EP4565110A1 - Proctoscope and method for using a proctoscope - Google Patents

Abstract

The problem addressed by the invention, which relates to a proctoscope (1) and a method for using a proctoscope (1), is to provide an improved proctoscope (1) with which surgical procedures in the region of the human rectum are made easier for the operator, while pain for the patients is reduced and the proctoscope (1) is easy to handle and can be economically produced. In terms of the arrangement, this problem is solved in that the securing ring (2) has multiple position markers (10), a positioning aid (11) in the form of a 12-hour marking, and multiple first locking elements (8), in that a second part is a surgical tube (9) which can be arranged in an inner diameter of the securing ring (2), has a second locking element (17) that can be interlockingly connected and fixed to one of the first locking elements (8), and has a truncated-cone-shaped or semi-spherical, at least partially closed first end (12) and a surgical window (13), which is a rectangular opening located substantially along a cylinder wall of the surgical tube (9), and in that a third part is an obturator (19) which can be introduced into the surgical tube (9) and radially fixed, has a first conical or semi-spherical closed end (20) adapted to the first end (12) of the surgical tube (9), and is introduced into the surgical tube (9) and radially fixed, entirely closing the surgical window (13).

Description

Proctoscope and method for using a proctoscope

The invention relates to a proctoscope which is constructed in three parts and has, as a first part, a fastening ring which is open on its opposite sides and has a first region with an at least partially cylindrical shape or cylindrically conical shape and a flange-like second region.

The invention also relates to a method for using a proctoscope, wherein a three-part proctoscope is provided, a first part being a fastening ring open on its opposite sides with a first region with an at least partially cylindrical shape or cylindrically conical shape and a flange-like second region and wherein the proctoscope can be inserted into a patient's rectum.

The content of this description is a proctoscope used in operative or surgical procedures in the area of the human rectum, which is also referred to as an anoscope or surgical proctoscope. This proctoscope is designed in several parts. It is used for visual inspection of the rectum and as an aid during rectal procedures.

It is known to use such proctoscopes or anoscopes for the treatment of hemorrhoids, rectoceles and in the treatment of rectal mucosaprolapse diseases. Proctoscopes or anoscopes are also used when performing mucopexy and recto-anal lifting as well as for direct tissue diagnostics. In particular, grade II-IV hemorrhoids are treated. Using a proctoscope or anoscope, surgeons are able to carry out minimally invasive operations that are relatively painless for the patient, such as mucopexy or recto-anal lifting.

Various proctoscopes or anoscopes are known from the prior art.

From EP 3 310 246 B1 an anoscope is known which is used in the proctological field as a diagnostic and/or surgical instrument can. The task to be solved is to improve an anoscope that can be used in surgical and diagnostic areas.

To solve this, an anoscope is provided which includes a movable part which rotates within a fixed part and is provided with a window.

The US 2008/0275306 A1 generally discloses an anoscope for anorectal diagnostics and surgery and in particular a composite anoscope consisting of three frustoconical components to be inserted into one another. The problem to be solved is to provide a composite anoscope that is free from the disadvantages known from the prior art. These disadvantages are that known anoscopes neither allow an exact assessment of the circumferential extent of the threads nor a determination of the distance of the threads from the anal edge. In addition, there is no provision for fixing the anoscope to the anal tissue during the operation.

The anoscope according to the invention offers the advantage that its three components, when inserted into the anal canal, form a truncated cone-shaped individual body with a pointed cone tip and a compact and smooth outer surface, which is suitable for penetrating the anal canal very quickly in an atraumatic manner.

WO 2004/021874 A1 relates to an anoscope that can be used in proctology as a diagnostic and/or surgical instrument. The aim is to overcome the disadvantage that the operation window only opens to a defined area of the speculum. The aim is to improve an anoscope that can be used in surgical practice.

To solve this, an anoscope is provided, comprising a first hollow body device open at opposite ends and a second hollow body device open at opposite ends, shapingly coupled to the first hollow body device and arranged to rotate coaxially internally, wherein the first hollow body means and the second hollow body means are provided with a window means which is arranged to make part of the rectal mucosa accessible, the window means having a dimension solution and a shape to enable the use of surgical means.

WO 002021021396 discloses an anoscope that includes an elongated hollow member with a longitudinal slot configured to receive tissue within an interior of the hollow member. The device also includes a clip applicator. The staple applicator includes a body slidably received in the slot and jaws at a distal end of the body configured to hold a ligature staple. The staple applicator further includes a piston slidably coupled to the body configured to actuate the jaws. As the staple applicator is inserted into the slot and the plunger is moved relative to the body, the jaws close and deform the ligature staple from an open position to a closed position around the tissue received in the slot.

These proctoscopes known from the prior art do not have a so-called 12h position for a rectocele, i.e. a bulge of the lower rectum above the sphincter. One advantage of such a sewing position is that it enables rectocele treatment.

Furthermore, the known solutions do not have a thread attachment by means of which a surgical thread can be attached to a part of the proctoscope. Such a possibility of attaching a thread has the advantage that these attachments can be fixed during the operation in such a way that the surgeon's field of vision and work is not impaired.

