DE69823862T2 - Biopolares elektrochirurgisches laparoskopieinstrument - Google Patents

Biopolares elektrochirurgisches laparoskopieinstrument Download PDF

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DE69823862T2
DE69823862T2 DE69823862T DE69823862T DE69823862T2 DE 69823862 T2 DE69823862 T2 DE 69823862T2 DE 69823862 T DE69823862 T DE 69823862T DE 69823862 T DE69823862 T DE 69823862T DE 69823862 T2 DE69823862 T2 DE 69823862T2
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push rod
flange
jaw members
laparoscopic
electrosurgical instrument
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DE69823862D1 (de
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John Michael LANDS
Wade Stephen LUKIANOW
Robert Donald LOEFFLER
Steven James CUNNIGHAM
Kate Ryland Lawes
Lee Daniel TRIMBERGER
Erle Mathew MITCHELL
Serafin Jenifer KENNEDY
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Covidien AG
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Sherwood Service AG
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical 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
    • A61B18/14Probes or electrodes therefor
    • A61B18/1442Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod

Description

  • Gebiet der Erfindung
  • Dies bezieht sich auf ein elektrochirurgisches Instrument zum Durchführen laparoskopischer chirurgischer Verfahren und insbesondere auf ein laparoskopisches elektrochirurgisches Instrument, das in der Lage ist, Gefäße und vaskuläres Gewebe mit hinreichender Kraft zwischen zwei bipolaren Backen zu ergreifen, um das Gefäß oder das vaskuläre Gewebe zu versiegeln.
  • Hintergrund der Offenbarung
  • WO 94/08524 offenbart die Merkmale der Präambel von Anspruch 1.
  • Laparoskopische chirurgische Instrumente werden verwendet, um chirurgische Eingriffe durchzuführen, ohne große Einschnitte in den Patienten zu machen. Die laparoskopischen Instrumente werden durch eine Kanüle oder einen Zugang, der mit einem Trokar gemacht worden ist, in den Patienten eingeführt. Typische Größen von Kanülen reichen von 3 mm bis 12 mm. Kleinere Kanülen werden üblicherweise bevorzugt, und dies stellt eine Entwurfherausforderung für Instrumentenhersteller dar, die Wege finden müssen, chirurgische Instrumente herzustellen, die durch die Kanülen passen.
  • Gewisse chirurgische Prozeduren erfordern das Schneiden von Blutgefäßen oder vaskulärem Gewebe. Dies stellt manchmal ein Problem für Chirurgen dar, weil es schwierig ist, Blutgefäße unter Verwendung laparoskopischer Werkzeuge zu nähen. Sehr kleine Blutgefäße im Bereich unter 2 mm Durchmesser können oft unter Verwendung von elektrochirurgischen Standardtechniken geschlossen werden. Falls ein größeres Gefäß genäht wird, kann es für den Chirurgen notwendig sein, die laparoskopische Prozedur in eine offene chirurgische Prozedur umzuwandeln und damit auf die Vorteile der Laparoskopie zu verzichten.
  • Verschiedene Zeitschriftenartikel haben Verfahren zum Versiegeln kleiner Blutgefäße unter Verwendung von Elektrochirurgie offenbart. Ein Artikel mit dem Titel "Studies on Coagulation and the Development of an Automatic Computerized Bipolar Coagulator", J. Neurosurg., Band 75, Juli 1991 beschreibt einen bipolaren Koagulator, der verwendet wird, um kleine Blutgefäße zu versiegeln. Der Artikel sagt, dass es nicht möglich war, Arterien mit einem Durchmesser größer als 2 bis 2,5 mm sicher zu koagulieren. Ein zweiter Artikel ist betitelt "Automatically Controlled Bipolar Electrocoagulation – "COA-COMP" ", Neurosurg. Rev. (1984), S. 187–190. Dieser Artikel beschreibt ein Verfahren zum Beenden von elektrochirurgischem Strom zum Gefäß, so das ein Verkohlen der Gefäßwände vermieden werden kann.
