• 专利附录
  • 专利说明
  • 权利要求
  • 类似技术
  • 同族专利
  • 引用文献
  • 法律状态
  • 优先权
    • 专利摘要:
    INSTRUMENT FOR FUSION AND VESSEL SEPARATION In the case of an instrument (10) for coagulation and fusion, as well as for cutting vessels, two arms (19, 20) are provided, between which a vessel is clamped and fused. A blade (21) for cutting the coagulated and molten vessel is provided with an insulator (40), which insulates the blade (21) against at least one of the electrodes or arms (19, 20), respectively. On the other hand, the blade (21) is preferably in mechanical contact with at least one of the electrodes or arms (19, 20), respectively, so that a safe separation of the fused tissue or biological vessel, respectively, is obtained. This concept can be used to increase the safety of surgery and to miniaturize the 918) tool to smaller dimensions.
    公开号:BR102014005880B1
    申请号:R102014005880-0
    申请日:2014-03-13
    公开日:2022-02-15
    发明作者:Martina Heim
    申请人:Erbe Elektromedizin Gmbh；
    IPC主号:
    专利说明:

    technical field
    [001] The invention relates to an instrument for clamping, coagulating and cutting tissue, in particular stapling, closing and cutting vessels, in particular blood vessels, in the living body of a human or animal patient. prior art
    [002] Instruments for closing and separating blood vessels may be known, for example, from ED 602 26 015 T2.
    [003] Typically such instruments comprise an elongated shaft, which extends away from a manipulator. A tool comprising two arms for clamping a blood vessel is arranged at the distal end of the shaft. Additionally, a blade, which can be displaced longitudinally, is arranged at that location so as to be able to cut a trapped and coagulated vessel. The shaft and blade can be actuated by means of the corresponding elements acting on the manipulator. The arms are incorporated as electrodes and can be supplied with current systematically so as to heat the vessel squeezed between them and fuse the vessel walls through coagulation.
    [004] Before cutting the blood vessels, one has to make sure that clotting has taken place to a sufficient extent so that the ends of the cut vessel remain securely closed. summary
    [005] Based on this, it is an object of the present invention to create an instrument for vessel fusion and separation, by means of which vessels can be safely closed and cut.
    [006] The objective is resolved through the instrument according to claim 1:
    [007] The instrument according to the invention incorporates a tool comprising two arms, at least one of which is movable, so that they can be moved towards each other and away from each other. The two arms form a fork or a means for stapling fabric, respectively, which can be closed by means of a corresponding transfer element, for example, a taut wire extending across the shaft. The tool also comprises a blade, which, in the rest position, is located outside a defined space between the arms, and which can be inserted in this space by means of an actuator element. The blade preferably consists of an electrically conductive material, for example stainless steel. The actuator element may also be made of an electrically conductive material, for example stainless steel. To actuate the arm(s) and the blade, one or a plurality of actuating elements, which serve the purpose of initially closing the yoke and then retracting the blade into the yoke, are attached to the housing. To connect the blade to the actuator element, an insulator is provided, which provides a mechanical connection between the actuator element and the blade, without allowing a current to flow between them. The realization of an eddy current passage, which could otherwise be created, in case the blade is possibly already moved slightly out of its resting position between the arms during the coagulation process due to an operating error, is avoided in this way. form.
    [008] The measurement according to the invention can then have the effect that the instrument can be used in different environments, for example also in accumulations of a physiological sodium chloride solution or similar electrically conductive fluids. The insulation of the actuator element blade prevents or reduces, respectively, the possibility of eddy current passages within the tool or instrument shaft and thus ensures that the current, which is to be applied to the biological tissue, actually moves through the biological tissue. . However, it is possible in particular to take care of and/or continue the supply of current to the arms when the blade is moved from its rest position to the active position. eliminates the possibility of the blade causing a short circuit between the arms or their electrodes, respectively. Electrical current is prevented from passing through the tissue through the blade. The electrical current is guided from the electrode through the tissue stapled to the respective other electrode. Coagulation of the stapled tissue is thus impacted in a positive way and is ensured even in the event that the user actuates the blade prematurely. This is possible in particular in the case of two-stage tool actuators, in which case an actuator manipulator is used to close the arms while covering the first distance and to push the blade forward while covering a second last distance. If the situation arises where the user unknowingly moves the hand lever too far towards the blade actuation position, the latter may have already been moved slightly and may cut off at least a part of the coagulation flow. The blade insulation according to the invention avoids this possible error.
