DE10201569A1 - Surgical instrument, especially a bipolar shear for uses in endoscopic interventions, e.g. for hardening of soft tissue, has an improved, more reliable, cooling arrangement with a closed loop cooling channel - Google Patents
Surgical instrument, especially a bipolar shear for uses in endoscopic interventions, e.g. for hardening of soft tissue, has an improved, more reliable, cooling arrangement with a closed loop cooling channelInfo
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- DE10201569A1 DE10201569A1 DE10201569A DE10201569A DE10201569A1 DE 10201569 A1 DE10201569 A1 DE 10201569A1 DE 10201569 A DE10201569 A DE 10201569A DE 10201569 A DE10201569 A DE 10201569A DE 10201569 A1 DE10201569 A1 DE 10201569A1
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- tool
- fluid
- instrument according
- fluid channel
- instrument
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/3201—Scissors
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
- A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
- A61B2018/00023—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids closed, i.e. without wound contact by the fluid
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
- A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
- A61B2018/00029—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids open
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B2018/146—Scissors
Abstract
Description
Die Erfindung betrifft ein chirurgisches Instrument mit einem proximalen und einem distalen Ende, mit einem ersten Werkzeug und einem zweiten, relativ zum ersten bewegbaren Werkzeug am distalen Ende des Instruments, mit einem dem ersten Werkzeug zugeordneten ersten Fluidkanal, der einen Fluideinlaß an seinem proximalen Ende aufweist und eine Fluidströmung in distaler Richtung ermöglicht, und mit einem zweiten Fluidkanal, der eine Fluidströmung in proximaler Richtung ermöglicht und einen Fluidauslaß an seinem proximalen Ende aufweist. The invention relates to a surgical instrument with a proximal and a distal end, with a first tool and a second, relative to the first movable tool at the distal end of the instrument, with a first fluid channel assigned to the first tool, the one Has fluid inlet at its proximal end and a fluid flow in distal direction, and with a second fluid channel, the one Allows fluid flow in the proximal direction and a fluid outlet on has its proximal end.
Chirurgische Instrumente der eingangs beschriebenen Art sind beispielsweise aus der US 5,417,709 bekannt. Diese offenbart beispielsweise eine endoskopische Bipolarschere, längs deren Schaft voneinander getrennt ein Saug- und ein Spülkanal vorgesehen sind. Am distalen Ende des Instruments schwenkbare Werkzeuge sind mit Austritts- bzw. Ansaugöffnungen versehen, die jeweils entweder mit dem Spül- oder dem Absaugkanal in Fluidverbindung stehen. Surgical instruments of the type described at the outset are, for example known from US 5,417,709. This reveals, for example endoscopic bipolar scissors, separated along the shaft Suction and a rinsing channel are provided. At the distal end of the instrument swiveling tools are provided with outlet or suction openings, each in fluid communication with either the flushing or suction channel stand.
Zum Veröden von Weichgewebe wird üblicherweise über zwei Elektroden ein Hochfrequenzstrom angelegt. Dieser kann direkt über das Instrument oder über separate Elektroden fließen. In beiden Fällen befindet sich das Instrument in Kontakt mit einem solchen Koagulationsbereich, mit der Folge, daß die beiden Werkzeuge sehr heiß werden können. To flatten soft tissue, one usually uses two electrodes High frequency current applied. This can be done directly via the instrument or flow over separate electrodes. The instrument is in both cases in contact with such a coagulation area, with the result that the both tools can get very hot.
Mit den beiden bei der Bipolarschere gemäß der US 5,417,709 vorgesehenen Spül- und Absaugkanälen ist zwar prinzipiell eine Kühlung möglich, doch birgt diese Ausgestaltung mehrere Nachteile. Zum einen tritt Spülflüssigkeit im Operationsbereich aus dem Instrument aus, so daß mit Flüssigkeitsverlusten gerechnet werden muß und daher auch nicht jede Flüssigkeit als Kühlflüssigkeit verwendet werden kann. Zum anderen kann der Absaugkanal verstopfen, wenn Gewebeteile mit abgesaugt werden. With the two provided in the bipolar scissors according to US 5,417,709 In principle, rinsing and suction ducts can be cooled, but they do have some this design has several disadvantages. On the one hand, rinsing liquid occurs in the Operating area from the instrument, so that with fluid loss must be counted and therefore not every liquid as Coolant can be used. On the other hand, the suction channel clog if tissue parts are also vacuumed.
Daher ist es Aufgabe der vorliegenden Erfindung, ein Instrument der eingangs beschriebenen Art so zu verbessern, daß die Werkzeuge auf einfache Weise und zuverlässig gekühlt werden können. It is therefore an object of the present invention to be an instrument of the beginning to improve the type described so that the tools in a simple manner and can be cooled reliably.
