WO2000059392A1

WO2000059392A1 - Surgical instrument

Info

Publication number: WO2000059392A1
Application number: PCT/EP2000/002908
Authority: WO
Inventors: Gerhard Buess; Ludger Schnieder; Klaus Roth; Heike Raestrup; Hans-Jörg SAILE
Original assignee: Erbe Elektromedizin; Gerhard Buess; Fischer Sabine Cecile; Ludger Schnieder; Klaus Roth; Heike Raestrup; Saile Hans Joerg
Priority date: 1999-04-01
Filing date: 2000-03-31
Publication date: 2000-10-12
Also published as: DE19915061A1

Abstract

Surgical instruments comprising a hook-shaped section are known. Said hook-shaped sections have a distal section with a free end and a proximal section which is connected to an actuating device. The invention is characterised in that the distal and the proximal sections are divided on a plane which runs substantially through the middle of the distal section, to form partial hooks. Said partial hooks are configured to be moved by the actuating device on an expansion plane, in such a way that the hook can be expanded in two parts.

Description

Surgical instrument

description

The invention relates to a surgical instrument according to the preamble of patent claim 1.

The preparation, dissection and hamostasis are steps of an operation that are currently still being carried out using two or more different instruments. An instrument change is always associated with a time and organizational effort that complicates the operations and protracted.

The implementation of minimally invasive operations requires, due to the restricted view of the operating field, particularly suitable procedures for the dissection of vascular structures. Stopping bleeding that may occur is significantly more difficult in minimally invasive surgery because of the indirect access to the operating field than in open surgery, making prophylactic hemostasis all the more important.

The energy required for thermal hamostasis can be introduced into the tissue using laser radiation, ultrasonic vibration or high-frequency current. Up to now, laser technology has been too expensive and complex and has therefore only gained importance for special applications, such as in ENT and neurosurgery.

Ultrasound detectors are increasingly used in operations and have led to a significant improvement in surgical technology for a number of applications. Laser and ultrasound applicators are very expensive to buy. A number of safety measures must also be taken when using lasers.

In hamostasis using high-frequency current, the high-frequency current can be coupled both monopolar and bipolar ^. The monopolar application has that

Disadvantage that the current flows from the applicator through the patient to the neutral electrode and in this way thermal damage can occur to tissues on which no energy input was actually intended. 0

Scissors or pliers are used for bipolar application, the current being limited to the tissue between the two electrodes. Such a device is known, for example, from DE 44 21 822 Cl, a knife being provided for cutting S tissue. Both the structure and the handling of the known surgical instrument are expensive. It is almost impossible to prepare tissue using the instrument.

The object of the invention is to enable a combination of the functions preparation, dissection and hamostasis with the simplest possible means. This object is achieved by a surgical instrument according to claim 1.

A first essential point of the invention is that a blunt preparation by means of a hook-shaped

Instrumentes and a spreading of tissue with this one instrument is made possible in a simple manner. This makes operations considerably easier. Preferably, at least one pressure device 0 is provided, which is connected to the actuation device and comprises a pressure element fastened to a holding element, which can be pressed on at least one of the distal partial sections to clamp tissue or the like in a movement substantially perpendicular to the spreading plane. This will make another one

Preparation possibility created. Two pressure devices, each with a pressure element, are preferably provided, each of which can be pressed onto a distal section. In this case, the pressure devices are preferably designed to simultaneously press the two pressure elements onto the distal sections, which facilitates the handling of the instrument.

The pressure elements are preferably complementary, preferably shell-shaped, that they can be pressed flat against the distal sections. In this way, a high holding force is ensured despite the low surface pressure.

) A cutting device connected to the fastening device is preferably provided, which can be passed between the distal partial sections in such a way that tissue lying on the spread partial hook can be severed is. So you can use the instrument to prepare, then grasp and pull apart the tissue and then cut.

Electrical electrode devices are preferably provided at least on the distal sections, which are connected to a controllable current source in such a way that a coagulation current can be supplied to tissue lying on the hook. This can cause hamostasis.

