DE69310072T2 - Rotierender endoskopischer Mechanismus mit gegliedertem Antriebsmechanismus - Google Patents
Rotierender endoskopischer Mechanismus mit gegliedertem AntriebsmechanismusInfo
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- DE69310072T2 DE69310072T2 DE69310072T DE69310072T DE69310072T2 DE 69310072 T2 DE69310072 T2 DE 69310072T2 DE 69310072 T DE69310072 T DE 69310072T DE 69310072 T DE69310072 T DE 69310072T DE 69310072 T2 DE69310072 T2 DE 69310072T2
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- 239000012636 effector Substances 0.000 abstract 3
- 102000004315 Forkhead Transcription Factors Human genes 0.000 description 10
- 108090000852 Forkhead Transcription Factors Proteins 0.000 description 10
- 238000000034 method Methods 0.000 description 4
- 210000001519 tissue Anatomy 0.000 description 4
- 238000002788 crimping Methods 0.000 description 2
- 210000000707 wrist Anatomy 0.000 description 2
- 238000007486 appendectomy Methods 0.000 description 1
- 238000002192 cholecystectomy Methods 0.000 description 1
- 230000000694 effects Effects 0.000 description 1
- 238000002674 endoscopic surgery Methods 0.000 description 1
- 230000003203 everyday effect Effects 0.000 description 1
- 239000002783 friction material Substances 0.000 description 1
- 238000002430 laser surgery Methods 0.000 description 1
- 239000000463 material Substances 0.000 description 1
- 210000003205 muscle Anatomy 0.000 description 1
- 210000000056 organ Anatomy 0.000 description 1
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
- A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
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Description
- Generell betrifft die vorliegende Erfindung endoskopische Vorrichtungen. Insbesondere betrifft die vorliegende Erfindung endoskopische Vorrichtungen wie Greifer, Dissektoren und Scheren, wobei die Vorrichtung drehbar ist. Besonders betrifft die vorliegende Erfindung solche Vorrichtungen, bei denen, während sich die Vorrichtung um die Längsachse des Instruments drehen kann, der Endabschnitt des Schaftes durch eine Gelenkverbindung derart abgewinkelt werden kann, daß sich der Schaft über einen Winkel von 0º bis 90º bewegen kann.
- Bei der endoskopischen Chirurgie besteht anerkanntermaßen ein Bedürfnis nach einfachen Geräten wie Greifern, Dissektoren, Scheren und anderen chirurgischen Basisinstrumenten. Diese Instrumente sind erforderlich, um bei der endoskopischen Maßnahme einfache Funktionen auszuführen. Insbesondere sind Greifer erforderlich, um die Arbeitsstelle geeignet von anderen lebenswichtigen Organen wegzubewegen, so daß das Gewebe, an dem zu arbeiten ist, isoliert ist und chirurgisch behandelt werden kann. Scheren sind erforderlich, um Gewebe, Muskeln oder Gefäße geeignet zu durchtrennen. Dissektoren können erforderlich sein, um einen Teil des Gewebes von einem anderen zu trennen. Diese Instrumente ermöglichen es auch, daß andere, größere Instrumente wie Klammergeräte und Ligaturklammeranleger genügend Raum haben, um Operationen wie Appendektomien, Cholezystektomien, Herniorrhaphien usw. durchzuführen.
- Herkömmlich sind Instrumente wie Greifer, Dissektoren, Scheren und andere endoskopische Instrumente an im wesentlichen geraden Schäften angebracht. Diese Schäfte können um die Längsachse des Schaftes drehbar sein oder auch nicht. Unabhängig davon wurde ein Bedürfnis erkannt, das Endwerkzeug des Schaftes bezüglich der Längsachse des Schaftes abwinkeln zu können. Dadurch wird der Chirurg in die Lage versetzt, das zu operierende Gewebe unter einem schrägen Winkel anzugehen. Es kann manchmal wünschenswert sein, den Schaft bezüglich seiner Längsachse um bis zu 90º abzuwinkeln. Diese Funktion ist analog zur Fähigkeit der menschlichen Hand zu sehen, die sich um die "Achse" des Arms drehen kann und um das Handgelenk "abwinkeln" kann. Die Hand kann natürlich auch nur mit einer Drehung gut funktionieren, die Freiheitsgrade, die sich mit dem Handgelenk ergeben, sind jedoch viel größer und verbessern die Fähigkeit der Hand, einfache alltägliche Funktionen auszuführen, auf mannigfache Weise. Es besteht daher ein Bedürfnis nach einem gelenkig abwinkelbaren endoskopischen Instrument, damit die Funktionen solcher Vorrichtungen verbessert werden können.
- Es gab bereits Ansätze, gelenkige Instrumente zu entwickeln, aber keines dieser Instrumente bot die Möglichkeit, Funktionen bei einer Abwinklung von 90º zum Längsschaft der endoskopischen Vorrichtung auszuführen. Dies liegt zum großen Teil an Problemen bei den Toleranzen und der Materialfestigkeit, die bei den Herstellern der Instrumente in Erscheinung traten. Es ist daran zu erinnern, daß es nicht nur erforderlich ist, ein Instrument zu haben, das diese Abwinklungen aufweist, sondern daß das Instrument auch in der Lage sein muß, die Endwerkzeuge bei solchen Abwinklungen zu betätigen. Diese Kombination ließ sich nur schwierig bewerkstelligen und hatte zur Folge, daß andere Konstruktionsvorgaben geopfert werden mußten. Generell betrafen diese Opfer die Anwendbarkeit der Instrumente, so daß diese endoskopischen Instrumente nicht unter 90º zum Schaft des Instruments abgewinkelt werden konnten. Mit dieser Einschränkung sind natürlich die Möglich keiten, die diese Abwinklungen bieten, nicht zu erreichen.
