U.S. patent application number 17/291816 was filed with the patent office on 2021-12-16 for endoscopic instrument.
The applicant listed for this patent is Richard Wolf GmbH. Invention is credited to Rudolf HEIMBERGER.
Application Number | 20210386442 17/291816 |
Document ID | / |
Family ID | 1000005842367 |
Filed Date | 2021-12-16 |
United States Patent
Application |
20210386442 |
Kind Code |
A1 |
HEIMBERGER; Rudolf |
December 16, 2021 |
ENDOSCOPIC INSTRUMENT
Abstract
An endoscopic instrument (1, 134), for inserting into a body of
a patient, includes a tubular shank (3, 47, 137) which is coupled
or can be coupled to a handling device (5, 135) and is with a
working channel (15). A shank tool can be led through the working
channel (15). The working channel (15) includes a proximal working
channel opening (153) for inserting the shank tool and a fluid
inlet (148) which is separate from the proximal working channel
opening.
Inventors: |
HEIMBERGER; Rudolf;
(Oberderdingen, DE) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Richard Wolf GmbH |
Knittlingen |
|
DE |
|
|
Family ID: |
1000005842367 |
Appl. No.: |
17/291816 |
Filed: |
November 7, 2019 |
PCT Filed: |
November 7, 2019 |
PCT NO: |
PCT/DE2019/200130 |
371 Date: |
May 6, 2021 |
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 2017/22078
20130101; A61B 2017/00238 20130101; A61B 2017/00296 20130101; A61B
17/00234 20130101; A61B 2017/2212 20130101; A61B 17/221 20130101;
A61B 2017/0023 20130101 |
International
Class: |
A61B 17/221 20060101
A61B017/221; A61B 17/00 20060101 A61B017/00 |
Foreign Application Data
Date |
Code |
Application Number |
Nov 7, 2018 |
DE |
10 2018 218 954.4 |
Claims
1. An endoscopic instrument for inserting into a body of a patient,
wherein the instrument comprises: a tubular shank which is coupled
or can be coupled to a handling device; and a working channel,
wherein a shank tool can be led through the working channel, and
the working channel comprises a proximal working channel opening
for inserting the shank tool, and a fluid inlet which is separate
from the proximal working channel opening.
2. An endoscopic instrument according to claim 1, wherein the
proximal working channel opening and the proximal fluid inlet are
connected to the working channel via a T-connection piece in the
handling device.
3. An endoscopic instrument according to claim 1, further
comprising at least two leads which run through the shank, wherein
a fluid channel, which individually directly surrounds the at least
two leads which run through the shank, is formed in the shank.
4. An endoscopic instrument according to claim 3, wherein the fluid
channel is configured as a discharge channel of rinsing fluid which
is fed to a distal shank end via the fluid inlet and the working
channel.
5. An endoscopic instrument according to claim 3, wherein the fluid
channel comprises a distal fluid channel opening and a proximal
fluid channel opening, wherein the proximal fluid channel opening
is arranged laterally on the shank and is subjectable to fluid
vacuum.
6. An endoscopic instrument according to claim 1, further
comprising: a plurality of leads which run through the shank; and a
sealing means which forms a proximal end of the fluid channel and
comprises feed-throughs for the leads.
7. An endoscopic instrument according to claim 1, further
comprising a handling device, wherein the handling device is
fixedly connected or is releasably connectable to a proximal end of
the shank.
8. An endoscopic instrument according to claim 1, wherein the shank
at least in a shank section is elastically jointlessly bendable by
more than 270.degree..
9. An endoscopic instrument according to claim 1, wherein the
instrument or at least the shank is configured as a disposable
article for disposal after a single use.
10. An endoscopic instrument according to claim 1, further
comprising a plurality of leads which run through a shank interior,
wherein a cross-sectional area of the fluid channel corresponds to
a cross-sectional area of a shank interior which is formed by the
shank, minus a sum of the cross-sectional areas of all leads which
run through the shank interior.
11. An endoscopic instrument according to claim 1, wherein the
shank in a distally bendable shank section comprises a plurality of
slots.
12. An endoscopic instrument according to claim 11, wherein the
slots only extend over a part of the shank periphery in the
circumferential direction.
13. An endoscopic instrument according to claim 11, wherein the
slots are arranged axially to one another such that the slots
alternately lie on a first lateral side of the shank and a second
lateral side of the shank which lies diametrically opposite the
first.
14. An endoscopic instrument according to claim 11, wherein the
slots are configured as a distal fluid channel opening for the
fluid channel and locally increase a flexibility of the shank for
the bending of a distal shank end.
15. An endoscopic instrument according to claim 1, wherein the
working channel is a first working channel, and further comprising
a second working channel which runs through the shank and which is
directly surrounded by the fluid channel.