  • Es ist jüngst festgestellt worden, dass elektrochirurgische Verfahren in der Lage sein können, größere Gefäße unter Verwendung einer geeigneten elektrochirurgischen Stromkurve zu versiegeln, gekoppelt mit einem Instrument, das zum Anlegen einer großen Verschlusskraft an den Gefäßwänden in der Lage ist. Man denkt, dass das Verfahren des Koagulierens kleiner Gefäße sich fundamental vom elektrochirurgischen Gefäßversiegeln unterscheidet. Die Koagulation ist als ein Verfahren des Verdörrens von Gewebe definiert, bei dem die Gewebezellen zerrissen und getrocknet werden. Gefäßversiegelung ist als der Prozess des Verflüssigens des Kollagens im Gewebe definiert, so dass es quervernetzt und sich in eine verschmolzene Masse umformt. Somit ist die Koagulation kleiner Gefäße hinreichend, um sie permanent zu schließen. Größere Gefäße müssen versiegelt werden, um einen permanenten Verschluss sicherzustellen.
  • Es wäre wünschenswert, ein chirurgisches Werkzeug zu haben, das in der Lage ist, elektrochirurgische Energie anzulegen, in der Lage ist, eine große Verschlusskraft an den Gefäßwänden anzulegen, und auch dazu in der Lage ist, durch eine Kanüle zu passen. Eine große Verschlusskraft zwischen den Backen erfordert typischerweise eines großes Moment um die Drehachse für jede Backe. Dies stellt eine Herausforderung dar, weil die ersten und zweiten Stifte einen kleinen Momentarm in Bezug auf die Drehachse jeder Backe haben. Eine große Kraft, gekoppelt mit einem kleinen Momentarm, ist unerwünscht, weil die großen Kräfte die ersten und zweiten Stifte scheren können. Es ist auch unerwünscht, den Momentarm der ersten und zweiten Stifte zu vergrößern, weil die physische Größe des Gabelkopfes nicht durch eine Kanüle passen mag.
  • Verschiedene bipolare Laparoskopieinstrumente sind bekannt. Beispielsweise offenbart das US-Patent 3,938,527 ein bipolares Laparoskopieinstrument für Eileiterkautierisierung. US-Patent 5,250,047 offenbart ein bipolares Laparoskopieinstrument mit einer austauschbaren Elektrodenspitzenbaugruppe. US-Patent 5,445,638 offenbart eine bipolare Koagulations- und Schneidpinzette mit vom distalen Ende sich erstreckenden ersten und zweiten Leitern. US-Patent 5,391,166 offenbart ein bipolares endoskopisches Instrument mit einem abnehmbaren Arbeitsende. US-Patent 5,342,359 offenbart eine bipolare Koagulationseinrichtung.
  • Die vorliegende Erfindung löst das Problem des Bereitstellens einer großen Verschlusskraft zwischen den Backen eines 1aparoskopischen bipolaren elektrochirurgischen Instruments, unter Verwendung eines kompaktes Designs, welches durch eine Kanüle passt, ohne ein strukturelles Versagen des Instrumentengabelkopfes zu riskieren.
  • Zusammenfassung der Erfindung
  • Gemäß der vorliegenden Erfindung wird ein laparoskopisches bipolares elektrochirurgisches Instrument bereitgestellt, welches umfasst:
    erste und zweite Backenelemente, die schwenkbar in gegenüberstehender Beziehung aneinander angebracht sind, wobei die Backenelemente von einer ersten offenen Position, bei der die Backenelemente in voneinander beabstandeter Beziehung angeordnet sind, zu einer zweiten klammernden Position, bei der die Backenelemente kooperieren, um zwischen sich Gewebe zu ergreifen, relativ beweglich sind;
    eine elektrisch leitfähige Schubstange, welche das erste Backenelement mit einem ersten Pol verbindet und eine elektrisch leitfähige Röhre, welche das zweite Backenelement so mit einem zweiten Pol verbindet, dass die Backenelemente in der Lage sind, bipolare Energie durch das zwischen ihnen gehaltene Gewebe zu leiten;
    ein am distalen Ende der Schubstange und zwischen den Backenelementen angebrachtes Traglager, wobei das Traglagerelement ein Paar von Stiften beinhaltet, die mit einem entsprechenden Paar Schlitze in einer Nockenstößelartigen Weise wechselwirken, um eine Bewegung der Backenelemente von den ersten und zweiten Positionen zu erteilen;
    ein Paar Schulterbereiche, die am Traglager angebracht sind; und
    ein an der Schubstange angebrachter Griff zum Erteilen von Bewegung an das Traglager, und
    dadurch gekennzeichnet, dass:
    jedes der Backenelemente einen Flansch beinhaltet, der sich davon weg erstreckt; und
    die Schulterbereiche dafür dimensioniert sind, an den Flanschen der Backenelemente anzustoßen, wenn die Backenelemente in die zweite Position bewegt werden, um Scherspannung auf den Stiften während des Klammerns und Versiegelns des Gewebes abzubauen.