In addition, unwanted rotations of the proctoscope cannot be effectively prevented, which can lead to torsion of the patient's tissue with the corresponding disadvantages.

Furthermore, localization of the dentate line is difficult with the known solutions. The linea dentata marks the transition between the non-sensitive mucous membrane of the rectum and the highly sensitive squamous epithelium of the anal canal and represents an important orientation aid in the anal canal. There is therefore a need for an improvement in the known state of the art and thus for an improved proctoscope for operative or surgical interventions in the area of the human rectum.

The object of the invention is to provide an improved proctoscope with which operative or surgical interventions in the area of the human rectum are made easier for the surgeon, pain for the patient is reduced and the proctoscope is easy to handle and inexpensive to produce.

In particular, easy handling by the surgeon should be ensured and the overview of the operating area should be improved.

The solution is a three-part proctoscope, which is made up of the components mounting ring, surgical tube and obturator.

The fastening ring, as the first part of the proctoscope, has a first region with an at least partially cylindrical shape or cylindrically conical shape and a flange-like second region. The fastening ring is hollow and open on the opposite sides or ends. Here, the first side is located on the flange-like second region and the opposite side is located on an end of the at least partially cylindrical or cylindrically conical first region facing away from the flange-like second region.

The attachment ring is also designed to be transparent to enable the localization of the dentate line.

The flange-like second area of the fastening ring is connected to a handle, which can be provided with a recessed grip, for example for the thumb and index finger. The flange-like second region of the fastening ring also has several so-called fastening holes. By means of these fastening holes, it is possible for a surgeon, for example, to sew the fastening ring in place for the duration of a perianal intervention using several skin sutures in order to ensure a secure hold of the proctoscope in the area of the patient's rectum. The fastening ring preferably has a plurality of inwardly oriented L-shaped first locking elements in its cylindrical first region. By means of these first locking elements, it is possible to temporarily firmly connect or lock a so-called surgical tube to the fastening ring, with only an L-shaped first locking element being used for such a locking. Each of the L-shaped first locking elements enables the surgical tube to be locked in the fastening ring in a different position or orientation of the surgical tube relative to the fastening ring.

For this purpose, the surgical tube with the obturator inserted into the surgical tube is inserted into the fastening ring and snapped or fixed into the first locking elements by means of a rotational movement, which can only include a few degrees. The obturator simultaneously serves to push the tissue back out of the operating window of the operating tube when inserting the proctoscope and as a handle or extension of the grip surface for releasing, rotating and locking the operating tube.

The fastening ring also has a plurality of position marks which are arranged at regular intervals along the circumference of the flange-like region of the fastening ring. Such position marks indicate to a surgeon the orientation of a so-called operating window of the proctoscope, in which an operative or surgical procedure in the area of the human rectum can be carried out by the surgeon using suitable instruments.

In addition to these position marks, a positioning aid is provided in the form of a 12 o'clock marking, which, when the fastening ring is appropriately positioned in the rectum of a patient on the human body, points upwards in the direction of the patient's spine or head.

A second part of the proctoscope is the surgical tube. The surgical tube has a cylindrical shape or a cylindrically conical shape and is designed as an elongated, hollow body. The first end of the surgical tube is truncated or hemispherical, partially closed, wherein at this end there is provided a substantially rectangular opening arranged essentially laterally or essentially along a cylinder wall of the surgical tube, which is referred to as a surgical window. It is also envisaged that the essentially rectangular opening of the surgical window partially protrudes into the truncated cone-shaped or hemispherical first end of the surgical tube.

The surgical window, for example, extends over a third of the total length of the surgical tube, starting at the first end of the surgical tube. The operating window is designed to be almost rectangular and is dimensioned in such a way that it is possible for a surgeon to carry out a surgical procedure on the patient's tissue protruding in the operating window. In an exemplary embodiment, the operating window has a length of approximately 4 to 6 cm and a width of approximately 2 to 3 cm.

The surgical tube is designed with an opening at its second end, which is arranged opposite the first end. This opening essentially corresponds to the diameter of the cylindrical surgical tube at the second end. This opening can also be made slightly larger than the diameter of the cylindrical surgical tube at the second end.

At this second end, the surgical tube is designed, for example, with corresponding holes or knobs along the circumference of the second end of the surgical tube in such a way that it can be securely gripped and held by a surgeon. Furthermore, at least one first alignment mark is arranged on this second end, which can be provided with a thread fastening.

To temporarily lock the surgical tube with the fastening ring, a second locking element is arranged at the second end of the surgical tube. This second locking element is designed in such a way that it can be snapped into the first locking elements of the fastening ring. Such a temporary locking can be done by means of a so-called bayonet lock, which, as is known, enables a quickly established and detachable mechanical connection of two cylindrical parts in their longitudinal axis. It is also provided that a radial fixation is arranged at the second end of the surgical tube to produce a positive, snap-in connection with a further radial fixation formed on the obturator. The obturator is thus inserted into the surgical tube and connected to it in a form-fitting manner or fixed to it in a snap-locking manner.

