DE102008033740A1 - Surgical instrument for use during minimal invasive and/or endoscopic interferences in human or animal body, has detection device for tactile recognizing of guiding depth of instrument, where detection device comprises detection unit - Google Patents

Abstract

The instrument (12) has an elongated shank (16) for inserting into a human or animal body via a guiding channel (34) of a guiding device (14) that is insertable into the human or animal body. A guiding depth detection device (36) is provided for tactile recognizing of a guiding depth (76) of the instrument in the guiding channel. The guiding depth detection device comprises a guiding depth detection unit (38) e.g. insertion depth detection recess, that is arranged at the shank. The guiding depth detection unit is connected to the shank in an undetachable manner.

Description

The The present invention relates to a surgical instrument having an elongated shaft for insertion into a human or animal body through a guide channel a guiding device insertable into a human or animal body.

Further The present invention relates to a surgical instrument comprising at least one surgical instrument with an elongated one Shaft for insertion in a human or animal body and at least one in the human or animal body insertable guide device with at least one guide channel for insertion of the shaft into the body the guide channel therethrough.

surgical Instruments and instruments of the type described above are in minimally invasive and / or endoscopic procedures on the human or animal body used. The management facility, for example in the form of a trocar sleeve, serves to defined and reproducible input and output of instruments or parts the same, for example, their shafts, in the body of the Patients in or out.

Around a surgeon the surgical field inside the body of the To visualize patients, endoscopes are commonly used with where an image of the surgical site can be generated. To the endoscopic Consequently, a surgeon must first and foremost perform surgery a monitor on which the image generated by the endoscope is displayed will have, in view. When inserting or Changing endoscopic instruments, however, the surgeon is forced to look away from the monitor towards the instruments. To the insertion of the shaft in the leadership, Introductory or Working channel of the guide device The surgeon pushes the instrument further with his shaft the management facility into it, with his eyes constantly between the monitor and the instrumentation changes until a tip of the inserted instrument can be seen in the monitor. Such a constant change of field of vision The surgeon is required so that he can determine how far the instrument still has to be pushed with its shaft, until its tip enters the surgical field. By checking a Position of the instrument relative to the guide means represents the Surgeon sure that the shaft is not inserted too deeply into the patient's body.

at The described procedure must therefore have the impression of an operator when a distal end of the shaft of the inserted instrument the guide channel distal to the inside of the body leaves or enters the surgical field.

Known are instrument shafts with ring marks, which in particular allow an insertion depth of the shaft into the guide channel. So can be visually displayed when the shaft distal the guide channel leaves.

The known solutions or procedures for endoscopic surgery however, it complicates the operation room for the endoscopic procedure often is darkened and so a surgeon marks on the instruments very difficult to recognize. The constant change of perspective between Monitor and instrumentation also prevents a fluid work, the is called an operating time is longer as actually required.

It is therefore an object of the present invention, a surgical Instrument and a set of instruments described above Art to improve so that an endoscopic procedure with the instrument easier and safer to be done can.

These Task is performed on a surgical instrument and a surgical Instrument of the type described above according to the invention thereby solved, that the instrument is an insertion depth detection device for tactile recognition of an insertion depth having the instrument in the guide channel.

With the introduction depth detection device, it is possible for a surgeon, without looking away from the monitor, at which a picture of the surgical site generated with an endoscope inserted into the body interior is tactilely recognized, ie sensed or felt, by how far the shaft the instrument to be introduced by him is already introduced into the guide channel. For example, it can be achieved that a surgeon receives a tactile feedback from the insertion depth detection device when a distal end of the shaft has reached a distal end of the guide channel. The surgeon then knows immediately that by further advancement of the instrument, the distal end of the shaft of the same extend beyond the guide channel and undesirably penetrate into body tissue and possibly injure it. Optionally, the insertion depth detection device can also be used to prevent the instrument tip from being introduced uncontrollably into the intraoperative surgical field, in particular by achieving the tactile feedback by preventing a forceless insertion of the device Shaft in the guide channel. Such an insertion or insertion protection can in particular ensure that when the guide channel is aligned parallel to the direction of gravity, the instrument tip may inadvertently escape from the guide channel, if the surgeon inadvertently the instrument should slide out of hand. The proposed development of the known instrument or instrument thus makes the handling of the same safer and easier and also allows a faster work for the surgeon, since the constant field of view between monitor and guide device or instrumentation is essentially superfluous.

Advantageous it is when the insertion depth detection means is designed such that a tactile by an operator tactile insertion resistance of the instrument during insertion in the guide channel at a certain insertion depth of the instrument is larger than in other relative positions of the instrument and the guide channel. The surgeon can thus the instrument with the shaft in the guide channel introduce and feel upon reaching a predetermined insertion depth, the effect of the insertion depth detection means in the form of an insertion resistance. The insertion resistance may in particular be provided in such a way that it becomes immediately noticeable when a distal end of the shaft has a distal end of the guide channel reached. However, it may be the insertion depth detection means be designed such that an insertion depth arbitrarily specified is.

conveniently, includes the insertion depth detection device at least one introduction depth detection member, which is arranged on the shaft or formed on the shaft. By the insertion depth detection member can easily at a predetermined position on the shaft of the instrument an insertion depth be defined, which the surgeon during insertion of the shaft in the guide channel of the guide means feel tactile can.

Especially simply the structure of the instrument, if that at least one Einführtiefendetektionsglied one piece is formed with the shaft.

Advantageous It may also be if the at least one insertion depth detection member insoluble with connected to the shaft. For example, this can be done by gluing, Welding, Soldering or The like can be achieved, in particular by a one-piece design the insertion depth detection member with the shaft.

Advantageous it is when the at least one insertion depth detection member has a short, in the longitudinal direction extending the shaft extending portion thereof. The shorter one Extension of the insertion depth detection member in the axial direction of the shaft, the more accurate the can Operator a tactile feedback on a Position of the shaft relative to the guide device obtained. So lets in particular a tactility point for the surgeon specify exactly.

Cheap is when the at least one insertion depth detecting member is at least one Part of the circumference of the shaft extends. In particular, so will be an arrangement of the insertion depth detection member in a twist-resistant leadership the shaft of the instrument possible. If such a rotationally secure guidance of the instrument shaft through the leadership facility is not provided, it is convenient if the at least one insertion depth detection member on the extends the entire circumference of the shaft. This makes it possible independently from a rotational position of the shaft relative to the guide means the Taktilitätspunkt or an insertion depth tactile to determine the shaft.

