WO2012093094A1 - Thread gripper - Google Patents

Abstract

For a thread gripper having a control element (3), a gripper (5) slidably mounted in a hollow needle (2) should be provided.

Description

 thread gripper

The invention relates to a thread gripper according to the preamble of claim 1.

PRIOR ART Various thread grippers for endoscopy are known from the prior art.

Endoscopic suturing techniques are used in numerous indications. The task of the endoscopic gripper is to guide the thread through the corresponding tissue pierced with the gripper cannula and to pick up a thread that has already been laid.

CONFIRMATION COPY A disadvantage of the instruments available on the market is that they are used by the trocar / portal and their degrees of freedom of movement are thus very limited to the accessibility in the operating area. Due to the accessibility through the trocar, the design is complex, the diameter of the cannula / shaft very large and therefore the forces when piercing the various tissues, such as rotators, cuff, labrum or meniscus very high. Furthermore, the tissue to be cut back when piercing, which makes the positioning of the gripper difficult. In addition, two mirror-inverted instruments are required for the left and right half of the body, which makes stockpiling difficult and increases sterilization costs. In the previous technique, after a stab incision several trocars / portals are set, which then form the operation access.

First, with the instrument through the trocar / portal, for example, through the labrum sting, then, for example, by the instrument a lasso, wire loop od. Like. Plugged. The thread is inserted with another instrument in this lasso. Thereafter, the instrument with the lasso and the underlying thread through the trocar / portal initially removed from the body. The tissue to be repositioned is returned to its original position and fixed or separated tissue parts are brought together again. Outside the body, a knot is placed and then inserted back into the body with a knot-shifter and knotted. This process takes place several times until the desired node is formed and the example Labrum is securely fixed. Various endoscopic methods are known in the art. Likewise, various sewing instruments have been developed which include suturing tissue during endoscopic surgical procedures to facilitate. Usually, access to the surgical site in the body is to a patient via one or more portals placed directly in the body of the patient, or through cannulas inserted through small incisions in the body of the patient. A particular surgical procedure is performed by a surgeon using elongated instruments inserted through these cannulas, and it is often necessary to suture selected tissue sections in the surgical field.

The surgical field can be achieved in the prior art only by an operation access described above. In addition, it is very difficult for the surgeon to knot threads within the body. Therefore, different devices and methods have been developed to allow the surgeon to endoscopically knot threads. In some procedures known in the art, the surgeon pulls suture through selected tissue to knot it outside the body. Subsequently, the node is then brought by a node shifter through the operation access to the predetermined location. Here, the surgeon links pieces of thread together after the thread has been pulled through the selected tissue to be sutured. This process is time consuming and costly. In this case, it is particularly difficult to loop the knot during endoscopic operations in which the field of vision is severely restricted for the surgeon due to the narrow operating area.

There is a need for surgical devices that facilitate the application of a surgical procedure known in the art. Object of the invention

The object of the invention is to provide a thread gripper available, which can be used percutaneously. Here as few parts as possible should be used. In addition, a more precise and faster suture technique is to be achieved.

Solution to the Problem To achieve the object, the characterizing part of claim 1.

 The thread gripper according to the invention is used in endoscopy. The term "endoscopy" is not intended to be exhaustive but merely illustrative, including arthroscopy, laparoscopy, and hysteroscopy, as well as any other method used in a patient's body through small openings, as opposed to open surgery, to be performed.

In the preferred embodiment, a thread gripper with a cannula and a control element is used. The thread gripper is used for piercing the skin and the tissue for catching and holding a thread, or to introduce a thread used in the gripper in the body. It has turned out to be particularly advantageous that the gripper should be integrated in the cannula. In addition, in turn, the cannula and the gripper to be connected to the control element. This control element is detachably connected to cannula and gripper.

In addition, cannula and gripper are designed separable from each other. The separable design of the individual parts of each other is used for better sterilization and easier handling.

In another embodiment, the cannula is provided preassembled with the gripper. This has the background that is in has advantageously been found that cannula and gripper can be produced inexpensively due to the simple structure. This in turn leads to the advantage that it requires no expensive sterilization. Therefore, the cannula and the loosely mounted gripper can be executed as a so-called disposable article. This means in detail that such disposable items are not processed, sterilized and reused, but only once delivered sterilized and used to be disposed of subsequently.

