DE20016423U1 - Clamping device that can be used endoscopically - Google Patents

Description

Forschungszentrum Karlsruhe GmbH ANR 5661498 Karlsruhe, 20 September 2000 PLA 0060 We/he

Endoscopic stapler

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Endoscopic stapler

The innovation relates to an endoscopically usable stapler according to the preamble of the first patent claim.

Such staplers are used for the endoscopic, air- and blood-tight closure of internal surgical wounds using surgical staples. The pivoting stapler head of the stapler containing these is inserted into the patient's body through a trocar and positioned on the surgical wound to be closed. The actual stapling process, i.e. the endoscopic placement of the staples, is carried out outside the patient's body using the operating handle.

A device for applying surgical staples, consisting of a staple head, an operating handle and a shaft that connects the two aforementioned components and can be bent and rotated about its longitudinal axis as a transmission element, is described in EP 0 630 614 B1. In this device, the staples, which are inserted in a staple magazine similar to that of a stapler in the staple head and are pushed axially towards the tip of the instrument head, can only be inserted individually. The staples consist of a U-shaped wire that is bent in the middle during application and the ends are bent together. Two design variants are proposed for the tilting device in the shaft near the staple head that is required for bending the shaft. The first is a tilting device mounted radially to the shaft, which must be combined with a rotating device mounted axially to the shaft in order to realize the rotary movements. In the second embodiment, the tilting and rotating device is structurally combined in one unit, whereby the two sleeve ends ending at the tilting device are each provided with a friction flange, which, by rolling against each other in the tilted state, causes rotary movements of the shaft

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without changing the tilting direction. The functions are transferred from the operating handle to the clamp head by means of a rod.

Furthermore, EP 0 793 943 A1 describes a combined endoscopic stapling and cutting device with an angled shaft. The stapling head of the instrument is designed as a non-curved instrument jaw in whose jaws magazines with surgical stapling elements, arranged in several rows, are inserted. The suture is placed by closing the instrument jaw, whereby the staples are pressed into the respective opposite counterparts. Furthermore, when the instrument jaw is closed, the compressed body organ can be separated by a cutting process.

The innovation is based on the task of significantly increasing the degrees of freedom for positioning the stapler head with minimal movement of the instruments in the human body compared to the last-mentioned state of the art when using staplers.

The object is achieved by the device described in claim 1. The further claims specify preferred embodiments of the device.

The new stapler is explained below using drawings of an example:

Fig. 1 shows the stapler in perspective without the hollow shaft 7 attached.

Fig. 2 a shows a perspective view of the attachable hollow shaft 7.

Fig. 2 b shows the tilting device of the attachable hollow shaft 7 in detail as a partial sectional view.

Fig. 3 a shows the cross-section (view) of the staple head 1 with closed instrument jaw 2.

Fig. 3 b shows the cross-section (top view) of the staple head 1 with closed instrument jaw 2.

Fig. 4 a shows the cross-section of the lower jaw 24 and the position of the upper magazine 20 of the staple head 1 with the instrument jaw closed before placing the staple elements.

Fig. 4 b shows a part of the longitudinal section of the lower jaw 24 of the staple head 1 with the position of the ramp-shaped slide 35 with the instrument mouth closed before setting the staple elements.

Fig. 4 c shows the cross-section of the lower jaw 24 and the position of the upper magazine 20 of the staple head 1 with the instrument jaw 2 closed when placing the staple elements.

Fig. 1 shows the stapler, consisting of a stapler head 1 with an instrument jaw 2 shown open here, an operating handle 3 and at least one, in the example two Bowden cables 4 as a transmission element for the movements from the operating handle to the stapler head. The operating handle 3 in the example contains two separate lever mechanisms 5 according to the general state of the art for actuating the closing movement of the jaws of the instrument jaw and for applying the staple elements in the tissue or organ part, each transmitted by the Bowden cables 4 to the stapler head 1. The operating handle 3 and stapler head 1 are each firmly connected to the Bowden cable tubes 22 of the Bowden cables 4. The staple elements 6 are inserted in magazines in the jaws of the instrument jaw 2.

The Bowden cables 4 represent the only connection between the operating handle 3 and the stapler head 1 required for the function of the stapler. This significantly increases the possible degrees of freedom in positioning the stapler head 1 in the patient's body with minimal handling effort, i.e., for example, without having to reattach the stapler (pulling out and reinserting the stapler head 1 into the body at another artificially created body opening).

