WO1992020292A1

WO1992020292A1 - Surgical appliance

Info

Publication number: WO1992020292A1
Application number: PCT/EP1992/001099
Authority: WO
Inventors: Harald Heidmüller
Original assignee: Heidmueller Harald
Priority date: 1991-05-24
Filing date: 1992-05-19
Publication date: 1992-11-26
Also published as: DE4116970A1; EP0540721A1

Abstract

A surgical appliance has a handle (1) and at least two instrument inserts (19, 20) that can be independently moved forward on the handle (1). The instrument inserts (19, 20) are axially adjustable by means of radially projecting slides (21; 45). The front ends of the instrument inserts (19, 20) carry functional parts (29, 30) that cooperate with each other and that form together a cutting device.

Description

Surgical device

The invention relates to a surgical device with a handle and an instrument arrangement, which is mounted to move a front functional part out of the handle and can be actuated by means of an external handle.

Electrosurgical devices (US 3,494,364) are used in microsurgery. In this case, an instrument insert that can be moved in a tube is supplied with high-frequency voltage and an electrical arc is generated directly between the instrument insert designed as an electrode and the tissue to be cut or removed. The predominant parts of the instrument insert are provided with insulation. Burning of the cutting electrode is prevented by using non-oxidizing material. DE 34 12 756 C2 discloses a device in the form of an arthroscopy knife, which is used in particular for removing minisks in arthroscopic surgery. Devices of the type mentioned are also used in laparoscopic surgery, where the movement possibilities of the instruments are limited by the guidance in a trocar.

A device according to the preamble of claim 1 is described in US 4,418,692. The instrument arrangement comprises a gripping member with two pliers electrodes which can either be retracted or extended into a tube simultaneously by means of a pressure member protruding axially from a grip part, or only one of which can be displaced longitudinally.

Proceeding from this, it is the object of the invention to create a device which can be easily adapted to a wide variety of applications and is easy to handle.

This object is achieved in that the instrument arrangement consists of at least two independently displaceable parallel instrument inserts, each of which is provided with a radially projecting pin which is guided in an associated longitudinal slot of the handle piece and since the longitudinal slots on one Are closed at the end by a detachable head piece of the handle.

This makes it possible to insert the device into a trocar, but the actuation when the working hand is resting on the grip piece is carried out exclusively by means of a sliding movement of the thumb or the index finger. compared to the handle. It is understood that the movements to be carried out can be controlled much better in this way. The functional parts of the axially displaceable instrument inserts can be an electrosurgical knife or any other elements that can be pulled out of the handle and exchanged after the head piece has been removed. Without changing the surgical device, which could result in loss of time and malfunctions, at least two instrument inserts with different or the same functional parts are optionally available, for example a pure manipulation instrument, such as a hook or button, and an electrosurgical instrument, such as a cutting knife . In order that faults caused by the unnecessary use of instruments are avoided, it is expedient to provide a snap-in arrangement in a rear rest position for each use of the instrument. In a further preferred embodiment, it is expedient to provide a locking device which locks the second instrument insert in the aforementioned rest position when an instrument insert is moved into an advanced working position.

The instrument inserts can each be multi-unit, for example designed as so-called pipe scissors with two tubes or rods guided into one another, in the mutual displacement of which a pair of scissors, pliers or clip applicators are actuated. In such an embodiment, it makes sense to provide a locking arrangement which only allows the multi-unit instrument insert to be actuated in an extremely advanced working position. Since the instrument inserts are extremely miniaturized and sensitive to damage, it makes sense and is beaten in each case to insert a protective and guide tube in the front handle, which protects the instrument inserts in the area of the trocar from damage and which guides them cleanly in the trocar tube. To improve the cleaning options, such a protective and guide tube can be detachably arranged in the handle. The longitudinal guidance of the axially displaceable instrument inserts within the handle is preferably carried out by means of guide rods and sleeves which are telescopically connected to the other part of the handle or the instrument insert. These can be electrically conductive and can be provided with an electrical feedthrough and plug connection on the releasable rear end piece of the handle piece. The end piece can be replaced by a end piece which is designed as a pipe socket with channels.

Embodiments of the invention are shown in the drawings.

