DE10159470B4 - Surgical instrument with anchor device at the head end - Google Patents

Surgical instrument with anchor device at the head end Download PDF

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Publication number
DE10159470B4
DE10159470B4 DE2001159470 DE10159470A DE10159470B4 DE 10159470 B4 DE10159470 B4 DE 10159470B4 DE 2001159470 DE2001159470 DE 2001159470 DE 10159470 A DE10159470 A DE 10159470A DE 10159470 B4 DE10159470 B4 DE 10159470B4
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Germany
Prior art keywords
sleeve
needles
anchor device
surgical instrument
head end
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Expired - Lifetime
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DE2001159470
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German (de)
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DE10159470A1 (en
Inventor
Andreas Kirschniak
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Ovesco Endoscopy AG
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Ovesco Endoscopy GmbH
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Priority to DE2001159470 priority Critical patent/DE10159470B4/en
Publication of DE10159470A1 publication Critical patent/DE10159470A1/en
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/50Instruments, other than pincettes or toothpicks, for removing foreign bodies from the human body
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/221Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • 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
    • A61B2017/00349Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/22031Gripping instruments, e.g. forceps, for removing or smashing calculi
    • A61B2017/22034Gripping instruments, e.g. forceps, for removing or smashing calculi for gripping the obstruction or the tissue part from inside

Abstract

Chirurgisches Instrument, – das an seinem Kopfende eine Ankervorrichtung aufweist – und das mittels eines biegsamen Führungsschlauches (6) endoskopisch mit der Ankervorrichtung voran in das Innere eines hohlen Organs einführbar ist, – wobei die Ankervorrichtung mittels einer Handhabe am anderen Ende des Instrumentes betätigbar ist, um die Ankervorrichtung in eine am Kopfende des Instrumentes vorhandene Hülse einzuziehen oder aus dieser auszufahren, – dass die Ankervorrichtung durch zwei oder mehrere elastisch verformbare Nadeln (3) gebildet ist, die sich in Richtung des Kopfendes der Hülse (5) von einem Grundkörper (4) hinwegerstrecken, der im Inneren der Hülse axial verfahbar gelagert ist – dass die Nadeln (3) beim axialen Zurückfahren des Grundkörpers (4) vollständig in die Hülse (5) eingezogen werden und dabei elastisch verformbar und im Inneren der Hülse (5) im Wesentlichen achsparallel ausgerichtet und positioniert sind – und dass die Nadeln (3) beim Vorfahren des Grundkörpers...Surgical instrument, - which has an anchor device at its head end - and which can be inserted endoscopically into the interior of a hollow organ with the anchor device first by means of a flexible guide tube (6), - the anchor device being actuable by means of a handle at the other end of the instrument, in order to pull the anchor device into or extend it from a sleeve provided at the head end of the instrument, - that the anchor device is formed by two or more elastically deformable needles (3) which extend in the direction of the head end of the sleeve (5) from a base body (4 ) stretch away, which is mounted in the interior of the sleeve so that it can be moved axially - that the needles (3) are completely retracted into the sleeve (5) when the base body (4) is axially retracted, thereby being elastically deformable and essentially inside the sleeve (5) are aligned and positioned axially parallel - and that the needles (3) during the advance the body ...

Description

Die Erfindung betrifft ein Instrument, das an seinem Kopfende eine Greifvorrichtung aufweist und das vorzugsweise als chirurgisches Instrument mittels eines biegsamen Führungsschlauches endoskopisch mit der Greifvorrichtung voran in das Innere eines hohlen Organs einführbar ist, wobei die Greifvorrichtung mittels einer Handhabe am anderen Ende des Instrumentes betätigbar ist, indem die Greifvorrichtung in eine am Kopfende des Instrumentes vorhandene Hülse eingezogen oder aus dieser ausgefahren wird.The invention relates to an instrument which has a gripping device at its head end and which is preferably endoscopically introduced as a surgical instrument by means of a flexible guide tube with the gripping device into the interior of a hollow member, wherein the gripping device is actuated by means of a handle at the other end of the instrument in that the gripping device is pulled into or out of a sleeve provided at the head of the instrument.