In a preferred embodiment, the cannula is used as a hollow needle or injection needle. This is a hollow needle, which is normally used in medicine to inject liquid into the human or animal body by means of a syringe or to remove or puncture it. The end of the cannula is usually sharpened with an oblique single- or multi-surface grinding in order to set a small cut at the penetration of the tissue. If the tissue were not cut, but merely displaced, as in a simple needle, the puncture would be more painful. Some products are additionally coated to allow the least painful injection possible. By piercing tissue or material, the sharpness of the cannula tip is partially lost, making the injection more painful. For this reason, the cannulas should advantageously be used only once. A gripper according to the invention has a hook element at one end, that is to say proximally, and at the other end, ie distally, a force coupling head. The power coupling head is formed towards the control element. The hook element is otherwise formed away from the control element. The power coupling head is used to connect the gripper with the control element and the transmission of sliding and / or pulling movements of the moving parts of the control element, so that the moving parts between eg clamping / extraction, ground, rest and Working position and in any intermediate positions can be moved, and in these if necessary, can engage. For this purpose, the power coupling head is connected to a flange of the control element. Subsequently, the gripper can be moved back and forth within the cannula. The reciprocating movement is to be understood in such a way that the hook element can be moved from a rest position to a working position and vice versa. The advantage here is a simple structure and cost-effective production. The inventive hook element has a rest position and a working position. In the rest position, the hook element is pushed out of the cannula proximally. In the rest position, the hook element is suitable for gripping a thread. When the hook element is pushed out of the cannula proximally, a first gripping arm of the hook element spreads independently against a second gripping arm. This is similar to an opened safety pin. The manner of self-spreading of the first gripping arm against the second gripping arm can be carried out in many ways. In addition to a spring, such as, for example, in a safety pin, also comes opposite to a base member under bias standing first gripping arm, into consideration. It is important in this context that the Selbstabspreizung can be performed several times in the context of an insert, without the bias or the spring force decreases. The advantage here is that an opening or closing of the hook element can be achieved by a linear reciprocating movement of the gripper. It is advantageous that, for example, the known from the prior art swivel joints, similar to a scissor mechanism, are unnecessary.

In another embodiment, the hook element is pushed out in the rest position substantially from the cannula. Essentially, here has the meaning that the hook element is completely pushed out of the cannula or only to a certain extent, as required by the user. Depending on whether the hook element is 90% 80%, 70%, 60% or is pushed out of the cannula to 50%, and the first gripping arm spreads against the second gripping arm automatically. The farther the hook element is pushed out of the cannula, the stronger the spread of the two gripping arms relative to one another takes place. In a hook element, which is pushed out only 50% from the cannula, the first gripping arm is spread only slightly opposite to the second gripping arm, so that while there is still an opening between the two gripping arms to grasp a thread, but this opening Accordingly, only 1 mm to 4 mm or 1 mm to 2 mm. The advantage here again is the fact that the user can very easily and adapted to the conditions of the operating place a corresponding opening of the two gripping arms control each other.

In another embodiment, the hook element is retracted in working position to the proximal end of the cannula substantially. In working position, the hook element is closed in such a way that due to the inner circumference of the cannula of the first gripping arm is pressed against the second gripping arm, so that no more opening between the first gripping arm and the second gripping arm, since the first gripping arm against a fishing hook, which ultimately represents a shape of the second gripping arm strikes. In the working position ultimately means that the hook element is closed against the Abspreizkräfte of the first gripping arm relative to the second gripping arm. This closed position is always given when the hook element is located substantially in the cannula. This can be done at the first insertion of the hook element at the distal end of the cannula or before a later transition from the rest position to the working position at the proximal end of the cannula. Essentially, this means that the first gripper arm and the second gripper arm no longer allow an opening through which a thread could slide. The advantage here is a correspondingly secure hold of the thread in this forming eyelet in the hook area and after the gripper stop to pull it through the cannula from the inside of the body completely outward and again percutaneously spend in the body. In another embodiment, the hook element completely fits into the inner circumference of the cannula. This ensures a smooth reciprocation of the hook element in the cannula. The advantage here is that the user can proceed accordingly easy in handling.

A hook element according to the invention has a catch hook. This fishing hook is crescent-shaped at its distal end. Crescent-shaped in this context means that, for example, a gripped thread is applied to the contour of the fishing hook and can slide along this guided without being damaged. The sickle shape can be more or less bulbous. Ultimately, it is also possible, instead of the sickle shape to form a perpendicular to one of the two gripping arms straight. The advantage here is the fact that the thread should be kept well.

In a preferred embodiment, the inner circumference of the cannula is adapted in such a way that not only the hook element or the gripper can be reciprocated, but also a thread located in the hook element or a node made outside the body without difficulty on the inner circumference the cannula to push or rub, can be moved back and forth.