Diese Aufgabe wird bei einem chirurgischen Instrument der eingangs beschriebenen Art erfindungsgemäß dadurch gelöst, daß das erste Werkzeug den zweiten Fluidkanal umfaßt und daß ein distaler Endbereich des ersten Fluidkanals mit einem distalen Endbereich des zweiten Fluidkanals in direkter Fluidverbindung steht. This task is the beginning of a surgical instrument described type according to the invention solved in that the first tool includes the second fluid channel and that a distal end portion of the first Fluid channel with a distal end region of the second fluid channel in direct Fluid connection is established.
Durch die direkte Fluidverbindung der beiden distalen Endbereiche der beiden Fluidkanäle kann kein Fluid mehr in den Operationsbereich gelangen. Am einfachsten wird die direkte Fluidverbindung hergestellt, indem die beiden distalen Enden der Fluidkanäle miteinander verbunden werden. Durch die Anordnung der beiden Fluidkanäle an einem Werkzeug entsteht somit ein geschlossener Kühlkreislauf. Verunreinigungen können nicht in diesen eindringen und den Kühlkanal verstopfen. Damit kann das eine Werkzeug auf sichere Weise gekühlt werden. In gleicher Weise könnte auch das zweite Werkzeug mit einem Kühlkanal versehen werden. Ferner wären auch die beiden Fluidkanäle im Bereich der Werkzeuge verbindende Querkanäle zur weiteren Verbesserung der Kühlung denkbar. Through the direct fluid connection of the two distal end regions of the two Fluid channels can no longer get fluid into the operating area. At the The easiest way to make the direct fluid connection is to use the two distal ends of the fluid channels are interconnected. Through the An arrangement of the two fluid channels on a tool thus arises closed cooling circuit. Impurities cannot be found in these penetrate and clog the cooling duct. So that can be a tool be chilled safely. The second could also be used in the same way Tool can be provided with a cooling channel. They would also be transverse channels connecting the two fluid channels in the area of the tools further improvement of the cooling conceivable.
Vorzugsweise sind der Fluideinlaß und/oder der Fluidauslaß in einem werkzeugfreien Bereich des Instruments angeordnet. Über den Fluideinlaß und den Fluidauslaß ist der Kühlkanal mit einer Fluidzufuhr bzw. -absaugung verbindbar. Die Anordnung der beiden Anschlüsse in einem werkzeugfreien Bereich des Instruments hat beispielsweise bei endoskopischen Instrumenten den Vorteil, daß die Anschlüsse am Instrument so angeordnet werden können, daß sie sich bei einem chirurgischen Eingriff außerhalb des menschlichen Körpers befinden können und den Operationsbereich nicht unnötig einschränken. Preferably, the fluid inlet and / or the fluid outlet are in one tool-free area of the instrument. About the fluid inlet and the fluid outlet is the cooling channel with a fluid supply or suction connectable. The arrangement of the two connections in a tool-free The area of the instrument has, for example, endoscopic instruments the advantage that the connections on the instrument can be arranged that during surgery outside of human Body and the surgical area is not unnecessary limit.
Bei einer bevorzugten Ausführungsform der Erfindung kann vorgesehen sein, daß sich der erste und der zweite Fluidkanal im wesentlichen vom proximalen zum distalen Ende des Instruments erstrecken und daß der Fluideinlaß und der Fluidauslaß am proximalen Ende des Instruments angeordnet sind. Auf diese Weise lassen sich besonders schlanke Instrumente ausbilden, die bevorzugt in der Endoskopie Anwendung finden können. Ferner wird die Handhabung des Instruments erleichtert, da keine störenden Anschlüsse für ein zu- bzw. abzuführendes Fluid in einem Griff- oder Werkzeugbereich des Instruments angeordnet sein müssen. In a preferred embodiment of the invention, that the first and second fluid channels are essentially from the proximal extend to the distal end of the instrument and that the fluid inlet and the Fluid outlet are arranged at the proximal end of the instrument. To this In this way, particularly slim instruments can be formed, which are preferred in endoscopy. Furthermore, the handling of the Instruments makes it easier because there are no annoying connections for a fluid to be removed in a handle or tool area of the instrument must be arranged.
Günstig ist es, wenn ein Abstand zwischen dem ersten und dem zweiten Fluidkanal im Bereich des ersten Werkzeugs am größten ist. Durch den großen Abstand der beiden Fluidkanäle kann das erste Werkzeug optimal gekühlt und Wärme von diesem großflächig abgeführt werden. It is beneficial if there is a distance between the first and the second Fluid channel is greatest in the area of the first tool. By the big one The first tool can be optimally cooled and spaced between the two fluid channels Heat can be dissipated from this over a large area.
