DE102013020818B4 - Endoscopic device - Google Patents

Abstract

Endoscopic device with a flexible tube (1) which has at least one lumen (10) running in its longitudinal direction, a guide element (12) running inside the lumen (10) which accommodates an actuating element (9) designed as an actuating wire or cable and, compensating for a radial play (11) between an inner lateral surface (20) of the lumen (10) and the actuating element (9), sliding on its outer lateral surface (19) formed by turns (13, 14, 15, 16, 17) in the inner lateral surface (20) of the lumen (10), wherein at a proximal end of both the tube (1) and the actuating element (9) there is an actuating unit (2) for the axial displacement of the actuating element (9) within the tube (1 ). running in a line, wraps around the actuating element (9) at least over sections of its longitudinal extent and is fixed relative to it, the windings (13, 14, 15, 16, 17) of the guide element (12) running at a distance from one another in its axial direction.

Description

The invention relates to an endoscopic device with a flexible tube, which has at least one lumen running in its longitudinal direction, with a guide element running inside the lumen, which receives an actuating element designed as an actuating wire or rope and, a radial play between an inner lateral surface of the lumen and compensating for the actuating element, is guided slidingly in the inner lateral surface of the lumen on its outer lateral surface formed by windings, an actuating unit for axially displacing the actuating element within the tube acting on a proximal end of both the tube and the actuating element, and on a distal end of the actuating element a treatment instrument is arranged.

Furthermore, the invention also relates to an endoscopic device with a flexible tube, which has at least one lumen running in its longitudinal direction, with guide elements running inside the lumen, which accommodate an actuating element designed as an actuating wire or cable, and radial play between an inner lateral surface of the lumen and compensating for the actuating element, slidingly guided in the inner lateral surface, with an actuating unit acting on a proximal end of both the tube and the actuating element for axially displacing the actuating element within the tube, and with a treatment instrument being arranged on a distal end of the actuating element

Endoscopes are used for diagnostics and for the treatment of patients, the advantage being that such interventions can be carried out with little physical stress and discomfort. This can involve, for example, interventions in the area of the gastrointestinal tract, the lungs or within blood vessels. The actual endoscope consists of a flexible, tubular body which is provided with a camera and a light source at its distal end and has a working channel for accommodating the aforementioned endoscopic device.

Endoscopic devices of the aforementioned type are provided distally, for example, with treatment instruments for an endoscopic resection of early gastrointestinal neoplasia. In this case, for example, a high-frequency tool acting as a knife can be formed on a stranded wire, which can be adjusted into different working positions in which the knife assumes different functions. Furthermore, the tube can be designed at its distal end for piercing the mucosa and can be energized, with the lumen accommodating the actuating wire being designed as an injection and/or rinsing device. During the function as an injection device, the high-frequency tool assumes a position in which the wire strand is fully retracted into the lumen. The distal end of the tube is inserted into the open area of the mucosa, after which a substance is injected under the lesion. The entire endoscopic submucosal dissection can preferably be carried out using the same endoscopic treatment instrument without having to exchange it for another one and without having to remove the entire endoscopic device from the gastrointestinal tract to change the treatment instrument. Consequently, the duration of the endoscopically performed intervention can be significantly reduced.

There is also the possibility of using corresponding endoscopic devices, for example to remove a gallstone from a bile and pancreatic duct or for polypectomy. To remove a gallstone, it is first removed from the papilla by means of a treatment device, which is designed as a papillotome and is provided on the endoscopic device. The gallstone loosened from the papilla is then removed from the bile duct and pancreas duct using a treatment device provided on a generic device, which is designed as a collecting basket. In polypectomy, polyps are removed from the upper or lower gastrointestinal tract by means of a polypectomy snare provided on the generic device, which removes them from the mucous membrane. The aforementioned possible uses of an endoscopic device designed according to the generic type are only to be regarded as examples, and the use of the device according to the invention is not restricted to these. For example, different types of cutting devices, devices for biopsy, devices for inserting or removing stents, for placing clips, etc. can be provided distally.