  • Ein Vorteil der vorliegenden Erfindung ist, dass Gewebe mit einer relativ großen Verschlusskraft ohne Beschädigung des Gabelkopfs ergriffen und geklammert werden kann. Der Gabelkopf ist in der Lage, die große Verschlusskraft auf die Instrumentbacken zu übertragen, während er klein genug ist, um durch eine Kanüle zu passen.
  • Das laparoskopische bipolare elektrochirurgische Instrument umfasst erste und zweite Backen, die jeweils erste und zweite Flansche mit ersten und zweiten Schlitzen aufweisen. Das Instrument ist elektrisch mit einem elektrochirurgischen Generator verbunden und leitet bipolaren elektrischen Strom zu den ersten und zweiten Backen. Ein Gabelkopf ist an einer Schubstange angebracht und so positioniert, dass er den ersten Flansch vom zweiten Flansch elektrisch isoliert. Erste und zweite Stifte auf dem Gabelkopf sind dafür entworfen, jeweils in Eingriff mit ersten und zweiten Schlitzen in einer Nockenstößelanordnung zu kommen, welche die Backen mit linearer Bewegung des Gabelkopfes öffnet und schließt. Der Gabelkopf ist vorzugsweise ein "Schubgabelkopf", was bedeutet, dass eine lineare Bewegung des Gabelkopfs in Richtung des distalen Endes des Instruments die Backen dazu veranlasst, sich zusammenzuschließen.
  • Der Gabelkopf hat erste und zweite Schultern, die von den ersten und zweiten Flanschen beabstandet sind, bis die Backen in enger bogenförmiger Nähe zueinander sind. An diesem Punkt kommen die ersten und zweiten Schultern in Eingriff mit den ersten und zweiten Flanschen, wodurch eine weitere distale Bewegung des Gabelkopfs eine Kraft auf die ersten und zweiten Flansche ausübt, die ein Moment um die Drehachse jeder Backe erzeugt. Im allgemeinen kann die Nockenstößelanordnung von Stiften und Schlitzen dafür entworfen sein, eine grobe Bewegung der Backen mit relativ kleinen Kräften bereitzustellen. Große Verschlusskräfte können, wenn die Backen erst einmal relativ nahe beieinander sind, durch Pressen der Schultern gegen die Flansche erhalten werden. Die ersten und zweiten Stifte wandern in Sackgassen in den ersten und zweiten Schlitzen hinein, um sie vor den großen Scherspannungen zu schützen, wenn die Schultern relativ große Kräfte auf die Flansche ausüben. Somit können die ersten und zweiten Stifte aus elektrisch isolierendem Material hergestellt sein, das nicht dafür entworfen ist, große Scherspannungen zu handhaben, große Verschlusskräfte können erhalten werden, und die gesamte Baugruppe kann kompakt sein und durch eine Kanüle passen.
  • Ein Verfahren zum Herstellen des laparoskopischen bipolaren elektrochirurgischen Instruments wird beschrieben, welches die folgenden Schritte umfasst: Ausbilden einer ersten Backe mit einem ersten Flansch mit einem ersten Schlitz und einer zweiten Backe mit einem zweiten Flansch mit einem zweiten Schlitz; Anbringen eines Gabelkopfs an einer Schubstange; elektrisches Isolieren des ersten Flanschs gegenüber dem zweiten Flansch mit dem Gabelkopf; Ineingriffbringen der ersten und zweiten Stifte mit den ersten und zweiten Schlitzen; Positionieren von ersten und zweiten Sackgassen in den ersten bzw. zweiten Schlitzen, um Scherspannungen auf den ersten und zweiten Stiften an einem unterschnittenen Winkel ungefähr da, wo die ersten und zweiten Schultern in Eingriff mit den ersten und zweiten Flanschen kommen, abzubauen.
  • Kurze Beschreibung der Zeichnungen
  • 1 ist eine perspektivische Ansicht eines laparoskopischen bipolaren elektrochirurgischen Instruments.
  • 2 ist eine perspektivische Ansicht des distalen Endes und der Backen des Instruments in 1
  • 3 ist eine Explosionsansicht des in 2 gezeigten distalen Endes.
  • 4 ist eine perspektivische Ansicht des distalen Endes des Instruments mit abgenommenen Backen.
  • 5 ist eine andere perspektivische Ansicht von 4.
  • 6 ist eine Seitenansicht eines elektrischen Federkontakts.
  • 7 ist eine Vorderansicht des in 6 gezeigten Federkontakts.