Alle in der Technik schlechthin und in der chirurgischen Praxis gängigen Greifvorrichtungen bestehen aus zwei- oder mehrarmigen Mechanismen, die den zu ergreifenden Zielgegenstand bzw. das zu ergreifende Zielgewebe von außen übergreifen und beim Schließen der Greifvorrichtung festhalten. Bei chirurgischen Instrumenten ist es bekannt, die Greifvorrichtung am Kopfende einer Hülse zu positionieren, und die Greifarme durch Einziehen der Greifvorrichtung in die am Kopfende des Instrumentes vorhandene Hülse zu schließen. Das geschieht üblicherweise mittels einer Handhabe am anderen Ende des Instrumentes, die mittels eines Zug-Druck-Drahtes oder mittels eines einfachen Zugdrahtes in An eines Bowdenzuges mit der Greifvorrichtung verbunden ist.All common in the art and common in surgical practice gripping devices consist of two- or multi-arm mechanisms that overlap the target to be taken or the target tissue to be taken from the outside and hold when closing the gripping device. In surgical instruments, it is known to position the gripping device at the head of a sleeve, and to close the gripping arms by pulling the gripping device into the existing at the head of the instrument sleeve. This is usually done by means of a handle at the other end of the instrument, which is connected by means of a train-pressure wire or by means of a simple pull wire in to a Bowden cable with the gripping device.

Solche Greifvorrichtungen arbeiten aus chirurgischer Sicht dann nicht zufriedenstellend, wenn das zu ergreifende Zielgewebe krankhaft verändert oder in der Oberfläche glatt und/oder organbedingt gleitend ist. Das Ergreifen und Festhalten des Zielgewebes ist dann schwierig und unsicher.Such gripping devices do not work satisfactorily from a surgical point of view if the target tissue to be grasped is altered morbidly or is slippery and / or organically sliding in the surface. The grasping and holding of the target tissue is then difficult and uncertain.

Aus der EP 0 814 703 B1 ist eine Vorrichtung zum Lokalisieren krankhafter Veränderungen in der Brust sowie ein Gerät zum Positionieren bereits bekannt. Dort ist ein Trokar gezeigt mit einem an seinem distalen Ende eine Schneide ausbildenden starren Schaft, in den ein Führungsdraht einsetzbar ist, der an seinem proximalen Ende mit einer Handhabe verbunden ist. Am distalen Ende des Führungsdrahts ist ein Grundkörper fixiert, in den drei elastisch deformierbare Nadeln eingesetzt sind, die in einem entspanntem Zustand eine Hakenform aufweisen. Durch Verschieben des Führungsdrahts längs des Trokarschafts lässt sich der ebenfalls im Schaft verschieblich gelagerte Grundkörper in Axialrichtung des Schafts bewegen, wobei hierdurch die hakenförmig gebogenen Nadeln aus dem distalen Ende des Trokarschafts vorgeschoben werden können. Dabei dringen sie in das zu untersuchende bzw. behandelnde Gewebe eines Patienten ein.From the EP 0 814 703 B1 For example, a device for locating pathological changes in the breast as well as a device for positioning is already known. There, a trocar is shown with a rigid shaft forming a cutting edge at its distal end, in which a guide wire can be inserted, which is connected at its proximal end to a handle. At the distal end of the guide wire, a base body is fixed in the three elastically deformable needles are used, which have a hook shape in a relaxed state. By displacing the guide wire along the trocar shaft, the base body also displaceably mounted in the shaft can be moved in the axial direction of the shaft, whereby the hook-shaped bent needles can be advanced out of the distal end of the trocar shaft. In doing so, they penetrate the tissue of a patient to be examined or treated.

Des weiteren ist beispielsweise gemäß der DE 299 13 219 U1 eine Induktionsnadelvorrichtung bekannt bestehend aus einer Hauptnadel, in der drei Unternadeln axial verschieblich gelagert sind und deren distale Endabschnitte bogenförmig vorgekrümmt sind.Furthermore, for example, according to the DE 299 13 219 U1 an induction needle device known consisting of a main needle, are mounted axially displaceably in the three Unternadeln and the distal end portions are arcuately pre-curved.

