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WO2025114110A1 - Dispositif de maintien d'instrument, ensemble de montage, système d'instrument et procédé de montage et de démontage - Google Patents

Dispositif de maintien d'instrument, ensemble de montage, système d'instrument et procédé de montage et de démontage Download PDF

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Publication number
WO2025114110A1
WO2025114110A1 PCT/EP2024/082987 EP2024082987W WO2025114110A1 WO 2025114110 A1 WO2025114110 A1 WO 2025114110A1 EP 2024082987 W EP2024082987 W EP 2024082987W WO 2025114110 A1 WO2025114110 A1 WO 2025114110A1
Authority
WO
WIPO (PCT)
Prior art keywords
arm
holding
coupling
section
axis
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
PCT/EP2024/082987
Other languages
German (de)
English (en)
Inventor
Torben Klingels
Florian Huber
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Karl Storz SE and Co KG
Original Assignee
Karl Storz SE and Co KG
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from DE102023133158.2A external-priority patent/DE102023133158A1/de
Priority claimed from DE102023133161.2A external-priority patent/DE102023133161A1/de
Application filed by Karl Storz SE and Co KG filed Critical Karl Storz SE and Co KG
Publication of WO2025114110A1 publication Critical patent/WO2025114110A1/fr
Pending legal-status Critical Current
Anticipated expiration legal-status Critical

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms
    • A61B90/57—Accessory clamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00477—Coupling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms
    • A61B2090/508—Supports for surgical instruments, e.g. articulated arms with releasable brake mechanisms

Definitions

  • the invention relates to an instrument holding device for securing medical instruments and to an assembly kit from which the instrument holding device can be assembled. Furthermore, the invention relates to an instrument system comprising the instrument holding device and the medical instruments, and to a method for assembling and disassembling the medical instruments and the instrument holding device.
  • EP 3 772 345 B1 describes a device for the simultaneous fixation of medical instruments and a system consisting of this device, a trocar, and an endoscope.
  • the device comprises a holding section and a coupling element, which is connected on the one hand to a holding arm and on the other hand pivotably holds the holding section.
  • a sliding element displaceable in the coupling element allows pivoting of the holding section in a first position and fixes the holding section in a second position with respect to rotation about the pivot axis.
  • the holding section is formed by two holding elements which, when joined together, define a passage opening designed to receive the medical instruments.
  • the coupling element For attachment to the holding arm, the coupling element has a flange which is fastened to the holding arm with a coupling element by means of a thread or a bayonet lock.
  • the coupling element has two recesses, each with a winding insertion slot, which face each other, and the holding section has a projection on two opposite sides, which must be threaded through the winding insertion slot to engage with a recess.
  • the coupling element is coupled to the holding section on the patient while the holding section is already attached to a first medical instrument, threading it into the insertion slot is a complicated assembly process.
  • This mounting of the holding section on the coupling element does not provide good bearing properties in terms of concentricity and can lead to jamming or sticking.
  • unfavorable relative movements of the holding section with respect to the coupling element can lead to unintentional release when the projection passes through the insertion slot.
  • a further task is to enable easy assembly and disassembly of different medical instruments to be fixed along a common longitudinal axis. This object is achieved by an assembly set having the features of claim 17.
  • EP 3 772 345 B1 likewise comprises a holding section with an instrument guide element and a coupling element, which is connected on the one hand to a holding arm and on the other hand pivotably holds the holding section.
  • a sliding element displaceable in the coupling element allows pivoting of the holding section in a first position and fixes the holding section with respect to rotation about the pivot axis in a second position.
  • the holding section is formed by two holding elements, each having a base element and an arm element, which, when joined together, delimit a passage opening which is designed in the region of the base elements to receive a second medical instrument or the trocar.
  • the passage opening is delimited by mutually facing support surfaces at the ends of the arm elements and is designed to receive a first medical instrument or the endoscope.
  • the instrument guide element has an opening which is concentric with the passage opening when the guide element is in contact with the support surfaces and can be easily clipped onto the arm elements in an interchangeable manner.
  • This guide element allows the device to be adapted to medical instruments of different diameters by providing different guide elements with openings of different diameters.
  • each guide element can only fix medical instruments of a specific diameter, to which the opening of the guide element is adapted, with a tolerance of less than 0.5 mm.
  • a guide element designed for a diameter of 5.0 mm cannot be used to fix an instrument with a diameter of 4.6 mm.
  • a further object is to provide an improved combination of medical instruments and a corresponding fixing holding device, which is achieved by the instrument holding device according to claim 7.
  • a first embodiment of an instrument holding device which is designed to fix medical instruments along a common longitudinal axis, comprises a holding device, a holding arm, and a coupling element. This connects the holding device and the holding arm, which defines an arm axis.
  • the holding arm is coaxially connected to a fastening device of the coupling element so as to be rotatable about the arm axis.
  • the holding device which has a distal holding element and a proximal holding element for receiving the medical instruments, is pivotally connected to the coupling element about a pivot axis that is orthogonal to the longitudinal axis and the arm axis, and the two holding elements provide a bearing section that is cylindrically shaped at least on its proximal side.
  • the axis of the cylinder corresponds to the pivot axis.
  • the bearing section has a projection on each side of the pivot axis or coaxially therewith, and the coupling element has two coupling arms diametrically parallel to the arm axis, each of which has a receiving opening at a coupling end section that serves to engage with the projection.
  • the coupling end sections are spaced apart from one another to receive the cylindrical bearing section.
  • Each of the projections has a partially cylindrical guide surface that is formed on the projection at least on the side of the distal holding element, and has an insertion bevel on the side of the proximal holding element.
  • the two coupling arms are elastically deformable in a direction radial to the arm axis, parallel to the pivot axis, and rigid in any direction orthogonal to the pivot axis, and are non-deformable even under the forces normally encountered.
  • Each receiving opening is formed with a hollow cylindrical guide surface for supporting one of the projections, corresponding to its partially cylindrical guide surface.
  • This design of the instrument holding device according to the invention advantageously results in a good mounting of the holding section on the coupling element.
  • the mounting with the cylindrical guide surfaces advantageously results in good concentricity, preventing tilting or jamming during alignment.
  • Another advantage is the lateral mounting of the coupling element to the holding device: By simply sliding the coupling arms onto the holding device and locking them into place, the process is quick, skillful, and easy. It is particularly elegant because it can be performed while the trocar is already in place on the patient. The holding device is then attached to the first instrument, the trocar, which has already been placed.
  • Disassembly is also very easy and simple by simply pushing the coupling arms further in the same direction - this corresponds to a relative movement of the holding device in the proximal direction: During operation, this is advantageously prevented by a pressure element, because according to a further embodiment, a pressure element connected to an actuator arranged in the holding arm extends from the holding arm through the coupling element, which pressure element is displaceable along the arm axis and can be arranged in at least three positions.
  • the pressure element contacts the cylindrical support section with a second force that is smaller than the first force, or which has a first distance from the cylindrical support section that is smaller than the dimension of the insertion bevel in the radial direction of the cylindrical support section, in order to prevent the holding device from being released by displacement in the proximal direction.
