WO2004047653A2 - Surgical instrument - Google Patents

Surgical instrument Download PDF

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Publication number
WO2004047653A2
WO2004047653A2 PCT/EP2003/012246 EP0312246W WO2004047653A2 WO 2004047653 A2 WO2004047653 A2 WO 2004047653A2 EP 0312246 W EP0312246 W EP 0312246W WO 2004047653 A2 WO2004047653 A2 WO 2004047653A2
Authority
WO
WIPO (PCT)
Prior art keywords
surgical instrument
characterized
instrument according
cannula
element
Prior art date
Application number
PCT/EP2003/012246
Other languages
German (de)
French (fr)
Other versions
WO2004047653A3 (en
Inventor
Stephan Koscher
Johann Würtz
Lee L. Swanstrom
Haio Fauser
Original Assignee
Stephan Koscher
Wuertz Johann
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority to DE10255246 priority Critical
Priority to DE10255246.0 priority
Priority to DE10257760A priority patent/DE10257760A1/en
Priority to DE10257760.9 priority
Application filed by Stephan Koscher, Wuertz Johann filed Critical Stephan Koscher
Publication of WO2004047653A2 publication Critical patent/WO2004047653A2/en
Publication of WO2004047653A3 publication Critical patent/WO2004047653A3/en

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34Trocars; Puncturing needles
    • A61B17/3417Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421Cannulas
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34Trocars; Puncturing needles
    • A61B17/3468Trocars; Puncturing needles for implanting or removing devices, e.g. prostheses, implants, seeds, wires
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003Steerable
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/00336Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means with a protective sleeve, e.g. retractable or slidable
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A61B2017/00473Distal part, e.g. tip or head
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00477Coupling
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0409Instruments for applying suture anchors
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0417T-fasteners
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12022Occluding by internal devices, e.g. balloons or releasable wires
    • A61B2017/1205Introduction devices
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34Trocars; Puncturing needles
    • A61B17/3403Needle locating or guiding means
    • A61B2017/3405Needle locating or guiding means using mechanical guide means
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/04Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06Blood vessels
    • A61F2/07Stent-grafts
    • A61F2002/075Stent-grafts the stent being loosely attached to the graft material, e.g. by stitching

Abstract

The invention relates to a surgical instrument for fixing an element, especially an implant, in a body by means of a fixing element. Said fixing element is arranged in or on a carrier (25), especially in a canula, on a traction element and/or a pressure element (4) guided in a guide (3) along a longitudinal axis (A). According to the invention, the carrier (25) can be rotated about the longitudinal axis (A) and/or can be pivoted in relation to the longitudinal axis (A).

Description

A surgical instrument

The present invention relates to a surgical instrument for fixing an element, in particular an implant in a body by means of a fixing element, wherein the fixing element is arranged in or on a holder, in particular in a cannula to a tensile and / or pressure element, which is guided in a guide along a longitudinal axis.

Such surgical instruments are known and used in a variety of forms and designs. They are used for example in favor of using implants, for example, in blood vessels, which are at risk of aneurysms. Such implants are for example thin wire mesh, which usually od in a biased state in a vein. Like. Are inserted and opening at the point in question to expand as a kind of additional tube the vein wall, or at least to strengthen and relieve.

A disadvantage with this type of procedure that is not fixed there by means of the implant of a surgical instrument inserted at the relevant site. This can cause the implant slip and, just when it, for example, is a wire mesh for reinforcing a bloodstream, getting broken or possibly the bloodstream can break through, which may consequently result in life-threatening situations to internal bleeding and.

This method was improved by the WO 99/33402 is that the implant, which od in a vein. The like is., Now od on the wall of the blood stream by means of a fastening element such as a T-anchor. Like. Is attached. This T-armature is pushed from outside the bloodstream through the wall of the blood stream opens in the interior, so to speak, the T and is located with the transverse bar from the inside of the implant. The stem of the T is fixed by means of other fastening elements on the outside of the wall of the blood stream, such as twisted. Subsequently, the cannula can be withdrawn again.

