WO2023006677A1 - Procédé de mise en forme et/ou de fixation de fils de guidage sur une plaque circulaire spatialement réglable, fils de guidage pour déplacer un mécanisme d'articulation côté distal, instrument médical et robot - Google Patents

Procédé de mise en forme et/ou de fixation de fils de guidage sur une plaque circulaire spatialement réglable, fils de guidage pour déplacer un mécanisme d'articulation côté distal, instrument médical et robot Download PDF

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Publication number
WO2023006677A1
WO2023006677A1 PCT/EP2022/070819 EP2022070819W WO2023006677A1 WO 2023006677 A1 WO2023006677 A1 WO 2023006677A1 EP 2022070819 W EP2022070819 W EP 2022070819W WO 2023006677 A1 WO2023006677 A1 WO 2023006677A1
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WO
WIPO (PCT)
Prior art keywords
steering
insert component
proximal
spatially adjustable
medical instrument
Prior art date
Application number
PCT/EP2022/070819
Other languages
German (de)
English (en)
Inventor
Dominik Längle
Janosz SCHNEIDER
Jochen Stefan
Sven Axel Grüner
Original Assignee
Karl Storz Se & Co. Kg
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
Application filed by Karl Storz Se & Co. Kg filed Critical Karl Storz Se & Co. Kg
Priority to EP22757865.5A priority Critical patent/EP4376754A1/fr
Publication of WO2023006677A1 publication Critical patent/WO2023006677A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A61B34/71—Manipulators operated by drive cable mechanisms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A61B34/71—Manipulators operated by drive cable mechanisms
    • A61B2034/715—Cable tensioning mechanisms for removing slack

Definitions

  • the invention relates to a method for reshaping and/or for attaching steering wires to a spatially adjustable disc, with a distal-side joint mechanism for bending a distal end section of a medical instrument being movable by means of the steering wires. Furthermore, the invention relates to steering wires for moving a distally mounted joint mechanism for angling a distal end section of a medical instrument, a medical instrument and a robot.
  • bendable instruments are often used, which are handheld and/or robotic instruments can be trained.
  • four or more external steering wires and/or steering cables are usually arranged around pivoting members of a joint mechanism on the distal side.
  • the use of a large number of thin steering wires is advantageous in order to enable uniform movement and force distribution in all bending directions.
  • the guide wires must be fixed in a tensioned state on the distal side (far from the user) and proximally (close to the user).
  • US 2017/0281296 A1 discloses a medical instrument with steering cables for moving an end effector, in which the steering cables are guided through openings in a gimbal plate and a locking plate, which each have locking wedges on the opposite sides The cardan plate and the locking plate clamp the steering cables by moving them. The gimbal plate and the locking plate are then screwed together for fixation.
  • the disadvantage here is that manufacturing tolerances when manufacturing the gimbal plate and the locking plate mean that the tensions with which the steering cables are fixed can vary. There is also a risk that the steering cables could be damaged by sharp edges on the cardan plate and the locking plate and/or by pinching. This has the disadvantage that the individual strands of the steering cable fray and thus significantly disrupt or complicate assembly.
  • each steering wire must first be individually pretensioned and then screwed to the swashplate. In addition to being very time-consuming, this can also lead to pre-damage of the steering wires. Furthermore, the threaded bores on the swash plate and the corresponding screws, which are usually inserted and attached in and on the radially circumferential side wall of the swash plate, require a large amount of space.
  • the object of the invention is to improve the prior art.
  • the problem is solved by a method for forming and/or for attaching steering wires to a spatially adjustable disc, using the steering wires a joint mechanism on the distal side can be moved to bend a distal end section of a medical instrument, the guide wires have a material hardness and the spatially adjustable disc has a hole with a cross-section through a thickness of the spatially adjustable disc for each guide wire, by means of an insert component with the following steps:
  • the insert component on a proximal side of the spatially adjustable disk, the insert component having holes corresponding to the holes in the spatially adjustable disk and a material hardness equal to or greater than the material hardness of the steering wires,
  • This provides a method for quickly and easily mounting the steering wires to a spatially adjustable disk and attaching the proximal ends of the steering wire by forming in combination with the very hard insert component.
  • the steering wires can be connected to the spatially adjustable disk in a tensioned state. Consequently, steering wires are provided which are optimally fixed to the proximal side of the spatially adjustable disc with a fixed, predetermined tension in the tensioned state. Thanks to the reproducible forming of the steering wire ends, the steering wires are fixed uniformly and are consequently pretensioned homogeneously.
  • a proximal drive movement on the spatially adjustable disk with means of the attached and tensioned steering wires is optimally applied to the distal components transmitted to a distal joint mechanism for bending the distal end portion of the medical instrument's.
  • the steering wires can be fastened to the spatially adjustable disk with the aid of the insert component. Because the insert component has the same or greater material hardness than the steering wires, cutting and/or settling of the steering wires in the fastening area is prevented by the optimum material pairing.