  • Detaillierte Beschreibung der Erfindung
  • Ein laparoskopisches bipolares elektrochirurgisches Instrument 10 ist in 1 gezeigt. Das Instrument 10 hat ein proximales Ende 11 mit einem Handgriff 14 zum Halten und Manipulieren des Instruments 10. Ein distales Ende 12 auf dem Instrument 10 wird für die chirurgische Manipulation von Gewebe verwendet. Das Instrument 10 umfasst eine längliche Röhre 13, die so bemaßt ist, dass sie durch eine Kanüle für 1aparoskopische Operationen hindurchpasst und kann in anderen Ausführungsformen so bemaßt sein, dass sie entweder durch eine 5 oder 7 mm Kanüle passt.
  • Ein Teil des distalen Endes 12 des Instruments 10 ist in 2 gezeigt. Eine erste Backe 15 und eine zweite Backe 16 sind in einer offenen Position gezeigt. Die Backen 15 und 16 liegen unter einem Winkel α. Das Schließen der Backen 15 und 16 ist als eine Verminderung des von den Backen 15 und 16 eingeschlossenen Winkels α definiert. Ähnlich ist ein Öffnen der Backen 15 und 16 als eine Vergrößerung des Winkels α definiert. Der Winkel α ist Null, wenn die Backen 15 und 16 aufeinander geschlossen sind. Das Rotationszentrum für die erste Backe 15 ist an der ersten Drehachse 41 und das Rotationszentrum für die zweite Backe 16 ist an der zweiten Drehachse 42 befestigt. Die erste Drehachse 41 ist auf einem äußeren Nasenstück 32 positioniert und passt in ein auf dem ersten Flansch 18 positioniertes Drehachsenloch 42. Die zweite Drehachse 42 ist auf einem inneren Nasenstück 42 positioniert und passt in ein auf dem zweiten Flansch 20 positioniertes Drehachsenloch 44.
  • Teile, welche das distale Ende 12 des Instruments 10 bilden, sind in einer Explosionsansicht in 3 gezeigt. Die erste Backe 15 und die zweite Backe 16 sind als vo einem Gabelkopf 17 getrennt gezeigt. Die erste Backe 15 hat einen ersten Flansch 18 und einen ersten Schlitz 19 darin. Die zweite Backe 16 hat einen zweiten Flansch 20 und einen zweiten Schlitz 21 darin. Jede Backe 15 und 16 ist vorzugsweise aus einem einzelnen Stück Edelstahl oder einem anderen elektrisch leitfähigen Material gebildet.
  • Wiederum unter Bezugnahme auf 3 ist der Gabelkopf 17 an einer Schubstange 22 angebracht. Der Gabelkopf 17 ist vorzugsweise aus einem elektrisch-isolierenden Material, wie etwa Kunststoff, gebildet. Eine erste Seite 23 des Gabelkopfes 17 weist zum ersten Flansch 18. Eine zweite Seite 24 des Gabelkopfs 17 weist zum zweiten Flansch 20. Wenn der Gabelkopf 17 zwischen den Flanschen 18 und 20 positioniert ist, dient der Gabelkopf 17 auch dazu, die erste Backe 15 gegenüber der zweiten Backe 16 elektrisch zu isolieren. Auf diese Weise kann bipolarer elektrochirurgischer Strom durch von den Backen 15 und 16 ergriffenes Gewebe geleitet werden, ohne Kurzschluss zwischen den Flanschen 18 und 20.
  • Ein erster Stift 25 ist auf der ersten Seite 23 positioniert, um in beweglichem Eingriff mit dem ersten Schlitz 19 zu kommen. Ähnlich ist ein zweiter Stift 26 auf der zweiten Seite 24 positioniert, um in beweglichem Eingriff mit dem zweiten Schlitz 21 zu kommen. Jede Stift- und Schlitzkombination arbeitet als eine mechanische Nockenstößel-Verbindung. Die Bewegung der Schubstange 22 bewegt den Gabelkopf 17, was die Stifte 25 und 26 veranlasst, innerhalb ihrer jeweiligen Schlitze 19 und 21 zu gleiten. Die Schlitze 19 und 21 sind in Bezug auf die distalen Ende der Backen 15 und 16 so gewinkelt, dass sich die Backen 15 und 16 in einer gebogenen Weise zueinander und voneinander weg bewegen. Die Stifte 25 und 26 sind andere als die Drehachsen 41 und 42. Die Stifte 25 und 26 geben eine Kraft gegen die Wände der Schlitze 19 und 20, was ein Moment um die Drehachsen 41 und 42 erzeugt.
