WO2018233773A1

WO2018233773A1 - Medical instrument

Info

Publication number: WO2018233773A1
Application number: PCT/DE2018/100578
Authority: WO
Inventors: Josef Heinen
Original assignee: Josef Heinen
Priority date: 2017-06-21
Filing date: 2018-06-20
Publication date: 2018-12-27
Also published as: DE202017103689U1

Abstract

The invention relates to a medical instrument for laparoscopic interventions in minimally invasive surgery, which instrument can be introduced via a trocar into the abdominal cavity of a patient and for this purpose has at the distal end of the medical instrument a functional unit in the form of a gripping element. This functional unit can be operated by means of an operating unit at the proximal end of the instrument. The gripping element is designed as a dissecting forceps having two clamping jaws (11, 12) which are movable in an articulated manner via an articulated joint mechanism. According to the invention, the articulated joint mechanism comprises a joint rod (13) which is movable in the axial direction and has a coupling ball (16) at the end, the joint mechanism further comprising a first pivotable shorter clamping jaw (12), which has a ball seat (17) for the coupling ball (16) of the joint rod (13), and also a second longer clamping jaw (11), which has a hollow shaft (18) in which the joint rod (13) is axially movably guided.

Description

Medical instrument

The present invention relates to a medical instrument for endoscopic interventions in minimally invasive surgery, which can be introduced via a trocar into the abdominal cavity of a patient and has at its distal end a functional unit in the form of a gripping element, said functional unit via an operating unit on the proximal End of the instrument is operable, wherein the gripping element is formed as Präparierklemme with two articulated by a hinge mechanism clamping jaws, wherein the hinge mechanism comprises a displaceable in the axial direction hinge rod with an endseitig coupling ball, the medical instrument further comprises a first pivoting shorter jaw, comprising a ball seat for the coupling ball of the joint rod, and a second longer jaw, which is provided with a hollow shaft, in which the joint rod is guided axially displaceably.

A so-called "Overholt" is a surgical instrument in the form of a slightly curved dissecting clamp with pointed but rounded ends, which are used, for example, for clamping and dissecting vessels.This type dissecting clamp is named after the American thoracic surgeon Richard Overholt.

In DE 68 08 486 U, for example, a surgical dissecting clamp is described according to Overholt. This has two branches with mostly fluted jaws, so you can capture the tissue better, but without damaging it. The Dissecting Clamp after Overholt has a spectacle handle and is operated by hand.

In the medical instrument according to the present invention, a Overholt dissecting clamp is provided as a functional unit at the distal end of the laparoscopic instrument and thus can be operated from outside the abdominal cavity during a minimally invasive procedure.

From WO 2010/121282 A1, for example, a medical instrument for laparoscopic interventions with the features mentioned above is known. In this known medical instrument, the gripping element comprises two mutually movable pliers arms, each with a clamping surface for preferably atraumatic clamping of hollow organs, organs or vessels. The clamping mechanism for the movement of the pliers arms comprises Here, a displaceably arranged in the tubular housing of the gripping member piston in the displacement of the forceps arms can be opened and closed via a kind of articulated parallelogram. The two mutually movable gun arms with the jaws are identical in this known device and functionally equivalent. A disadvantage of the known medical instruments of this type is, inter alia, the fact that they can not be dismantled or not easy. This has the consequence that the cleaning of the device is quite complex.

From DE 10 2014 117 393 A1 a medical instrument with the features mentioned in the introduction is known. In this known device, both jaws end proximally approximately at the level of the coupling ball of the joint rod. It then connects to the proximal end of an annular body and as a separate component to the two jaws, a tubular body is provided with a distal extension, which in turn receives a pull / push rod over which the joint rod is operated, the distal extension turn in the shaft of the instrument is added. In medical instruments of this type, it is generally the case that the two clamping jaws and the other components are screwed together in the joint area and / or are connected by cotter pins, so that the joint is not readily divisible for the user. DE 20 2007 013 372 U1 describes a surgical tubular shaft instrument with two clamping jaws, which are articulated to each other, wherein a sleeve is pushed over the joint area. Here, two mutually parallel bearing arms are provided, which form between them a receiving space for the proximal ends of the jaws. Both the bearing arms and the two clamping jaws here have bearing openings in each case and a bearing pin oriented transversely to the longitudinal axis of the instrument passes through all bearing openings in the clamping jaws and in the bearing arms. The sleeve serves only to cover the bearing openings and can consist of an elastically deformable material. The mounting of the bearing pin (the bearing shaft) should be facilitated here, but it is not intended that the two jaws can be easily disassembled after moving the sleeve. Rather, this is a disposable instrument, that is a disposable article for single use, so that here the question of disassembly of the jaws for the purpose of better cleaning of the instrument does not arise. The sleeve here has a continuous slot in the axis-parallel direction, so it is open at the periphery.