Advantageous it may be when at least a portion of the at least one insertion depth detection member is designed to be movable relative to the shaft and / or arranged. Such a design allows it, the insertion depth detection device so form in the tactile recognizable area the insertion depth detection member relative to the shaft occupies a detection position, immediately in front of it and / or thereafter, however, an insertion position in which the shank relative to the guide device practically powerless, that is for the Surgeon in not noticeable Way, in particular without resistance, is movable. The movable one Embodiment of the insertion depth detection member, at least partially so easily a transition between the insertion position and the detection position.

One Particularly simple construction of the instrument can be characterized in particular be achieved that the at least one insertion depth detection member in Formed an insertion detection projection is. In particular, the insertion detection projection movably mounted on the shaft or stored.

advantageously, is the insertion detection projection in the form of a longitudinal axis formed the shaft facing away annular projection. The ring protrusion may be wholly or partially in the circumferential direction of the shaft extend.

In the manufacture particularly simple, the insertion detection projection can be formed when in the form of a bead formed on the shaft is shaped.

According to one another preferred embodiment The invention may be provided that the insertion detection projection in an insertion position, in which the shaft is arbitrarily insertable into the guide channel, further from a longitudinal axis of the shaft protrudes than in a detection position in which an insertion depth of the shaft is tactile recognizable by an operator. In cooperation of the Einführtiefendetektionsglieds with the guide channel the management facility Thus, a deformation and / or a relative movement of the insertion detection projection take place relative to the shaft, in particular in dependence of which position the shaft occupies, namely the insertion position or the detection position.

Cheap can it may also be if the at least one insertion depth detection member in Shape of an insertion detection recess is trained. Of course can also two or more introduction depth detection members be provided. One can, for example, take the form of an insertion detection recess be formed, another in the form of an insertion detection projection. Conveniently, they can be formed directly next to each other, so that an insertion depth detection member, which in the form of a projection and at least partially movable is formed relative to the shaft, during further insertion of the Shaft in the guide channel at the transition from the detection position in the insertion position can spring, radially from the longitudinal axis away or on this, so tactile to an operator pinpoint to signal that reaches the predetermined insertion depth of the shaft is.

Especially For example, the instrument can be easy to manufacture be that the insertion detection recess is formed in the form of a depression of the shaft. The depression can over a part or over extend the entire circumference of the shaft, ie in particular Shape of Ringnutabschnitten or in the form of a circumferential annular groove.

Advantageous it is when in a detection position in which an insertion depth of the shaft is tactile recognizable by an operator, one of at least an insertion depth detection member practiced Force in a direction transverse or substantially transverse to the longitudinal axis of the shaft acts. The power can be generated in many ways, for example in the form of an elastic element or a spring element. Due to the acting force, the operator can insert a resistance feel at Passing the detection position through the shaft or the insertion depth detection member.

Cheap is when the at least one insertion depth detecting member transfers an insertion position, in which it arbitrarily in the guide channel insertable is, in a detection position, in which an insertion depth of the stem is tactilely recognizable by an operator, at least partially movable against the action of a restoring device is. Thus, a tactile recognizable tactile for the surgeon in a simple manner Resistance can be realized, for example in the form of a so-called Einführwiderstands.

Advantageous is it when the reset device a return member and if the at least one insertion depth detecting member comprises the Restoring member includes or forms. Such a design allows one particularly compact design of the instrument.

Especially just lets build the instrument when the at least one insertion depth detection member a force in a direction transverse or substantially transverse to longitudinal axis of the shaft. Such a configuration allows the insertion of the shaft into the guide channel in a targeted way to complicate the insertion resistance punctually or in sections during insertion of the Shaft in the guide channel to increase.

Preferably comprises the at least one insertion depth detection member a permanent magnet. It can also by the permanent magnet itself be formed. Such a permanent magnet can, for example, with another, appropriately directed arranged permanent magnet on Shank for forming the insertion depth detection device interact. Are the permanent magnets relative to each other in the vicinity brought, in particular by correspondingly wide introduction of the Stems in the guide channel, then can the magnets with a corresponding arrangement or orientation in the detection position and so the insertion of the shaft in the guide channel tactile recognizable complicate.

One particularly compact design of the instrument can be characterized in particular be achieved that the at least one insertion depth detection member in a trained on the shaft detection member recording used is. In particular, it may partially in the Detektionsgliedaufnahme be used and something over these project. However, an arrangement is also conceivable that the insertion depth detection member does not protrude from the Detektionsgliedaufnahme.

The at least one insertion depth detection member can be held and / or fixed to the shaft in a particularly simple and secure manner when it is shaped engages conclusively in the Detektionsgliedaufnahme.

Around dependent on the embodiment of the Einführiefendetektionsglieds no unwanted enlargement of the To cause shaft diameter, it is advantageous if the at least one introduction depth detection member no over protrudes a shaft outer surface.

Cheap can it further be, if the at least one insertion depth detection member from made of a material having a static coefficient of friction which is larger as a static coefficient of friction of the material from which the shaft is made. In this way, an insertion resistance during insertion of the Shaft in the guide channel purposefully increased be to a certain insertion depth for the Shank to specify.

Especially simply the construction of the surgical instrument, if the Shaft over his entire, in the guide channel insertable Length one constant outside diameter having. In particular, so can a guide channel a minimum Inner diameter, which to the outer diameter of the shaft adjusted, so a total of a particularly compact instrument train.

Preferably is the surgical instrument of surgical instruments formed in the form of one of the surgical instruments described above. It then has the above in connection with the preferred embodiments discussed and described advantages.

According to one preferred embodiment of The invention may be provided that the insertion depth detection device at least one on the guide channel comprises arranged or trained insertion depth detection element, that on the shaft an insertion depth detection member is arranged or formed, and that in a detection position the insertion depth detection element and the insertion depth detecting member cooperate with each other so that a tactile by an operator noticeable insertion resistance of the instrument during insertion in the guide channel is larger in the detection position than in other relative positions of the instrument and the guide channel. By appropriate arrangement of the at least one insertion depth detection element on the guide channel and the at least one insertion depth detection member on the shaft can in desired Be given way, when an operator or an operator a tactile feedback to that effect, that a certain insertion depth of the shaft in the guide channel is reached. In particular, it can be the depth, at a distal end of the shaft, a distal end of the guide channel reached.

