26, 26 ') of the base body (14, 14') of coupling elements (70, 70 '), which are inseparably connected with the respective base body (14, 14').

10.

Device according to one of claims 1 to 9, characterized in that the two cutting devices (12, 12 ') and the drive device (22) can be torsionally connected to the transmission (30), each through a coupling device (72).

eleven.

Device according to claim 10, characterized in that the coupling device (72) is made as a plug, interlock or elastic coupling device.

12.

Device according to claim 10 or 11, characterized in that the coupling device (72) has a tilting lever (74) which is oscillatingly arranged respectively in the drive bushings (66, 66 ') and in the housing (32) of the transmission (30), rotating around an axis of rotation (76), which

it is subjected at one end (72) to the force of a spring (80) and that at one end (82) opposite the first end comprises a pin (84), bolt or projection arranged approximately in a radial direction to fit into a hole ( 86) or recess made correspondingly in the coupling element (70, 72) of the two cutting devices (12, 12 ') or of the driving device (22).

13.

Device according to one of claims 9 to 12, characterized in that the coupling element (70) of the innermost of the two cutting devices (12, 12 ') is made as a sealing device (88) for closing and opening a hole proximal at the proximal end (26) of the base body (14).

14.

Device according to claim 13, characterized in that the sealing device (88) has a housing (92) bipartite and essentially in the form of a bowl, with a housing element (96) fixed to the base body

(14) and a closing element (98) in the form of a cover or cap that can be fixed in the housing element (96) as well as two sealing elements (94, 94 ') that are arranged in the housing (92) on the longitudinal axis (94) of the base body (14) of the cutting device (12), adjacent to each other and acting together. 15. Device according to claim 14, characterized in that one (94) of the two sealing elements (94, 94 ') of the sealing device (98) is essentially conical, cone-shaped, bowl-shaped, cap-shaped or the like, comprising a slot-shaped hole (106) that is disposed in a plane (108) offset from a plane (112) that passes through the base surface (110) of the sealing element (94), in the direction towards the distal end (16) of the base body (14) of the cutting device (12), and has a peripheral section (114) extending radially outward in the plane (112) that passes through the base surface (110) of the sealing element (94) for fixing in the housing (92).

16.

Device according to claim 14 or 15, characterized in that the other (94 ') of the two sealing elements (94, 94') of the sealing device (88) is disk-shaped and has a central recess (118) approximately circularly, through which another instrument can be passed, in particular a clamping instrument or other cutting element, preferably a clamp clamp or a myoma drill.

17.

Device according to one of claims 1 to 16, characterized in that the cutting elements (20, 20 ') of the two cutting devices (12, 12') are essentially chamfered, conical, conical or inclined away outward of the distal orifice (18, 18 ') and / or oriented towards the distal orifice (18, 18'), extending inwards.

18.

Device according to one of claims 1 to 17, characterized in that the cutting elements (20, 20 ') of the two cutting devices (12, 12') have a smooth, wavy or indented peripheral or discontinuous edge.

19.

Device according to one of claims 1 to 18, characterized in that the transmission (30) arranged between the two cutting devices (12, 12 ') and the drive device (22) is made and can be mounted with its various components in a manner modular.