WO2015117175A1

WO2015117175A1 - Endoscopic cutting device

Info

Publication number: WO2015117175A1
Application number: PCT/AT2015/050039
Authority: WO
Inventors: Kadir TOSUN
Original assignee: Tosun Kadir
Priority date: 2014-02-05
Filing date: 2015-02-03
Publication date: 2015-08-13
Also published as: AT515317A4; AT515317B1

Abstract

The invention relates to an endoscopic cutting device (1) for dissecting human or animal bodily tissue (7), comprising a tube (2), a displacement element (3) received in said tube (2) and displaceable in the longitudinal direction of same, and a cutting grid (5) connected to the distal end (4) of said displacement element (3), with or without a cutting element (16) at its tip and with mesh openings arranged (6, 6a) therebetween, said cutting grid (5) being transferable between a first position arranged outside of the tube (2) for receiving at least one part of the tissue (7) to be dissected, and a second position arranged inside the tube (2), the tissue (7) being forced through the mesh openings (6, 6a) of the cutting grid (5) and dissected.

Description

Endoscopic cutting device

The invention relates to an endoscopic cutting device or in general a device for endoscopic tissue fragmentation (ETF ... endoscopic tissue fragmentation) for the fragmentation of tissue of the human or animal body, in particular for comminuting the prostate and endoscopically or laparoscopically recessed tissue.

Devices which serve the endoscopic comminution of tissue ^¬ pieces and the removal of the tissue pieces from the Operations ^¬ area, are known from the prior art.

Endoscopes allow basically an investigation or medi ^¬ ical procedures within the human or animal body and in particular be used for minimally invasive surgical procedures. Typical applications include, but are not limited to, the examination and treatment of the gastrointestinal tract, respiratory system, urinary system, or general body cavity procedures. Thus, endoscopic cutting devices are used for the removal of excess or diseased prostate tissue, with resectoscopes for performing an electrical resection and so-called morcellators, which chop up the tissue, being used for such operations. For transurethral resections one-carrying electrical current wire loop can be used to ablate diseased tissue of the prostate in layers, possibly gleichzei ^¬ tig occurring bleeding electrically deserted.

DE 101 64 808 AI discloses a urological resectoscope with an inner shaft and an outer shaft, both of which are formed tubular and made of metal. The shafts are sealed against each other in the distal end area. In the inner shaft a longitudinally movable electrode carrier is arranged, which carries at the distal end a loadable with high-frequency current cutting loop. This is pulled backwards against the distal cutting edge of the outer shaft for the cutting process under the RF current application. The inner and outer shafts serve to ^¬ the supply and removal of rinsing liquid.

From WO 2012/003966 AI an electrode arrangement for co- agulation of body tissue or body vessels known. In particular, band-shaped, can be acted upon with high-frequency voltage electrode pairs provided in their relaxed position by known Resektionsschäfte the site to be treated ^¬ led and there ^spanned substantially spherical, such as meridians ei ^¬ nes balloon.

WO 2012/095873 A1 relates to a laser device, inter alia for cutting or coagulating tissue.

With the devices known from the prior art, it is thus possible to dissect diseased tissue by means of lasers or electrical loops adapted for cutting tissue, or to remove them by means of electrode arrangements. In addition, Morcelators are equipped with various cutting devices for

Parting tissue is known. However, these devices have the disadvantage that their use can lead to complications due to injuries to healthy tissue, in the case of a prostate operation in particular the bladder, the ureter or the urethra. In particular, by not sufficiently precise guidance of said cutting means can be accidentally cut in adjacent to the surgical site areas.

The object of the invention is to provide a cutting device of the above-mentioned type which avoids or reduces the disadvantages known from the prior art. The

Cutting device should be easily and accurately positioned by means of a minimally invasive procedure at the surgical site and allow a cutting process that avoids injury to healthy tissue or healthy organs as far as possible. In addition, the cutting device should allow rapid surgery to keep the burden on the patient low, and be inexpensive to manufacture and use.