In another preferred embodiment, the fishing hook has a bevelled shape at its proximal end. The beveled shape should hereby adapt to the end of the cannula, which is sharpened with an oblique cut. A certain position of the oblique cut of the cannula with the tapered shape of the hook element should fit together form-fitting.

In another preferred embodiment, the first gripping arm has a gripper stop. This gripper stop is semicircular on the Inside the first gripper arm formed towards the second gripping arm. It serves to prevent the hook element from bending. He also has the task of loosely guiding or at least retaining a thread once gripped within the hook element in interaction with the crescent-shaped side of the fishing hook. Whether a loose guide or a holder should be determined only by the user by selecting thread thickness and / or distance between gripper stop and fishing hook.

In a preferred embodiment, the force coupling head cooperates with the control element. This means in detail that the control has a flange which receives the power coupling head. This flange is used to transmit sliding tensile movements of the flange relative to the control or the cannula on the gripper. This ensures that the gripper can be moved for example from the rest position to the working position and vice versa. The advantage here is that simple design allows fast and error-free use.

The inventive control element has push / pull devices which can move the gripper via the force coupling head in the cannula. These sliding / pulling devices can be configured in many ways. For example, simple slides can be used directly on the surface of the control element, which can move the flange proximally or distally. In addition, but also scissors constructions, as they are widely known from the prior art, can be used to move the gripper in the proximal or distal direction. The power coupling head should advantageously establish a secure connection with the control and secure the reciprocating motion or the distal or proximal movement of the gripper. The advantage here is a relatively simple structure and, consequently, a relatively error-free handling of the thread gripper. An inventive Fadengeifer is designed in such a way that the cannula and the gripper with the control element is connectable and / or detachable. This detachable connection of the cannula and the gripper with the control element can be done via a quick release mechanism. As a quick-release mechanism should be any mechanism in question, which automatically assumes a firm connection by mating of cannula, gripper and control element and by unlocking, which can also be done manually, a solution of the parts from each other. The advantage here is that in a solid easy-to-release connection of the user during an operation can solve the control element of the cannula to pull out the gripper, for example, together with the thread through the cannula to the outside (percutaneously) from the body.

In this context, different approaches of the user come into consideration. First, the thread can be grasped in the body. For this purpose, the thread gripper is retracted via a slider on the control element in almost home position, which means that the gripper is almost flush with the cannula tip. Subsequently, in the cannula almost flush with the cannula tip retracted in basic position gripper is preferably placed with the attached Einbringhilfe on the handle of the cannula and then pierced percutaneously through the skin and further example by the labrum / inserted through an existing access to the surgical field , Subsequently, the hook element is manually extended from the cannula tip and preferably at the same time the hook element opens in such a way that the first gripping arm moves away from the second gripping arm in a self-stripping manner. Thereafter, a thread inside the body can be caught by the catch hook. Subsequently, the user can, for example, release the slider, which has been pressed against a spring force, so that the hook element moves back almost flush into the cannula tip and the first gripping arm and the second gripper arm close the hook element. Around To be able to feel better the resistance when pulling out the thread, the slider is preferably held and then shuttled with the hinged thread on the instrument from the body. Another embodiment of the use of the thread gripper is designed in such a way that the hook element is preferably extended by hand via the slider from the cannula tip and almost simultaneously the gripper mouth is opened, in which the first gripping arm is spread apart relative to the second gripping arm. Thereafter, the user can insert the thread in the hook element. Subsequently, the slider is released on the handle, so that the hook element is preferably pulled spring-assisted into the cannula, wherein the first gripping arm relative to the second gripping arm performs a closing movement. When reaching an integrated stop, for example, in the handle, the thread is preferably kept safe just before the cannula, so that the thread can not be perforated by the sharp needle tip. It is also conceivable, however, to make the cannula shape, for example, partly angular or elliptical in order to pull the thread into or through the cannula, without perforating it. It is also possible in the cannula or a cannula-like shaft to move a plurality of parts having a force coupling head for driving, such as grippers and an additional cutting knife, a needle, drill, or knot shifter one after another or side by side in the cannula independently or multiple controls can be moved.