  • the pressure element allows the two holding elements to be released from one another to change the held instruments or to rotate them about the longitudinal axis and pivot the holding device about the pivot axis;
  • a third proximal position as a disassembly position, in which the pressure element is spaced from the cylindrical bearing section by a second distance that is greater than the dimension of the insertion bevel in the radial direction of the cylindrical bearing section.
  • the pressure element allows a relative movement of the holding device in the proximal direction and release of the connection between the coupling element and the holding device.
  • the coupling element has a coupling base from which the coupling arms extend along the arm axis.
  • the fastening device is arranged on a side of the coupling base facing away from the coupling arms.
  • the fastening device is formed integrally with the coupling base, or alternatively, it can be designed as a fastening adapter that can be connected to the coupling base.
  • the coupling element has a reinforcement arm or preferably two reinforcement arms for each coupling arm.
  • This arm or these arms extend circumferentially along the arm axis adjacent to each coupling arm and are designed to stabilize the associated coupling arm in the direction radial to the arm axis and to prevent its elastic deformation and thus unwanted bending up to a limit force predetermined for assembly and disassembly.
  • each reinforcement arm engages behind the associated coupling arm at least in sections, providing stability, on a side facing away from the arm axis. Additionally or alternatively, each reinforcement arm has a guide tip that extends beyond the coupling end section and is designed to guide the projection during assembly with respect to the receiving opening.
  • the reinforcement arm may be formed integrally with the coupling base.
  • the coupling end section of the coupling arms has a flattened insertion section on the end side for guiding the projection during assembly, which is designed to point in the direction of the arm axis on one side and by two converging guide steps.
  • a disassembly bevel may be provided on a side of the receiving opening facing away from the end, which widens conically from the hollow cylindrical guide surface.
  • each coupling arm can have a so-called thin region, i.e., a region with a narrow cross-section that enables elastic deformability and encompasses the coupling end section with the receiving opening. Furthermore, it can have a solid region for connection to the fastening device.
  • the two holding elements which, when joined to form the holding device, define a passage opening orthogonal to the pivot axis and designed to receive the medical instruments along the common longitudinal axis, each have a base element and an arm element.
  • the two base elements when the holding elements are joined together to form the holding device, provide the storage section.
  • the passage opening in the area of the base elements is designed to receive a first medical instrument, and in the area of the arm elements, it is configured to receive a second medical instrument; it is delimited by the mutually facing contact surfaces at the ends of the arm elements.
  • a guide element arranged at the ends of the arm elements and particularly skillfully abutting the contact surfaces can be provided, which guide element has an opening coaxial with the passage opening for receiving the second medical instrument.
  • the coupling element can be designed to arrange a sterile disposable cover to cover the holding arm.
  • a piston of the pressure element coaxial with the arm axis, can extend through the fastening device and be displaceable along the arm axis between a mounting position accommodated in the fastening device and a connecting position. In this position, the piston extends into the holding arm to be coupled to an actuator.
  • the fastening device has a fastening section on the holding arm for fastening the coupling element.
  • This section can be designed as a truncated cone element offset by a neck section, wherein the truncated cone element tapers towards its free end.
  • the neck section is preferably a conical neck section that tapers towards the truncated cone element.
  • the holding arm can have at least two or even more gripping arms evenly distributed around the circumference with inwardly projecting gripping lugs at the free ends of the gripping lugs.
  • the gripping arms are elastically bendable or rotatably mounted on the holding arm in a radial direction.
  • the gripping lugs correspond to the neck section in terms of their configuration for engaging behind the truncated cone element.
  • the two or more gripping arms can be displaced relative to a housing end section of the holding arm along the arm axis between an assembly position protruding from the housing end section and a fastening position received in the housing end section.
  • a securing sleeve is provided which can be displaced relative to the holding arm and the fastening device along the arm axis between an assembly position, in which the securing sleeve is arranged on the fastening device or on the holding arm, and a so-called securing position. In this securing position, the securing sleeve secures the engagement of the gripping arms with the fastening section.
  • the fastening device for fastening the coupling element to the holding arm can have a fastening section designed as a mold connecting element.
  • the holding arm can have a counter-mold connecting element designed to correspond to the - quasi-positive - engagement with the mold connecting element.
  • the mold connecting element and the counter-mold connecting element can be joined in a joining direction orthogonal to the arm axis. It is further proposed to provide at least one securing device that secures the - quasi-positive - engagement of the mold connecting element with the counter-mold connecting element with respect to the joining direction.
  • the securing device is/are formed by at least one securing pin which is/are displaceable with respect to the holding arm and the fastening device parallel to the arm axis between an assembly position in which the securing pin or pins is/are received in the fastening device and in a securing position in which it/they secure the engagement of the mold connecting element with the counter-mold connecting element.
  • the securing device can be formed by a securing sleeve, which is considered particularly advantageous.
  • This securing sleeve is displaceable with respect to the holding arm and the fastening device along the arm axis between an assembly position, in which the securing sleeve is arranged on the fastening device or on the holding arm, and a fastening position. In this position, the securing sleeve secures the engagement of the mold connecting element with the counter-mold connecting element.
  • the or a securing device is provided by a housing end section of the holding arm, which is relatively displaceable with respect to the counter-mold connecting element along the arm axis between an assembly position protruding from the housing end section and a securing position accommodated in the housing end section.
  • the housing end section secures the engagement of the mold connecting element with the counter-mold connecting element.
  • the mold connection element can be formed by a profiled recess extending orthogonally to the arm axis through the fastening section, and the counter-mold connection element can be provided by a profile rail section extending orthogonally to the arm axis on the holding arm.
  • the mold connecting element and the counter-mold connecting element preferably have a dovetail-like connection
  • the fastening device for fastening the coupling element to the holding arm can have a fastening section which is designed as a flange collar offset by a cylindrical neck section. This has a circular round groove on the front side coaxial with the arm axis.
  • the holding arm has a connecting piece with a radially inwardly offset, U-shaped distal guide section, which delimits a U-shaped guide groove on the inside, which is designed to receive the flange collar.
  • the flange collar and the U-shaped guide section can be joined in a joining direction orthogonal to the arm axis.
  • At least one resilient pressure piece be arranged in the connecting piece parallel to the arm axis and positioned such that a pressure ball of the pressure piece engages in the circular round groove when the flange collar is received in the U-shaped guide groove of the guide section.
  • a further embodiment of the device according to the invention can then provide that the connecting piece has a radial groove that extends radially from a central passage opening for an actuator-side piston section through an insertion area that the U-shaped guide section leaves free or open.
  • the radial groove is designed to accommodate and guide a piston section of the pressure element that protrudes beyond the end face of the flange collar when inserting the flange collar into the U-shaped guide section.
  • Another device is a mounting set for securing medical instruments along a common longitudinal axis, which consists of the following components forming the set.
  • the set can always comprise at least one, but also several, of these components, which can correspond to one another but be designed differently with respect to components of the same type.