US 2016/0199087 A1 also describes a medical instrument of this type in which the jaws open via a hinge rod with a ball at the front end to let. Again, a kind of pin or sap extending in the transverse direction is used to connect the jaws together. Since the sap does not protrude laterally in the installed state, it can not be disassembled by the user without further ado. One of the jaws is also screwed by a thread at its proximal end with a threaded sleeve, which concentrically surrounds an extension of the joint rod.

The object of the present invention is to provide a medical instrument of the aforementioned type, which can be disassembled well, so that the resulting after dismantling items can be cleaned better. Another object of the present invention is to provide a medical instrument of the aforementioned type which has greater versatility with respect to the use of the instrument in endoscopic procedures.

The solution of these objects provides a medical instrument of the type mentioned above with the characterizing features of the main claim.

According to the invention it is provided that the medical device according to the invention further comprises a sleeve which is removable from the medical instrument and which is pushed onto a shaft portion of the second longer jaw, such that they are in a mounted end position to the hinge portion of the articulated connection of the two Jaws extending, wherein after removing the sleeve of the shaft portion of the second longer jaw, the two jaws and the hinge rod are removable.

The medical instrument can thus be dismantled easily by the user in a few simple steps. This only has to move the sleeve to the proximal region and then already the two jaws and the hinge rod can be solved with the coupling ball from each other. There are thus provided in the inventive solution neither screw nor pins or cotter pins in the joint area, which require the aid of a tool for the release of fasteners and / or special expertise. Unlike in the prior art, there are thus no cross-connections in the joint area, where the two clamping tools are connected to each other. After disassembly, said components are present as individual parts, so that a simple cleaning is possible, in which all surfaces of the components are easily accessible. Thus, the device can be cleaned so thoroughly that it is then absolutely germ-free and meets the high hygienic requirements in the surgical field and can therefore be reused. When mounting the instrument is provided in an advantageous manner that the sleeve is advanced to its final position and then rotated, for example, about its axis until a locking takes place, so that a fixation of the sleeve is given in this end position from which they themselves can not solve unintentionally. Due to the remaining components received by the sleeve, a tension is also created after the assembly process, so that they are securely bordered by the sleeve, but the latter can not yield outward in the radial direction. Preferably, the sleeve is made of a rigid metallic material. The determination of the sleeve in the deferred end position could also be achieved in other ways, for example by means of a screw connection achieved by means of rotation, if a thread is provided on the sleeve.

In the solution according to the invention the coupling ball at the front end of the hinge rod cooperates with the ball seat on the shorter jaw and forms the hinge about which the shorter jaw pivots when it opens, which is done by advancing the hinge rod in the axial direction. The longer jaw continues on its back beyond the joint out to the proximal end of the instrument away and takes the joint rod axially displaceable in itself.

Preferably, the longer jaw further has a positive reception for Teilkugelanformung in the joint region of the shorter jaw, so that the shorter jaw is guided and held in its pivotal movement in this recording of the longer jaw. By this holding function, the shorter jaw can not be moved in the axial direction with axial feed of the joint rod and instead performs a pivoting movement about the arranged in the center of Teilkugelanformung hinge axis. The opening and closing of the two jaws is thus effected in the inventive solution by three components, namely the shorter jaw with Teilkugelanformung, the longer jaw with their inclusion for Teilkugelanformung, these two component areas form the joint area, and by a piece in axial direction movable joint rod, which forms the actuating element for the joint function.

According to one embodiment of the invention, a joint fork is provided in the joint region of the shorter jaw, which forms the ball seat for the coupling ball of the joint rod. The coupling ball of the joint rod can thus act directly on the joint area during advancement of the joint rod and cause the pivoting movement of the shorter jaw to open the jaws. Furthermore, the hollow shaft is preferably formed by an axial extension of the second longer jaw toward the proximal end of the instrument. The hollow shaft can thus be mounted directly on the second jaw or formed integrally therewith. This reduces the number of components required for the function of the medical instrument.