Another embodiment is that in the cannula almost flush with the cannula tip retracted eg in basic position hook element with held thread preferably with the attached Einbringhilfe on the cannula, eg percutaneously pierced or pierced through the skin and / or the labrum or by a existing access to the surgical field. Advantageous in all versions here is the Saving of instruments and surgical steps. The surgical technique is simplified, the operating time significantly shortened and the patient incurs interventions that are barely visible. In another embodiment, the thread gripper consists of two parts. In the first place, a reusable, preferably dismantlable or resterilizable handle or control element with clamping and sliding mechanism for cannula and gripper is used. In addition, various thin cannulas, for example, approximately straight or straight or partially bent up to a U-shape to almost 180 °, or partially with a curled, spiral shape. These different thin cannulas should preferably be designed for percutaneous use with a corresponding preassembled gripper in the cannula, wherein the cannula and gripper are offered sterile as a disposable product and unsterile as a reusable product. The gripper is executed with hook element and preferably with sprung trained gripper arms, fishing hook or gripper stop. It is also conceivable to integrate only a hook hook or a lasso or a catch system not described in detail instead of the gripper. If necessary, a not necessarily necessary Einbringhilfe the thread gripper for percutaneous puncture through the skin or any solid tissue, preferably as a disposable sterile or non-sterile. The main advantages over instruments / techniques offered on the market are on the one hand the possibility of percutaneous working, for piercing, for example, the labrum, but also in the simple gripping of the thread with an instrument. With the help of this instrument, the user is free to work through an access or percutaneously pierce directly through the skin to place the sutures of his planned suture. In a preferred exemplary embodiment, the hook element is, for example, separated into two regions, separated by the gripper stop. This is the first area between the gripper stop and the Fishing hook and the second area between the gripper stopper and the base member. These two areas can each have the same grip or a different grip. You can also give the hook element in each case the same internal mass or shape depending on the area different inner mass of the hook element by various shaping. The advantage here is the fact that the user can grab the gripped thread depending on the selection of the area either loose or firm. Grip in this context means a loose or a firm gripping the thread.

In typical embodiments, the cannula includes a sharp tip. This results in the advantage that the thread gripper can be used directly for cutting. There is in particular in the indication of the so-called Kalkschulter with the cannula or needle percutaneously or through the portal to get to a deposition zone and from there on the operation, such as a slide extend a flat needle and stab with the needle tip into the tendon. The advantage is that the needle tip is very small and this intervention leaves no ruptures and the user can thus find and eliminate very small deposits. This increases the chances of success of the operation. Another advantage is that when the needle is removed from the tendon, the deposit in the eye is more visible from many sides.

In the typical embodiment, the control element comprises a spring element. This results in the advantage that the working element can be sprung and / or held in a desired position. In a typical embodiment, a thread gripper comprises a displaceably mounted in a cannula working element, wherein the working element a dull spoon, a sharp spoon, an eyelet, a pair of pliers, tweezers, a staple, and / or a knife.

This has the advantage that a surgical instrument for a variety of applications can be formed.

In typical embodiments, a plurality of working parts in a cannula are moved side by side, one of which is e.g. for cutting and the other can be designed for clamping.

In typical embodiments, the cannula is designed as a hollow shaft. Slots, bores, curves are particularly preferably formed in the hollow shaft. Depending on the application, the front side can be made tapered, dull or rounded. This has the advantage that the appropriate cannula shape can be used for the application.

In typical embodiments, the cannula comprises a passage, in particular for a thread stop. In another typical embodiment, the connection between the cannula and a handle part via a plug connection, for example, a Luer connection. Other plug-in elements can be designed in T-shape, star shape or mushroom shape. This has the advantage that a variety of tasks, such as sampling, cutting, holding, gripping, terminals can be exercised.

Preferably, the cannula is made of nitinol and plastic. This results in particular for angled cannulas the advantage that smoother motion sequences can be performed with less effort.

In typical embodiments, the jaws are made with a lock. This has the advantage that the function is improved. In another typical embodiment, the cannula is curved. This has the advantage that body cavities can be achieved.

In typical embodiments, the cannula bend is made so strong that the cannula is suitable for a backside insert.

In typical embodiments, the thread gripper comprises an outer tube. Preferably, the outer tube encloses the cannula and the working element and can be moved relative to the working element. This results in the advantage that the working element can be actuated by means of the outer tube. This is very advantageous especially with pliers or tweezers. When the outer tube is pushed over the forceps or tweezers, they are compressed. When the outer tube is removed from the forceps and tweezers, they open again.

This has the advantage that the control of tweezers or forceps in a simple manner is possible.

Separately, protection is claimed for the use of a surgical instrument with the features of a thread grab, wherein the working element is actuated by displacing an outer tube.