Grundsätzlich wäre es denkbar, das chirurgische Instrument auch als Rohrschaftinstrument auszugestalten. Vorteilhaft ist es jedoch, wenn das chirurgische Instrument zwei relativ zueinander verschwenkbar aneinander gelagerte Branchen umfaßt und wenn jedes der beiden distalen Enden der Branchen eines der beiden Werkzeuge umfaßt. So kann das Instrument beispielsweise in Form einer herkömmlichen Schere ausgestaltet sein, wobei ein oder beide Fluidkanäle in oder an einer der beiden Branchen angeordnet sind. Basically, it would be conceivable to use the surgical instrument as well To design tubular shaft instrument. However, it is advantageous if that surgical instrument two pivotable relative to each other stored industries and if each of the two distal ends of the Branches include one of the two tools. So the instrument can for example in the form of conventional scissors, wherein one or both fluid channels arranged in or on one of the two branches are.
Um die Ausbildung der beiden Fluidkanäle zu erleichtern, kann es günstig sein, wenn das erste Werkzeug mehrteilig ausgebildet ist und mindestens ein erstes und ein zweites Werkzeugelement umfaßt. So können ein oder beide Fluidkanäle teilweise in einem der beiden Werkzeugelemente gebildet werden. Ferner ist es möglich, unterschiedliche Materialien zu verwenden, beispielsweise ein abriebbeständiges Metall für ein schneidenförmiges Werkzeug und einen Kunststoff für einen Fluidkanal. Auch sind keramische Werkzeugelemente denkbar. In order to facilitate the formation of the two fluid channels, it can be advantageous if the first tool is formed in several parts and at least a first and comprises a second tool element. So one or both can Fluid channels are partially formed in one of the two tool elements. It is also possible to use different materials for example, an abrasion-resistant metal for a knife-shaped one Tool and a plastic for a fluid channel. Are also ceramic Tool elements conceivable.
Gemäß einer bevorzugten Ausführungsform der Erfindung umfaßt das erste Werkzeugelement den ersten und/oder den zweiten Fluidkanal mindestens teilweise. Es ist demnach möglich, den Fluidkanal bzw. die beiden Fluidkanäle auch einteilig auszugestalten, beispielsweise als Rohr. According to a preferred embodiment of the invention, the first comprises Tool element at least the first and / or the second fluid channel partially. It is therefore possible to use the fluid channel or the two fluid channels can also be designed in one piece, for example as a tube.
Vorteilhaft kann es aber auch sein, wenn das erste und das zweite Werkzeugelement den ersten und/oder den zweiten Fluidkanal mindestens teilweise umfassen. Beide Werkzeugelemente können bei der Bildung der beiden Fluidkanäle zusammenwirken, beispielsweise indem jedes Element mit einer halbschaligen Ausnehmung versehen ist. But it can also be advantageous if the first and the second Tool element at least the first and / or the second fluid channel partially include. Both tool elements can be used in the formation of the interact with two fluid channels, for example by adding each element a half-shell recess is provided.
Die beiden Fluidkanäle könnten vollständig innerhalb eines der beiden Werkzeugelemente angeordnet sein. Günstig ist es jedoch, wenn das erste und das zweite Werkzeugelement aneinander angrenzen und wenn der erste und/oder der zweite Fluidkanal entlang einer Grenzfläche zwischen dem ersten und dem zweiten Werkzeugelement verlaufen. Dadurch wird die Herstellung der Werkzeugelemente wesentlich vereinfacht. Teile der beiden Fluidkanäle können jeweils in die beiden Werkzeugelemente eingearbeitet werden, die dann aneinander herangeführt werden und gemeinsam die beiden Fluidkanäle bilden. Auch wäre es denkbar, eine rohrförmige Leitung entlang der Grenzfläche zwischen beiden Werkzeugelementen anzuordnen. The two fluid channels could be entirely within one of the two Tool elements can be arranged. However, it is favorable if the first and adjoin the second tool element and when the first and / or the second fluid channel along an interface between the first and the second tool element. This will make it the tool elements significantly simplified. Parts of the two fluid channels can be worked into each of the two tool elements, the then brought together and together the two fluid channels form. It would also be conceivable to have a tubular line along the To arrange the interface between the two tool elements.