A preferred embodiment of the invention provides that the hollow shaft has a proximal portion in which a preferably thickened trained area of the hinge rod is guided approximately positively. This allows a good guidance of the hinge rod in the hollow shaft of the longer jaw.

A preferred advantageous feature is that adjoins the thickened trained portion of the hinge rod to the distal end, a shaft portion of the hinge rod with a smaller diameter at the distal end of which is the coupling ball of the joint rod. Due to this smaller diameter of the joint rod in the hollow shaft of the instrument has some radial play.

According to a preferred embodiment of the invention, the shaft portion of the joint rod with a smaller diameter is formed slightly curved in itself. This makes it possible to achieve a lever effect on the joint rod, by means of which one can achieve a pivotal movement of the shorter jaw and thus the opening of the jaws of the instrument.

After removing the sleeve, you can then dismantle the two jaws and remove the joint rod. It is advantageous if the sleeve is removable by pulling the proximal end of the instrument out of the shaft portion of the second longer jaw.

It is particularly advantageous according to a preferred embodiment of the invention, when the second longer jaw has a stop region for the end position of the pushed sleeve.

According to one embodiment of the invention is located at the distal end of the sleeve in a side view approximately rectangular recess on the circumference of the sleeve, which is there to ensure the mobility of the upper jaw in the joint area. Preferably, according to the invention, the sleeve is closed over its circumference, particularly preferably up to a distal region in which there is a rectangular recess. Due to the closed sleeve results in an all-round enclosure of the components in the joint area, which is not yielding in the radial direction in the presence of forces due to the handling of the jaws, so does not spread.

The features mentioned in the dependent claims relate to preferred developments of the task solution according to the invention. Further advantages of the invention will become apparent from the following detailed description.

Hereinafter, the present invention will be described in more detail by way of embodiments with reference to the accompanying drawings.

Showing:

Figure 1 is a side view of the front portion of a medical instrument according to the invention according to a possible embodiment of the present invention in the open state; Figure 2 is a plan view of the medical instrument of Figure 1 in partial longitudinal section;

Figure 3 is a cross-section of the medical instrument taken along the line A-A of Figure 2;

FIG. 4 a longitudinal section through the medical instrument of FIG. 1 in the opened state;

FIG. 5 shows a corresponding longitudinal section through the medical instrument of FIG. 1 in the closed state; Figure 6 is a partial view of the upper jaw of the instrument seen from below;

Figure 7 is a side view of the upper jaw of Figure 6; Figure 8 is a view of the upper jaw from above;

9 shows a cross section through the upper jaw along the line BB of Figure 6; Figure 10 is a partial view of the lower jaw of the instrument seen from above; Figure 11 is a side view of the upper jaw;

Figure 12 is a sectional view through the upper jaw taken along the line E-E of Figure 1 1; Figure 13 is a sectional view through the upper jaw taken along line D-D of Figure 10;

Figure 14 is a sectional view through the upper jaw taken along the line C-C of Figure 10; Figure 15 is a view of the hinge rod of the medical instrument; Figure 16 is a view of the sleeve of the medical instrument; 17 shows a longitudinal section through the sleeve of FIG. 16.

First of all, reference is made to FIGS. 1 to 5 and an embodiment of the present invention will be explained with reference to FIG. The medical instrument 10 according to the invention comprises two clamping jaws 11, 12, which are each shown in the opened state in FIGS. 1 and 4 and are shown in the closed state in FIG. The medical instrument 10 consists essentially of four components in the front region relevant here, which is shown in FIGS. 1 to 5. These are the lower clamping jaw 11, the upper clamping jaw 12, the inner joint rod 13 and a sleeve 14, which is pushed over the lower clamping jaw 11 in the joint region and surrounds this in its shaft region.

In FIGS. 1 and 4 it can be seen that both clamping jaws 1 1, 12 each have a type of saw tooth profile 15 in the area facing each other in longitudinal section, so that a better clamping effect is achieved. In Figure 4 it can be seen that the front end of the hinge rod 13 has an integrally formed coupling ball 16 which engages in a yoke 12 a with a spherical shell 17, this receptacle 17 is located at the rear end of the upper jaw 12. This spherical shell-shaped receptacle 17 and the connection between the spherical shell-shaped receptacle 17 of the upper clamping jaw and the coupling ball 16 of the joint rod 13 can also be clearly seen in FIG. In the sectional view of Figure 3, in which the section exactly in the region of the seat of Coupling ball 16 is located in the spherical shell 17, these relationships are also clear.