If pressure elements are provided, then both pressure elements and hooks are attached to them

Electrode devices are provided, which are connected to a controllable current source, so that a coagulation current can be supplied, preferably when the hook is spread, in each case between a distal section and a pressure element for coagulation of tissue sections clamped between the distal section and the pressure element. Tissue or a blood vessel can thus be coagulated simultaneously at two spaced apart locations. After such coagulation, the coagulation sites can be severed without risk of bleeding. So now the most important functions such as blunt dissection, prophylactic and acute hemostasis, coagulation and

Separation united in one instrument. This enables continuous work without having to change instruments. The use of high-frequency current as an energy source and its supply via bipolar electrodes has various advantages. For one are

High frequency generators are standard in all well-equipped operating theaters. The energy input is still on that between the electrodes Tissue limited. Finally, the success of the coagulation can be assessed and controlled accordingly by recording and evaluating the electrical parameters current and voltage and the impedance of the tissue derived therefrom.

Preferably, the distal sections are mirror-symmetrical with rounded surfaces on their sides facing away from one another in such a way that at least the distal section of the hook has smooth outer surfaces in the unexpanded state. This allows the

Prepare instrument tissue particularly securely without the risk of causing lesions. After preparation, a portion of the tissue is loaded onto the hook and stretched or spread, then bipolar coagulated and finally cut. The aim here is to allow the coagulation to last only until the vessels contained in the charged tissue are closed. Effects (such as carbonization) that occur when the vessel is excessively heated should be avoided. This is achieved by means of a correspondingly controlled or controlled (or, for example, regulated via the impedance) interruption of the energy supply by the generator before the tissue finally dries out. Furthermore, the construction enables hemostasis on stumps and in the case of small, extensive bleeding.

The actuating device preferably comprises a distal hollow rod-shaped section with a substantially smooth outer surface, in which at least one proximal section is movably mounted. Such a structure can be manufactured with small dimensions. If pressure elements are provided, the actuation device likewise comprises a distal hollow rod-shaped section with an essentially smooth outer surface, in which on the one hand at least one proximal section and on the other hand the holding elements of the

Pressure elements are movably mounted. The construction becomes particularly simple when one of the two proximal sections is firmly attached to the hollow rod-shaped section, while the other section is movable for this purpose. The holding elements are preferably axially displaceable in the hollow rod-shaped section such that the pressure elements can be retracted up to or even into the hollow rod-shaped section. This creates a hook instrument that is particularly well suited for preparation.

The hook elements are preferably guided relative to the proximal sections such that the pressure elements come into contact with the distal sections when the hook is spread at least when the hook is axially displaced. This inevitable connection of the movements thus creates two forceps-like instruments by means of which tissue can be gripped (and coagulated) safely.

Preferred embodiments of the invention result from the subclaims.

The invention is explained in more detail below with the aid of an exemplary embodiment, which is described with the aid of the attached figures. Show here

Fig. 1 shows an embodiment of the invention closed hook,

Fig. 2 shows the arrangement of FIG. 1 with the hook spread

s Fig. 3 the embodiment according to FIGS. 1 and 2 with pressure devices applied to the partial hooks and

Fig. 4 shows the arrangement of Figures 1 to 3 with the cutting device extended for severing 10 tissue

In the following description, the same reference numerals are used for the same and equivalent parts.

As shown in FIG. 1, the embodiment of the surgical instrument according to the present invention comprises a hollow rod-shaped section 40, which leads to holding and actuating elements (not shown here) on a proximal section. 0

From the distal end of the hollow rod-shaped section 30 shown here in the figures, a hook-shaped section 10 projects, which has a proximal section 12 and a distal section 11 projecting vertically upward therefrom

2 ^ includes a free end 13. The hook-shaped

Section 10 consists of a first partial hook 10 ^λ and a second partial hook 10 ^{λ x} , these partial hooks 10, 10 ^λ each having essentially identical distal partial sections 11 ^λ , 11 ^{λ λ} and proximal partial sections 12,

V ^{) have} 12 ^x . The distal sections 11 ^λ , 11 ¹¹ are designed as half-truncated cones in the embodiment shown here, the outer surfaces 14 ', 14 ^{λ being} rounded off to form this truncated cone. The way trained hook is suitable (in the position shown in Fig. 1) for blunt dissection like a "normal" preparation hook.