An endoscopic device known in the preamble of claim 1 genus is from DE 10 2009 022 119 A1 known and in this case is provided distally with a manipulation device in the form of forceps or a gripper. A tubular shaft accommodates a transmission element designed as a pull or push rod, it being possible for the pull or push rod to be made from a thin rod that can be bent at least in sections. Within the shaft, a guide insert is arranged with by means of its support sections, it should be guided transversally with little or no play in the shaft, or it should even be elastically clamped there. Opposite this guide insert, which can have a helical structure, the pull or push rod is arranged to be longitudinally displaceable with respect to the guide insert.

Furthermore, from the WO 2012/088600 A1 a screw pump for sampling or removing a tissue from an organ of a body. This screw pump has a spindle driven in rotation by an electric motor, which is arranged inside a tube provided with a distal suction opening and a proximal outlet opening. The spindle consists of a shaft around which a helically running wire forming a conveying means is wound.

The object of the present invention is to further develop a device of the type specified in the respective preamble of patent claims 1 and 2 in such a way that the response behavior of the treatment instrument is improved with structurally simple means, i.e. the longitudinal or rotary movements performed on the actuating unit are transmitted to it without delay . The actuating wire or the actuating cable should be guided in the lumen with little friction.

Starting from the preamble of patent claim 1, this object is achieved in conjunction with its characterizing features.

According to the characterizing part of patent claim 1, the guide element made of a stranded wire or twisted individual wires, running helically, wraps around the actuating element at least over sections of its longitudinal extent and is fixed relative to it, with the windings of the guide element running at a distance from one another in its axial direction. Due to the exact guidance of the actuating element within the lumen, a very precise response behavior of the treatment elements arranged at the distal end is achieved, i.e. the actuating element can no longer move radially inside the lumen during a longitudinal or rotary movement initiated via the actuating unit. The guide element, which is fixed relative to the actuating element, compensates for the radial play between the actuating element and the lumen and has good sliding properties because it does not lie flat against the inner lateral surface of the lumen over the entire length of the tube.

In contrast, the actuator is after DE 10 2009 022 119 A1 designed as a pull or push rod, which is guided in a longitudinally displaceable manner in the guide insert fixed in the shaft. Consequently, the guide insert is not designed as a helical strand of wire and is fixed relative to an actuating wire. The device after WO 2012/088600 A1 is designed as a screw pump in contrast to the solution according to the invention.

In an alternative embodiment of the endoscopic device according to the preamble of independent claim 2, in which guide elements run within the lumen and accommodate an actuation element designed as an actuation wire or cable, at least three guide elements should run parallel to the actuation element and are each made of a wire strand or twisted individual wires be provided, which are fixed relative to the actuating element.

Furthermore, in the case of a helical guide element, the windings of the guide element should run at a distance from one another in its axial direction. Spaced apart means that the windings each have a significant distance from one another. The channel thus formed between the turns, also running in a helical manner, serves to conduct a liquid medium to the distal end of the endoscopic device, which is used for rinsing the treated area or for injection. The channel can be dimensioned in such a way that the injection resistance increases only slightly in comparison to a ring channel known from the prior art. In this case, however, the advantages explained above are achieved.

Furthermore, the helical windings of the guide element can run at an angle of inclination α≧30°, preferably approximately α=70°, to a transverse plane of the actuating element. In addition, by means of a variable pitch height, on the one hand the guidance of the actuating element can be adjusted and thus the precise and direct response behavior of the respective treatment instrument can be adjusted; on the other hand, the injection resistance can be regulated by the channel formed in the lumen.