FIG. 2 also shows how the rear (proximal) region of the upper jaw 12, on which the receptacle for the coupling ball 16 is located, lies inside the hollow shaft 18 of the lower jaw 11, this hollow shaft extending towards the proximal end of the lower jaw 11 (ie to the rear end) connects to the actual jaw region of the jaw. This hollow shaft 18 is in turn concentrically within the sleeve 14th

If one now compares the closed position shown in Figure 5 of the two jaws with the corresponding sectional view in the open state of Figure 4, then you can see that by slightly advancing the hinge rod 13 and thus the coupling ball 16, the yoke, located at the rear end of the Jaw 12 is about its axis pivots, with this the upper jaw 12 pivots upward and thus open the jaws 1 1, 12, so that you can then detect with the instrument tissue, vessels or the like. The operation of this function takes place via the handling of the joint rod 13, which is axially displaceable in the hollow shaft 18 of the lower jaw 1 1 extending beyond the joint region to the proximal end of the instrument and which can be actuated by the surgeon operating the laparoscopic instrument.

Further details regarding the upper jaw 12 will become apparent from FIGS. 6 to 9, to which reference will now be made. There one recognizes on the one hand the ground plan form of the jaw, which is slightly curved in the front distal end region at the tip 12 b, as is usual with dissecting clamps according to Overholt. Furthermore, you can see the shape of the yoke 12 a in particular in the plan view of the underside of Figure 6, which on the one hand inside a part-spherical receptacle for the coupling ball 16 of the joint rod, but on the other hand outside on both sides partially spherical curves 12 c has, so at the articulated opening movement of the upper jaw 12 relative to the lower jaw 1 1 in the joint results in a positive connection and a guide.

The cross section through the upper jaw 12 is shown in FIG. It can be seen that the upper jaw 12 is rounded on the upper side, while it is flat on the underside, since it rests there on the top of the lower jaw 11 in the closed state. The bottom view according to FIG. 6 shows that the upper jaw 12 is somewhat wider in the region facing the joint in front of the cross section BB, then a section towards the distal end follows with approximately constant width and then the upper jaw 12 tapers towards the top 12 b and thereby describes a slight arc.

The lower jaw 11 is described below with reference to FIGS. 10 to 14, which, like FIG. 10, has a similar outline shape in the front sections as described above for the upper jaw 12, towards the tip Tapered and bent slightly to the side. On the upper side, the lower jaw 11 is flat, while it is rounded on the underside, as the cross section C-C illustrated in FIG 14. Furthermore, the lower jaw 1 1 is longer than the upper jaw 12, since the former extends beyond the hinge portion 11 a, which is shown in the section DD of Figure 13, further to the rear (ie towards the proximal end of the instrument out), wherein There, the lower jaw 1 1 is formed as a hollow shaft 18, as can be seen also on the basis of the cross section EE, which is shown in Figure 12. It can also be seen from FIGS. 10 and 11 that the lower clamping jaw 11 has a stop region 19 in the region which lies distally in front of the joint region 11a and serves as a stop for the sleeve 14 which can be pushed over the lower clamping jaw 11. In this context, reference is also made to FIG. 1, which shows the assembled state, which shows the end position of the sleeve 14 pushed over the joint area. By comparison with Figures 10 and 11, it will be understood where the slidable sleeve 14 is seated on the lower jaw 1 1, since it covers the thickened portion of the lower jaw stem up to the heel 20 where the section EE of Figure 12 is located ,