Besonders einfach wird der Aufbau, wenn das erste und/oder das zweite Werkzeugelement jeweils mit einer Ausnehmung versehen sind zum gemeinsamen Ausbilden des ersten und/oder zweiten Fluidkanals. Beide Werkzeugelemente können getrennt voneinander zur Ausbildung eines Fluidkanals vorbereitet werden. Weitere Teile sind nicht notwendig. The construction becomes particularly simple if the first and / or the second Tool element are each provided with a recess for joint formation of the first and / or second fluid channel. Both Tool elements can be used separately to form a Fluid channel be prepared. No other parts are necessary.
Besonders vorteilhaft ist es, wenn das erste Werkzeugelement aus einem Isolator, insbesondere einem keramischen Material hergestellt ist. Damit läßt sich beispielsweise eine Isolierung zwischen dem ersten und zweiten Werkzeug herstellen, wenn das aus einem Isolator hergestellte erste Werkzeugelement an das andere der beiden Werkzeuge angrenzt. Auch kann damit ein elektrischer Leiter im Bereich des ersten Werkzeugs vollständig isoliert werden. It when the first tool element from a Insulator, in particular a ceramic material is made. With that leaves there is, for example, insulation between the first and second tools produce when the first tool element made of an insulator adjacent to the other of the two tools. Can also use it electrical conductor completely insulated in the area of the first tool become.
Vorzugsweise ist das zweite Werkzeugelement aus einem Metall, insbesondere aus einem hochleitfähigen Metall hergestellt. Insbesondere bei mit Strom beaufschlagbaren Instrumenten ist ein zuverlässiger elektrischer Leiter von Vorteil, um insbesondere die Erwärmung des Instruments gering zu halten. The second tool element is preferably made of a metal, in particular made of a highly conductive metal. Especially with electricity actable instruments is a reliable electrical conductor of Advantage, in particular to keep the heating of the instrument low.
Für eine dauerhafte Stabilität des Instruments ist es vorteilhaft, wenn das erste und das zweite Werkzeugelement miteinander verbunden sind, insbesondere verklebt oder verlötet. Derartige Verbindungen sind auch zwischen unterschiedlichen Materialien möglich. Gegenüber einer Verbindung durch Umhüllung mittels eines weiteren Werkzeugelements kann beim Kleben oder Verlöten darauf vollständig verzichtet werden. For permanent stability of the instrument, it is advantageous if that first and second tool elements are connected to one another, in particular glued or soldered. Such connections are also possible between different materials. Towards a connection by wrapping by means of a further tool element, when gluing or soldering can be completely dispensed with.
Besonders günstig ist es, wenn das erste und/oder das zweite Werkzeugelement mindestens teilweise mit einer Deckschicht bedeckt sind. Damit lassen sich insbesondere Grenzflächen oder Verbindungskanten schützen. Dies ist insbesondere bei Sterilisationsvorgängen, denen das chirurgische Instrument in der Regel unterworfen sein wird, unerläßlich. Außerdem kann eine Deckschicht gleichfalls als Isolationsschicht ausgebildet werden. Besonders einfach und vorteilhaft ist die Deckschicht, wenn sie durch Anspritzen eines Kunststoffs hergestellt wird. It is particularly favorable if the first and / or the second Tool element are at least partially covered with a cover layer. This makes it possible, in particular, to interface or join edges protect. This is particularly the case with sterilization processes, which the surgical instrument will usually be subjected to indispensable. In addition, a cover layer can also be formed as an insulation layer become. The top layer is particularly simple and advantageous when it is through Injection molding of a plastic is made.
Um ein sicheres Fließen des Fluids in den Fluidkanälen zu gewährleisten, umfaßt mindestens ein Abschnitt des ersten und/oder des zweiten Fluidkanals ein Rohr. Damit kann vermieden werden, daß beispielsweise aufgrund von Verkleben oder Verlöten von zwei Werkzeugelementen ein Fluidkanal bei der Herstellung verschlossen wird. In order to ensure a safe flow of the fluid in the fluid channels, comprises at least a portion of the first and / or the second fluid channel a pipe. It can thus be avoided that, for example, due to Gluing or soldering two tool elements together in a fluid channel Manufacturing is closed.
