WO2009071070A2

WO2009071070A2 - Surgical clamp instrument

Info

Publication number: WO2009071070A2
Application number: PCT/DE2008/002018
Authority: WO
Inventors: Werner Boxbücher
Original assignee: Stapleline Medizintechnik Gmbh
Priority date: 2007-12-07
Filing date: 2008-12-05
Publication date: 2009-06-11
Also published as: DE102007059064A1; WO2009071070A3; DE112008003698A5

Abstract

The invention relates to a surgical instrument (1) used to attach surgical fastening means (2) to tissue. Said instrument has a proximal part (3) comprising a housing (5) and an assembly (6) on the distal part (4), and an anvil (8), comprising a fixed anvil part (9) and an anvil part (10) movable against said fixed anvil part in order to press the fastening means (10) into the tissue and/or for forming the fastening means (2) in the tissue; said instrument further has a pneumatic and/or hydraulic control of the assembly (6).

Description

DESCRIPTION

Surgical stapler

The invention relates to a surgical instrument for attaching surgical fasteners to tissue, comprising a housing having a proximal part and an assembly on the distal part, with a shaft, an anvil formed from a fixed anvil part and an anvil movable against this anvil for pressing the fastener in the tissue and / or for forming the attachment means in the tissue.

Such medical devices are used in particular in laparoscopic or endoscopic surgery for performing surgical procedures. They serve as a staple as well as a cutting instrument. Thus, in some surgical procedures, the tissue is clamped by clamping fasteners in and possibly through the tissue. This happens in the interaction of a movable and a fixed anvil part at the distal end of the surgical instrument. In between there are contact surfaces between which the tissue can be pinched or grasped. They are movable relative to each other by the movable part of the anvil is pivotally mounted. The pivoting mechanism is triggered by manual operation in the area of the housing, so that the tissue placed between the two anvil parts is clamped or grasped. Subsequently, the staples can be injected from a magazine into the clamped tissue, whereby they deform on the fixed anvil part. The described control functions are accomplished mechanically in common surgical instruments. Previously known such surgical instruments can in the field of Laparoscopy are used only conditionally, which is not least due to the lack of compactness and maneuverability.

The object of the present invention is thus to provide a particularly compact surgical instrument for minimally invasive surgery, wherein vascular occlusion and separation are possible in one work step.

This object is achieved by a pneumatic and / or hydraulic control of the assembly.

Hereby, a particularly compact and agile way of controlling the assembly is created by the corresponding forces are transmitted pneumatically and / or hydraulically and replace the hitherto customary, to be regarded as particularly sensitive mechanics. Instead, it is through the

Trigger mechanism of the surgical instrument a pneumatically and / or hydraulically operated, very precise and trouble-free control set in motion.

For transmitting the pressure forces from a corresponding pressure accumulator at least one displaceably mounted in the housing, pressurized cylinder is provided. Forward and backward movement of this cylinder, as will be explained later, controls the movements on the distal part of the surgical instrument.

In order to ensure a particularly good transmission of these forces, it is provided that two cylinders are mounted in the housing, which are arranged coupled to each other with respect to a displacement between a front and a rear position. The two cylinders are coordinated so that the one cylinder is moved when extending the other in its rear position. In this way it is thus ensured that the pressurized and thus reached in its front position Cylinder returns by the coupling with the adjacent cylinder in the rear position, without the need for a separate unit would be provided.

Within the actual outer housing, an inner housing is additionally provided. In this regard, it is proposed that the cylinders are arranged in an inner housing displaceably mounted in the housing. A displacement of the inner housing in its rear position is in view of a mechanism to be described later in connection with the fixed and movable anvil member and the adjustment of a slidable on both Anvil parts sliding sleeve advantage.

The coupling of the two cylinders can be achieved in an advantageous manner by each cylinder is associated with a rack, wherein the teeth of both racks are arranged facing each other. Between the two racks facing each other there is a control shaft, which ensures that a movement of the one cylinder forward always means a backward movement of the other.