The disadvantage here is that the cannula, in which the T-anchor is located, does not specify. It moves freely on the instrument end and is therefore difficult to perform. The object of the present invention is to avoid the abovementioned disadvantages and to provide a surgical instrument which opens a handling of a holder, in particular a cannula having a fixing element, in particular a T-anchor, simplified and the possibility of the holder determined on a and to direct position in a certain position and set there.

To achieve this object, resulting in that the holder about the longitudinal axis rotatable and / or pivotable with respect to the longitudinal axis.

Is selected as a holder, a cannula, this cannula is guided in a receptacle which is in turn connected via a joint to a main part. Together they form the cannula used. The cannula insert is at one end provided with a latching device, which comes into use with a receptacle of a pulling and pushing rod and a retaining seat at the end of the outer tube in engagement. The locking device connects the cannula insert releasably connected to the tension and compression element and the outer tube. The tensile and compressive element here is preferably a rod, in turn guided in the outer tube of the surgical instrument.

The Ras.teinrichtung consists in detail of a ball at the end of a pull and push rod portion for insertion into the receptacle of the pulling and pushing rod and at least two opposing pins on a guide projection along which a groove or recess of the holding seat at the end retract the outer tube. As the locking connection can look in any particular case, is of secondary importance. The main thing is that a releasable connection between the needle cartridge and the outer tube or the pulling and pushing rod is formed. Therefore intended to be encompassed by the present invention, all the different possibilities of connection.

The tension and compression rod of the cannula insert is hingedly connected at its distal end with the cannula recording. By movement of the pulling and pushing rod portion caused by movement of the tension and compression rod in the outer tube, the cannula is moved uptake and with it the needle guided therein. The movement is carried out by an arbitrary angle of 0 ° to 90 ° relative to the longitudinal axis.

The tension and compression rod in the outer tube is articulated and rotatably in a handle arm of a handle at its proximal end. By moving this Griffschenkeis or the handle to the pulling and pushing rod can be present in the outer tube and back. Is therefore the cannula insert via the locking device to the pulling and pushing rod connected, it can be, upstream when moving the Griffschenkeis, and the tension and compression rod portion back and forth, whereby the cannula which is mounted within the cannula receiving the cannula insert, opposite the longitudinal axis can be pivoted.

In order to rotate the .Kanüle about the longitudinal axis by preferably 360 °, a turning knob is provided on the surgical instrument, which is connected to the outer tube. Since the pin of the latching device of the cannula insert are firmly engaged in the recess of the holder receiving the end of the outer tube and can be turned by a rotation of the rotary knob not only the outer tube, but also of the cannula insert coupled to the pin. Further possibilities of rotation of the outer tube and the design of the rotary knob intended to be encompassed by the present invention.

The present invention also relates to a surgical instrument having an outer tube and at least one working element which is connected to the outer tube.

The disadvantage of such surgical instruments that especially the working element, which is attached to the tip of the outer tube, is without protection. The outer tube with the working element is introduced into the body and can get stuck due to the lack of protection and possibly cause injury inside the body as well as damage there.

Object of the present invention is therefore to provide a surgical instrument, which allows working with a working element without causing injury inside the body or damaging the working element itself.

To achieve this object, resulting in that a protective tube is fitted on the outer tube, which consists of two telescopically movable tube sections, of which a pipe section, the working element at least partially removable wrapped.

The protection tube associated with it a funnel-shaped attachment with which the tube section and the protective tube to a connecting member of the outer tube may be disposed. The arrangement of the protective tube is used, for example, a snap ring, which can expand and thus aufklickbar to the connecting element. Any other connection between the funnel-shaped attachment and the connecting element is possible and is intended to be encompassed by the present invention.

The two pipe sections are connected together by means of a bayonet-type connection and one inside the other.