Furthermore, it is provided that the at least one guide element is made from a single stranded wire or from twisted individual wires. This wire strand or the twisted individual wires can be made of a metal, a metal alloy or plastic. If it is a corresponding stranded wire, it can be profiled, ie have a cross-sectional shape that deviates from the circular cross-section. A suitably designed semi-finished product for the guide element can be used both for its screw-like design and for the design consisting of several parallel guide elements.

In both cases, the device can also have a connection opening into the interior of the lumen for the delivery of a liquid for rinsing or for injecting a treated area, which may be a lesion, via the inter-coils or inter-coils to a distal end of the device at distances provided by the longitudinal guide elements. A lesion can be injected by means of the distal end of the tube in the manner explained in the introduction to the description. Flushing of the treated area is provided in many applications.

Furthermore, the at least one guide element should be fastened proximally to a push-pull rod that interacts with the actuating unit. The corresponding guide element can also be fixed directly or indirectly to the actuating element at least in the region of the distal end.

Finally, the guide element should be fixed either in a front receiving bore of the pull-push rod, by means of a shrink tube on an outer lateral surface of the pull rod or by at least one welded, soldered or adhesive connection on the actuating element. In addition, a sleeve can also be pressed onto the push-pull rod, which sleeve fixes the guide element to the push-pull rod.

Further features of the invention result from the following description and from the drawing, in which an exemplary embodiment of the invention is shown in simplified form.

• 1 eine Seitenansicht einer erfindungsgemäßen Vorrichtung zur endoskopischen Resektion mit einem sichelförmigen Messer,
• 2 eine vergrößerte perspektivische Darstellung eines Abschnitts des in der 1 verwendeten Tubus' mit einem in dessen Lumen über ein erfindungsgemäß ausgebildetes Führungselement geführtes Betätigungselement, wobei das Führungselement einen schraubenlinienartigen Verlauf aufweist,
• 3 einen Querschnitt durch den Tubus in 2 gemäß Linie III - III,
• 4 eine vergrößerte perspektivische Darstellung eines Abschnitts des in der 1 verwendeten Tubus' mit einem in dessen Lumen über erfindungsgemäß ausgebildete Führungselemente geführtes Betätigungselement, wobei die Führungselemente parallel zum Betätigungselement verlaufen,
• 5 einen Querschnitt durch den Tubus in 4 gemäß Linie V - V,
• 6 eine erste Ausführung einer Fixierung eines schraubenlinienförmigen Führungselements an einer Zug-Druckstange,
• 7 einen Querschnitt durch die Zug-Druckstange in 6 gemäß Linie VII - VII,
• 8 eine zweite Ausführung einer Fixierung eines schraubenlinienförmigen Führungselements an einer Zug-Druckstange,
• 9 eine erste Ausführung einer Fixierung eines schraubenlinienförmigen Führungselements am Betätigungselement,
• 10 eine zweite Ausführung einer Fixierung eines schraubenlinienförmigen Führungselements am Betätigungselement und
• 11 eine dritte Ausführung einer Fixierung eines schraubenlinienförmigen Führungselements an einer Zug-Druckstange, wobei diese mittels einer Hülse erfolgt.

Show it:

• 1 a side view of a device according to the invention for endoscopic resection with a sickle-shaped knife,
• 2 an enlarged perspective view of a portion of in the 1 used tube' with an actuating element guided in its lumen via a guide element designed according to the invention, the guide element having a helical course,
• 3 a cross section through the tube in 2 according to line III - III,
• 4 an enlarged perspective view of a portion of in the 1 used tube' with an actuating element guided in its lumen via guiding elements designed according to the invention, the guiding elements running parallel to the actuating element,
• 5 a cross section through the tube in 4 according to line V - V,
• 6 a first embodiment of fixing a helical guide element on a push-pull rod,
• 7 a cross-section through the push-pull rod in 6 according to line VII - VII,
• 8th a second embodiment of fixing a helical guide element on a push-pull rod,
• 9 a first embodiment of fixing a helical guide element on the actuating element,
• 10 a second embodiment of a fixation of a helical guide element on the actuating element and
• 11 a third embodiment of fixing a helical guide element to a push-pull rod, this being done by means of a sleeve.

