DE19537897A1 - Multi=functional surgical instrument suitable for variable surgical methods - Google Patents

Abstract

The multi-functional surgical instrument has several individually controllable and activatable applicators (12-14) e.g. HF applicator (12) arranged in an elongated housing (1). The applicators or parts of these, are movable or rotatable about the longitudinal axis, by a respectively assigned actuator (2), in a predetermined position away from the distal end of the instrument. One or more applicators are supplied, simultaneously or in a specified sequence to interact or act alternately, at the object to be treated e.g. tissue. The automatic control of the actuator can be effected by an activating signal to an applicator or applicators. Sensors are provided for controlling functional conditions also an instantaneous position of the applicators and for the observation of the object zones to be treated.

Description

The invention relates to a multifunctional surgical Instrument with which without changing instruments entirely different surgical methods, such as ultrasound surgery, high-frequency surgery and / or laser surgery, convenient and time-saving can be carried out.

Surgical instruments for high frequency surgery are for example with a monopolar or bipolar active Electrode for cutting and / or coagulating or with more as such an electrode for treating biological Tissue equipped with HF current. Beyond that surgical instruments for high frequency surgery known which for monopolar and / or bipolar cutting or also coagulating with devices for suctioning off Gases and / or liquids from the surgical field or to Instilling rinsing liquids. For example, an instrument is known in which a Drive device or a locking device provided with which a needle electrode can be used for cutting is pulled into a sleeve or out of the sleeve can be pushed out. In addition, this points Instrument a suction provided within a shaft or flushing channel.  

The US-PS 40 43 342 shows cutting instruments for the High frequency surgery, one of which is used as a cutting electrode serving thin metallic needle from a neutral electrode-serving metal sleeve, electrically against this isolated, protrudes in the axial or radial direction or can be pushed out. Such an instrument is suitable for example for fine preparation cuts. Each the thinner the metallic needle, the less high frequency quenzstrom is required for cutting and the lower the cut edges are thermally damaged. A thin one Metallic needles, however, increase the risk of them becoming light can bend or break off and inadvertently tissue injured. There is also a risk of injury to the Surgeons and the rest of the surgical staff with that too additional risk of infection as a result of such Injury.

The US-PS 50 07 008 shows an electrical surgical Instrument, which at its distal end with a monopolar or bipolar coagulation electrode from which one is suitable for cutting if necessary Needle electrode can be pushed out. In addition this instrument has a flushing channel through which Irrigation fluid can be applied to the surgical field to flush it with blood. A disadvantage of the above mentioned solution is that the surgeon to Cut the needle electrode out of the instrument manually push out and at the same time the cutting mode of the must activate the high-frequency surgical device used.

Also in other known instruments of the aforementioned Type in which electrodes for cutting and / or coagulating are provided, which are mechanically displaceable and at which devices for extracting or applying gases and / or liquids can be provided Operation is complex because the surgeon during the operation the position of the electrodes must be set manually.  

Furthermore, instruments for ultrasound surgery, d. H. known for tissue selective dissections.

Radio frequency surgery is a method by which everyone Tissues other than bone are cut largely non-selectively can. Ultrasound surgery, on the other hand, lacks that Hemostasis effect. The high-frequency surgery can therefore with good success can be applied to hemostasis. Especially The combined use of ultrasound surgery is advantageous and high-frequency surgery in particular endoscopic operations since both are described Complement properties and thereby the Have surgical technique improved or new applications become possible. The tissue specific selectivity of the Dissection with ultrasound results on the one hand from the different tensile strength as well as the relative Water content of different tissues and on the other hand the power density of ultrasound in the tissue. Fabric with low tensile strength and relatively high water content even with low power density of ultrasound to be fragmented. Fabric with high tear strength and / or low water content, e.g. B. connective tissue, goiter, require a relatively high power density of ultrasound.