  • Die Schlitze 19 und 21 sind so angeordnet, dass eine distale Bewegung der Schubstange 22 die Backen 15 und 16 dazu veranlasst, sich aufeinander zu bewegen. Die distale Bewegung der Schubstange 22 ist als Bewegung in Richtung des distalen Endes 12 des Instruments 10 definiert. Wenn einmal die Backen 15 und 16 aufeinander geschlossen sind, hält die vorliegende Erfindung die Backen 15 und 16 mit einer Kompressionskraft auf die Schubstange 22 zusammen.
  • Einer der Vorteile dieser Erfindung ist, dass Scherkräfte auf den Stiften 25 und 26 entlastet werden können, um mechanisches Versagen zu verhindern, wenn große Kräfte auf die Backen 15 und 16 übertragen werden. Jeder Schlitz 19 und 20 hat eine Sackgasse 27 bzw. 28, wie in 3 gezeigt. Die erste Sackgasse 27 ist eine Vergrößerung des ersten Schlitzes 19 nahe an seinem distalen Ende. Die zweite Sackgasse 28 ist eine Vergrößerung des zweiten Schlitzes 21 nahe an seinem distalen Ende. Die Nockenstößelbewegung der Stifte 25 und 26 in den Schlitzen 19 und 21 bringt die Stifte 25 und 26 in ihre entsprechenden Sackgassen 27 und 28. Diese Position der Stifte 25 und 26 lässt einen sehr kleinen Drehmomentarm zwischen den Stiften 25 und 26 den Schwenkachsen 41 und 42. Der Gabelkopf 17 weist Schultern 29 und 30 auf, die ein relativ großes Moment um die Drehachsen 41 und 42 bereitstellen können, um eine hohe Verschlusskraft zwischen den Backen 15 und 16 ohne eine hohe Scherkraft auf den Stiften 25 und 26 zu bewirken, wie unten beschrieben.
  • Wenn die Stifte 25 und 26 einmal in den Sackgassen 27 und 28 sind, wird die Kraft von der Schubstange von einer ersten Schulter 29 und einer zweiten Schulter 30 auf die Flansche 18 und 20 übertragen. Die Schultern 29 und 30 stoßen am proximalen Ende der Flansche 18 und 20 an, um die Backen 15 und 16 zu veranlassen, aufeinander zu schließen. Die Drehachsen 41 und 42 sind vorzugsweise aus Metall hergestellt und können relativ hohen Scherkräften widerstehen. Im Gegensatz dazu sind die Stifte 25 und 26 vorzugsweise aus Kunststoff hergestellt und werden unter relativ hohen Scherkräften brechen. Somit stellen die Schultern 29 und 30 ein Moment um die Drehachsen 41 und 42 bereit, wodurch die Notwendigkeit des Anlegens von hohen Scherkräften an den Stiften 25 und 26 vermieden wird, wenn der Momentarm von den Stiften 25 und 26 klein wäre. Es gibt einen Winkel α, unter dem die Stifte 25 und 26 in ihre jeweiligen Sackgassen 27 und 28 eindringen und die Schultern 29 und 30 an den Flanschen 18 und 20 anstoßen. Der Winkel α, unter dem das Vorstehende auftritt, liegt vorzugsweise bei etwa 3 Grad.
  • Das bipolare elektrochirurgische Element weist erste und zweite Pole eines Wechselpotentials auf, die längs des Instruments 10 und durch das Gewebe geleitet werden, das zwischen den Backen 15 und 16 ergriffen ist. Der erste Pol wird vom proximalen Ende 11 zum distalen Ende 12 längs der Schubstange 22 geleitet. Der zweite Pol wird vom proximalen Ende 11 zum distalen Ende 12 längs der Röhre 13 geleitet. Die äußere Oberfläche der Röhre 13 ist vorzugsweise mit einem elektrisch isolierenden Material beschichtet. Auch gibt es vorzugsweise eine elektrisch isolierende Trennung zwischen der Schubstange 22 und der Röhre 13, um Kurzschlüsse im Instrument 10 zu vermeiden.