A knob-like element which is connected to the inner tube section through the outer tubular section and slidable on the latter, is a better handling during the displacement of the two pipe sections. Another attitude is conceivable.

Behind the bayonet-type connection can be at one pipe section may be provided besides a ring, which limits the displacement of the other tube section.

The protective tube is distinguished by its two sliding pipe sections to protect different sizes work items.

Another advantage of the protective tube of the present invention that this can be easily taken apart, whereby a cleaning of the individual components of the protective tube is possible. the tube tapers even downward, so the flushing pressure increases and a better cleaning is obtained.

The present invention further relates to a surgical instrument with a guided in an outer pipe tensile and / or pressing member, wherein the tensile and / or pressure element, a fixing device is associated. Previous such surgical instruments have the disadvantage that putting it off while the tensile and / or pressure element in the outer tube arbitrarily back and, however, can not be determined. Thus, there is no way to lead 5 example, attached to the tension and / or compression element cannula use with the needle and set in a certain position. A conducting the cannula takes place for example by contact with an element or the like, but this is only a small fuse 10 of the cannula.

Object of the present invention is therefore also to provide a surgical instrument which enables the tensile and / or push rod in the outer tube 15 and thus set the cannula used with the cannula in a specific position and posture.

To achieve this object, resulting in that the fixing means comprises a to the tensile and / or pressure element patch clamping sleeve 20, whose diameter is variable.

The clamping sleeve which surrounds the tension and compression rod in the region of the front Griffschenkeis of the handle for this purpose has a through slot 5 on a certain width. As the clamping sleeve is supported on a trough of a cylinder body of a shaft, the width of the slot, when the shaft is rotated by means of a clamping lever is reduced, whereby the diameter of the clamping sleeve can be reduced and thus the 0 tensile and compressive element is clamped and not more can be moved. The trough in the cylinder body of the shaft is preferably arranged eccentrically and has a sickle shape. Instead of the trough is also an element can be disposed in the shaft, for example, containing 5 causes rotation of the shaft, a reduction in the width of the clamping sleeve and the pulling and pushing rod clamps. The various possibilities are intended to be encompassed by the present invention.

In order to rotate the shaft by means of the clamp lever, the shaft has a ring gear which is in position for use with teeth of a bore of the clamping lever into engagement. The shaft can be rotated while only to the extent permitted by the co-operating with a pin on the handle recess on the clamping lever. Another possibility for limiting the movement of the clamping lever and thus of the shaft in the handle arm of the handle is possible and is intended to be encompassed by the present invention. Similarly a different arrangement of the clamping lever on the shaft or the rotation of the shaft is at all possible, and to be also encompassed by the invention vorliegendend.

Even with these elements, a good decomposability is given, whereby the cleaning of the entire surgical instrument is simplified. This can prevent that, due to, for example, complicated construction just a careless cleaning is done, which could result in the worst case to a dangerous infection in the body, if such carelessly cleaned devices are used again.

Although protection is sought separately for the individual elements, with the present invention, a total of a surgical instrument were provided which significantly simplifies the work in the body, by rotating the cannula in both the longitudinal axis by 360 °, and with respect to the longitudinal axis at an angle can be pivoted from 0 ° to 90 °. Further, it is possible to position the cannula in any desired position and by the fixing device is actuated on the handle determine. Damage to the cannula itself or injury through the cannula is prevented by the protective tube, which is available through the two telescoping pipe sections in arbitrary lengths.

The good dismantling of the surgical instrument also allows optimum cleaning of the individual elements as far as they like, for example, the cannula, no products for single use only.

The present instrument is mainly used for repairing an anatomic vessel wall or the wall of a hollow organ, such. As the esophagus, particularly in the human body. It is used in particular as applying forceps for a closure element for fixing an implant such as a stent or stent-graft in a vascular or hollow organ from outside the vessel wall.