16. An endoscopic instrument according to claim 15, wherein the
first and/or second working channel is configured to selectively
lead through a laser fibre optic, the capture basket or a Dormia
loop.
17. An endoscopic instrument according to claim 15, wherein the
first working channel serves as a feed channel with a flow
direction which runs opposite with respect to the fluid
channel.
18. An endoscopic instrument according to claim 15, wherein the
first and/or second working channel runs axially through a sealed
proximal end of the fluid channel.
19. An endoscopic instrument according to claim 15, wherein the
first and/or second working channel comprises a distal working
channel opening and a proximal working channel opening.
20. An endoscopic instrument according to claim 19, wherein the
respective proximal working channel opening is arranged proximally
of the proximal end of the fluid channel.
21. An endoscopic instrument according to claim 19, wherein the
respective distal working channel opening is arranged distally of a
distal fluid channel opening of the fluid channel.
22. An endoscopic instrument according to claim 19, further
comprising a handling device, wherein the handling device is
fixedly connected or releasably connectable to a proximal end of
the shank, wherein the respective proximal working channel opening
is formed by the handling device.
23. An endoscopic instrument according to claim 19, wherein a cross
section of the respective distal working channel opening is smaller
than a cross section of the associated working channel.
24. An endoscopic instrument according to claim 23, wherein the
cross section of the respective working channel tapers towards the
respective distal working channel opening.
25. An endoscopic instrument according to claim 1, wherein a
through-flow direction and/or a through-flow rate through the fluid
channel is selectable or can be set.
26. An endoscopic instrument according to claim 1, wherein a distal
shank end is controllably jointlessly bendable in a controllable
manner.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] This application is a United States National Phase
Application of International Application PCT/DE2019/200130, filed
Nov. 7, 2019, and claims the benefit of priority under 35 U.S.C.
.sctn. 119 of German Application 10 2018 218 954.4, filed Nov. 7,
2018, the entire contents of which are incorporated herein by
reference.
TECHNICAL FIELD
[0002] The disclosure relates to an endoscopic instrument for
inserting into a body of a patient, preferably as a disposable
article for disposal after using once and preferably for the
minimal-invasive diagnosis of kidney tubes and ureters as well as
for the removal of kidney and urinary stones.
TECHNICAL BACKGROUND
[0003] The starting point of the invention are uretero-renoscopes
as are known for instance from EP 2 986 237 B1. A shank of the
uretero-renoscope is inserted into the body of a patient via the
ureter, in order with a distal gripping means such as for instance
a capture basket or a Dormia loop, to capture a kidney stone or a
urinary stone and to remove it. Such uretero-renoscopes however can
not only be used therapeutically, but also merely diagnostically,
since the treating person can herewith view and diagnose the kidney
tube or ureter in a direct manner. Usually, the visibility is
improved by rinsing fluid which at the distal end of the shank
exits through a rinsing conduit which is led through the shank, and
carries along tissue which inhibits the view.
[0004] There is the constant desire to reduce the shank diameter of
such instruments, in order to fashion the medical operation in a
minimal invasive manner as much as possible or to better utilize
the cross section which is available, in order to be able to
provide more or improved functionalities given the same cross
section.
SUMMARY
[0005] The endoscopic instrument which is disclosed herein can be
configured with a smaller shank diameter than known endoscopic
instruments of this type or utilizes the cross section which is
available to a better extent, in order given the same cross section
to be able to provide more or improved functionalities.
[0006] According to an aspect of the present disclosure, an
endoscopic instrument for inserting into a body of a patent is
provided, wherein the instrument comprises a tubular shank which is
coupled or can be coupled to a handling device and is with a
working channel, wherein a shank tool, for example a capture basket
insert or a forceps instrument can be led through the working
channel. The working channel herein comprises a proximal working
channel opening for inserting a shank tool, and a fluid inlet which
is separate from the proximal working channel opening. By way of
this, the working channel can be used as a feed channel for rinsing
fluid even given an inserted shank tool.
[0007] Optionally, the proximal working channel opening and the
fluid inlet can be connected to the working channel via a
T-connection piece in the handling device. The T-connection piece
is herein preferably arranged distally of the proximal working
channel opening and proximally of the fluid inlet.