The ultrasound dissection is suitable from the above Reasons in particular for selective, anatomically correct Preparation of tissue structures, e.g. B. to unmask Organs or vessels of enveloping adipose tissue, for Fragmentation or aspiration undesirable or pathological tissue, e.g. B. adipose tissue or tumors, and Dissection of parenchymal tissue, e.g. B. liver. At Presence of suitable ultrasonic applicators as well correct application and dosage of the power density of the Ultrasound is selective dissection or fragmentation and the aspiration of tissues in almost all surgical Disciplines applicable.  

However, the following problems exist particularly in the Use within endoscopic operations. For one thing this is the lack of ultrasound's hemostasis effect especially during the dissection of parenchymal organs and on the other hand the insufficient or even missing Cutting effect of ultrasound in binding and / or structures containing support tissue. These two at the In contrast, ultrasound surgery lacks effects well accomplished with high frequency surgery.

For the combined use of ultrasound surgery and The high frequency surgery are different techniques known. The simplest technique is that the Operator alternately a special instrument for the applies the respective technology. The disadvantage here is that the interoperative change of instruments especially at endoscopic application is inconvenient and time consuming.

A technique known from US-PS 49 31 047, in which an interoperative change of instruments is avoided, is ultrasound surgery and the High frequency surgery using the same applicator tip to use multifunctional instruments. Here, the Ultrasonic and high frequency current at the same time or can be applied alternately.

However, this technique is problematic in that during high-frequency current coagulation, electric arcs or Sparks are created between the applicator tip and the tissue can, causing spark erosion and thus damage to the Surface of the applicator tip. Besides, can coagulated tissue on the surface of the applicator tip stick and hinder the ultrasonic dissection or even prevent. Another problem with this technique is in that the shape of the for ultrasound dissection  optimized applicator tip for cutting with High-frequency current is only suitable to a limited extent.

It is therefore an object of the invention to be a reliable one multifunctional surgical instrument to specify which is able to switch to interoperative individuals To waive surgical instruments, the application of the Instrumentes to be beneficial and simple for the surgeon should, without the manual operational possibilities of Restrict surgeons.

The object of the invention is achieved with a Object according to claim 1, wherein the Subclaims at least useful configurations and Training includes.

According to the basic idea of the invention, a multi functional surgical instrument, which in one housing combines a variety of individually controllable as well as discretely activatable applicators, wherein in each case the applicators with an assigned actuator in Are connected, which the respective applicator in a very specific operation position towards the distal end of the Instruments move. The movement of the respective applicators takes place in such a way that one or more applicators to act simultaneously or successively Interaction with the object to be treated, e.g. B. tissue, can be brought without the surgeon consuming Manipulations on the instrument must be carried out.

In addition, the multifunctional surgical Instrument Means for automatic control of the actuators on so that when a specific application from the Operator's point of view, an activation signal is necessary is provided, in addition to the appropriate setting Parameters for the applicator in an operation position emotional. Ultimately, sensors are used to control the  Functional status and the current location or position of the respective applicators provided. It is particularly advantageous the application of an optical sensor, with whose help visually, e.g. B. on a monitor, the operation and considered the position of the applicator to support the operation can be.

According to a further basic idea of the invention, this includes multifunctional surgical instrument applicators, which are able to do an ultrasound dissection, an argon plasma coagulation, an RF current application, a laser application and / or mechanical cutting, cutting and To allow holding, funds still provided are to remove liquids or gases from the surgical field aspirate and / or flush liquid.

For example, in the instrument according to the invention Applicators for ultrasound surgery, at least one Applicator for high frequency surgery, e.g. B. for cutting and / or coagulate and / or an applicator for the Laser surgery arranged at the distal end of the housing that both ultrasound surgery and high frequency surgery and / or laser surgery without Instrument changes carried out conveniently and in a time-saving manner can be. The fact that means for optical control the functional state of the applicators and means for suction and rinsing, d. H. to keep the operating field clear are provided, the operation time can be shortened and thus the physical and mental stress of both the patient as well as the surgeon.

The multifunctional surgical instrument according to the Invention can be specific for each application have designed applicator tips. So z. B. Applicator tips for ultrasonic dissection and on the other hand there are monopolar or bipolar hook probes, like this one for laparoscopic chole  cystectomy used, present. To cut and / or coagulation or hemostasis using radio frequency current and / or by means of a laser probe for separation or Vaporizing tissue structures or for coagulating Other special applicators are provided for tissues.