Further advantages, features and details of the invention will become apparent from the following description of preferred embodiments and with reference to the drawing; this shows

Figure 1 is a side view of a surgical instrument according to the present invention with a cannula insert and an associated cannula;

Figure 2 is a front view of the surgical instrument of Figure 1;

Figure 3 is a rear view of the surgical instrument of Figure 1;

Figure 4 is an enlarged view of a connection between the needle cartridge and the surgical instrument;

Figure 5 is a side view of a protective tube according to the present invention;

Figures 6a - 6d at 90 ° intervals around a longitudinal axis rotated to the right views of a clamp lever according to the present invention;

Figure 7 is a side view of a shaft for use in the surgical instrument of Figure 1;

8 shows a section along the line VIII-VIII through the shaft in Figure 6;

Figure 9 is a side view of a collet according to the present invention; Figure 10 is a plan view of the clamping sleeve of Figure 8; and

Figure 11 is a schematic representation of the arrangement of the clamping sleeve on the shaft in the surgical instrument together with the clamping lever.

According to FIG 1 comprises a surgical instrument 1 has a handle 2, an associated outer tube 3, and a guided in the outer tube 3 pulling and pushing rod. 4 The handle 2 consists of two grip limbs 5 and 6 which are connected to each other via a hinge. 7 Handle loops 8 and 9 are provided to facilitate handling of the handle 2 at the respective ends of the two handle legs 5 and 6. FIG.

The handle of the loop 9 opposite the end of the Griffschenkeis 6 comprises a stop 10, which limits the opening of the two gripping arms 5 and 6 of the handle. 2

The handle of the loop 8 opposite end of the Griffschenkeis 5 is formed extended with a curvature. In this curvature of the Griffschenkeis 5 a shaft 12 is seen which a locking lever 13 is associated, on the opposite, that is the non-visible side. From this clamping lever 13, however, only a handle 14 can be seen in this view. The shaft 11 is described below in more detail.

At which subsequent to the curvature of the end of the

5 is a Griffschenkeis with a not shown in detail

-Threaded neck element 15 is arranged. With this in turn a rotation knob 16 is rotatably connected to a connecting element 17 and a further neck element connect 18th The outer tube 3 inserted therein is rotatable about a longitudinal axis A by means of the rotary knob sixteenth

The approach the element 18 opposite the end of the outer tube 3 is provided with a holder receiving the nineteenth

The pulling and pushing rod 4, which is at one end articulated and rotatably in the handle leg 6 of the handle 2, extending in the other by the curvature of Griffschenkeis 5 and the outer tube 3 and the retainer receiving 19th

The end of the pulling and pushing rod 4 comprises, as can be seen in Figure 4, a receptacle 20 for docking a cannula insert 21. The cannula insert 21 is composed of a latching device 22, a main portion 23 and a cannula receiving 24th The cannula receptacle 24 serves to receive a cannula 25 with an associated slide 26, which is inserted at one end into the cannula 25th The cannula 25 is at one end guided in a not shown in detail in the cannula bore receptacle 24 and at the other provided with an inclined outgoing peak.

For the slider 26 is at the top of the body 23 provided behind .the cannula receptacle 24, a trough 27, in which - the slide od 26 when entering into a human body or the like is located (see Figure 1) and can not be bent, if.. for example, a protective tube 40 is pushed from the rear across the entire cannula insert 21st

The cannula receptacle 24 is connected via a hinge 28 to the main part 23, wherein the latching device 22 is associated on the opposite side. The latching device 22 of the cannula insert 21 has on the one hand a ball 29 for insertion into the receptacle 20 of the pulling and pushing rod 4 and opposing pegs 30 for insertion into a groove 31 in the holding recess 19 at the end of the outer tube 3. There, the other two engage the pin 30 in a corresponding recess 32 at the end of the groove 31st

The ball 29 is connected via a stop 33 with a pull and push rod portion 34, which is guided in a guide lug 35 on the main part 23rd the pins 30 are arranged opposite one another on the spigot 35th