It is also planned that the part of the system that can be rotated in the fastening ring, i.e. the surgical tube, can be locked into, for example, 7 positions by turning and thus fixed. These positions are preferably a 1 o'clock, 3 o'clock, 5 o'clock, 7 o'clock, 9 o'clock, 11 o'clock and 12 o'clock position, which are known, for example, from an analog clock face. These positions are indicated accordingly using the position marks and the 12 o'clock marking on the fastening ring. In the event that the first alignment mark of the surgical tube is aligned with the 3 o'clock position mark on the mounting ring, the surgical window of the surgical tube is positioned aligned in the 3 o'clock direction in the patient's rectum. The surgeon can therefore carry out a surgical procedure in this 3 o'clock direction. These relationships also apply to the other selectable positioning options at the positions 1 o'clock, 3 o'clock, 5 o'clock, 7 o'clock, 9 o'clock, 11 o'clock and 12 o'clock.

The third part of the three-part proctoscope is the obturator, which has a substantially cylindrical or cylindrically conical elongated shape. The obturator has a conical or hemispherical closure at its first end. It is designed in such a way that it can be inserted into the surgical tube and thus completely closes the surgical window of the surgical tube. For this purpose, the outer diameter of the obturator is optimally adapted to the inner diameter of the surgical tube. For this purpose, the second end of the obturator is also optimally adapted to the second end of the surgical tube with its conical or hemispherical shape.

The second end of the obturator is designed, for example, with corresponding holes or knobs along the circumference of the second end of the obturator in such a way that it can be securely gripped and held by a surgeon. In addition, the second end of the obturator has a radial fixation with which the obturator can be positively connected to the surgical tube. Additionally, the second end of the obturator has a second alignment mark.

The obturator is inserted into the surgical tube in such a way that the first alignment mark of the surgical tube, which can also be a thread attachment, corresponds to the second alignment mark of the inserted obturator.

By completely closing the operating window of the surgical tube by the obturator, an improved, friction-reduced insertion of the proctoscope is possible, stretching the muscular wall of the rectum but not damaging the mucous membrane.

In addition, safe rotation of the surgical window of the surgical tube to the different positions is enabled when the obturator is inserted into the surgical tube. After a corresponding rotation to a desired position, the obturator is removed from the surgical tube and the surgical window of the surgical tube is thus released for the surgeon. Once the surgical procedure has been carried out in this position, the obturator can be reinserted into the surgical tube, locked and the surgical window closed. The surgical tube with the inserted and locked obturator is then rotated into a position desired by the surgeon. Once the subsequently desired position has been reached, the obturator is removed from the surgical tube and the surgical window of the surgical tube is thus released for the surgeon at the subsequently desired position.

By making the fastening ring in a transparent material, localization of the dentate line is possible after the surgical tube with the obturator has been removed from the fastening ring.

It is intended that the surgical tube can be fixed in the fastening ring in at least 7 positions (1 o'clock, 3 o'clock, 5 o'clock, 7 o'clock, 9 o'clock, 11 o'clock and 12 o'clock), with the 12 o'clock position being used for rectocele procedures is provided. According to the invention, it is also provided that the further radial fixation is i-shaped, with arcuate locking elevations being arranged on opposite parallel outer legs of the U-shaped further radial fixation, so that the radial fixation is also U-shaped, with on opposite parallel inner legs of the radial fixation, arc-shaped locking recesses are arranged and that the arc-shaped locking elevations of the further radial fixation and the arc-shaped locking recesses of the radial fixation have corresponding, complementary shapes and snap into one another in a form-fitting manner when the obturator is inserted into the surgical tube.

The further radial fixation is designed as an elevation on the obturator with a U-shaped course of the outer contour and, for example, two arcuate locking elevations arranged opposite one another on the parallel outer legs of the U-shaped further radial fixation.

The radial fixation is designed as a notch in the surgical tube with a U-shaped course of its inner contour and, for example, two arcuate locking recesses arranged opposite one another on the parallel inner legs of the U-shaped radial fixation.

Due to the inventive design of the arcuate locking elevations of the further radial fixation corresponding to the arcuate locking recesses of the radial fixation, the obturator can be inserted into the surgical tube if the orientation of the radial fixation of the surgical tube matches the orientation of the further radial fixation of the obturator . This introduction of the obturator into the surgical tube is continued until the arcuate locking elevations of the further radial fixation have reached the position of the arcuate locking recesses of the radial fixation and these lock into one another due to their complementary shapes and thus create a positive connection.

According to the invention, it is further provided that at least the obturator and the surgical tube are made of a material that can be used in medical technology, laboratory technology and in the diagnostic field. For such For example, polypropylene homopolymers are known in certain areas of application, such as Purell HP 373, Purell HP 371, PPH 9020 or PPM H250. The material from which the obturator and the surgical tube are made should have a ball compression hardness according to ISO 2039-1 of 55 to 70 MPa and a tensile modulus according to ISO 527-1, -2 of 1200 to 1700 MPa, i.e. sufficient Have strength and be at least partially elastically deformable.

The deformability is particularly advantageous in the area of the radial fixation and the further radial fixation, since the further radial fixation can thus be inserted into the radial fixation, although the outer dimension of the further radial fixation, i.e. the maximum distance between the arcuate locking elevations, is larger than the inner dimension of the radial fixation of the surgical tube in the area of the parallel inner legs, excluding the area of the arcuate locking recesses.