  • a core idea of the invention is that the respective end of the steering wire is formed into a final shape by means of the forming tool, the final shape being larger in one dimension in cross section as a result of the forming than the cross-sectional area of the respective corresponding hole in the insert component and the respective hole in the spatially adjustable disc and the final form under tension of the steering wires directly on the insert component with the same or higher material hardness.
  • proximal guide wire ends into a final shape with a dimension with a larger cross section than the cross section of the hole consequently prevents the individual guide wires from being pulled in the direction of the distal side through the corresponding holes of the insert component and the spatially adjustable disk .
  • the steering wires are not attached directly to the spatially adjustable disk, but rather indirectly on the proximal side by means of reshaping with the aid of the insert component.
  • the distal sides of the reshaped final shape as the proximal end of the steering wire rest against the proximal side of the insert component, which has a hardness that is the same as or greater than the final shape.
  • the end forms of the steering wire ends each rest on the insert component with the same or higher material hardness and the steering wires are attached indirectly to the spatially adjustable disk allows a free choice of material for the spatially adjustable disk itself. This means that it does not have to be made from a material that is difficult to machine and/or join, such as Nitinol, or from a hardened material.
  • the three-dimensionally adjustable disc itself can be manufactured from a significantly softer and therefore more economical, lighter and easier to machine material.
  • the guide wires are fastened on the proximal side by means of the insert component and the proximal guide wire ends formed into final shapes, whereby, depending on the thickness of the insert component, the length of the shaft and/or the joint mechanism in the longitudinal direction may be slightly, if at all, is extended, but the overall size is not increased in the radial direction and/or at the beginning of the spatially adjustable disk.
  • This indirect connection of the steering wires with the spatially adjustable disk in the proximal longitudinal direction can thus be optimally integrated into an instrument shaft whose cross-section is limited from the outset due to the application.
  • a "steering wire” is a thin and long shaped pliable metal and/or metal alloy.
  • a steering wire has in particular a nickel-titanium alloy and thus nitinol.
  • a steering wire is preferably made entirely of Nitinol.
  • a steering wire can have any cross-sectional shape, for example a circular, oval and/or curved cross-section, a flat-edged, square or profiled wire cross-section.
  • the steering wire preferably has a round cross section.
  • a steering wire can also be a steering cable which has a plurality of wires, in particular braided or twisted wires.
  • the steering wires are arranged radially on the outside around pivoting links and/or link bodies, by means of which a delicate bending of the distal end section is realized.
  • a movement of the spatially adjustable disc caused by a proximal drive is converted into a corresponding relative movement of the pivoting members on the distal side via the steering wires connected to the disc, which are tensioned along the longitudinal direction of the shaft up to the distal ends of the steering wire fixed in the distal end section thus causing the distal end portion to bend.
  • a large number of thin steering wires are used in particular for fine motor control of the distal end section of the medical instrument in order to achieve a more even force distribution and thus relative movements in all possible bending directions.
  • a “joint mechanism” has in particular a “distal joint mechanism” and a “proximal joint mechanism”.
  • the “proximal-side joint mechanism” has in particular the insert component, the spatially adjustable disc, associated shafts and the proximal-side steering wire sections.
  • the steering wires On the distal side of the proximal joint mechanism, the steering wires in particular are brought together, for example via a guide ring or a serrated washer in the direction of the distal tip, at a closer spacing of the steering wires from the longitudinal axis of the shaft, so that they essentially enter parallel at the proximal end of the shaft and are guided within the shaft up to the distal end section.
  • the diameter of the steering wires radially surrounding the longitudinal axis of the shaft narrows from 18 mm to 4 mm.
  • the associated shaft of the spatially adjustable disk is connected to a main shaft in the distal direction, with the latter being able to rotate the shaft.
  • the joint mechanism can be arranged in particular in the transition between the hand and/or holding part of the medical instrument and the shaft or in the hand and/or holding part.
  • the "distal-side joint mechanism" has in particular the distal-side Steering wire sections and the pivoting links and / or link body, through which an angling of the distal end portion can be realized.
  • a “spatially adjustable disk” (also called “swash plate”) is in particular a disk which is mounted in such a way that when it is moved by a proximal drive relative to the center of the disk, it causes an outer pivoting movement transverse to the longitudinal axis through the disk and thus an up and down movement on both sides Ab movement (tumbling movement) performs.
  • the swash plate has a cardanic bearing.
  • the spatially adjustable disk is connected in particular to a ball joint on the distal side or a ball joint on the distal side and a ball joint on the proximal side or a ball joint on the distal side.
  • the steering wires are routed through the thickness of the spatially adjustable disc.