This object is achieved by an endoscopic cutting device of the type mentioned above, with a tube, a slidably received in the tube in the longitudinal direction of the displacement element and a member connected to the distal end of the displacement ^¬ elements cutting net arranged therebetween Mesh openings, wherein the cutting net is transferable between a first position located outside the tube for receiving at least a portion of the tissue to be divided and a second position disposed within the tube, wherein the tissue is forced and divided by the mesh openings of the cutting net. The cutting power can be placed in the first position at the surgical site in the body of the patient thus first in which it surrounds at least a part of the to zertei ^¬ lumbar tissue. Since the cutting grid is attached to the Verschiebungsele ^¬ ment, it can be pulled by applying a pulling force on the displacement member into the tube in which the displacement ^¬ element is slidably received. The connection or attachment of the cutting net takes place at the distal end of the displacement element, which is the intended for insertion into the body of the patient end. To the

To enable cutting operation, the tube has a correspondingly small inner diameter, so that by means of the transfer of the tissue-containing cutting net into the narrow tube or in the second position, the volume within the cutting net is reduced and the tissue is divided by the cutting net. The cutting device thus only divides the tissue received within the cutting net, so that injury to surrounding healthy tissue can be avoided. In addition, the division of the tissue to be removed into several parts is rapid and clean, generally by means of a single operation that forces the cutting net against and into the tube. The number of parts into which the fabric is divided depends on the design of the cutting net, in particular on the number and size of the mesh openings of the cutting net. The mesh openings are arranged between the cutting elements, at least partially making the cut, forming the cutting net, for example cutting threads. The divided tissue parts can then be removed in a manner known to those skilled in the art. The cutting net can be formed in its simplest embodiment as a loop which to

Dividing dividing tissue into two parts. When the cutting power, however, has three mesh sizes, which it preferably ^¬ is directed by the cutting power of the cut three effecting, extending in the longitudinal direction of the cutting network

Cutting threads or cutting elements, which at their respective ligen end points are connected to each other, the tissue to be divided is divided into three parts. Of course, the cutting net can have more than three, for example more than ten mesh openings. In particular, the cutting net does not have to have cutting elements extending transversely to its longitudinal direction, thus extending in the circumferential direction, although this may be preferred depending on the particular application of the cutting device. The tube is preferably part of prior art resectoscopes or morcellators, so that no separate production of the tube is required. The endoscopic cutting device according to the invention can thus ^¬ with, for example, in the case of Prostataenukleation (HoLEP ... Holmium Laser Enucleation of the Prostate or TULEP ... transurethral Lasernukleation of the prostate), where two or three pieces of the prostate tissue ^¬ be flushed into the bladder to completely replace the use of morcellators. The use of such tubes also has the advantage that the doctor is already familiar with the hand ^¬ tion of the endoscopic tube. The slidably received in the tube in its longitudinal direction displaceable element is preferably formed in the form of a rod or a shaft. When reference is made in the following to the uptake and disintegration of parts of the tissue to be divided, this naturally also includes a picking and dividing of the entire tissue to be divided.

One sees the inclusion of the tissue to be cut from favoring ^¬ leadership form before that the cutting power is directly connected to the displacement member, and from

Displacement element arranged remote mesh openings of the cutting net smaller than the displacement element close to ^¬ arranged mesh openings are formed, between which close mesh openings in the first position of the cutting net, the part of the tissue to be divided is receivable. The cutting net thus has different sized mesh openings, wherein the mesh size near the Verschiebungsele ^¬ ment is greater than far away from the displacement element. The Separating to tissue can thus be received between the larger Maschenöff ^¬ calculations and during the transfer of the

Cutting net into the pipe, at least for the most part, through a part of the cutting net which has the smaller mesh sizes. points, be parted. The cutting net is in this case connected directly to the displacement element.

An alternative imple mentation form provides that between the cutting net and the displacement element connecting elements are arranged to, between which connecting elements in the ers th position of the cutting net, the part of the tissue to be divided is receivable. In contrast to a direct connection of the cutting net with the displacement element are in the execution of this form between these at least two

Provided connecting elements, preferably similar or the same thin as the cutting threads or cutting elements of the

Cutting network are formed. In this way, the tissue to be divided can be introduced between the connecting elements and placed within the cutting net. In order to facilitate the Aufnah me the tissue between the connecting elements and yet transmit the forces applied to the displacement element tensile ^¬ forces on the cutting net can be seen preferably three or four such fasteners before. The connecting elements can also be made in one piece with the cutting net, in particular of the same material. The mesh openings of the cutting net are formed smaller than the openings formed between the connecting elements Publ.