In the embodiment shown here, one of the proximal sections 12 ^{λ of} the first partial hook 10 ^{λ is} firmly connected to the hollow rod-shaped section 40, while the other proximal section 12 ^{x λ of} the second partial hook 10 ^ compared to the first proximal section 12 ^Λ or to the first Partial hook 10 ^{λ can be} pivoted such that the distal sections 11, 11 ^λ can be moved apart from the folded position shown in FIG. 1 into a spread position shown in FIGS. 2-4.

Furthermore, in the embodiment shown here, excellent pressure devices 20 ^λ , 20 ^{λ λ} are arranged displaceably from the hollow rod-shaped section 40 along the axis of the hollow rod-shaped section 40. The pressure devices 20, 20 ^{λ λ} comprise a holding element 21 ^λ , 21 protruding from the hollow rod-shaped section 40 and at the end of each a pressure element 22 ^v , 22 ^λ . The pressure elements 22, 22 ^{Λ Λ} have on their sides facing the partial hooks 10, 10 ^λ rounded surfaces which are shaped such that when the pressure elements 20 ', 20 ^{λ are moved} out of the hollow rod-shaped section 40 in the direction of the hook-shaped section 10 come into contact with the distal sections 11 ^λ , 11 ^{λ x} , as is shown in particular in FIGS. 3 and 4.

Between the partial hooks 10, 10 ^λ or their proximal sections 12 ^λ , 12 ^vv and the pressure devices 20 ^λ , 20 ^{Λ λ is} a cutting device 30 arranged in the hollow rod-shaped section 40 so that it can move slowly (parallel to its axis), as is shown in particular in FIGS. 3 and 4. The extent to which the cutting device 30 can be pulled out of the hollow rod-shaped section 40 is such that in each case the plane between the hook-shaped sections 10 and the pressing devices 20 ^λ , 20 ^ is “broken through”.

From the above description in connection with FIGS. 1 to 4 it is clear that with the embodiment of the surgical instrument shown tissue (after blunt preparation) tissue can be picked up on the hook and 10 ^v , 10 ^{λ λ} spread apart by moving the partial hooks apart. Then you can clamp the captured tissue section by moving out the pressure device 20 ^λ , 20 ^λ (Fig. 3). By moving out the cutting device 30, the tissue piece that has been picked up and held in place can then be easily severed.

Preferably, electrodes are now provided on the distal sections 11, 11 'and the pressure elements 22 ^x , 22 as well as on the distal end (on the cutting edge) of the cutting device 30, which electrodes are connected to high-frequency generator devices (not shown here). Thus, when the above-described process has been carried out and a tissue section or a vessel has been picked up on the hook and in the position of the surgical instrument shown in FIG. 3 between the pressure elements 22 ^λ , 22 and the associated distal partial sections 11 ^v , 11 ^{λ of} the partial hook 10 ^x , 10 '' is clamped, the generators are controlled such that between a pressure element 21 or 22 ^λ and the associated counter electrode on distal section 11, 11 ^{λ x} flows a coagulation current that coagulates the tissue at this point. These are two bipolar coagulation devices that are electrically connected so that the tissue that is stretched between the partial hooks 10 ^λ and 10 ^λ 'is not flowed through by current. In another embodiment of the invention, however, a specific current flow is set here, which likewise causes this tissue section to coagulate.

In the above explanations there was talk of electrode devices. However, it should be expressly emphasized here that the hook-shaped sections 10 and the pressure device 20, 20 ^{λ λ can} advantageously be made of electrically conductive material, in particular of metal, but which are insulated on their outer surfaces in such a way that a current flow into the tissue only at the contact points between the pressure elements 22 ^λ , 22 ^{Λ λ} and the distal sections 11 ^v , 11 ^{λ N} can take place. Furthermore, it should be noted that the parts shown, in particular the hook-shaped section 10, are coated with an anti-adhesive layer, which facilitates preparation.