  • the set always comprises at least one holding device, a holding arm, and a coupling element, wherein the holding device can be connected to the holding arm via the coupling element and thus forms an instrument holding device according to the invention as described above.
  • Yet another device is an instrument system comprising an instrument holding device disclosed herein and furthermore at least two medical instruments, wherein the instrument holding device fixes the medical instruments along a common longitudinal axis.
  • the second instrument is preferably an endoscope that is inserted into the trocar.
  • connection of the coupling element and the holding arm in step A) comprises the steps
  • A1 Bending or pivoting the at least two circumferentially evenly distributed gripping arms on the holding arm in the radial direction and pushing them onto the truncated cone element of the coupling element until the inwardly projecting gripping lugs of the gripping arms engage behind the truncated cone element and engage in the neck section; or
  • this provides the step before or after connecting the coupling element and the holding arm in step A):
  • step B) Arranging a steep disposable sheath on the coupling element and pulling the sterile disposable sheath over the holding arm; and/or wherein the arranging and fastening of the holding device in step B) comprises the step
  • the holding device is designed to receive medical instruments along a common longitudinal axis and to couple to a coupling element of an instrument holding device fastened to a holding arm.
  • the holding device has a distal holding element with a distal arm section and a proximal holding element with a proximal arm section.
  • the two holding elements in an arrangement in which they are joined together to form the holding device, delimit a passage opening for receiving the medical instruments along the longitudinal axis.
  • the distal arm element and the proximal arm element are each connected at a free end section by a guide element for receiving a first medical instrument.
  • the free end section of the proximal arm element is angled in the direction of the longitudinal axis and forms a contact surface facing the longitudinal axis.
  • the guide element for receiving the first medical instrument is an instrument adapter with a bore coaxial with the passage opening.
  • a hollow cylindrical sleeve is arranged therein, which is elastically deformable in the direction radial to the longitudinal axis and defines an adapter opening aligned with the passage opening.
  • the instrument adapter has a proximal receiving portion which delimits a receiving opening which is designed to receive the angled end portion of the proximal holding element, wherein the receiving opening extends through the instrument adapter in a direction radial to the longitudinal axis up to the bore, wherein the receiving opening is separated from the adapter opening by the hollow cylindrical sleeve.
  • the receiving opening defined by the proximal receiving section is configured for the positive reception of the angled end section of the proximal retaining element.
  • “Positive reception” here means "defined by a cross-sectional profile that is shaped complementarily to a cross-sectional profile of the angled end section of the proximal retaining element.”
  • the holding device according to the invention advantageously allows the holding of instruments with shaft diameters within a tolerance range of +1.0 mm to -1.5 mm of a nominal diameter.
  • the first medical instrument is advantageously protected from damage by the separate sleeve during the clamping process and offers a secure holding function for a second medical instrument that is inserted into or connected to a second, already fixed instrument. Due to the positive reception of the angled end section of the proximal holding element in the receiving opening of the proximal receiving section, the clamping force can be transmitted to the sleeve via this first arm element.
  • the holding device enables a holding function of parts of the instrument complex, which consists of the first instrument, which can be fixed by the instrument adapter, and a second medical instrument, in particular a trocar, which is received in the passage opening of the holding device.
  • the adapter opening for receiving the first medical instrument has a variable diameter due to the elastic deformability of the hollow cylindrical sleeve in the radial direction.
  • the diameter is preferably variable within a range of +1.0 mm to -1.5 mm, based on an initial diameter of the adapter opening in an undeformed state.
  • the hollow cylindrical sleeve can be designed as a flexible element and consist of silicone, for example. The clamping force can thus be gently transmitted to the first medical instrument to be held and the sleeve can adapt to the outer surface of the first medical instrument in order to evenly distribute the clamping force. The first medical instrument is thus also protected from damage by the holding device.
  • the free end section of the distal holding element extends parallel to the longitudinal axis and has a bevel on a side facing the longitudinal axis.
  • the instrument adapter has a distal clamping section which has a receiving opening parallel to the longitudinal axis and is designed to receive the end section.
  • the distal clamping section delimits a spring chamber connected to the receiving opening, which extends in the radial direction to the longitudinal axis and in which a pre-tensioned spring is arranged, which is fastened at a proximal end in the instrument adapter and is operatively connected at a distal end to the end section of the distal holding element, by means of which the end section strikes the receiving opening on the distal side.
  • the holding device can thus be assembled quickly and easily by inserting the bevel of the free end section of the distal holding element behind, i.e. on the distal side of, the spring permanently installed in the instrument holder.
  • This design of the holding device with the bevel on the distal holding element and the spring in the instrument adapter allows the holding element to be easily inserted into the instrument adapter, so that it remains securely in place. This allows all distal parts of the holding device to be fastened around the trocar and to hold themselves until the holding arm is attached.
  • the spring then presses the distal holding element against a stop provided by the clamping section on the distal side of the receiving opening, ensuring a frictional connection.
  • inserting the distal holding element into the distal receiving section increases the spring preload to the desired level.
  • the preload is determined by the spring constant, or spring hardness or spring characteristic, and by defines the spring travel when the distal retaining element is inserted. Different preloads can be achieved by using springs with different spring constants or by changing the spring travel.
  • a clamping force is determined for securing the medical instruments in the holding device. This causes the instrument adapter to behave like a rigid block until the first medical instrument is clamped with the clamping force defined by the spring.
  • the maximum clamping force applied to the first medical instrument is limited by the separately inserted, flexible sleeve, which protects the first medical instrument.
  • the bore in the instrument adapter has at least one cylindrical guide section that is aligned with the adapter opening and adjoins the sleeve, the diameter of which section corresponds at least to the initial diameter of the adapter opening.
  • the guide section can adjoin the sleeve at the top (i.e., on a side facing away from the passage opening) and at the bottom (i.e., facing the passage opening); alternatively, it can also be present only at the top or only at the bottom.
  • the bore can have a conical guide section that is aligned with the adapter opening, is located on a side facing away from the passage opening and tapers funnel-like toward the sleeve to a diameter that corresponds at least to the initial diameter of the adapter opening. This makes it easier to insert the instrument part of the medical instrument to be held into the sleeve.
  • the distal holding element has a distal base section connected to the distal arm section
  • the proximal holding element has a proximal base section connected to the proximal arm section, wherein the passage opening in the region of the base elements is designed to receive a second medical instrument.
  • the two base elements have a bearing section for pivotably connecting the holding device to the coupling element, which defines an arm axis with the holding arm.
  • the bearing section provides a pivot axis orthogonal to the longitudinal axis and the arm axis, wherein at least the proximal base section is cylindrically shaped for engagement with a pressure element movable along the arm axis, and a cylinder axis corresponds to the pivot axis.
  • the holding device relate to the fact that the second medical instrument is a trocar and/or that the pressure element is connected to a drive unit which is provided by the holding arm.
  • a further device is an instrument holding device which is designed for fixing medical instruments along a common longitudinal axis and has a holding device according to the invention, a holding arm and a coupling element which connects the holding device according to the invention and the holding arm, which is coaxially connected to a fastening device of the coupling element so as to be rotatable about an arm axis.