  • the upper section of the swash plate when viewing the shaft in longitudinal cross-section, the upper section of the swash plate, transverse to the longitudinal direction of the shaft, is shifted towards the distal end, while the lower section is shifted toward the proximal end, whereby due to the corresponding movement of the steering wires fixed to the swash plate distal end portion is angled down accordingly. Consequently, depending on the arrangement of the tensioned and fixed steering wires on the swash plate, some steering wires are simultaneously pushed and other steering wires are pulled by pivoting movement of the swash plate.
  • a "medical instrument” is in particular any mechanical or mechanical-electrical active unit that is suitable for the diagnosis and/or treatment of humans or animals.
  • the medical instrument is used in particular to inspect a human or animal body cavity and/or to manipulate human or animal tissue.
  • the medical instrument has a handle or handpiece, a shaft and a tool and/or an optical system for viewing a viewing area.
  • the medical instrument can in particular have a gripping tool, a cutting tool, a needle holder, a clip setter and/or a different type of tool.
  • a medical instrument is, for example, an endoscope with a long shaft and an end section that can be bent.
  • the medical instrument can be a hand-held and/or hand-guided instrument.
  • the medical instrument can also be used as a End effector arranged on a robotic arm of a surgical robot and thus be a robotic instrument.
  • the "shank" of the medical instrument is designed in particular as an elongated tube.
  • the shaft has a diameter in a range from 2 mm to 10 mm.
  • the shaft can have further components, such as an optical waveguide for illuminating the object field, a working channel or several working channels for supplying rinsing fluid or a tool, such as a biopsy needle or an electrode.
  • a central actuation element for example a pull/push cable, for actuating a tool, for example a jaw part, can be arranged on the bendable, distal instrument tip from its proximal to distal end inside the shaft.
  • a "proximal drive” is a drive unit for acting and thus pivoting the spatially adjustable disc.
  • the drive movement of the proximal drive is converted into a pivoting movement of the spatially adjustable disk and, through the steering wires attached to the spatially adjustable disk, to a corresponding relative movement of the distal-side pivoting links and/or link bodies for pivoting the end section of the medical instrument.
  • the proximal drive can be a manual drive, for example by rotating an actuating element, or it can be a motorized drive. In the case of a motorized drive, this has one motor or several motors and/or a transmission, such as driven gears.
  • the proximal drive is arranged in particular in the hand and holding part.
  • an "actuating unit” is in particular a component or consists of several components which act on the proximal drive.
  • an actuation unit can have one or more actuation elements.
  • the actuating elements can be, for example, a push button or a rotary wheel, by means of which movement the proximal drive is actuated.
  • an actuating element of the actuating unit can also be an electronic control signal.
  • the actuation unit can be a manually actuable handle or a structural unit that is designed for robotic use and can be actuated without manual action.
  • a "hole” is in particular a usually round breakthrough through the thickness of the spatially adjustable pane. The hole can be made in the spatially adjustable pane, for example by means of laser or water jet cutting or drilling.
  • the holes can also be introduced directly during manufacture of the spatially adjustable pane and thus during the shaping process, such as casting or sintering.
  • the hole does not necessarily have to have a round cross section, but can also have a non-round shape or a shape adapted to the shape of the steering wire.
  • Each hole has a cross-section that is larger than the outer diameter of the steering wire that is passed through the respective hole.
  • a “corresponding hole” is a hole as defined above in terms of shape and design, but this hole is made through the thickness of the at least one insert component in the longitudinal direction of the shaft.
  • “Corresponding” means that the corresponding holes of the spatially adjustable disc and the insert component, through which the same end of the steering wire is guided, are one above the other when viewed in the longitudinal direction and / or the center point of these two holes is aligned in a straight line, in particular in a straight line parallel to the longitudinal axis of the shaft.
  • an “insert component” is in particular a component which is arranged on the proximal side of the spatially adjustable disk in the longitudinal direction of the shaft.
  • the insert component is inserted between the formed final shapes of the steering wires and the proximal side of the spatially adjustable disk, in particular after the proximal steering wire ends have been shaped.
  • the insert component can be made in one piece or two or more insert components can be used.
  • the insert component has a material hardness that is greater than or equal to the material hardness of the steering wires.
  • the insert component has in particular a cross-section which is larger than the cross-section of the respective hole or holes of the spatially adjustable disk.
  • the insert component has its own corresponding holes, in particular corresponding to the hole or holes of the spatially adjustable disk.
  • An insert component is in particular a hardened material, for example steel. Hardening results in a targeted increase in the mechanical resistance of the material by changing and transforming its structure. Hardening can be done, for example, by heat treatment followed by quenching.
  • the insert component can also have ceramic and/or hard metal.
  • a “termination shape” is in particular a deformed shape of each proximal steering wire end, which has a larger maximum cross section than the cross section of the corresponding hole of the insert component.
  • the final shape is in particular formed directly from the material of the respective proximal end of the steering wire by reshaping.
  • additional material for example in the form of a sleeve slipped over the proximal end of the steering wire, can be added before the shaping and shaped together with the end of the steering wire.