Especially simple and compact is the structure of the surgical instruments, when the at least one insertion depth detection element is integral with the guide channel is trained.

advantageously, For example, the at least one insertion depth detection element unsolvable with the guide channel be connected. In particular, it may be integrally formed with the guide channel or glued to this, welded, soldered or the like.

advantageously, the at least one insertion depth detection element extends over a short, longitudinal of the guide channel extending section of the same. This makes it possible, with very exact position, practically almost exactly to specify when the shaft a certain insertion relative to the guide channel has reached.

Cheap is when the at least one insertion depth detecting element is at least one Part of the circumference of the guide channel extends. Of course he can also talk about the Circumference of the guide channel total extend.

Preferably At least a portion of the at least one insertion depth detection element is relative to the guide channel movably formed and / or arranged. This embodiment allows a Cooperation between the insertion depth detection element and the shaft such that upon reaching a desired insertion of the shaft, for example, when the Einführiefendetektionsglied with the insertion depth detection element interacts with the shaft of the instrument in the guide channel introductory Person a change of insertion resistance feel.

Especially simply the structure of the surgical instruments, if the at least one insertion depth detection element is formed in the form of a projection.

Advantageously, the projection is designed in the form of an annular projection pointing in the direction of a longitudinal axis of the guide channel. Such an annular projection may cooperate with the insertion depth detecting member independently of a configuration of an insertion depth detecting member on the shaft, particularly whether the latter extends over the entire circumference or only a part of the shaft. Of course, it would be conceivable to form the insertion depth detection element in the form of a projection which extends only over part of the circumference of the guide channel. The scope of Füh It must be borne in mind that this includes an inner circumference of the guide channel.

Preferably is the projection in an insertion position, in which the shaft is arbitrarily insertable into the guide channel, closer to a longitudinal axis of the guide channel positioned as in a detection position in which an insertion depth of the shaft is tactile recognizable by an operator. This embodiment allows in particular, the insertion depth detection element arrange so that when interacting with the shaft, in particular with an insertion depth detecting member thereof, specifically from the insertion position is movable in the detection position.

Of Furthermore, it may be advantageous if the at least one insertion depth detection element in Form of a recess is formed. In particular, she can directly adjacent to an insertion depth detecting element forming projection may be arranged or formed. For example in cooperation with a radial direction relative to the shaft on this movably mounted insertion depth detection member this at least partially when passing an insertion depth detection element be moved in the direction of the longitudinal axis in the form of a projection, then, directly afterwards to the projection in the recess in the radial direction outward, for example to spring or otherwise move into the recess. In any case, when passing the transition between the projection and the recess for the surgeon or an operator a modified insertion resistance during insertion of the shaft in the guide channel palpable, that is called tactile recognizable.

Especially easy to train the at least one insertion depth detection element, if the recess in the form of a recess in a wall of the guide channel is trained. The recess can in particular also in the form of an opening a wall of the guide device, which the guide channel includes, be formed.

According to one another preferred embodiment the invention can be provided that in a detection position, in which an insertion depth of the shaft is tactile recognizable by an operator, one of at least one insertion depth detection element practiced Force in a direction transverse or substantially transverse to the longitudinal axis of the guide channel acts. The from the insertion depth detection element practiced Force can be used in particular to work in conjunction with the shaft insertion the same at a desired insertion or from a desired insertion To complicate, so an insertion resistance to increase.

targeted may be a force exerted by the at least one insertion depth detection element set when the at least one insertion depth detection element when transferring from an insertion position, in which the shaft is arbitrarily insertable into the guide channel, in a detection position in which an insertion depth of the shaft of a Operator is tactile recognizable, at least partially opposite the effect of a reset device is movable. By appropriate choice of the reset device can thus also the acting force can be set purposefully and desired.

Especially simply the structure of the instruments, if the restoring device a return member and if the at least one insertion depth detection element comprises the Restoring member includes or forms. Furthermore, as well as a structure of the guide device be kept very compact.

Easy and lets it safely the management device with an insertion depth detection element form when the at least one insertion depth detection element in Shape of a ball print piece is formed or comprises a ball pressure piece. For example can the ball pressure piece, which usually a return spring has, against the action of the return spring by the shaft, for example, by an insertion depth detecting member disposed thereon in the form of a projection, in the radial outward direction of the longitudinal axis be moved away. The compression of the return member is for an operator tactile recognizable.

Cheap can it further be when the at least one insertion depth detection element is a force in a direction transverse or substantially transverse to the longitudinal axis of the shaft. In the at least one insertion depth detection element it is an arbitrary component, with which such personnel exercisable are, for example, elastic elements or spring elements as well any mechanical forces performing Components.

In particular, the insertion depth detection device can be formed without contact if the at least one insertion depth detection element comprises a permanent magnet. Such a permanent magnet, which is arranged on the guide channel, can cooperate contactless in particular with a correspondingly poled arranged permanent magnet on the shaft. For example, the south pole of a Perma Magnets are brought to the north pole of the other permanent magnet relative to each other in the detection position in close proximity to each other, so that the acting magnetic forces during insertion of the shaft in the guide channel and passing the permanent magnets are felt by an operator.

Around the insertion depth detection element on the guide channel being able to keep things simple and safe is it is advantageous if it is in a trained on the guide channel detection element recording is used. In particular, it may be complete or even partial be used in the detection element recording.

Especially the at least one insertion depth detection element can be held securely at the guide channel, if it is form-fitting engages in the detection element recording.

Around an undesirable Cross-sectional constriction of the guide channel it is convenient to avoid when the at least one insertion depth detecting element no over a guide channel inside surface protrudes. This configuration allows it, for example in connection with introduction depth detection elements and members in the form of permanent magnets, a maximum shaft outer diameter and to achieve a maximum inner diameter of the guide channel and to be able to use.