On not shown in detail, the sliding in the main portion 23 pulling and pushing rod portion 34 is connected to a joint 39 outside the longitudinal axis A of the needle seat 24, thereby, as described hereinafter, the cannula socket 24 can be pivoted about the hinge 28 ,

Furthermore, it is, according to FIG 1, the connecting element 17 is a protection tube 40 mounted on the outer tube 3 and to the neck member 18 and. The protective tube 40 consists of two telescopically displaceable Rohrabs.chnitten 41 and 42 (see Figure 5), wherein the pipe section is guided in the pipe section 41 and 42 can be handled by means of a knob-like element 43rd

At one end of the pipe section 41 a stopper 44 is arranged, which cooperates with the knob-like element 43, so that the pipe section 42 can not be moved beyond the end of the pipe section 41 addition. The other end of the pipe section 41 has a funnel-shaped attachment 45, which is placed in position of use on the neck element 18 and the connecting member 17 and secured thereto for example via a snap ring not shown in detail. In this way, the protective tube can be set 40 to be slightly removed.

The pipe sections 41 and 42 go to each other a a bayonet-type connection 55th The necessary elements are a pin 56 and an overflow groove 57. The pin 56 is disposed inside the knob-like element 43 at the end of the pipe section 42 and the overflow channel 57 in the pipe portion 41st The pin 56 is guided in the running groove 57th The overflow channel 57 is formed S-shaped, that is, their respective ends 58 and 59 are curved in a hook shape. By bayonet-type connection 55, the total length of the protective tube can be changed at the 40th

Protrudes from the boss member 17 as shown in Figures 2 and 3, the side of a connection nipple 46 from being arranged on which a male thread 47 provided with a head 48th Over the external thread 47 of the head 48, for example, a liquid supply can be connected to the fitting 46 so that liquid passes through the connection nipple 46 in the surgical instrument 1, to flush such as blood in an application in the body. Also conceivable is the connection of compressed air to form, for example, cavities in the body.

According to FIG 3 the arrangement of the clamping lever 13 is further illustrated in the non-visible here grip limbs 5 of the handle. 2 The clamping lever 13 is, as shown in Figures 6a to 6d, a P-shaped structure, whose upper portion 49 has a bore 50 whose inner surface is provided with individual teeth 51st These teeth 51 are in the use position with a ring gear 52 of the shaft 12 in engagement (see Figure 7).

Furthermore, in the upper region 49 of the P-shaped clamping lever 13 a recess 53 is provided which is used on the handle legs 5 of the handle 2, in use, to receive a Zapfes 54th The pin 54 (see Figure 3) is used to limit the movement of the clamping lever. 13

The handle 14 of the clamp lever 13 is, especially for better handling of the clamp lever 13 is formed flattened in contrast to the upper portion 49 and widened and slightly protrudes to the side from the upper portion 49 of the clamp lever 13 from.

The shaft 12, which is shown illustrated in Figure 7, also has in addition to the ring gear 52 to a cylinder 60 which has a smooth casing surface 61st let into the lateral surface 61 is a recess 62 which is arranged as can be seen in the cross-section AA, sickle-shaped and eccentrically and draws only a part of the circumference of the cylinder 60 of the shaft 12th

The recess 62 serves for receiving a clamping sleeve 63, which supports 64 and a ring 65 consisting of a bevelled at one end and tapered sleeve section. In this case, an outer diameter of a x of the ring 65 is larger than an outer diameter a of 3 of the sleeve portion 64, whereas an inner diameter A 2 of the ring 65 is equal to an inner diameter of the sleeve section 4 a 64th Thus, a uniform bore 66. Both the ring 65 and the sleeve portion 64 of the clamping sleeve 63 is given by the clamping sleeve 63 are on one side, as seen in Figure 10, traversed by a slot 67th The slot 67 in this case has a width b. The ring 65, which has more material than the sleeve portion 64, counteracts a closing of the slot 67, so that opens automatically after a prolonged closing of the slit 67th