    [009] The first electrode preferably incorporates a blade sliding surface, along which the blade can run. An electrical contact between the first electrode and the blade is created in this way, at least during cutting of the clotted vessel. A current flow that can negatively influence coagulation can thus result between the coagulated tissue and the slide. Blade insulation prevents this flow of current as well as damage to the blade or its corner or cutting edge caused by current flow.
    [0010] A vertical adjustment mechanism may be associated with the blade so as to adjust the blade as a function of its longitudinal movement at right angles, preferably vertically to this movement, so as to float guide the blade tip and bring it into contact only with the first electrode, but not with other corners, stages or the like. This protects the blade and ensures its long-lasting sharpening even in response to repeated use.
    [0011] The two electrodes preferably incorporate a shape, which is complementary to each other, so that, in the closed state, they define a gap of substantially constant width between them. This slit can be made to be flat or curved. The blade is arranged and guided so that it passes through this slit. Preferably, the blade thereby runs between one of the two arms, which are concretized to be open for this purpose, while it slides on the electrode of the other arm.
    [0012] Preferably, the blade is embodied as a lamella, that is, as a thin metal plate. For example, it is made of a hardenable blade steel with a thickness of between 0.1 mm and 0.2 mm. It can have a length of several millimeters, for example between 7 mm and 10 mm, and a height of a few millimeters, for example between 2 mm and 3 mm.
    [0013] At its distal end, it preferably comprises a cutting nose comprising at least one cutting corner as well as an axis, which extends away from the cutting nose. The cutting nose and the axis can be realized in the same piece of material and can thus be fused.
    [0014] Preferably, the insulator is a plastic body, in which at least the axis of the blade extends. The insulator thus preferably covers at least the two flat side sides of the shaft and thus prevents extensive contact between the blade and biological tissue, which is present, as liquid may be present. Additionally, the insulator extends above the blade axis to an insulating cutting wall, which extends above the cutting nose. The insulator and its insulating cutting wall (measured at right angles to the direction of movement of the blade) are thicker than the blade, in particular thicker than its cutting nose. Every electrical contact between the blade and the second arm, in the slot from which the blade can be retracted, is thus prevented. The cutting nose is arranged to be protected in a recess in the insulator.
    [0015] It is advantageous when the shaft as well as the actuator element, in each case, comprises at least one opening, which is permeated by the insulator. In this way, a shape lock is obtained between the insulator and the blade. More preferably, the blade and the actuator element determine a slit, which can be embodied as a parallel slit. This gap can be filled with insulator material. Preferably, this slit is oriented transversely to the direction of movement of the blade. This results in a mechanically durable connection between the actuator element and the blade, whereby the actuator element is able not only to transfer traction and pressure, but also a pressing force to the blade, which is directed vertically towards it. . This pressure force can press the blade against the first non-slitted electrode and thereby make a clean cut of the coagulated tissue.