[0008] Optionally, the handling device for receiving a shank tool
can comprises a first rotatable receiving part and a second
receiving part which is connected to the first receiving part in a
rotationally fixed manner. The first receiving part can be fixedly
coupled to a jacket element of the shank tool, for example via a
Luer connection, nonetheless be displaceably mounted for the exact
axial positioning relative to the working channel inlet. The second
receiving part can be coupled to a distal tool head, for example a
capture basket or forceps jaw parts, via a control wire which is
led through the jacket element of the shank tool, and be axially
displaceably mounted relative to the first receiving part. The
shank tool can be pushed in the instrument through the first
receiving part into different axial positions. By way of this, it
is possible to insert the shank tool through the shank onto the
distal shank tip in a positioned manner, so that it firstly does
not project beyond it. The distal shank tip can consequently be
moved to an operating region in an uninhibited manner and a danger
of injury due to a sharp-edged tool head is avoided. After reaching
the operating region, by way of displacing the first receiving part
in the distal direction, the shank tool can be pushed out of the
distal shank end. The wire which is coupled to the tool head, for
example the capture basket or forceps jaw parts, as the case may be
can then be subsequently pushed out of the jacket element of the
shank tool by way of displacing the second receiving part. The
shank tool can be rotated by way of a rotationally fixed coupling
of the shank tool and of the first receiving part as well as a
rotationally fixed coupling between the second receiving part and
the first receiving part. By way of such a construction,
furthermore it is very easily possible to position and actuate the
shank tool by a single user. Coordination with a second user is
consequently not necessary.
[0009] The first receiving part is optionally displaceable with
respect to the working channel inlet by a first displacement path.
The second receiving part is movable relative to the first
receiving part by a second displacement path. The length of the
second displacement path can herein optionally exceed or fall short
of the length of the first displacement path. The first
displacement path is exclusively conceived to bring the shank tool
into a position which lies axially outside the distal shank tip.
Herewith, the tool head can be extended out of the distal tip
without hindrance. The length of the first displacement path can
merely be a few millimeters. It is conceivable to provide a
displacement path of roughly 5 mm. The first displacement part can
also lie in a range of 2 mm to 10 mm depending on the configuration
of the endoscopic shank. The second displacement path in the
meanwhile is dependent on the type and size of the tool head and
can be for example up to 20 or 25 mm.
[0010] The first receiving part and/or the second receiving part
can optionally be held in a momentary axial and/or rotated position
via latching means. The first receiving part and/or the second
receiving part for example could have a lateral surface which is
provided with peripheral grooves which are arranged parallel to one
another, wherein the grooves each comprise a rounded profile cross
section. If these are led through a suitably dimensioned opening,
the latching can be effected between two consecutive grooves. The
latched position however can also be released again by way of a
suitable force transverse to the grooves.
[0011] The first receiving part and/or the second receiving part
can further be configured with a shoulder which comprises a
knurling. By way of this, a user can easily grip the respective
receiving part and carry out a rotation by feel and with a direct
haptic feedback.
[0012] Optionally, a fluid channel which individually directly
surrounds at least two leads which run through the shank, to which
the working channel also belongs, can be formed in the shank. Here
"individually directly surrounds" is to mean that the leads have no
common sheathing within the fluid channel, but are peripherally
rinsed by fluid in the fluid channel in a direct manner. The leads
can each be sheathed individually and for example be insulated.
"Directly" here is therefore not to be misunderstood to the extent
that the leads may not have a sheathing themselves. The leads can
be of an optical nature, for example as fiber optics for coupling
in and coupling out light at the distal end. In particular, the
leads can comprise one or more laser fiber optics, in order for
example to shoot a kidney or urinary stone with laser light and to
thus vaporize it. Alternatively or additionally, one or more of the
leads can transmit electrical signals and/or electrical power and
be connected to a distal LED and/or to a distal picture sensor.
Alternatively or additionally, the leads can transmit mechanical
control signals for the jointless bending and/or controlling the
distal shank end, for example as pull cables which are led
laterally in the shank. All leads are each individually directly
surrounded by the fluid channel. "Surrounded" here is to mean that
the leads at least to the larger part are peripherally rinsed in
cross section. They do not need to be completely peripherally
rinsed in cross section by 360.degree., but can bear laterally on
the shank or on one or more of the other leads.
[0013] On the one hand, concerning the endoscopic instrument which
is disclosed here, a fluid lead which is led through the shank can
be done away with. Furthermore, the complete cross section of the
inner volume of the shank which the leads do not occupy can be used
as a fluid channel, so that the available cross section is better
utilized. Herein, a shank outer diameter of 3 mm or less can be
realized.
[0014] Optionally, the fluid channel can serve as a feed channel
and/or discharge channel. Depending on the requirement, rinsing
fluid for improving the view at the distal shank end can be fed
distally or rinsing fluid with an annoying tissue suspension can be
led away proximally. A return of fluid proximally can be effected
by way of active suctioning or passively without active suctioning,
for example by way of overpressure in the body of the patient.