- Das US-Patent 4 872 456 beschreibt die Merkmale des Oberbegriffs der Patentansprüche 1 und 6, wobei letzterer eine Vorrichtung für die Laser-Chirurgie mit einem äußeren Rohr mit hohlem Inneren und einem mit dem äußeren Rohr ver .10 bundenen Endwerkzeugabschnitt sowie einen Gelenkmechanismus zum Drehen des Endwerkzeugabschnittes umfaßt.
- Die vorliegende Erfindung betrifft eine endoskopische Vorrichtung und eine Vorrichtung zum Durchführen endoskopischer Maßnahmen, wie es in den Patentansprüchen beschrieben ist.
- Diese Vorrichtung wird bei einem endoskopischen Instrument wie einem Dissektor, einer Schere oder einem Greifer angewendet, wobei ein Schaft vorgesehen ist, der eine Längsachse des Instruments festlegt. Der Schaft kann um den Griffabschnitt des Instruments gedreht werden. Diese Drehung bewirkt auch eine Drehung der Endwerkzeuge, etwa der Scheren und Greifer am Ende des Instruments. Die Drehung wird durch einen Drehknopf hervorgerufen, der zum Griffabschnitt des Instruments hin angeordnet ist. Die Betätigung des Instruments, um zu greifen oder zu schneiden oder dergleichen, wird durch eine scherenartige Bewegung von zwei Handgriffen ausgeführt, die an der Rückseite des Instruments vorgesehen sind. Ein Handgriff steht relativ zum Antriebsschaft fest. Der andere Handgriff kann bezüglich der Längsachse des Schaftes geschwenkt werden. Diese Schwenkung bewirkt eine Gleitbewegung eines Antriebsschaftes, der sich im äußeren Rohr der Vorrichtung befindet. Die Gleitbewegung dieses Antriebsab schnittes betätigt ein flexibles Kabel. Das flexible Antriebskabel bewegt sich relativ zu einem Gabelkopf, der eine Betätigung der Endwerkzeuge dieser Vorrichtung bewirkt. Auf diese Weise wird die Vorrichtung betätigt, wobei der Chirurg eine stationäre Handposition beibehalten kann.
- Dieser Mechanismus sorgt auch für ein Auslenken der Endwerkzeuge bezüglich der Längsachse des Schaf tes. Dieses Auslenken wird dadurch bewirkt, daß die Endwerkzeuge bezüglich des Schaftes abgewinkelt werden. Das Auslenken erfolgt mittels eines Auslenkknopfes, der eine Schraube veranlaßt, auf eine Flügelmutter an einem Auslenkrohr in dem Mechanismus eine Relativbewegung auszuüben. Mit der Bewegung dieser Antriebsschraube wird bewirkt, daß sich das Auslenkrohr bezüglich sowohl des äußeren Rohrs des Mechanismusses als auch des Antriebsschaftes bewegt. Durch das Bewirken dieser Relativbewegung veranlaßt das Auslenkrohr eine Gelenkverbindung, sich relativ zum äußeren Rohr des Mechanismusses abzuwinkeln. Diese Verbindung bewirkt, daß sich das Endwerkzeug bezüglich der Längsachse des äußeren Rohrs abwinkelt. In Abhängigkeit vom Ausmaß der Auslenkung, das mit dem Auslenkknopf erzeugt wird, wird der äußere Schaft zwischen 0º und 90º bezüglich des äußeren Schaftes des Mechanismusses abgewinkelt.
- Es ist natürlich wichtig, daß, nachdem der Mechanismus abgewinkelt wurde, die Vorrichtung weiter betriebsfähig ist. Dies wird durch einen Kabelmechanismus erreicht, mit dem der Schaft und dessen Endwerkzeuge bei allen Winkeln betätigt werden können, die bei der Auslenkung erzeugt werden. Da der Antrieb des Kabels bei jedem Winkel möglich ist, sind die Endwerkzeuge weiter betriebsfähig. Auf diese Weise kann die Vorrichtung bei jedem Winkel zwischen 0º und 90º bezüglich der Längsachse des Schaftes angewendet werden.
- Schließlich ist noch ein Sperrmechanismus beschrieben, mit dem der Drehabschnitt der Vorrichtung so betätigt werden kann, daß der ganze Gelenkmechanismus gedreht wird. Dabei ist während einer Drehbewegung die Gelenkverbindung gesperrt, und es erfolgt kein Auslenken des Endwerkzeugs bezüglich der Längsachse des Schaf tes. Im Gegensatz dazu ist während des Auslenkens der Drehmechanismus gesperrt, so daß die relative Drehstellung erhalten bleibt. Dieser "kupplungsartige" Mechanismus ermöglicht es dem Benutzer, während einer endoskopischen Maßnahme viele verschiedene Funktionen auszuführen. Die Brauchbarkeit bleibt erhalten, und die Verbesserungen der Auslenkung können realisiert werden.
- Die neue Erfindung läßt sich besser mit Bezug zu den anliegenden Zeichnungen und in Verbindung mit der genauen Beschreibung der Erfindung verstehen.