Aufgabe der Erfindung ist es, ein verbessertes Instrument der gattungsgemäßen Art vorzuschlagen, das insbesondere in der chirurgischen Praxis ein sicheres Erfassen und Festhalten des jeweiligen Zielgewebes gewährleistet.The object of the invention is to propose an improved instrument of the generic type, which ensures a secure capture and retention of the respective target tissue, especially in surgical practice.

Diese Aufgabe wird erfindungsgemäß durch ein chirurgisches Instrument mit den Merkmalen des Anspruches 1 gelöst.This object is achieved by a surgical instrument having the features of claim 1.

Die Ankervorrichtung des neuen Instruments ist vorzugsweise mit drei Nadeln auszuführen, die relativ zueinander um jeweils 120° versetzt angeordnet sind. Für Sonderfälle sind auch Greifvorrichtungen mit zwei Nadeln möglich.The anchor device of the new instrument is preferably designed with three needles, which are arranged offset relative to each other by 120 °. For special cases, gripping devices with two needles are also possible.

Die Nadeln der Greifvorrichtung müssen gemäß der Lehre der Erfindung aus einem elastischen Material gefertigt sein. Gemäß Anspruch 2 eignen sich grundsätzlich alle sogenannten Formgedächtnislegierungen, die in dem Anwendungstemperaturbereich superelastische Eigenschaften aufweisen. Insbesondere gilt dies für NiTi-Legierungen. Nadeln aus diesen Legierungen sind extrem elastisch biegsam und können bei entsprechenden Materialabmessungen auch mit sehr geringer Kraft in die kopfseilige Hülse des Instrumentes eingezogen werden.The needles of the gripping device must be made according to the teachings of the invention made of an elastic material. According to claim 2, in principle all so-called shape memory alloys which have superelastic properties in the application temperature range are suitable. This applies in particular to NiTi alloys. Needles made of these alloys are extremely flexible and elastic can be fed with corresponding material dimensions with very little force in the head sleeve of the instrument.

Die Geometrie der Nadelenden in ihrer entlasteten Ursprungsform ist so zu wählen, dass sie in das Zielgewebe möglichst tangential einstechen, damit vollständige Durchstechungen (Perforationen) des Zielgewebes vermieden werden.The geometry of the needle ends in their unloaded original form should be chosen so that they pierce the target tissue as tangentially as possible, so that complete perforations (perforations) of the target tissue can be avoided.

Sobald die Ankervorrichtung des chirurgischen Instruments in dem Zielgewebe ”verankert” ist, kann dieses mittels des Instrumentes verschoben oder in jede gewünschte Position angehoben werden, was bei chirurgischen Eingriffen und Begutachtungen von besonderem Vorteil ist.Once the anchor device of the surgical instrument is "anchored" in the target tissue, it can be translated by means of the instrument or raised to any desired position, which is of particular advantage in surgical procedures and assessments.

Gemäß Anspruch 5 können die Nadeln der Ankervorrichtung auch mit zusätzlichen Befestigungsvorrichtungen zum lösbaren Befestigen von Adaptern versehen sein. Solche Adapier können z. B. Hilfsinstrumente oder zusätzliche Bewegungshilfen sein, aber auch Kapseln o. dergl. zur medikamentösen Versorgung des jeweiligen Zielgewebes.According to claim 5, the needles of the anchor device can also be provided with additional fastening devices for releasably securing adapters. Such Adapier can z. B. auxiliary instruments or additional mobility aids, but also capsules o. The like. For medical care of the respective target tissue.

Die Ankervorrichtung kann auch für eine Dauerbefestigung von Adaptern an einem Zielgewebe verwendet werden, und zu diesem Zweck sieht Anspruch 4 vor, dass die Nadeln mit dem Grundkörper, von dem sie sich hinwegerstrecken, einstückig ausgebildet sind und dass diese Baueinheit vom Kopfende des Instrumentes lösbar und mit dem Kopfende wieder verbindbar ist.The anchor device may also be used for permanent attachment of adapters to a target tissue, and to this end, claim 4 provides that the needles are integrally formed with the body from which they extend, and that this assembly is detachable from the head end of the instrument is connectable to the headboard again.