_{1 g}

DESCRIPTION OF THE FIGURES

BRIEF DESCRIPTION OF THE DRAWINGS Further advantages, features and details of the invention will become apparent from the following description of preferred embodiments and from the drawing; these

FIG. 1 shows a three-dimensional view of an inventive device

 Thread gripper;

FIG. 2 shows a three-dimensional view of an inventive device

 cannula; FIG. 3 shows a two-dimensional side view of a gripper;

Figure 4 is an enlarged detail view of a portion of Figure 1;

FIG. 5 shows a hook element according to the invention in working position;

FIG. 6 shows a hook element according to the invention in the rest position;

FIG. 7 shows a part of the gripper according to the invention; FIG. 8 shows a detail of a gripper according to the invention

 cannula;

Figure 9 is a sectional side view of a portion of a cannula; FIG. 10 shows a three-dimensional view of an inventive device

Cannula. FIG. 11 shows a side view of a thread gripper according to the invention;

Figure 12 shows a schematic representation of a sectional view of a thread grab according to the invention with a curved cannula;

FIG. 13 shows an enlarged detail of a front region of the

 FIG. 12;

Figure 14 shows a schematic representation of a sectional view of an inventive thread gripper with a spring element in the control; Figure 15 is an enlarged view of a front portion of the figure

 14;

Figure 16 is an enlarged view of a rear portion of the figure

 14;

Figure 17 shows a schematic representation of a cut

 Side view of a front region of a further embodiment of an inventive thread gripper in the open position;

FIG. 18 shows a schematic illustration of the front region according to FIG

 Figure 17, wherein the working element is in a closed position; Figure 19 shows a schematic representation of a cut

Side view of another embodiment of a inventive surgical instrument with an outer tube.

In Figure 1, a yarn gripper 1 is shown. This thread gripper 1 consists primarily of a cannula 2, in which a gripper 5 is located and a control element with a slider 8. In addition, a region 4 is shown in Figure 1, which is shown in Figure 4 again enlarged.

FIG. 2 shows another embodiment of a cannula 2.1 according to the invention, which is bent. In de cannula 2.1, the gripper 5 is mounted. In Figure 1, the gripper 5 is at rest and in Figure 2, the gripper 5 is in working position. This can be seen from the fact that in Figure 1 at the proximal end of the cannula 2 of the gripper 5 is pushed out. In Figure 2, the gripper 5 is retracted at the proximal end of the cannula 2.1.

FIG. 3 shows the gripper 5. The gripper 5 has a hook element 7 at its proximal end. In addition, the gripper 5 has a force coupling head 6 at its distal end. This force coupling head 6 can also be seen in FIG. The power coupling head 6 is connected to a flange portion 9 of the control element 3. The flange portion 9 has a detent spring 10. This detent spring 10 is positively connected to the power coupling head 6, so that sliding movements of the slider 8, which act directly on the detent spring 10, allow the reciprocating motion or the proximal and distal movement of the gripper. The slide 8 is in this case pressed against a spring, not shown in the figures, so that upon release of the slide 8, this returns to its original position. The gripper 5, which is forced over the force-coupling head 6 and the detent spring 10, will also proceed in the same way. FIG. 5 shows a hook element 7 in the working position. The hook element 7 consists of a base element 11, which connect a first gripper arm 12 and a second gripper arm 13 with each other. The first gripper arm 12 has In addition, a gripper stop 14, which almost abuts or abuts in the working position on the second gripping arm 13. In addition, the gripping arm 13 forms a catch hook 15. This fishing hook 15 is pointed at its proximal end in side view and sickle-shaped at its distal end.

The thread is loosely guided in the region of the catch hook 15 of the gripper arm 13 and held in the area after gripper stop 14. This arrangement can also be reversed, or only a function of both, wherein the branches for the thread-holding function can be flat as shown, or formed with teeth, or any handy structure.

FIG. 6 shows the hook element 7 in the rest position. There, it is easy to see how the first gripper arm 12 is spread away from the second gripping arm 13. This spread can be done due to a predetermined bias in the base element or by a spring not shown in detail.

FIG. 7 shows the force-coupling head 6. This force-coupling head 6 has a shoulder 16 which serves to prevent the gripper from being inserted too far into the control element 3. In addition, the shoulder 16 but also against that the gripper slips too far into the cannula. At the shoulder 16, a web 17 is formed. This web 17 in turn represents the connection between the shoulder 16 and the coupling element 18. The coupling element 18 is intended to finally establish the connection with the flange region 9 of the control element 3. For this purpose, the coupling element 18 is inserted into a recess of the transmission element / detent spring 10 in the flange region 9.

Figure 8 shows the hook member 7 in the rest position, as it is pushed out of the cannula 2 and just a thread 19 receives.

Figure 9 shows a sectional side view of a cannula 2.1, in which the hook element 7 is in the working position. In this case, the first gripping arm 12 against pressed the second gripping arm 13, so that the gripper stopper 14 with the second gripping arm 13 receives almost a touch or a touch.