  • the instrument holding device allows two medical instruments to be held easily and safely along a common longitudinal axis.
  • Yet another device is an instrument system comprising an instrument holding device, also according to the invention, and medical instruments arranged with the instrument holding device along a common longitudinal axis.
  • the second medical instrument is preferably a trocar, which is guided in the passage opening of the holding device, and the first medical instrument is an endoscope, which is inserted into the trocar and fixed in the adapter opening of the instrument adapter.
  • Other nestable instruments can also be held in the instrument holding device with the aid of the instrument system according to the invention.
  • Fig. 1 is a perspective view of an instrument system with an instrument holder device according to the invention for fixing a trocar and endoscope
  • Fig. 2 is a perspective view of an instrument holder device according to the invention
  • Fig. 3 is a perspective view of a holding device and a separate coupling element of an instrument holder device according to the invention
  • Fig. 4 is a perspective view of the holding device and the coupling element of Fig. 3 in the coupled state
  • Fig. 5 is an enlarged detailed view of the bearing section of the holding device in the coupled state with the coupling element
  • Fig. 6 is a longitudinal sectional view of the bearing portion of the holding device in coupled state with the coupling element along section line X-X in Fig. 5,
  • Fig. 7 is an enlarged detailed view of the coupling end portion of a coupling arm of the coupling element
  • Fig. 8 is a perspective view of a coupling element
  • Fig. 9 is a perspective view of a fastening adapter and a holding arm according to an embodiment of the instrument holder device according to the invention.
  • Fig. 10 is a side sectional view of the mounting adapter from Fig. 9 attached to the support arm,
  • Fig. 11 is a side sectional view of the mounting adapter from Fig. 9 attached and secured to the support arm,
  • Fig. 12 is a perspective view of a coupling element and a holding arm according to a further embodiment of the instrument holder device according to the invention.
  • Fig. 13 is a perspective view of the coupling element attached to the support arm from Fig. 12,
  • Fig. 14 is a side sectional view of the coupling element of Fig. 12 attached and secured to the holding arm,
  • Fig. 15 is a perspective view of a coupling element with protective cover and a holding arm according to a further embodiment of the instrument holder device according to the invention.
  • Fig. 16 is a perspective view of the coupling element attached to the support arm from Fig. 15,
  • Fig. 17 is a perspective view of a coupling element attached to a holding arm according to a further embodiment of the instrument holder device according to the invention.
  • Fig. 18 is a plan view of the coupling element from Fig. 17 attached to the holding arm,
  • Fig. 19 is a side sectional view of the coupling element attached to the support arm from Fig. 17,
  • Fig. 20 is a perspective view of the support arm of Fig. 17.
  • Fig. 21 is a perspective view of an instrument system with an instrument holder device according to the invention for guiding a trocar and fixing an endoscope,
  • Fig. 22 is a perspective view of an instrument holder device according to the invention.
  • Fig. 23 is a perspective view of an instrument adapter
  • Fig. 24 is a longitudinal sectional view of the instrument adapter from Fig. 23,
  • Fig. 25 a longitudinal sectional view of the instrument adapter according to Fig. 24 with the spring relaxed before insertion of the distal holding element.
  • the invention relates to an instrument holding device designed to hold medical instruments, and to an instrument system comprising the instrument holding device and the medical instruments fixed thereby. Furthermore, the invention relates to a mounting set comprising a Holding device, a holding arm and a coupling element which can be mounted to the instrument holding device, as well as a method for fixing medical instruments using the instrument holding device and a method for disassembling the instrument system.
  • FIG. 2 An example of the instrument holding device 1 with the components holding device 10, coupling element 11 and holding arm 12 is shown in Fig. 2;
  • Fig. 1 shows an instrument system 4 in which two medical instruments, here a trocar 2 and an endoscope 3, are fixed by an instrument holding device 1 along a common longitudinal axis L.
  • the holding device 10 has a distal holding element 101 - i.e., remote from the holding arm - and a proximal holding element 102 - i.e., close to the holding arm - which are designed in a joined arrangement to receive the medical instruments 2, 3.
  • the two holding elements 101, 102 in the joined arrangement delimit a passage opening 103 which defines the common longitudinal axis L.
  • the two holding elements 101, 102 each have, as shown in Fig. 3 to 6, a partially cylindrical base element 10.1, 10.2 and an arm element 10.6, 10.7, wherein the two partially cylindrical base elements 10.1, 10.2 provide a cylindrical storage section 100 in the arrangement of the holding elements 101, 102 joined together to form the holding device 10.
  • the passage opening 103 is designed to receive a first medical instrument 2 (trocar 2 in Fig. 1), while the arm elements 10.6, 10.7 are designed to receive a second medical instrument 3 (endoscope 3 in Fig. 1).
  • the arm elements 10.6, 10.7 have contact surfaces facing each other at their ends (not labeled in Fig. 3, 4), which delimit the passage opening 103 in the region of the arm elements 10.6, 10.7 for receiving the second medical instrument 3.
  • a guide element 13 (Figs. 1 and 2) can be arranged, e.g. clipped, at the ends of the arm elements 10.6, 10.7, which has an opening 13.1 coaxial with the passage opening 103 with an adapted diameter for receiving the second medical instrument 3.
  • the coupling element 11 connects the holding device 10 and the holding arm 12, which, together with the coupling element 11, defines an arm axis A that is orthogonal to the longitudinal axis L.
  • the holding device 10 is pivotably connected to the coupling element 11 about a pivot axis S that is orthogonal to the longitudinal axis L and the arm axis A.
  • the instrument holding device 1 allows the instruments 2, 3 to be fixed in any position because it provides four degrees of freedom: translation of the instruments 2, 3 along the longitudinal axis L, rotation of the instruments 2, 3 in the holding device 10 about the longitudinal axis L, and rotation with the holding device 10 about the pivot axis S and rotation with the holding device 10 and the coupling element 11 about the arm axis A.
  • a pressure element 14 (seen in Figs. 5 and 6) extends through the coupling element 11 and is connected to an actuator 16 arranged in the holding arm 12 (cf. Fig. 14).
  • This actuator actuates the pressure element 14, which is displaceable along the arm axis A between a first position (distal clamping position), in which the pressure element 14 fixes the holding device 10 with respect to its rotational position and clamps the instruments 2, 3 by pressing the holding elements 101, 102 together, and a second position (middle alignment position), in which the pressure element 14 pivots the holding device 10 about the pivot axis S and changes the second Instrument 3 or rotation or displacement of the second instrument 3 with respect to the longitudinal axis L.
  • the holding device 10 has the cylindrical bearing section 100, wherein the cylinder axis of the cylinder shape corresponds to the pivot axis S.
  • a projection 10.3 is formed which is coaxial with the pivot axis S and provides a partially cylindrical guide surface 10.5.
  • each projection 10.3 has an insertion bevel 10.4 on the proximal side, i.e., on the side of the proximal holding element 102, so that the partially cylindrical guide surface 10.5 is formed on the projection 10.3 at least on the distal side, i.e., on the side of the distal holding element 101.