To prepare for the use of the proctoscope 1 in the rectum of a human, the proctoscope, consisting of its fastening ring, surgical tube and obturator, is assembled in a first step, with the parts being connected or fixed to one another accordingly.

For this purpose, the obturator is inserted into the surgical tube, making sure that the further radial fixation of the obturator (nose of the obturator) completely snaps into the radial fixation of the surgical tube (groove of the surgical tube) or is connected in a form-fitting manner and the obturator is fully inserted into the surgical tube.

To form this connection between the obturator and the surgical tube, it is provided according to the invention that the further radial fixation is provided in a U-shape, with arc-shaped locking elevations being provided on opposite parallel outer legs of the U-shaped further radial fixation, so that the radial fixation Is provided in a U-shape, with arcuate locking recesses being provided on opposite parallel inner legs of the radial fixation and the arcuate locking elevations and the arcuate locking recesses corresponding, complementary have shapes and when inserting the obturator into the surgical tube, they snap into each other and create a positive connection.

The surgical tube with the inserted obturator is then inserted into the fastening ring and the second locking element of the surgical tube is connected or fixed in a form-fitting manner with one of the seven first locking elements (bayonet locks) of the fastening ring. The surgical tube with the inserted obturator is thus fixed and locked in the fastening ring.

After the proctoscope has been coated with a lubricant, it can be inserted into the patient. It should be noted that the handle of the mounting ring faces 6 o'clock. It is helpful if both halves of the buttocks are pulled apart to insert the proctoscope as deeply as possible into the anal canal and rectum. This ensures that the fastening ring sits securely and correctly during the procedure.

After the proctoscope is inserted, it is secured using skin sutures through the attachment holes at 12 o'clock, 5 o'clock and 7 o'clock.

To carry out a surgical procedure, the obturator is subsequently removed from the surgical tube arranged and fixed in the fastening ring.

Now the operating window of the operating tube is exposed and the surgeon can carry out a surgical procedure in the area of the human rectum. This can be done at the point described as the 12 o'clock position if the surgical window has been aligned according to this position. For this purpose, the first alignment mark is brought into line with the positioning aid or the 12 o'clock marking or aligned accordingly.

To select a different direction or position for the surgical window, the obturator is reinserted into the surgical tube. Here, the second alignment mark of the obturator is brought into line with the first alignment mark of the surgical tube.

This insertion of the obturator into the surgical tube completely closes the surgical window in the surgical tube again. When the obturator is inserted into the surgical tube and the surgical window is closed, the surgical tube and thus the surgical window can be safely rotated to different positions. Such a rotation or alignment of the operating window can take place in all directions shown by the position marks on the fastening ring or the 12 o'clock marking.

To change the direction or position of the surgical window, the surgical tube must be unlocked with the obturator, completely pulled out and repositioned. Rotating the surgical tube in the anal canal must be avoided at all costs, otherwise the tissue may be torsioned.

Depending on the indication, the surgical window of the surgical tube can be positioned at seven different locations, which are designated as recesses on the fastening ring (1 o'clock, 3 o'clock, 5 o'clock, 7 o'clock, 9 o'clock, 11 o'clock and 12 clock position). The direction or position of the window opening of the surgical tube is marked extracorporeally via the first alignment mark, which also serves as a thread attachment.

To carry out a surgical procedure, the obturator is subsequently removed from the surgical tube arranged and fixed in the fastening ring and the surgical window of the surgical tube is thus exposed at the new position indicated by the position marks or the 12 o'clock marking.

Before removing the proctoscope from the rectum, the obturator can be reinserted into the surgical tube located in the fastening ring, locked and the surgical window can be closed. The three skin sutures are then cut and the proctoscope is removed. Alternatively, after cutting the three skin sutures, the fastening ring can be removed without the surgical tube with the obturator inserted.

The advantages of the proctoscope according to the invention lie in particular in its easy, simple handling for the surgeon, in an ergonomic design, in striking design elements, • in a secure connection of the fastening ring with the surgical tube through a bayonet lock,

• in the possibility of attaching the surgical thread to the surgical tube,

• in a variety of alignment marks,

• in a marking of the surgical positions,

• in a cost-effective, outpatient surgical method when using the proctoscope according to the invention.

The previously explained features and advantages of this invention can be better understood and evaluated after careful study of the following detailed description of the preferred, non-limiting example embodiments of the invention herein with the accompanying drawings, which show:

Fig. 1: the fastening ring of the proctoscope according to the invention,

2a, 2b, 2c: further views of the fastening ring according to the invention,

3a, 3b: the surgical tube of the proctoscope according to the invention,

4a, 4b: the obturator of the proctoscope according to the invention,

Fig. 5: the obturator inserted into the surgical tube,

Fig. 6: the assembled proctoscope according to the invention,

7a, 7b: further views of the proctoscope according to the invention,

Fig. 8: removing the obturator from the surgical tube,

Fig. 9: an insertion of the obturator into the surgical tube,

Fig. 10: a release of the surgical tube with obturator from the fastening ring,

Fig. 11: rotation of the surgical tube with obturator in the fastening ring,

Fig. 12: the assembled proctoscope and

Fig. 13: an enlargement of the area of radial fixation on the operating room

tube and further radial fixation on the obturator.