  • Bei der bevorzugten Ausführungsform umfasst das distale Ende des Instruments 10 ein inneres Nasenstück 31 und ein äußeres Nasenstück 32, wie in 2 gezeigt. Das innere Nasenstück 31 ist elektrisch mit der Schubstange 22 verbunden, während das äußere Nasenstück elektrisch mit der Röhre 13 verbunden ist. Das innere Nasenstück 31 und das äußere Nasenstück 32 fangen den Gabelkopf 17 zusammen mit den ersten und zweiten Flanschen 18 und 20 ein, wie in 2 gezeigt. Der Gabelkopf 17 bewegt sich axial längs einer durch die Röhre definierten Achse in einem Raum zwischen den inneren und äußeren Nasenstücken 31 und 32. Ein Abstandskragen 33 hält die Trennung zwischen den Nasenstücken 31 und 32 an ihren distalen Enden aufrecht. Die Nasenstücke 31 und 32 stellen einen lateralen Halt für die Flansche 18 und 20 bereit, um zu helfen, sicherzustellen, dass die Stifte 25 und 26 innerhalb der Schlitze 19 und 21 bleiben.
  • Die bevorzugte Ausführungsform umfasst auch einen inneren Isolator 34 und einen äußeren Isolator 35 zum Aufrechterhalten einer elektrischen Isolierung zwischen den Polen. Der äußere Isolator 35 sitzt zwischen der Röhre 13 und der inneren Nase 31, wie in den 2 und 4 gezeigt. Der innere Isolator 34 sitzt zwischen der Röhre 13 und der Schubstange 22. Auf diese Weise kann das äußere Nasenstück 32 einen elektrischen Durchgang zwischen der Röhre 13 und der zweiten Backe 16 bereitstellen, während das innere Nasenstück 34 einen elektrischen Durchgang zwischen der Schubstange 22 und der ersten Backe 15 bereitstellen kann. Da die Schubstange 22 verschiebbar innerhalb der Röhre 13 montiert ist, weist die bevorzugte Ausführungsform einen Federkontakt 36 auf, wie in den 6 und 7 gezeigt, der auf der Schubstange 22 montiert ist, um eine elektrische Verbindung mit dem inneren Nasenstück 34 während einer axialen Bewegung aufrechtzuerhalten.
  • Die ersten und zweiten Backen 15 und 16 haben beide Zacken 37 und 38 an ihren distalen Enden, die vorzugsweise ineinander greifen. Die Backen 15 und 16 weisen auch Siegeloberflächen 39 und 40 auf, wie in 2 gezeigt. Die Breite der Siegeloberflächen 39 und 40 ist ein Parameter, der die Qualität der chirurgischen Ergebnisse berührt. Die Schließkraft zwischen den Backen 15 und 16 variiert über die Länge der Siegeloberflächen 39 und 40, mit der größten Kraft an der distalen Spitze und der kleinsten Kraft am proximalen Ende der Siegeloberfläche 39 und 40. Es ist experimentell gefunden worden, dass gute Gefäßversiegelungsergebnisse erhalten werden, wenn die Verschlusskraft in Gramm geteilt durch die Breite in Millimetern im Bereich von 400 bis 650 liegt. Da die Verschlusskraft mit der Länge der Siegeloberflächen 39 und 40 variiert, ist es als vorteilhaft gefunden worden, die Breite der Siegeloberflächen 39 und 40 über ihre Länge zulaufen zu lassen, wobei die breiteste Breite am proximalen Ende und die schmalste Breite am distalen Ende ist. Dieser Entwurf gestattet es den Backen 15 und 16, eine relativ konstante Verschlusskraft pro Einheitsbreite aufzubringen, vorzugsweise 525 g/mm Breite.
  • Ein Verfahren zum Herstellen eines laparoskopisch bipolaren elektrochirurgischen Instruments 10 wird hier ebenfalls beschrieben. Das Verfahren umfasst die Schritte des Ausbildens einer ersten Backe 15 mit einem ersten Flansch 18 mit einem ersten Schlitz 19 und einer zweiten Backe 16 mit einem zweiten Flansch 20 mit einem zweiten Schlitz 21. Die Backen 15 und 16 werden bevorzugt in einem Gussverfahren hergestellt, auch wenn es möglich ist, die Backen 15 und 16 aus einem Ausgangsmaterial herauszuarbeiten. Das Gussverfahren kann das Einspritzen von Pulvermetall durch Druck in eine Form und dann das Anwenden von Hitze beinhalten.
  • Andere Schritte im Verfahren beinhalten Anbringung eines Gabelkopfs 17 an einer Schubstange 22 und elektrisches Isolieren des ersten Flansches 18 gegenüber dem zweiten Flansch 20 mit dem Gabelkopf 17. Der Gabelkopf 17 ist vorzugsweise ein Spritzguss-Kunststoffteil mit Merkmalen, die eine erste Schulter 29 und eine zweite Schulter 30 beinhalten.