FIG. 10 shows an insertion aid 20, which cooperates with an adaptation element 21 of the cannula. This makes it easier for the user to handle the thread gripper, although this is not absolutely necessary.

The handling of the thread gripper according to the invention is described as follows:

The sterile-packed cannula 2 with gripper 5 and insertion aid 20 is removed from the packaging. The preassembled cannula 2 with gripper 5 is inserted into the provided receptacle or collet on the control element. The control element is preferably a handle.

By further insertion as far as the stop in the collet, the cannula flange and / or the force coupling head of the gripper 5 are automatically centered on the flange region 9 of the control element 3. The slide 8 is pushed back in this process. At the same time he drives cannula flange against the flange portion 9 of the control element 3, so that the detent spring 10 on the slide 8 along with the stepped guideway, so that the power coupling head 6 of the gripper 5 is locked. By screwing a clamping nut on the control element pressure is generated on the cone of the collet on the cone and the cannula is stretched.

Upon further movement of the slider 8, the gripper 5 is automatically taken. To remove the cannula 2 and / or the gripper 5 from the collet, the collet is first released to then push the slider along the guideway to position 22.1 in Figure 11. In this process, the detent spring tilts for the power coupling head 6 of the gripper 5 on the gradation of the guideway, unlocks the gripper 5 and pushes this part of the cannula 2 out. Prior to the surgical intervention, the gripper 5 used is pressed by pressing an actuator 23 on the slider 8 spring-assisted in the position 24.1 and snaps there.

Now, for example, be inserted percutaneously to the desired location, since the hook tip or the hook element 7 is retracted substantially flush with the tip of the cannula 2.

After the thread has become visible in the surgical field via the endoscope, the gripper 5 is extended out of the cannula 2 by pressing the pressure region 25 up to the position 26.1. At the same time, the first gripping arm, which is designed to be self-spreading, opens and the thread is gripped and, by releasing the slide 8, the slide 8 moves with the gripper 5 at least partially spring-assisted into the position 27.1.

In this case, the hook element 7 closes preferably automatically by retracting into the inner circumference of the cannula 2. The retraction of the slide 8 to the position 27.1 can also be done partially manually. Now, for example, the thread can be loosely guided or held firmly out of the body. But this can also be done manually with or without locking functions. The shape of the hook element 7 can be formed as a pliers, sling, lasso or simple hook. The individual parts of a thread gripper according to the invention are conceivable from surgical spring-hard steel or else from nithinol or plastics or other materials. The thread gripper according to the invention can be made percutaneously or via accesses with or without a tip, without a cannula for piercing or introduction into the body. The thread gripper according to the invention also allows a loose guidance of the thread without perforating or excessively pulling it. The thread is loosely guided in the region of the catch hook 15 of the gripper arm 13 and held in the area after gripper stop 14. This arrangement can also be reversed, or only a function of both, wherein the branches for the thread-holding function can be flat as shown, or formed with teeth, or any handy structure.

It is also possible to move in the cannula several parts for different functions, which have a power coupling head for driving. One after the other or side by side in the cannula can be moved independently of each other via one or more controls.

FIG. 12 shows a thread gripper 29. The thread gripper has a cannula 30, which is bent at its front end 31.

In the cannula 30, a needle 32 is guided with an eyelet 33. The eyelet 33 can be seen in the enlarged view of FIG. To the needle 32 is integrally provided at a rear portion of the needle 32, a connecting part 34 for a handle part. The connecting part 34 serves as a coupling. The cannula 30 is connected to a holding part 35. In the present exemplary embodiment, the holding part 35 is connected to the cannula 30 via a Luer connection 36.

In further embodiments, not shown, the holding part 35 is formed integrally with the cannula.

FIG. 14 shows a further surgical instrument 37. This is designed essentially analogously to the surgical instrument 29, but differs by the formation of a control element 38. The control element 38 comprises a holding part 39, which is connected to one of the cannula 30. The holding part 39 is a spring guide 40 is placed. The spring guide 40 includes a stop 41 for a spring element 42. Furthermore, the spring guide 40 comprises a pin 43. The pin 43 is in a Long hole 44 in a terminal thickening 45 of a needle 46 out. As can be better seen in the enlarged view of FIG. 16, the oblong hole 44 has a bend 47. As a result, the slot 44 is given a curve shape. By the cooperation of the pin 43 and the shape of the slot 44, the needle 46 can be locked in a certain position. As can be seen in the enlarged view of FIG. 15 of the front region of the surgical instrument 37, the eyelet 33 protrudes completely from the cannula 30. FIGS. 17 and 18 show a front region of another embodiment of a surgical instrument 48. The surgical instrument comprises as a working element 48, a pair of tweezers 49. The tweezers 49 comprises a first leg 50 and a second leg 51, which are brought together in a common shaft 52. The forceps 49 is guided in a cannula 53. The cannula 53 has a pointed front side 54. As a result, the cannula 44 is directly suitable for cutting and piercing in the tissue. FIG. 18 shows tweezers 49 with opened legs 50 and 51. For this purpose, the legs project 50 and 51 substantially completely out of the cannula 53.

