DE29505619U1 - Surgical instrument, in particular for an endoscope - Google Patents

Description

Harald Maslanka
Stockacher Strasse 172
78532 Tuttlingen

KOPERNIKUSSTRASSE 9 81679 MUNICH

Surgical instrument, especially for an endoscope

The invention relates to a surgical instrument, in particular for an endoscope , comprising an elongated flexible actuation cable to be connected to a surgical tool at an end near the patient, which has a tubular cable sheath and a cable core that is slidably guided in the cable sheath, a manual actuation unit connected to an end of the actuation cable remote from the patient for manually displacing the cable core relative to the cable sheath, a sheath unit that encloses the actuation cable and can be displaced beyond the end of the actuation cable near the patient relative to it into at least one advanced position, which can be fixed in a retracted position releasing the surgical tool in the direction of displacement relative to the actuation cable, and a preload spring that acts between the sheath unit and the manual actuation unit and preloads the sheath unit to its advanced position.

One application of such a surgical instrument can be, for example, the placement of hemostasis or marking clips. With the help of such clips, lesions, i.e. injuries to internal organs, can be marked before surgical interventions. They are also suitable for stopping bleeding by clamping veins. They can also be used for clamping

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of hemorrhoids. Such clips usually consist of a spring-elastic forceps whose arms are pressed together when the forceps are forced through an associated locking sleeve. This is done by hooking the forceps through the locking sleeve onto the cable core and pulling the latter back against the cable sheath. The locking sleeve rests on the cable sheath so that the forceps are pulled into the locking sleeve and the arms close. The clips have a predetermined breaking point that allows the closed clips to be left in the body and the instrument to be pulled out.

To insert the clips into the body through the instrument channel of an endoscope, the sheathing unit, which usually consists of a plastic tube at least in the area of the end of the actuating cable closest to the patient, is pushed over the clip so that it is protected and cannot become jammed in the instrument channel. Once the body part to be marked or clamped has been reached, the tube is pulled back. The now exposed clip is then attached to the intended body part using the manual actuating unit.

In a known, previously used embodiment of an instrument of the type described above, the sheathing unit has a plastic grip sleeve which encloses a guide shaft of the manual actuation unit, which is also made entirely of plastic, in the same axis and can be moved relative to it. The actuation cable is attached to the guide shaft and is covered by a plastic hose connected to the grip sleeve. In order to be able to lock the sheathing unit in the retracted position, the grip sleeve is designed with a sliding piece which can be moved transversely to the guide shaft relative to the grip sleeve and can be moved in front of an axial stop surface of the guide shaft in the retracted position. A separate, patient-

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The cover part placed on the far end of the handle sleeve secures the sliding piece against loss.

The disadvantage of the known design is that it is relatively susceptible to damage under the harsh operating conditions in an operating room, where it is often not possible to handle the instruments carefully and cautiously. Due to the consistent use of plastic parts, one of the parts can easily break. Furthermore, the sliding piece presses on the cover part in the retracted position, so that this can possibly come loose from the handle sleeve. Handling the relatively small sliding piece can also be difficult in the hectic pace of an operation.

The invention is based on the object of creating a surgical instrument of the type described above which is reliable and easy to operate despite its simple construction.

To achieve this object, the invention provides that the casing unit is designed with at least one holding surface and the manual operating unit with at least one counter-holding surface and that, in order to fix the casing unit, these two surfaces can be moved in front of each other by relative rotation of the parts of the casing unit or the manual operating unit that carry them.

The rotary connection between the casing and the manual operating unit can be opened and closed with simple movements of the whole hand, without the need to use individual fingers. It can withstand the stresses of everyday operations and allows the casing unit to be locked securely and quickly, and it cannot be loosened by accidental manipulation.

Preferably, the holding surface and the counter-holding surface are part of a, in particular, multi-start screw connection between the casing unit and the manual operating unit. Alternatively, the holding surface and the counter-holding surface can also be part of a bayonet connection between these two units. In the event that several holding or counter-holding surfaces are provided, it is suggested that these are each spaced apart from one another by the same angular amounts. In this way, jamming when closing the rotary connection can be avoided. For example, in a preferred embodiment of the invention, a two-start screw thread is provided on the manual operating unit, the threads of which are offset by 180° from one another, and two diametrically opposed segments of an annular shoulder or thread are provided on the casing unit. Of course, a complete screw thread can also be provided on the casing unit. The resilient screw or bayonet connection between the casing unit and the manual operating unit enables the operator to close the connection essentially blindly with a quick and sometimes powerful hand movement. It is particularly advantageous if the rotary connection between the casing unit and the manual operating unit formed by the holding and counter-holding surfaces can be closed by a relative rotation of at most 360°, preferably from 180° to 270°. A single short rotary movement is then sufficient to close the connection.