If the cutting net is releasably verbun with the displacement element, the tissue to be divided can be particularly easily introduced into da cutting network. For this purpose, the cutting net initially separated from the displacement element is placed over the fabric or around the fabric and then reconnected with the displacement element in a suitable manner in order to be pulled into the pipe by means of the displacement element. The positioning of the cutting net may be similar to the placement of bucket used in surgery. For connection to the cutting net, the displacement member may have a hook or other equally suitable connection means at the distal end. Especially in the case of laparoscopic procedures, in which often larger pieces of tissue are to be cut, the provision of a detachable connection with the displacement element, the introduction of the tissue into the cutting net facilitate. If the cutting net is connected via connecting elements with the displacement element, in particular the connecting elements can be releasably connected to the displacement element verbun ^¬ .

Alternatively, the cutting net and / or the connecting elements may be formed integrally with the displacement element and preferably have the same material. For example, the displacement element may be formed as an extension of the cutting net or the connecting elements in the form of a rod or a shaft. In this way, the displacement ^¬ element must not be designed as a separate element.

In the case of arranged between the cutting net and the displacement element connecting elements or a releasably connectable to the displacement element cutting network, it is particularly advantageous if the mesh openings of the cutting net in We ^¬ sentlichen are the same size. To follow all mesh sizes for the division of the tissue may be appropriately sized in equal parts in materiality ^¬ union.

It is particularly advantageous if the cutting net or the Ma ^¬ openings is symmetrical angeord ^¬ net around the lying substantially in the extension of the tube longitudinal axis of the cutting net /, as this the cutting net can be easily made.

For a simple possible removal of at least part of the divided pieces of tissue from the hollow organ or from the surgical site through the tube at least a part of the Maschenöff ^¬ voltages of the cutting grid are smaller than the inner diameter of the tube. Particularly preferred are all ene mesh openings of the cutting network through which the Ge ^¬ tissue is forced during the cutting process, formed smaller than the inner diameter of the tube.

Particularly advantageous for the fragmentation of tissue is when the network consists of cutting wire because both the wire erforder ^¬ Liche tensile strength than can be produced according to thin for a simple cutting operation. In particular, the wire may be surgical steel or titanium wire and may be easily cleaned to meet the stringent hygiene and sterile operating conditions. Of course, the wire may also be made of other materials, such as copper or other metals.

The cutting process can be additionally facilitated and thus the patient can be spared, if the wire is sharp-edged. For this purpose, the wire may have a different cross-section from a round shape, for example a triangular or square cross-section. In addition, or alternatively, the wire can be similar to a saw blade at least partially serrated be oriented ^¬ forms.

The cutting net can be particularly easily inserted through the tube into the body and handle for receiving the tissue to be divided when the wire is elastic. Due to the elastic training unintentional, manually correcting deformations of the cutting network in the hollow organ, wel ^¬ che complicate the uptake of the tissue in the cutting net Wür ^¬ the, avoided. In particular, the wire may have such elastic properties that it unfolds balloon-like after emerging from the tube, whereby the tissue can be easily introduced into the resulting interior of the balloon without first having to develop the cutting net in a separate step.

According to a further preferred embodiment of the present invention, the cutting net has at least partially an electrically conductive material. In this way, the cutting operation can be assisted by the electrical current flowing through the conductive material and through the tissue to be divided. In addition, any bleeding occurring due to the cutting process can be largely stopped. The electrically conductive material may be on the cutting grid is arranged ^¬ completely, in particular the cutting power can be coated therewith.

If the electrically conductive material or the wire is electrically is connected electrically conductively connected to a power connection, the at least partially current-conducting cutting network can be easily and kos ^¬ tengünstig formed. The electric current flows in this case, as in unipolar resectoscopes to a arranged outside the operating area counter electrode. It should be pointed out ^¬ represents that the wire is either sufficiently electrically conductive itself, or comprises electrically conductive material.