- Die Fig. 1 ist eine perspektivische Ansicht des erfindungsgemäßen endoskopischen Instruments;
- die Fig. 2 eine auseinandergezogene Ansicht der Teile des Endwerkzeugabschnitts des erfindungsgemäßen Instruments;
- die Fig. 3 eine auseinandergezogene Ansicht der Teile des Griffabschnitts des erfindungsgemäßen Instruments;
- die Fig. 4 eine perspektivische Ansicht des Gelenkendes des erfindungsgemäßen Instruments; und
- die Fig. 5 eine Schnittansicht des Griffabschnitts des erfindungsgemäßen Instruments längs der Linie 5-5 in der Fig. 1.
- Es wird im folgenden eine Vorrichtung 1 zum Durchführen endoskopischer Maßnahmen beschrieben, wie sie insgesamt in der Fig. 1 zu sehen ist. Die Vorrichtung 1 kann um den Schaft oder das äußere Rohr 10 des Mechanismusses gedreht werden. Die Vorrichtung 1 kann auch so abgewinkelt werden, daß der Endwerkzeugabschnitt 100 des Mechanismusses unter einem Winkel bis zu 90º bezüglich der vom Schaft des Mechanismusses gebildeten Längsachse angeordnet werden kann, wie es besser in der Fig. 4 zu sehen ist. Es wird jede dieser Funktionen beschrieben.
- In der Fig. 2 ist ein Antriebsstab 30 gezeigt, der im wesentlichen zylindrisch ist und der im wesentlichen über die ganze Länge des Instruments verläuft. Dieser Antriebsstab 30 befindet sich in einem Auslenkrohr 20. Das Auslenkrohr 20 ist ebenfalls zylindrisch und kann sich bezüglich des Antriebsstabes 30 in Längsrichtung bewegen. Das Auslenkrohr 20 und der Antriebsstab 30 passen in das äußere Rohr 10 der Vorrichtung.
- Es wird nun der Antriebsabschnitt der Vorrichtung und der Endwerkzeuge beschrieben. Der Antriebsstab 30 kann sich wie oben angegeben bezüglich des äußeren Rohrs 10 gleitend bewegen. Der Antriebsstab 30 ist an seinem distalen Ende an einer Crimpstelte 32 mit einem Antriebskabel 50 verbunden. Dieses Antriebskabel 50 paßt genau in eine Kabelhülse 140. Am distalen Abschnitt des Antriebskabels so ist an einer Crimpstelle 102 ein Stabende 101 angebracht. Dieses Stabende 101 kann die Funktionen des jeweiligen Mechanismusses bewirken. Das Stabende 101 wird im Longitudinalzentrum 42 des Gabelkopfes 40 gehalten. Das Antriebskabel 50 paßt fest in das Zentrum 42 des Gabelkopfes 40, und sowohl das Stabende 101 als auch das Antriebskabel 50 können sich bezüglich des Gabelkopfes 40 bewegen.
- Wenn sich das Antriebskabel 50 bezüglich des Gabelkopfes 40 bewegt, wird das Stabende 101 bezüglich des Gabelkopfes 40 in Längsrichtung geführt. Dabei schwenkt das Stabende 101 die beiden Backenverbindungselemente 80. Diese Backenverbindungselemente 80 drehen sich am Stabende 101 an Schwenkpunkten 103, die mit erweiterten Enden 82 verbunden sind, so daß sich die Backenverbindungselemente 80 von der Achse, die durch den Antriebsstab 30 und das Antriebskabel 50 gebildet wird, nach außen erstrecken.
- Am distalen Ende der Stabverbindungselemente 80 sind die Endwerkzeuge des Instruments angebracht. Zum Beispiel sind bei dieser Ausführungsform Endwerkzeuge dargestellt, die einen oberen Backen 60 und einen unteren Backen 70 eines Greifmechanismusses umfassen. Diese Endwerkzeuge können jedoch auch Scheren oder Dissektoren oder andere endoskopische Instrumente sein. Erforderlich ist, daß die Endwerkzeuge 60, 70 mit ihren proximalen Enden 62, 72 an den distalen Enden 84 der Backenverbindungselemente 80 angebracht sind, damit die Backenverbindungselemente 80 die Bewegung der Endwerkzeuge 60, 70 führen können.
- Wenn der Antriebsstab 30 in proximaler Richtung zum Benutzer hin bewegt wird, wird daher das Antriebskabel 50 gleichermaßen in proximaler Richtung gezogen. Das Antriebskabei 50 zieht am Stabende 101, so daß sich dieses ebenfalls in proximaler Richtung bewegt. Da die Backenverbindungselemente 80 an den beiden Schwenkpunkten 103 mit dem Stabende 101 verbunden sind, werden die Backenverbindungselemente 80 auch in proximaler Richtung gezogen. Auf diese Weise drehen sich die Backenverbindungselemente 80 bezüglich der Längsachse des Antriebsstabes 30 von einer nach außen ausgestellten Stellung in eine nach innen weisende Stellung. Wenn dies erfolgt, drehen die Backenverbindungselemente 80 an ihren distalen Enden die proximalen Enden der Endwerkzeuge 60, 70 zur Längsachse des Instruments. Die Endwerkzeuge 60, 70 werden dabei an den Stellen 64, 74 um die Schulterschraube 90 geschwenkt, die sich in den Schwenklöchern 44 im Ende des Gabelkopfes 40 befindet. Die Endwerkzeuge 60, 70 drehen sich daher gleichermaßen um den Gabelkopf 40, so daß der ganze Mechanismus "geschlossen" wird.