  • the shaping to form the final shape does not have to take place directly at the proximal end of the steering wire, but can be carried out at any position of a steering wire, with the steering wire being cut off the proximal end of the final shape after shaping into the final shape, so that a proximal end of the steering wire is present .
  • the final shape created by forming can have any geometric shape and/or spatial progression and only has to have a cross section at one point and/or dimension that is larger than the corresponding hole in the insert component and/or the hole in the spatially adjustable one disc is.
  • the final shapes of the formed steering wires can all be the same or different shapes.
  • the dimension with a larger cross-section is achieved in a steering wire with a round cross-section, for example, by flattening the steering wire so that the round cross-section becomes flatter in the pressing direction and wider transversely to the pressing direction.
  • the final shape of the steering wire formed in this way no longer fits through the respective associated hole in the insert component and the spatially adjustable disk.
  • the “material hardness” is in particular a mechanical resistance that a material opposes the mechanical penetration of another body.
  • the material hardness not only characterizes the resistance to harder bodies, but also to softer bodies or bodies of the same hardness.
  • the material hardness is also a measure of the wear behavior of materials.
  • the material hardness can be specified according to various hardness test methods and hardness scales.
  • the material hardness is specified in Rockwell in particular as an internationally used unit of measurement for the hardness of technical materials with the abbreviation HR (Hardness Rockwell) and a suffixed letter to identify the respective test method, with the letter indicating the scale and thus the test forces and test specimens.
  • Forming is understood to mean, in particular, a manufacturing process in which a change in shape is introduced in a targeted manner.
  • the respective proximal end of the steering wire is specifically formed into a final shape of the respective steering wire.
  • Forming includes, in particular, wire forming and/or solid forming.
  • the forming can take place in particular by rolling, open-die forging, drop forging, pressing, pressing, pressing in, clamping, twisting and/or bending.
  • the forming can be cold forming, semi-hot forming and/or hot forming. The cold forming is carried out in particular below the recrystallization temperature of the material of the end of the steering wire.
  • the end of the steering wire is heated, but to a temperature below the recrystallization temperature.
  • the steering wire end is heated to a temperature above the recrystallization temperature of the material of the steering wire end prior to forming, which causes recrystallization during forming.
  • a corresponding forming tool is used for forming.
  • a hardened metal, a hardened metal alloy, a hard metal and/or a ceramic material is used as the material of the insert component.
  • the insert component can thus be made from a metal and/or a metal alloy and/or hardened in a simple manner, the only requirement being that the material hardness of the material of the steering wires is greater than or equal to the material of the insert component.
  • the insert component can be made of a hard metal and thus a metal matrix composite material and/or a ceramic material. It is particularly advantageous that the insert component can be produced from a correspondingly hard material in a simple manner in terms of production technology.
  • a nickel-titanium alloy is used as the material for the steering wires and/or the insert so that the steering wires can withstand a large load and are very robust to alternating stress due to their superelastic properties, and so that the insert component can be designed with at least an equivalent material hardness.
  • a nickel-titanium alloy also called nitinol
  • an optimal attachment of the steering wires can be achieved using the process on the spatially adjustable disc.
  • the steering wires can in particular also be made of stainless steel.
  • the steering wires are preferably made of nitinol in particular, while the insert component can optionally also be made of nitinol or another material, such as a powder metallurgical steel with a material hardness of 64 HRC to 67 HRC or hardened carbon steel.
  • a powder metallurgical steel with a material hardness of 64 HRC to 67 HRC or hardened carbon steel such as a powder metallurgical steel with a material hardness of 64 HRC to 67 HRC or hardened carbon steel.
  • the material Nitinol has a material hardness of about 64 HRC.
  • the spatially adjustable disc itself cannot be manufactured from such a hard material and subsequent hardening of the spatially adjustable disc is difficult or impossible to achieve, the steering wires made of nitinol would get stuck, especially at a respective fastening point Cut into a spatially adjustable disk and the wire tension of the steering wires would decrease in the joint mechanism over the course of the period of use.
  • this cutting is prevented precisely by the fact that the insert component with a material hardness of > 64 HRC is inserted between the spatially adjustable disc and the formed steering wire ends, which means that the formed steering wire ends are not cut due to the attachment via the respective final shape on the insert component is prevented.
  • a “nickel-titanium alloy” is in particular a nickel-titanium intermetallic compound.
  • a nickel-titanium alloy is in particular nitinol.
  • “Nitinol” is an intermetallic phase NiTi with an ordered, cubic crystal structure that differs from titanium and nickel.
  • the nickel-titanium alloy and nitinol usually have a slightly larger proportion of nickel, for example 55%, and titanium.
  • Nitinol can also contain 50% nickel and 50% titanium and/or other alloy ratios and/or small amounts of additional alloy components.