  • Während des Zusammenbaus des distalen Teils des Instruments 10 enthalten die Schritte im Verfahren ein Ineingriffbringen eines ersten Stifts 25 in den ersten Schlitz 19 und ein Ineingriffbringen eines zweiten Stifts 26 in den zweiten Schlitz 21. Die Schlitze 19 und 21 sind so gebildet, dass ein Schnittwinkel α zwischen den ersten und zweiten Backen 15 und 16 mit distaler Bewegung der Schubstange 17 kleiner wird, und die Schlitze 19 und 20 sind mit Sackgassen 27 und 28 versehen, die so positioniert sind, dass sie Scherspannungen auf den ersten und zweiten Stiften 25 und 26 beim Schnittwinkel α ungefähr dann freigeben, wenn die ersten und zweiten Schultern 29 und 30 in die ersten und zweiten Flansche 18 und 20 eingreifen.
  • Weitere Schritte im Verfahren umfassen: Umgeben zumindest eines Teils der Schubstange 22 mit einer elektrisch-leitfähigen Röhre 13; elektrisches Isolieren der Röhre 13 gegenüber der Schubstange 22; elektrisches Verbinden eines inneren Nasenstücks 31 an der Schubstange 22 und elektrisches Verbinden eines äußeren Nasenstücks 32 an der Röhre 13, wobei das innere Nasenstück 31 und das äußere Nasenstück 32 den Gabelkopf 17 gemeinsam mit den ersten und zweiten Flanschen 18 und 20 einfangen, um bipolaren elektrochirurgischen Strom zu den ersten und zweiten Backen 15 und 16 zu leiten. Bei der bevorzugten Ausführungsform gibt es einen Schritt des elektrischen Verbindens der Schubstange 22 und des inneren Nasenstücks 31 mit einem Federkontakt 36.
  • Das Verfahren des Herstellens des Instruments 10 beinhaltet in einigen Ausführungsformen die Schritte des Zulaufenlassens der Breite der Dichtoberflächen 39 und 40 längs der Länge jeder der ersten und zweiten Backen 15 und 16.
  • Während eine bestimmte bevorzugte Ausführungsform illustriert und beschrieben worden ist, bestimmt sich der nachgesuchte Schutzumfang aus den Ansprüchen, die folgen.

Claims (9)

  1. Laparoskopisches bipolares elektrochirurgisches Instrument (10), umfassend: erste (15) und zweite (16) Backenelemente, die schwenkbar in einander gegenüberliegender Beziehung aneinander angebracht und relativ zueinander von einer ersten offenen Position, bei der die Backenelemente in voneinander beabstandeter Beziehung angeordnet sind, zu einer zweiten klammernden Position beweglich sind, bei der die Backenelemente zusammenwirken, um zwischen sich Gewebe zu ergreifen; eine elektrisch leitfähige Schubstange (22), welche das erste Backenelement mit einem ersten Pol verbindet und eine elektrisch leitfähige Röhre (13), welche das zweite Backenelement so mit einem zweiten Pol verbindet, dass die Backenelemente bipolare Energie durch das zwischen ihnen gehaltene Gewebe leiten können; einen am distalen Ende der Schubstange und zwischen den Backenelementen angebrachten Gabelkopf (17), wobei das Gabelkopfelement ein Paar von Stiften (25, 26) beinhaltet, die mit einem entsprechenden Paar Schlitze (19, 21) in einer Nockenfolge gliedartigen Weise wechselwirken, um den Backenelementen Bewegung aus den ersten und zweiten Positionen zu verleihen; ein Paar Schulterbereiche (29, 30), die am Gabelkopf angebracht sind; und einen an der Schubstange angebrachten Griff (14) um dem Gabelkopf Bewegung zu verleihen, und dadurch gekennzeichnet, dass: jedes der Backenelemente einen Flansch (18, 20) aufweist, der sich von ihm weg erstreckt; und die Schulterbereiche dafür dimensioniert sind, an den Flanschen der Backenelemente anzuliegen, wenn die Backenelemente in die zweite Position bewegt sind, um während des Klammerns und Versiegelns des Gewebes Scherspannung auf den Stiften abzubauen.