- Andererseits bewirkt das Stabende 101, wenn der Antriebsstab 30 distal vorgeschoben wird, daß sich die Backenverbindungselemente 80 von der Längsachse des Antriebsstabes 30 nach außen ausstellen. Dieses Ausstellen nach außen bewirkt wiederum, daß sich die Enden 66, 76 der Endwerkzeuge 60, 70 nach außen bewegen. Die Endwerkzeuge 60, 70 schwenken an den Stellen 64, 74 um die Schulterschraube 90, die mit den Schwenklöchern 44 am Ende des Gabelkopfes 40 verbunden ist. Bei dieser Drehung schwenken die Endwerkzeuge 60, 70 mit, so daß die Vorrichtung nun "offen" ist. Auf diese Weise werden durch eine Hin- und Herbewegung des Antriebsstabes 30 die Endwerkzeuge 60, 70 der Vorrichtung 1 betätigt.
- Der Antriebsstab 30 kann sich sowohl bezüglich des Auslenkrohrs 20 als auch des äußeren Rohrs 10 der Vorrichtung 1 bewegen. Auf diese Weise kann der Antriebsstab 30 unabhängig von den relativen Positionen des Auslenkrohrs 20 und des äußeren Rohrs 10 bewegt werden. Mittels der Bewegung des Antriebsstabs 30 können daher die Endwerkzeuge 60, 70 bei jeder Drehstellung der Vorrichtung 1 betätigt werden.
- Es wird nun das Auslenken des distalen oder Endwerkzeugabschnitts 100 der Vorrichtung 1 beschrieben. Dieses Auslenken läßt sich am besten aus einer Betrachtung der Bewegung des Auslenkrohrs 20 in Relation zum äußeren Rohr 10 des Mechanismusses verstehen. Das Auslenkrohr 20 ist durch eine Schweißstelle an seinem distalen Ende 22 mit der inneren Kammer 122 des Gleitstücks 120 verbunden. Das distale Ende 12 des äußeren Rohrs 10 paßt über den kleineren äußeren Umfang 132 am proximalen Ende des festen Winkels 130 und ist damit starr verbunden. Das Gleitstück 120 kann sich daher bezüglich des äußeren Rohrs 10 längs der Längsachse der Vorrichtung 1 bewegen. (Dies ist zum Beispiel aus den Fig. 1 und 4 ersichtlich. Hier hat sich das Auslenkrohr 20 distal bewegt. Vom Auslenkrohr 20 wurde das Gleitstück 120 distal bewegt. Wie weiter unten noch genauer beschrieben, bewirkt diese Gleitbewegung das Abwinkeln des Endwerkzeugabschnitts 100 der Vorrichtung.)
- Das distale Ende 124 des Gleitstücks 120 ist durch einen Stift 150 mit dem proximalen Ende 112 des Verbindungsstücks 110 verbunden. Dieses Verbindungsstück 110 ist an seinem entgegengesetzten oder distalen Ende 114 durch einen ähnlichen Stift 150 mit Schwenklöchern 46 an Laschen 146 des Gabelkopfes 40 verbunden. Der Gabelkopf 40 ist durch den Stift 150 an einem Schwenkloch 48 an einer entgegengesetzten Lasche 148 mit dem festen Winkel 130 verbunden. Mit diesen so angeordneten Verbindungen wird ein Abwinkeln des Endwerkzeugabschnitts 100 bezüglich der Längsachse des Instruments er reicht. Wenn das Auslenkrohr 20 distal bewegt wird, bewegt sich auch das Gleitstück 120 distal. Diese distale Bewegung des Gleitstückes 120 bewirkt eine Drehung des Verbindungsstückes 110 um das proximale Ende 112, das mit dem Gleitstück 120 verbunden ist. Diese Bewegung bewirkt gleichermaßen eine Bewegung des Verbindungsstückes 110 um das distale Ende 114, das das Verbindungsstück 110 und den Gabelkopf 40 verbindet. Da der Gabelkopf 40 an der Lasche 148 an dem festen Winkel 130 befestigt ist, der mit der Längsachse des äußeren Rohr 10 verbunden ist, dreht sich der Gabelkopf 40 um die Längsachse des äußeren Rohrs 10 in der Art einer typischen Viergelenkverbindung.
- Dies ist am besten in der Fig. 4 zu sehen, in der die Bewegung ausgeführt wurde. Es ist ersichtlich, daß die distale Bewegung des Gleitstückes 120 ein Abwinkeln des Gabelkopfes 40 am äußeren Rohr 10 bewirkt hat. Eine proximale Bewegung des Gleitstückes 120, die durch eine proximale Bewegung des Auslenkrohrs 20 bewirkt wird, bewirkt natürlich ein Rückdrehen des Gabelkopfes 40 in eine Stellung, in der der Gabelkopf 40 nicht aus der Längsachse des äußeren Rohrs 10 ausgelenkt ist.