  • Nitinol has in particular a thermal shape memory and superelasticity.
  • Nitinol steering wires are produced in particular by means of drawing through, with the wire being soft-annealed between the drawing processes.
  • Nitinol can be shaped, for example, by grinding or electroerosion. Due to its super-elastic properties, steering wires made of nitinol can be bent more than steering wires made of stainless steel, for example. In addition, the Nitinol steering wires can be bent several times, but still remain controllable. In addition, Nitinol maintains its shape under tension and is kink resistant.
  • Nitinol when using Nitinol for the steering wires, the specific properties, such as thermal shape memory and mechanical shape memory as superelasticity, can be exploited. It is particularly important to note that nitinol alloys return to their original shape after plastic deformation if they are heated above their transformation temperature. However, in order to achieve the optimum superelastic properties of Nitinol, a heat treatment at 350°C to 600°C can be carried out after cold working.
  • the transformation temperature of nitinol is usually not critical in medical technology for the purpose of forming to achieve the superelastic properties in particular, since the transformation temperature is usually below the application temperature.
  • Nitinol steering wires for example, can be cold-formed without heat treatment. The steering wire can also, for example, be drawn, soft-annealed and then the end of the steering wire can be cold-formed. The brittleness of nitinol in particular can be reduced by means of a preceding heat treatment.
  • the material of the steering wires and the insert component can have the same nickel-titanium alloy.
  • a one-piece or multi-piece insert component is used.
  • the assembly can be further simplified by using a two-part or multi-part insert component.
  • the two or more insert components can take up a smaller area than the proximal end face of the spatially adjustable disk, so that material is saved and/or the force distribution is adjusted in a targeted manner.
  • the entire contact surface on the proximal side of the spatially adjustable disk does not have to be covered with one or more insert components, but two or more insert components can be arranged locally in the area of the holes of the spatially adjustable disk.
  • a two-part insert component can be two half rings, for example.
  • a “multi-part insert” is functionally an insert as defined above, but the insert has two or more components or includes two or more inserts.
  • a ring is used as the insert component.
  • the insert component in the form of a ring, this can be designed with its inner diameter and outer diameter of the same shape and completely adjacent to the proximal end face of the spatially adjustable disc, whereby an optimal contact surface between the two is realized.
  • the ring in particular a wire retaining ring, preferably has the corresponding holes so that the proximal steering wire ends are guided through the holes in the spatially adjustable disk and through the corresponding holes in the ring and are formed on the proximal side of the ring to form the final shapes.
  • a ring does not necessarily have to be circular in shape, but can also have a hexagonal shape, for example.
  • the respective steering wire ends are formed into the respective final shape in the form of a wedge, a cube, a cuboid, a trapezoid, a sphere, a cone, a cylinder and/or a pyramid.
  • the respective end of the steering wire can be formed into any final shape, as long as the final shape has a cross-section larger than the corresponding hole and/or the hole at a position in its longitudinal direction. It is particularly advantageous if the respective form of termination on the distal side is either flat, has a homogeneous end face which rests against the surface of the insert component, or if the end shape widens conically from its distal end to a larger diameter, for example, so that when the guide wire is tensioned and the end shape is pulled in the distal direction to the corresponding hole, a defined blocking occurs .
  • a sleeve is clamped onto the respective steering wire as an alternative to reshaping.
  • a sleeve can additionally be placed on the respective end of the steering wire before the forming, with the sleeve forming the end of the steering wire after the forming.
  • the sleeve and the steering wire end are formed together.
  • a “sleeve” is in particular a solid, tubular body which at least partially encloses the proximal end of the steering wire. At least on the distal side, the sleeve has an opening for inserting the respective proximal steering wire end or steering wire.
  • the shaped sleeve preferably represents the proximal end of the steering wire after the shaping.
  • the steering wire protruding on the proximal side can be cut off and/or removed after the shaping.
  • the proximal end face of the sleeve can be open and/or closed. In principle, the sleeve can be deformed partially or completely.
  • the sleeve is in particular a hardened sleeve with a material hardness greater than or equal to the material hardness of the steering wires.
  • the spatially adjustable disc is inserted with a ball shaft on the distal side into a main shaft of the proximal side joint mechanism before forming and after forming the steering wire ends to pretension the attached steering wires, the spatially adjustable disc is inserted partially pulled out of the main shaft in the proximal direction with the ball shaft on the distal side.
  • a "ball shaft” is in particular a shaft with a ball joint.
  • the spatially adjustable disk (swash plate) has, in particular, a spherical shaft on the proximal side for transmitting the drive movement of the proximal drive to the spatially adjustable disk in the form of a pivoting movement.
  • the swash plate has in particular a special recording for sliding on the ball head of the ball shaft and thus a movable recording about all axes.
  • the spatially adjustable sheave has a distal-side spherical shaft for biasing the fixed steering wires on the spatially adjustable sheave to connect to the mainshaft and/or transmit movement to the mainshaft.