Specifically, this means that between the racks, a control shaft carrying a gear for controlling the movement of the movable anvil member against the fixed anvil member is arranged. If a cylinder together with a rack moves into its forward position as a result of the application of pressure, the control shaft is quasi taken along, so that an adjustment of a sliding sleeve mounted displaceably on the anvil parts takes place on the distal part of the surgical instrument. The control shaft is thus taken from the respective cylinder; their forward and backward movement ultimately leads to the adjustment of the sliding sleeve at the distal end. The displacement of the inner housing causes the movable anvil member pivots, and presses against the fixed anvil member. The forward and backward movement of the cylinder only causes the Klammersetz- and cutting function. A kind of emergency release provides that the control shaft is designed to be operable from the outside of the housing. Removing a safety cap, the anvil can be opened by turning on a provided on the control shaft return wheel. Thus, a mechanical bridging of the pneumatic and / or hydraulic drive is provided in the event that the pneumatic system should fail, because about a pressure loss has occurred. The medical device can be removed after the appropriate provision at least from the surgical field in a comparatively simple and particularly secure manner.

The function of the sliding sleeve has already been addressed. This is arranged jointly displaceable on the fixed anvil part and the movable anvil part. The sliding sleeve may comprise the fixed and the movable anvil part in a clamp-like manner, so that the kinematic relationship is established. If the sliding sleeve is moved in the distal direction, both anvil parts must lie within the sliding sleeve, they are encompassed by the latter. This interaction is used to close the anvil and absorb the necessary deformation forces for the brackets.

The invention further provides that the sliding sleeve between a

Basic position and an intermediate position on the housing facing the end of the anvil is adjustable. Only from the latter position, the sliding sleeve can be moved beyond the anvil in the direction of the distal end. In a first movement step of the sliding sleeve in the distal direction of the anvil is closed. This corresponds to a method of the sliding sleeve from the basic to the intermediate position. This allows on the one hand the insertion into the trocar and thus the achievement of the surgical field and on the other hand - after temporary opening - the pinching of the vessel to be separated. In order to open the anvil again, the sliding sleeve must be pulled back so that the spring force opens the anvil again. The already described displacement of the inner housing in the actual housing in its front position corresponds to the adjustment of the sliding sleeve from her Basic to its intermediate position. This means that a displacement of the sliding sleeve on the anvil in the direction of the distal end is possible only on condition that the inner housing is in the rear position.

Another function of the sliding sleeve provides that it serves as an abutment for introducing the fastening means. The necessary deformation forces when inserting the brackets are intercepted in this way.

A particularly advantageous embodiment of the invention is that in which a cable guide is used to transmit the forces between the cylinders and the anvil and / or the sliding sleeve. The pressure medium causes the adjustment of a cylinder in its forward position, whereby it is then moved by the racks or the control shaft also in the direction of the distal end. In this way, the forces are transferred (via the sliding sleeve) to the anvil. This is done by a rope in out and return in the form of a cable or belt drive, which controls the forward and backward movement of the sliding sleeve in a simple and secure manner depending on the adjustment of the cylinder. Such a cable guide is conceivable without the described pneumatic or hydraulic control.

With the present invention, an articulation of the distal end of the surgical instrument can be achieved in a manner not previously known. This can now be pivoted in both directions by up to 90 °. For this purpose, it is provided that an adjusting shaft for adjusting the pivot angle of the anvil is arranged in the housing. Such a cable guide is conceivable without the described pneumatic or hydraulic control.

Also in this regard, it is again proposed that a cable guide is used to transmit the forces between the adjusting shaft and a distal joint. The stapling and cutting function can be independent of the Pivoting position to be executed. The rotation takes place without translation, so z. B. a rotation of 30 ° on a rotary knob provided on the housing also has a rotation of 30 ° at the distal joint result. In turn, a detent is mounted in the knob, which fixes the set position.

As already stated, the anvil is pivotable about the distal joint in at least one direction by 45 ° to 90 °. This is compared to known from the prior art devices, almost a double swing angle of about 90 ° feasible, which greatly simplifies the handling of the device according to the invention. Due to the functional separation of this pivoting movement and the stapling or cutting mechanism latter is independent of the angular position feasible.