    [0016] Other details of advantageous embodiments of the invention are the subject of the figures, description or dependent claims. Terms associated with direction, such as top, bottom, top, bottom, etc., which are used in describing an exemplary embodiment, refer to directions in the figure and should not be construed as limiting in that regard. Description of drawings
    [0017] Figure 1 shows an instrument according to the present invention in a schematic representation;
    [0018] Figure 2 shows the instrument tool according to the invention, in perspective view;
    [0019] Figure 3 shows the tool according to figure 2, in cross section;
    [0020] Figure 4 shows a blade, the insulator and a tool actuation element according to figure 3, in a partial side view;
    [0021] Figures 5 to 7 show the tool comprising the arms closed in different operating positions; and
    [0022] Figure 8 shows the blade, the actuator element and the insulator according to figure 4 in an overview. Detailed Description
    [0023] Figure 1 illustrates an instrument 10, which can serve to staple, fuse and cut biological tissue, for example, a vessel, for example, a blood vessel when performing an operation on a human or animal body. The instrument 10 can be used, in particular, for endoscopic surgery. It comprises a thin shaft 11, which is supported in a housing 12 at its proximal end. This housing comprises a handling means, such as, for example, a manipulator 13, as well as actuating elements 14. The latter may consist, for example, of a pivotable gripping member 15 and/or an actuation button or lever. 16, as well as other elements, if applicable, for example electrical switches. The actuating elements 14 are connected to a tool 18, which is arranged at the distal end of the shaft 11, by means of the power transmission means 17, which are only schematically illustrated in figure 1 in dashed line. The tool 18 comprises at least two arms 19, 20 as well as a blade 21. The arms 19, 20 serve to hold tissue, for example from a vessel, when they are moved towards each other, wedge the vessel between them and clot it. The blade 21 serves the purpose of cutting the clotted vessel.
    [0024] The power transmission means may include pushing or pulling members for moving one or both of the arms 19, 20, as well as an actuator element 22 for actuating the blade 21. Such an actuator element 22 may be, for example, a metal band 22, which consists of a thin sheet, as seen in Figure 8. The actuator element 22 extends from the blade 21 through a partial area of the shaft 11 to the thrust or pulling members. The latter, in turn, extend to an actuator, which is not illustrated in detail, which transfers an actuation movement, which starts at the gripping member 15, to the blade 21.
    [0025] For example, the actuator can be embodied so that the arms 19, 20 are initially closed in response to the movement of the gripping member 15 towards the manipulator 13, with the blade 21 still remaining in the rest position, or that is, outside a space 23, which is contained between the arms 19, 20. This state is illustrated in figure 2. The actuator can still be embodied so that the blade 21 is pushed forward towards the distal end of the tool 18 between the arms 19, 20 during the last part of the movement of the gripping member 15 towards the manipulator 13 when the arms are already closed. For this purpose, one of the arms 19, 20, for example the arm 20, can be provided with a slot 24 which extends longitudinally through the arm 20, so as to accommodate the blade 21. The slot 24 can, in addition, In addition, it can be seen in figure 3. In place of the actuator described above, which derives the movement of the arms 19, 20 and the blade 21 from a movement of an actuating member (eg, the gripping member 15), it can be other actuating members, in particular separate actuating members, are also provided for the tool 18 and for the blade 21.
    [0026] The blade 21, which is guided in the slot 24, consists of a metal lamella, for example, which, as can be seen in figure 4, incorporates a cutting nose 25 at its distal end, and a shaft 26, which connects the same. Cutting nose 25 and shaft 26 are preferably a part of a small metal plate with a thickness of between 0.1 mm and 0.2 mm, preferably 0.15 mm, comprising two flat sides 27, 28, which can be seen in the figure. 3. The cutting nose 25 forms a blade comprising a tip 29, from which a front cutting corner 30 extends outward so as to ascend transversely. At an acute angle thereto and thus parallel to the first arm 19, the cutting nose 25 incorporates a cutting corner 31 which slides along the first arm 19 when in use.
    [0027] The shaft 26, which has a rectangular cross-section, extends away from the cutting nose 25 and ends at a corner 32, which is preferably angled or which is also arranged transversely, as illustrated. Said corner preferably has an obtuse angle α of, for example, between 110° and 130°, for example 115°, with the upper corner 33 of axis 26, which is preferably straight.
    [0028] Located opposite the corner 32, the actuating element 22 incorporates a front corner 34, which is preferably oriented parallel to the corner 32 and which thus defines a parallel slot 35 therewith. The corner 34 preferably has an acute angle β of 65°, for example with an upper side 36 of the actuating element 22.