1 shows a first part of the proctoscope 1 according to the invention, the fastening ring 2. The fastening ring 2 has a first region 3 with an at least partially cylindrical shape or cylindrically conical shape and a flange-like second region 4. The fastening ring 2 is hollow and open on the opposite sides or ends. The flange-like second region 4 of the fastening ring 2 is connected to a handle 5, which is provided with a recessed grip 6, for example for the thumb and index finger. The flange-like second region 4 of the fastening ring 2 has three fastening holes 7 in FIG. Using these fastening holes 7, the fastening ring 2 can be sutured perianally using three skin sutures for the duration of an intervention in order to ensure a secure hold of the proctoscope in the area of the patient's rectum.

The fastening ring 2 has in its cylindrical first region 3 a plurality of inwardly oriented L-shaped first locking elements 8. By means of these first locking elements 8, a surgical tube 9, not shown in FIG. 1, is temporarily firmly connected to the fastening ring 2 and locked. For this purpose, the surgical tube 9 is inserted into the fastening ring 2 and snapped into the first locking elements 8 by means of a rotational movement, which can only include a few degrees, as will be shown later.

The fastening ring 2 also has six position marks 10, which are arranged at regular intervals along the circumference of the flange-like second region 4 of the fastening ring 2. Using these position marks 10, the alignment of a so-called surgical window 10 in the surgical tube 9 of the proctoscope 1 is displayed. The surgical tube 9 with the surgical window 10 are not shown in Figure 1.

In addition to the six position marks 10, another positioning aid 11, a 12 o'clock marking, is shown in FIG. This 12 o'clock position is particularly intended for rectocele procedures.

Figures 2a, 2b and 2c show further views of the fastening ring 2.

For better understanding, the fastening ring 2 already shown in FIG. 1 is shown in a further perspective view in FIG. 2a, in a frontal view in FIG. 2b and in a side view in FIG. 2c. All elements shown in Figures 2a, 2b and 2c have already been described in detail for Figure 1, so a repetition is not necessary at this point. Figures 3a and 3b show the surgical tube 9 according to the invention of the proctoscope 1 in a perspective view in Figure 3a and in a side view in Figure 3b.

The surgical tube 9 has a cylindrical shape or a cylindrically conical shape and is designed as an elongated, hollow body. The surgical tube 9 is designed to be partially closed in the shape of a truncated cone or hemispherical shape at its first end 12, with an elongated opening arranged essentially laterally or essentially along a cylindrical wall of the surgical tube 9 being provided at this first end 12, which serves as an operating window 13 is referred to.

The surgical window 13 extends, for example, over a third of the total length of the surgical tube 9, starting at the first end 12 of the surgical tube. The operating window 13 is designed to be almost rectangular and dimensioned in such a way that it is possible for a surgeon to carry out a surgical procedure on the patient's tissue protruding in the operating window.

The surgical tube 9 is designed with an opening at its second end 14, which is arranged opposite the first end 12. This opening essentially corresponds to the diameter of the cylindrical surgical tube 9 at the second end 14. This opening can also be made slightly larger than the diameter of the cylindrical surgical tube 9 at the second end 14.

At this second end 14, the surgical tube 9 is designed, for example, with corresponding holes or knobs 15 along the circumference of the second end 14 of the surgical tube 9 in such a way that it can be safely gripped and held by a surgeon. Furthermore, the first alignment mark 16 or a thread fastening 16 is arranged at this second end 14.

To temporarily lock the surgical tube 9 with the fastening ring 2, a second locking element 17 is arranged at the second end 14 of the surgical tube 9. This second locking element 17 is designed such that it can be snapped into one of the first locking elements 8 of the fastening ring 2. Such a temporary locking can be done by means of a so-called bayonet lock, which, as is known, can be quickly manufactured and released mechanical connection of two cylindrical parts in their longitudinal axis. Depending on which first locking element 8 of the fastening ring 2 the second locking element 17 engages in or forms a positive connection, the surgical tube 9 is fixed in one of the 7 selectable positions (1 o'clock, 3 o'clock, 5 o'clock, 7 o'clock, 9 o'clock, 11 a.m. and 12 p.m.).

It is also envisaged that at the second end 14 of the surgical tube 9 a radial fixation 18 is arranged for an obturator 19, not shown in Figures 3a and 3b, which can be inserted into the surgical tube 9 and locked with it.

An obturator 19 of the proctoscope 1 according to the invention is shown in two different perspective views in FIGS. 4a and 4b.

The obturator 19 has a substantially cylindrical or cylindrically conical elongated shape. The obturator 19 has a conical or hemispherical closure at its first end 20. The obturator 19 is designed in such a way that it can be inserted into the surgical tube 9 and thus completely closes the surgical window 13 of the surgical tube 9. For this purpose, the outer diameter of the obturator 19 is optimally adapted to the inner diameter of the surgical tube 9 and the first end 20 of the obturator 19 to the first end 12 of the surgical tube 9 with its conical or hemispherical shape.