Nachfolgend wird ein Ausführungsbeispiel der Erfindung anhand der Zeichnungen näher beschrieben. Es zeigen:Hereinafter, an embodiment of the invention will be described in more detail with reference to the drawings. Show it:

1 einen Längsschnitt durch die Ankervorrichtung gemäß der Erfindung mit eingezogenen Nadeln, 1 a longitudinal section through the anchor device according to the invention with retracted needles,

2 einen Längsschnitt durch die Ankervorrichtung gemäß 1 mit ausgefahrenen Nadeln. 2 a longitudinal section through the anchor device according to 1 with extended needles.

Dargestellt ist eine Greifvorrichtung gemäß der Erfindung mit drei Nadeln 3, die relativ zueinander um jeweils 120'' versetzt und einstückig mit einem Grundkörper 4 ausgebildet sind, der im Inneren der Hülse 5 axial verfahrbar gelagert ist.Shown is a gripping device according to the invention with three needles 3 which offset relative to each other by 120 '' and in one piece with a base body 4 are formed in the interior of the sleeve 5 is mounted axially movable.

Die Hülse befindet sich am Kopfende eines chirurgischen Instrumentes, das mittels des biegsamen, spiralgestützten Führungsschlauches 6 mit der Ankervorrichtung voran in das Innere eines Organs eingeführt und bis zu dem Zielgewebe (nicht dargestellt) herangeführt werden kann derart, dass die Nadeln 3 beim Vorfahren des Grundkörpers 4 in Richtung des Kopfendes der Hülse 5 (siehe 2) in das Zielgewebe einstechen.The sleeve is located at the head of a surgical instrument, by means of the flexible, spiral-supported guide tube 6 can be introduced with the anchor device ahead in the interior of an organ and brought up to the target tissue (not shown) such that the needles 3 when ancestors of the body 4 towards the head of the sleeve 5 (please refer 2 ) into the target tissue.

1 zeigt die Nadeln 3 mit dem Grundkörper 4 im vollständig eingezogenen Zustand, in dem die Nadeln elastisch verformt sind und im Inneren der Hülse im wesentlichen achsparallel ausgerichtet und positioniert sind. 1 shows the needles 3 with the main body 4 in the fully retracted state in which the needles are elastically deformed and are aligned and positioned in the interior of the sleeve substantially parallel to the axis.

2 zeigt die Nadeln 3 mit dem Grundkörper 4 im vollständig ausgefahrenen Zustand, in dem die Nadeln aufgrund ihrer elastischen Materialeigenschaften in ihre entlastete Ursprungsform zurückgekehrt sind und in der sie sich hakenförmig in dem Zielgewebe verankert haben. 2 shows the needles 3 with the main body 4 in the fully extended state, in which the needles have returned due to their elastic material properties in their relieved original form and in which they have hooked anchored in the target tissue.

Dabei ist wesentlich, dass das Elastizitätsverhalten der Nadeln dafür sorgt, dass diese beim Vorfahren des Grundkörpers 4 in Richtung des Kopfendes der Hülse 5 in einem etwa radial endenden Bogen aus dem Kopfende der Hülse auslaufen.It is essential that the elasticity behavior of the needles ensures that this when ancestors of the body 4 towards the head of the sleeve 5 in an approximately radially ending arc from the head of the sleeve leak.

Das Vorfahren und Zurückfahren des Grundkörpers 4 in der Hülse 5 wird mittels des Drahtes 7 bewirkt, der zug- und druckfest in dem spiralgestützten Führungsschlauch 6 geführt ist und der mittels einer Handhabe am anderen Ende des Instrumentes (nicht dargestellt) betätigt wird.The ancestor and return of the body 4 in the sleeve 5 is done by means of the wire 7 causes the tension and compression-resistant in the spiral-supported guide tube 6 is guided and by means of a handle at the other end of the instrument (not shown) is actuated.