Show here:

1 shows a first embodiment of the instrument with two instrument inserts in top view,

1A is a longitudinal section through the instrument of FIG. 1,

2 shows a second embodiment of the instrument with a coagulation ball and a hook-shaped knife on two instrument inserts in longitudinal section,

2A shows a cross section through the instrument of FIG. 2, 3 shows a third embodiment of the instrument with a button and a hook-shaped knife on two instrument inserts in longitudinal section,

3A shows a cross section through the instrument of FIG. 3,

4 shows a fourth embodiment of the instrument in partial top view,

4A shows a longitudinal section through the complete instrument of FIG. 4,

4B shows a cross section through the instrument according to FIGS. 4.4A,

5 shows a fifth embodiment of the instrument with three instrument inserts in a partial top view,

5A shows a longitudinal section through the instrument of FIG. 5,

6 shows a sixth embodiment of the instrument with two instrument inserts in a partial top view,

6A shows a longitudinal section through the instrument of FIG. 6,

7 shows a seventh embodiment of the instrument with two instrument inserts in longitudinal section, FIGS. 8th,

8A partial longitudinal section and cross section through the

Protective tube to illustrate the guidance of two instrument inserts,

Fig. 9,

9A shows a modified guide arrangement in partial longitudinal section and in cross section and

Fig.

10A-10F views, cross sections and longitudinal sections of different functional parts of the instrument inserts.

1.1A shows a device which consists of a multi-part, octagonal cross-section handle 1, a protective tube 2 and two instrument inserts 19, 20 and a screwed-on end piece 4 in the form of a plug connector 8. The protective tube 2 is inserted with a base piece 14 into an inner recess 15 in a detachable head piece 17 of the handle piece 1 and secured therein by means of a radial grub screw 16.

The two instrument inserts 19, 20 are held axially displaceably in the handle 1, a radially movable and spring-supported adjustment pin 21 with a slide button 22 on the instrument insert 19 and a fixed adjustment pin 45 with a slide button 46 on the instrument insert 20 being provided are each guided in longitudinal slots 23, 24 of the handle piece 1. At the pin 21, which is supported by a spring 25, there are articulated connecting means 26 for the instrument insert 19 and articulated connecting means 27 arranged for instrument insert 20. When the pin 21 springs out in the position shown on the right, cutting edges 29, 30 at the front ends of the instrument inserts 19, 20 move axially apart. When the pin 21 is pressed in against the spring force, the cutting edges 29, 30 move into the closed position. Through an annular groove 31 in the pin 21 and in this engaging guide edges 32 of the longitudinal slot 23, a deflection and deflection of the pin 21 is only possible in the position shown in dashed lines. An extension 33 is provided in the front area of the longitudinal slot 23 for this purpose. Operating the cutting edges 29, 30 is therefore only possible in the advanced working position.

The instrument inserts 19, 20 can also be guided in one another in such a way that their relative displacement to one another is possible completely independently of one another. In the embodiment shown, this is not possible due to the connecting means 26, 27 between the instrument inserts 20.

In Figure 2.2A, the same details are denoted by the same numerals as in the previous figures. Deviating from this, the upper instrument insert 35 has a coagulation ball 37 and the lower instrument insert 36 has a knife-like hook 38 at the front end. The shaft 39 of the instrument insert 35 is sleeve-shaped at least in the rear region and is guided on a rod 40. Accordingly, the shaft 41 of the instrument insert 36 can be displaced as a sleeve on a rod 42. Both shafts 39, 41 are electrically conductively connected to the plug contact 8. A radial actuation is provided on the shaft 39 for axial displacement. supply pin 43 attached, which protrudes from the longitudinal slot 23 and has a slide button 44. The shaft 41 is displaceable via an actuating pin 45, which protrudes from the longitudinal slot 24 with a push button 46. In the section shown on the left in FIG. 2A it can be seen that the shafts are each sleeve-shaped.

FIG. 3.3A shows a device which largely corresponds to the illustration in FIG. 2, the same details being denoted by the same numbers. However, one of the instrument inserts 35 is designed here as a simple button 47 rounded in the front, in particular made of non-conductive material.