Advantageous it is when the at least one insertion depth detection element is off made of a material having a static coefficient of friction which is larger as a static coefficient of friction of the material from which the guide channel is made. For example, when inserting the Shaft can be achieved that the operator when in contact of the stem with the insertion depth detecting element an increased frictional force feels which signals the operator that a given insertion depth of the shaft in the guide channel is reached.

conveniently, has the guide channel over his whole length a constant inner diameter. This allows shafts in the guide channel introduce, which have an only slightly smaller outer shaft diameter. It So can a whole inner cross-sectional area of the guide channel along its Extension be used.

According to one another preferred embodiment The invention may further be provided that the insertion depth detection member comprises at least one spring element, which on the one hand in Instrument and on the other hand supported on the guide device and during insertion of the shaft in the guide channel is elastically deformable. The insertion depth detection member may formed in particular in the form of an elastic spring element be, which surrounds the shaft at least partially and from a certain insertion depth of the shaft at the guide channel can be compressed relative to this. This way you can an operator, the restoring force exerted by the spring element due to a Compression of the same feel directly.

Preferably includes the guide device a trocar sleeve with one or more guide channels. On this way you can one instrument or several instruments simultaneously in defined and desired Way in the body introduced by a patient become.

The following description of preferred embodiments of the invention used in conjunction with the drawings for further explanation. Show it:

1 : an overall perspective view of a surgical instrumentation;

2 : a longitudinal sectional view of a guide device of the instrument from 1 with inserted instrument shaft shortly before reaching the detection position;

3 : An enlarged partial view of the sectional view in 1 upon reaching the detection position;

4 : a view similar 3 a further embodiment of a surgical instrumentation;

5 : a sectional view analog 3 a further embodiment of a surgical instrumentation;

6 : a sectional view analog 3 a further embodiment of a surgical instrumentation;

7 : a sectional view analog 3 a further embodiment of a surgical instrument in an insertion shortly after reaching the detection position;

8th : a sectional view analog 3 a further embodiment of a surgical instrument in the insertion position shortly after reaching the detection position; and

9 : a fragmentary perspective view similar 1 a further embodiment of a surgical Instrumentari killed.

In 1 is a total with the reference numeral 10 provided surgical instrumentation comprising a surgical instrument 12 and a surgical guide device 14 for inserting a shaft 16 of the instrument 12 presented in a human or animal body.

The surgical instrument 10 has at its distal end a movable tool assembly 18 on, with two around a transversely to a longitudinal axis 22 of the shaft 16 extending pivot axis 24 pivotable tool elements 20 , which may be in the form of cutting or jaws or the like. Inside the shaft 16 is a non-illustrated power transmission member mounted longitudinally displaceable and with the tool elements 20 coupled at its distal end or end portion, at its proximal end with an industry 26 , which pivot on an instrument handle 28 is stored. The industry 26 forms part of an actuator 30 which is another industry 32 includes that on the instrument handle 28 laterally projecting and is immobile relative to this. The power transmission member inside the shaft 16 may be due to a movement of the industry 26 relative to the industry 32 be moved in the distal or proximal direction, with the result that the tool elements 20 relative to each other about the pivot axis 24 be pivoted. In this way, the tool assembly 18 be opened and closed again, for example, to cut tissue, to grasp or to hold it in place. Optional is the instrument handle 28 with the shaft 16 releasably connectable and relative to the shaft 16 around its longitudinal axis 22 rotatably mounted.

The management device 14 , which, for example, an elongated hollow cylindrical trocar sleeve 33 include or may be formed as such, comprises in the embodiments illustrated in the figures, three guide channels 34 whose longitudinal axes parallel to each other, but may optionally also be slightly inclined relative to each other.

To give an operator an insertion depth of the shaft 16 inside the patient's body, without the instrument 12 and the leadership facility 14 To constantly have an eye on the surgical instrument 12 an insertion depth detection device 36 for tactile detection of an insertion depth of the instrument 12 in the guide channel 34 , In particular, it is designed such that one of the instrument 12 tactile tactile insertion resistance of the instrument 12 when inserted into the guide channel 34 at a certain depth of insertion of the instrument 12 is greater than in other relative positions of the instrument 12 and the guide channel 34 ,

The insertion detection device 36 can be realized in many ways. Below some examples are explained in more detail by way of example.

In the in the 1 to 3 illustrated embodiment of a surgical instrument 10 includes the instrument 12 two introduction depth detection members 38 , which are integral with the shaft 16 are formed. They are each formed by an insertion detection projection 40 , which in the form of a through a wall portion of the shaft 16 defined spring tongue is defined. To form the spring tongue is transverse to the longitudinal axis 22 on the shaft 16 in its wall 60 a U-shaped opening 42 formed such that two parallel longitudinal slots 44 parallel to the longitudinal axis 22 are oriented and with a transverse slot 46 connected on the proximal side. As a result, the insertion detection projection 40 in the form of the narrow spring tongue with a free end 48 pointing in the proximal direction.

The insertion detection projection 40 is by two fold lines 50 and 52 separated into a total of three sections. A first section 54 , which extends over about one quarter of an entire length of the insertion detection projection 40 extends, runs parallel to the longitudinal axis 22 and is right with the wall 60 connected. The bend line 52 separates the section 54 from one at an angle of 5 ° to 10 ° relative to the longitudinal axis 22 inclined section 56 , which has something in the radial direction to the outside. The bend line 50 marks about a middle of the insertion detection projection 40 and forms a transitional area between the section 56 and an end portion 58 , which is about half the length of the insertion detection projection 40 extends and with the free, again at a shallow angle directed against the longitudinal axis end 48 ends, at a distance from the longitudinal axis 22 , which is about the radius of a wall 60 of the shaft 16 equivalent. The insertion detection projection 40 is thus at least with the sections 54 and 56 outside over the wall 60 in front. The two identically formed insertion depth detection members 38 are offset by 180 ° relative to the longitudinal axis 22 on the shaft 16 educated. Thus, the respective bend lines 50 in radially opposite directions. The insertion depth detection member 38 thus extends only over part of a circumference of the shaft 16 and is inextricably linked to this.