  • the insertion bevel 10.4 is directed towards the coupling element 11 or the holding arm 12.
  • the coupling element 11 has two coupling arms 11.1 diametrically parallel to the arm axis A, the coupling end sections 11.2 of which are spaced apart to receive the cylindrical bearing section 100.
  • each coupling end section 11.2 there is a receiving opening 11.3 which has a hollow cylindrical guide surface 11.7 for supporting one of the projections 10.3, so that the hollow cylindrical guide surface 11.7 of the receiving openings 11.3 is designed to correspond to the partially cylindrical guide surface 10.5 of the projections 10.3.
  • the coupling arms 1 1.1 are elastically deformable in a direction radial to the arm axis A and parallel to the pivot axis S and are rigid in any direction orthogonal to the pivot axis S, i.e. they are not deformable under the forces normally occurring in the application.
  • the coupling element 11 can be mounted on the holding device 10 simply by sliding the coupling arms 11.1 laterally orthogonally to the longitudinal axis L onto the insertion slope 10.4, whereby the coupling arms 11.1 bend open until the receiving opening 11.3 reaches the projection 10.3 and the coupling arms 11.1 snap back into their original shape, so that the holding device 10 is pivotably mounted on the cylindrical bearing section 100 with the projection 10.3 in the receiving opening 11.3 about the pivot axis S.
  • the holding device 10 is contacted by the pressure element 14 on the outer surface of the cylindrical bearing section 100 in the first position, wherein the pressure element 14 exerts a first force or pressure on the cylindrical bearing section 100 that is sufficiently large to clamp the instruments 2, 3 in place and prevent rotation of the holding device 10 with the held instruments 2, 3.
  • the pressure element 14 is moved in the direction of the holding arm 12, so that the pressure element 14 either contacts the cylindrical bearing section 100 with a second force that is smaller than the first force and that allows the holding device 10 to rotate about the pivot axis S.
  • the pressure element 14 has a distance from the cylindrical bearing section 100 that is smaller than a dimension of the insertion bevel 10.4 in the radial direction of the cylindrical bearing section 100.
  • the pressure element 14 can be arranged along the arm axis A in a third position in which the pressure element 14 has a distance from the cylindrical bearing section 100 that is greater than the Dimension of the insertion bevel 10.4 in the radial direction of the cylindrical bearing section 100. Then, with the longitudinal axis L orthogonally aligned to the arm axis A, the holding device 10 can be moved in the direction of the holding arm 12, so that the coupling arms 11.1 are bent up by the insertion bevel 10.4 and the coupling end sections 11.2 are spaced apart from one another so far that the projections 10.3 emerge from the receiving openings 11.3.
  • the coupling element 11 has two reinforcing arms 11.8 for each coupling arm 11.1, which extend circumferentially along the arm axis A adjacent to the respective coupling arm 11.1.
  • the reinforcing arms 11.8 are designed to stabilize the associated coupling arm 11.1 in its deformation direction, i.e., in the direction away from the arm axis A, and to prevent unintentional bending.
  • the reinforcing arms 11.8 are designed to prevent elastic deformation of the coupling arms 11.1 up to a limit force predetermined for assembly and disassembly.
  • the reinforcement arms 11.8 can engage behind the coupling arms 11.1 in sections from the outside, i.e., on a side facing away from the arm axis A, in a stabilizing manner. Furthermore, the reinforcement arms 11.8 can be used as guide elements that facilitate the assembly of the coupling arms 11.1 on the projections 10.3 of the cylindrical bearing section 100. For this purpose, the reinforcement arms 11.8 can have a guide tip 11.9 that projects beyond the coupling end section 11.2 and is designed to guide the projection 10.3 in the direction of the receiving opening 11.3.
  • the coupling end section 11.2 of the coupling arms 11.1 has a flattened insertion section 11.4 at the end for guiding the projection 10.3, shown in Fig. 7, which is designed to point on one side in the direction of the arm axis A.
  • This flattened insertion section 11.4 is delimited laterally by two converging guide shoulders 11.6, which guide the projection 10.3 into the receiving opening 11.3.
  • the coupling end section 11.2 of the coupling arms 11.1 has a disassembly bevel 11.5 for guiding the projection 10.3 on a side of the receiving opening 11.3 facing away from the free end, which widens conically from the hollow cylindrical guide surface 11.7.
  • the coupling arm 11.1 can have a thin region 111, which enables elastic deformability and comprises the coupling end section 11.2 with the receiving opening 11.3.
  • the coupling arm 11.1 has a solid region 112.
  • the division of the coupling arms 11.1 into the two regions further reduces the forces required for assembly and disassembly.
  • the solid region 112 has a solid and stable cross-section in order to absorb lateral forces and moments.
  • the thin region 111 has a thin and flexible cross-section in order to be able to be bent open by manually applied forces without compromising stability.
  • the different stability of the regions 111, 112 is achieved through different geometries, whereby the length of the coupling arm and the length of the regions also influence the stability.
  • a long arm has only minimal stability in the direction in which it is to be bent, but very great stability in the direction of pull.
  • the coupling element 11 has a coupling base 11.10, from which the coupling arms 11.1 extend along the arm axis A.
  • the coupling arms 11.1 can be fastened to the coupling base 11.10 or manufactured in one piece with the coupling base 11.10.
  • the reinforcing arms 11.8 are also formed in one piece with the coupling base 11.10 or can optionally be fastened thereto.
  • the fastening device for connection to the holding arm 12 is arranged, wherein the fastening device is preferably formed in one piece with the coupling base 11.10.
  • the fastening device can be designed as a fastening adapter 113, which can be connected to the coupling base 11.10.
  • Both variants are included in the different fastening devices described below, whereby the respective fastening device is not limited to the described one-piece variant of the coupling element or as a fastening adapter.
  • the fastening devices connected integrally to the coupling base can also be implemented as adapters, or the fastening devices described here as fastening adapters can also be formed integrally with the coupling base 1 1.10.
  • FIG. 9 A first example of a fastening device for fastening the coupling element 11 to the holding arm 12 is illustrated in Figs. 9 to 11.
  • the fastening device is shown as a fastening adapter 113, which has a base connection section 114 for connection to the coupling base 11.10 of the coupling element 11.
  • a fastening section 11.20 of the fastening adapter 113 has a truncated cone element 11.21 offset by a neck section 11.22, which tapers towards its free end.
  • the neck section 11.22 is also conically shaped and tapers towards the truncated cone element 11.21.
  • the holding arm 12 has four gripping arms 12.1 distributed evenly around the arm axis A, which have radially inwardly projecting gripping lugs 12.2 at their free ends, the profile of which corresponds to the conical shape of the neck section 11.22.
  • the gripping arms 12.1 are elastically mounted on the holding arm 12 so that they can be bent or pivoted open in the radial direction, so that the gripping arms 12.1 are bent open when pushed onto the truncated cone element 11.21 until the gripping lugs 12.2 engage behind the truncated cone element 11.21 and snap into place on the neck section 11.22.