In the 1 1 denotes a shortened tube of an endoscopic device, at the proximal end of which an actuating unit 2 is arranged. This actuating unit 2 has a thumb ring 4 supported on the tube 1 via a guide element 3, with a guide bushing 5 being guided in a longitudinally displaceable manner on the guide element, which causes an adjustment of a treatment instrument 6 arranged at the distal end of the tube 1, which in the present case is designed as a high-frequency tool is. Finger rings 7 are arranged on the guide bushing 5, so that the attending physician can adjust the high-frequency tool 6 with one hand. In addition, a connector 8 is provided on the actuating unit 2, through which a liquid substance can be introduced into the tube 1, which, as will be explained further, is guided to the distal end of the device. How to continue 1 can be removed, the treatment instrument 6 designed as a high-frequency tool has a crescent-shaped outer contour with an extension. However, this high-frequency tool is only one example of a treatment instrument 6 that can be used within the scope of the invention.

A first variant of an inventive design of an arrangement of an actuating element 9 in a lumen 10 of the endoscopic device 1 is in the 2 , 3 as well as 6 to 11 shown. After that, as from the 2 and 3 As can be seen, the lumen 10 over the entire length of the tube 1 and accommodates the actuating element 9, which is designed as an actuating wire or actuating cable, with a particularly 3 visible radial play 11 on. According to this exemplary embodiment of the invention, the actuating element 9 is wrapped with a guide element 12 in such a way that this guide element made of a wire or a cable has a helical course with a large pitch. This results in turns 13 through 17 being spaced apart and having an in 3 visible channel 18, also running in a helical shape, through which a liquid medium, for example a rinsing liquid or injection liquid, supplied via the connection piece 8, is guided into the region of the treatment instrument 6, ie up to the distal end of the endoscopic device. As well as from the 3 shows that the helical guide element 12 lies with its outer lateral surface 19 on an inner lateral surface 20 of the lumen 10, so that the actuating element 9 is guided exactly in the lumen 10.

A second variant of an inventive design of the endoscopic device with an actuating element 21 in a lumen 22 of the 1 tube shown 'is to be arranged, can the 4 and 5 be removed. In this case, the actuating element 21 is supported on an inner lateral surface 26 of the lumen 22 via guide elements 23, 24 and 25 which extend parallel thereto. These guide elements 23, 24 and 25 are also based on a push-pull rod to which they are fixed. Delimited by the guide elements 23, 24, 25, the actuating element 21 and the inner lateral surface, channels 23a, 24a and 25a are formed for conducting a liquid medium which is fed to the endoscopic device via the connection piece. In addition, instead of three guide elements 23, 24, 25, four guide elements can also be provided.

In the 6 until 11 are different variants for fastening one after the 2 and 3 helically running guide element 12 shown.

after the 6 and 7 a front bore 28 is provided in a push-pull rod 27 from which the actuating element 9 extends. One end of the guide element 12 is inserted into this bore 28 and fastened by means of soldering, welding or gluing. From the 6 also shows that the windings extend at an angle of inclination α to a transverse plane 33, α=69° in the present case. According to the invention, the pitch angle α should be greater than or equal to 30°.

After 8th the guide element 12 is fastened to the pull-push rod 27 by means of a shrink tube 29 radially surrounding it. The guide element 12 is inserted into a profiled receptacle, and then the shrink tube 29 is shrunk onto the outer lateral surface of the push-pull rod 27 .

From the 9 a type of connection of the guide element 12 to the actuating element 9 emerges, in which these components are fixed to one another via a welded connection 30 . Instead of the welded joint can according 10 an adhesive connection 31 may also be provided.