Gemäß einer bevorzugten Ausführungsform der Erfindung kann vorgesehen sein, daß der erste und der zweite Fluidkanal in einem Bereich des ersten Werkzeugs im wesentlichen in einer Werkzeugebene angeordnet sind, daß der erste und der zweite Fluidkanal außerhalb des Bereichs des ersten Werkzeugs im wesentlichen in einer Zuleitungsebene angeordnet sind, die im wesentlichen quer zur Werkzeugebene verläuft. Mit dieser Anordnung kann insbesondere eine schlanke Bauform erreicht werden, was für endoskopische Instrumente von Vorteil ist. Außerdem ermöglicht diese Ausgestaltung, daß beispielsweise bei einer zwei schwenkbare Branchen umfassenden Schere Anschlüsse der beiden Fluidkanäle quer zur Scherenebene abstehen und so eine Bewegung der zweiten Branche relativ zur ersten Branche nicht stören können. According to a preferred embodiment of the invention can be provided be that the first and the second fluid channel in a region of the first Tool are arranged essentially in a tool plane that the first and second fluid channels outside the area of the first tool are arranged essentially in a feed line, which essentially runs across the tool plane. With this arrangement, in particular a slim design can be achieved, what endoscopic instruments is an advantage. In addition, this configuration enables, for example with a pair of scissors that swivel, connections of the two fluid channels protrude transversely to the scissor plane and thus a movement in the second branch relative to the first branch.
Eine Drehung der Zuleitungsebene und der Werkzeugebene kann beispielsweise erreicht werden, indem die beiden Fluidkanäle entsprechend gekrümmt sind. Günstig ist es jedoch, wenn eine zwei Teilkammern umfassende Fluidverteilkammer in einem Übergangsbereich zwischen dem ersten Werkzeug und einem werkzeugfreien Bereich vorgesehen ist, wenn die Fluidverteilkammer zwei parallel zur Werkzeugebene und zwei parallel zur Zuleitungsebene ausgerichtete Anschlüsse umfaßt und wenn jeweils eine der beiden Teilkammern eine Fluidverbindung zwischen einem parallel zur Werkzeugebene und einem parallel zur Zuleitungsebene ausgerichteten Anschluß bildet. Auf diese Weise werden komplizierte und die Fluidkanäle in ihrer Stabilität gefährdende Biegungen derselben vermieden. Die Fluidkanäle können beidseitig direkt an die Fluidverteilkammer angeschlossen werden. A rotation of the supply level and the tool level can can be achieved, for example, by the two fluid channels accordingly are curved. However, it is expedient if one has two subchambers comprehensive fluid distribution chamber in a transition area between the first tool and a tool-free area is provided when the Fluid distribution chamber two parallel to the tool plane and two parallel to the Line level aligned connections and if each one of the a fluid connection between the two sub-chambers parallel to Tool level and one aligned parallel to the supply level Connection forms. This way, the fluid channels become complicated Avoid bending of the same which endangers their stability. The fluid channels can be directly connected to the fluid distribution chamber on both sides.
Zur Ausbildung des Instruments als Monopolar- und/oder Bipolarinstrument ist es vorteilhaft, wenn das erste und das zweite Werkzeug elektrisch gegeneinander isoliert sind. Dadurch werden unerwünschte Kurzschlüsse vermieden. Ein Koagulieren von Weichgewebe mittels Anlegen eines Hochfrequenzstroms an das Instrument ist auf einfache Weise möglich. To train the instrument as a monopolar and / or bipolar instrument it is advantageous if the first and second tools are electric are isolated from each other. This will cause undesirable short circuits avoided. A coagulation of soft tissue by applying a High frequency current to the instrument is easily possible.
Besonders günstig ist es, wenn die erste Branche eine erste elektrische Zuleitung umfaßt, die mit dem ersten Werkzeug in Verbindung steht, und wenn an der ersten oder der zweiten Branche eine zweite, von der ersten elektrisch isolierte elektrische Zuleitung vorgesehen ist, die mit dem zweiten Werkzeug in Verbindung steht. Auf diese Weise kann ein Strom einfach und sicher zu den beiden Werkzeugen geleitet werden, beispielsweise um das Werkzeug anzutreiben oder um Weichgewebe zu koagulieren. It is particularly favorable if the first branch has a first electrical one Includes supply line which is connected to the first tool, and if at the first or the second branch a second one, from the first one electrically insulated electrical supply line is provided which is connected to the second Tool communicates. In this way, a stream can be simple and be guided safely to the two tools, for example around the Power tool or to coagulate soft tissue.
Grundsätzlich ist es von Vorteil, wenn die beiden Fluidkanäle so miteinander verbunden sind, daß kein Fluid auslaufen kann. Es kann jedoch günstig sein, wenn mindestens einer der beiden Fluidkanäle in seinem distalen Endbereich mit Öffnungen versehen ist. Die beiden Fluidkanäle dienen dann einerseits als Kühlkanal, andererseits als Spülkanal zum Spülen eines Operationsbereichs mit einer dafür geeigneten Spülflüssigkeit. Basically, it is advantageous if the two fluid channels together are connected that no fluid can leak. However, it can be beneficial if at least one of the two fluid channels in its distal end region is provided with openings. The two fluid channels then serve as Cooling channel, on the other hand as a flushing channel for flushing an operating area with a suitable rinsing liquid.