According to FIG 11, the arrangement and the orientation of the shaft 12 in a transverse bore 11 in the handle leg 5 of the handle 2 as well as the arrangement of the clamping sleeve 63 in the hollow 62 of the shaft 12 is shown. Furthermore, the arrangement of the clamping lever 13 is indicated on the ring gear 52 of the shaft 12 by an arrow 68th

The operation of the present invention is as follows:

In order to make the surgical instrument 1 functional, uss this are first connected to the cannula insert 21 and the cannula 25th For this purpose, the two pipe sections of the protective tube 40 along the bayonet-type connection 55 reciprocally moved completely 41 and 42, so that the holder support 19 is exposed at the end of the outer tube. 3 In the holder support 19 is inserted anschli.essend the cannula insert 21st This is done as follows.

First, the gripping arms are fully opened 5 and 6 of the handle 2, so that the pulling and pushing rod 4 moves as far as possible from the retainer receiving 19th Subsequently, the ball 29 of the locking device 22 is inserted into the receptacle 20 of the pulling and pushing rod 4 from the side and mounted. The stop 33 behind the ball 29 rests against an edge 69 of the pulling and pushing rod. 4

Subsequently, the two handle legs 5 and 6 of the handle 2 to be fully closed again. Thereby, the pulling and pushing rod 4 is pulled together with the cannula insert 21 to the rear. In a complete closing of the two gripping arms 5 and 6 simultaneously drive the two pins 30 into the grooves 31 on or snap into the recesses 32 of the holder receiving the nineteenth The cannula insert 21 is now securely connected to the surgical instrument 1, except that the pulling and pushing rod portion 34 is axially movable.

Due to the mounting of the pin 30 in the recess 32 of the holder support 19 of the outer tube 3, the holder support 19, the latched here pin, by rotating the rotary knob 16, whereby the outer tube 3 is rotated, with it 30 and thus the entire cannula insert 21 to the A longitudinal axis to rotate.

In addition to the rotation and movement of the cannula insert 21 along and around the longitudinal axis A of the cannula recording can 24 in which the cannula 25 is disposed, further od by means of a wire 38. Like. Connecting element which is connected to the non-visible end of the pulling and pushing rod 34 is connected to pivot the hinge 28 and to the longitudinal axis A.

In order to protect the cannula insert 21, or the cannula 25 itself, for example, during insertion into a body and also to prevent injury through the cannula 25, the tubular portion 42 of the protective tube 40 after the attachment of the cannula insert 21 to the surgical instrument 1 again extended. For this is rotated on the knob-like element 43rd Arranged on the inside of the knob-like element 43 pins 56 are so out of the respective curvature 58 and 59 moves to the respective end of the groove 57 of the bayonet-type connection 55 and shifted along the overflow trough 57, where they are then in the curvature 58 by again turning of the knob-like element 43, this time in the opposite direction, retract. In this position, the tube section 42 is extended so far beyond the Kanuleneinsatz 21 beyond the cannula 25 is well protected.

If the needle reached its point of use 25, the two pipe sections are 41 and 42 move into each other again. Now, the cannula can be pivoted free 25 and twisted. However, if it reaches its desired position and posture, so it must be possible to note the cannula 25th This is necessary, first, to allow for accurate work with the cannula 25 and on the other to prevent damage to the cannula itself or damage to surrounding tissues through it.

For this purpose, the cannula can be fixed by means 25 of the clamping lever 13 to the handle leg 5 of the handle. 2 This is done by setting the tension and compression rod 4, as the pulling and pushing rod is guided in the Spannhulse 63 4, which rests in the handle leg 5 of the handle 2 to the trough 62 in the cylinder 60 of the shaft 12th

If the pulling and pushing rod 4 and hence the needle 25 are set, the clamp lever 13, which is seated in a rotationally fixed by means of the teeth 51 on the ring gear 52 of the shaft 12, moves to the left or right. Thereby the shaft 12 and hence the trough 62 of the cylinder moves 60. The pin 54 acts on the lever arms 5 of the handle 2 thereby together with the recess 53 of the clamping lever 13, the rotation of the clamping lever 13 in one direction or the other to limit.