With regard to the pivotability is thought that serves as a distal hinge a rotating strand with a round basic shape, which has at least one groove for guiding the belt, which extends approximately over a semicircle. Thus, a form of joint is realized in which the cable guide is exactly in the axis of rotation.

The leadership of the rope is achieved by extending in the rotation center perpendicular to the groove a bore through which the rope is guided.

Another advantage of the invention is that the handle of the surgical instrument is equipped with a handle in the release position of the handle is pivotally mounted to the housing. The free pivoting of the handle leads to a much better handling of the surgical instrument. When handling in the release position, the handle can be infinitely swung around the housing back and forth. This is achieved by the housing aulweist on its outside a plurality of teeth, to which the handle is designed to correspond. If you open the handle in the release position, the handle is pivoted out of the teeth and is freely rotatable. At the same time, the gears completely surround the housing so that the handle can be fixed at any point by fixing the handle in a suitable position, eg by releasing the handle.

In addition to the actual gripping surface is thereby thought that the handle has a leg, whose side facing the housing is formed corresponding to the teeth. When the handle is pulled in the release position, this leg releases the teeth, so that the handle can be rotated arbitrarily and endlessly.

Finally, a further embodiment of the invention provides that the surgical instrument has a pressure accumulator for a gaseous and / or liquid medium. It is intended in particular to carbon dioxide, which is held in a pressure accumulator provided at the proximal end of the housing. Under certain circumstances, it may be necessary to rearrange the accumulator nor a pressure reducer.

The invention is characterized in particular by the fact that a surgical stapling instrument which is particularly well and safely handled in several respects is provided. This is initially characterized by an infinitely mounted handle, so that the device remains easy to operate at any time, by ultimately the handle of each positioning of the instrument for left and right handed people can be adjusted. This is accompanied by an up to 90 ° in both directions feasible pivoting of the anvil to a distal joint. Responsible for this is in particular a cable guide between the distal joint and an adjusting shaft associated with the housing. Again, regardless of this, another cable guide, via which the control of the movable and fixed anvil part takes place. This will be two in one Inner cylinder mounted cylinder in an interaction between a front and a rear position adjusted, which affects thanks to the cable guide on the two anvil parts or a comprehensive, movably mounted sliding sleeve.

Further details and advantages of the invention will become apparent from the following description of the accompanying drawings in which preferred, partially greatly simplified embodiments with the necessary details, and individual parts are shown. Show it:

Figure 1 is a surgical instrument in perspective

View,

FIG. 2 shows a section through the complete housing,

3 shows a partial section through the housing, FIG. 4 shows another partial section through the housing,

FIG. 5 shows the anvil,

FIG. 6 shows the sliding sleeve with anvil open,

FIG. 7 shows the sliding sleeve with closed anvil,

8 shows the anvil with sliding sleeve, FIG. 9 shows a sliding sleeve,

FIG. 10 shows the proximal part of the housing with handle, FIG. 11 shows a turret and FIG. 12 shows a positive guide.

FIG. 1 shows a surgical instrument 1 for attaching surgical fastening means 2 to tissue. The latter are associated with the fixed part 9 of the anvil 8, against which the movable anvil part 10 is moved for pressing the fastening means 2 into the tissue and / or for forming the fastening means 2 in the tissue. The shaft 7 and the anvil 8 are hinged together in the region of the distal joint 23. The components described together form the assembly 6 on the distal part 4 of the surgical instrument 1. At the proximal part 3 of the surgical Instrument 1 is the housing 5 with the adjustment, including the rotary knob provided with the reference numeral 38 and the two rotary rings 40 and 41. The reference numeral 34, the accumulator for providing a liquid and / or a gaseous medium is called. The reference numeral 28 carries the handle with the handle 29, by means of which

Adjustment of the handle 28 is mounted at any 360 ° about the housing 5 pivotally.