In Figure 18, the tweezers 49 are shown in a substantially closed state. For this purpose, the cannula 53 is pushed over the legs 50 and 51 of the forceps 49 until they are substantially closed. Another possibility is to pull the tweezers 49 on the shaft 52 into an interior of the cannula 53 until the legs 50 and 51 are closed.

FIG. 19 shows a further exemplary embodiment of a front region of a surgical instrument 55. Surgical instrument 55 likewise comprises tweezers 56, which are guided in a cannula 57. Furthermore, the surgical instrument comprises an outer tube 58. The outer tube has an inner diameter d, which corresponds to an outer diameter of the cannula 57. In Figure 19, the tweezers with closed legs 59 and 60th shown. The outer tube is pushed over an area of the legs so that they are closed.

The operation of the surgical instrument 55 is as follows:

To open the legs 59 and 60 of the tweezers 56, the outer tube 58 is pulled back in the direction of arrow P, thereby going the legs 59 and 60 apart.

The tweezers 52 and 56 are designed so that, without counteracting the legs 50 and 51 or 59 and 60 strive to occupy the greatest possible distance.

LIST OF REFERENCE NUMBERS

Thread gripper 34 connecting part 67

 Cannula 35 holding part 68

 Control element 36 Luer 69

 Area 37 Surgical 70

 instrument

 Gripper 38 Control elements 71

 nt

 Power coupling head 39 holding part 72nd

 Hook element 40 spring guide 73

 Slider 41 stop 74

 Flange region 42 spring element 75

 Transmission element 43 pin 76

/ Detent spring

 Base element 44 slot 77

 First gripper arm 45 connection 78

 Second gripper arm 46 needle 79

 Gripper stop 47 Bend

 Fanghook 48 Surgical

 instrument

 Shoulder 49 tweezers

 Bridge 50 thighs

 Coupling element 51 legs

 Thread 52 shaft

 Insertion aid 53 cannula

 Adapter 54 sharp point

 Position 55 Surgical

 instrument

 Actuator 56 tweezers

 Position 57 cannula

 Pressure range 58 outer tube

 Position 59 thighs

 Position 60 leg d diameter

Collet 61 P arrow direction

Thread gripper 62

 Cannula 63

 Front end 64

 Needle 65

 Eyelet 66

Claims

Patent claims 1. Thread gripper with a control element (3, 38), characterized by a gripper (5) slidably mounted in a cannula (2, 30, 53). 2. Thread gripper according to claim 1, characterized in that the gripper (5) comprises a hook element (7). 3. Thread gripper according to claim 1 or 2, characterized in that the gripper (5) comprises a force coupling head (6). 4. Thread gripper according to claim 2 or 3, characterized in that the hook element (7) in the rest position, suitable for gripping a thread (19), is essentially pushed out of the cannula (2, 30, 53) proximally. 5. Thread gripper according to one of the preceding claims 2 to 4, characterized in that the hook element (7) is essentially retracted into the cannula (2, 30, 53) in the working position, suitable for holding the thread (19). 6. Thread gripper according to one of the preceding claims 2 to 5, characterized in that the hook element (7) fits completely into the inner circumference of the cannula (2, 30, 53). 7. Thread gripper according to one of the preceding claims 2 to 6, characterized in that the hook element (7) comprises a catch hook (15), which is sickle-shaped at its distal end. 8. Thread gripper according to one of the preceding claims 2 to 7, characterized in that the catch hook (15) forms a beveled shape at its proximal end. 9. Thread gripper according to one of the preceding claims 2 to 8, characterized in that a first gripper arm (12) is self-expanding against a second gripper arm (13). 10. Thread gripper according to claim 9, characterized in that the first gripper arm (12) is connected to the second gripper arm (13) via a base element (11). 1 1. Thread gripper according to claim 9 or 10, characterized in that the first gripper arm (12) comprises a gripper stop (14). 12. Thread gripper according to one of the preceding claims 3 to 1 1, characterized in that the force coupling head (6) cooperates with the control element (3, 38). 13. Thread gripper according to one of the preceding claims 3 to 12, characterized in that the control element (3, 38) has pushing/pulling devices which move the gripper (5) via the force coupling head (6) in the cannula (2). 14. Thread gripper according to one of the preceding claims, characterized in that the cannula (2, 30, 53) can be connected and/or detached from the control element (3, 38) via a quick-release mechanism. 15. Thread gripper according to one of the preceding claims, characterized in that the cannula (2, 30, 53) has a sharp tip (54). 