An embodiment of the instrument according to the invention is like this designed that, for example, one for blunt dissection, Cutting and / or coagulating usable hook probe relatively to the distal end or to the probe tip of the ultrasound applicator is movable that they are the same, larger or smaller distance from the tissue than the distal end of the ultrasound applicator. The same applies to one provided argon plasma probe.

In the manner described above, either the HF current applicator and / or the probe tip of the Ultrasonic applicator in an optimal working position to be brought.

The distal end of a laser applicator, for example a laser probe, can be positioned relative to the distal end of the Ultrasonic applicator or the HF current applicator like this be fixed that the respective focus of the laser to Cut or coagulate outside the area of the distal end of the ultrasound applicator or the HF current applicator lies so that the ultrasound applicator or RF current applicator during laser surgery as Spacers or focusing aid can be used.

In the case where the ultrasound applicator for example is designed as a thin tube, this can also be used for Sucking or rinsing can be used.

The individual probes can be electrically isolated in the be essentially coaxial or in another Embodiment of the invention via a  Revolver rotating mechanism so that each by combined Rotate and move the corresponding applicator in its operation position is movable.

It is also another idea of the invention subsequently some of the applicators are designed to be interchangeable and / or with a possibility of pivoting in one Area at the distal end. This panning is used, for example, to perform certain operational steps in an otherwise inaccessible area, e.g. B. in the intestinal tract, to be able to make.

The multifunctional surgical instrument can be used also be part of a known endoscope, so that partially resorted to commercially available assemblies can be.

An automatic movement proves to be particularly advantageous of the respective applicators by controlling the assigned ones Actuators when the surgical technique in question the surgeon is to be applied. For this, in addition to a foot pedal operation also a voice control be made, which significantly relieves the surgeon.

The actuators for moving the applicators from a rest in a working position, d. H. to create a movement in the essentially in the longitudinal direction of the instrument for example piezoelectric, electromagnetic, electro motor, pneumatic or hydraulic drives.

It is not necessary that the actual Drive unit is part of the housing of the applicator, but the drive unit can also be arranged remotely be and via appropriate pneumatic or hydraulic or other connecting lines into the applicators move desired movement.  

The individual applicators can, as far as they are functional feasible, pushed into one another concentrically and be coaxial, but it is also possible to have several to arrange the applicators bundled side by side in such a way that the available cross-sectional area of the surrounding housing can be used optimally.

The invention will now be described with reference to the description of Embodiments and with the help of a figure are explained in more detail.

The figure shows an embodiment of a multi functional surgical instrument in partial section Representation with different applicators and one interchangeable, curved applicator, especially for Argon plasma coagulation.

According to the figure, the surgical instrument is accommodated in a housing 1 , in the end section 1.1 of which actuators 2 , not shown, are arranged.

As actuators 2 , for example, hydraulically or pneumatically operated piston-cylinder configurations can be used, which interact with the individual applicators described later in order to achieve the desired movement in the longitudinal direction, ie towards the operating field.

There is a possibility that at least one of the Actuators an applicator with one in the distal area curved end set in a rotational movement, so that for example, coagulation processes without elaborate manual movement of the entire surgical Instrumentes can be carried out.

An optical sensor, for example an optical fiber lighting cable in connection with a photosensitive element, e.g. B. in the form of a CCD matrix 4 is part of the multifunctional instrument and aligned towards the distal end, so that the surgeon is able via an image display device, the operation process and the location of the individual applicators based on that to recognize treating tissue 3 , so that there is a further simplification when using the instrument.

The figure only shows in principle an applicator for suction 10 , another applicator for rinsing 11 , a high-frequency applicator 12 and an argon plasma coagulation applicator 13 . A section of the suction applicator and / or the rinsing applicator 10/11 can be used as an ultrasound applicator 14 .

One or more of the applicators can have a curved section 15 in order to better grasp certain areas of the tissue to be treated.