Claims (5)

Chirurgisches Instrument, – das an seinem Kopfende eine Ankervorrichtung aufweist – und das mittels eines biegsamen Führungsschlauches (6) endoskopisch mit der Ankervorrichtung voran in das Innere eines hohlen Organs einführbar ist, – wobei die Ankervorrichtung mittels einer Handhabe am anderen Ende des Instrumentes betätigbar ist, um die Ankervorrichtung in eine am Kopfende des Instrumentes vorhandene Hülse einzuziehen oder aus dieser auszufahren, – dass die Ankervorrichtung durch zwei oder mehrere elastisch verformbare Nadeln (3) gebildet ist, die sich in Richtung des Kopfendes der Hülse (5) von einem Grundkörper (4) hinwegerstrecken, der im Inneren der Hülse axial verfahbar gelagert ist – dass die Nadeln (3) beim axialen Zurückfahren des Grundkörpers (4) vollständig in die Hülse (5) eingezogen werden und dabei elastisch verformbar und im Inneren der Hülse (5) im Wesentlichen achsparallel ausgerichtet und positioniert sind – und dass die Nadeln (3) beim Vorfahren des Grundkörpers (4) in Richtung des Kopfendes der Hülse (5) für ein Einstechen in ein Zielgewebe in einem etwa radial endenden Bogen und entgegengesetzt zueinander aus dem Kopfende der Hülse (5) auslaufen und dabei in ihre entlastete Ursprungsform zurückkehren, in der sie hakenförmig in dem Zielgewebe des hohlen Organs zu verankern sind.Surgical instrument - which has an anchor device at its head end - and that by means of a flexible guide tube ( 6 ) is endoscopically inserted into the interior of a hollow member with the anchor device, - wherein the anchor device is actuated by means of a handle at the other end of the instrument to retract the anchor device in an existing at the head of the instrument sleeve or extend from this, - that the Anchoring device by two or more elastically deformable needles ( 3 ) is formed, which extends in the direction of the head end of the sleeve ( 5 ) of a basic body ( 4 ), which is axially displaceable inside the sleeve - that the needles ( 3 ) during the axial retraction of the main body ( 4 ) completely into the sleeve ( 5 ) are retracted while elastically deformable and inside the sleeve ( 5 ) are aligned and positioned substantially parallel to the axis - and that the needles ( 3 ) when ancestors of the body ( 4 ) in the direction of the head end of the sleeve ( 5 ) for a piercing into a target tissue in an approximately radially ending arc and opposite to each other from the head end of the sleeve ( 5 ) and return to their original unloaded form in which they are hook-shaped in the target tissue of the hollow organ. Chirurgisches Instrument nach Anspruch 1, dadurch gekennzeichnet, – dass die Nadeln (3) aus einer superelastischen Formgedächtnislegierung sind.Surgical instrument according to claim 1, characterized in that - the needles ( 3 ) are of a superelastic shape memory alloy. Chirurgisches Instrument nach Anspruch 2, dadurch gekennzeichnet, dass die Nadeln (3) aus einer NiTi-Legierung gefertigt sind.Surgical instrument according to claim 2, characterized in that the needles ( 3 ) are made of a NiTi alloy. Chirurgisches Instrument nach Anspruch 1, dadurch gekennzeichnet, – dass die Nadeln (3) mit dem Grundkörper (4) einstückig ausgebildet sind – und dass diese Baueinheit vom Kopfende des Instrumentes lösbar und mit dem Kopfende des Instrumentes wieder verbindbar ist.Surgical instrument according to claim 1, characterized in that - the needles ( 3 ) with the basic body ( 4 ) are integrally formed - and that this unit from the head of the instrument is releasably and reconnectable with the head of the instrument. Chirurgisches Instrument nach Anspruch 1, dadurch gekennzeichnet, – dass die Nadeln (3) im Bereich des Grundkörpers (4) mit einer oder mehreren Befestigungsvorrichtungen zum lösbaren Befestigen von Adaptern versehen sind.Surgical instrument according to claim 1, characterized in that - the needles ( 3 ) in the region of the basic body ( 4 ) are provided with one or more fastening devices for releasably securing adapters.
DE2001159470 2001-12-04 2001-12-04 Surgical instrument with anchor device at the head end Expired - Lifetime DE10159470B4 (en)

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