Proximally behind this paragraph 20, the hollow shaft 18 has a smaller diameter. In the proximal rear portion of the shaft of the lower jaw 1 1 is also a bayonet 23, so that one can attach the shank of the lower jaw and thus the Overholt to a tubular shaft or the like of a laparoscopic instrument, by which the handling of the opening function of the jaws 11, 12 and the medical instrument in total. The articulated rod 13 shown by itself in FIG. 15 with its coupling ball 16 at the front end has a rear proximal thickened shaft portion 21 which is guided in the hollow shaft 18. Since this shaft portion 21 is thickened, it is approximately suitably received and guided in the tubular cavity 22 (see FIG. 12) of the hollow shaft 18, while the front portion 13 between the thickened shaft portion 21 and the coupling ball 16 is narrower in diameter and therefore in the hollow shaft 18 has a certain play, so that it is possible, the joint rod 13 in the hollow shaft 18 in the radial direction to move slightly to actuate the joint and to move the two jaws 1 1, 12 apart, wherein the hinge rod 13 is slightly curved to produce a lever, as can be seen from Figure 4 well. In Figures 16 and 17, the sleeve 14 is shown by itself. It can be seen that, in principle, it is a tubular, hollow-cylindrical component which is open at its two axial ends. Only at the distal end 14 a of the sleeve 14 is a side view approximately rectangular recess 14 b on the circumference of the sleeve 14, which is there to make the mobility of the upper jaw 12 in the joint area safe.

LIST OF REFERENCE NUMBERS

10 medical instrument

11 lower jaw

1 1 a joint area

12 upper jaw

12 a joint fork

12 b tip

12 c Rounding / Teilkugelanformung 13 joint rod

14 sleeve

14 a distal end

14 b rectangular recess

15 sawtooth profile

16 coupling ball

17 bowl-shaped receptacle / ball seat

18 hollow shaft

19 stop area

20 paragraph

21 thickened shaft section

22 tubular cavity

23 bayonet area

Claims

claims

Medical instrument for endoscopic procedures in minimally invasive surgery, which is introduced via a trocar into the abdominal cavity of a patient and to its distal end has a functional unit in the form of a gripping element, said functional unit is operated via an operating unit at the proximal end of the instrument in which the gripping element is designed as a dissecting clamp with two clamping jaws (11, 12) which are articulated by means of a joint mechanism, wherein the articulation mechanism comprises an articulated rod (13) which can be displaced in the axial direction with an end coupling ball (16), the medical instrument furthermore has a first pivotable shorter jaw (12), which has a ball seat (17) for the coupling ball (16) of the joint rod (13), and a second longer jaw (1 1), which is provided with a hollow shaft (18), in which joint staff

(13) is axially displaceably guided, characterized in that the medical instrument further comprises a sleeve (14) which is removable from the medical instrument and which is pushed onto a shaft portion of the second longer jaw (1 1), such that they extends to the hinge region of the articulated connection of the two jaws (11, 12) and that after removing the sleeve

(14) of the shaft portion of the second longer jaw (11), the two jaws (11, 12) and the joint rod (13) are removable.

Medical instrument according to claim 1, characterized in that the second longer clamping jaw (11) further comprises a positive reception for Teilkugelanformung (12 c) in the joint region of the shorter jaw, so that the shorter jaw (12) during its pivotal movement in this recording of longer jaw (11) is guided and held.

Medical instrument according to claim 1 or 2, characterized in that in the hinge region of the shorter clamping jaw (12) a joint fork is provided, which forms the ball seat (17) for the coupling ball (16) of the joint rod (13).

Medical instrument according to one of claims 1 to 3, characterized in that the hollow shaft (18) is formed by an axial extension of the second longer jaw (11) towards the proximal end of the instrument.

5. Medical instrument according to one of claims 1 to 4, characterized in that the hollow shaft (18) has a proximal portion in which a preferably thickened trained area (21) of the joint rod (13) is guided approximately positively.

Medical instrument according to claim 5, characterized in that adjoining the thickened region (21) of the joint rod towards the distal end is a shaft region of the joint rod (13) of smaller diameter, at the distal end of which the coupling ball (16) of the joint rod ( 13) is located.

Medical instrument according to claim 6, characterized in that the shank region of the joint rod (13) with a smaller diameter is formed slightly curved in itself.

A medical instrument according to any one of claims 1 to 7, characterized in that the sleeve (14) is detachable from the shaft portion of the second longer jaw (11) by being withdrawn toward the proximal end of the instrument.

Medical instrument according to one of claims 1 to 8, characterized in that the second longer clamping jaw (11) has a stop region for the end position of the pushed sleeve (14).

10. Medical instrument according to one of claims 1 to 9, characterized in that at the distal end (14 a) of the sleeve (14) has a side view approximately rectangular recess (14 b) on the circumference of the sleeve (14), which is there to ensure the mobility of the upper jaw (12) in the joint area.

11. Medical instrument according to one of claims 1 to 10, characterized in that the sleeve (14) is closed over its circumference, preferably up to a distal region (14 a), in which a rectangular recess (14 b) is located.