In the drawing of the curved section 15 of an exemplary applicator, a movable probe 16 is arranged inside, which can be moved longitudinally by means of an associated actuator.

The probe 16 can be pulled in so far that it is located in the section 17 , whereby an opening 18 is exposed.

The opening 18 then interacts with a channel 19 , which is used to supply flushing liquid or to aspirate blood or the like.

In the example shown, the applicators 10 and 11 and 14 are coaxial; on the other hand, the applicators 12 and 13 are arranged adjacent.

However, each of the applicators can be separately in the longitudinal direction be moved.

The curved section 15 is additionally set in a rotational movement about the longitudinal axis via a corresponding actuator, so that a further simplification in the handling of the multifunctional instrument during the actual operation, e.g. B. in body cavities.

In addition to the applicators shown, other, e.g. B. a laser applicator can be arranged, which for change the focus is also movable.

In the case where the multifunctional surgical instrument has an ultrasound applicator, an electroacoustic transducer can expediently be located next to the actuators in the rear section or in the end section 1.1 .

The ultrasound applicator consists, in a manner known per se, of an impedance transformer, the distal end of which can be brought into contact with the tissue 3 to be fragmented either directly or by connecting a special applicator tip.

For laparoscopic applications, electro acoustic transducer and the impedance transformer and / or between impedance transformer and applicator tip in known way so-called Cuschieri extension pieces be switched, which the ultrasound to the distal end of the Guide instruments. A necessary protective tube for Surrounding the ultrasound transmission part can simultaneously for removing or supplying rinsing liquid or the like be used.

The applicator for supplying high frequency current serves as Electrode for cutting and / or coagulating or can for example as a hook electrode for blunt dissection, Cutting and / or coagulating can be formed. By doing  Trap where high frequency applicators and a Argon plasma coagulation probe are provided, is conveniently on proximal end of the instrument a connector (not shown) provided, with the help of which each required media, such as high-frequency current, Argon and / or a laser can be connected. As well are an operating handle and connections at the proximal end arranged for suction and rinsing.

In another embodiment, some of the Applicators with removable heads designed to work on the Coordinated instruments for each type of operation To have available.

In one embodiment, the instrument can be designed in this way be that the ultrasound applicator is completely removable.

In the example shown, the HF current applicator 12 is designed as a monopolar, spherical coagulation electrode. The coagulation electrode can be moved a corresponding distance from the tissue surface 3 by axial displacement by actuating a corresponding actuator. A corresponding movement of the ultrasound applicator 14 and of the high-frequency applicator 12 enables alternating ultrasound and high-frequency treatment.

The argon plasma coagulation probe or the corresponding applicator 13 can also be axially displaced in order to set the corresponding effective distance from the tissue 3 to be treated. In this way, ultrasound dissections and argon plasma coagulation can be used alternately.

In another embodiment of the invention just some of the actuators electromagnetic, electromotive, moved pneumatically or hydraulically, whereas others by mechanical guidance via a corresponding grip element  are longitudinally displaceable. The surgeon can do this Enclose the instrument on the handle and move one on the handle provided sliding element manually and sensitive fine movements of the applicator concerned To run. If necessary, a combination of Longitudinal displacement or movement of the respective applicator by an appropriate actuator with a manual movement immediately possible by the surgeon.

One embodiment assumes that the individual applicators are automatically advanced or retracted in such a way that when appropriate activation signals are triggered by high-frequency devices, lasers or ultrasound devices connected to the instrument, the respective applicator moves toward the tissue to be treated. For example, an activation signal "cutting with high frequency current" can control the associated actuator so that a corresponding electrode, for. B. that of the HF applicator 12 is advanced into a working position.

In another embodiment, the multifunction works nale surgical instrument with a speech recognition module together which through certain verbal commands converts the operator into control signals so that the operator only by appropriate articulation is able to activate certain actuators in order to activate a corresponding one to bring the assigned applicator into its working position.

In those shown in the figure and above The exemplary embodiments described is an adjustability of the individual applicators by a shift in Longitudinal direction, possibly in combination with a Rotational movement provided.