In contrast to the known solution, in which individual parts or even the entire instrument often had to be replaced after a single use due to damage, the embodiment according to the invention is characterized by a longer service life. This is particularly achieved by the measure that at least the part of the casing unit having the holding surface and/or at least the part of the manual operating unit having the counter-holding surface are made of a metallic material.

In a preferred embodiment, the manual operating unit has an elongated guide shaft, which has a first finger grip at one end and at whose other end the cable sheath is coaxially attached, and a second finger grip that can be moved relative to the guide shaft and is coupled to the cable core in the guide shaft. The sheathing unit has a flexible hose that surrounds the operating cable and a grip sleeve that is connected to it and can be moved coaxially over the guide shaft. This is known per se from the known embodiment. A particularly stable construction is obtained, however, when both the holding surface and the counter-holding surface are arranged stationary relative to the grip sleeve or the guide shaft. In this case, the grip sleeve must be rotated relative to the guide shaft to close the rotary connection, which makes handling the instrument particularly easy.

For cleaning purposes, the instrument should be as dismantled as possible. This goal is achieved by placing a coaxially protruding sleeve piece on the side of the handle sleeve that is firmly but detachably connected to the sleeve and has a holding surface on its protruding end. In particular, a highly resilient, possibly replaceable metal sleeve piece can then be combined with an easy-to-manufacture plastic handle sleeve.

Preferably, a stop closer to the patient is provided on the guide shaft and a stop further away from the patient is provided on the handle sleeve, axially opposite the stop closer to the patient, whereby these two stops are axially spaced apart from one another in the retracted position of the sheath unit. This ensures that the instrument is always ready for use and the handle sleeve is kept within easy reach of the guide shaft. The axial distance is dimensioned such that when the two stops are in contact with one another, the hose extends sufficiently far beyond the end of the actuating device.

supply cable in order to be able to shield a clip that is attached. In order to be able to disassemble the instrument, at least one of the stops can be adjustable. In this case, it is preferably provided that the stop closest to the patient is formed by a radially outward-projecting, essentially axially directed ring shoulder of the guide shaft and the stop further away from the patient is formed by an adjusting screw that radially penetrates the grip sleeve.

To make handling easier, the guide shaft can have a rotationally fixed, in particular profiled, rotary handle, which is preferably designed as a knurled wheel attached coaxially to the guide shaft. The handle sleeve can also be designed with a surface profile that prevents slipping.

Finally, the end of the cable core closest to the patient is expediently designed with an anchoring hook for use with the instrument for placing hemostasis and/or marking clips, the point of application of force of which for a clip to be attached is preferably located on the axis of the cable core.

In the following, an embodiment of the invention will be explained in more detail with reference to the accompanying drawings. They show:

Figure 1 shows a surgical instrument for placing hemostasis or marking clips, with the manual operating unit and part of the sheath unit shown in plan view and the end of the instrument closest to the patient shown in an enlarged section,

Figure 2 is an enlarged sectional view of the part of the sheath unit remote from the patient and

Figure 3 is an exploded view of a marker clip suitable for use with the instrument of Figures 1 and 2.

The surgical instrument shown in Figures 1 and 2 for placing hemostasis or marking clips comprises a hand-operated unit 1, which can be connected to surgical tools via a flexible, relatively thin but long actuating cable 3, whereby in the illustrated embodiment an anchoring hook 5 is provided for a marking clip shown in Figure 3. Furthermore, the instrument comprises a sheath unit 7 which encloses the actuating cable 3 and a part of the hand-operated unit 1 near the patient. The hand-operated unit 1 comprises an elongated guide shaft 9, which has a rotatably mounted thumb ring 11 at its end remote from the patient. At its end near the patient, the guide shaft 9 is connected to a cable sheath 13 of the actuating cable 3, which is formed by coiled wire material. A flexible cable core 15, designed as a strand or solid wire, is slidably guided in the cable sheath 13. The cable core 15 is connected via a coupling rod (not shown) that passes through the guide shaft 9 to a sliding handle 17 that is slidably guided on the guide shaft 9 and can be operated, for example, by the index and middle fingers. The anchoring hook 5 is held at the end of the cable core 15 closest to the patient. However, it should not be ruled out that the instrument shown is also designed with other surgical tools, e.g. with an injection cannula. If the sliding handle 17 is brought closer to the thumb ring, the cable core 15 retracts into the cable sheath 13, whereby a suspended marking clip can be closed in a manner to be described below. An engagement element (not shown) accommodated in the sliding handle 17 is spring-loaded into engagement with a tooth surface 19 of the guide shaft 9 and can be lifted out of the tooth surface 19 by a push button 21 so that the sliding handle 17 can be moved against the direction of the teeth.