To guide shape to avoid in an alternative from a current flow through the patient's body to a counter electrode, the electrically conductive material or wire vonein ^¬ other in an electrically insulated sections, which ^¬ are tend each connected to a power terminal electrically lei. In this way, the flow assisting the mechanical cutting process flows through the tissue, as in the case of bipolar resectoscopes, between sections which are electrically insulated from one another and which are each connected to different power connections. This embodiment, which has the connection of mutually insulated sections, each with a power connection, is in particular ^¬ special in patients with pacemakers advantageous because there is a lower risk of interaction.

In order to handle the cutting device easy and to simplify the operation process in the hollow organ, the tube can be flexible. In comparison to a rigid tube, the positioning of the cutting network to the tissue to be cut and the receiving of the fabric may be in particular in association ^¬ fanned. The flexibility is advantageous only in the longitudinal direction of the tube; The dimensions of the inner diameter of the pipe should be as constant as possible.

The cutting process can be additionally assisted by the cutting net being connected to a device for displacing the cutting net in vibration. For example, the vibration-causing device with the displacement ^¬ element be directly mechanically connected, which in turn is stable enough connected to the cutting net to transmit the vibration to the cutting net. The device preferably has adjustment means for determining the amplitude and the frequency of the Adjust vibration according to the particular application. The frequency of the vibration may be in particular in the ultrasonic range, ie above 16 kHz.

In order to remove the crushed tissues and as simple as possible for the patien ^¬ th gently from the hollow organ, is provided in a further guide form from an connected to the tube or with a tube insertable into the suction hose for sucking the divided tissue. If the suction device is connected to an insertable into the tube tube, this tube is formed as thin as possible in order to suck the divided pieces of tissue through the tube can. Generally, the inner diameter of the tube or hose is to be formed large enough to be able to aspirate the tissue fragments, whose size is determined at least in cross section through the mesh size of Schneidnet ^¬ zes from the hollow organ. In the context of the invention, the suction device also means devices for flushing out the tissue pieces. The suction device may in particular be a syringe or known from the prior art evacuator having (eg evacuator according Ellik Fa. Optec Endoscopy Systems GmbH), which are connected to a resectoscope, to flush out the tissue fragments from the Ope ^¬ rationsstelle.

The cutting device may be used particularly advantageously ^¬ the when the cutting network, preferably facing away from the distal end of the displacement member end comprises a Schneidele ^¬ ment for enucleation or for cutting tissue. In this way, the cutting device can be used both for enucleation or peeling or for cutting tissue as well as for cutting tissue with the cutting net, whereby the operation process can be simplified and accelerated if necessary. The Schneidele ^¬ ment is designed to suit this, with different

Cutting nets may have different cutting elements. For example, the cutting element may be formed spoon-shaped and curved in the longitudinal extension is ^¬ ner. Likewise, the cutting element may have two substantially parallel to each other, preferably curved before ^¬ wires or metallic tips. In order to avoid contamination of the cutting device or parts thereof prior to application to the patient, it is advantageous if the tube, the displacement element and the

Cutting network of the endoscopic cutting device are arranged in a preferably sterile packaging.

For the dissection of tissue of the human or animal body with an endoscopic cutting device as described above, the cutting net is placed in a first position located outside the tube for receiving at least a portion of the tissue to be divided, at least the portion of the tissue to be divided into the tissue Cutting net received, and transferred the cutting net in a second angeord ^¬ nete within the tube ^¬ position, wherein the tissue is forced through the Maschenöff ^¬ openings of the cutting net and divided.

If in an off form the cutting guide network is directly connected to the displacement member and having larger near the shift ^¬ element mesh as the remote Verschiebungsele ^¬ ment, the portion of the tissue to be cut

received between the arranged near the displacement element mesh openings in the first position of the cutting net.

If, however, are in another disclosed embodiment, between the cutting grid and the displacement member connecting elements at ^¬ sorted, the portion of tissue to be cut, before ^¬ preferably first in between the connecting members

Position of the cutting net added.

The cutting power need not be fixedly connected necessarily with the displacement ^¬ advertising element. Therefore, if prior to transferring the cutting net into the tube, the part of the tissue to be divided is arranged in the separate from the displacement element

Cutting net is added and the cutting net is connected to the displacement element, the tissue to be divided can be particularly easily introduced into the cutting net.