Each insertion depth detection member 38 is designed to interact with one on the guide channel 34 trained introduction depths tion element 62 in the form of an annular self-contained and on the longitudinal axis 22 pointing outward projection 64 which is parallel to the longitudinal axis 22 extends over a length substantially equal to a length of the insertion detection projection 40 equivalent. An inner diameter of the shaft 16 in the area of the projection 64 is insignificantly larger than an outer diameter of the shaft 16 , Will the shaft 16 of the instrument 12 in the guide channel 34 introduced, then it can be displaced relative to this essentially powerless until a proximal end 68 of the projection 64 at the radially in the direction of something from the longitudinal axis 22 way-pointing section 56 slides open. As a result, the insertion detection projection 40 overall upon further insertion of the shaft 16 in the guide channel 34 in the direction of the longitudinal axis 22 is pivoted until the bend line 50 at one in the direction of the longitudinal axis 22 pointing hollow cylindrical wall surface 70 of the projection 64 is applied. The insertion depth detection member 38 thus simultaneously forms a return device 66 off, which is a return member 72 in the form of the insertion detection projection 40 includes. The relative movement of the insertion depth detection member 38 relative to the shaft 16 takes place against an effect of the return device 66 thus having a radially outward direction from the longitudinal axis 22 pointing away force when the crease line 50 on the wall surface 70 is present, as in 3 is shown. The instrumentation 10 takes the detection position, because in this is an insertion depth of the shaft 16 tactile recognizable by the operator. This is because of the pivoting of the insertion depth detecting members 38 applied restoring force, which a sliding along the shaft 16 at the lead 64 impeded against an insertion position in which the Einführiefendetektionsglied 38 with the insertion depth detection element 62 does not interact or cooperate. Such an insertion position is for example in the 1 and 2 shown.

Will the shaft 16 so far in the guide channel 34 introduced that the proximal end 48 the insertion detection projection 40 a distally facing annular end surface 74 of the projection 64 can engage behind, then spring the Einfiefiefendetektionsglieder 38 in the radial direction again outward from the longitudinal axis 22 off and the shaft 16 can relative to the guide device 14 in the guide channel 34 be moved substantially powerless further in the distal direction.

By appropriate arrangement, that is positioning, the Einführiefendetektionsglieds 38 on the shaft 16 can depending on a on the guide device 14 predetermined position of the insertion depth detection element 62 a tactile marker on the instrument 12 be realized, so that an insertion depth 76 of the shaft 16 of the instrument 12 is substantially defined within the body by a distance between a distal end of the tool assembly 18 on the shaft 16 and the insertion depth detecting member 38 or the bend line defined by this 50 , This distance corresponds to a length of the trocar sleeve 33 , The surgeon leads the instrument 12 with its distal end coming from the proximal ago in the guide channel 34 a, then he can the shaft 16 relative to the guide device 14 move without noticeable forces until the Einführdetek tion member 38 and the insertion depth detecting element 62 interact in the manner described. The increased insertion resistance is then felt and the surgeon can, without the whole time the instruments 10 to have an eye on, yet recognize tactically, as soon as the depth of insertion 76 is reached, that is when the distal end of the instrument 12 the distal end of the trocar sleeve 33 has reached.

The in connection with the 1 to 3 described arrangement and configuration of the insertion depth detection device 36 can of course also be such that the Einführiefendetektionsglied 38 not on the shaft 16 but at the guide channel 34 , as well as the insertion depth detection element 62 not on the guide channel 34 but on the shaft 16 are formed.

In 4 is one compared to the one in the 1 to 3 shown guide device 14 slightly changed leadership device 14 shown. The insertion depth detection element 62 extends along the guide channel 34 only over a length, which is about a length of the sections 54 respectively 56 the insertion detection projection 40 equivalent. Furthermore, closes directly on the distal side of the projection 64 another insertion depth detection element 62a in the form of a recess 78 which defines a so-called "free-wheeling cavity". Due to the short extension of the projection 64 parallel to the longitudinal axis 22 is through the recess 78 a rebound of the by the projection 64 in the direction of the longitudinal axis 22 pressed insertion detection projection 40 in the radial direction to the outside possible or supported, so that for an operator when passing or directly after passing the projection 64 with the insertion detection projection 40 a noticeable change in an insertion resistance becomes noticeable. The tactile recognizable by the operator insertion resistance decreases abruptly when the end 48 of the end section 58 the end 68 of the projection 64 can engage behind distally. The narrower the lead 64 is formed parallel to the longitudinal axis, the punctiform the insertion depth can be 76 defined and for the Be Servant tactile recognizable.

As in 4 exemplified, each guide channel 34 individually with insertion depth detection elements 62 be equipped. The insertion channels 34 In addition, they can have different inner diameters in order to be able to accommodate different instruments with divergent outer diameters of their shafts.

At the in 5 illustrated variant of the surgical instruments 10 is the insertion depth detection element 62 in the form of an elastic ring 80 , For example, an O-ring formed, which in a detection element recording 82 in the form of an annular groove in an inner wall 84 of the guide channel 34 is used. The ring 80 sits positively in the detection element recording 82 but protrudes in the direction of the longitudinal axis 22 pointing something over the inner wall 84 before, so again a head start 64 is formed, which with the Einführiefendetektionsglied 38 on the shaft 16 can interact in the manner described above.

The ring 80 may in particular be made of a material which has a greater coefficient of static friction than the material from which the shaft 16 is made. As a result, when the insertion depth detection member slides along 38 on the ring 80 In addition, an insertion resistance is increased, allowing for an operator by the position of the ring 80 in conjunction with a position of the insertion depth detecting member 38 on the shaft 16 defined insertion depth 76 tactile is recognizable.

The introduction depth detection members 38 on the shaft 16 of the instrument 12 when moving from the insertion position in the manner described above in the direction of the longitudinal axis 22 are pivoted and take the detection position, one in the radial direction, that is transverse to the longitudinal axis 22 court, power out. Such a lateral force is also transmitted through the insertion depth detection member 38 and the insertion depth detecting element 62 which at the in 6 illustrated embodiment of a surgical instrument 10 used, exercised. In a detection element recording 86 on the shaft 16 is a permanent magnet 88 which is an insertion depth detection member 38 forms, positively inserted and does not protrude over the wall 60 of the shaft 16 outward. In a corresponding detection element recording 82 , which in the form of a recess on the guide channel 34 is formed, is a second permanent magnet 90 used, which is an insertion depth detection element 62 forms. The permanent magnets 88 and 90 are arranged such that their south poles (S) respectively in the direction of the longitudinal axis 22 directed, their north poles (N) respectively from the longitudinal axis 22 path.