  • the gripping arms 12.1 which here extend from a sleeve- or ring-shaped gripping arm base 12.5 and end with a neck collar 12.4 which, in the assembled position, forms a rear grip with the gripping arm 12.1, are connected to a mechanism for displacing the gripping arms 12.1 with respect to a housing end section 12.3 of the holding arm 12 along the arm axis A.
  • the gripping arms 12.1 can thus be moved into an assembled position protruding from the housing end section 12.3 (Fig. 9) and into a fastening position received in the housing end section 12.3 (Fig. 10, Fig. 11). In this way, the engagement of the gripping arms 12.1 with the fastening section 11.20 in the fastening position of the gripping arms 12.1 is secured by the housing end section 12.3.
  • a securing sleeve 12.3 displaceable along the arm axis A can be used to secure the engagement instead of the end section 12.3 which is immovable with respect to the holding arm 12, while the gripping arms 12.1 are immovable in the direction of the arm axis A with respect to the holding arm 12.
  • the securing sleeve 12.3 is retracted in the direction of the holding arm 12 for the assembly position of the gripping arms 12.1, so that the gripping arms 12.1 can bend radially outwards, and in the fastening position comes into contact with the fastening adapter 113 in order to ensure the rear grip of the gripping lugs 12.2 with the truncated cone element 1 1.21.
  • the gripper arms 12.2 are elastically deformable.
  • the gripper arms 12.2 that are pivotably connected to a gripper arm base 12.5 about a tangential axis, the latter can be provided with a corresponding movement mechanism.
  • a piston 14.1 of the pressure element 14 is shown which is coaxial with the arm axis A and extends through the fastening adapter 113 and is displaceable along the arm axis A between an assembly position (Fig. 10), in which the piston 14.1 is received in the fastening device and does not protrude beyond the truncated cone element 11.21, and a connection position (Fig. 11), in which the piston 14.1 extends into the holding arm 12 for coupling with an actuator 16 (cf. Fig. 14).
  • Figs. 12 to 14 illustrate a fastening device formed integrally with the coupling base 11.10 and the coupling arms 11.1 for fastening the coupling element 11 to the holding arm 12.
  • the fastening section 11.20 of this fastening device is designed as a shaped connecting element 11.23 for positive engagement with a counter-shaped connecting element 12.6 of the holding arm 12.
  • the shape is selected such that the shaped connecting element 11.23 and the counter-shaped connecting element 12.6 can be joined in a joining direction orthogonal to the arm axis A.
  • a securing device (not shown) secures the engagement of the mold connecting element 11.23 with the counter-mold connecting element 12.6 with respect to the joining direction.
  • the securing device is provided by a securing sleeve which is displaceable with respect to the holding arm 12 and the coupling element 11 along the arm axis A between an assembly position in which the securing sleeve is arranged on the fastening device or the holding arm 12, and a securing position in which the securing sleeve secures the engagement of the mold connecting element 11.23 with the counter-mold connecting element 12.6.
  • the piston 14.1 of the pressure element 14 acts as a locking pin which is displaceable along the arm axis A between the mounting position accommodated in the fastening device and a connecting position in which the piston 14.1 extends into the holding arm 12 for coupling with an actuator 16 (cf. Fig. 14) and therefore prevents a release of the engagement of the mold connecting element 11.23 and the counter-mold connecting element 12.6.
  • the engagement can also be secured as described above by a housing end section 12.3 of the holding arm 12, if the counter-mold connecting element 12.6 is relatively displaceable along the arm axis A between an assembly position protruding from the housing end section 12.3 and a securing position accommodated in the housing end section 12.
  • the mold connecting element 11.23 is a profiled recess 11.23 that extends orthogonally to the arm axis A through the fastening section 11.20.
  • the counter-mold connecting element 12.6 is a complementary profile rail section 11.23 that extends orthogonally to the arm axis A on the holding arm 12, wherein the profiled recess 11.23 and the profile rail section 12.6 provide a type of dovetail connection.
  • a coupling element 11 on which a sterile disposable cover 15 (a so-called drape) is arranged in an area between the fastening section 11.20 and the coupling base 11.10, which, after the coupling element 11 has been fastened to the holding arm 12, is slipped over the holding arm 12 in order to cover it in a sterile manner.
  • a sterile disposable cover 15 a so-called drape
  • FIG. 17 to 20 Another alternative fastening device for fastening the coupling element 11 to the holding arm 12 is shown in Figs. 17 to 20.
  • the fastening section 11.20 of this fastening device has a flange collar 11.23 offset by a cylindrical neck section 11.24, which has a circular groove 11.25 on its front side that is coaxial with the arm axis A.
  • the holding arm 12 has a connecting piece 12.6 with a radially inwardly offset, U-shaped distal guide section 12.7. This defines a U-shaped guide groove 12.9 on the inside, which is designed to receive the flange collar 11.23.
  • the open side of the U-shaped guide section 12.7 determines an insertion area for the flange collar 11.23 and the joining direction, so that the flange collar 11.23 can be inserted into the U-shaped guide groove 12.9 of the U-shaped guide section 12.7 in a joining direction orthogonal to the arm axis A.
  • three spring-loaded pressure pieces 12.10 are arranged in the connecting piece 12.6, distributed along a circular line parallel to the arm axis A.
  • two of the three pressure pieces 12.10 can be seen; the third is concealed by the guide section 12.7.
  • the three pressure pieces 12.10 are positioned such that the pressure balls 12.11 of the pressure pieces 12.10 engage in the circular groove 11.25 on the front side of the flange collar 11.23 when the flange collar 11.23 is received in the U-shaped guide groove 12.9 of the guide section 12.7.
  • the spring-loaded pressure pieces 12.10 thus prevent the coupling element 10 from being separated from the holding arm 12 with the actuator unit without considerable force. This prevents unwanted loosening.
  • the groove 11.25 is designed to be larger than the ball 12.11 of the spring-loaded pressure piece 12.10.
  • the pressure piece 12.10 exerts no force on the coupling element 10, thus preventing additional friction. Therefore, the coupling element 10 can be rotated around the arm axis A with minimal force, without disrupting the surgeon's force feedback.
  • the connecting piece 12.6 has a radial groove 12.8, which extends radially from a central passage opening 12.12 for an actuator-side piston section 14.2 through the insertion area, which the U-shaped guide section 12.7 leaves free or open.
  • a piston section 14.3 of the pressure element 14, which protrudes beyond the end face of the flange collar 11.23, can be received and guided in this radial groove 12.8 when the flange collar 11.23 is inserted into the U-shaped guide section 12.7, in order to come into contact with the actuator-side piston section 14.2.
  • step A the attachment of the coupling element 11 to the holding arm 12 being the first process (step A), which can be carried out preparatory away from the patient.
  • step B the holding device 10, possibly with a guide element 13, is placed around the trocar 2 and locked there or acts self-locking.
  • step C the coupling element 11 attached to the holding arm 12 is then connected to the holding device 10 applied to the trocar 2.