[0015] Optionally, the fluid channel can comprise a distal fluid
channel opening and a proximal fluid channel opening, wherein the
proximal fluid channel opening is arranged laterally on the shank
and can be subjected to fluid pressure or fluid vacuum. For this, a
pressure pump or vacuum pump can be connected onto the proximal
fluid channel opening or a fluid reservoir which is located at a
height above the instrument can be connected, as with a drip, so
that a hydrostatic pressure bears in the proximal fluid channel
opening. A saline solution can serve for example as a rinsing
fluid.
[0016] Optionally, the instrument can comprise a seal device which
forms a proximal end of the fluid channel and comprises
feed-throughs for the leads. The seal device can comprise for
example an elastomer cell foam block which is arranged in a
proximal end region of the shank and/or in a handling device which
is connected or connectable to a proximal end region of the shank.
Preferably, the cell foam block is configured in a closed-celled
manner. The leads can be led through the seal device through
feed-throughs, wherein the feed-throughs each have an initially
smaller diameter than the associated, led-through lead, however are
elastically widened by the led-through lead. By way of this, a
sealing effect can be achieved, so that no fluid can flow
proximally through the feed-throughs axially out of the shank to
the outside or into the handling device. The fluid specifically is
preferably not to flow axially, but laterally through a proximal
fluid channel opening which is provided for this and which is
arranged laterally on the shank and preferably distally of the seal
device.
[0017] Optionally, the instrument can comprise a handling device
which is fixedly connected or releasably connectable to a proximal
end of the shank. The handling device can preferably be configured
ergonomically, such that it can be comfortably gripped by a
treating person and lies well in the hand, in order to manually
control the instrument. For this, the handing device can be
configured in an essentially Y-shaped manner with two rigid grip
limbs which distally run together towards the shank. The handling
device can then either be gripped such that both grip limbs can be
gripped around as a forceps or the ball of the thumb is led between
the grip limbs. Concerning the first posture, the index finger can
be applied on a gun-like trigger for pulling a pull cable below the
shank. Concerning the second posture, the index finger can be
applied on an upper trigger for pulling an upper pull cable above
the shank and the middle finger applied on a lower trigger for
pulling a lower pull cable below the shank. The upper pull cable
and the lower pull cable can be configured as sections of a pull
cable which is deflected around a guide roller which in the
handling device is rotatably mounted about an axis which is
transverse to the longitudinal axis of the shank. Depending on the
rotation direction of the guide roller, the upper or the lower pull
cable is pulled proximally whilst the respective other pull cable
yields distally. The upper trigger and the lower trigger can each
be directly connected to one another via a guide roller or be
coupled in an indirect manner, so that they move oppositely on
actuation. It is particular, the second posture which ergonomically
particularly advantageous, since the longitudinal axis of the shank
runs essentially coaxially to the longitudinal axis of the lower
arm, so that the instrument can be comfortably rotated by
supination and pronation of the lower arm about its longitudinal
axis. Furthermore, by way of actuating the upper or lower trigger
with the index finger or middle finger, an abrupt bending of the
distal shank end can be effected in two opposite directions by way
of the upper and lower pull cable. Concerning the first posture,
the handling device can be peripherally gripped by 180.degree., in
order to pull the other trigger with the index finger, or the
instrument can be rotated by 180.degree. about its longitudinal
axis, in order to effect an abrupt bending of the distal shank end
by way of the upper or lower pull cable in two opposite directions.
The leads can be led through one or both of the grip limbs of the
handling device and at a proximal end of the grip limb or grip
limbs can each comprise a proximal-side connection. The working
channel is preferably led through a grip limb of the handling
device and other leads through the other grip limb of the handling
device.
[0018] Optionally, the shank at least in a part-section can be
flexible or semi-flexible. In particular, a high torsional
stiffness given a certain bending flexibility is advantageous for
the exact control of the distal shank end. The bending stiffness
can be quantitatively dimensioned by way of how deep the distal
shank end sags downwards solely under the weight force of the shank
given a horizontal position of the instrument. It has been found
that it is particularly advantageous if the distal shank end sags
downwards solely by the weight force of the shank by 20% to 60% of
the shank length given a horizontal position of the instrument. In
this range of the bending stiffness, the shank is flexible enough,
in order to be able to penetrate as deeply and simultaneously
minimally invasively as possible into the kidney tube and ureter
and is flexurally rigid enough, in order to be able to control the
distal shank end in a controlled manner.
[0019] Optionally, the instrument or at least the shank can be
configured as a disposable article for disposal after having been
used once. This is a particularly advantageous embodiment since the
cleaning of the instrument for further uses is done away with and
the components and materials only need to be configured for a
single use. The leads which are individually directly surrounded by
the fluid channel can be configured in a very delicate manner and
without consideration of the configuration of poorly cleanable
corners, edges and/or dead spaces by the fluid channel. On account
of the delicate configuration of the leads and the shank itself, a
shank outer diameter of 2.7 mm or less can be realized.