- Es ist wünschenswert, die Vorrichtung bei jeder Abwinklung des Gabelkopfes 40 bezüglich des äußeren Rohrs 10 betätigen zu können. Es ist daher wichtig, daß sich der Antriebsstab 30 bezüglich des Gabelkopfes 40 bei jeder Winkelstellung des Gabelkopfes 40 bewegen kann. Dies wird durch das Anbringen des Antriebsstabes 30 am Antriebskabel 50 erreicht. Da das Antriebskabel 50 flexibel ist, kann es sich beim Abwinkeln des Gabelkopfes 40 bezüglich des äußeren Rohrs 10, des Auslenkrohrs 20 und des Antriebsstabes 30 mitbewegen. Das Antriebskabel 50 verläuft durch eine Kabelhülse 140 aus einem Material geringer Reibung, etwa Teflontm, weshalb die Bewegung des Antriebskabels 50 im Gabelkopf 40 leicht möglich ist.
- Die Bewegung des Antriebskabels so ist daher bei jeder Winkelstellung des Gabelkopfes 40 bezüglich des äußeren Rohrs 10 möglich, auch bei einem Winkel von 90º, was bisher bei einem endoskopischen Instrument des Auslenktyps nicht möglich war.
- Da nun der Endwerkzeugabschnitt 100 der Vorrichtung beschrieben wurde, ist die Vorrichtung 1 in Verbindung mit dem Steuerabschnitt der Vorrichtung zu verstehen, der sich im Griff der Vorrichtung befindet. Es ist daran zu erinnern, daß, während ein Auslenken und ein Betatigen der Endwerkzeuge 60, 70 bewirkt wird, sich nur drei Abschnitte in den Handgriff erstrecken. Das heißt, nur das äußere Rohr 10, das Auslenkrohr 20 und der Antriebsstab 30 erstrecken sich in den Handgriffabschnitt des Instruments. Es ist wichtig anzumerken, daß das äußere Rohr 10 mittels seines Flansches 14 mit der Endkappe 240 an der Vorderseite des Auslenkknopfes 260 des Instruments verbunden ist. Dies ist am besten aus den Fig. 3 und 5 ersichtlich. Das Auslenkrohr 20 ist so angeordnet, daß es unmittelbar distal an die Flügel 252 der Flügelschraube 250 ansetzt, siehe Fig. 3, so daß eine Bewegung der Flügelschraube 250 eine Bewegung des Rohrs 20 bewirkt. Der Antriebsstab 30 erstreckt sich durch die ganze Vorrichtung, er ist an seinem proximalen Ende mit der Antriebskugel 310 verbunden, die sich im Auslöser 350 am proximalen Ende des Instruments 1 befindet. Diese Antriebskugel 310 wird von einer Stellschraube 320 im Auslöser 350 gehalten.
- Der Auslöser 350 kann sich aufgrund eines Stiftes 330, der den Handgriff und den Auslöser an den Schwenklöchern 352, 362 verbindet, um den Handgriff 360 des Instruments drehen. Dieser Stift 330 wird von einer Auslöserabdeckung 340 gehalten, wie besser in der Fig. 3 zu sehen ist. Der Antrieb der Endwerkzeuge 60, 70 des Instruments wird daher nur durch eine Scherenbewegung des Handgriffs 360 bezüglich des Auslösers 350 erreicht. Wenn der Auslöser 350 so geschwenkt wird, daß er sich näher am Handgriff 360 befindet, dreht sich die Antriebskugel 310 bezüglich des Handgriffs 360 proximal. Diese proximale Bewegung der Antriebskugel 310 bewirkt eine proximale Bewegung des Antriebsstabes 30 und folglich ein Schließen der Endwerkzeuge 60, 70 aufeinander zu. Man kann somit greifen oder schneiden oder jede andere gewünschte endoskopische Funktion ausführen. Die Bewegung des Auslösers 350 vom Handgriff 360 weg bewirkt ein Schwenken um den Stift 330 derart, daß sich der Antriebsstab 30 distal bewegt. Auf diese Weise ergibt sich eine distale Bewegung am distalen Ende 32 des Antriebsstabes 30, wodurch sich die Backen der Endwerkzeuge 60, 70 voneinander weg bewegen, womit sich die Schere oder der Greifer oder die anderen endoskopischen Endwerkzeuge öffnet bzw. öffnen.
- Diese Antriebsmöglichkeit der Vorrichtung 1 läßt sich nun in Verbindung mit dem oben beschriebenen Auslenken oder Abwinkeln und in Verbindung mit dem Drehen des Instruments verstehen. Zuerst wird die Auslenkung des Instruments beschrieben. Das Auslenken wird mittels einer Auslenkknopfanordnung erreicht, die die Endkappe 240, den vorderen Auslenkknopf 260 und den hinteren Auslenkknopf 270 umfaßt. In dieser Auslenkknopfanordnung befindet sich die Auslenkflügelschraube 250, die in den Schlitz 164 des doppelt geschlitzten Rohrs 160 eingesetzt ist. Das geschlitzte Rohr 160 ist am Gewinde 162 an die Kappe 240 angeschraubt. Dieser Mechanismus ist so angeordnet, daß das doppelt geschlitzte Rohr 160 die Auslenkflügelschraubenanordnung 250 sicher festhält. Eine Feder 230 steuert die Bewegung der Auslenkflügelschraube 250 zwischen der Endkappe 240 und dem Schlitz 164. Die Auslenkflügelschraube 250 ist mit dem Auslenkantriebsrohr 20 verbunden, so daß sie mit den Endwerkzeugen 60, 70 und dem Gabelkopf 40 am distalen Ende der Vorrichtung zusammenwirken kann. Da das äußere Rohr 10 am Flansch 14 mit der Auslenkendkappe 240 verbunden ist, wenn ein Auslenken bewirkt wird, kann sich das Auslenkrohr 20 bezüglich des äußeren Rohrs 10 bewegen.