However, when the staple line is placed endoscopically in the patient's body, sufficient fixation of the staple head 3 must be ensured. This is ensured, for example, by the use of additional endoscopically usable fixation instruments or forceps instruments with which the staple head can be positioned and held in the body.

To facilitate the insertion of the stapler through the trocar into the body and to hold and position it inside the patient's body, the stapler according to the invention can be equipped with a hollow shaft as a rigid but removable additional connection between the stapler head 1 and the operating handle.

Fig. 2 a shows an embodiment of a hollow shaft 7 with a tilting device 8. The hollow shaft 7 shown consists of an inner tube 13 and an outer tube 14 enclosing the inner tube, which can be axially displaced against each other via a rotary knob 9 and a gear-rack transmission housed in the housing 10 to actuate the tilting device 8. The tilting device 8, which can also be seen in detail in Fig. 2 b, consists of an internally stepped end tube 11 for receiving the effector base body 15 of the clamp head 1 as well as spring bands 12 arranged axially and parallel to each other, which are firmly connected at one end to the circumference of the end tube 11 on

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are connected on opposite sides. The other ends of the two spring strips 12 are firmly connected to the inner tube 13 and outer tube 14 of the hollow shaft. The two spring strip ends of the inner tube 13 and outer tube 14 also follow the axial relative movement of the said tubes, whereby the end tube 11 is tilted relative to the hollow shaft 7 due to the other two spring strip ends being rigidly attached to one another. Furthermore, the hollow shaft 7 and the end tube must have a longitudinal slot along their entire length for attachment and removal to the stapler, through which the Bowden cables 4 of the stapler can be passed laterally. When attached, the operating handle 3 is connected to the outer tube 14 and the stapler head 1 is connected to the end tube 11 of the hollow shaft 7. The pivoting range of the tilting device according to the described embodiment is approximately ± 50°.

The stapler is inserted into the body with the hollow shaft attached, with the stapler head 1 being pushed close to the internal surgical wound. The hollow shaft 7 is then released from the stapler and pulled out of the body. As previously described, the stapler head can be positioned precisely with additional instruments to close an internal surgical wound.

Fig. 3 a and b show the clamp head 1 in detail. This consists of an effector base body 15 with the lower jaw 24 and a separate upper jaw 18 that can be rotated about a bolt 17. Furthermore, an axially movable sliding sleeve 21 is arranged above the effector base body 15 in the area of the bolt 17, which is firmly connected to the end of the Bowden cable hose 22 and is also pushed back and forth via this. The Bowden cable 23, on the other hand, is firmly connected to the effector base body 15. Pushing the sliding sleeve 21 forward in the direction of the instrument mouth causes the upper jaw 18 to be pressed against the lower jaw 24 and thus closes the instrument.

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jaws 2. During this process, the sliding sleeve 21 is guided over a pin 25 which projects into the interior of the sliding sleeve 21 and engages in the groove 26 in the upper jaw 18. If the sliding sleeve 21 is pushed back again, the pin 25 at the rear end of the groove 26 meets a web 27 which is pushed backwards by the pin 25 so that the upper jaw 18 presses open and thus opens the instrument jaw 2 again.

The stapler shown has an instrument mouth 2 which, in contrast to the last-mentioned prior art, is not straight but curved. The curved design of the instrument mouth 2 allows surgical wounds to be closed more precisely, i.e. with less consumption of healthy tissue than with straight sutures and thus with less stress on the patient. In the embodiment described with reference to Fig. 3 a and b, the jaws 18 and 24 of the instrument mouth 2 have a curvature angle 28 of 120° in total and a lateral curvature radius 29 of 36 mm, based on the center line 30 of the effector base body 15.

In the area of the curved instrument mouth, the magazines 19 and 20 for the clamp pins 31 and sleeves 32 are inserted in the upper and lower jaws 18 and 24 respectively. While the upper magazine 20 is firmly positioned and clamped in the upper jaw 18 without any moving parts, an additional device for pressing the clamp pins 31 into the clamp sleeves 32 must be provided in the lower jaw. In the example described, the lower magazine 19 is designed in segments, with two clamp pins 31 inserted into each individual magazine segment 16 and each individual magazine segment 16 being able to move in a vertical direction, guided by two guide pins 33 inserted into the lower jaw 24. In the lower jaw 24 in the space below the lower magazine 19 there is a ramp-shaped slide 35 (cf. Fig. 4 a and b), which can be moved using the Bowden cable 34.