In certain cases, however, it is an advantage that Applicators to be provided in a turret unit around their Longitudinal axis is rotatably arranged on the instrument.  

This makes it possible to assign several applicators to one actuator, the respective applicator being able to be operatively connected to the actuator by a corresponding rotation of the turret unit. On the other hand, it is possible if, for example, three applicators are provided and if the distal end of the ultrasound applicator 14 is initially in the working position, then automatically bring the distal end of a further applicator into the same working position by either pulling the first applicator back or remains in its position and then, by rotating the turret unit, the second or third applicator is brought into a suitable working position after a suitable advance by actuating the associated actuator in order to achieve a predetermined distance from the tissue. In this case, the instrument itself does not have to be moved.

The control process can basically be done by one logic circuit using a microprocessor be made, which with appropriate Switching devices or the described voice control cooperates so that a predetermined program flow automatic settings for the intended functions possible are. This will handle the multifunctional instrument further simplified, so that the surgeon confines himself to his work can and not with hiring and monitoring one Variety of parameters is concerned.

All in all, the invention enables multifunctional surgical instrument the application of a Variety of operational methods and techniques, in particular under indirect conditions or as a component or in Connection with an endoscope makes performing this more difficult Operations without the need to switch from Instruments. The fact that sensors to control the  Functional status and the current position of the position of the Applicators are provided, is the Use of the instrument further simplified, the The surgeon is able to use an advantageous voice input is fully relocated to the operation actual operation and handling of the Focus instrumentes.

In the proposed instrument, for example Applicators for ultrasound surgery with applicators for high-frequency surgery, for example for cutting and / or coagulate, an applicator for laser surgery and suction and flushing devices in connection with Monitoring sensors are arranged at the distal end that both ultrasound applications as well as radio frequency treatments or laser surgery steps without time-consuming and stressful instrument changes can. Activating and moving the special Applicators to the tissue to be treated are carried out by corresponding actuators largely automatically and under Adherence to given parameters, which correspond to the selected type of operation automatically are adjustable.

Reference list

1 housing
1.1 end section
2 actuator
3 tissues
4 optical sensor
10 suction opening
11 rinse opening
12 high frequency applicator
13 Argon plasma applicator
14 ultrasound applicator
15 curved section
16 probe
17 section
18 opening
19 channel

Claims (9)

1. Multifunctional surgical instrument with the following features:

• - Several arranged in an elongated, rod-shaped or tubular housing, individually controllable and activatable applicators, the applicators or parts thereof being movable by an associated actuator in a predetermined position towards the distal end of the instru ment or rotatable about the longitudinal axis are such that one or more applicators at the same time or in a predetermined sequence one after the other to act or interact with the object to be treated, e.g. B. brought a tissue, and
• - Means for automatically actuating the actuators when the applicator (s) are supplied with an activation signal.

2. Instrument according to claim 1, marked by Sensors for checking the functional status and the current position or position of the applicators and the Observation of the object area to be treated. 3. Instrument according to claim 1 or 2, characterized, that several of the applicators in one turret unit are arranged, which are rotatable about their longitudinal axis in or is arranged on the housing. 4. Instrument according to claim 1, 2 or 3, characterized, that the housing is part of an endoscopic device tung is. 5. Instrument according to one of the preceding claims, characterized,  that the applicators are means for ultrasonic dissection, for argon plasma coagulation, for suction and rinsing, for High frequency current application, laser application and / or mechanical separation, cutting and holding around grasp. 6. Instrument according to one of the preceding claims, characterized, that the applicators are interchangeably arranged in the housing are. 7. Instrument according to one of the preceding claims, characterized, that the actuators are piezoelectric, electromagnetic, pneumatic and / or hydraulic means for generating of movements that are transferred to the applicators are, are. 8. Instrument according to one of the preceding claims, characterized, that at least one applicator in the distal area End of the instrument at an angle other than is aligned with the longitudinal axis of the housing or in such a position can be moved. 9. Instrument according to one of the preceding claims, characterized, that the means for controlling the actuators is a language include identification module.