In order to be able to avoid the step of connecting the cutting net containing the at least part of the tissue to be divided with the displacement element, it is advantageous if the Cutting net is connected to the displacement element and is transferred through the tube into the first, arranged outside the tube position for receiving at least the part of the tissue to be divided. Preferably, the cutting net is designed for this purpose elas ^¬ table.

In the event that the cutting net at least partially an elec ^¬ trically conductive material, such as wire, it is advantageous to support the cutting action of the cutting net, if the electrically conductive material or the wire before transferring the cutting net in the second within the tube arranged position is electrically conductively connected to a power supply.

In contrast, if the electrically conductive material or wire having mutually electrically insulated portions, it is be ^¬ Sonders advantageous if the sections are electrically conductive prior to transferring of the cutting system in the second arranged within the tube Po ^¬ sition, each having a power connector ver ^¬ connected ,

In order to assist the cutting action of the cutting network, the cutting power can be connected to the second tube disposed within the position with a ^¬ A device for displacing the cutting network in vibration before the transferring of the cutting network.

In order to be able to remove the divided pieces of tissue from the surgical site, a suction device for sucking the divided tissue is advantageously connected to the tube or to a tube insertable into the tube.

If to be made with the cutting network also enucleation or coring or enucleation or the cutting of tissue, in the pipe a cutting power is introduced, which, preferably abgewand ^¬ th at its distal end of the displacement member end, a cutting element for enucleation or fragmentation of Having tissue. In order to avoid an unfavorable for the execution of the enucleation twisting of the cutting network ent ^¬ neither a cutting power can be used accordingly resistant material be, or the cutting net is pushed out during enucleation only so far out of the tube that only the cutting element protrudes from the tube. For example, with one and the same cutting device, this would allow both the transurethral prostate enucleation with the cutting element at the tip and the fragmentation of the enucleates with the cutting net.

Depending on the design of the cutting net, the divided pieces of tissue have corresponding dimensions. A From ^¬ suck the divided tissue substantially through the tube even in the case of divided tissue pieces to allow a large size, the process of fragmentation of tissue of the human or animal body may, after the cutting of at least a part of the to Separating fabric with an endoscopic cutting device can be additionally applied to the divided tissue pieces.

Although reference is made in the description of, inter alia, to the removal of prostatic tissue, the endo ^¬ scopic cutting device can also be applied in the context of laparoscopic procedures, for example by supplying C0 ₂ gas through the tube. Furthermore, can be used in both laparoskopi ^¬ rule procedures and in the mountains Prostataenukleation bags that catch the shredded tissue. In the case of malignant tissue where should be no contact with other tissues because of the risk of metastasis, the Zer ^¬ kleinerung could take place directly in the extraction bag. Here, the tissue could be introduced in a conventional manner in a Bergebeutel, preferably introduced flexible tube directly into the rescue bag and after sealing and filling the Bergebeutels with gas or a liquid comminution with the cutting net are made directly in the Bergebeutel. The shredded tissue pieces can either be aspirated as described above or taken out with the rescue bag. Advantageously, with this process, no editing would be necessary. For the tight connection with the possible recovery bag, the tube may have, for example, arranged on the outer circumference clamping devices.

The invention will be described below with reference to preferred, not restricting embodiments with reference to the drawings even further explained. Show it:

1 shows an endoscopic cutting device with a first imple mentation of a cutting network.

FIG. 2 shows an endoscopic cutting device with a second embodiment of a cutting net; FIG.

Fig. 3 shows the endoscopic cutting device of Fig. 1 during the dicing of the tissue;

4 shows the tube of the endoscopic cutting device with a suction device;

5 shows an endoscopic cutting device with a third embodiment of a cutting net; and

Fig. 6 shows a disclosed embodiment of a cutting network which is a ^¬ lumps formed with connecting elements and a displacement member.

It should be noted that the drawings, in particular various parts of the illustrated objects, for the purpose of clarity not necessarily to scale Darge ^¬ represents are.