Will the shaft 16 with the permanent magnet 88 in the guide channel 34 introduced, then act the two permanent magnets 88 and 90 then very strong together if the north pole (N) of the permanent magnet 88 near the south pole (S) of the permanent magnet 90 arrives. The permanent magnets 88 and 90 then attract each other and exert a force transverse to the longitudinal axis 22 out to each other. The thus acting magnetic force can be felt by the operator, that is, tactile detected, and can thus be seen that by the positions of the Einführiefendetektionsglieds 38 on the shaft 16 and the insertion depth detection element 62 on the guide channel 34 predetermined insertion depth 76 is reached.

Another embodiment of a surgical instrument 10 with a further variant of an insertion depth detection device 36 is in 7 shown in detail. It comprises an insertion depth detection member 38 which passes through a longitudinal groove 92 in the wall 60 of the shaft 16 is defined, which is parallel to the longitudinal axis 22 extends. The longitudinal groove 92 is divided into two sections, namely the proximal and distal side of a Einführdetektionsvorsprungs 40 , in the area of the shaft 16 is formed without recess. The insertion detection projection 40 separates the two sections of the longitudinal groove 92 from each other. With the insertion detection tab 40 an insertion depth detection element acts 62 on the guide channel 34 in the form of a ball print piece 94 together. It includes a transverse bore 96 at the management facility 14 , which up to the guide channel 34 zoom ranges. Just before reaching the guide channel 34 an inner diameter of the bore tapers 96 something. To an outer side, the transverse bore widens in one stage and is on a short, facing away from the longitudinal axis and having the largest inner diameter portion with an internal thread 98 provided so that the transverse bore 96 with a lid 100 , which has a corresponding external thread 102 has, can be closed. The lid 100 Alternatively, it can also be designed without a thread and into the transverse bore slightly widened in the inside diameter 96 glued, soldered or welded. Before attaching the lid 100 at the management facility 14 becomes a ball 104 in the cross hole 96 used, whose outer diameter is slightly smaller than a maximum inner diameter of the longitudinal axis 22 pointing portion of the transverse bore 96 , By the rejuvenation of the transverse bore 96 to the guide channel 34 The ball can go 104 not get into this, but is in the transverse bore 96 withheld, although something in the guide channel 34 can protrude. A spring element in the form of a spiral spring 106 relies on the one hand on the Ku gel 104 and on the other side on the lid 100 from. The spiral spring 106 forms a return member 72 a reset device 66 which the ball 104 in a basic position in the direction of the longitudinal axis 22 pushes down.

Will the shaft 16 with the longitudinal groove 92 in the guide channel 34 introduced, then the ball can 104 at least partially in the section of the guide groove 92 distal side of the insertion detection projection 40 plunge. Is the shaft 16 so far in the guide channel 34 introduced that ball 104 the insertion detection projection 40 touched distally, then pushes the ball 104 against the action of the spiral spring 106 from the longitudinal axis 22 path. The through the compressed coil spring 106 exercised, in the direction of the longitudinal axis 22 acting force can perceive the operator as increased insertion resistance, that is tactile recognize. Will the shaft 16 even further in the guide channel 34 advanced, then the ball can 104 back to the section of the longitudinal groove 92 dipping, which is proximal to the insertion detection projection 40 is trained. The spiral spring 106 pushes the ball 104 doing so in the direction of the longitudinal axis 22 out. The insertion depth 76 of the shaft 16 into the leadership facility 14 and / or the body of the patient can in the described manner practically precisely by the operator of the instrument 10 be felt.

In 8th is an instrument 10 represented in which at the instrument 12 on the shaft 16 for forming an insertion detection member 38 a circumferential, that is in the circumferential direction of the shaft 16 extending bead 108 educated. It interacts with an insertion depth detection element 62 on the guide channel 34 in the form of an annular insertion detection projection 40 , which over the inner wall 64 something in the direction of the longitudinal axis 22 protrudes. Optionally, the insertion detection projection 40 be defined only by short, extending in the circumferential direction projection portions.

The functioning of the instrumentarium 10 as it is in 8th is shown provided insertion detection means 36 is essentially the same as in the context of 1 to 3 described insertion detection device 36 , An outer diameter of the bead 108 corresponds to an inner diameter of the guide channel 34 which only in the region of the insertion detection projection 40 something is reduced by this. Thus, the shaft can 16 practically force-free in the guide channel 34 be introduced until the beading 108 with the insertion detection projection 40 comes into contact. The water then forces the bead 108 , which is slightly elastic and thus at the same time a return member 72 a reset device 66 forms, something in the direction of the longitudinal axis 22 to deform elastically. This, however, the insertion of the shaft 16 in the guide channel 34 noticeably more difficult, which an operator can recognize tactually as an increased insertion resistance. As soon as the shaft 16 so far inserted into the guide channel, that it is distal to the insertion detection projection 40 is located, the bead can 108 again elastic from the longitudinal axis 22 extending away, which in turn further movement of the shaft in the guide channel 34 essentially without forces felt by the operator.

Another variant of a surgical instrument 10 is exemplary in 9 shown in detail. The insertion depth detection device 36 here comprises an insertion depth detection member 38 in the form of a shaft 16 surrounding spiral spring 110 whose proximal end 112 at a distal end 114 of the instrument handle 28 is fixed. A proximal end 116 of the guide channel 34 at the management facility 14 defines an insertion depth detection element 62 , which with the spiral spring 110 cooperates as follows.

Will the distal end of the shaft 16 with the tool arrangement 18 in the guide channel 34 introduced, this may be substantially powerless to the operator until a distal end 118 the spiral spring 110 with the insertion depth detection element 62 comes into contact. Will the instrument 12 further in the distal direction in the guide channel 34 introduced, then this has the consequence that the coil spring 110 is compressed, which tactile recognizes an operator by a successively increasing insertion resistance in response to compression of the coil spring 110 ,

The instrumentation 10 as it is in 9 is shown, as long as the detection position, as the coil spring 110 with the guide device 14 in contact.