[0020] Optionally, the cross-sectional area of the fluid channel
can correspond to the cross-sectional area of a shank interior
which is formed by the shank, minus the sum of the cross-sectional
area of all leads which run through the shank interior. This means
that no unused cross-sectional area results in the shank and the
shank interior can therefore be optimally utilized.
[0021] Optionally, the shank can comprise a plurality of slots in a
distal region. Herein, the slots can only extend over a part of the
shank periphery in the circumferential direction. Herein, the
flexibility of the shank can be locally increased, thus the bending
radius can be locally reduced, in order to achieve a bending of the
distal shank end by up to 140. Alternatively or additionally, the
slots can be arranged axially to one another in a manner such that
they lie alternately on a first lateral side of the shank and on a
second lateral side of the shank which lies diametrically opposite
the first. Herewith, the distal shank end can be bent in two
opposite directions and given pull cables which are accordingly
actuatable independently of one another can even execute two
opposite curved bends in an S-shaped manner. For the curved bending
to a first side, the slots are pressed together at a first aside
and the slots are pulled apart at a second side which is opposite
to the first side. Accordingly, for the curvature to the second
side, the slots are pressed together at the second side and the
slots are pulled apart at the first side. The pull cables then
preferably run in the shank along the first and second side and
engage on the distal shank end, in order to bend away the distal
shank end to the respective side by way of a pulling force.
[0022] Optionally, the slots on the one hand can serve as a distal
fluid channel opening for the fluid channel and on the other hand
for locally increasing the flexibility of the shank for the bending
away of a distal shank end. The rinsing fluid can then exit
laterally out of the shank proximally of the distal shank end.
Amongst other things, this has the advantage that more cross
section for functions such as for instance a picture sensor and/or
at least one illumination LED is available at the distal shank
end.
[0023] Optionally, the working channel can be a first working
channel, wherein the instrument comprises a second working channel
which runs through the shank and which is likewise directly
surrounded by the fluid channel. Such a second working channel can
be selectively used in different manners. Inasmuch as the
instrument does not already comprises an optical lead such as a
laser fiber optic which is led through the fluid channel, such a
laser fiber optic can be introduced through the second working
channel from an associated proximal working channel opening, for
example at a proximal axial end of a grip limb of the handling
device, and be pushed through the second working channel up to a
distal working channel opening at the distal shank end. Laser light
can be coupled in by the laser fiber optic, in order for example to
vaporize a kidney stone or urinary stone and to flush it out of the
rinsing channel by way of rinsing fluid. The laser fiber optic when
not in use can be withdrawn from the working channel again, in
order to release this for possible other uses. A capture basket
insert or a Dormia loop insert can be pushed through the first
working channel in parallel, in order herewith to capture a kidney
stone or urinary stone at the distal shank end. The proximal
working channel opening of the first working channel, for example
at a proximal axial end of a grip limb of the handling device can
comprise a Luer lock connection, in order to fix a jacket element
of the capture basket insert or of a Dormia loop insert with
respect to the instrument, and by way of pushing a wire which leads
through the jacket and which at the distal side forms the capture
basket or the Dormia loop, to open the capture basket or the Dormia
loop. The capture basket or the Dormia loop closes on pulling the
wire when the jacket is arrested in the Luer lock connection.
[0024] Optionally, a working channel can serve as a feed channel
and/or discharge channel with a flow direction which is opposite
with respect to the fluid channel. In particular, this is
advantageous if, given a longer treatment time and larger
quantities of rinsing fluid, this must be led away out of the body
again without interrupting the treatment. A return of rinsing fluid
at the outer side of the shank or through an additionally inserted
auxiliary shank leads to an additionally expansion of the tissue
and is disadvantageous with respect to a minimal invasive
operation. Furthermore, an overpressure can build up, such
counteracting the flow of rinsing agent. The working channel can
preferably be used as a feed conduit of rinsing fluid which is led
away via the fluid channel as a discharge conduit. Alternatively,
the flow of rinsing agent can run the other way round, so that the
working channel serves as a discharge channel and the fluid channel
as a feed channel. The use of the working channel as a feed channel
and/or as a discharge channel can simplify a continuous
rinsing.
[0025] Optionally, the first and/or the second working channel can
run axially through a sealed proximal end of the fluid channel. The
working channel therefore, analogously to the other leads, can be
led through an associated axial feed-through in the seal device
which is configured for example in the form of an elastomer cell
foam block.
[0026] Optionally, the respective proximal working channel opening
can be arranged proximally of the proximal end of the fluid
channel, preferably at a proximal axial end of a grip limb of the
handling device. Herewith, the respective working channel can be
used in a comprehensive as possible manner and is as straight as
possible which is to say has only relatively large bending
radii.