Fig. 1 shows an endoscopic cutting device 1 with a tube 2, a slidably received in the tube 2 in the longitudinal direction thereof displacement element 3 and connected to the distal end 4 of the displacement element 3 cutting net 5 with mesh openings arranged therebetween 6. The cutting net 5 is in one first, arranged outside the tube 2 position for receiving at least a portion of the tissue to be divided 7 shown. In order to accommodate the tissue 7, are arranged between the cutting system 5 and the displacement member 3 Verbindungsele ^¬ elements 8, which are spaced sufficiently far apart to the to Separating fabric 7 einzubrin ^¬ gene between them. The measures provided for the fragmentation of the fabric 7 Mesh openings 6 of the cutting net 5 can be substantially the same be formed large or, as shown in Fig. 1, ^{voneinan ¬ have} different sizes.

Another embodiment of the cutting net 5 is illustrated in FIG. 2, in which the mesh openings 6a of the cutting net 5 remote from the displacement element 3 are smaller than the mesh openings 6b located close to the displacement element 3. This design allows the Recordin ^¬ me of the part to be cut of the tissue 7 between the closely arranged meshes openings 6b, so that no Verbindungsele ^¬ elements 8 for connection of the cutting network 5 to the end of the shift Ver ^¬ elements 3 are required.

For the division of the fabric 7, the cutting net 5 located in the first position according to FIG. 1 or FIG. 2 is moved in the direction of the tube 2 and into it, whereby the tissue 7 is forced through the mesh openings 6, 6a of the cutting net 5 thus divided. In particular, that will

Cutting net 5 pulled by means of the displacement element 3 in the tube 2.

The process of dicing is shown in Fig. 3, in which the cutting net 5 was only partially pulled into the tube 2, whereby the fabric 7 was initially only cut and not yet completely divided. During the cutting power is drawn into the tube 2 5, the cutting of the fabric 7 is carried out essentially by the distance from the displacement member 3 is arranged ^¬ part of the cutting network 5 so that the sliced tissue 7 through the mesh openings 6 passes. An exemplary, already cut in and passing through the mesh openings 6 through tissue part is denoted by 7a. If, instead of the cutting net of Fig. 1 that of Fig. 2 is used, the fabric 7 is also mainly forced by the narrower or from the displacement element 3 remote mesh openings 6a. Thereby have at least most of divided tissue pieces 7b has a smaller cross section than the Ver ^¬ shift element 3 disposed close mesh openings 6b.

The embodiments of the cutting nets 5 are not limited to the examples shown in FIGS. 1 and 2, so that Also cutting nets 5 can be used, which break the tissue 7 in only a few, correspondingly large parts. Selbstver ^¬ Naturally, the endoscopic cutting device 1 can be used with different cutting networks. 5 The cutting net 5 is detachably or fixedly connected in the region of the distal end 4 of the displacement element 3.

As can be further seen from Fig. 1, the cutting net 5 may be electrically connected to a power terminal 9a to assist the mechanical cutting by the flow of electric current. For this purpose, the cutting net 5 at least partially on an electrically conductive material. In particular ^¬ sondere, the cutting power the electrically conductive material having 5 mutually electrically insulated portions 10a, 10b having electrically conductively connected with a respective power connection 9a, 9b. In order to assist the cutting process, the cutting net 5 can additionally or alternatively be connected to a device 11 for displacing the cutting net 5 in vibration in order to be supported by electric current.

FIGS. 1 and 2 also show an optional cutting element 16 for enucleation or for cutting tissue on the end 17 of the cutting net 5 facing away from the distal end 4 of the displacement element 3. In the illustrated embodiment, the cutting element 16 is spoon-shaped and / or blade-shaped also partially curved along its longitudinal extent. Here, FIG. 1 shows the cutting ^element 16 in a side view, while FIG. 2 represents its view from above. However, the cutting element 16 may also have any other suitable for Enuklea ^¬ tion or gutching or Ausschälung or for cutting tissue shape.

Fig. 4 shows a suction device 13 for sucking the divided tissue 7 b, which introduced with a in the tube 2

Hose 12 is connected. However, the suction device 13 may also be connected directly to the tube 2, whereby advantageously a larger cross-section or inner diameter D is available for suction. In Fig. 5 is a particularly simple imple mentation form of

Cutting net 5 shown, in which the cutting net 5 has three mesh openings 6. The cutting system 5 is for this purpose made up of three the cut effecting cutting elements 15, in particular cutting threads or cutting wires arranged side by side and are connected together at their respective opposite end points 14, 14 ', so that the tissue can be divided in three Tei ^¬ le. 7 One of the connection points of the Schnei ^¬ delemente 15 of the distal end 4

Displacement element 3 connected. Of course, the cutting net 5 in a similar imple mentation form only two or more than three such cutting elements 15 have.