- Wenn eine Auslenkung erfolgen soll, dreht der Benutzer die Auslenkknopfanordnung. Dabei bewirken die inneren schraubenförmigen Schraubengänge 262 des vorderen Auslenkknopfes 260 eine relative Bewegung zwischen den Flügeln 252 der Auslenkflügelschraube 250 und dem Rest des Instruments 1. Mit anderen Worten wird bei einer Bewegung gegen den Uhrzeigersinn 4ie Auslenkflügelschraube 250 in der Mitte 264 des Knopfes 260 proximal zum Benutzer hin gezogen. Daher bewegt sich das Auslenkrohr 20 gleichermaßen proximal und damit auch das Gleitstück 120. Dadurch wird der Gabelkopf 40 bezüglich der Längsachse des Schaftes der Vorrichtung gestreckt. Umgekehrt bewirkt, wenn die Knöpfe 260, 270 im Uhrzeigersinn bewegt werden, der schraubenförmige Abschnitt 262 des Knopfes 260, daß sich die Auslenkflügelschraube 250 im Schlitz 164 distal bewegt. Diese distale Bewegung bewirkt eine distale Bewegung des Gleitstückes 120, was wiederum ein Abwinkeln des Gabelkopfes 40 bezüglich der Längsachse des Schafts auslöst.
- Die Schraube 262 wandelt die Drehbewegung der Knöpfe 260, 270 in eine lineare Bewegung des Auslenkrohrs 20 um. Diese Drehbewegung erzeugt ein Verhältnis zwischen Bewegung und Auslenkung von im wesentlichen eins zu eins. Für eine Auslenkung des Schaftes von 90º ist eine Drehung des Knopfes um etwa 1200 erforderlich. Der Benutzer kann daher ein allgemeines "Gefühl" der Abwinklung des Gabelkopfes 40 über eine relativ leichte (aus der Perspektive des Benutzers) Bewegungslänge erhalten.
- Es ist nun die Drehbewegung des Instruments zu beschreiben. Dazu ist es zuerst erforderlich, die Beziehung zwischen dem Auslenkabschnitt des Instruments und dem Drehabschnitt des Instruments zu verstehen. Generell bewirkt, wie aus der Zeichnung zu sehen ist, die Drehfeder 220, daß sich der Drehknopf 290 im Instrument proximal bewegt. Dieser Drehknopf 290 enthält eine Reihe von Rastnocken 292. Die Rastnokken 292 greifen in den Zahnkranz 302 der Drehsperre 300 ein. Die Drehsperre 300 ist in der Öffnung 364 im Handgriff 360 angeordnet und wird dort vom Haltering 200 in einer festen Stellung gehalten, der über dem distalen Ende 182 des Rohrs 180 angebracht ist, über dem die Sperre 300 gehalten wird. Da die Drehf eder 220 auf den Drehknopf 290 drückt, rasten die Rastnocken am Drehknopf 290 in den Drehsperrenzahnkranz 302 ein, so daß der Drehknopf 290 bezüglich des Handgriffs 360 festgehalten wird. Wenn der Benutzer die Auslenkknöpfe 260, 270 dreht, können sich die Auslenkknöpfe 260, 270 unabhängig von der Drehung des Drehknopfes 270 drehen. Dadurch wird eine Bewegung der Auslenkflügelschraube 250 und des damit verbundenen Auslenkrohrs 20 bezüglich der ganzen Vorrichtung einschließlichdes feststehenden äußeren Rohrs 10, des feststehenden Handgriffs 360, des Auslösers 350 und des Drehknopfes 290 bewirkt.
- In der distalen Öffnung 294 des Drehknopfes 290 ist die Auslenkrastsperre 280 angeordnet. Die Auslenkrastsperre 280 weist eine Reihe von Zähnen 282 auf, die mit Zähnen 272 im proximalen Abschnitt 274 des hinteren Auslenkknopfes 270 zusammenwirken können. In der Mitte des Drehknopfes 290 ist das Rohr 180 angebracht. Dieses Rohr 180 ist im feststehenden Handgriff 360 befestigt. Es wird dort vom Haltering 200 gehalten. Am Rohr 180 befindet sich ein Flansch 182, an dem die Drehsperre 300 gehalten ist, wie es oben angegeben ist. Die Drehsperre 300 wird zwischen dem Flansch 182 und dem Haltering 200 gehalten. Das Rohr 180 weist an seinem distalen Ende ein Gewinde 184 auf, das in das Gewinde des geschlitzten Rohrs 160 in den Auslenkknöpfen 260, 270 eingeschraubt ist. Die Auslenkknöpfe 2G0, 270 können sich bezüglich des Handgriffs 360 frei drehen, weshalb sich die Auslenkflügelschraube 250 bezüglich der Kombination von Handgriff 360 und Auslöser 350 bewegen kann. Das Antriebsrohr 30 verläuft durch die Mitte 186 des etwa 10 mm-Rohrs 180 und in den Handgriff 360, wie es oben angegeben ist.