The second end of the obturator is designed, for example, with corresponding holes or knobs 15 along the circumference of the second end 21 of the obturator 19 in such a way that it can be securely gripped and held by a surgeon.

In addition, the second end 21 of the obturator 19 has a further radial fixation 22, with which the obturator 19 can be positively connected to the surgical tube 9. In addition, the second end 21 of the obturator 19 has a second alignment mark 23.

Figure 5 shows the obturator 19 inserted into the surgical tube 9. To prepare for the use of the proctoscope 1 in the rectum of a human, the proctoscope 1, consisting of its fastening ring 2, surgical tube 9 and obturator 19, is assembled in a first step, with the parts being connected or fixed to one another accordingly

For this purpose, the obturator 19 is inserted into the surgical tube 9, whereby it should be noted that the further radial fixation 22 of the obturator completely snaps into the radial fixation 18 of the surgical tube or is positively connected and the obturator 19 is completely in the surgical tube 9 is introduced.

This alignment between the obturator 19 and the surgical tube 9 is achieved when the second alignment mark 23 of the obturator 19 has been brought into line with the first alignment mark 16 or the thread attachment 16 of the surgical tube 9, as can be seen in Figure 5.

The surgical tube 9 with the inserted obturator 19 is then inserted into the fastening ring 2 and the second locking element 17 of the surgical tube 9 is connected or fixed in a form-fitting manner with one of the seven first locking elements 8 of the fastening ring 2. The surgical tube 9 with the inserted obturator 19 is thus fixed and locked in the fastening ring 2.

After the proctoscope 1 has been wetted with a lubricant, it can be inserted into the patient. Please note that the handle 5 of the fastening ring 2 points to 6 o'clock.

After the proctoscope is inserted, it is fixed via skin sutures via the mounting holes 7 at 12 o'clock, 5 o'clock and 7 o'clock.

If the obturator 19 has been inserted into the surgical tube 9 in this way, the surgical window 13 of the surgical tube 9 is closed by the obturator 19.

Figure 6 shows the assembled proctoscope 1 according to the invention.

As already explained, in preparation for using the proctoscope 1 in the rectum of a human being, the unit, consisting of the surgical tube 9 and the inserted and fixed obturator 19, is inserted into the fastening ring 2 and attached. for example, fixed in the manner of a bayonet lock by means of one of the first locking elements 8 arranged on the fastening ring 2 and the second locking element 17 attached to the surgical tube 9. The process of inserting the unit, consisting of the surgical tube 9 and fixed obturator 19, into the fastening ring 2 is shown by the first arrow 24. The process of fixing and locking the unit in the fastening ring 2 is shown by the second arrow 25.

The three-part proctoscope 1 is shown in FIG. 6 in its assembled form and, for example, inserted into the rectum. In this assembled form, the first end 12 of the surgical tube 9 is arranged at the first end 20 of the obturator 19 and the second end 14 of the surgical tube 9 is arranged at the second end 21 of the obturator 19.

In this assembled form, the positioning aid 11, the first alignment mark 16 or the thread fastening 16 and the second alignment mark 23 are arranged in an imaginary line. Such an imaginary line runs parallel to a longitudinal axis of the elements of the surgical tube 9 and/or obturator 19.

In this assembled form, the operating window 13 of the operating tube 9 is completely closed by the obturator 19. The closed operating window 13 enables improved, friction-reduced insertion of the proctoscope 1, stretching the muscle wall of the rectum but not damaging the mucous membrane.

The figures do not show the proctoscope 1 in the area of the human rectum because this is sufficiently known to those skilled in the art.

Figures 7a and 7b show further views of the proctoscope.

For better understanding, the proctoscope 1 already shown in FIG. 6 is shown in a side view in FIG. 7a and in a further perspective view in FIG. 7b. All elements shown in Figures 7a and 7b have already been described in detail for previous figures, so a repetition is not necessary at this point. To carry out a surgical procedure, the obturator 19 is subsequently removed from the surgical tube 9 arranged and fixed in the fastening ring 2, which is shown in FIG. 8 by the third arrow 26. A redundant explanation of the known elements shown in FIG. 8 is omitted.

Now the operating window 13 of the operating tube 9 is exposed and the surgeon can carry out a surgical procedure in the area of the human rectum. This can be done at the point described as the 12 o'clock position, since the OP window 13 is aligned as shown in Figures 6 to 8.

To select a different direction or position for the surgical window 13, the obturator 19 is reintroduced into the surgical tube 9, as shown by the fourth arrow 27 in Figure 9. Here, the second alignment mark 23 of the obturator 19 is brought into alignment with the first alignment mark 16 of the surgical tube 9.

This introduction of the obturator 19 into the surgical tube 9 completely closes the surgical window 13 in the surgical tube 9 again. This introduction is carried out in such a way that the first alignment mark 16 of the surgical tube 9 and the second alignment mark 23 of the obturator 19 are brought into alignment.

When the obturator 19 is inserted into the surgical tube 9 and the surgical window 13 is thus closed, a safe rotation of the surgical tube 9 and thus the surgical window 13 to different positions is made possible.