The cutting device 30 is likewise preferably designed as an HF surgical instrument, that is to say has a cutting edge designed as an electrode, which is connected to an HF generator (not shown here). The other pole of the HF generator is connected to at least one of the other instrument parts, namely one of the distal sections 11 ^v , 11 ^{λ x} or a pressure element 22 ^λ , 22 ^{λ λ} , so that an HF cutting current between the cutting edge of the cutting device 30 and this other pole can flow. With suitable circuit measures it is possible to mentioned parts 11, 11 ', 22, 22 ^{λ to} connect in parallel during the cutting process.

Furthermore, it is possible to design the distal sections 11 ^λ , i 11 'or the electrode devices located thereon in such a way that they are (bipolar)

Coagulation instrument can be used. In this case, electrodes (if necessary additional) can also be provided on the sides of the distal sections 11 ^λ , 11 ^Λ facing away from the hollow rod-shaped section 40, in order to be able to carry out a particularly flat coagulation.

The actuating devices (not shown here) for the (movable) partial hook 10 ^{λ λ} or the pressing devices 20, 20 ^{v λ} are preferably designed in such a way that defined pressing forces can be applied. Such pressing forces can also act when the partial hooks 10 ^v , 10 ^{λ λ} move from the position shown in FIG. 2 back to the position shown in FIG. 1 between the distal partial sections 11 ^λ , 11 ^λ , so that the partial hooks 10 ^λ , 10 ^N can be used not only for spreading but also for holding pliers in place. In order to be able to coagulate tissue which is held between the distal sections 11 ^λ , 11 ^{Λ λ} , the mutually facing ^ surfaces of the distal sections 11 ^λ , 11 ^{v can} in turn be designed as electrodes or include such electrodes, so that a bipolar coagulation of tissue is possible, which is clamped between the partial hooks 10 ^x , 10 ^{λ λ}

⁾ The hollow rod-shaped section 40, which is used for holding and

(Movable) guidance of the hook-shaped section 10, the pressure device 20 ^λ , 20 ^{λ N} and the cutting device 30 is used in addition to supplying a winding liquid or also serve to aspirate rinsing or body fluids.

Reference list

10 hook-shaped section

10 \ 10 "partial hook

11 distal section 11 \ 11 distal sections

12 proximal section

12 ^λ , 12 ^{λ λ} proximal sections

13 free end

14, 14 ^Λ rounded faces

20 ^v , 20 ^{λ N} pressure device

21 \ 21 '* holding element

22 ^x , 22 ^{Λ λ} pressure element

30 cutting device

40 hollow rod-shaped section

Claims

claims

Surgical instrument comprising a hook-shaped section (10) which has a distal section (11) with a free end (13) and a proximal section (12) which is connected to an actuating device,

d a d u r c h g e k e n n z e i c h n e t that

the distal and the proximal section (11, 12) along a plane running essentially through the center of the distal section (11) to form partial hooks (10 ^λ , 10 ^{, v} ), each with a proximal section (12 12 ^{, λ} ) and a distal section (11 ll ^{, λ} ) is divided and can be moved into a spreading plane by the actuating device in such a way that the hook (10) can be spread out into the two partial hooks (10 ^λ , 10 ^{, λ} ) and again as a forceps instrument to form a hook ( 10) can be merged.

2. Surgical instrument according to claim 1,

marked by

at least one pressure device (20 ^λ , 20 ^{, λ} ), which is connected to the actuating device and comprises a pressure element (22 ', 22 ^{, λ} ) fastened to a holder element (21, 21 ^{, x} ), which in a movement substantially perpendicular to Spreading level at least one of the distal sections (11 ^λ, ^ll) can be pressed for clamping of tissue or the like.

3. Surgical instrument according to claim 2,

d a d u r c h g e k e n n z e i c h n e t that

two pressure devices (20 ^λ , 20 ^, ) are provided, each with a pressure element (22 ^v , 22 ^, ), each of which can be pressed onto a distal section (11 ^λ , 11 ^{, λ} ).

4. Surgical instrument according to claim 3,

d a d u r c h g e k e n n z e i c h n e t that

the pressure device (20, 20 ^{λ λ} ) for simultaneous

Press the two pressure elements (22 ^λ , 22 ^, ) are formed on the distal sections (11 ^λ , ll ^{, λ} ).

