WO2011042584A1 - Instrument for endoscopic surgery - Google Patents

Instrument for endoscopic surgery Download PDF

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Publication number
WO2011042584A1
WO2011042584A1 PCT/ES2010/070644 ES2010070644W WO2011042584A1 WO 2011042584 A1 WO2011042584 A1 WO 2011042584A1 ES 2010070644 W ES2010070644 W ES 2010070644W WO 2011042584 A1 WO2011042584 A1 WO 2011042584A1
Authority
WO
WIPO (PCT)
Prior art keywords
handle
drive
intermediate tube
distal tool
rod
Prior art date
Application number
PCT/ES2010/070644
Other languages
Spanish (es)
French (fr)
Inventor
Ramón SANCIBRIÁN HERRERA
José Carlos MANUEL PALAZUELOS
Original Assignee
Universidad De Cantabria
Fundación Marqués De Valdecilla
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Universidad De Cantabria, Fundación Marqués De Valdecilla filed Critical Universidad De Cantabria
Publication of WO2011042584A1 publication Critical patent/WO2011042584A1/en

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Classifications

    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • 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
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2933—Transmission of forces to jaw members camming or guiding means
    • A61B2017/2936—Pins in guiding slots
    • 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
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2939—Details of linkages or pivot points

Definitions

  • the present invention relates to an instrument for endoscopic surgery comprising a handle, a distal tool, a linking mechanism, and an articulation mechanism of the distal tool linked to the handle by means of the linking mechanism.
  • Laparoscopic or endoscopic surgery is a minimally invasive surgical technique where the patient is operated through small incisions. Laparoscopic or endoscopic surgery tools are introduced through these incisions allowing the surgeon to manipulate them from outside the patient using various surgical instruments such as: dissectors, scissors, retractors, etc.
  • US5702408 describes a tool articulation system based on a four-bar mechanism that is actuated from the handle to move the distal part of the tool. However, it is a completely different mechanism from the opening and closing of the distal tool that makes the surgical instrument remarkably complicated.
  • US5827323 discloses a tool articulation system based on two elongated pieces each of which is provided with a toothed area that meshes with respective gears belonging to the jaws of the distal tool.
  • the translation of the extension tube with respect to these elongated parts produces the articulation of the tool.
  • the need to allow translation of the extension tube complicates the system and also the work of the surgeon.
  • the link mechanism of the endoscopic surgical instrument comprises an extension tube that houses a drive rod and an intermediate tube disposed between the drive rod and the extension tube itself, and the articulation mechanism comprises a rocker, a short connecting rod and a long connecting rod, so that each of the drive rod and the two connecting rods is articulated to the rocker at a different point of the same, and each connecting rod is also articulated to the distal tool at a different point of the same, also connecting the connecting rod long to the intermediate tube by means of a cam link, whereby a translation of the intermediate tube relative to the drive rod causes the articulation of the distal tool about an axis perpendicular to the longitudinal axis of the extension tube.
  • the long connecting rod comprises a cam groove and the intermediate tube comprises a pivot oriented perpendicularly to the extension tube that acts as a probe of said cam.
  • the distal tool comprises two jaws, the short connecting rod being articulated to one of said jaws through a first hole provided in this jaw, and the long connecting rod being articulated to the other jaw through a second hole provided in this jaw , so that the jaws are articulated with each other and to the extension tube by means of a pin that is housed in a third hole of the jaw and in a fourth hole of the jaw, so that a joint translation of the intermediate tube and the drive rod causes the opening or closing of said jaws.
  • the line that joins the centers of the first, second, and third or fourth holes forms an angle of substantially 45 degrees with the plane of closure of the jaws. This allows a rotation of up to 90 degrees of the jaws.
  • the handle comprises a first drive for articulation of the distal tool around an axis perpendicular to the longitudinal axis of the extension tube, and a bushing that is threaded on the actuation rod, is integral in translation to the intermediate tube and is integral with rotation to the first drive, so that when acting rotatably on the first drive there is a translation of the intermediate tube relative to the drive rod and the consequent articulation of the tool.
  • an intermediate tube recess is coupled to a bushing flange.
  • the handle comprises a second drive for opening or closing the jaws that can be actuated by the drive rod, which is connected to the intermediate tube through the bushing, so that, when acting on the second drive, the rod of actuation displaces the intermediate tube by means of the bushing and there is a joint translation of the actuating rod and the intermediate tube, which implies the opening or closing of the jaws.
  • the second drive is a pivoting handle handle.
  • the handle comprises a third drive for the orientation of the extension tube around its longitudinal axis, operation that is independent of the articulation of the tool and of the opening / closing of the jaws, since preferably the intermediate tube and the operating rod are integral in rotation to the extension tube.
  • the first drive and the third drive are mounted on a fixed part of the handle, which comprises a fixed handle.
  • the extension tube is integral in translation to the fixed part of the handle, which also contributes to improving the operability of the instrument.
  • the endoscopic surgical instrument comprises an electrical connector for cauterization of the tissue intervened by the distal tool.
  • the object of the present invention is to provide a surgical instrument for endoscopic or laparoscopic surgery applications comprising a tool in the distal area formed by two cooperating jaws that can be articulated by turning with respect to an axis perpendicular to the axis. longitudinal of its extension tube.
  • This movement allows the distal tool to be oriented between approximately 0 and 90 °.
  • the tool located in the distal part of the instrument comprises opening and closing movements of the cooperating jaws and rotation movement around an axis that coincides with the longitudinal axis of the extension tube.
  • the invention comprises the distal tool and its articulation mechanism, an extension tube and the drives preferably located in the tool handle.
  • the distal part of the instrument that includes the cooperating jaws and their joint mechanism is called the joint section.
  • This system can be used with any type of handle of the employees usually in the instruments conventions of laparoscopic or endoscopic surgery. However, it is necessary to make some modifications to the handle to accommodate the drive elements that the additional articulation of the instrument requires.
  • the surgical instruments referred to in the present invention can use a wide variety of distal tools generally formed by two cooperating jaws, such as scissors, dissectors, claws, etc.
  • the handle may have a retention mechanism incorporated if it is necessary to maintain the jaw opening position.
  • the present invention can be applied to all these distal tools and their instruments.
  • the surgical instrument that incorporates this system will have a light weight, it will not prevent it from being used with either hand, right or left, independently and can perform cauterization operations when necessary. It can be used in both disposable and reusable tools and with extension tubes that will be of conventional diameters of 5 mm, 10 mm and 12 mm, or other diameters if necessary. In addition, manufacturing the system will be inexpensive.
  • the main advantages of the present invention lie in their simplicity and in the elimination of flexible elements.
  • the articulation system of the present invention is formed by a small number of parts that are very easy to manufacture and assemble.
  • all the mechanical elements that allow the drive and transmit the movement are rigid elements, which allows to have a greater sensitivity in the touch of the instrument and a better transmission of efforts.
  • the articulation of the instrument allows to reach angles even greater than 90 ° rotating around the same axis of pivoting that is used for the opening and closing of the jaws, which simplifies the design and improves the operability of the instrument.
  • the instrument is therefore divided into a handle part, external to the patient, and another endoscopic part.
  • the handle part is located the handle of the instrument that provides the elements for holding by the surgeon's hand and comprises the activation system of the different movements of the distal tool and the connection for cauterization.
  • the endoscopic part consists of the extension tube of the instrument, the articulation mechanism of the distal tool and the distal tool itself.
  • the articulation mechanism is located between the distal end of the extension tube and the distal tool itself.
  • a drive located on the handle of the instrument allows selective pivoting of the distal tool around an axis perpendicular to the longitudinal axis of the extension tube. This drive allows turning the distal tool approximately 90 °.
  • the opening and closing of the cooperating jaws of the distal tool is allowed in order to perform different operations depending on the type of jaw that is incorporated. These operations include grip and dissection of tissues inside the patient's body.
  • the surgical instrument is formed by an extension tube connected proximally to the fixed part of the instrument handle. This connection allows the tube to rotate around its longitudinal axis with respect to the handle, in order to rotate the distal tool with a rotation of 360 °. This movement is achieved by means of a drive wheel preferably also located in the fixed part of the handle.
  • the extension tube cannot move in its longitudinal direction with respect to the fixed part of the handle.
  • the extension tube there are two elements that in a preferred embodiment have a circular section and are concentric with respect to the circular section of the extension tube. These two elements move longitudinally with alternative movement with respect to the extension tube.
  • the first of these elements is an intermediate tube of greater length than the extension tube, so that its outer longitudinal surface approximately coincides with the internal longitudinal surface of the extension tube.
  • the distal end of this intermediate tube is connected to the articulation mechanism of the distal tool.
  • the proximal end of the intermediate tube is connected to a part of the mechanical system of actuation of the articulation movement preferably located in the fixed part of the handle.
  • the second element disposed inside the extension tube is the actuation rod, which is longer than the extension tube and also larger than the intermediate tube, which moves axially with alternative movement inside the intermediate tube.
  • the longitudinal surface of the drive rod approximately coincides with the internal longitudinal surface of the intermediate tube.
  • the distal end of the drive rod is connected to the articulation mechanism of the distal tool.
  • the drive rod rests on the fixed part of the handle and connects at its proximal end to the mobile part thereof.
  • a pivoting handle located on the handle axially displaces the actuating rod providing the opening and closing movement of the distal tool.
  • two types of movements occur in the distal tool. If only the intermediate tube is displaced, the drive rod remaining static, the articulation movement of the distal tool is activated.
  • This articulation movement causes the distal tool to rotate with its two solidarity jaws around an axis perpendicular to the longitudinal axis of the extension tube. This movement is selective and covers an inclination of between 0 and 90 ° or approximately to the distal tool. If at the initial moment the distal tool is closed, it will remain closed during the joint movement. If at the initial moment the distal tool is open, it will rotate open in the joint movement.
  • the opening and closing of the distal tool occurs.
  • the opening and closing of the distal tool occurs for any position in the inclination thereof within the range of angles mentioned above.
  • the inclination value of the distal tool produced by the joint will depend on the relative position of the intermediate tube and the drive rod at the initial moment of movement.
  • the third movement of the distal tool is the rotation around the longitudinal axis of the extension tube.
  • This movement is preferably activated from the handle through the wheel located in the part fixed of this one.
  • an orientation wheel When an orientation wheel is rotated, preferably activated by the surgeon's finger, it transmits the movement to the extension tube which in turn rotates the intermediate tube, the actuation rod, the articulation mechanism and the distal tool.
  • Preferred embodiments of this invention include means for activating the articulation of the articulation section from, preferably, the handle. These means provide when required the three described movements of the linking mechanism, that is: the articulation, orientation and the opening-closing of the distal tool.
  • the drive rod in its proximal area and at the height of the fixed part of the handle comprises a threaded area in its longitudinal direction. This threaded part is outside the intermediate tube so that a cylindrical bushing can be placed covering both elements.
  • the cylindrical bushing in its proximal part has a threaded part inside which allows said bushing to be threaded on the threaded outer part of the drive rod.
  • the cylindrical bushing is disposed externally on the intermediate axis allowing its rotation around its longitudinal axis but not its relative displacement in the axial direction.
  • the cylindrical bushing and the intermediate tube have an alternative movement in the longitudinal direction.
  • a preferred embodiment of the articulated section comprises the two cooperating jaws whose movement is performed through the linking mechanism.
  • the two jaws undergo the opening and closing movement turning around a common axis located in its proximal part and this axis also rotates around a fixed point of the extension tube in its distal part.
  • the articulation mechanism is located between the cooperating jaws and the linking mechanism.
  • it is basically formed by a three element mechanism. These elements are: a short connecting rod with two links, a long connecting rod with three links and a rocker.
  • Each of the cooperating jaws is connected in one of the cranks mentioned by a point that allows its relative pivoting.
  • the two connecting rods are linked at the ends of the rocker at two pivot points.
  • the link mechanism is connected to the articulation section through the drive rod and the intermediate tube.
  • the drive rod is connected at its distal end to the rocker at a point located approximately in the center of the latter. This connection allows pivoting between the drive rod and the rocker.
  • the intermediate tube comprises a pivot shaft at its distal end that serves as a connecting element with the long connecting rod at its third connecting point.
  • This third connecting point of the long connecting rod is a sliding joint that allows the articulation of the distal tool by means of a cam-type connection with the intermediate tube.