By the rotation of the trough 62, the width b of the slot 67 of the collet 63 is reduced due to the sickle shape of the trough 62nd With increasing rotation of the clamping lever 13 and thus the shaft 12, the width b of the slot 67 is thus reduced so that the tension and compression rod 4, which is guided in the clamping sleeve 63, is clamped. The pull and push rod 4 and consequently the cannula insert 21 can not now be moved forward or backward, and not be rotated. Furthermore, the cannula 25 with respect to the longitudinal axis A and can not be pivoted and is set together with the cannula insert 21 in its intended position and posture.

Subsequently, a is located Direction in the canula T-anchor may for example be ejected from the cannula 25 by means of a further, not shown in detail here instrument by instrument pushes from the rear on the slide 26, whereupon the latter, in turn, retracts into the cannula 25 and the T Anchors or the like.. pushes out.

If the determination of the cannula insert 21 be reversed, only the clamping lever has to be rotated in the opposite direction. 13 Characterized the width b of the slot is enlarged 67 of the clamping sleeve 63 and a movement of the pulling and pushing rod 4 is again possible.

Detachment of the cannula insert 21 of the surgical

Instrument 1 after completion of the application is done in the reverse manner by the two handle gifts! 5 and 6 of the handle 2 to open as much as possible again. Thereby, the resistance which due to the latched in the recess 32 of the holder support 19 pins 30 of the locking device 22 is present, overcome by the pressure of the pulling and pushing rod. 4 The pins 30 are pushed out by the pulling and pushing rod 4 out of the groove 31 of the holder support 19 and the ball 29 of the locking device 22 can be removed from the receptacle 20 of the pulling and pushing rod. 4 The connection between the cannula insert 21 and the surgical instrument no longer exists.