- Zwischen der Auslenkrastsperre 280 und dem Federhalter 170 befindet sich eine Auslenkfeder 210, die vorn Schnappring 190 am geschlitzten Rohr 160 gehalten wird. Diese Anordnung ist in der distalen Öffnung 294 des Drehknopfes auf der proximalen Seite der Auslenkrastsperre 280 angebracht. Die Drehfeder 220 kann daher auf die Auslenkrastsperre 280 eine distale Kraft ausüben. Da jedoch diese Drehfeder 220 eine kleinere Federkraft aufweist als die steifere Auslenkfeder 210, befindet sich die frei bewegliche Auslenkrastsperre 280 in der Regel an einer Stelle, die vom hinteren Auslenkknopf 270 proximal verschoben ist. Die Drehfeder 220 übt daher auf den Drehknopf 290 eine proximale Kraft aus, so daß der Knopf 290 mit der Drehsperre 300 in Eingriff steht. Die Auslenkfeder 210 wird durch den Federhalter 170, der durch die Halteringe 190 am geschlitzten Rohr 160 gehalten wird, über dem distalen Ende 168 des Rohrs 160 gehalten.
- Wenn die Rohre 10, 20 und 30 bezüglich des Handgriffs 360 gedreht werden sollen, übt der Benutzer auf den Drehknopf 290 eine distale Kraft aus. Die Auslenkrastsperre 280 kommt deshalb mit dem Auslenkknopf 270 in Kontakt. Der Drehknopf 290 kommt daher derart mit dem geschlitzten Rohr 160 in Eingriff, daß das geschlitzte Rohr 160 die Drehung zum Gewinde 262 des vorderen Drehknopfes 260 überträgt, der irlit den Flügeln 252 der Auslenkflügelmutter 250 nur im Sinne einer Drehbewegung, und nicht einer Längsbewegung, in Kontakt steht, so daß das Auslenkrohr bezüglich der Longitudinalstellung der Auslenkknöpfe 260, 270 effekt "gesperrt" ist. Die distale Bewegung des Drehknopfes 290 verursacht daher ein "Sperren" des ganzen Drehmechanismusses. Auf diese Weise bewirkt eine Drehung des Drehknopfes 290 eine Drehung der Auslenkknöpfe 260, 270, was wiederum eine Drehung des äußeren Rohrs 10 sowie des Auslenkrohrs 20 hervorruft. Diese Drehung löst eine gleichzeitige Drehung des festen Winkels 130 und des Gabelkopfes 40 aus. Damit wird die Drehstellung der Backen 60, 70 festgelegt.
- Da die Backen über das Antriebskabel 50 mit dem Antriebsstab 30 verbunden sind, bewirkt dies eine Drehung des Antriebsstabes 30 im ganzen Mechanismus. (Man sollte sich daran erinnern, daß sich normalerweise der Antriebsstab 30 unabhängig vom Auslenkrohr 20 und dem äußeren Rohr 10 bewegt.) Eine Drehung des Antriebsrohrs 30 bewirkt eine Drehung der Kugel 310 im Handgriff 360. Dadurch wird ein Ausrichten des Antriebsstabes 30 im Handgriff 360 bewirkt. Da jedoch der Auslöser 350 eine Bewegung des Antriebsstabes 30 bei jeder Drehstellung des Antriebsstabes 30 bewirken kann, wird die Anwendbarkeit der Kombination von Handgriff 360 und Auslöser 350 nicht beeinflußt.
- Es besteht natürlich wie erwähnt auch die Möglichkeit, das Instrument auszulenken, wenn die Auslenkknöpfe 260, 270 nicht mit dem Drehknopf 290 in Kontakt stehen.
- Da die Funkionsmöglichkeiten der Vorrichtung nun adäquat beschrieben sind, ist zu erwähnen, daß die Vorrichtung in Verbindung mit einer besonders bevorzugten Ausführungsform erläutert wurde. Es ist daran zu erinnern, daß auch die Äquivalente der Erfindung eingeschlossen sein sollen, wobei die Erfindung und ihre Äquivalente von den folgenden Ansprüchen abzuleiten sind.
Claims (8)
1. Endoskopische Vorrichtung mit
einem endoskopischen Abschnitt mit einem äußeren Rohr
(10) mit einer Längsachse des Rohres (10), durch das ein
Antriebsstab (30) betätigbar ist;
einem Antriebsstab (30) in dem äußeren Rohr (10),
wobei der Antriebsstab (30) ein mit einem Griff verbundenes
proximales Ende und ein mit einem Endwerkzeugabschnitt (100)
verbundenes distales Ende aufweist; und mit
einem Auslöser, der mit dem Antriebsstab (30) verbun
den ist, wobei mit dem Auslöser der Endwerkzeugabschnitt
(100) betätigt werden kann; und
wobei der Endwerkzeugabschnitt (100) um bis zu 90º
zum äußeren Rohr (10) abwinkelbar ist, dadurch
gekennzeichnet, daß der Endwerkzeugabschnitt (100) mit einem Auslenkrohr
(20) verbunden ist, das sich im äußeren Rohr (10) befindet,
und daß mit dem Auslenkrohr (20) der Endwerkzeugabschnitt
(100) bezüglich der genannten Längsachse bewegt werden kann.
2. Vorrichtung nach Anspruch 1, wobei das äußere Rohr
(10) um die Längsachse drehbar ist.
3. Vorrichtung nach Anspruch 1, wobei der Antriebsstab
(30) mit einem Antriebskabel (50) am Endwerkzeugabschnitt
(100) verbunden ist, wobei das Kabel den Endwerkzeugabschnitt
(100) in jeder Position betätigen kann.