  • Figure 1 is a general perspective view of an endoscopic surgical instrument or laparoscopic according to the invention
  • Figure 2 is an exploded exploded view of the surgical instrument of Figure 1 and includes a detail A of a part thereof;
  • Figure 3 represents a section on a central and longitudinal plane of a sleeve of the surgical instrument;
  • Figure 4 is a perspective view of the surgical instrument representing the articulation movement of the distal tool produced by a drive located in the handle;
  • Figure 5 is a view like that of Figure 4 but represents the orientation movement of the distal tool produced by another drive located in the handle;
  • Figure 6 is a side view of the surgical instrument when the distal tool is articulated and closed;
  • Figure 7 is a view like that of Figure 6 but shows how the opening and closing movement of the jaws of the distal tool is operated;
  • Figure 8 is a partially sectioned schematic view of the end distal of the surgical instrument when the distal tool is in its neutral position (not articulated) and with the jaws closed;
  • Figure 9 is a view like that of Figure 8 but with the jaws open;
  • Figure 10 is a view like that of Figure 8 but with the distal tool in an articulated position, with an inclination of approximately 75 degrees;
  • Figure 1 1 is a view like that of Figure 10 but with the jaws open;
  • Figure 12 is a partially sectioned schematic view of the grip of the surgical instrument corresponding to a neutral and closed position of the distal tool
  • Figure 13 is a view like that of Figure 12 but corresponding to a neutral and open position of the distal tool
  • Figure 14 is a view like that of Figure 12 but corresponding to an articulated and closed position of the distal tool.
  • Figure 1 illustrates a surgical instrument for applications in endoscopic or laparoscopic surgery in accordance with the present invention. Overall, this configuration is designated by reference 10. Also globally, the system comprises an endoscopic part composed of the articulation section 20 and the link mechanism that is designated globally by reference 50.
  • the articulation section 20 comprises a distal tool 21 and an articulation mechanism 22.
  • the non-endoscopic part comprises the handle or handle of the instrument which is designated globally with the reference 70.
  • the handle 70 comprises a fixed part 71 and the drives 72, 73 and 74.
  • the drives 72 and 73 are an orientation wheel and an articulation wheel, respectively, which allow rotation of the distal tool 21 around different axes.
  • the drive 74 is a pivoting handle that allows the jaws of the distal tool to open and close.
  • a fixed handle 86 allows the manual grip of the handle 70.
  • FIG. 2 shows an exploded view of the laparoscopic or endoscopic surgery instrument.
  • the assembly detail A of the articulation section is also shown.
  • the distal tool 21 located in the articulation section 20 comprises the cooperating jaws 23 and 24 mounted on the pin 25 in their respective housings 26 and 33 created for this purpose.
  • the articulation mechanism 22 is formed by the long connecting rod 28, the short connecting rod 29 and the rocker 30.
  • the connecting rod 28 connects with the jaw 24 in its hole 32 through a pivot 35 which allows the pivoting between both elements.
  • the connecting rod 29 links through its pivot 27 in a similar hole 31 comprised in the jaw 23.
  • the connecting rod 28 also has a cam groove 37 which serves as a link element with the linking mechanism 50.
  • the rocker arm comprises three link holes.
  • the hole 38 of the rocker arm links with the connecting rod 29 in a pivot 34 so that relative movement between them is allowed.
  • the connecting rod 28 links with the rocker in the hole 40 by the pivot 36.
  • the third hole 39 of the rocker serves as a linkage element with the link mechanism 50 through the pivot 62 as described in detail below.
  • the link mechanism 50 is formed by the extension tube 51 in its outermost part. In its distal part this tube comprises the hole 53 where the pin 25 is positioned so that it allows the cooperating rotation of the jaws 23 and 24 in their opening-closing and articulation movements. In the distal part of the extension tube there is also a groove 52 in its longitudinal direction that extends approximately from its distal end. The object of the groove 52 is to allow pivotal movement of the articulation section 20 around the pin 25.
  • the extension tube 51 comprises two longitudinal recesses 54 and 55.
  • the longitudinal recess 54 is intended to fix the linkage mechanism to the fixed part of the handle 70. This longitudinal recess allows the rotation about the longitudinal axis of the extension tube but not its displacement in the longitudinal direction.
  • the second longitudinal recess 55 is located in its most proximal part and is intended to position the orientation wheel 72.
  • the orientation wheel 72 comprises a projection that fits into a longitudinal groove of the extension tube 51 so as to allow the integral rotation of both elements
  • the extension tube 51 comprises an intermediate tube 56 which is located inside said extension tube, so that its external longitudinal surface approximately coincides with the internal surface of the extension tube.
  • the intermediate tube 56 can move in the longitudinal direction with respect to the extension tube 51 but the rotation of both tubes with respect to its longitudinal axis is integral.
  • the intermediate tube 56 comprises in its distal part an extension 57 that approximately coincides with the wall thickness of said tube.
  • a pivot 58 is located which is preferably perpendicular to a longitudinal plane of the intermediate tube. This pivot 58 serves as a cam probe defined by the groove 37 of the connecting rod 28, since it can move inside this groove.
  • the intermediate tube 56 comprises in its proximal part a longitudinal recess 59 that affects its entire external perimeter and which serves as an element of link with a cylindrical bushing 76, which is housed in the handle 70 and links with a drive rod disposed inside the intermediate tube 56.
  • the drive rod 60 comprises in its proximal area a longitudinally threaded part 63 which cooperates with a female thread 78 of the bushing 76.
  • a link 64 with the pivoting handle 74.
  • the drive rod 60 comprises in its distal part a longitudinal recess 61 where an axis is located pivot 62.
  • This pivot axis 62 is perpendicular to a longitudinal plane of the drive rod 60 and serves as a link with the articulation mechanism 22 through the rocker 30 on its pivot axis 39.
  • means 75 and 87 that allow electro-cauterization are shown.
  • FIG. 3 A longitudinal section of the cylindrical bushing 76 is shown in Fig. 3.
  • This cylindrical bushing 76 serves as a link between the intermediate tube 56 and the actuating rod 60.
  • Said cylindrical bushing comprises a through longitudinal hole.
  • This hole in its distal part comprises a flange 77 that links with the recess 59 of the intermediate tube 56.
  • both elements can rotate relative to each other around their common longitudinal axis.
  • the proximal part of the longitudinal bore of the cylindrical sleeve is threaded with an internal thread 78 that is screwed into the external thread 63 of the drive rod 60.
  • the fixed part 71 of the handle 70 which includes the different drives, in turn includes some Complementary sections 79 and 80 that are mounted together through a series of protuberances and fixed by screws 81.
  • the inner part of the two complementary sections comprise a series of hollows or stepped flanges 82, also complementary, with mainly circular shapes and prepared to accommodate the various components of the handle 70.
  • a circumferential flange 83 is used for the accommodation of the extension tube 51 in its recess 54.
  • the circumferential flange 84 is used for the accommodation of the cylindrical bushing 76 and allows its alternative displacement in the direction of its longitudinal axis.
  • the recess 85 allows the housing of the pivoting handle 74 and its coupling with the actuating rod 60.
  • the endoscopic surgical instrument of the present invention comprises the necessary drives for articulation and rotation of the endoscopic part.
  • Figure 4 shows the drives for the integral rotation of the two jaws of the distal tool 21.
  • Figure 4 also shows how the rotation of the articulation wheel 73 allows the distal tool 21 to rotate by means of the articulation mechanism 22.
  • the articulation wheel 73 rotates in one direction the distal tool 21 rotates about an axis perpendicular to the longitudinal axis of the extension tube 51. In this way it goes from having a neutral position, aligned with the extension tube, to an articulated position with an articulation angle proportional to the angle rotated by said orientation wheel 73 and up to a value of approximately 90 °.
  • Figure 5 shows how the orientation wheel 72 allows the distal tool 21 to rotate about the longitudinal axis of the extension tube 51.
  • the orientation wheel 72 allows this rotation to be 360 ° and in both directions, clockwise and counterclockwise, if It was necessary.
  • Figures 6 and 7 show how the present invention allows opening and closing movement of the distal tool 21 in any position when it is articulated. This movement is achieved by rotating the pivoting handle 74 of the handle 70. As shown in Figure 6, when the pivoting handle 74 remains closer to the fixed handle 86, the distal tool 21 is closed and the holding surface of jaws 23 and 24 is in contact with each other. On the other hand, as shown in Figure 7, when the pivoting handle 74 rotates away from the fixed handle, 86 the jaws of the distal tool 21 open at an angle proportional to the rotation produced in the pivoting handle 74. This movement is similar for any orientation of the distal tool produced by the movements of drives 72 and 73 and also includes the neutral position of the jaws.
  • Figure 8 shows the scheme of the articulation section that includes the articulation mechanism 22 together with the distal tool 21 and the link mechanism 50 in its most distal part.
  • the position shown in Figure 8 corresponds to the neutral position of the distal tool 21, where its longitudinal axis is aligned with the longitudinal axis of the extension tube 51.
  • Figure 8 shows the closed distal tool 21 and therefore the gripping surface of the cooperating jaws 23 and 24 are in contact.
  • Figure 9 shows how when the drive rod 60 and the intermediate tube 56 are displaced jointly towards the proximal part of the instrument 10, the distal tool 21 is opened. On the one hand, the drive rod 60 displaces the rocker arm. 30 through pivot shaft
  • Figure 10 shows the scheme of the articulation section 20 in a manner similar to that shown in Figure 8, but in this case the distal tool 21 is articulated.
  • the actuating rod 60 remaining static.
  • the articulation wheel 73 located in the fixed part 71 of the handle 70 is rotated, the orientation wheel 72 and the pivoting handle 74 remain motionless. This movement causes the intermediate tube 56 to move towards the distal area of the instrument.
  • the intermediate tube 56 in turn displaces the connecting rod 28 through the link formed by the pivot 58 and the cam 37. Therefore, the articulation movement is achieved in the articulation mechanism 22 by a mechanism equivalent to a quadrilateral formed by the connecting rod 28, the connecting rod 29, the rocker 30 (which rotates around the pivot 62) and the two cooperating jaws 23 and 24, the latter with a solidarity movement and therefore acting as a single element.
  • Figure 1 1 shows the opening position of the cooperating jaws 23 and 24. In order to achieve the position shown in Figure 11 from the position shown in Figure 10, it is sufficient to move the actuator rod 60 and the intermediate tube 56 in solidarity towards the proximal part of the instrument. This displacement is achieved by turning the pivoting handle 74.
  • FIG. 12 shows the elements comprising the handle 70 of the instrument, the assembly with the link mechanism 50, and the operation of said subset.
  • Figure 12 shows the handle elements 70 for a neutral and closed position of the distal tool 21, that is, for the position shown in Figure 8.
  • Figure 12 shows how the extension tube 51 is connected with the handle 70 through of its recess 54 in the flange 83 that the fixed part 71 has for this purpose.
  • This link allows the extension tube 51 to rotate around the fixed part of the handle 71 but not its displacement in the axial direction.
  • the mounting of the orientation wheel 72 occurs in the recess 55 of the extension tube 51.
  • Figure 12 also shows the link between the intermediate tube 56 and the cylindrical bushing 76. This connection is carried out by means of the recess 59 of the intermediate tube 56 and the shoulder 77 of the cylindrical bushing 76 (shown in Figure 3).
  • connection between the cylindrical bushing 76 and the drive rod 60 is produced through the threaded zones 78 and 63 of the cylindrical bushing 76 and the drive rod 60, respectively.
  • the articulation wheel 73 is concentrically mounted on the cylindrical bushing 76 so that its rotation is integral but can move relative to each other in the longitudinal direction.
  • Figure 13 shows the movement of the pivoting handle 74 to produce the opening of the distal tool 21 in its neutral position. This figure 13 therefore corresponds to the configuration of the distal tool 21 shown in Figure 9.
  • the drive rod 60 drags the intermediate tube 56 through the cylindrical bushing 76, producing the opening of the distal tool.
  • Figure 14 shows the configuration of the fixed handle 71 when the articulation of the distal tool 21 occurs in its closed position.
  • the configuration shown in Figure 14 corresponds to a position of the distal tool similar to that shown in Figure 10.
  • the rotation of the articulation wheel 73 when the drive rod 60 remains static causes the cylindrical bushing.
  • 76 move the intermediate tube 56 a certain distance to produce the articulation of the distal tool 21.
  • the pivoting handle rotation 74 causes the cooperating jaws 23 and 24 to open or close depending on the direction of rotation.
  • the configuration of the open tool corresponds approximately to Figure 1 1.
  • - Orientation wheel 72 produces rotation (between 0 or 360 °) of the distal tool 21 around the longitudinal axis of the extension tube 51 based on rotating on it.
  • the articulation wheel 73 produces the articulation (between 0 or approximately 90 °) of the distal tool 21 about an axis perpendicular to the longitudinal axis of the extension tube 51 based on acting rotatably on the cylindrical bushing 76, which, at the drive rod 60 remains static, it is screwed onto it thus displacing the intermediate tube 56.
  • the pivoting handle 74 produces the opening and closing of the jaws of the distal tool 21 based on linearly displacing the drive rod 60, which, keeping the articulation wheel 73 static, in turn displaces the intermediate tube 56 jointly by means of the cylindrical bushing 76.