  • the object is achieved by steering wires for moving a distal-side joint mechanism for angling a distal end section of a medical instrument, the steering wires being attached to a spatially adjustable disc by means of a previously described method.
  • steering wires indirectly connected to a spatially adjustable disc are provided, which are connected in the state of tension due to a frictional connection by means of the termination forms on the proximal sides of the steering wires and the insert component without cutting and setting behavior.
  • these steering wires are therefore suitable for stepless and very fluid control of the distal joint mechanism for bending the distal end section of the medical instrument.
  • a shaft with steering wires is provided, the steering wires being fastened according to the method described above, which allow an optimally controllable joint mechanism in the shaft due to the homogeneous indirect connection and uniform, defined tension.
  • the shaft can be releasably connected to a hand and/or holding part of a medical instrument and/or can be reused or is designed for single use.
  • a medical instrument with an elongated shaft, an actuating unit for actuating a proximal drive being arranged at a proximal end of the shaft and an end section being arranged at a distal end, the end section being actuated by means of a distal the joint mechanism on the proximal side can be bent relative to the longitudinal axis of the shaft, several steering wires are guided through the elongated shaft and connect the drive on the proximal side with the joint mechanism on the distal side, with the drive on the proximal side being able to act on a spatially adjustable disk, and each steering wire with its pro ximal end of the steering wire is guided through a hole with a cross section through a thickness of the spatially adjustable disk and through a respective corresponding hole of an insertion component arranged proximally on a proximal side of the insertion component and the proximal steering wire ends each have a final shape with a measurement from a
  • the guide wires and/or the insert component each have a nickel-titanium alloy.
  • the spatially adjustable disc can have stainless steel, a stainless steel alloy, aluminum and/or plastic.
  • the object is achieved by a robot with at least one robot arm for holding and/or positioning a medical instrument and/or with an actuator for controlling a distal-side joint mechanism of the medical instrument, the medical instrument having a previously described medical instrument is, so that the medical instrument by means of at least one robot arm can be positioned and/or the distal joint mechanism can be actuated by the action of the robot's actuator on the proximal drive of the medical instrument.
  • the steering wires attached to a spatially adjustable disc can be used not only in a hand-held medical instrument but also in a robotically guided instrument.
  • the robot ensures that the medical instrument is held firmly at the end of the at least one robot arm and that the medical instrument is precisely positioned.
  • the joint mechanism and the bending of the distal end section of the medical instrument as an end effector can be performed very precisely via an input device on the robot, for example by means of a joystick on a control console and/or input handles of the robot attached to the hand.
  • the proximal drive of the medical instrument can also be arranged in the distal end of the robot arm and a coupling and/or interface between the distal end of the robot arm and the holding unit of the medical instrument can be designed accordingly.
  • a “robot” is in particular a medical and/or surgical robot.
  • a robot is in particular a surgical robot.
  • the robot is usually a telemanipulator, which uses the input and/or operating elements of the surgeon on the one hand to control the medical instrument as an end effector on the other hand at the end of a robot arm.
  • the robot preferably has a plurality of robot arms, with a camera, in particular a three-dimensional camera, being arranged on one robot arm and one or more interchangeable medical instruments on the robot arm or the other robot arms.
  • each robot arm is designed to be movable on 3 to 8 axes. Instead of a robot with several arms, it is of course also possible to use several robots, each with one arm or only two arms, which are controlled together.
  • the camera can also be held endoscopically or exoscopically.
  • the proximal drive of the medical instrument can be actuated by means of the actuator of the robot arm through a coupling and/or interface between the end of the robot arm which holds the medical instrument and the medical instrument.
  • an actuator any drive component or Unit are used, which converts an electrical signal into a mechanical BeWe supply.
  • Figure 1 shows a schematic three-dimensional representation of fixed steering wires on a swash plate in a proximal side view and a section B of a press wedge on a wire retaining ring
  • FIG. 2 shows a schematic, three-dimensional representation of attached steering wires on a swash plate in a distal side view
  • Figure 3 is a flow chart of a method for attaching steering wires with associated steps
  • FIG. 4 shows a three-dimensional representation of a video endoscope with a bendable tip of a shaft
  • FIG. 5 shows a highly schematic representation of a surgical robot with an endoscopic instrument attached to a robot arm.
  • a medical instrument 101 comprises a video endoscope 127, the video endoscope 127 having a handle 133 and a flexible shaft 129.
  • a plurality of operating elements 135 for operating the video endoscope 127 by a user are arranged on the handle 133 .
  • the handle 133 of the video endoscope 127 is connected to a supply hose 137, at the end of which a plug 141 is arranged.
  • the flexible shaft 129 of the video endoscope 127 has a bendable tip 131 on, which by means of an internal joint mechanism in the shaft 129 on the operating elements 135 can be bent (Figure 4).