  • step D the ready-to-use
  • the final step of the instrument system 4 obtained involves arranging the endoscope 3 and fixing the trocar 2 and the endoscope 3 in the desired orientation.
  • the fifth step can be considered the disassembly of the instrument system 4, which essentially involves the reverse order of the first four steps and is therefore described below as a separate procedure with the opposite sequence of steps D', C', B', A'.
  • the method for fixing the medical instruments 2, 3 along a common longitudinal axis L comprises, using the above-described instrument holding device 1, the steps
  • step B holding elements 101, 102 are placed around the trocar 2 and hold themselves thereto independently upon arrangement of the guide element 13 in step B1, which is selected to adapt the passage opening of the holding device 10 to the diameter of the second medical instrument, here the endoscope 3.
  • the guide element 13 is clipped, for example, to the ends of the arm elements 10.6, 10.7 of the assembled holding elements 101, 102.
  • step D) the pressure element 14 is pushed from the second position of step C) in the distal direction, e.g. by actuating or releasing a lever or automatically by an actuator, in order to prevent demolding of the device 1 by preventing the necessary movement of the holding device 10 in the proximal direction.
  • the pressure element 14 exerts a force on the cylindrical bearing section 10 made up of the two partially cylindrical base sections 10.1, 10.2 and clamps it. Unlike what is shown in Figures 2 to 5, it is possible that, as can be seen in Fig. 1, only the proximal base section 10.2, on which the pressure element 14 acts, is cylindrical. Its cylindrical shape is necessary in order to transmit the clamping force in every rotational position of the holding device 10. This clamping force also moves the two holding elements 101, 102 toward each other or presses them together, so that, with the fixation of the rotational position, the second medical instrument 3 is simultaneously clamped between the arm sections 10.6, 10.7.
  • the holding device 10 is transferred to an unlocked state in which the base sections 10.1, 10.2 can move away from each other linearly in the direction of the arm axis A or open in a V-shape, for example to enable a realignment of the medical instruments 2, 3.
  • connection of the coupling element 11 and the holding arm 12 in step A) can optionally comprise one of the following steps.
  • the method comprises step A1): bending or pivoting the four circumferentially evenly spaced gripping arms 12.1 on the holding arm 12 in the radial direction and sliding them onto the truncated cone element 11.21 of the coupling element 11.21 until the inwardly projecting gripping lugs 12.2 of the gripping arms 12.1 engage behind the truncated cone element 11.21 and engage in the neck section 11.22.
  • connection in step A2) comprises joining the mold connecting element 11.23 on the coupling element 11 and the counter-mold connecting element 12.6 on the holding arm 12 in the joining direction orthogonal to the arm axis A and securing the positive engagement of the mold connecting element 11.23 with the counter-mold connecting element 12.6 with respect to the joining direction by means of a securing device.
  • connection step A3 Inserting the flange collar 11.23 on the coupling element 11 in the joining direction orthogonal to the arm axis A into the U-shaped guide groove 12.9 of the guide section 12.7 of the connecting piece 12.6 on the holding arm 12 and securing the positive engagement of the flange collar 11.23 in the U-shaped guide groove 12.9 of the guide section 12.7 with respect to the joining direction by means of resilient pressure pieces 12.10, the balls 12.11 of which engage in the circular round groove 11.25 on the front side of the flange collar 11.23.
  • the method can, as can be seen from Fig. 15, 16, comprise step A4): Arranging a steep disposable cover 15 on the coupling element 11 and pulling the sterile disposable cover 15 over the holding arm 12.
  • a sterile drape can be placed over the sterile coupling unit and then partially over the unsterilized len holding arm 12 with the actuator unit to enable contact during the coupling process without risk of contamination.
  • the arrangement of the drape prevents contact of a sterile person with a non-sterile surface of the holding arm 12.
  • the person can, if necessary, actuate buttons or levers on the holding arm 12 to complete the coupling process, i.e.
  • the procedure for disassembling the instrument system 4 then comprises the steps
  • the simple assembly and disassembly according to the invention is not only ensured by the fastening device for connecting the coupling element 11 to the holding arm 12, but in particular by the coupling of the holding device 10 to the coupling element 11 by the coupling arms 11.1, which grip around the cylindrical bearing section 100 and are flexible in the direction away from the arm axis A, while they are rigid in the other spatial directions.
  • the coupling arms 11.1 are pushed onto the cylindrical bearing section 100 and there bent open by the insertion bevel 10.4 until they snap shut again when the projections 10.3 enter the receiving openings 11.3. Due to the arrangement of the insertion bevel 10.4 and the disassembly bevel 11.5, the holding device 10 cannot be moved in the distal direction, i.e.
  • the invention relates to a holding device with an instrument adapter and an instrument holding device configured to hold medical instruments. Furthermore, the alternative invention relates to an instrument system comprising the instrument holding device and the medical instruments guided and secured thereby, and to a method for guiding, positioning, and securing medical instruments using the instrument holding device.
  • An example of the instrument holding device 1 with its components holding device 10 with instrument adapter 13, coupling element 11 and holding arm 12 is shown in Fig. 22;
  • Fig. 21 shows an instrument system 4 in which two medical instruments, here a trocar 2 and an endoscope 3, are arranged along a common longitudinal axis L by an instrument holding device 1.
  • the holding device 10 has a distal holding element 101 - i.e.
  • the two holding elements 101, 102 in the joined arrangement delimit a passage opening 103 which defines the common longitudinal axis L.
  • the two holding elements 101, 102 each have a partially cylindrical base element 10.1, 10.2 and an arm element 10.6, 10.7, wherein the two partially cylindrical base elements 10.1, 10.2 provide a cylindrical storage section 100 in the arrangement of the holding elements 101, 102 joined together to form the holding device 10.
  • the passage opening 103 is designed to receive a second medical instrument 2 (trocar 2 in Fig. 21), while the arm elements 10.6, 10.7 are designed to receive a first medical instrument 3 (endoscope 3 in Fig. 21).
  • the arm elements 10.6, 10.7 have contact surfaces 10.8, 10.9 (in Fig. 24) facing each other at their ends, which delimit the passage opening 103 in the region of the arm elements 10.6, 10.7 for receiving the first medical instrument 3.
  • an instrument adapter 13 (Figs. 23 and 24) can be arranged, e.g. clipped, at the ends of the arm elements 10.6, 10.7, which has an opening 13.1 coaxial with the passage opening 103 with an adapted diameter for receiving the first medical instrument 3.
  • a sleeve 16 is arranged in the opening 13.1, which is a bore.
  • the sleeve 16 is hollow-cylindrical and can be elastically deformed in a direction radial to the longitudinal axis L. It defines an adapter opening 16.1 aligned with the passage opening 103 of the storage section 100, in which the first instrument 3 can be received.
  • the instrument adapter 13 has a proximal receiving section 13.4, which in turn is delimited by an elongated receiving opening 13.5, into which the angled end section 10.4 of the proximal arm section of the proximal holding element 102 can be received.