Abstract

Instrument for endoscopic surgery that comprises a handle (70), a distal tool (21) and a mechanism (22) for articulation of the distal tool, linked to the handle by means of a linking mechanism (50), which comprises an extender tube (51) that accommodates an actuating rod (60) and an intermediate tube (56) arranged between the two. The articulation mechanism comprises a rocker (30), a short connecting rod (29) and a long connecting rod (28), such that the actuating rod and the two connecting rods are articulated to the rocker at three points of the latter, respectively, and the connecting rods are articulated individually to the distal tool at points thereof, the long connecting rod furthermore being linked to the intermediate tube by means of a cam link (37, 58), with the result that a translational movement of the intermediate tube relative to the actuating rod gives rise to the articulation of the distal tool about an axis perpendicular to the longitudinal axis of the extender tube.

Description

INSTRUMENTO PARA CIRUGÍA ENDOSCÓPICA  INSTRUMENT FOR ENDOSCOPIC SURGERY
La presente invención se refiere a un instrumento para cirugía endoscópica que comprende un mango, una herramienta distal, un mecanismo de enlace, y un mecanismo de articulación de la herramienta distal enlazado al mango por medio del mecanismo de enlace. The present invention relates to an instrument for endoscopic surgery comprising a handle, a distal tool, a linking mechanism, and an articulation mechanism of the distal tool linked to the handle by means of the linking mechanism.
ESTADO DE LA TÉCNICA ANTERIOR La cirugía laparoscópica o endoscópica es una técnica quirúrgica de mínima invasión donde se interviene al paciente a través pequeñas incisiones. Las herramientas de cirugía laparoscópica o endoscópica se introducen a través de estas incisiones permitiendo al cirujano manipularlas desde el exterior del paciente utilizando diversos instrumentos quirúrgicos como por ejemplo: disectores, tijeras, retractores, etc. STATE OF THE PREVIOUS TECHNIQUE Laparoscopic or endoscopic surgery is a minimally invasive surgical technique where the patient is operated through small incisions. Laparoscopic or endoscopic surgery tools are introduced through these incisions allowing the surgeon to manipulate them from outside the patient using various surgical instruments such as: dissectors, scissors, retractors, etc.
Aunque se pueden encontrar ejemplos de instrumentos para cirugía endoscópica o laparoscópica desde hace muchos años, la evolución más significativa de estas técnicas se produce en la segunda mitad de los años 70 y la década de los años 80 del siglo XX. Durante los años 90 las herramientas de cirugía laparoscópica fueron refinando sus diseños a la vez que se adaptaron a los avances tecnológicos de la electrónica aplicada a la cirugía endoscópica. Aunque está evolución ha sido importante, las herramientas siguen sin satisfacer a los cirujanos principalmente por la pérdida de movilidad que imponen estos instrumentos en sus operaciones. Although examples of instruments for endoscopic or laparoscopic surgery can be found for many years, the most significant evolution of these techniques occurs in the second half of the 70s and the 80s of the 20th century. During the 1990s, laparoscopic surgery tools were refining their designs while adapting to the technological advances of electronics applied to endoscopic surgery. Although this evolution has been important, the tools still do not satisfy surgeons mainly due to the loss of mobility that these instruments impose in their operations.
Efectivamente, las herramientas de cirugía laparoscópica o endoscópica tienen dificultades para alcanzar determinadas posiciones en el interior del paciente y el cirujano debe adoptar posturas incómodas que pueden producir lesiones físicas en el paciente y en el propio cirujano. Con objeto de solventar estos problemas, desde finales de los años 80 hasta la actualidad se han solicitado algunas patentes que incorporan articulaciones adicionales. Por ejemplo, la patente US5374277 describe un instrumento para cirugía de mínima invasión que permite la inclinación (articulación) de la herramienta distal con respecto al eje longitudinal del instrumento mediante el giro de una rueda situada en la empuñadura. Este movimiento se transmite por medio de un elemento flexible, pero la intervención de elementos flexibles dificulta la sensibilidad al tacto del instrumento quirúrgico. Indeed, laparoscopic or endoscopic surgery tools have difficulty reaching certain positions inside the patient and the surgeon must adopt awkward postures that can produce physical injuries to the patient and the surgeon himself. In order to solve these problems, some patents incorporating additional articulations have been applied since the late 1980s to the present. For example, US5374277 discloses an instrument for minimally invasive surgery that allows the inclination (articulation) of the distal tool with respect to the longitudinal axis of the instrument by turning a wheel located in the handle. This movement is transmitted by means of a flexible element, but the intervention of flexible elements makes sensitivity to the touch of the surgical instrument difficult.
La patente US5702408 describe un sistema de articulación de la herramienta basado en un mecanismo de cuatro barras que es accionado desde la empuñadura para mover la parte distal de la herramienta. Sin embargo se trata de un mecanismo completamente diferente al de apertura y cierre de la herramienta distal que hace que el instrumento quirúrgico sea notablemente complicado. US5702408 describes a tool articulation system based on a four-bar mechanism that is actuated from the handle to move the distal part of the tool. However, it is a completely different mechanism from the opening and closing of the distal tool that makes the surgical instrument remarkably complicated.
La patente US5827323 describe un sistema de articulación de la herramienta basado en dos piezas alargadas cada una de las cuales está provista de una zona dentada que engrana con respectivos engranajes pertenecientes a las mordazas de la herramienta distal. La traslación del tubo prolongador con respecto a estas piezas alargadas produce la articulación de la herramienta. Pero la necesidad de permitir la traslación del tubo prolongador complica el sistema y también el trabajo del cirujano. US5827323 discloses a tool articulation system based on two elongated pieces each of which is provided with a toothed area that meshes with respective gears belonging to the jaws of the distal tool. The translation of the extension tube with respect to these elongated parts produces the articulation of the tool. But the need to allow translation of the extension tube complicates the system and also the work of the surgeon.
DESCRIPCIÓN DE LA INVENCIÓN DESCRIPTION OF THE INVENTION
Un objetivo de la presente invención es el de mejorar la sensibilidad del cirujano en el manejo de la herramienta distal y la respuesta de ésta al manejo del cirujano. Entonces, el mecanismo de enlace del instrumento quirúrgico endoscópico comprende un tubo prolongador que aloja una varilla de accionamiento y un tubo intermedio dispuesto entre la varilla de accionamiento y el propio tubo prolongador, y el mecanismo de articulación comprende un balancín, una biela corta y una biela larga, de manera que cada una de la varilla de accionamiento y las dos bielas se articula al balancín en un punto diferente del mismo, y cada biela también se articula a la herramienta distal en un punto diferente de la misma, enlazándose además la biela larga al tubo intermedio por medio de un enlace de leva, con lo cual una traslación del tubo intermedio relativa a la varilla de accionamiento produce la articulación de la herramienta distal alrededor de un eje perpendicular al eje longitudinal del tubo prolongador. An objective of the present invention is to improve the surgeon's sensitivity in the management of the distal tool and its response to the surgeon's management. Then, the link mechanism of the endoscopic surgical instrument comprises an extension tube that houses a drive rod and an intermediate tube disposed between the drive rod and the extension tube itself, and the articulation mechanism comprises a rocker, a short connecting rod and a long connecting rod, so that each of the drive rod and the two connecting rods is articulated to the rocker at a different point of the same, and each connecting rod is also articulated to the distal tool at a different point of the same, also connecting the connecting rod long to the intermediate tube by means of a cam link, whereby a translation of the intermediate tube relative to the drive rod causes the articulation of the distal tool about an axis perpendicular to the longitudinal axis of the extension tube.
La ausencia de elementos flexibles que transmitan movimiento mejora la operatividad del instrumento quirúrgico endoscópico. Además, esta disposición de elementos simplifica el diseño del instrumento. The absence of flexible elements that transmit movement improves the operability of the endoscopic surgical instrument. In addition, this arrangement of elements simplifies the design of the instrument.
En una realización, la biela larga comprende una ranura de leva y el tubo intermedio comprende un pivote orientado perpendicularmente al tubo prolongador que actúa como palpador de dicha leva. In one embodiment, the long connecting rod comprises a cam groove and the intermediate tube comprises a pivot oriented perpendicularly to the extension tube that acts as a probe of said cam.
Ventajosamente, la herramienta distal comprende dos mordazas, estando la biela corta articulada a una de dichas mordazas a través de un primer orificio provisto en esta mordaza, y estando la biela larga articulada a la otra mordaza a través de un segundo orificio provisto en esta mordaza, de modo tal que las mordazas están articuladas entre sí y al tubo prolongador por medio de un pasador que se aloja en un tercer orificio de la mordaza y en un cuarto orificio de la mordaza, de manera que una traslación solidaria del tubo intermedio y la varilla de accionamiento produce la apertura o el cierre de dichas mordazas. En una realización, cuando las dos mordazas están cerradas, la recta que une los centros de los orificios primero, segundo, y tercero o cuarto, forma un ángulo de sustancialmente 45 grados con el plano de cierre de las mordazas. Esto permite un giro de hasta 90 grados de las mordazas. Advantageously, the distal tool comprises two jaws, the short connecting rod being articulated to one of said jaws through a first hole provided in this jaw, and the long connecting rod being articulated to the other jaw through a second hole provided in this jaw , so that the jaws are articulated with each other and to the extension tube by means of a pin that is housed in a third hole of the jaw and in a fourth hole of the jaw, so that a joint translation of the intermediate tube and the drive rod causes the opening or closing of said jaws. In one embodiment, when the two jaws are closed, the line that joins the centers of the first, second, and third or fourth holes, forms an angle of substantially 45 degrees with the plane of closure of the jaws. This allows a rotation of up to 90 degrees of the jaws.
Preferiblemente, el mango comprende un primer accionamiento para la articulación de la herramienta distal alrededor de un eje perpendicular al eje longitudinal del tubo prolongador, y un casquillo que está roscado sobre la varilla de accionamiento, es solidario en traslación al tubo intermedio y es solidario en rotación al primer accionamiento, de manera que al actuar giratoriamente sobre el primer accionamiento se produce una traslación del tubo intermedio relativa a la varilla de accionamiento y la consiguiente articulación de la herramienta. En una realización, un rebaje del tubo intermedio está acoplado a una pestaña del casquillo. Preferably, the handle comprises a first drive for articulation of the distal tool around an axis perpendicular to the longitudinal axis of the extension tube, and a bushing that is threaded on the actuation rod, is integral in translation to the intermediate tube and is integral with rotation to the first drive, so that when acting rotatably on the first drive there is a translation of the intermediate tube relative to the drive rod and the consequent articulation of the tool. In one embodiment, an intermediate tube recess is coupled to a bushing flange.
Preferiblemente, el mango comprende un segundo accionamiento para la apertura o el cierre de las mordazas que puede accionar la varilla de accionamiento, la cual está enlazada al tubo intermedio a través del casquillo, de manera que, al actuar sobre el segundo accionamiento, la varilla de accionamiento desplaza el tubo intermedio por medio del casquillo y se produce una traslación solidaria de la varilla de accionamiento y el tubo intermedio, lo cual implica la apertura o el cierre de las mordazas. Preferably, the handle comprises a second drive for opening or closing the jaws that can be actuated by the drive rod, which is connected to the intermediate tube through the bushing, so that, when acting on the second drive, the rod of actuation displaces the intermediate tube by means of the bushing and there is a joint translation of the actuating rod and the intermediate tube, which implies the opening or closing of the jaws.
En una realización, el segundo accionamiento es una manilla pivotante del mango. Preferiblemente, el mango comprende un tercer accionamiento para la orientación del tubo prolongador alrededor de su eje longitudinal, operación que es independiente de la articulación de la herramienta y de la apertura/cierre de las mordazas, ya que preferiblemente el tubo intermedio y la varilla de accionamiento son solidarios en rotación al tubo prolongador. Ventajosamente, el primer accionamiento y el tercer accionamiento están montados sobre una parte fija del mango, la cual comprende una manilla fija. In one embodiment, the second drive is a pivoting handle handle. Preferably, the handle comprises a third drive for the orientation of the extension tube around its longitudinal axis, operation that is independent of the articulation of the tool and of the opening / closing of the jaws, since preferably the intermediate tube and the operating rod are integral in rotation to the extension tube. Advantageously, the first drive and the third drive are mounted on a fixed part of the handle, which comprises a fixed handle.
Preferiblemente, el tubo prolongador es solidario en traslación a la parte fija del mango, lo cual también contribuye a mejorar la operatividad del instrumento. Preferably, the extension tube is integral in translation to the fixed part of the handle, which also contributes to improving the operability of the instrument.
En una realización, el instrumento quirúrgico endoscópico comprende un conector eléctrico para la cauterización del tejido intervenido por la herramienta distal. In one embodiment, the endoscopic surgical instrument comprises an electrical connector for cauterization of the tissue intervened by the distal tool.