In order to change the position of the operating window 13, the unit, consisting of the operating tube 9 with the obturator 19 inserted, is rotated in the direction shown by the arrow 28 in FIG the arrow 29 is shown. This process corresponds to releasing or opening the bayonet lock, which is formed by the first locking element 8, not shown in FIG. 10, and the second locking element 17.

Subsequently, the surgical tube 9 with the obturator 19 inserted is rotated into a position that is completely pulled out of the fastening ring 2. In the fi- gur 11, the arrow 30 shows the process of turning, whereby in the selected representation the surgical tube 9 with the obturator 19 inserted is not shown completely pulled out of the fastening ring 2. It is essential to avoid turning the surgical tube 9 in the anal canal, otherwise the tissue may be torsioned.

In the example of Figure 11, the operating window 13 is rotated to the 3 o'clock position. For this purpose, the first alignment mark 16 and the second alignment mark 23 are brought into line with the 3 o'clock position mark 10 shown in FIG. 11 with the reference number 10.

To fix the operating window 13 in this 3 o'clock position, the operating tube 9 with the obturator 19 inserted is pressed into the fastening ring 2 and rotated, whereby the bayonet lock is closed again in the new 3 o'clock position. This process is a reversal of the process described in FIG. 10 and is not shown separately.

In the manner described, the other positions 10, 11 can also be reached or selected for the orientation of the surgical window 13.

It is also intended that the part of the system that can be rotated in the fastening ring 2, i.e. the surgical tube 9, can be locked into, for example, 7 positions and thus fixed by turning. These positions correspond to the position marks 10 visible in FIG. 1 at the positions 1 o'clock, 3 o'clock, 5 o'clock, 7 o'clock, 9 o'clock, 11 o'clock and 12 o'clock. Another position is the 12 o'clock mark on the fastening ring.

To carry out a surgical procedure, the obturator 19 is subsequently removed from the surgical tube 9 arranged and fixed in the fastening ring 2, which is shown in FIG. 8 by the third arrow 26. In this way, the surgical window is released at the newly selected position.

To remove the proctoscope 1, the obturator 19 is reinserted into the surgical tube 9, as shown by the fourth arrow 27 in Figure 9. Here, the second alignment mark 23 of the obturator 19 is brought into alignment with the first alignment mark 16 of the surgical tube 9. This introduction of the obturator 19 into the surgical tube 9 completely closes the surgical window 13 in the surgical tube 9 again.

Subsequently, for example, the surgical tube 9 with the obturator 19 inserted is removed from the fastening ring 2 by opening the bayonet lock, as described in FIG. 10. Subsequently, the surgical tube 9 with the obturator 19 inserted is completely pulled out of the fastening ring 2.

The fastening ring 2 is then loosened by separating the skin sutures and removed from the area of the human rectum.

12 shows the assembled proctoscope 1 and FIG.

In Figure 12, the three-part proctoscope 1 already known from Figure 6 is shown in its assembled form. The proctoscope 1 includes the fastening ring 2, the surgical tube 9 and the obturator 19. The radial fixation 18 of the surgical tube 9 and the further radial fixation 22 of the obturator are in an area of the proctoscope 1 in FIG. 12 that is surrounded by a ring 19 shown.

Figure 13 shows that the further radial fixation 22 is designed as an elevation on the obturator 19 and is U-shaped, with arcuate locking elevations 32 being arranged on opposite, parallel outer legs 31 of the U-shaped further radial fixation 22. Furthermore, Figure 13 shows that the radial fixation 18 is designed as a U-shaped notch in the surgical tube 9, with arcuate locking recesses 34 being arranged on opposite, parallel inner legs 33 of the radial fixation 18.

The arcuate locking elevations 32 and the arcuate locking recesses 34 are designed to correspond to one another. They therefore have complementary shapes and make it possible to insert them of the obturator 19 into the surgical tube 9, the arcuate locking elevations 32 snap into the arcuate locking recesses 34 and a positive connection of the obturator 19 is formed in the surgical tube 9.

List of reference symbols

1 proctoscope

2 fastening ring

3 first area fastening ring (cylindrical)

4 second area fastening ring (flange)

5 handle

6 recessed grip

7 mounting holes

8 first locking elements

9 surgical tube

10 position markers

11 position aid/12 o'clock mark

12 first end surgical tube

13 operating windows

14 second end of surgical tube

15 holes/nubs

16 first alignment mark/thread attachment

17 second locking element

18 radial fixation on the surgical tube for obturator

19 obturator

20 first end obturator

21 second end obturator

22 further radial fixation

23 second alignment mark

24 first arrow

25 second arrow

26 third arrow

27 fourth arrow

28 fifth arrow

29 sixth arrow

30 seventh arrow Outer leg arched locking elevations. Inner leg arched locking recesses