    [0029] The lower corner 37, which extends approximately parallel to the upper side 33 of the shaft 26, is preferably embodied to be straight and may be provided with a step 38. Additionally, the shaft 26 preferably comprises at least one opening 39. The latter can be made to be round, angular or otherwise. It serves to hold an insulator 40, which is preferably formed of a plastic part in a form-to-shape interlocking manner. The insulator 40 surrounds the axis 26 of the blade 21 at least partially, the insulator 40 preferably leaving the cutting nose 25 of the blade 21 open. The insulator 40 may be formed of an injection molded plastic part, preferably consisting of a thermostable, temperature resistant material. As can be seen from figure 3 in combination with figure 4, the insulator preferably incorporates two flat sections 41, 42 which cover the sides 27, 28 of the shaft 26 and which are connected to each other by means of a section, which extends through opening 39. Sections 41, 42 can be connected together above the upper side of shaft 26 as well as below lower corner 37, so that a compact insulation body is formed as a whole. As shown in Figure 4, the common lower closure of sections 41, 42 runs below the lower corner of the shaft 26, but above the cutting corner 31.
    [0030] As shown in figure 4, the actuator element 22 extends to the insulator 40 and is surrounded by it. At its distal end, the insulator 40 preferably comprises an insulator cutting wall 44, which surrounds a leading end 45 of the blade 21 and which extends beyond the cutting nose 25. A free space 46, which forms a insertion corner, preferably comprising a right angle, is realized below the insulator cutting wall. The cutting nose 25 is arranged in the free space 46. According to Figure 3, the insulator cutting wall 44 is thicker than the cutting nose 25, which then cannot touch the inner wall surfaces of the slot 24. .
    [0031] An opening 47 can be provided in the actuator element 22, which is permeated by material from the insulator 40, in order to connect the actuating element 22 and the insulator 40 in order to lock by the form. The material of the insulator 40 can, in addition, fill the parallel slot 35.
    [0032] As shown in figure 3, the insulator 40 is preferably embodied so as to be flat on its two sides. Sections 41, 42 incorporate a thickness of between 0.1 mm and 0.3 mm. In the area of the shaft 26, the material thickness of the sections 41, 41 is between 0.2 mm and 0.3 mm, for example, preferably 0.26 mm. In the area of the actuation element 22, the material thickness of the corresponding sections of the insulator 40 is preferably between 0.1 mm and 0.2 mm, for example 0.16 mm. Sufficient mechanical stability as well as a desired electrical insulation, particularly of the cutting nose 25, is thus obtained, due to a sufficient distance from the slot sides 24.
    [0033] In tier 38, the insulator 40 can also be provided with a tier 48 on its lower side. Said step 48, together with step 49, which is provided on the first arm 19 or on the axle 11, forms a vertical adjustment mechanism 50 (see figures 5 to 7). As shown in figure 4, recesses 51 can also be provided in some locations of the insulator 40, by means of which the shaft 26 or a free end of the actuating element 22 can be accessed. These recesses 51 can serve to position the blade 21 and the actuating element 22 during the production of the insulator 40 by means of standard shaping.
    [0034] Starting from the insulator 40, the actuating element 22 extends across the entire axis 11 and thereby serves to move the blade 21 in the longitudinal direction L. For this purpose, the actuating element 22 is embodied in such a way that be resistant to traction and compression. Additionally, it runs on the axis 11 along corresponding opposing surfaces, which, as illustrated in figure 8 by means of arrows, exert the position dependent forces F1 and F2 on the actuating element 22. These forces are transferred to the blade 21. by means of the insulator 40, so that the tip 29 and the cutting corner 31 thereof slide along the first (lower) axis 19 at a pretension.