En otras palabras, el objeto de la presente invención es proporcionar un instrumento quirúrgico para aplicaciones de cirugía endoscópica o laparoscópica que comprenda una herramienta en la zona distal formada por dos mordazas cooperantes que puede ser articulada mediante el giro con respecto a un eje perpendicular al eje longitudinal de su tubo prolongador. Este movimiento permite orientar la herramienta distal entre 0 y 90° aproximadamente. Además de este movimiento de articulación, la herramienta situada en la parte distal del instrumento comprende movimientos de apertura y cierre de las mordazas cooperantes y movimiento de giro alrededor de un eje que coincide con el eje longitudinal del tubo prolongador. La invención comprende la herramienta distal y su mecanismo de articulación, un tubo prolongador y los accionamientos situados preferentemente en el mango de la herramienta. La parte distal del instrumento que incluye a las mordazas cooperantes y su mecanismo de articulación se denomina sección de articulación. Este sistema puede ser empleado con cualquier tipo de mango de los empleados habitualmente en los instrumentos convenciones de cirugía laparoscópica o endoscópica. Sin embargo, es necesario hacer algunas modificaciones en el mango para alojar los elementos de accionamiento que la articulación adicional del instrumento requiere. In other words, the object of the present invention is to provide a surgical instrument for endoscopic or laparoscopic surgery applications comprising a tool in the distal area formed by two cooperating jaws that can be articulated by turning with respect to an axis perpendicular to the axis. longitudinal of its extension tube. This movement allows the distal tool to be oriented between approximately 0 and 90 °. In addition to this articulation movement, the tool located in the distal part of the instrument comprises opening and closing movements of the cooperating jaws and rotation movement around an axis that coincides with the longitudinal axis of the extension tube. The invention comprises the distal tool and its articulation mechanism, an extension tube and the drives preferably located in the tool handle. The distal part of the instrument that includes the cooperating jaws and their joint mechanism is called the joint section. This system can be used with any type of handle of the employees usually in the instruments conventions of laparoscopic or endoscopic surgery. However, it is necessary to make some modifications to the handle to accommodate the drive elements that the additional articulation of the instrument requires.
Los instrumentos quirúrgicos a que hace referencia la presente invención pueden utilizar una gran variedad de herramientas distales formadas en general por dos mordazas cooperantes, como por ejemplo: tijeras, disectores, garras, etc. El mango puede tener incorporado un mecanismo de retención si fuese necesario mantener la posición de apertura de las mordazas. A todas estas herramientas distales y a sus instrumentos se les puede aplicar la presente invención. El instrumento quirúrgico que incorpore este sistema tendrá un peso ligero, no impedirá que pueda ser empleado con cualquiera de ambas manos, derecha o izquierda, de forma independientemente y podrá efectuar operaciones de cauterización cuando sea necesario. Se puede emplear tanto en herramientas desechables como reutilizables y con tubos prolongadores que serán de diámetros convencionales de 5 mm, 10 mm y 12 mm, u otros diámetros si fuera necesario. Además, la fabricación del sistema será poco costosa. The surgical instruments referred to in the present invention can use a wide variety of distal tools generally formed by two cooperating jaws, such as scissors, dissectors, claws, etc. The handle may have a retention mechanism incorporated if it is necessary to maintain the jaw opening position. The present invention can be applied to all these distal tools and their instruments. The surgical instrument that incorporates this system will have a light weight, it will not prevent it from being used with either hand, right or left, independently and can perform cauterization operations when necessary. It can be used in both disposable and reusable tools and with extension tubes that will be of conventional diameters of 5 mm, 10 mm and 12 mm, or other diameters if necessary. In addition, manufacturing the system will be inexpensive.
Las principales ventajas de la presente invención, frente a otros sistemas de articulación empleados en herramientas de cirugía laparoscópica o endoscópica, residen en su sencillez y en la eliminación de elementos flexibles. El sistema de articulación de la presente invención está formado por un número pequeño de piezas que resultan muy fáciles de fabricar y montar. Además, todos los elementos mecánicos que permiten el accionamiento y transmiten el movimiento son elementos rígidos, lo que permite tener una mayor sensibilidad en el tacto del instrumento y una mejor transmisión de esfuerzos. La articulación del instrumento permite alcanzar ángulos incluso superiores a 90° rotando alrededor del mismo eje de pivotamiento que es empleado para la apertura y cierre de las mordazas, lo que simplifica el diseño y mejora la operatividad del instrumento. El instrumento está por tanto dividido en una parte de empuñadura, externa al paciente, y otra parte endoscópica. En la parte de empuñadura está situado el mango del instrumento que proporciona los elementos para la sujeción por la mano del cirujano y comprende el sistema de activación de los diferentes movimientos de la herramienta distal y la conexión para cauterización. La parte endoscópica consiste en el tubo prolongador del instrumento, el mecanismo de articulación de la herramienta distal y la propia herramienta distal. El mecanismo de articulación está situado entre el extremo distal del tubo prolongador y la propia herramienta distal. Un accionamiento situado en la empuñadura del instrumento permite el pivotamiento selectivo de la herramienta distal alrededor de un eje perpendicular al eje longitudinal del tubo prolongador. Mediante este accionamiento se permiten giros de la herramienta distal de aproximadamente 90°. Mediante otro accionamiento situado preferentemente en el mango se permite la apertura y cierre de la de las mordazas cooperantes de la herramienta distal con el objeto de realizar diferentes operaciones en función del tipo de mordaza que se incorpore. Entre estas operaciones se incluyen el agarre y la disección de los tejidos en el interior del cuerpo del paciente. En una realización preferida, el instrumento quirúrgico está formado por un tubo prolongador conectado en su parte proximal a la parte fija del mango del instrumento. Esta conexión permite el giro del tubo alrededor de su eje longitudinal con respecto al mango, con el objeto de poder girar la herramienta distal con una rotación de 360°. Este movimiento se consigue mediante una rueda de accionamiento situada preferentemente también en la parte fija del mango. El tubo prolongador no puede desplazarse en su dirección longitudinal con respecto a la parte fija del mango. En el interior del tubo prolongador se encuentran dos elementos que en una realización preferida tienen sección circular y son concéntricas con respecto a la sección circular del tubo prolongador. Estos dos elementos se mueven longitudinalmente con movimiento alternativo con respecto al tubo prolongador. El primero de estos elementos es un tubo intermedio de longitud mayor que el tubo prolongador, de forma que su superficie longitudinal exterior coincide aproximadamente con la superficie longitudinal interior del tubo prolongador. El extremo distal de este tubo intermedio se encuentra conectado con el mecanismo de articulación de la herramienta distal. Por otro lado, el extremo proximal del tubo intermedio se encuentra unido a una parte del sistema mecánico de accionamiento del movimiento de articulación situado preferentemente en la parte fija del mango. The main advantages of the present invention, compared to other articulation systems used in laparoscopic or endoscopic surgery tools, lie in their simplicity and in the elimination of flexible elements. The articulation system of the present invention is formed by a small number of parts that are very easy to manufacture and assemble. In addition, all the mechanical elements that allow the drive and transmit the movement are rigid elements, which allows to have a greater sensitivity in the touch of the instrument and a better transmission of efforts. The articulation of the instrument allows to reach angles even greater than 90 ° rotating around the same axis of pivoting that is used for the opening and closing of the jaws, which simplifies the design and improves the operability of the instrument. The instrument is therefore divided into a handle part, external to the patient, and another endoscopic part. In the handle part is located the handle of the instrument that provides the elements for holding by the surgeon's hand and comprises the activation system of the different movements of the distal tool and the connection for cauterization. The endoscopic part consists of the extension tube of the instrument, the articulation mechanism of the distal tool and the distal tool itself. The articulation mechanism is located between the distal end of the extension tube and the distal tool itself. A drive located on the handle of the instrument allows selective pivoting of the distal tool around an axis perpendicular to the longitudinal axis of the extension tube. This drive allows turning the distal tool approximately 90 °. By means of another drive preferably located in the handle, the opening and closing of the cooperating jaws of the distal tool is allowed in order to perform different operations depending on the type of jaw that is incorporated. These operations include grip and dissection of tissues inside the patient's body. In a preferred embodiment, the surgical instrument is formed by an extension tube connected proximally to the fixed part of the instrument handle. This connection allows the tube to rotate around its longitudinal axis with respect to the handle, in order to rotate the distal tool with a rotation of 360 °. This movement is achieved by means of a drive wheel preferably also located in the fixed part of the handle. The extension tube cannot move in its longitudinal direction with respect to the fixed part of the handle. Inside the extension tube there are two elements that in a preferred embodiment have a circular section and are concentric with respect to the circular section of the extension tube. These two elements move longitudinally with alternative movement with respect to the extension tube. The first of these elements is an intermediate tube of greater length than the extension tube, so that its outer longitudinal surface approximately coincides with the internal longitudinal surface of the extension tube. The distal end of this intermediate tube is connected to the articulation mechanism of the distal tool. On the other hand, the proximal end of the intermediate tube is connected to a part of the mechanical system of actuation of the articulation movement preferably located in the fixed part of the handle.
El segundo elemento dispuesto en el interior del tubo prolongador es la varilla de accionamiento, de longitud mayor que el tubo prolongador y mayor también que el tubo intermedio, que se mueve axialmente con movimiento alternativo en el interior del tubo intermedio. La superficie longitudinal de la varilla de accionamiento coincide aproximadamente con la superficie longitudinal interna del tubo intermedio. El extremo distal de la varilla de accionamiento se encuentra conectado al mecanismo de articulación de la herramienta distal. De esta forma, la parte endoscópica del instrumento que abarca el tubo prolongador queda como un sistema compacto, con movimiento relativo entre los tres elementos, formado en su núcleo por la varilla de accionamiento, en su exterior por el tubo prolongador y entre estos dos elementos el tubo intermedio. A este sistema se le denomina mecanismo de enlace ya que realiza está función entre el mango del instrumento y la sección de articulación. La varilla de accionamiento se apoya en la parte fija del mango y se conecta en su extremo proximal a la parte móvil del mismo. De esta forma, cuando la mano del cirujano acciona una manilla pivotante situada en el mango desplaza axialmente la varilla de accionamiento proporcionando el movimiento de apertura y cierre de la herramienta distal. Dependiendo de cómo sea el desplazamiento relativo del tubo intermedio y la varilla de accionamiento de producen dos tipos de movimientos en la herramienta distal. Si únicamente se desplaza el tubo intermedio, permaneciendo estático la varilla de accionamiento, se activa el movimiento de articulación de la herramienta distal. Este movimiento de articulación hace que la herramienta distal gire con sus dos mordazas solidarias alrededor de un eje perpendicular al eje longitudinal del tubo prolongador. Este movimiento es selectivo y abarca una inclinación de entre 0o y 90° aproximadamente para la herramienta distal. Si en el instante inicial la herramienta distal se encuentra cerrada permanecerá cerrada durante el movimiento de articulación. Si en el instante inicial la herramienta distal se encuentra abierta girará abierta en el movimiento de articulación. The second element disposed inside the extension tube is the actuation rod, which is longer than the extension tube and also larger than the intermediate tube, which moves axially with alternative movement inside the intermediate tube. The longitudinal surface of the drive rod approximately coincides with the internal longitudinal surface of the intermediate tube. The distal end of the drive rod is connected to the articulation mechanism of the distal tool. In this way, the endoscopic part of the instrument that encompasses the extension tube remains as a compact system, with relative movement between the three elements, formed at its core by the actuating rod, outside by the extension tube and between these two elements. the intermediate tube This system is called the link mechanism since it performs this function between the handle of the instrument and the articulation section. The drive rod rests on the fixed part of the handle and connects at its proximal end to the mobile part thereof. In this way, when the The surgeon's hand drives a pivoting handle located on the handle axially displaces the actuating rod providing the opening and closing movement of the distal tool. Depending on the relative displacement of the intermediate tube and the drive rod, two types of movements occur in the distal tool. If only the intermediate tube is displaced, the drive rod remaining static, the articulation movement of the distal tool is activated. This articulation movement causes the distal tool to rotate with its two solidarity jaws around an axis perpendicular to the longitudinal axis of the extension tube. This movement is selective and covers an inclination of between 0 and 90 ° or approximately to the distal tool. If at the initial moment the distal tool is closed, it will remain closed during the joint movement. If at the initial moment the distal tool is open, it will rotate open in the joint movement.
Por otro lado, si el desplazamiento axial del tubo intermedio y la varilla de accionamiento se realiza solidariamente, es decir, sin que exista desplazamiento relativo entre ambos, se produce la apertura y cierre de la herramienta distal. La apertura y cierre de la herramienta distal se produce para cualquier posición en la inclinación de la misma dentro del rango de ángulos anteriormente mencionados. El valor de la inclinación de la herramienta distal producido por la articulación dependerá de la posición relativa del tubo intermedio y la varilla de accionamiento en el momento inicial del movimiento. On the other hand, if the axial displacement of the intermediate tube and the drive rod is carried out jointly, that is, without there being relative displacement between the two, the opening and closing of the distal tool occurs. The opening and closing of the distal tool occurs for any position in the inclination thereof within the range of angles mentioned above. The inclination value of the distal tool produced by the joint will depend on the relative position of the intermediate tube and the drive rod at the initial moment of movement.