5. Surgical instrument according to claim 2,

d a d u r c h g e k e n n z e i c h n e t that

the pressure elements (22 ^v , 22 ^{, λ} ) are complementary, preferably bowl-shaped, in such a way that they can be pressed flat against the distal sections (11 ^λ , ll ^{, λ} ).

Surgical instrument according to one of the preceding claims, marked by ,

a cutting device (30) connected to the actuating device, which can be passed between the distal partial sections (11 ^v , ll ^{, λ} ) in such a way that tissue lying on the spread partial hooks (10 10 ^u ) can be severed.

7. Surgical instrument according to one of the preceding 0 claims,

d a d u r c h g e k e n n z e i c h n e t that

At least on the distal sections (11 ^Λ , 11 ^λ> ) there are provided electrode devices which are connected to a controllable current source, so that a coagulation current is clamped on or between the tissue lying on the hook or between the partial hooks (10 ^λ , 10 ^{λ λ} ) the partial hook (10 10 ^{, v} ) adjacent tissue 0 can preferably be fed bipolar.

8. Surgical instrument according to one of claims 2 or

3,

S d a d u r c h g e k e n n z e i c h n e t that

Electrode devices are provided on the hook (10) and on the pressure elements ( ^22λ , 22 ^Xλ ) and are connected to a controllable current source, so that the coagulation current is preferably when the hook is spread

(10) each between a distal section (11 ^λ , 11 ^x ) and a pressure element (22 ^v , 22 ^{, λ} ) for coagulation between the distal section (11 \ ll '') and the pressure element (22 ^λ , 22 ^λ ) clamped tissue sections can be supplied.

9 Surgical instrument according to claim 1,

d a d u r c h g e k e n n z e i c h n e t that

the distal sections (11, 11 ^{X Λ} ) are designed in such a mirror-symmetrical ^manner with rounded faces (14 ^λ , 14 ^VΛ ) 0 on their sides facing away from each other that at least the distal section (11 ^λ ,

11 ^{λ λ} ) of the hook (10) has smooth outer surfaces in the unspread state.

s 10. Surgical instrument according to claim 1,

d a d u r c h g e k e n n z e i c h n e t that

the actuating device comprises a distal section (40) in the form of a hollow rod with an essentially smooth outer surface, in which at least one proximal section (12 ^λ , 12) is movably mounted

^ 11 Surgical instrument according to claim 2,

d a d u r c h g e k e n n z e i c h n e t that

the actuating device comprises a distal) hollow rod-shaped section (40) with a substantially smooth outer surface, in which at least one proximal section (12 ^λ , 12 ^{, λ} ) and Holding elements (21 ^λ , 21 ^{, Λ} ) of the pressure elements (22 ^λ , 22 ^λ, J are movably mounted.

12. Surgical instrument according to one of claims 10 or 11

d a d u r c h g e k e n n z e i c h n e t that

a proximal section (12 ^N , 12 ^λ ) is fixedly attached to the hollow rod-shaped section (40).

13. Surgical instrument according to claim 11,

d a d u r c h g e k e n n z e i c h n e t that

the holding elements (21 ^v , 21 ^{, λ} ) are axially displaceable in the hollow rod-shaped section (40) such that the pressure elements (22 ^λ , 22 ^, ) can be retracted up to or into the hollow rod-shaped section (40).

14. Surgical instrument according to claim 13,

d a d u r c h g e k e n n z e i c h n e t that

the holding elements (21, 21 ^λ ) are guided relative to the proximal sections (12 12 ^λ ) in such a way that at least when the hook (10) is spread, the pressure elements (22 22 ^{, λ} ) move axially in the direction of the distal sections (11, ll ^{, λ} ) come into contact with them.

15. Surgical instrument according to claim 6, characterized in that

the cutting device (30) comprises an electrode to cut tissue by supplying an RF cutting current.

16. Surgical instrument according to claim 15,

d a d u r c h g e k e n n z e i c h n e t that

the opposite pole to the electrode of the cutting device (30) is formed by the hook (10) and / or the pressure device (20 ^λ , 20 ^{, Λ} ) or electrodes attached there.