DR. PETER WEISS & DIPL.-ING. A. BRECHT

Patent Attorneys European Patent Attorney

Case Number: P 2841 / PCT Date: 28.10.2003 W / HE

Position Number List

Figure imgf000022_0001

Claims

1. A surgical instrument for fixing an element, in particular an implant in a body by means of a fixing element, wherein the fixing element is arranged in or on a holder (25), in particular in a cannula to a tensile and / or pressing member (4) which (a) is guided in a guide (3) along a longitudinal axis,
characterized,
that the holder (25) about the longitudinal axis (A) is rotatably and / or to the longitudinal axis (A) is pivotable. is.
2. A surgical instrument according to claim 1, characterized in that the holder (25) between 0 ° to 90 ° relative to the longitudinal axis (A) is pivotable.
3. A surgical instrument according to claim 1 or 2, characterized in that the holder (25) to
is 3.60 ° rotation.
4. A surgical instrument according to any one of claims 1 to 3, characterized in that the cannula (25) in a cannula holder (24) is guided.
5. A surgical instrument according to claim 5, characterized in that the cannula holder (24) via a joint (28) having a main part (23) of a cannula insert (21).
6. A surgical instrument according to claim 6, characterized in that associated with the main part (23) of the cannula insert (21) is a pulling and pushing rod portion (34) and this via a latching means (22) releasably (with the tensile and / or pressing member 4 ) connected is.
7. A surgical instrument according to claim 6, characterized in that the latching means (22) having opposite pins (30) and a ball (29).
8. A surgical instrument according to claim 7, characterized in that the ball (29) on the pulling and pushing rod portion (34) and the pin (30) on a guide projection (35) on the main part (23) are arranged.
9. A surgical instrument according to claim 9, characterized in that the ball (29) having a
Receiving (20) at the distal end of the pulling and pushing rod (4) is engaged.
10. A surgical instrument according to claim 8 or 9, characterized in that the pins (30) with grooves
(31) or recesses (32) of a holder receptacle (19) are engaged on the distal end of the outer tube (3).
11. A surgical instrument according to at least one of claims 6 to 10, characterized in that the other end of the pulling and pushing rod portion (34) with the cannula holder (24) is hingedly connected.
12. A surgical instrument according to at least one of claims 1 to 11, characterized in that the pulling and pushing rod (4) other end to a handle limb (6) of a handle (2) is coupled.
13. A surgical instrument according to claim 12, characterized in that the pulling and pushing rod (4) is axially movable by means of the Griffschenkeis (6).
14. A surgical instrument according to at least one of claims 1 to 13, characterized in that formed on the as an outer tube (3) guiding a turning knob (16) for rotating said outer tube (3) and the cannula (25) about the longitudinal axis (A ) is provided.
15. A surgical instrument comprising an outer tube (3) and at least one working element (21) which is connected to the outer tube (3), characterized in that on the outer tube (3) is placed a protective tube (40) which is telescopically composed of two telescoping tube sections (41, 42), of which a tube section (42) of the working element (21) wrapped at least partially removable.
16. A surgical instrument according to claim 22, characterized in that the two pipe portions (41, 42) by means of a bayonet-type connection (55) are connected together.
17. A surgical instrument according to claim 15 or 16, characterized in that one end of the pipe section (41) with a funnel-shaped attachment (45) for placing onto a connecting element (17) is provided.
18. A surgical instrument according to any one of claims 15 to 17, characterized in that an opposite end of the tube section (41) with a stopper (44) is provided, the movement of the
Tube section (42) is limited during extension.
19. A surgical instrument according to at least one of claims 15 to 18, characterized in that the tube section (42) at one end with a knob-like element (43) is connected, which slides on the tubular portion (41).
20. A surgical instrument according to claim 19, characterized in that the knob-like element (43) is provided in its interior with at least one pin (56), via which it is connected to the pipe section (42).
21. A surgical instrument according to claim 20, characterized in that the pin (56) in curvatures (58, 59) or in an overflow channel is guided (57) in the pipe section (41).
22. A surgical instrument having a in an outer tube (3) guided in tensile and / or pressure element
(4), wherein the tensile and / or pressure element (4) is assigned a fixing device, characterized in that the fixing device comprises a to the tensile and / or pressing member (4) put on the clamping sleeve (63), the diameter (a x to a 4) are changeable.
23. A surgical instrument according to claim 22, characterized in that the clamping sleeve (63) has a sleeve portion (64) and a beef (65).
24. A surgical instrument according to claim 23, characterized in that an outside diameter (ai) of the ring (65) is greater than the outside diameter (a 3) of the sleeve portion (64).
25. A surgical instrument according to claim 23 or 24, characterized in that an inner diameter (a 2) of the ring (65) equal to the inner diameter (a 4) of the sleeve portion (64).
26. A surgical instrument according to claim 23, characterized in that a slot (67) in the sleeve portion (64) and the ring (65) is formed.
27. A surgical instrument according to at least one of claims 22 to 26, characterized in that the clamping sleeve (63) in a depression (62) of a cylinder (60) a shaft (12).
28. A surgical instrument according to claim 27, characterized in that the trough (62) is arranged eccentrically and crescent shaped.
having 29. A surgical instrument according to claim 28, characterized in that the shaft (12) has a toothed rim (52) of the bore is provided with a toothed (51) (50) on a head (49) of a clamping lever (13) in engagement stands.
30. A surgical instrument according to claim 29, characterized in that the clamping lever (13) has a recess (53).
31. A surgical instrument according to claim 30, characterized in that the recess (53) for receiving a pin (54) on the gripping arms (5) of the handle (2) is used.
PCT/EP2003/012246 2002-11-26 2003-11-03 Surgical instrument WO2004047653A2 (en)

Priority Applications (4)

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DE10255246.0 2002-11-26
DE10257760A DE10257760A1 (en) 2002-11-26 2002-12-10 A surgical instrument
DE10257760.9 2002-12-10

Applications Claiming Priority (1)

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