    [0035] Instrument 10, which has been described in this regard, operates as follows:
    [0036] In the position, which is illustrated in figures 1 and 2, the instrument 10 is taken to a vessel so that the latter is located between the two arms 19, 20. The user then pulls the gripping member 15 towards the manipulator 13, the arms 19, 20 being initially closed when the blade 21 is still in the retracted position. The vessel is thus clamped between the electrode surface 52 of the first arm 19 and the electrode surface 53 of the second arm 20 and is clamped until the walls of the vessel, which are located opposite each other, touch. The user can now initiate the activation of the electrode surfaces 52, 53 by means of the actuation button 16, whereby a current, which serves for vessel coagulation, is guided to the vessels 19, 20. For example, this can be a high frequency AC voltage. A nose which is provided at the distal end of one of the arms, for example the arm 20, or other projection 54 thus ensures that a defined space 55 is maintained between the arms 19, 20. The flow of current between the surfaces of electrode 52, 53 runs completely through the biological material, which is pressed between them, and coagulates it. As shown in figure 5, the blade 21 is in the retracted position.
    [0037] In case the user now wants to cut the clotted vessel, he moves the gripping member 15, if necessary overcoming an increase in resistance, still against the manipulator 13, where the blade 21, as can be seen in figure 6 , is inserted into the slot 24 of the arm 20. The vertical adjustment mechanism 50 thus supports the tip 29 and the corner 31 so as to still float above the electrode surface 52 of the arm 19. Still in the course of the forward movement, the corners blade 31 and tip 29, however, lower to electrode surface 52, as illustrated in Figures 6 and 7. Actuating element 22 now pushes blade 21 forward to projection 54 and cuts the clotted vessel. The insulator 40 thus interrupts each current flow between the blade 21 and the second electrode surface 52, as well as the arm 20 and in this way ensures that the blade 21 does not take on any noticeable portion of the current, which serves for coagulation, even if she reaches the slit slightly prematurely. Finally, this even makes it possible to cut vessels during the final phase of coagulation from the ends of the vessels, which are clamped between the arms 19, 29. A shortening of the operative time can be achieved with this. However, an increase in coagulation reliability is essential. Even if blade 21 was actuated prematurely, this does not influence the quality of the coagulation result.
    [0038] It is important to note that the insulator 40 can also include the entire actuation element 22. In this case, the blade 21 and the actuation element 22 can be embodied in a single piece or can be connected to each other in another way.
    [0039] Additionally, it is important to note that the actuation element can also be made of an electrically non-conductive material, either completely or partially. In this case, the insulator 40 can be a part of the actuation element 22. For example, the distal end of the actuation element 22 can form the insulator 40.
    [0040] In the case of an instrument 10 for coagulation and effusion, as well as for cutting vessels, two arms 19,20 are provided, between which a vessel is clamped and fused. A blade 21 for cutting the coagulated and molten vessel is provided with an insulator 40, which insulates the blade 21 against at least one of the electrodes or arms 19, 20, respectively. On the other hand, the blade 21 is preferably in mechanical contact with at least one of the electrodes or arms 19, 20 so that a safe cut of the fused tissue or biological vessel, respectively, is obtained. This concept can be used to increase the safety of surgery and to miniaturize the instrument 18 in relation to smaller dimensions. Numerical reference list:10 instrument11 axis12 housing13 manipulator14 actuation elements15 gripping member16 actuation button or lever17 means of transmission of energy18 tool19 first arm20 second (upper) arm21 blade22 actuating element for 2123 space between arms 19 and 2024 slot in 2025 cutting nose of 2126 axis27, 28 flat sides of 26α, β angle29 tip of 2530 front cutting corner of 2531 cutting corner on bottom side of 2532 back corner of 2633 top side of 2634 front corner of 2235 parallel space36 top side of 2237 bottom corner of 2638 step of bottom corner of 2639 opening in 2640 insulator41, 42 sections44 insulator cutting wall45 distal end of the blade 2146 free space47 opening in 2248 step in 4049 step in 1950 vertical adjustment mechanism51 positioning recesses 4052 electrode surface in 1953 electrode surface in 2054 projection55 space between arms 19 and 20L longitudinal direction.