Vorzugsweise umfassen das erste und das zweite Werkzeug jeweils eine Schneide. So läßt sich auf einfache Art eine Schere ausbilden. Preferably, the first and second tools each include one Cutting. In this way, scissors can be easily formed.
Die nachfolgende Zeichnung dient im Zusammenhang mit der Beschreibung bevorzugter Ausführungsformen der Erfindung der näheren Erläuterung. Es zeigen: The following drawing is used in connection with the description preferred embodiments of the invention of the detailed explanation. It demonstrate:
Fig. 1 eine teilweise durchbrochene Gesamtansicht einer Bipolarschere; Figure 1 is a partially broken overall view of a bipolar scissors.
Fig. 2 eine Längsschnittansicht durch eine der beiden Branchen der Schere; Figure 2 is a longitudinal sectional view through one of the two branches of the scissors.
Fig. 3 eine Querschnittsansicht längs Linie A-A in Fig. 2; Fig. 3 is a cross-sectional view taken along line AA in Fig. 2;
Fig. 4 eine Querschnittsansicht längs Linie B-B in Fig. 2; Fig. 4 is a cross-sectional view along line BB in Fig. 2;
Fig. 5 eine ausschnittsweise Querschnittsansicht eines zweiten Ausführungsbeispiels; Fig. 5 is a partial cross-sectional view of a second embodiment;
Fig. 6 eine teilweise durchbrochene Seitenansicht einer Schneide eines dritten Ausführungsbeispiels; Fig. 6 is a partially broken side view of a cutting edge of a third embodiment;
Fig. 7 eine teilweise Längsschnittansicht der Schneide aus Fig. 6; und FIG. 7 is a partial longitudinal sectional view of the cutting edge from FIG. 6; and
Fig. 8 eine Ansicht ähnlich Fig. 2 eines vierten Ausführungsbeispiels einer gekühlten Schere. Fig. 8 is a view similar to Fig. 2 of a fourth embodiment of a cooled pair of scissors.
In Fig. 1 ist eine insgesamt mit dem Bezugszeichen 10 versehene Bipolarschere mit zwei über eine gleichzeitig als Drehlager dienende Verbindungsschraube 12 miteinander verbundenen und relativ zueinander verschwenkbaren Branchen 14 und 15. Proximale Enden der beiden Branchen 14 und 15 sind mit seitlich abstehenden, im wesentlichen ovalen Fingeröffnungen 16 und 17 versehen, die eine Scherenebene definieren. Distale Enden der Branchen 14 und 15 sind aus der Scherenebene heraus gekrümmt und als Schneiden 18 und 19 ausgebildet. In Fig. 1 is a generally denoted by reference numeral 10 having two bipolar scissors via a rotary bearing simultaneously serving as the connecting screw 12 connected to each other and relative to each other pivotable branches 14 and 15. Proximal ends of the two branches 14 and 15 are provided with laterally protruding, essentially oval finger openings 16 and 17 which define a scissor plane. Distal ends of the branches 14 and 15 are curved out of the plane of the scissors and designed as cutting edges 18 and 19 .
Am proximalen Ende 20 der Bipolarschere 10 ist an jeder Branche 14 und 15 ein Sackloch 22 bzw. 23 angeordnet, die in proximaler Richtung weisend geöffnet sind. In diesen sind jeweils in proximaler Richtung abstehende Kontaktstifte 24 und 25 vorgesehen, die mit längs der beiden Branchen 14 und 15 in diese eingearbeiteten elektrischen Zuleitungen 26 und 27 verbunden sind. Die Sacklöcher 22 und 23 bilden in Verbindung mit den Kontaktstiften 24 und 25 elektrische Anschlüsse, beispielsweise zur Verbindung mit einer Hochfrequenzstromquelle über mit Steckern 28 und 29 versehene Zuleitungen 30 und 31. At the proximal end 20 of the bipolar scissors 10 , a blind hole 22 and 23 is arranged on each branch 14 and 15 , which are open pointing in the proximal direction. In these, contact pins 24 and 25 protruding in the proximal direction are provided, which are connected to electrical leads 26 and 27 incorporated into the two branches 14 and 15 in these. The blind holes 22 and 23 form electrical connections in connection with the contact pins 24 and 25 , for example for connection to a high-frequency current source via supply lines 30 and 31 provided with plugs 28 and 29 .