A section through the housing 5 is shown in FIG. To recognize the accumulator 34 with the downstream pressure reducer 35. As a result, pressure medium z. B. in the form of carbon dioxide on the cylinder, of which only one is shown and provided with the reference numeral 12, exercised. This results in a displacement of the cylinder 12 forward, which in turn is coupled to the cylinder, not shown here, arranged adjacent thereto. This coupling is accomplished via the rack 15 and the control shaft 17 together with the gear 16. About this control shaft 17 and the knob 39 on the outer side 18 of the housing 5 of the Klammersetzmechanismus is controlled. Serves for this purpose, a cable guide, not shown in this illustration, for exerting the forces on the anvil, also not shown here, which is located at the distal end of the shaft 7. Said units are located in a displaceably mounted in the actual housing 5 inner housing 14, which must be in its rear position, in order to ensure that actually the corresponding forces can be applied and exerted on the anvil. The reference numeral 22 denotes the adjusting shaft, via which the anvil can be pivoted by up to 90 ° in both directions.

The addressed cable guide is now in particular the subject of Figure 3. On the one hand, a cable guide 21 between the control shaft 17 and the sliding sleeve, not shown here is realized. On the other hand, another is

Cable guide 24 realized between the adjusting shaft 22 and the distal joint, also not shown. Well recognizable here is that the cylinder 12 positively connected at its front end 42 to the inner housing 5, so that it is ensured that the corresponding pressure forces can also be exercised here.

In the illustration according to FIG. 4, value is now primarily on the two

Cylinders 12 and 13 and their interaction laid. If pressure is exerted on one of the two cylinders 12, 13, these are coupled to one another, thanks to the rack 15 and / or the control shaft 17, so that a forward movement of a cylinder always effects a movement of the adjacent cylinder backwards. A separate return mechanism is therefore unnecessary. For this purpose, both cylinders 12, 13 are equipped with a rack, of which only one is shown here and provided with the reference numeral 15, while the other, here the cylinder 13 associated rack is positioned so that the teeth 43 are opposite to each other and the trajectory for the control shaft 17 and the gear 16 is thus predetermined.

The anvil is shown in FIG. This consists of a fixed anvil part 9, which is equipped here with the attachment means 2 and a movable against this movable anvil part 10. The control of this function takes over the sliding sleeve 19, which is movable over the anvil 8, provided that the movable anvil part 10 is in the pivoted position, as it is then shown in the figure 7. Between shaft 7 and anvil 8, the joint 23 is positioned, which allows pivoting of the anvil 8 about the distal joint 23 by up to 90 ° in both directions.

The mentioned mechanisms are also shown once again in FIGS. 6 and 7. In Figure 6, the movable anvil member 10 is in the pivoted position, the sliding sleeve 19 can not move in the direction of arrow 44. For this purpose, it is only necessary that the movable anvil member 10 is pivoted in, as shown in Figure 7. Now, the sliding sleeve 19 in the direction of arrow 44 on the anvil 6 by pressing the fasteners into the tissue and / or for forming the fasteners 2 in the tissue move. The prerequisite for this is always that the sliding sleeve 19 is moved from the basic position shown in Figure 6 in the intermediate position shown in Figure 7 on the housing 5 facing the end 20 of the anvil 8.

In Figure 8, the sliding sleeve 19 is now completely at the distal end 46 of the anvil 8, after it has been moved over this.

Explicitly, the sliding sleeve 19 is shown again in FIG. The sliding sleeve 19 also serves as an abutment during penetration of the fastening means 2 by being comparable to a carriage via the anvil, more precisely the fixed and the movable anvil part movable. It has for this purpose a vertically arranged web 47, a trough-like substructure 48 and also serving as a guide track 49.

FIG. 10 shows in particular the handle 28 with the handle 29, in which

Actuation in the form of retraction, the latter can be pivoted about the pivot point 36. This results in that the leg 32 pivots as part of the handle 28 by the same angle and from the teeth 31 on the outer side 30 of the housing 5, which is shown here only hinted dissolves. Consequently, it is now possible to arbitrarily rotate the handle 28 shown here together with the handle 29 by 360 ° about the housing 5 and to fix it in the teeth 31 extending over the entire circumference of the housing 5.