FIGS. 4,4A, 4B show a device which essentially corresponds to those according to FIGS. 2 and 3, the same details being designated with the same reference numerals. Deviating from this, one of the instrument inserts 35 is designed in several parts and has two jaws 49, 50 which are movable relative to one another and which can be pivoted relative to one another about an axis of rotation 51 at the front end. The actuation takes place in the manner of a tube shear known per se, in which two rod or sleeve parts lying one inside the other are axially displaced relative to one another. This is done by a radially movable pin 52, which has a slide button 53 and is supported by a compression spring 54. Connecting means 55, 56 (handlebars) are fastened to the pin 52. The link 55 is connected to the inner sleeve through a slot in the outer sleeve and the link 56 is connected to the outer sleeve. The pin 52 has an annular groove 57. A guide edge 32 is provided in the longitudinal slot 23, while an extension is provided at the front end of the longitudinal slot 33 through which the pin 52 fits. In the working position advanced up to this extension 33, the pin 52 is radially freely movable, so that the pliers or scissors can be actuated by springing out and pressing in the pin 52. Instead of the illustrated pipe shears, it is also possible, in the case of pliers, to provide two jaws that expand under the elastic inner tension when being pushed out of the outer sleeve on the inner sleeve, which are integrally connected to one another and become retracted when the inner sleeve is pulled into the Forcibly close the outer sleeve. The relative axial displacement can take place in the same way as in the figure shown here. The hollow shafts of the instrument inserts are axially guided on rods 40, 42.

FIG. 5.5A shows a device which essentially corresponds to that according to FIG. 2, parts which correspond to one another being assigned the same numbers. In addition, a further instrument insert 58 with a front oblique cutting edge 59 is provided, which can be axially displaced via a further pin, not shown in detail, with a sliding button 60, the pin, which cannot be recognized, being guided in a longitudinal groove 61.

FIG. 6,6A shows a device which essentially corresponds to that in FIG. 5, but the details are in some cases not completely carried out. It comprises two instrument inserts 35, 36, the former of which is made up of multiple members with two jaws 49, 50 that can be pivoted about an axis of rotation 51, and the second comprises a hook knife 38. In the area of the head piece 14 of the protective tube 2, a radial bore 74 is provided, into which a locking pin 75 is inserted. Its length is such that it only projects into one of the bores for the shafts of the instrument inserts 35, 36 in the protective tube. In the extremely retracted position, the shafts have inner recesses 76, 77 directed toward the locking pin 75. When one of the instrument inserts 35 or 36 is pushed forward, the contour of these inner recesses pushes the locking pin 75 into the opposite inner recess 77, 76, so that the other instrument insert is locked in a form-fitting manner. Only in the extremely retracted position of this first instrument insert 35 is it then possible to advance the other instrument insert 36. The locking pin 75 can be held in a central position by means of springs (not shown) when the instrument inserts are withdrawn.

The locking of the instrument insert in use in the foremost position takes place, as already described, by the protrusion of the pin 52 with the slide button 53 in the region of a front extension 33 of the guide edges 32 in the longitudinal slot 23. Accordingly, an opposite one is Pin 78 supported by a push button 79 by a compression spring 80 and has an annular groove 81 which is guided on a guide edge 82. In the foremost position, the guide edges 82 also merge into an extension 83, which is opposite the extension 33 and has the same effect. This leads to the instrument insert 36 being locked in this foremost position, which can only be lifted by first pushing the pin 78 down again with the sliding button 79 before it is returned in the longitudinal slot 23. A further locking device is shown in FIG. 7. Two arch springs 100, 101 directed against one another engage in depressions 102, 103 when one of the instrument inserts 35, 36 is advanced.

In FIG. 8.8A it can be seen that two shafts 62, 63 of two parallel instrument inserts, which are located within a protective tube 2, are guided relative to one another via a sleeve 64 which is drilled twice, this sleeve preferably at the rear end opposite the octagonal handle 1 or the protective and guide tube 2 is fixed axially.

It can be seen in FIG. 9.9A that two shafts 66, 67 of two instrument inserts can be supported against one another via a composite guide bridge 65. Two such bridges arranged symmetrically to one another, which can lie axially one behind the other, form a support against loads from both lateral directions. The bridges can in turn be fixed axially in the protective tube 2, not shown here.