El tercer movimiento de la herramienta distal es el giro alrededor del eje longitudinal del tubo prolongador. Este movimiento se activa preferentemente desde el mango a través de la rueda situada en la parte fija de éste. Cuando se hace girar una rueda de orientación, activada preferentemente por el dedo del cirujano, ésta transmite el movimiento al tubo prolongador que a su vez hace girar solidariamente el tubo intermedio, la varilla de accionamiento, el mecanismo de articulación y la herramienta distal. The third movement of the distal tool is the rotation around the longitudinal axis of the extension tube. This movement is preferably activated from the handle through the wheel located in the part fixed of this one. When an orientation wheel is rotated, preferably activated by the surgeon's finger, it transmits the movement to the extension tube which in turn rotates the intermediate tube, the actuation rod, the articulation mechanism and the distal tool.
Realizaciones preferidas de esta invención incluyen medios para la activación de la articulación de la sección de articulación desde, preferentemente, el mango. Estos medios proporcionan cuando sea requerido los tres movimientos descritos del mecanismo de enlace, esto es: el de articulación, orientación y el de apertura-cierre de la herramienta distal. En estas realizaciones preferidas la varilla de accionamiento en su zona proximal y a la altura de la parte fija del mango comprende una zona roscada en su dirección longitudinal. Esta parte roscada queda fuera del tubo intermedio de forma que pueda colocarse un casquillo cilindrico que abarque a ambos elementos. El casquillo cilindrico en su parte proximal tiene una parte roscada en su interior que permite roscar dicho casquillo en la parte exterior roscada de la varilla de accionamiento. Por otro lado, en su extremo distal el casquillo cilindrico está dispuesto externamente sobre el eje intermedio permitiendo su giro en torno a su eje longitudinal pero no su desplazamiento relativo en la dirección axial. En otras palabras, el casquillo cilindrico y el tubo intermedio tienen un movimiento alternativo solidario en la dirección longitudinal. Con esta configuración, cuando la parte móvil del mango del instrumento desplaza la varilla de accionamiento, el tubo intermedio y la propia varilla de accionamiento se mueven solidariamente, siendo impedido el movimiento relativo entre ellos por el casquillo cilindrico. De esta forma se consigue el movimiento de apertura y cierre de la herramienta distal. Por otro lado, cuando, a través de una segunda rueda de accionamiento situada preferentemente en el mango fijo, se hace girar el casquillo cilindrico, se reduce la distancia relativa entre la varilla de accionamiento y el tubo intermedio. Esta reducción de distancia proporciona el movimiento de articulación de la herramienta distal. Esta reducción de distancia es selectiva permitiendo al cirujano establecer cualquier ángulo de articulación dentro del rango anteriormente mencionado. Preferred embodiments of this invention include means for activating the articulation of the articulation section from, preferably, the handle. These means provide when required the three described movements of the linking mechanism, that is: the articulation, orientation and the opening-closing of the distal tool. In these preferred embodiments the drive rod in its proximal area and at the height of the fixed part of the handle comprises a threaded area in its longitudinal direction. This threaded part is outside the intermediate tube so that a cylindrical bushing can be placed covering both elements. The cylindrical bushing in its proximal part has a threaded part inside which allows said bushing to be threaded on the threaded outer part of the drive rod. On the other hand, at its distal end the cylindrical bushing is disposed externally on the intermediate axis allowing its rotation around its longitudinal axis but not its relative displacement in the axial direction. In other words, the cylindrical bushing and the intermediate tube have an alternative movement in the longitudinal direction. With this configuration, when the moving part of the handle of the instrument displaces the drive rod, the intermediate tube and the drive rod itself move in solidarity, the relative movement between them being prevented by the cylindrical bushing. In this way the opening and closing movement of the distal tool is achieved. On the other hand, when, through a second drive wheel preferably located in the fixed handle, the cylindrical bushing is rotated, reduces the relative distance between the drive rod and the intermediate tube. This distance reduction provides the articulation movement of the distal tool. This distance reduction is selective allowing the surgeon to establish any joint angle within the aforementioned range.
Una realización preferida de la sección articulada comprende las dos mordazas cooperantes cuyo movimiento se realiza a través del mecanismo de enlace. Las dos mordazas experimentan el movimiento de apertura y cierre girando alrededor de un eje común situado en su parte proximal y este eje gira también alrededor de un punto fijo del tubo prolongador en su parte distal. El mecanismo de articulación está situado entre las mordazas cooperantes y el mecanismo de enlace. En esta realización preferida está formado básicamente por un mecanismo de tres elementos. Estos elementos son: una biela corta con dos enlaces, una biela larga con tres enlaces y un balancín. Cada una de las mordazas cooperantes se enlaza en una de las bielas mencionadas mediante un punto que permite su pivotamiento relativo. A su vez las dos bielas se enlazan en los extremos del balancín en sendos puntos de pivotamiento. El mecanismo de enlace se conecta a la sección de articulación a través de la varilla de accionamiento y el tubo intermedio. La varilla de accionamiento se conecta en su extremo distal al balancín en un punto situado aproximadamente en el centro de este último. Esta conexión permite el pivotamiento entre la varilla de accionamiento y el balancín. A preferred embodiment of the articulated section comprises the two cooperating jaws whose movement is performed through the linking mechanism. The two jaws undergo the opening and closing movement turning around a common axis located in its proximal part and this axis also rotates around a fixed point of the extension tube in its distal part. The articulation mechanism is located between the cooperating jaws and the linking mechanism. In this preferred embodiment it is basically formed by a three element mechanism. These elements are: a short connecting rod with two links, a long connecting rod with three links and a rocker. Each of the cooperating jaws is connected in one of the cranks mentioned by a point that allows its relative pivoting. In turn, the two connecting rods are linked at the ends of the rocker at two pivot points. The link mechanism is connected to the articulation section through the drive rod and the intermediate tube. The drive rod is connected at its distal end to the rocker at a point located approximately in the center of the latter. This connection allows pivoting between the drive rod and the rocker.
En una realización preferida el tubo intermedio comprende un eje de pivotamiento en su extremo distal que sirve como elemento de enlace con la biela larga en el tercer punto de enlace de ésta. Este tercer punto de enlace de la biela larga es una unión de corredera que permite la articulación de la herramienta distal mediante una conexión de tipo leva con el tubo intermedio. Mediante esta configuración, cuando la varilla de accionamiento permanece estática y se activa el movimiento del tubo intermedio, la sección de articulación gira alrededor del punto de enlace entre el balancín y la varilla de accionamiento. Cuando la varilla de accionamiento y el tubo intermedio se desplazan solidariamente en la dirección longitudinal del tubo prolongador el mecanismo permite la apertura y cierre de las mordazas de la herramienta distal. In a preferred embodiment, the intermediate tube comprises a pivot shaft at its distal end that serves as a connecting element with the long connecting rod at its third connecting point. This third connecting point of the long connecting rod is a sliding joint that allows the articulation of the distal tool by means of a cam-type connection with the intermediate tube. Through this configuration, when the rod The drive remains static and the movement of the intermediate tube is activated, the articulation section revolves around the point of connection between the rocker arm and the operating rod. When the actuator rod and the intermediate tube move in solidarity in the longitudinal direction of the extension tube the mechanism allows the jaws of the distal tool to be opened and closed.
BREVE DESCRIPCIÓN DE LOS DIBUJOS A continuación se describirá, a título de ejemplo no limitativo, una realización de la invención, haciendo referencia a los dibujos adjuntos, en los cuales: la figura 1 es una vista general en perspectiva de un instrumento de cirugía endoscópica o laparoscópica de acuerdo con la invención; BRIEF DESCRIPTION OF THE DRAWINGS An embodiment of the invention will now be described, by way of non-limiting example, with reference to the accompanying drawings, in which: Figure 1 is a general perspective view of an endoscopic surgical instrument or laparoscopic according to the invention;
la figura 2 es una vista de despiece explosionado del instrumento quirúrgico de la figura 1 e incluye un detalle A de una parte del mismo; la figura 3 representa una sección sobre un plano central y longitudinal de un casquillo del instrumento quirúrgico; Figure 2 is an exploded exploded view of the surgical instrument of Figure 1 and includes a detail A of a part thereof; Figure 3 represents a section on a central and longitudinal plane of a sleeve of the surgical instrument;
la figura 4 es una vista en perspectiva del instrumento quirúrgico que representa el movimiento de articulación de la herramienta distal producido por un accionamiento situado en la empuñadura; Figure 4 is a perspective view of the surgical instrument representing the articulation movement of the distal tool produced by a drive located in the handle;
la figura 5 es una vista como la de la figura 4 pero representa el movimiento de orientación de la herramienta distal producido por otro accionamiento situado en la empuñadura; Figure 5 is a view like that of Figure 4 but represents the orientation movement of the distal tool produced by another drive located in the handle;
la figura 6 es una vista lateral del instrumento quirúrgico cuando la herramienta distal se encuentra articulada y cerrada; Figure 6 is a side view of the surgical instrument when the distal tool is articulated and closed;
la figura 7 es una vista como la de la figura 6 pero muestra cómo se acciona el movimiento de apertura y cierre de las mordazas de la herramienta distal; Figure 7 is a view like that of Figure 6 but shows how the opening and closing movement of the jaws of the distal tool is operated;
la figura 8 es una vista esquemática parcialmente en sección del extremo distal del instrumento quirúrgico cuando la herramienta distal se encuentra en su posición neutra (no articulada) y con las mordazas cerradas; Figure 8 is a partially sectioned schematic view of the end distal of the surgical instrument when the distal tool is in its neutral position (not articulated) and with the jaws closed;
la figura 9 es una vista como la de la figura 8 pero con las mordazas abiertas; Figure 9 is a view like that of Figure 8 but with the jaws open;
la figura 10 es una vista como la de la figura 8 pero con la herramienta distal en posición articulada, con una inclinación de aproximadamente 75 grados; Figure 10 is a view like that of Figure 8 but with the distal tool in an articulated position, with an inclination of approximately 75 degrees;
la figura 1 1 es una vista como la de la figura 10 pero con las mordazas abiertas; Figure 1 1 is a view like that of Figure 10 but with the jaws open;
la figura 12 es una vista esquemática parcialmente en sección de la empuñadura del instrumento quirúrgico correspondiente a una posición neutra y cerrada de la herramienta distal; Figure 12 is a partially sectioned schematic view of the grip of the surgical instrument corresponding to a neutral and closed position of the distal tool;
la figura 13 es una vista como la de la figura 12 pero correspondiente a una posición neutra y abierta de la herramienta distal; y Figure 13 is a view like that of Figure 12 but corresponding to a neutral and open position of the distal tool; Y
la figura 14 es una vista como la de la figura 12 pero correspondiente a una posición articulada y cerrada de la herramienta distal. Figure 14 is a view like that of Figure 12 but corresponding to an articulated and closed position of the distal tool.
DESCRIPCIÓN DE REALIZACIONES PREFERIDAS La figura 1 ilustra un instrumento quirúrgico para aplicaciones en cirugía endoscópica o laparoscópica de acuerdo con la presente invención. De forma global esta configuración se designa con la referencia 10. También de forma global, el sistema comprende una parte endoscópica compuesta por la sección de articulación 20 y el mecanismo de enlace que se designa globalmente con la referencia 50. La sección de articulación 20 comprende una herramienta distal 21 y un mecanismo de articulación 22. La parte no endoscópica comprende la empuñadura o mango del instrumento que se designa de forma global con la referencia 70. El mango 70 comprende una parte fija 71 y los accionamientos 72, 73 y 74. Los accionamientos 72 y 73 son una rueda de orientación y una rueda de articulación, respectivamente, que permiten la rotación de la herramienta distal 21 alrededor de distintos ejes. El accionamiento 74 es una manilla pivotante que permite la apertura y cierre de las mordazas de la herramienta distal. En la parte fija 71 , una manilla fija 86 permite la sujeción manual del mango 70. Sobre la parte fija 71 del mango también se encuentra una conexión para electro-cauterización 75. DESCRIPTION OF PREFERRED EMBODIMENTS Figure 1 illustrates a surgical instrument for applications in endoscopic or laparoscopic surgery in accordance with the present invention. Overall, this configuration is designated by reference 10. Also globally, the system comprises an endoscopic part composed of the articulation section 20 and the link mechanism that is designated globally by reference 50. The articulation section 20 comprises a distal tool 21 and an articulation mechanism 22. The non-endoscopic part comprises the handle or handle of the instrument which is designated globally with the reference 70. The handle 70 comprises a fixed part 71 and the drives 72, 73 and 74. The drives 72 and 73 are an orientation wheel and an articulation wheel, respectively, which allow rotation of the distal tool 21 around different axes. The drive 74 is a pivoting handle that allows the jaws of the distal tool to open and close. In the fixed part 71, a fixed handle 86 allows the manual grip of the handle 70. On the fixed part 71 of the handle there is also a connection for electro-cauterization 75.