Die beiden Zuleitungen 26 und 27 führen bis in den Bereich der beiden Schneiden 18 und 19. Zur Vermeidung eines Kurzschlusses umfaßt die Schneide 18 ein keramisches Schneidelement 32, wodurch eine elektrische Isolation der beiden Schneiden 18 und 19 realisiert wird. The two feed lines 26 and 27 lead into the area of the two cutting edges 18 and 19 . To avoid a short circuit, the cutting edge 18 comprises a ceramic cutting element 32 , as a result of which the two cutting edges 18 and 19 are electrically insulated.
Zur Vermeidung einer übermäßigen Erwärmung der beiden Schneiden 18 und 19 erstrecken sich zur Bildung eines Kühlkanals 33 in etwa von der Mitte zwischen der Verbindungsschraube 12 und dem proximalen Ende 20 der Bipolarschere 10 ein erster Fluidkanal 34 bis an das distale Ende 36 der Branche 15 sowie ein zweiter Fluidkanal 35, der an das distale Ende des Fluidkanals 34 angeschlossen ist und sich in proximaler Richtung so weit erstreckt wie der Fluidkanal 34. Der erste Fluidkanal 34 ist an seinem proximalen Ende mit einem quer zur Scherenebene schräg in proximaler Richtung abstehenden Anschlußstutzen 38 versehen, der zweite Fluidkanal 35 mit einem Anschlußstutzen 39. Beide Stutzen 38 und 39 können mit einer Fluidversorgung bzw. -entsorgung verbunden werden, so daß ein Kühlkreislauf im Kühlkanal 33 mittels eines durch den ersten und zweiten Fluidkanal strömenden beliebigen Fluids entsteht. To avoid excessive heating of the two cutting edges 18 and 19 , to form a cooling channel 33, a first fluid channel 34 extends approximately from the center between the connecting screw 12 and the proximal end 20 of the bipolar scissors 10 to the distal end 36 of the branch 15 and second fluid channel 35 , which is connected to the distal end of the fluid channel 34 and extends in the proximal direction as far as the fluid channel 34 . The first fluid channel 34 is provided at its proximal end with a connection piece 38 projecting obliquely in the proximal direction transversely to the scissors plane, the second fluid channel 35 with a connection piece 39 . Both nozzles 38 and 39 can be connected to a fluid supply or disposal, so that a cooling circuit is created in the cooling channel 33 by means of any fluid flowing through the first and second fluid channels.
Wie in Fig. 1 dargestellt, ist der Abstand zwischen dem ersten und dem zweiten Fluidkanal 34 bzw. 35 im Bereich der Verbindungsschraube 12 am größten. Dadurch wird eine optimale Kühlung der gesamten Schneide 19 der Branche 15 erreicht. As shown in FIG. 1, the distance between the first and second fluid channels 34 and 35 is greatest in the area of the connecting screw 12 . In this way, optimal cooling of the entire cutting edge 19 of the branch 15 is achieved.
Die beiden Fluidkanäle 34 und 35 verlaufen im Bereich der Schneide 19 im wesentlichen in einer parallel zur Scherenebene verlaufenden Schneidenebene. Im Bereich der Stutzen 38 und 39 verlaufen die Fluidkanäle 34 und 35 jedoch in einer Ebene quer zur Schneidenebene. Um einen Übergang herzustellen zwischen den jeweils in den Ebenen parallel verlaufenden Abschnitten der Fluidkanäle 34 und 35 ist eine Fluidverteilkammer 40 im Übergangsbereich zwischen den Stutzen 38 und 39 und der Verbindungsschraube 12 angeordnet. Sie umfaßt zwei im Querschnitt im wesentlichen nierenförmige Teilkammern 42 und 43, die jeweils einen proximalen Anschluß 44 bzw. 45 sowie distalen Anschluß 46 bzw. 47 aufweisen. Die Verbindungslinien der beiden proximalen Anschlüsse 44 und 45 sowie der distalen Anschlüsse 46 und 47 stehen im wesentlichen rechtwinklig zueinander. In Fig. 3 ist die Anordnung der Anschlüsse 44 bis 47 besonders gut zu erkennen. The two fluid channels 34 and 35 run in the area of the cutting edge 19 essentially in a cutting plane running parallel to the scissors plane. In the area of the connecting pieces 38 and 39, however , the fluid channels 34 and 35 run in a plane transverse to the cutting plane. In order to create a transition between the sections of the fluid channels 34 and 35 running parallel in the planes, a fluid distribution chamber 40 is arranged in the transition region between the connecting pieces 38 and 39 and the connecting screw 12 . It comprises two partial chambers 42 and 43 which are essentially kidney-shaped in cross section, each of which has a proximal connector 44 or 45 and a distal connector 46 or 47 . The connecting lines of the two proximal connections 44 and 45 and of the distal connections 46 and 47 are essentially at right angles to one another. The arrangement of the connections 44 to 47 can be seen particularly well in FIG. 3.