Another embodiment of a cutting net 5 is apparent from FIG. 6, which shows the cutting net 5 formed in one piece with connecting elements 8 and a displacement element 3.

Claims

Claims:

1. Endoscopic cutting device (1) for the fragmentation of tissue (7) of the human or animal body, with a tube (2), a slidably received in the tube (2) in its longitudinal direction displacing element (3) and one with the dista ^¬ len end (4) of the displacement member (3) connected to the cutting ^¬ network (5) disposed therebetween mesh openings (6, 6a), wherein the cutting network (5) between a first outside the tube (2) arranged in position for receiving at least a portion of the to dividing fabric (7) and a second within the tube (2) arranged position, wherein the fabric (7) through the mesh openings (6, 6a) of the cutting net (5) is forced and divided.

2. Cutting device (1) according to claim 1, characterized in that the cutting net (5) is directly connected to the Verschiebungsele ^¬ ment (3), and the displacement of the element (3) arranged remote mesh openings (6a) of the cutting net (5) smaller which the shift element (3) close to being arrange ^¬ th mesh openings (6b) are designed as, between which arranged close mesh openings (6b) in the first position of the cutting network (5) of the part of to be cut fabric (7) is receivable.

3. Cutting device (1) according to claim 1, characterized in that between the cutting net (5) and the Verschiebungsele ^¬ ment (3) connecting elements (8) are arranged between which connecting elements (8) in the first position of the cutting net (5) the portion of the tissue to be cut (7) is on ^¬ nehmbar.

4. Cutting device (1) according to one of claims 1 to 3, characterized in that the cutting net (5) is releasably connected to the displacement element (3).

5. Cutting device (1) according to one of claims 1 to 3, characterized in that the cutting net (5) and / or the connecting elements (8) are formed integrally with the displacement element (3) and preferably the same material aufwei- sen.

6. Cutting device (1) according to claim 3 or 4, characterized in that the mesh openings (6, 6a) of the Schneidnet ^¬ zes (5) are formed substantially the same size.

7. Cutting device (1) according to one of claims 1 to 6, characterized in that at least a part of the Maschenöffnun ^¬ gene (6, 6a) of the cutting net (5) smaller than that

Inner diameter (D) of the tube (2) are.

8. Cutting device (1) according to one of claims 1 to 7, characterized in that the cutting net (5) is made of wire be ^¬ .

9. Cutting device (1) according to claim 8, characterized in that the wire is sharp-edged.

10. Cutting device (1) according to claim 8 or 9, characterized in that the wire is elastic.

11. Cutting device (1) according to one of claims 1 to 10, characterized in that the cutting net (5) at least partially ^{¬ has} an electrically conductive material.

12. Cutting device (1) according to claim 11, characterized in that the electrically conductive material or the wire is electrically conductively connected to a power connection (9a).

13. Cutting device (1) according to claim 11, characterized in that the electrically conductive material or the wire from each other electrically insulated portions (10a, 10b), which are electrically connected to a respective power connector (9a, 9b).

14. Cutting device (1) according to one of claims 1 to 13, characterized in that the tube (2) is flexible.

15. Cutting device (1) according to one of claims 1 to 14, characterized in that the cutting net (5) is connected to a device (11) for displacing the cutting net (5) in vibration.

16. Cutting device (1) according to one of claims 1 to 15, characterized in that with the tube (2) or with egg ^¬ nem in the tube (2) insertable hose (12) connected to the suction device (13) for sucking the divided Tissue (7b) is provided.

17. Cutting device (1) according to one of claims 1 to 16, characterized in that the cutting net (5), preferably at its the distal end (4) of the displacement element (3) facing away from the end (17), a cutting element (16) Enucleation or cutting tissue has.

18. Cutting device (1) according to one of claims 1 to 17, characterized in that the tube (2), the Verschiebungsele ^¬ ment (3) and the cutting net (5) are arranged in a preferably sterile packaging.