En la figura 2 se observa una vista explosionada del instrumento de cirugía laparoscópica o endoscópica. Se muestra también el detalle A de montaje de la sección de articulación. La herramienta distal 21 situada en la sección de articulación 20 comprende las mordazas cooperantes 23 y 24 montadas sobre el pasador 25 en sus respectivos alojamientos 26 y 33 creados para tal efecto. El mecanismo de articulación 22 está formado por la biela larga 28, la biela corta 29 y el balancín 30. La biela 28 enlaza con la mordaza 24 en su orificio 32 a través de un pivote 35 que permite el pivotamiento entre ambos elementos. De la misma forma, la biela 29 enlaza a través de su pivote 27 en un orificio similar 31 comprendido en la mordaza 23. La biela 28 cuenta además con una ranura de leva 37 que sirve como elemento de enlace con el mecanismo de enlace 50. Cuando ambas mordazas están cerradas, una recta imaginaria que pase por los tres orificios 31 , 26 y 32 forma un ángulo preferentemente de 45 grados con respecto al plano de cierre de ambas mordazas (que es el ángulo representado en la Fig. 8, donde también se aprecia que la dirección de dicha recta coincide sustancialmente con la del eje longitudinal del balancín 30). El balancín comprende tres orificios de enlace. El orificio 38 del balancín enlaza con la biela 29 en un pivote 34 de forma que se permite el movimiento relativo entre ellos. La biela 28 enlaza con el balancín en el orificio 40 mediante el pivote 36. El tercer orificio 39 del balancín sirve como elemento de enlace con el mecanismo de enlace 50 a través del pivote 62 como se describe en detalle más adelante. Figure 2 shows an exploded view of the laparoscopic or endoscopic surgery instrument. The assembly detail A of the articulation section is also shown. The distal tool 21 located in the articulation section 20 comprises the cooperating jaws 23 and 24 mounted on the pin 25 in their respective housings 26 and 33 created for this purpose. The articulation mechanism 22 is formed by the long connecting rod 28, the short connecting rod 29 and the rocker 30. The connecting rod 28 connects with the jaw 24 in its hole 32 through a pivot 35 which allows the pivoting between both elements. In the same way, the connecting rod 29 links through its pivot 27 in a similar hole 31 comprised in the jaw 23. The connecting rod 28 also has a cam groove 37 which serves as a link element with the linking mechanism 50. When both jaws are closed, an imaginary line that passes through the three holes 31, 26 and 32 forms an angle preferably of 45 degrees with respect to the closing plane of both jaws (which is the angle represented in Fig. 8, where also it can be seen that the direction of said straight line substantially coincides with that of the longitudinal axis of the rocker 30). The rocker arm comprises three link holes. The hole 38 of the rocker arm links with the connecting rod 29 in a pivot 34 so that relative movement between them is allowed. The connecting rod 28 links with the rocker in the hole 40 by the pivot 36. The third hole 39 of the rocker serves as a linkage element with the link mechanism 50 through the pivot 62 as described in detail below.
El mecanismo de enlace 50 está formado por el tubo prolongador 51 en su parte más externa. En su parte distal este tubo comprende el orificio 53 donde se sitúa el pasador 25 de forma que permite el giro cooperante de las mordazas 23 y 24 en sus movimientos de apertura-cierre y articulación. En la parte distal del tubo prolongador existe también una ranura 52 en su dirección longitudinal que se extiende aproximadamente desde su extremo distal. El objeto de la ranura 52 es permitir el movimiento pivotante de la sección de articulación 20 alrededor del pasador 25. En su parte proximal el tubo prolongador 51 comprende dos rebajes longitudinales 54 y 55. El rebaje longitudinal 54 tiene por objeto fijar el mecanismo de enlace a la parte fija del mango 70. Este rebaje longitudinal permite el giro alrededor del eje longitudinal del tubo prolongador pero no su desplazamiento en la dirección longitudinal. El segundo rebaje longitudinal 55 está situado en su parte más proximal y tiene por objeto situar la rueda de orientación 72. La rueda de orientación 72 comprende un resalte que se encaja en una ranura longitudinal del tubo prolongador 51 de forma que permite el giro solidario de ambos elementos. The link mechanism 50 is formed by the extension tube 51 in its outermost part. In its distal part this tube comprises the hole 53 where the pin 25 is positioned so that it allows the cooperating rotation of the jaws 23 and 24 in their opening-closing and articulation movements. In the distal part of the extension tube there is also a groove 52 in its longitudinal direction that extends approximately from its distal end. The object of the groove 52 is to allow pivotal movement of the articulation section 20 around the pin 25. In its proximal part the extension tube 51 comprises two longitudinal recesses 54 and 55. The longitudinal recess 54 is intended to fix the linkage mechanism to the fixed part of the handle 70. This longitudinal recess allows the rotation about the longitudinal axis of the extension tube but not its displacement in the longitudinal direction. The second longitudinal recess 55 is located in its most proximal part and is intended to position the orientation wheel 72. The orientation wheel 72 comprises a projection that fits into a longitudinal groove of the extension tube 51 so as to allow the integral rotation of both elements
El tubo prolongador 51 comprende un tubo intermedio 56 que está situado en el interior de dicho tubo prolongador, de forma que su superficie longitudinal externa coincide aproximadamente con la superficie interna del tubo prolongador. Como se ha mencionado, el tubo intermedio 56 puede desplazarse en la dirección longitudinal con respecto al tubo prolongador 51 pero el giro de ambos tubos con respecto a su eje longitudinal es solidario. El tubo intermedio 56 comprende en su parte distal una prolongación 57 que coincide aproximadamente con el espesor de pared de dicho tubo. Sobre esta prolongación 57 se sitúa un pivote 58 que es preferentemente perpendicular a un plano longitudinal del tubo intermedio. Este pivote 58 sirve como palpador de la leva definida por la ranura 37 de la biela 28, ya que puede desplazarse por el interior de esta ranura. El tubo intermedio 56 comprende en su parte proximal un rebaje longitudinal 59 que afecta a todo su perímetro externo y que sirve como elemento de enlace con un casquillo cilindrico 76, el cual está alojado en el mango 70 y enlaza con una varilla de accionamiento dispuesta en el interior del tubo intermedio 56. Para ello, la varilla de accionamiento 60 comprende en su zona proximal una parte roscada longitudinalmente 63 que coopera con una rosca hembra 78 del casquillo 76. En el extremo proximal de la varilla de accionamiento también se encuentra un enlace 64 con la manilla pivotante 74. La varilla de accionamiento 60 comprende en su parte distal un rebaje longitudinal 61 donde se sitúa un eje de pivotamiento 62. Este eje de pivotamiento 62 es perpendicular a un plano longitudinal de la varilla de accionamiento 60 y sirve como elemento de enlace con el mecanismo de articulación 22 a través del balancín 30 en su eje de pivotamiento 39. En la misma figura 2 se muestran los medios 75 y 87 que permiten la electro-cauterización. The extension tube 51 comprises an intermediate tube 56 which is located inside said extension tube, so that its external longitudinal surface approximately coincides with the internal surface of the extension tube. As mentioned, the intermediate tube 56 can move in the longitudinal direction with respect to the extension tube 51 but the rotation of both tubes with respect to its longitudinal axis is integral. The intermediate tube 56 comprises in its distal part an extension 57 that approximately coincides with the wall thickness of said tube. On this extension 57 a pivot 58 is located which is preferably perpendicular to a longitudinal plane of the intermediate tube. This pivot 58 serves as a cam probe defined by the groove 37 of the connecting rod 28, since it can move inside this groove. The intermediate tube 56 comprises in its proximal part a longitudinal recess 59 that affects its entire external perimeter and which serves as an element of link with a cylindrical bushing 76, which is housed in the handle 70 and links with a drive rod disposed inside the intermediate tube 56. For this, the drive rod 60 comprises in its proximal area a longitudinally threaded part 63 which cooperates with a female thread 78 of the bushing 76. At the proximal end of the drive rod there is also a link 64 with the pivoting handle 74. The drive rod 60 comprises in its distal part a longitudinal recess 61 where an axis is located pivot 62. This pivot axis 62 is perpendicular to a longitudinal plane of the drive rod 60 and serves as a link with the articulation mechanism 22 through the rocker 30 on its pivot axis 39. In the same figure 2 means 75 and 87 that allow electro-cauterization are shown.
En la figura 3 se muestra una sección longitudinal del casquillo cilindrico 76. Este casquillo cilindrico 76 sirve como elemento de enlace entre el tubo intermedio 56 y la varilla de accionamiento 60. Dicho casquillo cilindrico comprende un orificio longitudinal pasante. Este orificio en su parte distal comprende una pestaña 77 que enlaza con el rebaje 59 del tubo intermedio 56. De esta forma el movimiento longitudinal del casquillo 76 y el tubo intermedio 56 es solidario. Sin embargo, ambos elementos pueden girar uno con respecto al otro alrededor de su eje longitudinal común. La parte proximal del orificio longitudinal del casquillo cilindrico se encuentra roscada con una rosca interna 78 que se enrosca en la rosca externa 63 de la varilla de accionamiento 60. Volviendo a la figura 2, se observa que la parte fija 71 del mango 70, que comprende los distintos accionamientos, comprende a su vez unas secciones complementarias 79 y 80 que se montan entre sí a través de una serie de protuberancias y se fijan mediante unos tornillos 81 . La parte interna de las dos secciones complementarias comprenden una serie de huecos o pestañas escalonadas 82, también complementarias, con formas principalmente circulares y preparadas para alojar los diversos componentes del mango 70. Una pestaña circunferencial 83 se emplea para el alojamiento del tubo prolongador 51 en su rebaje 54. La pestaña circunferencial 84 se emplea para el alojamiento del casquillo cilindrico 76 y permite su desplazamiento alternativo en la dirección de su eje longitudinal. El hueco 85 permite el alojamiento de la manilla pivotante 74 y su acoplamiento con la varilla de accionamiento 60. A longitudinal section of the cylindrical bushing 76 is shown in Fig. 3. This cylindrical bushing 76 serves as a link between the intermediate tube 56 and the actuating rod 60. Said cylindrical bushing comprises a through longitudinal hole. This hole in its distal part comprises a flange 77 that links with the recess 59 of the intermediate tube 56. In this way the longitudinal movement of the bushing 76 and the intermediate tube 56 is integral. However, both elements can rotate relative to each other around their common longitudinal axis. The proximal part of the longitudinal bore of the cylindrical sleeve is threaded with an internal thread 78 that is screwed into the external thread 63 of the drive rod 60. Turning to Figure 2, it can be seen that the fixed part 71 of the handle 70, which includes the different drives, in turn includes some Complementary sections 79 and 80 that are mounted together through a series of protuberances and fixed by screws 81. The inner part of the two complementary sections comprise a series of hollows or stepped flanges 82, also complementary, with mainly circular shapes and prepared to accommodate the various components of the handle 70. A circumferential flange 83 is used for the accommodation of the extension tube 51 in its recess 54. The circumferential flange 84 is used for the accommodation of the cylindrical bushing 76 and allows its alternative displacement in the direction of its longitudinal axis. The recess 85 allows the housing of the pivoting handle 74 and its coupling with the actuating rod 60.
El instrumento quirúrgico endoscópico de la presente invención comprende los accionamientos necesarios para la articulación y el giro de la parte endoscópica. La figura 4 muestra los accionamientos para el giro solidario de las dos mordazas de la herramienta distal 21 . La figura 4 muestra también como el giro de la rueda de articulación 73 permite el giro de la herramienta distal 21 mediante el mecanismo de articulación 22. Cuando la rueda de articulación 73 gira en un sentido la herramienta distal 21 gira alrededor de un eje perpendicular al eje longitudinal del tubo prolongador 51 . De esta forma pasa de tener una posición neutral, alineada con el tubo prolongador, a una posición articulada con un ángulo de articulación proporcional al ángulo girado por dicha rueda de orientación 73 y hasta un valor de aproximadamente 90°. Si la rueda de articulación 73 gira en sentido contrario la herramienta distal 21 gira de nuevo hacia su posición neutral. La figura 5 muestra como la rueda de orientación 72 permite el giro de la herramienta distal 21 alrededor del eje longitudinal del tubo prolongador 51. La rueda de orientación 72 permite que este giro sea de 360° y en ambos sentidos, horario y antihorario, si fuese necesario. The endoscopic surgical instrument of the present invention comprises the necessary drives for articulation and rotation of the endoscopic part. Figure 4 shows the drives for the integral rotation of the two jaws of the distal tool 21. Figure 4 also shows how the rotation of the articulation wheel 73 allows the distal tool 21 to rotate by means of the articulation mechanism 22. When the articulation wheel 73 rotates in one direction the distal tool 21 rotates about an axis perpendicular to the longitudinal axis of the extension tube 51. In this way it goes from having a neutral position, aligned with the extension tube, to an articulated position with an articulation angle proportional to the angle rotated by said orientation wheel 73 and up to a value of approximately 90 °. If the articulation wheel 73 rotates in the opposite direction the distal tool 21 rotates again to its neutral position. Figure 5 shows how the orientation wheel 72 allows the distal tool 21 to rotate about the longitudinal axis of the extension tube 51. The orientation wheel 72 allows this rotation to be 360 ° and in both directions, clockwise and counterclockwise, if It was necessary.