In FIG. 10A-F two hook-shaped knives 68, 69 with angled rearward-facing cutting edge are shown in side view and in cross section, furthermore two knives 70, 71 with a differently curved cutting edge on the side, and ultimately two further knives 72, 73 with in each case the front-side cutting edge, which in any case, when used on electrosurgical instrument inserts, is metallically bare only in the area of the cutting edges and is otherwise not conductively insulated.

Claims

PATENT CLAIMS

1. Surgical device with a handle (1) and an instrument arrangement, which is mounted for moving a front functional part out of the handle (1) in this longitudinally displaceable and actuatable by means of an outer handle (22), characterized in that the instrument arrangement consists of at least two independently there are mutually longitudinally displaceable parallel instrument inserts (19, .20; 35.36; 58), each of which is provided with a radially projecting pin (21, 45; 43; 52; 78) which is located in an associated longitudinal slot (23, 24 ) of the handle (1), and that the longitudinal slots (23, 24) are closed at one end by a detachable head piece (17) of the handle (1).

2. Apparatus according to claim 1, characterized in that the displaceable instrument inserts (19, 20) are guided into one another by means of sliding guides.

3. Apparatus according to claim 1 or 2, characterized gekennzeich¬ net that at least one instrument insert (35) is in several parts and includes two axially limited movable rod and sleeve parts um¬, at the front end functional parts in the form of pliers jaws or scissor blades (49.50) are arranged.

4. Device according to one of claims 1-3, characterized ge indicates that the pin (21; 52) axially movable is borrowed and spring-loaded and cooperates with edge profiles (32, 33) of the longitudinal slot (23) such that actuation of the functional parts of a multi-part instrument insert (35) or of instrument inserts (19, 20) with interacting functional parts (29, 30 ) is only possible in the working position advanced from the handle (1).

5. Device according to one of claims 1-4, characterized ge indicates that the relative movement of the instrument inserts (35, 36) is alternately blocked by a locking device (75, 76).

6. Device according to one of claims 1-5, characterized ge indicates that the head piece (17) of the handle piece (1) has a coaxial inner recess (15) in which a protective and guide tube (2) for the instrument inserts (19, 20; 35, 36) are inserted in a detachable connection.

7. Device according to one of claims 1-6, characterized gekenn¬ characterized in that for the releasable attachment of the protective and guide tube (2) on the handle (1) a radial stud (16) in the head piece (17) is seen vor¬.

8. Device according to one of claims 1-6, characterized ge indicates that threads are provided for the releasable connection of the protective and ^' guide tube (2) on the head piece (17).

9. Device according to one of claims 1-6, characterized ge indicates that a bayonet lock is provided for the releasable connection of the protective and guide tube (2) on the head piece (17).

10. Device according to one of claims 1-9, characterized ge indicates that at least one instrument insert (36) is formed at the front end as a hook (38).

11. Device according to one of claims 1-9, characterized ge indicates that at least one Instrumenten¬ insert (36) is designed as - in particular electro-surgical - knife (30; 38) »

12. Device according to one of claims 1-9, characterized ge indicates that at least two of the Instrumen¬ ten inserts (19, 20) at the front end. are designed as a knife-counter knife arrangement (29, 30).

13. Device according to one of claims 1-9, characterized ge indicates that at least one Instrumenten¬ insert (35) is formed at the front end as an electro-surgical coagulation ball (37).

14. Device according to one of claims 1-3, characterized ge indicates that at the rear end of the handle piece (1) a closure piece (4) is releasably attached, the guide rods (40,42) for sleeve-like shafts (39,41 ) carries the instrument inserts (35, 36) and is designed as an electrical connector that is conductively connected to at least one of the shafts (39, 41).

15. Device according to one of claims 1-13, characterized ge indicates that at the rear end of the handle (1) a terminal piece is releasably attached, which is seen as a pipe socket with channels for the passage of elongated objects and / or fluids .

16. Device according to one of claims 1-15, characterized ge indicates that the handle (1) is polygonal in cross section, preferably octagonal, and that open radial slots on the outside are the guides for the instrument inserts (19, 20 ; 35,36) form.