    权利要求:
    Claims (14)
    [0001]
    1. Vessel fusion and separation instrument, with a longitudinal axis (11) which extends away from the housing (12) and carries a tool (18) at its distal end, with a first arm (19) belonging to the tool (18) and comprises a first electrode surface (52) with a second arm (20) belonging to the tool and is mounted so as to be movable towards the first electrode surface (52) and away from the tool. same, the second arm (20) having an electrode surface (53) and a longitudinal slot (54), with a blade (21), which belongs to the tool (18) and consists of an electrically conductive material, and is arranged movably with respect to the longitudinal axis (11) and projects into the longitudinal slot (24) or can be inserted therein, with an actuating element (22) extending from the housing (12) through the axis (11) for the blade (21), characterized in that the blade (21) and the actuating element (22) establish a space (35) between and they, and in which the instrument (10) comprises an insulator (40) which is arranged to connect the blade (21) and the actuating element (22) together.
    [0002]
    2. Instrument according to claim 1, characterized in that the first electrode surface (52) is a sliding blade surface.
    [0003]
    3. Instrument according to any one of claims 1 or 2, characterized in that a vertical adjustment mechanism (50) is associated with the blade (21) in order to adjust the blade (21) transversally to its longitudinal movement, depending on of the longitudinal movement, the vertical adjustment mechanism (50) being configured to move the blade (21) in a forward movement oriented along the first arm (19), perpendicularly to the forward movement towards the first electrode surface (52), and in a return movement oriented along the first arm (19), perpendicular to the return movement away from the first electrode surface (52).
    [0004]
    4. Instrument according to any one of claims 1 to 3, characterized in that the second arm (20) is formed by a solid metal body and, on its side facing the electrode surface (52) of the first arm (19), have a shape following the shape of the electrode surface (52).
    [0005]
    5. Instrument, according to any one of claims 1 to 4, characterized in that at least one of the arms (19, 20) has a projection (54), so as to establish a space (55) between the surface of electrode (52) and the electrode surface (53) of the second arm (20) when the arms (19, 20) of the instrument (10) are closed.
    [0006]
    6. Instrument according to any one of claims 1 to 5, characterized in that the actuation element (22) is formed to be electrically conductive.
    [0007]
    7. Instrument according to any one of claims 1 to 6, characterized in that the blade (21) is formed as a lamella with two flat side sides (27, 28).
    [0008]
    8. Instrument according to any one of claims 1 to 7, characterized in that the blade (21) has a cutting nose (25) and an axis (26).
    [0009]
    9. Instrument according to claim 8, characterized in that the cutting nose (25) has a sharp cutting corner (31), facing the first electrode surface (52) and parallel thereto, and a cutting corner sharp cut (30), on the front side which is oriented at an angle to the direction of movement of the blade (21).
    [0010]
    10. Instrument, according to claim 7, characterized by the fact that the axis (26) of the blade (21) extends to the insulator (40).
    [0011]
    11. Instrument according to any one of claims 1 to 10, characterized in that the insulator (40) has an insulator wall (44), which is arranged above a cutting nose (25) of the blade (21).
    [0012]
    12. Instrument, according to claim 10, characterized in that the shaft (26) has at least one opening (39), through which the insulator (40) passes, and that the actuation element (22) has at least at least one opening (47) through which the insulator (40) passes.
    [0013]
    13. Instrument, according to any one of claims 1 to 12, characterized in that the actuation element (22) extends inside the insulator (40).
    [0014]
    14. Instrument, according to any one of claims 1 to 13, characterized in that the space (35) is oriented obliquely to the direction of movement of the blade (21).
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    法律状态:
    2016-02-23| B03A| Publication of a patent application or of a certificate of addition of invention [chapter 3.1 patent gazette]|
    2018-11-13| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|
    2020-07-07| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|
    2021-11-30| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|
    2022-02-15| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 13/03/2014, OBSERVADAS AS CONDICOES LEGAIS. |
    优先权:
    申请号 | 申请日 | 专利标题
    EP13159361.8|2013-03-15|
    EP13159361.8A|EP2777583B1|2013-03-15|2013-03-15|Instrument for vessel fusion and separation|
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