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The sheathing unit 7 comprises a flexible plastic hose 23 which seals around the cable sheath 13 and which is connected at its end remote from the patient to a grip sleeve 25 pushed over the end of the guide shaft 9 closest to the patient. The grip sleeve 25 can be rotated relative to the guide shaft 9. In the illustration in Figure 1, the sheathing unit 7 is in an advanced position in which the hose 23 protrudes beyond the anchoring hook 5. In this position, a marking clip hooked onto the anchoring hook 5 is securely and safely received in the hose 23 so that it can be inserted into the body through an instrument channel of an endoscope. By moving the grip sleeve 25 closer to a knurled wheel 27 that serves as a rotary handle and is attached coaxially to the guide shaft 9, the hose 23 is retracted and ultimately releases the anchoring hook 5 together with the clip hanging from it. In this retracted position, the grip sleeve 25 can be fixed in the direction of displacement relative to the guide shaft 9 using a rotary lock 29 provided between the grip sleeve 25 and the guide shaft 9. This situation is shown in Figure 2.

The rotary closure 2 9 designed as a Luer-Lock closure is constructed as follows: A sleeve piece 31 is coaxially screwed into the end of the grip sleeve 2 5 that is remote from the patient. The sleeve piece 31 has a knurled edge 33 for easier handling. On the part of the sleeve piece 31 that protrudes from the grip sleeve 25, two radially outward-projecting projections 3 5 and 37 are formed diametrically opposite one another on a circumferential line, which can be formed, for example, by two ring shoulder segments. Each of these two projections 35 and 3 7 forms a substantially axially directed holding surface 39. A nut body 41 is pushed onto the guide shaft 9, which is designed with a two-start internal screw thread 45 that forms a counter-holding surface 43. According to the two projections 35 and 37, the two threads of the internal thread 45 are offset by 180° from each other. In the case of several projections and threads, these are each offset by the same amount.

offset from each other by the same angle in order to achieve a symmetrical arrangement that allows for jam-free screwing.

A preload spring 51 is supported between an annular shoulder 47 of the guide shaft 9 and a radially inwardly projecting annular projection 49 of the grip sleeve, which is compressed in the retracted position of the grip sleeve 25 shown in Figure 2 and preloads the latter in the direction of the advanced position shown in Figure 1. After the handle 25 has approached the nut body 41 against the effect of the preload spring 51, the holding surfaces 3 9 can be moved in front of the counter-holding surfaces 43 by rotating these two components relative to one another, thus closing the screw cap 2 9. The screw cap 2 9 can be closed quickly and safely if a rotation of no more than 360° is required. Preferably, half to three-quarters of a turn is sufficient.

In a preferred embodiment, the guide shaft 9, the nut body 41 and the sleeve piece 31 are made of metal. This guarantees a stable instrument with a long service life. The handle sleeve 25 can, for example, be injection-molded from plastic.

The ring shoulder 47 forms a ring stop 53 on its side facing the sleeve piece 31 axially, opposite which an adjusting screw 55 screwed radially through the handle sleeve 25 serves as a counter stop at an axial distance. This construction prevents the casing unit 7 from being pushed further forward beyond the position shown in Figure 1 when the adjusting screw 55 is screwed in. The casing unit 7 cannot be lost and is always ready to hand. To dismantle the instrument, the adjusting screw 55 is unscrewed from the area of the stop 53 so that it can be moved past the adjusting screw 55. The adjusting screw 55 preferably also passes through the metal sleeve piece 31, as

This can be clearly seen in Figure 2. In this case, the sleeve piece 31 is expediently designed with a suitable screw thread and the grip sleeve 25 only has a through-hole for the screw 55. This creates a permanently secure hold for the screw 55.

On its outside, the grip sleeve 25 is provided with flattened portions 57 which prevent slipping during rotation.

The marking clip sketched as an example in Figure 3 comprises a pair of pliers 59 with spring-loaded pliers arms 61 in their open position, a locking sleeve 63 to be pushed over the pliers 59 and a pulling hook 65 to be hooked at one end to the anchoring hook 5 and at the other end to the pliers 59. The pulling hook 65 is provided with a predetermined breaking point which allows the clip to be separated from the anchoring hook 5 when the locking sleeve 63 is pushed over the pliers 59. To place the marking clip, the pulling hook 65 is hooked onto the anchoring hook 5 and connected to the pliers 59 through the locking sleeve 63. The locking sleeve 63 is pushed over the pliers 59 by pulling the cable core 15 back relative to the cable sheath 13. The locking sleeve 63 rests on the edge of the opening where the cable core 15 emerges from the cable sheath 13. As soon as the pliers are completely closed, the pulling hook 65 is separated from the pliers 59 if there is sufficient pulling force and can be pulled back through the endoscope with the actuating cable 3.