Finally shows the 11 an arrangement in which the guide member 12 instead of after the 8th provided shrink tubing 29 is attached to the push-pull rod 27 by means of a sleeve 32 .

reference list

1

tube

2

operating unit

3

guide element

4

thumb ring

5

guide bush

6

treatment tool

7

finger rings

8th

Support

9

operating wire

10

lumens

11

radial play

12

helical guide element

13

coil

14

coil

15

coil

16

coil

17

coil

18

channel

19

Outer jacket surface of 12

20

Inner lateral surface of 10

21

actuator

22

lumens

23

guide element

24

guide element

25

guide element

26

inner lateral surface

27

pull-push rod

28

drilling

29

shrink tubing

30

welded joint

31

adhesive connection

32

sleeve

Claims (8)

Endoscopic device with a flexible tube (1) which has at least one lumen (10) running in its longitudinal direction, a guide element (12) running inside the lumen (10) which accommodates an actuating element (9) designed as an actuating wire or cable and, compensating for a radial play (11) between an inner lateral surface (20) of the lumen (10) and the actuating element (9), sliding on its outer lateral surface (19) formed by turns (13, 14, 15, 16, 17) in the inner lateral surface (20) of the lumen (10), wherein at a proximal end of both the tube (1) and the actuating element (9) there is an actuating unit (2) for the axial displacement of the actuating element (9) within the tube (1 ) engages, a treatment instrument (6) being arranged at a distal end of the actuating element (9), characterized in that the guide element (12) made from a wire strand or twisted individual wires, screw running linearly, wraps around the actuating element (9) at least over sections of its longitudinal extension and is fixed relative to it, the windings (13, 14, 15, 16, 17) of the guide element (12) running at a distance from one another in its axial direction. Endoscopic device with a flexible tube (1) which has at least one lumen (22) running in its longitudinal direction, guide elements (23, 24, 25) running inside the lumen (22) which have an actuating element ( 21) and compensating for radial play (11) between an inner lateral surface (26) of the lumen (22) and the actuating element (21), slidingly guided in the inner lateral surface (26), with a proximal end of both the tube (1st ) and the actuating element (21) engages an actuating unit (2) for the axial displacement of the actuating element (21) within the tube (1) and wherein a treatment instrument (6) is arranged at a distal end of the actuating element (21), characterized in that that at least three guide elements (23, 24, 25) are provided which run parallel to the actuating element (21) and are each made of a stranded wire or twisted individual wires d, which are fixed relative to the actuating element (21). Endoscopic device according to Claim 1 , characterized in that the windings (13, 14, 15, 16, 17) run at a pitch angle α≥30°, preferably α equal to about 70° to a transverse plane of the actuating element (9). Endoscopic device according to patent claims 1 , characterized in that the device has a connection (8) opening into the interior of the lumen (10) for the supply of a liquid for rinsing or for injecting areas to be treated, which via the windings (13, 14, 15, 16 , 17) provided spacings, which form at least one channel (18), is fed to a distal end of the device. Endoscopic device according to patent claim 2 , characterized in that the device has a connection (8) opening into the interior of the lumen (22) for the supply of a liquid for rinsing or for injecting the areas to be treated, which can be connected via the guide elements (23, 24, 25) running lengthwise between them ) provided spacings which form channels (23a, 24a, 25a) to a distal end of the device. Endoscopic device according to Claim 1 or 2 , characterized in that the at least one guide element (12, 23, 24, 25) is fixed in a front receiving bore (28) of a push-pull rod (27) interacting with the actuating unit (2). Endoscopic device according to Claim 1 or 2 , characterized in that the at least one guide element (12, 23, 24, 25) is fixed by means of a shrink tube (29) or a sleeve (32) on an outer lateral surface of a push-pull rod (27) interacting with the actuating unit. Endoscopic device according to Claim 1 or 2 , characterized in that the at least one guide element (12, 23, 24, 25) is fixed to the actuating element (9, 21) by means of at least one welded (30), soldered or adhesive connection (31).

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