  • a joint mechanism of the shaft 129 has an inner proximal side joint mechanism 103, which has a swash plate 109 made of stainless steel with a central steering ring 111, the swash plate 109 proximal side being internally connected to a ball shaft 121 proximal side.
  • a pivoting motion is impressed on the ball shaft 121 of the swash plate 109, which is proximal.
  • the joint mechanism has ten steering wires 105 made of nitinol, which are attached on the inside in the area of the bendable tip 131 on the distal side and are guided tensioned through the shaft 129 to the opposite end of the shaft 129 on the proximal side to the joint mechanism 103 on the proximal side.
  • the steering wires 105 are evenly distributed radially circumferentially through holes that are not visible in FIG.
  • the guide wires guided on the proximal end face of the wire securing ring 115 each have a press wedge 117 as the final shape.
  • the compression wedges 117 as the proximal end forms of the steering wires 105, are pulled against the proximal end face of the wire retaining ring 115, with a displacement of the respec gene pressing wedge 117 is prevented in the distal direction.
  • a pivoting movement which is imposed on the swash plate 109 for bending the distal, bendable tip 131, is very delicately transmitted to a distal-side joint mechanism, not shown in FIG.
  • the wire lock ring 115 is created as an insert component on the proximal end face of the swash plate 109 and thus mounted (step 203), the associated holes of the swash plate 109 and the corresponding holes of the wire lock ring 115 are each aligned through.
  • the respective proximal steering wire ends of the steering wires 105 are passed through the holes in the swash plate 109 with steering ring 111 and the corresponding holes in the wire locking ring 115, so that the steering wire ends protrude proximally on the proximal side of the wire locking ring 115 (step 205).
  • the proximal steering wire ends of the steering wires 105 are then reshaped using a pressing tool (step 207), the pressing tool applying a greater pressing force to the outer proximal end of the respective steering wire end, so that the pressing wedge 117 shown in detail B in Figure 1 is formed as the final shape .
  • the distal end of each ferrule 117 abuts the proximal side of the wire locking ring 115 .
  • the respective insert component is applied 203 and wire ends are passed through 205 and wire ends are reshaped 207 one after the other, so that steps 203, 205 and 207 are repeated 209 for each insert component and the associated steering wires.
  • an insert component is first arranged (step 203) and the steps of passing through 205 a steering wire end and shaping 207 a steering wire end are carried out directly one after the other before the next steering wire is passed through (step 205) and the corresponding steering wire end is shaped (step 207).
  • steps 205 and 207 are carried out one after the other and then repeated for each next steering wire (step 209).
  • a swash plate 109 has a ball-and-socket shaft 123 on the distal side for prestressing and for connection to a main shaft (not shown) and a ball-and-socket shaft 121 on the proximal side.
  • the swashplate further includes a central steering ring 111, holes 113 for each of the ten nitinol steering wires 105, and the wire retaining ring 115 proximally. At the proximal end of the steering wires 105, these are each secured with a sleeve pressing wedge 119.
  • For Ferti gene of each sleeve press wedge 119 was a hardened sleeve on each placed on the proximal end of the steering wire and formed together with the end of the steering wire using the pressing tool (see Figure 2).
  • an endoscopic instrument 301 is designed as the end effector of a surgical robot 341 .
  • the surgical robot 341 has a base 347 with four robot arms, only the one robot arm 343 which holds the endoscopic instrument 301 being shown in FIG.
  • the proximal-side joint mechanism 103 shown in Fig. 1 is arranged in a shaft 329 of the endoscopic instrument 301, with the endoscopic instrument 301 having a bendable tip 331 with a jaw tool 335 at its distal end (jaw tool 335 is shown in Fig 5 enlarged and not drawn to scale).
  • the endoscopic instrument 301 has a holding unit 333 which is held at the end of a robot arm 343 of the surgical robot 341.
  • An interface 345 is arranged between the holding unit 333 of the endoscopic instrument 301 and the end of the robot arm 334 for the purpose of coupling, at which an internal actuator of the surgical robot 341 (not shown in Figure 5) actuates a likewise internal proximal drive of the endoscopic instrument 301 becomes.
  • This imparts a pivoting movement to swash plate 109 via ball shaft 121 on the proximal side, whereby the connection of steering wires 105 to wire retaining ring 115 located proximal to swash plate 109 by means of pressure wedges 117 and the state of tension in steering wires 105 cause the induced pivoting movement is transferred to the bendable tip 331 in a corresponding bending movement.
  • a medical instrument 101 with a video endoscope 127 and a surgical robot 341 with an endoscopic instrument 301 are provided, in which by reshaping the proximal steering wire ends of the steering wires 105 to terminal forms 117, 119 a stepless, homogeneous and fluid movement of the respective bendable tip 131, 331 is effected.