Claims (1)

1 - Protection claims 1. Surgical instrument, in particular for an endoscope, comprising - an elongated flexible actuating cable (3) to be connected to a surgical tool (59, 63, 65) at an end near the patient _; which has a tubular cable sheath (13) and a cable core (15) slidably guided in the cable sheath (13), - a manual control unit (1) connected to an end of the actuating cable (3) remote from the patient for manually moving the cable core (15) relative to the cable sheath (13), - a sheathing unit (7) which surrounds the actuating cable (3) and can be displaced beyond the end of the actuating cable (3) closest to the patient into at least one advanced position relative to the latter, which can be fixed in a retracted position releasing the surgical tool (59, 63, 65) in the direction of displacement relative to the actuating cable (3), and - a pre-tensioning spring (51) acting between the casing unit (7) and the manual actuation unit (1) to pre-tension the casing unit (7) to its advanced position, characterized, that the casing unit (7) is designed with at least one holding surface (39) and the manual operating unit (1) with at least one counter-holding surface (43) and that in order to fix the casing unit (7) these two surfaces (39, 43) can be moved in front of each other by relative rotation of the parts (31, 41) of the casing unit (7) or the manual operating unit (1) that carry them. 2. Surgical instrument according to claim 1, characterized in that the holding surface (39) and the counter-holding surface (43) are part of a screw connection (29), in particular a multi-start one, between the casing unit (7) and the manual actuation unit (1). 3. Surgical instrument according to claim 1, characterized in that the holding surface (39) and the counter-holding surface (43) are part of a bayonet connection between the sheath unit (7) and the manual operating unit (1). 4. Surgical instrument according to claim 2 or 3, characterized in that several holding surfaces (3 9) or counter-holding surfaces (43) are each spaced apart from one another by equal angular amounts. 5. Surgical instrument according to claim 1, characterized in that the rotary connection (29) formed by the holding surface (3 9) and the counter-holding surface (43) between the casing unit (7) and the manual actuation unit (1) can be closed by a relative rotation of at most 360°, preferably from 180° to 270°. 6. Surgical instrument according to one of claims 1 to 5, characterized in that at least the part (31) of the casing unit (7) having the holding surface (39) and/or at least the part (41) of the manual operating unit (1) having the counter-holding surface (43) consist of a metallic material. •&Idigr; ti * ♦ » « 3 - 7. Surgical instrument according to one of claims to 6, wherein the hand-operated unit (1) has an elongated guide shaft (9) which has a first finger grip (11) at one end and at the other end of which the cable sheath (13) is coaxially fastened, and a second finger grip (17) which is displaceable relative to the guide shaft (9) and which is coupled to the cable core (15) in the guide shaft (9), and wherein the sheathing unit (7) has a flexible hose (23) which surrounds the actuating cable (3) and a grip sleeve (25) which is connected to the hose and can be moved coaxially over the guide shaft (9), characterized in that both the holding surface (39) and the counter-holding surface (43) are arranged stationary relative to the grip sleeve (25) or the guide shaft (9). 8. Surgical instrument according to claim 7, characterized in that on the side of the grip sleeve (25) remote from the patient there is arranged a coaxially projecting sleeve piece (31) which is firmly but detachably connected to the latter and has the holding surface (39) at its projecting end. 9. Surgical instrument according to one of claims to 8 in conjunction with the features of the preamble of claim 7, characterized in that a stop (53) closer to the patient is provided on the guide shaft (9) and a stop (55) further away from the patient, axially opposite the stop (53) closer to the patient, is provided on the grip sleeve (25), and that these two stops (53, 55) are axially spaced from one another in the retracted position of the sheath unit (7). -A- 10. Surgical instrument according to claim 9, characterized in that the stop (53) closer to the patient is formed by a radially outwardly projecting, essentially axially directed annular shoulder (47) of the guide shaft (9) and the stop (55) further away from the patient is formed by an adjusting screw (55) radially penetrating the grip sleeve (25). 11. Surgical instrument according to one of claims 1 to 10 in conjunction with the features of the preamble of claim 7, characterized in that the guide shaft (9) carries a rotary handle (27) connected to it in a rotationally fixed manner, in particular a profiled one. 12. Surgical instrument according to claim 11, characterized in that the rotary handle (27) is designed as a knurled wheel (27) fastened coaxially to the guide shaft (9). 13. Surgical instrument according to one of claims 1 to 12 in conjunction with the features of the preamble of claim 7, characterized in that the grip sleeve (25) is designed with a slip-preventing surface profile (57). 14. Surgical instrument according to one of claims 1 to 13, characterized in that for use of the instrument for placing hemostasis and/or marking clips (59, 63, 65), the end of the cable core (15) closest to the patient is designed with an anchoring hook (5). 31.03.95 /ak/llSUG-bes+ans