[0027] Optionally, the respective distal working channel opening
can be arranged distally of a distal fluid channel opening of the
fluid channel. Herewith, in particular a kidney stone or urinary
stone which is smashed can be led away through the respective
working channel, wherein clear viewing conditions are created by
way of the lateral discharge or run-off of rinsing fluid through
the fluid channel opening.
[0028] Optionally, the cross section of the respective distal
working channel opening can be smaller than the cross section of
the respective working channel. Herewith, the risk of blockage of
the respective working channel is reduced, since the smaller
working channel opening acts as a filter to large pieces of tissue
and these cannot pass through the working channel opening.
[0029] Optionally, the cross section of the respective distal
working channel can taper towards the distal working channel
opening. Herewith, an inner-side step or edge in front of the
smaller working channel opening is avoided, on which a laser fiber
optic which is inserted through the respective working channel, or
an inserted shank tool, such as a capture basket insert and/or a
Dormia loop insert could snag.
[0030] Optionally, a throughflow direction and/or throughflow rate
through the fluid channel can be selected or set. This can be
carried out for example via a pressure control and/or by way of
opening and closing a valve, preferably on the proximal fluid
channel opening.
[0031] Optionally, a distal shank end can be jointlessly bendable
in a controllable manner. This can be preferably realized as
described above via a bending flexibility of the shank which is
locally increased by way of lateral slots in the shank, and via at
least one pull cable which laterally engages on the distal shank
end.
[0032] On use of a fiber optic and in particular a laser fiber
optic with an outer diameter of significantly below 1 mm, for
example 272 .mu.m, a dedicated second working channel with a cross
section (e.g. 1.65 Fr.=0.55 mm) which is significantly less than
the first cross section of the first working channel (e.g. 3.6
Fr.=1.2 mm) which is used for leading through the capture basket
can be provided. Herewith, a laser fiber optic for destroying a
kidney stone or urinary stone and a capture basket for capturing
fragments of the kidney stone or urinary stone can be
simultaneously arranged in the shank and be operated in parallel.
Preferably, the inner diameter of the second working channel
exceeds the outer diameter of the fiber optic by 30% at the most,
at least in a bendable shank region. By way of this, one allows a
fiber optic to be able to be displaced in the second channel even
in the case of a bent distal tip of the endoscopic instrument. A
relatively sharp-edged end of the fiber optic, on account of the
specified diameter ratio, undergoes only a relatively small
engagement angle to its surface and does not injure it, even in the
case of an arcuate course of the working channel. The second
working channel and the endoscopic instrument are consequently not
un-tight and can be used or a further duration. A rinsing
performance is further improved by way of replacing a conventional
working channel by a significantly narrower working channel. The
outer diameter of the fiber optic can lie in a region of 0.4 mm to
0.7 mm, preferably in a region of 0.45 mm to 0.6 mm and
particularly preferably of 0.45 to 0.5 mm. It particularly lends
itself to equip an endoscopic instrument with such a second working
channel, concerning which a fluid channel which individually
directly surrounds two leads which run through the shank is formed
in the shank.
[0033] Optionally, the material of the first and/or second separate
working channel for the fiber optic can be polyimide or polyamide.
The first and/or second working channel should consist of a hard as
possible material and herein it should change its cross section as
little as possible in the bent state. By way of this, the danger of
the shank tool or fiber optic penetrating into the inner surface of
the working channel is significantly reduced. The material for the
respective working channel can be for instance polyimide or
polyamide (also known as nylon) in a corresponding hardness.
[0034] Optionally, the wall of the first and/or second separate
working channel can comprise reinforcements. In particular, these
can run in circumferential direction and prevent a bending collapse
of the cross section of the separate working channel.
[0035] Further optionally, the material of the first and/or second
separate working channel can also comprise a metallic material.
This can comprise for instance nitinol which is a nickel-titanium
alloy with super elastic characteristics at room temperature. This
material can have the demanded and necessary
elasticity/flexibility/bending possibility given the aforementioned
small diameters.
[0036] According to a further aspect of the present disclosure, on
use of an endoscopic instrument with a shank with a jointlessly
bendable distal tip, an arrangement of first slots which are
optionally located alternately on a first lateral side of the shank
and on a second lateral side of the shank which is diametrically
opposite to the first can be provided. By way of this one can
achieve a jointless bending in a main bending plane without having
to create individual segments which are connected by a joint and
which partly extend into the inner lumen of the shank. For further
improving the movability, optionally several second slots which are
offset to the first slots by 90.degree. can connect proximally onto
the region with first slots. The second slots can extend in the
circumferential direction preferably only over a part of the shank
periphery. Further preferably, the two slots are arranged axially
to one another in a manner such that they alternately lie on a
third lateral side of the shank and a fourth lateral side of the
shank which lies diametrically opposite the third. By way of this,
a second bending plane which lies transversely to the main bending
plane is formed.