In all variants of instrumentation described above, the respective insertion detection device 36 optionally also be designed such that the Einführiefendetektionsglied 38 not on the shaft 16 but at the management facility 14 is provided, and corresponding to the insertion depth detection element 62 not on the guide device or its guide channel 34 but on the shaft 16 or at the instrument 12 ,

All the instruments described above have an additional security feature, because the instrument 12 can by the provided insertion depth detection means 36 even then, in an undesirable manner, due to an acting weight force in a parallel to the Gravity direction aligned guide channel 34 submerge and cause unwanted introoperative structural injuries in the patient's body interior, due to the insertion depth detection members formed in the described manner 38 and insertion depth detection elements 62 an increased insertion resistance is defined, which can preferably be overcome only by additional and possibly defined force introduction by the operator, but not due to the weight of the instrument 12 , Thus, in a simple way, a secure Ausschleitschutz for the instrument 12 by the insertion detection means 36 be formed.

Claims (50)

Surgical instrument ( 12 ) with an elongated shaft ( 16 ) for insertion into a human or animal body through a guide channel ( 34 ) guiding means insertable into a human or animal body ( 14 ), characterized by an insertion depth detection device ( 36 ) for tactile recognition of an insertion depth ( 76 ) of the instrument ( 12 ) in the guide channel ( 34 ). Surgical instrument according to claim 1, characterized in that the insertion depth detection device ( 36 ) is designed such that a tactile felt by an operator insertion resistance of the instrument ( 12 ) when inserted into the guide channel ( 34 ) at a certain insertion depth of the instrument ( 12 ) is greater than in other relative positions of the instrument ( 12 ) and the guide channel ( 34 ). Surgical instrument according to claim 1 or 2, characterized in that the insertion depth detection device ( 36 ) at least one introduction depth detection member ( 38 ), which on the shaft ( 16 ) or on the shaft ( 16 ) is trained. Surgical instrument according to claim 3, characterized in that the at least one insertion depth detecting member ( 38 ) in one piece with the shaft ( 16 ) is trained. Surgical instrument according to claim 3 or 4, characterized in that the at least one insertion depth detection member ( 38 ) unsolvable with the shaft ( 16 ) connected is. Surgical instrument according to one of claims 3 to 5, characterized in that the at least one insertion depth detecting member ( 38 ) over a short, longitudinal ( 22 ) of the shaft ( 16 ) extending portion thereof extends. Surgical instrument according to one of claims 3 to 6, characterized in that the at least one insertion depth detection member ( 38 ) over at least part of a circumference of the shaft ( 16 ). Surgical instrument according to one of claims 3 to 7, characterized in that at least one part ( 54 . 56 . 88 ) of the at least one insertion depth detection member ( 38 ) relative to the shaft ( 16 ) is designed to be movable and / or arranged. Surgical instrument according to one of claims 3 to 8, characterized in that the at least one insertion depth detecting member ( 38 ) in the form of an insertion detection projection ( 40 ) is trained. Surgical instrument according to claim 9, characterized in that the insertion detection projection ( 40 ) in the form of a longitudinal axis ( 22 ) of the shaft ( 16 ) pointing away ring protrusion ( 40 ) is trained. Surgical instrument according to claim 9 or 10, characterized in that the insertion detection projection ( 40 ) in the form of a shaft ( 16 ) formed bead ( 108 ) is trained. Surgical instrument according to one of claims 9 to 11, characterized in that the insertion detection projection ( 40 ) in an insertion position, in which the shaft ( 16 ) arbitrarily in the guide channel ( 34 ) is insertable, further from a longitudinal axis ( 22 ) of the shaft ( 16 ) protrudes than in a detection position in which an insertion depth of the shaft ( 16 ) is tactile recognizable by an operator. Surgical instrument according to one of claims 3 to 12, characterized in that the at least one insertion depth detecting member ( 38 ) in the form of an insertion detection recess ( 78 ) is trained. Surgical instrument according to claim 13, characterized in that the insertion detection recess ( 78 ) in the form of a depression of the shaft ( 16 ) is trained. Surgical instrument according to one of claims 3 to 14, characterized in that in a detection position in which an insertion depth of the shaft ( 16 ) is tactile recognizable by an operator, one of the at least one insertion depth detection member ( 38 ) applied force in a direction transverse or substantially transverse to the longitudinal axis ( 22 ) of the shaft ( 16 ) acts. Surgical instrument after one of the Claims 3 to 15, characterized in that the at least one insertion depth detection member ( 38 ) when transferring from an insertion position, in which it arbitrarily in the guide channel ( 34 ) is insertable, in a detection position in which an insertion depth of the shaft ( 16 ) is tactile recognizable by an operator, at least in sections against the action of a restoring device ( 66 ) is movable. Surgical instrument according to Claim 16, characterized in that the restoring device ( 66 ) a reset member ( 72 ) and that the at least one insertion depth detection member ( 38 ) the reset member ( 72 ) comprises or forms. Surgical instrument according to one of claims 3 to 17, characterized in that the at least one insertion depth detection member ( 38 ) a force in a direction transverse or substantially transverse to the longitudinal axis ( 22 ) of the shaft ( 16 ) exercises. Surgical instrument according to one of claims 3 to 18, characterized in that the at least one insertion depth detecting member ( 38 ) a permanent magnet ( 88 ). Surgical instrument according to one of claims 3 to 19, characterized in that the at least one insertion depth detecting member ( 38 ) in one on the shaft ( 16 ) trained Detektionsgliedaufnahme ( 86 ) is used. Surgical instrument according to claim 20, characterized in that the at least one insertion depth detecting member ( 38 ) in a form-fitting manner into the detection element receptacle ( 86 ) intervenes. Surgical instrument according to one of claims 3 to 21, characterized in that the at least one insertion depth detecting member ( 38 ) not over a shaft outer surface ( 60 ) protrudes. Surgical instrument according to one of claims 3 to 22, characterized in that the at least one insertion depth detecting member ( 38 ) is made of a material having a coefficient of static friction which is greater than a static coefficient of friction of the material from which the shaft ( 16 ) is made. Surgical instrument according to one of the preceding claims, characterized in that the shaft ( 16 ) over its entire, in the guide channel ( 34 ) insertable