Las figuras 6 y 7 muestran como la presente invención permite el movimiento de apertura y cierre de la herramienta distal 21 en cualquier posición cuando ésta se encuentra articulada. Este movimiento se logra mediante el giro de la manilla pivotante 74 del mango 70. Como se muestra en la figura 6, cuando la manilla pivotante 74 permanece más próxima a la manilla fija 86, la herramienta distal 21 se encuentra cerrada y la superficie de sujeción de las mordazas 23 y 24 está en contacto entre sí. Por otro lado, como se muestra en la figura 7, cuando la manilla pivotante 74 gira alejándose de la manilla fija, 86 las mordazas de la herramienta distal 21 se abren en un ángulo proporcional al giro producido en la manilla pivotante 74. Este movimiento es similar para cualquier orientación de la herramienta distal producida por los movimientos de los accionamientos 72 y 73 y también incluye la posición neutra de las mordazas. Figures 6 and 7 show how the present invention allows opening and closing movement of the distal tool 21 in any position when it is articulated. This movement is achieved by rotating the pivoting handle 74 of the handle 70. As shown in Figure 6, when the pivoting handle 74 remains closer to the fixed handle 86, the distal tool 21 is closed and the holding surface of jaws 23 and 24 is in contact with each other. On the other hand, as shown in Figure 7, when the pivoting handle 74 rotates away from the fixed handle, 86 the jaws of the distal tool 21 open at an angle proportional to the rotation produced in the pivoting handle 74. This movement is similar for any orientation of the distal tool produced by the movements of drives 72 and 73 and also includes the neutral position of the jaws.
La figura 8 muestra el esquema de la sección de articulación que incluye el mecanismo de articulación 22 junto con la herramienta distal 21 y el mecanismo de enlace 50 en su parte más distal. La posición mostrada en la figura 8 se corresponde con la posición neutra de la herramienta distal 21 , donde su eje longitudinal está alineado con el eje longitudinal del tubo prolongador 51 . La figura 8 muestra la herramienta distal 21 cerrada y por tanto la superficie de agarre de las mordazas cooperantes 23 y 24 se encuentran en contacto. En la figura 9 se muestra como cuando la varilla de accionamiento 60 y el tubo intermedio 56 son desplazados solidariamente hacia la parte proximal del instrumento 10 se produce la apertura de la herramienta distal 21. Por un lado, la varilla de accionamiento 60 desplaza el balancín 30 a través del eje de pivotamientoFigure 8 shows the scheme of the articulation section that includes the articulation mechanism 22 together with the distal tool 21 and the link mechanism 50 in its most distal part. The position shown in Figure 8 corresponds to the neutral position of the distal tool 21, where its longitudinal axis is aligned with the longitudinal axis of the extension tube 51. Figure 8 shows the closed distal tool 21 and therefore the gripping surface of the cooperating jaws 23 and 24 are in contact. Figure 9 shows how when the drive rod 60 and the intermediate tube 56 are displaced jointly towards the proximal part of the instrument 10, the distal tool 21 is opened. On the one hand, the drive rod 60 displaces the rocker arm. 30 through pivot shaft
62, y el balancín 30 desplaza la biela 29 a través del enlace entre el orificio 38 y el pivote 34 (ver figura 2). Por otro lado, el tubo intermedio 56 desplaza la biela 28 a través del enlace de leva 58-37 que existe entre ambos y del enlace entre el orificio 40 y el pivote 36. El movimiento conjunto y solidario de los elementos 60 y 56 hace que la bielas 28 y 29 hagan girar a las mordazas 23 y 24 alrededor del pasador 25 produciendo el movimiento de apertura. El movimiento de cierre de ambas mordazas se produce cuando el tubo intermedio 56 y la varilla de accionamiento 60 son desplazados solidariamente hacia la parte distal del instrumento 10. El movimiento de apertura o cierre de las mordazas se consigue mediante el giro de la manilla pivotante 74. 62, and the rocker 30 moves the connecting rod 29 through the link between the hole 38 and the pivot 34 (see figure 2). On the other hand, the intermediate tube 56 moves the connecting rod 28 through the cam link 58-37 that exists between them and the link between the hole 40 and the pivot 36. The joint and integral movement of the elements 60 and 56 makes connecting rods 28 and 29 rotate jaws 23 and 24 around pin 25 producing the opening movement. The closing movement of both jaws occurs when the intermediate tube 56 and the actuating rod 60 are jointly displaced towards the distal part of the instrument 10. The opening or closing movement of the jaws is achieved by rotating the pivoting handle 74 .
La figura 10 muestra el esquema de la sección de articulación 20 de forma similar a como se mostraba en la figura 8, pero en este caso la herramienta distal 21 se encuentra articulada. En la figura 10 se muestra una posición intermedia de articulación de aproximadamente 75°, pero esta herramienta puede ser articulada en cualquier posición entre 0o y 90° aproximadamente. Para producir la rotación de la herramienta distal 21 desde su posición neutral, mostrada en la figura 8, hasta la posición articulada mostrada en la figura 10 se ha producido únicamente el desplazamiento de el tubo intermedio 56, permaneciendo estático la varilla de accionamiento 60. Para conseguir este movimiento se gira la rueda de articulación 73 situada en la parte fija 71 del mango 70, permaneciendo inmóviles la rueda de orientación 72 y la manilla pivotante 74. Este movimiento hace desplazarse al tubo intermedio 56 hacia la zona distal del instrumento. El tubo intermedio 56 desplaza a su vez a la biela 28 a través del enlace formado por el pivote 58 y la leva 37. Por tanto, el movimiento de articulación se consigue en el mecanismo de articulación 22 mediante un mecanismo equivalente a un cuadrilátero formado por la biela 28, la biela 29, el balancín 30 (que gira alrededor del pivote 62) y las dos mordazas cooperantes 23 y 24, esta últimas con un movimiento solidario y actuando por tanto como un solo elemento. La figura 1 1 muestra la posición de apertura de las mordazas cooperantes 23 y 24. Para conseguir alcanzar la posición mostrada en la figura 11 desde la posición mostrada en la figura 10 basta con desplazar solidariamente la varilla de accionamiento 60 y el tubo intermedio 56 hacia la parte proximal del instrumento. Este desplazamiento se consigue mediante el giro de la manilla pivotante 74. Cuando la manilla pivotante 74 se gira por la acción de la mano del cirujano alejándose de la parte fija 86 del mismo se produce la apertura de las mordazas cooperantes 23 y 24. Cuando la manilla pivotante 74 se gira acercándose a la parte fija del mango 86 se produce el cierre de ambas mordazas. El desplazamiento solidario de la varilla de accionamiento 60 y el tubo intermedio 56 desplaza la misma distancia el pivote 62 y 58 haciendo que las bielas 28 y 29 abran las mordazas cooperantes 23 y 24 tal y como se muestra en la figura 11 . En las figuras 12 a 14 se muestra los elementos que comprenden el mango 70 del instrumento, el ensamblaje con el mecanismo de enlace 50, y el funcionamiento de dicho subconjunto. La figura 12 muestra los elementos del mango 70 para una posición neutral y cerrada de la herramienta distal 21 , es decir, para la posición mostrada en la figura 8. La figura 12 muestra como el tubo prolongador 51 está enlazado con el mango 70 a través de su rebaje 54 en la pestaña 83 que la parte fija 71 dispone para tal efecto. Este enlace permite el giro del tubo prolongador 51 alrededor de la parte fija del mango 71 pero no su desplazamiento en la dirección axial. El montaje de la rueda de orientación 72 se produce en el rebaje 55 del tubo prolongador 51 . Mediante una pequeña ranura realizada en este rebaje 55 y un pequeño resalte realizado en la parte interna de la rueda de orientación 72 (no mostrados en las figuras) se produce el movimiento de rotación solidario de la rueda de orientación 71 y el tubo prolongador 51 . En la figura 12 también se observa el enlace entre el tubo intermedio 56 y el casquillo cilindrico 76. Este enlace se lleva a cabo mediante el rebaje 59 del tubo intermedio 56 y el resalte 77 del casquillo cilindrico 76 (representado en la figura 3). Figure 10 shows the scheme of the articulation section 20 in a manner similar to that shown in Figure 8, but in this case the distal tool 21 is articulated. In Figure 10 an intermediate position of articulation of about 75 ° it is shown, but this tool can be articulated in any position between 0 and 90 °. In order to produce the rotation of the distal tool 21 from its neutral position, shown in Figure 8, to the articulated position shown in Figure 10, only the displacement of the intermediate tube 56 has occurred, the actuating rod 60 remaining static. to achieve this movement, the articulation wheel 73 located in the fixed part 71 of the handle 70 is rotated, the orientation wheel 72 and the pivoting handle 74 remain motionless. This movement causes the intermediate tube 56 to move towards the distal area of the instrument. The intermediate tube 56 in turn displaces the connecting rod 28 through the link formed by the pivot 58 and the cam 37. Therefore, the articulation movement is achieved in the articulation mechanism 22 by a mechanism equivalent to a quadrilateral formed by the connecting rod 28, the connecting rod 29, the rocker 30 (which rotates around the pivot 62) and the two cooperating jaws 23 and 24, the latter with a solidarity movement and therefore acting as a single element. Figure 1 1 shows the opening position of the cooperating jaws 23 and 24. In order to achieve the position shown in Figure 11 from the position shown in Figure 10, it is sufficient to move the actuator rod 60 and the intermediate tube 56 in solidarity towards the proximal part of the instrument. This displacement is achieved by turning the pivoting handle 74. When the pivoting handle 74 is rotated by the action of the surgeon's hand away from the fixed part 86 thereof the cooperating jaws 23 and 24 are produced. When the pivoting handle 74 is rotated approaching the part Fixed handle 86 causes the closure of both jaws. The joint displacement of the drive rod 60 and the intermediate tube 56 moves the same distance between the pivot 62 and 58 causing the connecting rods 28 and 29 to open the cooperating jaws 23 and 24 as shown in Figure 11. Figures 12 to 14 show the elements comprising the handle 70 of the instrument, the assembly with the link mechanism 50, and the operation of said subset. Figure 12 shows the handle elements 70 for a neutral and closed position of the distal tool 21, that is, for the position shown in Figure 8. Figure 12 shows how the extension tube 51 is connected with the handle 70 through of its recess 54 in the flange 83 that the fixed part 71 has for this purpose. This link allows the extension tube 51 to rotate around the fixed part of the handle 71 but not its displacement in the axial direction. The mounting of the orientation wheel 72 occurs in the recess 55 of the extension tube 51. By means of a small groove made in this recess 55 and a small projection made in the internal part of the orientation wheel 72 (not shown in the figures), the movement of integral rotation of the orientation wheel 71 and the extension tube 51 is produced. Figure 12 also shows the link between the intermediate tube 56 and the cylindrical bushing 76. This connection is carried out by means of the recess 59 of the intermediate tube 56 and the shoulder 77 of the cylindrical bushing 76 (shown in Figure 3).
Por otro lado, la conexión entre el casquillo cilindrico 76 y la varilla de accionamiento 60 se produce a través de las zonas roscadas 78 y 63 del casquillo cilindrico 76 y la varilla de accionamiento 60, respectivamente. La rueda de articulación 73 se monta concéntricamente sobre el casquillo cilindrico 76 de forma que su giro es solidario pero pueden desplazarse uno con respecto al otro en la dirección longitudinal. Mediante esta configuración, cuando la rueda de articulación 73 gira respecto del eje longitudinal del mecanismo de enlace 50 se produce la articulación de la herramienta distal 21 respecto de un eje perpendicular al eje longitudinal del instrumento 10. On the other hand, the connection between the cylindrical bushing 76 and the drive rod 60 is produced through the threaded zones 78 and 63 of the cylindrical bushing 76 and the drive rod 60, respectively. The articulation wheel 73 is concentrically mounted on the cylindrical bushing 76 so that its rotation is integral but can move relative to each other in the longitudinal direction. By this configuration, when the articulation wheel 73 rotates with respect to the longitudinal axis of the link mechanism 50, the articulation of the distal tool 21 with respect to an axis perpendicular to the longitudinal axis of the instrument 10 occurs.
La figura 13 muestra el movimiento de la manilla pivotante 74 para producir la apertura de la herramienta distal 21 en su posición neutra. Esta figura 13 se corresponde por tanto con la configuración de la herramienta distal 21 mostrada en la figura 9. Cuando la manilla pivotante 74 gira como se indica en la figura 13 la varilla de accionamiento 60 arrastra al tubo intermedio 56 mediante el casquillo cilindrico 76, produciendo la apertura de la herramienta distal. Figure 13 shows the movement of the pivoting handle 74 to produce the opening of the distal tool 21 in its neutral position. This figure 13 therefore corresponds to the configuration of the distal tool 21 shown in Figure 9. When the pivoting handle 74 rotates as indicated in Figure 13, the drive rod 60 drags the intermediate tube 56 through the cylindrical bushing 76, producing the opening of the distal tool.