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The actual sewing process can be described using Fig. 4 a to c, which show in detail the cross-section and partial longitudinal section of the lower jaw 24 and a magazine segment 16 before and the above-mentioned cross-section after the staple pins 31 are pressed into the staple sleeves 32. During the sewing process, the instrument mouth 2 is first closed, whereby the surgical wound is compressed therein. The ramp-shaped carriage 35 is then pulled under the lower magazine 19 over its entire length with the Bowden cable 34, whereby the individual magazine segments 16 are raised one after the other and the staple pins 31 are pushed through the tissue to be sewn into the opposite staple sleeves 32 in the upper magazine 20 and engage therein. If the instrument mouth 2 is opened again, the interlocking staple pins 31 and staple sleeves 32 are released from the magazines 19 and 20; The stapler can then be removed from the patient's body. The staple pins 31 and chamber sleeves 32 used in the procedure are preferably made of a resorbable material.

List of reference symbols:

1 Staple head 19 Lower magazine 2 Instrument mouth 20 Upper Magazine 3 Operating handle 21 Sliding sleeve 4 Bowden cable 22 Bowden cable hose 5 Lever mechanism 23 Bowden cable 6 Clamp element 24 Lower cheek 7 Hollow shaft 25 Pin code 8th Tilting device 26 Groove 9 Rotary knob 27 web 10 Housing 28 Curvature angle 11 Tailpipe 29 Radius of curvature 12 Spring band 30 Centerline 13 Inner tube 31 Staple pin 14 Outer tube 32 Clamp sleeve 15 Effector body 33 Guide pin 16 Magazine segment 34 Bowden cable 17 bolt 35 Sleds 18 Upper cheek

Claims (8)

1. Endoscopic stapler for minimally invasive surgery for placing staples to isolate tissues or organ parts, consisting of a) a clamp head ( 1 ) with an instrument jaw ( 2 ), in the jaws of which one or more rows of clamp elements ( 6 ) are inserted, b) an actuating handle ( 3 ) with lever mechanisms ( 5 ) for actuating the closing movement of the jaws ( 18 ) and ( 24 ) of the instrument mouth and for applying the clamp elements ( 6 ) in the tissue or organ part, and c) a transmission element for the movements from the operating handle ( 3 ) to the clamp head ( 1 ), characterized in that a) the transmission element consists of at least one flexible and freely pivotable Bowden cable ( 4 ) and b) this represents the only connection between the operating handle ( 3 ) and the clamp head ( 1 ). 2. Endoscopically usable stapler according to claim 1, characterized in that the stapler head ( 1 ) and the actuating handle ( 3 ) can additionally be firmly connected to one another by a hollow shaft ( 7 ) which encloses the Bowden cables ( 4 ). 3. Endoscopically usable stapler according to claim 2, characterized in that the hollow shaft ( 7 ) contains a joint and can thus be bent. 4. Endoscopically usable stapler according to claims 2 and 3, characterized in that the hollow shaft ( 7 ) is removable from the endoscopically usable stapler. 5. Endoscopically usable stapler according to one of the preceding claims, characterized in that the instrument mouth ( 2 ) of the stapler head ( 1 ) is curved and thus the staple seam to be created has a curvature. 6. Endoscopically usable stapler according to one of the preceding claims, characterized in that the staple elements ( 6 ) are made of a resorbable material. 7. Endoscopically usable stapler according to one of the preceding claims, characterized in that the staple elements ( 6 ) are inserted in magazines ( 19 ) and ( 20 ), which in turn are inserted and positioned in the jaws ( 18 ) and ( 24 ) of the instrument mouth ( 2 ). 8. Endoscopically usable stapler according to one of the preceding claims, characterized in that the stapler elements ( 6 ) each consist of a stapler pin ( 31 ) and a stapler sleeve ( 32 ), wherein the stapler pins are pressed in the closed instrument mouth ( 2 ) by a wedge or a cam through the tissue or organ part into the stapler sleeves.