[0037] The movability in the second bending plane can be adjusted
depending on the number of second slots. It particularly lends
itself to select the number of the second slots in a manner such
that the distal end of the shank is bendable in the second bending
plane about an angular range of at least +/-15 and preferably of
+/-20. It is particularly the ability to reach kidney stones in the
lower caliceal region of the kidneys which can be improved by way
of this.
[0038] The movement of the distal end of the shank in the second
bending plane can be achieved by way of separate mechanical leads
in particular pull wires. These are coupled to the shank in a
direct manner distally in front of the region which is provided
with second slots. An aforementioned handling device can be applied
for moving the pull wires.
[0039] According to a further aspect of the present disclosure, on
use of an endoscopic instrument which comprises a shank which can
be coupled to a handling device and is with a jointlessly bendable
distal tip and in which a fluid channel is formed, said fluid
channel individually directly surrounding at least two leads which
run through the shank, a seal device or a sealing means can be
provided, in order to seal the leads with respect to the handling
device. As a result, the sealing means forms a proximal end of the
fluid channel. The sealing means is preferably coupled to the shank
in a rotationally fixed manner. The rotating of the shank
consequently leads to a rotating of the leads and sealing means, so
that the relative positions of the leads which are led through the
sealing means, to the sealing means, remain unchanged. The sealing
means is therefore not loaded by transverse forces which could
elastically deform the material of the sealing means to such an
extent that a sealing effect is at least regionally lifted. The
rotationally fixed coupling can be realized by way of positive fit
means which are formed in the sealing means and in the seal
receiver in a manner corresponding to one another.
[0040] Optionally, the sealing means has a disc-like, round shape.
Herein, the sealing means can be easily pressed into the seal
receiver.
[0041] Optionally, the positive-fit means can be realized in the
form of a peripheral tongue and groove arrangement. The groove can
project into a peripheral surface of the sealing means or be formed
in the seal receiver. The tongue could be formed in the seal
receiver or in the sealing means as a radial projection. The
positive fit means are preferably arranged exclusively at a single,
peripheral-side position, so that a correct placement of the
sealing means is achieved even in the case of a sealing means which
is configured in a non-symmetrical manner.
[0042] Optionally, the sealing means can comprise at least two
slots as feed-throughs which pass through a peripheral surface of
the sealing means and each extend partly through the sealing means.
The slots can be provided for leading mechanical leads such as for
instance pull wires, through the sealing means. The pull wires
extend from the handling device to the distal end of the shank and
can be used to bend the distal tip. If the pull wires are
configured as flat wires, then these can also be sealingly led
through the sealing means in a reliable manner.
[0043] Optionally, the sealing means can comprise four slots as
feed-throughs, said slots being arranged in the sealing means in a
manner distanced to one another. As a result, the sealing means can
also be applied for sealing a fluid channel in a shank of an
endoscopic instrument, concerning which the tip is jointlessly
bendable in a main bending plane and additionally movable in a
second bending plane. Consequently, the endoscopic instrument can
comprise four mechanical leads in the form of pull wires or the
like, which are led through the four slots and extend through the
shank. The size and alignment of the slots is herein dependent on
the type and arrangement of the pull wires.
[0044] Further optionally, the slots can also be based on radial
lines which are displaced in parallel and which are offset to one
another by at least 90.degree. on a surface which is covered by the
sealing means. The slots can project beyond a middle line which
runs perpendicularly to the respective slot and which intersects a
middle point of the sealing means. If four pull wires are applied,
then four slots are necessary and these are then offset to one
another for example by 90.degree.. Given only two pull wires, two
slots can be sufficient and these are then offset to one another
for example by 180.degree..
[0045] Optionally, the sealing means can be manufactured of a
material which comprises polyethylene or cellular rubber. Cellular
rubber can be based for example on a fluoropolymer.
[0046] Optionally, the endoscopic instrument which comprises the
sealing means explained above can comprise a shank connection part
which is rotatable in a control housing and which is fixedly
connectable to the shank. The shank connection part can optionally
comprise a connection pipe stub which extends radially outwards
from a shank connection axis. Optionally, a sealing ring can be
arranged between a seal receiver for receiving the sealing means
and the shank connection part.