  2. Laparoskopisches bipolares elektrochirurgisches Instrument (10) gemäß Anspruch 1, wobei: das Paar von Schlitzen so angeordnet ist, dass der Flansch (18) auf der ersten Backe (15) den ersten Schlitz (19) aufweist und der Flansch (20) auf der zweiten Backe (16) den zweiten Schlitz (21) aufweist; der erste Schlitz und der zweite Schlitz so geformt sind, dass ein Winkel, der von den ersten und zweiten Backen gebildet wird, mit distaler Bewegung der Schubstange abnimmt; erste (27) und zweite (28) Sackgassen jeweils in den ersten und zweiten Schlitzen positioniert sind, um Scherspannungen auf den ersten (25) und zweiten (26) Stiften ungefähr dann abzubauen, wenn die ersten (29) und zweiten (30) Schultern jeweils in Eingriff mit den ersten und zweiten Flanschen kommen, um eine Schließkraft zwischen den ersten und zweiten Backen bereitzustellen; und wobei der an der Schubstange (22) angebrachte Gabelkopf (17) den ersten Flansch (18) elektrisch vom zweiten Flansch (20) isoliert und eine erste, zum ersten Flansch hin weisende sowie eine zweite, zum zweiten Flansch hin weisende Seite aufweist.
  3. Laparoskopisches bipolares elektrochirurgisches Instrument (10) nach Anspruch 1 oder 2, wobei die elektrisch leitfähige Röhre (13) zumindest einen Teil der Schubstange (22) umgibt; und eine elektrisch isolierende Schicht (34) zwischen der Röhre und der Schubstange angeordnet ist, die ein elektrochirurgisches Wechselpotential zwischen Röhre und Schubstange aushalten kann.
  4. Laparoskopisches biopolares elektrochirurgisches Instrument (10) nach einem der vorstehenden Ansprüche, weiterhin umfassend: ein inneres Nasenstück (31), das elektrisch mit der Schubstange (22) verbunden ist, und ein äußeres Nasenstück (32), das elektrisch mit der Röhre (13) verbunden ist, wobei das innere Nasenstück und das äußere Nasenstück den Gabelkopf (17) zusammen mit den ersten und zweiten Flanschen einfangen, um den ersten (15) und zweiten (16) Backen bipolaren elektrochirurgischen Strom zuzuleiten.
  5. Laparoskopisches biopolares elektrochirurgisches Instrument (10) nach Anspruch 4, weiterhin umfassend einen elektrischen Federkontakt (36) zwischen der Schubstange (22) und dem inneren Nasenstück (31), um zwischen ihnen elektrischen Durchgang bereitzustellen.
  6. Laparoskopisches bipolares elektrochirurgisches Instrument (10) nach einem der vorstehenden Ansprüche, weiterhin in jeder der ersten und zweiten Backen (15, 16) Zacken (37, 38) umfassend.
  7. Laparoskopisches bipolares elektrochirurgisches Instrument (10) nach einem der vorstehenden Ansprüche, wobei jeder der ersten und zweiten Backen eine Siegeloberfläche (39, 40) mit einer Breite und einer Länge aufweist, und wobei zumindest eine Stelle längs der Länge eine solche Breite aufweist, dass die Verschlusskraft in Gramm dividiert durch die Breite in Millimetern im Bereich von 400 bis 650 liegt.
  8. Laparoskopisches bipolares elektrochirurgisches Instrument (10) nach Anspruch 7, wobei sich die Breite jeder Siegeloberfläche (39, 40) über ihre jeweilige Länge verjüngt.
  9. Laparoskopisches bipolares elektrochirurgisches Instrument (10) gemäß Anspruch 7 oder 8, wobei die Verschlusskraft, geteilt durch die Breite, bei der ersten und der zweiten Backe ungefähr konstant über die Länge ist.
DE69823862T 1997-11-14 1998-11-13 Biopolares elektrochirurgisches laparoskopieinstrument Expired - Lifetime DE69823862T2 (de)

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JP4010479B2 (ja) 2007-11-21
ES2221226T3 (es) 2004-12-16
US20080215051A1 (en) 2008-09-04
CA2310004A1 (en) 1999-05-27
US7828798B2 (en) 2010-11-09
US6960210B2 (en) 2005-11-01
US20060009764A1 (en) 2006-01-12
EP1030612B1 (de) 2004-05-12
EP1030612A1 (de) 2000-08-30
AU732660B2 (en) 2001-04-26
WO1999025261A1 (en) 1999-05-27
EP1030612A4 (de) 2002-10-29
DE69823862D1 (de) 2004-06-17
US20030032956A1 (en) 2003-02-13
CA2310004C (en) 2007-01-09
AU1459099A (en) 1999-06-07
US6451018B1 (en) 2002-09-17
JP2001522685A (ja) 2001-11-20
US7207990B2 (en) 2007-04-24
US6228083B1 (en) 2001-05-08

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