Der Aufbau der Schneide 19 ist in Fig. 4 dargestellt. Das keramische Schneidelement 32 umfaßt eine Schneidkante 48 sowie zwei sich in Längsrichtung erstreckende halbschalige Ausnehmungen 50 und 51. Zwei im wesentlichen parallel zum Schneidelement verlaufende und sich in Längsrichtung erstreckende Trägerelemente 52 und 53 aus Metall sind ebenfalls mit sich in Längsrichtung der Schere 10 erstreckenden halbschaligen Ausnehmungen 54 und 55 versehen, die mit den Ausnehmungen 50 und 51 des Schneidelements 32 den ersten und zweiten Fluidkanal 34 und 35 bilden. Die Trägerelemente 52 und 53 sind mit dem Schneidelement 32 entlang einer gemeinsamen Grenzfläche 60 verklebt oder verlötet. Eine Deckschicht 56 aus Kunststoff ist auf die von der Schneidkante 48 weg weisende Oberfläche des Schneidelements 32 aufgespritzt und umgibt bzw. bedeckt somit teilweise auch die beiden Trägerelemente 52 und 53. The structure of the cutting edge 19 is shown in FIG. 4. The ceramic cutting element 32 comprises a cutting edge 48 and two half-shell recesses 50 and 51 extending in the longitudinal direction. Two metal support elements 52 and 53 which run essentially parallel to the cutting element and extend in the longitudinal direction are likewise provided with half-shell recesses 54 and 55 which extend in the longitudinal direction of the scissors 10 and which, with the recesses 50 and 51 of the cutting element 32, provide the first and second fluid channels Form 34 and 35 . The carrier elements 52 and 53 are glued or soldered to the cutting element 32 along a common interface 60 . A cover layer 56 made of plastic is sprayed onto the surface of the cutting element 32 facing away from the cutting edge 48 and thus also partially surrounds or covers the two carrier elements 52 and 53 .
Bei der in den Fig. 1 bis 4 dargestellten Bipolarschere 10 sind die Fluidkanäle 34 und 35 teilweise in einzelne Bestandteile der Branchen 15 eingearbeitet. Alternativ ist es möglich, wie bei einem in Fig. 5 teilweise dargestellten zweiten Ausführungsbeispiel, die beiden Fluidkanäle 34a und 35a in Form von Röhrchen auszubilden. Die Fluidkanäle 34a und 35a können auch nur abschnittsweise von Röhrchen gebildet werden, beispielsweise nur im Bereich zwischen den Anschlußstutzen 38 und 39 und der Verteilkammer 40. In the bipolar scissors 10 shown in FIGS . 1 to 4, the fluid channels 34 and 35 are partially incorporated into individual components of the branches 15 . Alternatively, it is possible, as in a second exemplary embodiment partially shown in FIG. 5, to form the two fluid channels 34 a and 35 a in the form of tubes. The fluid channels 34 a and 35 a can also be formed only in sections by tubes, for example only in the area between the connecting pieces 38 and 39 and the distribution chamber 40 .
In Fig. 6 ist eine alternative Ausgestaltung eines Fluidkanals 35b dargestellt, welcher nicht vollständig geschlossen ist, sondern eine Mehrzahl von Spülöffnungen 58 im Bereich des Schneidelements 32 aufweist, welche Durchbrechungen des Schneidelements 32 bilden und das Austreten einer geeigneten, gewebeschonenden Spülflüssigkeit ermöglichen. In FIG. 6, an alternative embodiment of a fluid channel 35 is represented b, which is not completely closed but has a plurality of scavenging ports 58 in the region of the cutting element 32, which apertures form the cutting element 32 and allow the escape of a suitable tissue-sparing rinsing liquid.
Schließlich ist in Fig. 8 noch eine vierte Variante eines chirurgischen Instruments 10c dargestellt, bei dem keine seitlichen Anschlußstutzen vorgesehen sind, sondern die Fluidkanäle 34c und 35c bis zum proximalen Ende 20c der Bipolarschere 10c herausgeführt sind. In proximaler Richtung stehen vom proximalen Ende 20c somit zwei Anschlußstutzen 38c und 39c ab. Finally, a fourth variant of a surgical instrument 10 c is shown in FIG. 8, in which no lateral connecting pieces are provided, but rather the fluid channels 34 c and 35 c are led out to the proximal end 20 c of the bipolar scissors 10 c. In the proximal direction, two connecting pieces 38 c and 39 c protrude from the proximal end 20 c.
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