The hinge 23 in the form of the turret 25 is shown in more detail in FIG. Grooves 26, 37 serve to guide the rope, not shown here, wherein perpendicular and here indicated by the reference numeral 27 only indicates a bore through which the cable can be performed without there being a change in length of the rope, especially as its kinking exactly located within the axis of rotation 52. Reference numeral 50 denotes a sleeve and a holder 51 to be accommodated in the housing in order to enable the function of this hinge 23 in the form of the turret 25. Finally, FIG. 12 also shows a positive guide 53, via which it is ensured that the sliding sleeve must always be in the intermediate position before pressure medium can be supplied to the cylinders via the pressure reservoir.

Claims

PATENT CLAIMS E

A surgical instrument (1) for attaching surgical fasteners (2) to tissue, comprising a proximal portion (3) having a housing (5) and an assembly (6) on the distal portion (4), comprising a shaft (7). , one of a fixed anvil member (9) and an anvil (8) formed against this movable anvil (8) for pressing the fastening means (2) into the tissue and / or for forming the fastening means (2) in the tissue, you name a pneumatic and / or hydraulic control of the assembly (6).

2. Surgical instrument according to claim 1, geken nzeich net d u rch at least one displaceably mounted in the housing (5), pressurized cylinder (12, 13).

A surgical instrument according to claim 2, further comprising two cylinders (12, 13) mounted in the housing (5) and coupled to each other with respect to displacement between front and rear positions.

4. Surgical instrument according to claim 3, characterized in that the cylinders (12, 13) are arranged in an inner housing (14) displaceably mounted in the housing (5).

5. Surgical instrument according to claim 3, characterized in that there is associated with each cylinder (12, 13) a toothed rack (15), wherein the toothings (43) of both toothed racks (15) are arranged facing each other ,

6. A surgical instrument according to claim 5, characterized in that between the racks (15) a control shaft (17) carrying a gear (16) for controlling the movement of the movable anvil member (10) against the fixed anvil member (15) 9) is arranged.

7. A surgical instrument according to claim 6, characterized in that the control shaft (17) is operable from the outside (18) of the housing (5).

8. Surgical instrument according to claim 1, geken nzeich net one on the fixed anvil part (9) and the movable anvil part (10) together slidably mounted sliding sleeve (19).

9. Surgical instrument according to claim 8, characterized in that the sliding sleeve (19) between a basic position and an intermediate position on the said housing (5) facing the end (20) of the anvil (8) is adjustable.

10. Surgical instrument according to claim 8, characterized in that the sliding sleeve (19) serves as an abutment during insertion of the fastening means (2).

11. Surgical instrument according to claim 1, dadu rc hge ke nn ze ze I net, that for the transmission of forces between the cylinders (12, 13) and the anvil (8) and / or the sliding sleeve (19) serves a cable guide (21) ,

12. Surgical instrument according to claim 1, dad urc h geken nzeichnet that in the housing (5) an adjusting shaft (22) for adjusting the pivot angle of the anvil (8) is arranged.

13. Surgical instrument according to claim 12, dad urch gekennzeich net that for transmitting the forces between the adjusting shaft (22) and a distal joint (23) serves a cable guide (24).

14. Surgical instrument according to claim 12, characterized in that the anvil (8) about the distal joint (23) in at least one direction is pivotally mounted at an angle between 45 ° and 90 °.

15. Surgical instrument according to claim 13, characterized in that the distal joint (23) is a turret (25) with a round basic shape, which has at least one groove (26) for guiding the rope (24), which extends approximately extends over a semicircle.

16. Surgical instrument according to claim 15, dad u rch geken nzeichnet that in the turret (25) perpendicular to the groove (26) extends a bore (27).

17. Surgical instrument according to claim 1, dad urch gekennzeich net, that the handle (28) of the surgical instrument (1) is equipped with a handle (29) in the release position of the handle (28) pivotally mounted to the housing (5) is.

18. Surgical instrument according to claim 17, characterized in that the housing (5) has on its outer side (30) a plurality of toothings (31) to which the handle (28) is designed to correspond.

19. Surgical instrument according to claim 18, characterized in that the handle (28) has a limb (32) whose side (33) facing the housing (5) corresponds to the toothings (31). is trained.

20. Surgical instrument according to claim 1, characterized in that the surgical instrument (1) has a pressure accumulator (34) for a gaseous and / or liquid medium.