  • the receiving opening 13.5 extends through the longitudinal extent of the instrument adapter 13 in a direction radial to the longitudinal axis L up to the bore 13.1 and opens into the latter.
  • the hollow cylindrical sleeve 16 is inserted into the receiving opening 13.5 and thus separates the receiving opening 13.5 from the adapter opening 16.1. If the angled end section 10.4 is received in the receiving opening 13.5, as can be seen in Figs. 23 and 24, the contact surface 10.9 is spaced from the sleeve 16.
  • the angled end section 10.4 touches the sleeve 16 from the outside with the contact surface 10.9.
  • the instrument adapter 13 has a distal clamping section 13.2, which faces away from the proximal receiving section 13.4.
  • a receiving opening 13.3 is provided, parallel to the longitudinal axis L, in which the free end section 10.3 of the distal holding element 101 is received.
  • the free end section 10.3 of the distal holding element 101 extends parallel to the longitudinal axis L and has, on a side facing the longitudinal axis L, a bevel 10.8, which defines the cross section of the distal Retaining element 101 tapers towards the free end.
  • the bevel 10.8 at the free end section acts as an insertion bevel, along which the spring 15 slides and is simultaneously increasingly compressed and thus increasingly tensioned until the spring 15 rests against the adjoining non-beveled section of the distal retaining element 101 with the stronger preload.
  • a spring chamber 13.6 Formed in the distal clamping section 13.2 is a spring chamber 13.6 which is connected to the receiving opening 13.3 and extends in a direction radial to the longitudinal axis L along the longitudinal extent of the adapter 13.
  • a spring 15 is arranged in the spring chamber 13.6 and is pretensioned by inserting the end section 10.3.
  • the spring 15 is fastened with its proximal end 15.1 or a fastening end turn 15.1 in the body of the instrument adapter 13 and, with its distal end 15.2 or an active end turn 15.2, is in operative connection during insertion first with the bevel 10.8 and then with the end section 10.3 of the distal holding element 101. Due to the force of the spring 15, the end section 10.3 strikes the receiving opening 13.3 on the distal side.
  • Fig. 25 shows the spring 15 in a non-preloaded or less preloaded state before the distal retaining element 101 is inserted into the receiving opening 13.3.
  • a second medical instrument 2 Arranging and fastening the holding device 10 to a second medical instrument 2, which can in particular be a trocar 2 placed on the patient and defines the longitudinal axis L;
  • step C the coupling element 11 attached to the holding arm 12 is coupled to the holding device 10, and
  • the sleeve 16 By adapting the sleeve 16 to the outer surface of the first medical instrument 3, the latter can be positioned on the trocar 2 in an almost self-retaining manner and cannot fall off.
  • the spring 14 When the spring 14 is compressed, the first medical instrument 3 does not press against a rigid stop, but always only against the flexible sleeve 16, whereby the first medical instrument 3 is well protected from damage.

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Abstract

L'invention concerne un dispositif de maintien d'instrument (1) conçu pour la fixation d'instruments médicaux (2, 3) le long d'un axe longitudinal (L) commun, un ensemble de montage pour la fixation de ceux-ci, un système d'instrument et un procédé pour le démontage de celui-ci. Le système d'instrument comprend un dispositif de maintien (10), un bras de maintien (12) et un élément d'accouplement (11) qui les relie. Le bras de maintien (12) définit un axe de bras (A) et l'élément d'accouplement (11) comporte un dispositif de fixation pour la liaison coaxiale et rotative autour de l'axe de bras (A) avec le bras de maintien (12). Pour recevoir les instruments (2, 3), le dispositif de maintien (10) comporte un élément de maintien (101) distal et un élément de maintien (102) proximal qui est relié à l'élément d'accouplement (11) de manière à pouvoir pivoter autour d'un axe de pivotement (S) orthogonal à l'axe longitudinal (L) et à l'axe de bras (A). Les éléments de maintien (101, 102) forment une partie de logement (100) qui présente un axe de cylindre lequel correspond à l'axe de pivotement (S), et comporte de part et d'autre respectivement une structure saillante (10.3) dans l'axe de pivotement (S). L'élément d'accouplement (11) comprend deux bras d'accouplement (11.1) comportant une ouverture de réception (11.3) destinée à venir en prise avec la structure saillante (10.3), chaque structure saillante (10.3) comportant une surface de guidage (10.5) partiellement cylindrique qui est formée sur la structure saillante (10.3) au moins d'un côté de l'élément de maintien (101) distal et une partie inclinée d'insertion (10.4) d'un côté de l'élément de maintien (102) proximal. Les bras d'accouplement (11.1) peuvent être déformés élastiquement dans la direction radiale par rapport à l'axe de bras (A), parallèlement à l'axe de pivotement (S) et sont rigides dans chaque direction orthogonale à l'axe de pivotement (S), et chaque ouverture de réception (11.3) est formée de manière à comporter une surface de guidage (11.7) cylindrique creuse pour le montage de l'une des structures saillantes (10.3).
PCT/EP2024/082987 2023-11-28 2024-11-20 Dispositif de maintien d'instrument, ensemble de montage, système d'instrument et procédé de montage et de démontage Pending WO2025114110A1 (fr)

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
DE102023133158.2 2023-11-28
DE102023133158.2A DE102023133158A1 (de) 2023-11-28 2023-11-28 Instrumentenhaltevorrichtung, montageset, instrumentensystem und verfahren zur montage und demontage
DE102023133161.2 2023-11-28
DE102023133161.2A DE102023133161A1 (de) 2023-11-28 2023-11-28 Haltevorrichtung mit instrumentenadapter für eine instrumentenhaltevorrichtung zur führung und fixierung von medizinischen instrumenten

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WO2025114110A1 true WO2025114110A1 (fr) 2025-06-05

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PCT/EP2024/082987 Pending WO2025114110A1 (fr) 2023-11-28 2024-11-20 Dispositif de maintien d'instrument, ensemble de montage, système d'instrument et procédé de montage et de démontage

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20120296281A1 (en) * 2009-10-07 2012-11-22 Joris Emanuel Nicolaas Jaspers Holding Device for Holding a Manually Operated Medical Device
DE102018115435A1 (de) * 2018-06-27 2020-01-02 avateramedical GmBH Trokarhalterung
EP3772345A1 (fr) * 2019-08-07 2021-02-10 Karl Storz SE & Co. KG Dispositif de fixation simultanée des instruments médicaux et système correspondant

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20120296281A1 (en) * 2009-10-07 2012-11-22 Joris Emanuel Nicolaas Jaspers Holding Device for Holding a Manually Operated Medical Device
DE102018115435A1 (de) * 2018-06-27 2020-01-02 avateramedical GmBH Trokarhalterung
EP3772345A1 (fr) * 2019-08-07 2021-02-10 Karl Storz SE & Co. KG Dispositif de fixation simultanée des instruments médicaux et système correspondant
EP3772345B1 (fr) 2019-08-07 2021-12-22 Karl Storz SE & Co. KG Dispositif de fixation simultanée des instruments médicaux et système correspondant

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