4. Vorrichtung nach Anspruch 1, wobei das Auslenkrohr
(20) im Griff mit einem Auslenkknopf verbunden ist.
5. Vorrichtung nach Anspruch 4, wobei der Endwerkzeugab
schnitt (100) um die Längsachse drehbar ist.
6. Vorrichtung zur Durchführung endoskopischer
Maßnahmen, mit
einem äußeren Rohr (10), mit einem hohlen Inneren und
einer Längsachse;
einem Endwerkzeugabschnitt (100), der mit dem hohlen
äußeren Rohr (10) verbunden ist, wobei der
Endwerkzeugabschnitt (100) um das Rohr (10) schwenkbar ist;
dadurch gekennzeichnet, daß ein Auslenkrohr (20), das
sich im äußeren Rohr (10) befindet, mit dem
Endwerkzeugabschnitt (100) verbunden ist, wobei das Auslenkrohr (20)
bezüglich der Längsachse hin- und herbewegbar ist; daß
ein Griffteil am Auslenkrohr (20) angebracht ist,
wobei der Griffteil einen Auslenkknopf zum Hin- und
Herbewegen des Auslenkrohres (20) enthält; und daß
das Auslenkrohr (20) den Endwerkzeugabschnitt (100)
bezüglich der genannten Längsachse bewegen kann.
7. Vorrichtung nach Anspruch 6, wobei mittels des
Auslenkknopfes der Endwerkzeugabschnitt (100) bis zu 90º um das
äußere Rohr (10) schwenkbar ist.
8. Vorrichtung nach Anspruch 7, wobei der Auslenkknopf
innen schraubenförmig ausgestaltet ist und das Auslenkrohr
(20) mit einer Flügelschraube in dem schraubenförmigen
Inneren verbunden ist, derart, daß eine Drehung des
Auslenkknopfes die Flügelschraube veranlaßt, das Auslenkrohr (20)
bezüglich der Längsachse hin- und herzubewegen.
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US07/959,017 US5330502A (en) | 1992-10-09 | 1992-10-09 | Rotational endoscopic mechanism with jointed drive mechanism |
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DE69310072T2 true DE69310072T2 (de) | 1997-11-06 |
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DE69310072T Expired - Fee Related DE69310072T2 (de) | 1992-10-09 | 1993-10-08 | Rotierender endoskopischer Mechanismus mit gegliedertem Antriebsmechanismus |
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US (1) | US5330502A (de) |
EP (1) | EP0592243B1 (de) |
JP (1) | JPH06197906A (de) |
AT (1) | ATE151973T1 (de) |
AU (1) | AU667239B2 (de) |
BR (1) | BR9304189A (de) |
CA (1) | CA2107931A1 (de) |
DE (1) | DE69310072T2 (de) |
ES (1) | ES2100470T3 (de) |
IL (1) | IL107203A0 (de) |
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- 1992-10-09 US US07/959,017 patent/US5330502A/en not_active Expired - Lifetime
-
1993
- 1993-10-06 IL IL107203A patent/IL107203A0/xx unknown
- 1993-10-07 CA CA002107931A patent/CA2107931A1/en not_active Abandoned
- 1993-10-07 AU AU48900/93A patent/AU667239B2/en not_active Ceased
- 1993-10-08 JP JP5275946A patent/JPH06197906A/ja active Pending
- 1993-10-08 EP EP93308030A patent/EP0592243B1/de not_active Expired - Lifetime
- 1993-10-08 ES ES93308030T patent/ES2100470T3/es not_active Expired - Lifetime
- 1993-10-08 BR BR9304189A patent/BR9304189A/pt unknown
- 1993-10-08 AT AT93308030T patent/ATE151973T1/de active
- 1993-10-08 DE DE69310072T patent/DE69310072T2/de not_active Expired - Fee Related
Cited By (4)
Publication number | Priority date | Publication date | Assignee | Title |
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US7909850B2 (en) | 1999-10-25 | 2011-03-22 | Boston Scientific Scimed, Inc. | Forceps for medical use |
US8083686B2 (en) | 2003-09-10 | 2011-12-27 | Boston Scientific Scimed, Inc. | Forceps and collection assembly with accompanying mechanisms and related methods of use |
US8460205B2 (en) | 2003-09-10 | 2013-06-11 | Boston Scientific Scimed, Inc. | Forceps and collection assembly with accompanying mechanisms and related methods of use |
US7942896B2 (en) | 2003-11-25 | 2011-05-17 | Scimed Life Systems, Inc. | Forceps and collection assembly and related methods of use and manufacture |
Also Published As
Publication number | Publication date |
---|---|
EP0592243A2 (de) | 1994-04-13 |
DE69310072D1 (de) | 1997-05-28 |
BR9304189A (pt) | 1994-04-12 |
EP0592243A3 (de) | 1994-12-28 |
JPH06197906A (ja) | 1994-07-19 |
EP0592243B1 (de) | 1997-04-23 |
AU4890093A (en) | 1994-04-21 |
IL107203A0 (en) | 1994-01-25 |
CA2107931A1 (en) | 1994-04-10 |
ATE151973T1 (de) | 1997-05-15 |
US5330502A (en) | 1994-07-19 |
ES2100470T3 (es) | 1997-06-16 |
AU667239B2 (en) | 1996-03-14 |
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