length has a constant outer diameter. Surgical instruments ( 10 ) comprising at least one surgical instrument ( 12 ) with an elongated shaft ( 16 ) for insertion into a human or animal body and at least one guiding device (which can be introduced into the human or animal body) ( 14 ) with at least one guide channel ( 34 ) for inserting the shaft ( 16 ) into the body through the guide channel ( 34 ), characterized in that the instrument ( 12 ) an insertion depth detection device ( 36 ) for tactile recognition of an insertion depth ( 76 ) of the instrument ( 12 ) in the guide channel ( 34 ). Surgical instrumentation according to claim 25, characterized by a surgical instrument ( 12 ) according to one of claims 2 to 24. Surgical instrumentation according to claim 25 or 26, characterized in that the insertion depth detection device ( 66 ) at least one on the guide channel ( 34 ) arranged or formed insertion depth detection element ( 62 ), that on the shaft ( 16 ) an insertion depth detection member ( 38 ) is arranged or formed and that in a detection position the insertion depth detection element ( 62 ) and the insertion depth detection member ( 38 ) cooperate with each other in such a way that an insertion resistance of the instrument tactilely perceptible by an operator ( 12 ) when inserted into the guide channel ( 34 ) is greater in the detection position than in other relative positions of the instrument ( 12 ) and the guide channel ( 34 ). Surgical instrumentation according to claim 27, characterized in that the at least one insertion depth detection element ( 62 ) integral with the guide channel ( 34 ) is trained. Surgical instrumentation according to claim 27 or 28, characterized in that the at least one insertion depth detection element ( 62 ) unsolvable with the guide channel ( 34 ) connected is. Surgical instrumentation according to one of claims 27 to 29, characterized in that the at least one insertion depth detection element ( 62 ) over a short, longitudinal ( 22 ) of the guide channel ( 34 ) extending portion thereof extends. Surgical instrumentation according to one of claims 27 to 30, characterized in that the at least one insertion depth detection element ( 62 ) over at least part of a circumference of the guide channel ( 34 ). Surgical instrumentation according to one of claims 27 to 31, characterized in that at least one part ( 104 ) of the at least one Insertion depth detection element ( 62 ) relative to the guide channel ( 34 ) is designed to be movable and / or arranged. Surgical instrumentation according to one of claims 27 to 32, characterized in that the at least one insertion depth detection element ( 62 ) in the form of a projection ( 64 ) is trained. Surgical instrumentation according to claim 33, characterized in that the projection ( 64 ) in the form of a towards a longitudinal axis ( 22 ) of the guide channel ( 34 ) pointing out annular projection ( 64 ) is trained. Surgical instrumentation according to claim 33 or 34, characterized in that the projection ( 64 ) in an insertion position, in which the shaft ( 16 ) arbitrarily in the guide channel ( 34 ) is insertable, closer to a longitudinal axis ( 22 ) of the guide channel ( 34 ) is positioned as in a detection position in which an insertion depth ( 76 ) of the shaft ( 16 ) is tactile recognizable by an operator. Surgical instrumentation according to one of claims 27 to 35, characterized in that the at least one insertion depth detection element ( 62 ) in the form of a recess ( 78 ) is trained. Surgical instrumentation according to claim 36, characterized in that the recess ( 78 ) in the form of a depression ( 78 ) in a wall ( 70 ) of the guide channel ( 34 ) is trained. Surgical instrumentation according to one of claims 27 to 37, characterized in that in a detection position in which an insertion depth ( 76 ) of the shaft ( 16 ) is tactile recognizable by an operator, one of the at least one insertion depth detection element ( 62 ) applied force in a direction transverse or substantially transverse to the longitudinal axis ( 22 ) of the guide channel ( 34 ) acts. Surgical instrumentation according to one of claims 27 to 38, characterized in that the at least one insertion depth detection element ( 62 ) when transferring from an insertion position, in which the shaft ( 16 ) arbitrarily in the guide channel ( 34 ) is insertable, in a detection position in which an insertion depth ( 76 ) of the shaft ( 16 ) is tactile recognizable by an operator, at least partially against the action of a restoring device ( 66 ) is movable. Surgical instrumentation according to claim 39, characterized in that the resetting device ( 66 ) a reset member ( 72 ) and that the at least one insertion depth detection element ( 62 ) the reset member ( 72 ) comprises or forms. Surgical instrumentation according to claim 39 or 40, characterized in that the at least one insertion depth detection element ( 62 ) in the form of a ball pressure piece ( 94 ) is formed or a ball pressure piece ( 94 ). Surgical instrumentation according to one of claims 27 to 41, characterized in that the at least one insertion depth detection element ( 62 ) a force in a direction transverse or substantially transverse to the longitudinal axis ( 22 ) of the shaft ( 16 ) exercises. Surgical instrumentation according to one of claims 27 to 42, characterized in that the at least one insertion depth detection element ( 62 ) a permanent magnet ( 90 ). Surgical instrumentation according to one of claims 27 to 43, characterized in that the at least one insertion depth detection element ( 62 ) in one on the guide channel ( 34 ) formed detection element recording ( 82 ) is used. Surgical instrumentation according to claim 44, characterized in that the at least one insertion depth detection element ( 62 ) in a form-fitting manner into the detection element receptacle ( 82 ) intervenes. Surgical instrumentation according to one of claims 27 to 45, characterized in that the at least one insertion depth detection element ( 62 ) not via a guide channel inner surface ( 70 ) protrudes. Surgical instrumentation according to one of Claims 27 to 46, characterized in that the at least one insertion depth detection element ( 62 ) is made of a material having a coefficient of static friction which is greater than a static coefficient of friction of the material from which the guide channel ( 34 ) is made. Surgical instrumentation according to one of claims 25 to 47, characterized in that the guide channel ( 34 ) has a constant inner diameter over its entire length. Surgical instrumentation according to one of Claims 27 to 48, characterized in that the insertion depth detection member ( 38 ) at least one spring element ( 110 ), which is on the one hand on the instrument ( 12 ) and on the other hand at the Leadership facility ( 14 ) and when inserting the shaft ( 16 ) in the guide channel ( 34 ) is elastically deformable. Surgical instrumentation according to one of Claims 25 to 49, characterized in that the guide device ( 14 ) a trocar sleeve ( 33 ) with one or more guide channels ( 34 ).