Claims

Patent claims 1 . Proctoscope (1), which is constructed in three parts and has, as a first part, a fastening ring (2) which is open on its opposite sides and has a first region (3) with an at least partially cylindrical shape or cylindrically conical shape and a flange-like second region (4). , characterized in that the fastening ring (2) consists of a transparent material, has several position marks (10), a positioning aid (11) in the form of a 12 o'clock marking and several first locking elements (8), and a second part has an operating tube (9), which can be arranged in an inner diameter of the fastening ring (2), which has a second locking element (17) which can be positively connected and fixed to one of the first locking elements (8), and which has a frustoconical or hemispherical, at least partially closed first end (9). 12) and an operating window (13), which is a rectangular opening arranged essentially along a cylindrical wall of the operating tube (9), that a third part is an obturator (which can be inserted into the operating tube (9) and can be fixed radially ( 19), which has a first conical or hemispherical closed end (20) adapted to the first end (12) of the surgical tube (9) and which is inserted into the surgical tube (9) and radially fixes the surgical window ( 13) is arranged in a completely closing manner, that at least one first alignment mark (16) with a thread fastening and a radial fixation (18) are arranged on a second end (14) of the surgical tube (9) and that another one is arranged on the obturator (19). radial fixation (22) is arranged, which is arranged to snap into a radial fixation (18) arranged on the surgical tube (9) when the obturator (19) is inserted into the surgical tube (9). 2. Proctoscope (1) according to claim 1, characterized in that the fastening ring (2) has a plurality of fastening holes (7) and a handle (5). Proctoscope (1) according to claim 1 or 2, characterized in that the further radial fixation (22) is U-shaped, with arcuate locking elevations (32) on opposite parallel outer legs (31) of the U-shaped further radial fixation (22). ) are arranged that the radial fixation (18) is also U-shaped, with arcuate locking recesses (34) being arranged on opposite parallel inner legs (33) of the radial fixation (18) and that the arcuate locking elevations (32) and the arcuate locking recesses (34) have corresponding, complementary shapes and thus snap into one another when the obturator (19) is inserted into the surgical tube (9). Proctoscope (1) according to one of claims 1 to 3, characterized in that a plurality of holes or knobs (15) are arranged at the second end (14) of the surgical tube (9) along the circumference of the surgical tube (9). Proctoscope (1) according to one of claims 1 to 4, characterized in that the obturator (19) has a second alignment mark (23) at a second end (21) and that several holes or. along the circumference of the surgical tube (9). Knobs (15) are arranged. Method for using a proctoscope (1), a three-part proctoscope (1) being provided, a first part having a fastening ring (2) which is open on its opposite sides and has a first region (3) with at least one partially cylindrical shape or cylindrically conical shape and a flange-like second region (4) and wherein the proctoscope (1) can be inserted into a rectum of a patient, characterized in that for inserting the proctoscope (1) in a first step, the fastening ring (2 ) is introduced into the rectum and attached, that a second part, an operating tube (9), and a third part, an obturator (19), are provided, that in a second step the obturator (19) is inserted into the operating room Tube (9) is introduced and fixed radially with this, so that in a subsequent step the unit consisting of surgical tube (9) with inserted obturator (19) is inserted into the fastening ring (2) is introduced and locked with it so that the obturator (19) is subsequently removed from the surgical tube (9) and an surgical window (13) is released in the surgical tube (9), which is a surgical Intervention in the area of the rectum allows the obturator (19) to be inserted into the surgical tube (9) and locked with it in order to remove the proctoscope (1), so that the unit consisting of the surgical tube (9) with the inserted obturator (19 ) is released and removed from the fastening ring (2) and that the fastening ring (2) is loosened and removed, with the obturator (19) inserted in the fastening ring (2) being locked in the fastening ring (2) to lock the surgical tube (9). a plurality of first locking elements (8) and a second locking element (17) are provided on the surgical tube (9), wherein in each case one of the first locking elements (8) can be connected and fixed to one another in a form-fitting manner with the second locking element (17), and for the form-fitting Connecting the obturator (19) inserted into the surgical tube (9) to the surgical tube (9) provides a radial fixation (18) on the surgical tube (9) and a further radial fixation (22) on the obturator (19). which enable the positive connection to snap into place by interlocking. Method according to claim 6, characterized in that the unit of surgical tube (9) with inserted obturator (19) is inserted into the fastening ring (2) and, before locking, is rotated with the fastening ring (2) until the position of a first alignment mark (16) of the surgical tube (9) has been brought into line with the position of a position mark (10) provided on the fastening ring (2) or a positioning aid (11), the surgical window (13) of the surgical tube ( 9) is aligned in the direction shown by the position mark (10) or the positioning aid (11). Method according to claim 6 or 7, characterized in that the fastening ring (2) is provided with six position marks (10) and a positioning aid (11), the position marks (10) providing the alignment 1 o'clock, 3 o'clock, 5 o'clock, 7 o'clock, 9 o'clock, 11 o'clock and the positioning aid (11) are aligned at 12 o'clock. Method according to one of claims 6 to 8, characterized in that the further radial fixation (22) is provided in a U-shape, with arcuate locking elevations (32) on opposite parallel outer legs (31) of the U-shaped further radial fixation (22). be provided that the radial fixation (18) is also provided in a U-shape, with arcuate locking recesses (34) being provided on opposite parallel inner legs (33) of the radial fixation (18), and the arcuate locking elevations (32) and the arcuate Locking recesses (34) have corresponding, complementary shapes and thus snap into one another when the obturator (19) is inserted into the surgical tube (9) and create a positive connection. Method according to one of claims 6 to 9, characterized in that the fastening ring (2) is provided consisting of a transparent material.