16. Thread gripper according to one of the preceding claims, characterized in that the cannula (2, 30, 53) is curved. 17. Thread gripper according to one of the preceding claims, characterized in that the control element (3, 38) comprises a spring element (42). 18. Use of a thread gripper according to claims 1 to 17, characterized by the following steps: - the gripper (5) is displaced in the cannula (2, 30, 53) by actuating the pushing/pulling device of the control element (3, 38); - The hook element (7) is essentially pushed out of the cannula (2, 30, 53) at one end in the rest position, suitable for gripping a thread (19), with the first gripping arm (12) spreading away from the second gripping arm (13). ; - In the working position, suitable for holding a thread, the hook element (7) is essentially drawn into the cannula (2, 30, 53) at one end, the first gripping arm (12) due to the inner circumference of the cannula (2, 30 , 53) is pressed against its spreading force towards the second gripping arm (13). 19. Surgical instrument characterized in that the thread gripper according to one of the preceding claims 1 to 16 comprises a working element which is slidably mounted in a cannula (2, 30, 53), the working element being a blunt spoon, a sharp spoon, an eyelet (33). , pliers, tweezers (49, 56), a clamp or a knife. 20. Surgical instrument according to claim 19, characterized by an outer tube for actuating the working element, in particular pliers or tweezers (49, 56). 21. Use of a surgical instrument according to claims 19 or 20, characterized by the step that the working element is actuated by moving the outer tube. -27- 8. Thread gripper according to one of the preceding claims 2 to 7, characterized in that the catch hook (15) forms a beveled shape at its proximal end. 9. Thread gripper according to one of the preceding claims 2 to 8, characterized in that a first gripper arm (12) is self-expanding against a second gripper arm (13). 10. Thread gripper according to claim 9, characterized in that the first gripper arm (12) is connected to the second gripper arm (13) via a base element (11). 11. Thread gripper according to claim 9 or 10, characterized in that the first gripper arm (12) comprises a gripper stop (14). 12. Thread gripper according to one of the preceding claims 3 to 11, characterized in that the force coupling head (6) cooperates with the control element (3, 38). 13. Thread gripper according to one of the preceding claims 3 to 12, characterized in that the control element (3, 38) has pushing/pulling devices which move the gripper (5) via the force coupling head (6) in the cannula (2). 15. Thread gripper according to one of the preceding claims, characterized in that the cannula (2, 30, 53) can be connected and/or detached from the control element (3, 38) via a quick-release mechanism. 16. Thread gripper according to one of the preceding claims, characterized in that the cannula (2, 30, 53) has a sharp tip (54). -28- 17. Thread gripper according to one of the preceding claims, characterized in that the cannula (2, 30, 53) is curved. 18. Thread gripper according to one of the preceding claims, characterized in that the control element (3, 38) comprises a spring element (42). 19. Use of a thread gripper according to claims 1 to 19, characterized by the following steps: - the gripper (5) is displaced in the cannula (2, 30, 53) by actuating the pushing/pulling device of the control element (3, 38); - The hook element (7) is essentially pushed out of the cannula (2, 30, 53) at one end in the rest position, suitable for gripping a thread (19), with the first gripping arm (12) spreading away from the second gripping arm (13). ; - In the working position, suitable for holding a thread, the hook element (7) is essentially drawn into the cannula (2, 30, 53) at one end, the first gripping arm (12) due to the inner circumference of the cannula (2, 30 , 53) is pressed against its spreading force towards the second gripping arm (13). 20. Surgical instrument characterized in that the thread gripper according to one of the preceding claims 1 to 17 comprises a working element which is slidably mounted in a cannula (2, 30, 53), the working element being a blunt spoon, a sharp spoon, an eyelet (33). , pliers, tweezers (49, 56), a clamp or a knife. 21. Surgical instrument according to claim 20, characterized by an outer tube for actuating the working element, in particular pliers or tweezers (49, 56). -29- 20. Use of a surgical instrument according to claims 20 or 21 , characterized by the step that the working element is actuated by moving the outer tube.