La figura 14 muestra la configuración del mango fijo 71 cuando se produce la articulación de la herramienta distal 21 en su posición cerrada. La configuración mostrada en la figura 14 se corresponde con una posición de la herramienta distal similar a la mostrada en la figura 10. En este caso, el giro de la rueda de articulación 73 cuando la varilla de accionamiento 60 permanece estática hace que el casquillo cilindrico 76 desplace el tubo intermedio 56 una determinada distancia para producir la articulación de la herramienta distal 21 . Una vez la herramienta distal ha sido articulada el ángulo deseado, el giro de manilla pivotante 74 hace que las mordazas cooperantes 23 y 24 se abran o cierren en función del sentido de giro. En este caso la configuración de la herramienta abierta se corresponde aproximadamente con la figura 1 1 . Figure 14 shows the configuration of the fixed handle 71 when the articulation of the distal tool 21 occurs in its closed position. The configuration shown in Figure 14 corresponds to a position of the distal tool similar to that shown in Figure 10. In this case, the rotation of the articulation wheel 73 when the drive rod 60 remains static causes the cylindrical bushing. 76 move the intermediate tube 56 a certain distance to produce the articulation of the distal tool 21. Once the distal tool has been articulated the desired angle, the pivoting handle rotation 74 causes the cooperating jaws 23 and 24 to open or close depending on the direction of rotation. In this case, the configuration of the open tool corresponds approximately to Figure 1 1.
Para resumir el funcionamiento del instrumento quirúrgico 10:  To summarize the operation of surgical instrument 10:
— La rueda de orientación 72 produce la rotación (entre 0o y 360°) de la herramienta distal 21 alrededor del eje longitudinal del tubo prolongador 51 a base de actuar giratoriamente sobre éste. - Orientation wheel 72 produces rotation (between 0 or 360 °) of the distal tool 21 around the longitudinal axis of the extension tube 51 based on rotating on it.
— La rueda de articulación 73 produce la articulación (entre 0o y aproximadamente 90°) de la herramienta distal 21 alrededor de un eje perpendicular al eje longitudinal del tubo prolongador 51 a base de actuar giratoriamente sobre el casquillo cilindrico 76, el cual, al permanecer estática la varilla de accionamiento 60, se enrosca sobre ésta desplazando así el tubo intermedio 56. - The articulation wheel 73 produces the articulation (between 0 or approximately 90 °) of the distal tool 21 about an axis perpendicular to the longitudinal axis of the extension tube 51 based on acting rotatably on the cylindrical bushing 76, which, at the drive rod 60 remains static, it is screwed onto it thus displacing the intermediate tube 56.
— La manilla pivotante 74 produce la apertura y cierre de las mordazas de la herramienta distal 21 a base de desplazar linealmente la varilla de accionamiento 60, la cual, manteniendo estática la rueda de articulación 73, a su vez desplaza solidariamente el tubo intermedio 56 por medio del casquillo cilindrico 76. Aunque en la presente memoria sólo se han representado y descrito realizaciones particulares de la invención, el experto en la materia sabrá introducir modificaciones y sustituir unas características técnicas por otras equivalentes, dependiendo de los requisitos de cada caso, sin separarse del ámbito de protección definido por las reivindicaciones adjuntas.  - The pivoting handle 74 produces the opening and closing of the jaws of the distal tool 21 based on linearly displacing the drive rod 60, which, keeping the articulation wheel 73 static, in turn displaces the intermediate tube 56 jointly by means of the cylindrical bushing 76. Although only particular embodiments of the invention have been represented and described herein, the person skilled in the art will know how to introduce modifications and replace some technical characteristics with equivalent ones, depending on the requirements of each case, without separating of the scope of protection defined by the appended claims.

Claims

REIVINDICACIONES
1 . Instrumento para cirugía endoscópica que comprende un mango (70), una herramienta distal (21 ), un mecanismo de enlace (50), y un mecanismo de articulación (22) de la herramienta distal enlazado al mango por medio del mecanismo de enlace, caracterizado por el hecho de que el mecanismo de enlace (50) comprende un tubo prolongador (51 ) que aloja una varilla de accionamiento (60) y un tubo intermedio (56) dispuesto entre la varilla de accionamiento y el propio tubo prolongador, y el mecanismo de articulación (22) comprende un balancín (30), una biela corta (29) y una biela larga (28), de manera que la varilla de accionamiento se articula al balancín en un punto y cada biela se articula al balancín en un punto, siendo dichos tres puntos diferentes, y cada biela también se articula a la herramienta distal en un punto diferente de la misma, enlazándose además la biela larga al tubo intermedio por medio de un enlace de leva (37, 58), con lo cual una traslación del tubo intermedio relativa a la varilla de accionamiento produce la articulación de la herramienta distal alrededor de un eje perpendicular al eje longitudinal del tubo prolongador. one . An instrument for endoscopic surgery comprising a handle (70), a distal tool (21), a link mechanism (50), and an articulation mechanism (22) of the distal tool linked to the handle by means of the link mechanism, characterized by the fact that the link mechanism (50) comprises an extension tube (51) that houses a drive rod (60) and an intermediate tube (56) disposed between the drive rod and the extension tube itself, and the mechanism of articulation (22) comprises a rocker (30), a short connecting rod (29) and a long connecting rod (28), so that the actuating rod is articulated to the rocker at one point and each connecting rod is articulated to the rocker at a point , said three different points being, and each connecting rod is also articulated to the distal tool at a different point thereof, the long connecting rod being also linked to the intermediate tube by means of a cam link (37, 58), whereby a intermediate tube translation relative to the drive rod produces the articulation of the distal tool around an axis perpendicular to the longitudinal axis of the extension tube.
2. Instrumento según la reivindicación 1 , caracterizado por el hecho de que la biela larga (28) comprende una ranura de leva (37) y el tubo intermedio (56) comprende un pivote (58) orientado perpendicularmente al tubo prolongador (51 ) que actúa como palpador de dicha leva (37). 2. Instrument according to claim 1, characterized in that the long connecting rod (28) comprises a cam groove (37) and the intermediate tube (56) comprises a pivot (58) oriented perpendicularly to the extension tube (51) which acts as a probe of said cam (37).
3. Instrumento según la reivindicación 1 ó 2, caracterizado por el hecho de que la herramienta distal (21 ) comprende dos mordazas (23, 24), estando la biela corta (29) articulada a una de dichas mordazas (23) a través de un primer orificio (31 ) provisto en esta mordaza, y estando la biela larga (28) articulada a la otra mordaza (24) a través de un segundo orificio (32) provisto en esta mordaza, de modo tal que las mordazas (23, 24) están articuladas entre sí y al tubo prolongador (51 ) por medio de un pasador (25) que se aloja en un tercer orificio (26) de la mordaza (23) y en un cuarto orificio (33) de la mordaza (24), de manera que una traslación solidaria del tubo intermedio (56) y la varilla de accionamiento (60) produce la apertura o el cierre de dichas mordazas. 3. An instrument according to claim 1 or 2, characterized in that the distal tool (21) comprises two jaws (23, 24), the short connecting rod (29) being articulated to one of said jaws (23) through a first hole (31) provided in this jaw, and the long connecting rod (28) being articulated to the other jaw (24) through a second hole (32) provided in this jaw, such that the jaws (23, 24) are articulated with each other and to the extension tube (51) by means of a pin (25) that is housed in a third hole (26) of the jaw (23) and in a fourth hole (33) of the jaw (24), so that a solidary translation of the intermediate tube (56) and the rod of drive (60) causes the opening or closing of said jaws.
4. Instrumento según la reivindicación 3, caracterizado por el hecho de que, cuando las dos mordazas (23, 24) están cerradas, la recta que une los centros de los orificios primero (31 ), segundo (32), y tercero (26) o cuarto (33), forma un ángulo de sustancialmente 45 grados con el plano de cierre de las mordazas. 4. Instrument according to claim 3, characterized in that, when the two jaws (23, 24) are closed, the line joining the centers of the first (31), second (32), and third (26) holes ) or fourth (33), forms an angle of substantially 45 degrees with the closing plane of the jaws.
5. Instrumento según cualquiera de las reivindicaciones anteriores, caracterizado por el hecho de que el mango (70) comprende un primer accionamiento (73) para la articulación de la herramienta distal (21 ) alrededor de un eje perpendicular al eje longitudinal del tubo prolongador (51 ), y un casquillo (76) que está roscado sobre la varilla de accionamiento (60), es solidario en traslación al tubo intermedio y es solidario en rotación al primer accionamiento, de manera que al actuar giratoriamente sobre el primer accionamiento se produce una traslación del tubo intermedio relativa a la varilla de accionamiento. 5. Instrument according to any of the preceding claims, characterized in that the handle (70) comprises a first drive (73) for articulating the distal tool (21) about an axis perpendicular to the longitudinal axis of the extension tube ( 51), and a bushing (76) that is threaded on the drive rod (60), is integral in translation to the intermediate tube and is rotatably integral to the first drive, so that when acting rotatably on the first drive a translation of the intermediate tube relative to the drive rod.
6. Instrumento según la reivindicación 5, caracterizado por el hecho de que un rebaje (59) del tubo intermedio (56) está acoplado a una pestaña (77) del casquillo (76). 6. Instrument according to claim 5, characterized in that a recess (59) of the intermediate tube (56) is coupled to a flange (77) of the bushing (76).
7. Instrumento según cualquiera de las reivindicaciones 3 a 6, caracterizado por el hecho de que el mango (70) comprende un segundo accionamiento (74) para la apertura o el cierre de las mordazas (23, 24) que puede accionar la varilla de accionamiento (60), la cual está enlazada al tubo intermedio (56) a través del casquillo (76), de manera que, al actuar sobre el segundo accionamiento, la varilla de accionamiento desplaza el tubo intermedio por medio del casquillo y se produce una traslación solidaria de la varilla de accionamiento y el tubo intermedio. 7. Instrument according to any of claims 3 to 6, characterized in that the handle (70) comprises a second drive (74) for opening or closing the jaws (23, 24) that can actuate the rod of drive (60), which is connected to the intermediate tube (56) through the bushing (76), so that, when acting on the second drive, the drive rod displaces the intermediate tube by means of the bushing and there is a joint translation of the drive rod and the intermediate tube.
8. Instrumento según la reivindicación 7, caracterizado por el hecho de que el segundo accionamiento (74) es una manilla pivotante del mango (70). 8. An instrument according to claim 7, characterized in that the second drive (74) is a pivoting handle handle (70).
9. Instrumento según cualquiera de las reivindicaciones anteriores, caracterizado por el hecho de que el mango (70) comprende un tercer accionamiento (72) para la orientación del tubo prolongador (51 ) alrededor de su eje longitudinal. 9. Instrument according to any of the preceding claims, characterized in that the handle (70) comprises a third drive (72) for orientation of the extension tube (51) around its longitudinal axis.
10. Instrumento según la reivindicación 9, caracterizado por el hecho de que el primer accionamiento (73) y el tercer accionamiento (72) están montados sobre una parte fija (71 ) del mango (70). 10. An instrument according to claim 9, characterized in that the first drive (73) and the third drive (72) are mounted on a fixed part (71) of the handle (70).
1 1 . Instrumento según la reivindicación 10, caracterizado por el hecho de que la parte fija (71 ) comprende una manilla fija (86). eleven . Instrument according to claim 10, characterized in that the fixed part (71) comprises a fixed handle (86).
12. Instrumento según la reivindicación 10 u 1 1 , caracterizado por el hecho de que el tubo prolongador (51 ) es solidario en traslación a la parte fija (71 ) del mango (70). 12. An instrument according to claim 10 or 1, characterized in that the extension tube (51) is integral in translation to the fixed part (71) of the handle (70).
13. Instrumento según cualquiera de las características anteriores, caracterizado por el hecho de que el tubo intermedio (56) y la varilla de accionamiento (60) son solidarios en rotación al tubo prolongador (51 ). 13. Instrument according to any of the above characteristics, characterized in that the intermediate tube (56) and the actuating rod (60) are integral with rotation to the extension tube (51).
14. Instrumento según cualquiera de las características anteriores, caracterizado por el hecho de que comprende un conector eléctrico para la cauterización del tejido intervenido por la herramienta distal (21 ). 14. Instrument according to any of the above characteristics, characterized in that it comprises an electrical connector for cauterization of the tissue intervened by the distal tool (21).
15. Instrumento según cualquiera de las características anteriores, caracterizado por el hecho de que todos sus elementos transmisores de movimiento son sólidos rígidos. 15. Instrument according to any of the above characteristics, characterized by the fact that all its transmitting elements of Movement are rigid solids.
PCT/ES2010/070644 2009-10-07 2010-10-06 Instrument for endoscopic surgery WO2011042584A1 (en)

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