  • the invention relates to a method for forming and / or for attaching steering wires to a spatially adjustable disc, using the steering wires a distal side Joint mechanism for angling a distal end section of a medical instrument is movable, the steering wires have a material beard and the spatially adjustable disc has a hole with a cross-section through a thickness of the spatially adjustable disc for each steering wire, by means of an insert component with the following steps:
  • the insert component on a proximal side of the spatially adjustable disk, the insert component having holes corresponding to the holes in the spatially adjustable disk and a material hardness equal to or greater than the material hardness of the steering wires,
  • the invention relates to steering wires, a medical instrument and a robot.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Robotics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Manipulator (AREA)

Abstract

L'invention concerne un procédé de mise en forme et/ou de fixation de fils de guidage sur une plaque circulaire spatialement réglable, selon lequel, au moyen des fils guides, un mécanisme d'articulation côté distal servant à faire pivoter une section d'extrémité distale d'un instrument médical peut être mis en mouvement, les fils de guidage présentant une dureté de matériau et la plaque circulaire spatialement réglable présentant pour chaque fil de guidage un trou ayant une section transversale à travers une épaisseur de la plaque circulaire spatialement réglable, ledit procédé faisant intervenir un élément d'insertion et comprenant les étapes suivantes : - mise en place de l'élément d'insertion sur un côté proximal de la plaque circulaire spatialement réglable, l'élément d'insertion présentant des trous correspondants aux trous de la plaque circulaire spatialement réglable et une dureté de matériau égale ou supérieure à la dureté de matériau des fils de guidage, - introduction des extrémités respectives des fils de guidage à travers les trous respectifs de la plaque circulaire spatialement réglable et les trous correspondants de l'élément d'insertion, de sorte que les extrémités des fils de guidage respectivement introduites font saillie sur un côté proximal de l'élément d'insertion, - mise en forme des extrémités des fils de guidage au moyen d'un outil de mise en forme, de façon que les extrémités des fils de guidage présentent chacune une forme finale possédant une dimension de section transversale plus grande que la section transversale des trous respectifs, les fils de guidage étant fixés sur la plaque circulaire spatialement réglable. L'invention concerne en outre des fils de guidage, un instrument médical et un robot.
PCT/EP2022/070819 2021-07-28 2022-07-25 Procédé de mise en forme et/ou de fixation de fils de guidage sur une plaque circulaire spatialement réglable, fils de guidage pour déplacer un mécanisme d'articulation côté distal, instrument médical et robot WO2023006677A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
EP22757865.5A EP4376754A1 (fr) 2021-07-28 2022-07-25 Procédé de mise en forme et/ou de fixation de fils de guidage sur une plaque circulaire spatialement réglable, fils de guidage pour déplacer un mécanisme d'articulation côté distal, instrument médical et robot

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102021119517.9A DE102021119517A1 (de) 2021-07-28 2021-07-28 Verfahren zum Umformen und/oder zum Befestigen von Lenkdrähten an einer räumlich verstellbaren Scheibe, Lenkdrähten zum Bewegen einer distalseitigen Gelenkmechanik, medizinisches Instrument und Roboter
DE102021119517.9 2021-07-28

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WO2023006677A1 true WO2023006677A1 (fr) 2023-02-02

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EP (1) EP4376754A1 (fr)
DE (1) DE102021119517A1 (fr)
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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20150164524A1 (en) * 2008-08-04 2015-06-18 Covidien Lp Articulating Surgical Device
US20170281296A1 (en) 2001-06-29 2017-10-05 Intuitive Surgical Operations, Inc. Apparatus for pitch and yaw rotation
EP3508166A1 (fr) * 2016-08-31 2019-07-10 Beijing Surgerii Technology Co., Ltd. Instrument chirurgical flexible et unité d'entraînement associée
WO2020218920A2 (fr) * 2019-04-08 2020-10-29 Fortimedix Assets Iii B.V. Instrument orientable comprenant une partie détachable

Family Cites Families (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2013059821A2 (fr) 2011-10-21 2013-04-25 Viking Systems, Inc. Endoscope stéréoscopique électronique orientable
DE102019201277A1 (de) 2019-01-31 2020-08-06 Deutsches Zentrum für Luft- und Raumfahrt e.V. Vorrichtung zur Führung eines medizinischen flexiblen Schafts

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20170281296A1 (en) 2001-06-29 2017-10-05 Intuitive Surgical Operations, Inc. Apparatus for pitch and yaw rotation
US20150164524A1 (en) * 2008-08-04 2015-06-18 Covidien Lp Articulating Surgical Device
EP3508166A1 (fr) * 2016-08-31 2019-07-10 Beijing Surgerii Technology Co., Ltd. Instrument chirurgical flexible et unité d'entraînement associée
WO2020218920A2 (fr) * 2019-04-08 2020-10-29 Fortimedix Assets Iii B.V. Instrument orientable comprenant une partie détachable

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EP4376754A1 (fr) 2024-06-05

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