[0047] Further optionally, the shank connection part comprises
guide devices for guiding pull wires. By way of guiding the pull
wires, these can directly follow each rotation of the shank
connection part. A crossing of the pull wires and of the associated
slots in the sealing means can be prevented, so that the sealing
effect is not compromised by way of this. The seal receiver can
further be supplemented by a cover in the distal direction, said
cover being away from the shank connection part and likewise being
coupled to the shank connection part in a rotationally fixed
manner. The cover can further likewise comprise guide devices, with
which pull wires can be led. The guide devices in the cover and in
the shank connection part are preferably flush, so that the sealing
means experiences exclusively axial forces of the pull wires.
[0048] According to a further aspect of the present disclosure,
concerning an endoscopic instrument which comprises a shank which
can be coupled to a handling device, a shank tool, for example with
a capture basket which is integrated therein or a forceps, can be
pushed through a working channel of the instrument onto the distal
end of the instrument. The handling device for this can preferably
comprise a working channel inlet, a first rotatable receiving part
and a second receiving part which is connected to the first
receiving part in a rotationally fixed manner. The first receiving
part can be fixedly coupled to a jacket element of the shank tool,
for example via a Luer connection, nonetheless be displaceably
mounted for the exact axial positioning relative to the working
channel inlet. The second receiving part can be coupled to a distal
tool head, for example a capture basket or forceps jaw parts, via a
control wire which is led through the jacket element of the shank
tool, and be axially displaceably mounted relative to the first
receiving part. The shank tool can be pushed in the instrument into
different axial positions through the first receiving part. By way
of this, it is possible to insert the shank tool through the shank
onto the distal shank tip in a positioned manner, so that it
firstly does not project beyond it. The distal shank tip can
consequently be moved to an operation region in an uninhibited
manner and a danger of injury due to a sharp-edged tool head is
avoided. After reaching the operational region, by way of
displacing the first receiving part in the distal direction, the
shank tool can be pushed out of the distal shank end. The wire
which is coupled to the tool head, for example the capture basket
or forceps jaw parts, as the case may be can then be subsequently
pushed out of the jacket element of the shank tool by way of
displacing the second receiving part. The shank tool can be rotated
by way of a rotationally fixed coupling of the shank tool and of
the first receiving part as well as a rotationally fixed coupling
between the second receiving part and the first receiving part. By
way of such a construction, furthermore it is very easily possible
to position and actuate the shank tool by a single user.
Coordination with a second user is consequently not necessary.
[0049] The first receiving part and/or the second receiving part
can optionally be held in a momentary axial and/or rotated position
via latching means. The first receiving part and/or the second
receiving part for example could have a lateral surface which is
provided with peripheral grooves which are arranged parallel to one
another, wherein the grooves each comprise a rounded profile cross
section. If these are led through a suitably dimensioned opening,
the latching can be effected between two consecutive grooves. The
latched position however can also be released again by way of a
suitable force transverse to the grooves.
[0050] The at least one cam disc is optionally fixable in its
momentary position via an arresting device. The arresting device
could be realized for example in the form of a knurled screw, with
which a user can arrest a position of the at least one cam disc,
said position having been set once. A jointless bending which is
created by the pull wires can consequently remain in its state,
without it having to be retained by way of permanent manual
intervention which is demanding.
[0051] The previously described aspects of the present disclosure
although being preferably applied in an arbitrary combination in
the embodiments of an endoscopic instrument which is disclosed
here, however they can also be advantageously applied independently
of one another without the other aspects.
[0052] The invention is hereinafter explained in more detail by way
of embodiment examples which are represented in the drawing. The
various features of novelty which characterize the invention are
pointed out with particularity in the claims annexed to and forming
a part of this disclosure. For a better understanding of the
invention, its operating advantages and specific objects attained
by its uses, reference is made to the accompanying drawings and
descriptive matter in which preferred embodiments of the invention
are illustrated.
BRIEF DESCRIPTION OF THE DRAWINGS
[0053] In the drawings:
[0054] FIG. 1 is a perspective view of an example of an embodiment
of an endoscopic instrument which is disclosed herein;
[0055] FIG. 2a, 2b are perspective views of a distal end section of
an exemplary embodiment of an endoscopic instrument which is
disclosed herein;
[0056] FIG. 3a, 3b, 3c are exploded perspective views of parts of
an exemplary embodiment of a working channel of an endoscopic
instrument which is disclosed herein;
[0057] FIG. 4a, 4b are schematic cross-sectional views of a distal
end section of a working channel of an exemplary embodiment of an
endoscopic instrument which is disclosed herein;
[0058] FIG. 5 is a cross-sectional view of a proximal connection
section of an exemplary embodiment of an endoscopic instrument
which is disclosed herein;
[0059] FIG. 6a, 6b, 6c are lateral views of a handling device with
detailed views of the distal shank end of an exemplary embodiment
of an instrument which is disclosed herein;
[0060] FIG. 7a, 7b, 7c, 7d, 7e, 7f are different views on the shank
and in particular the distal shank end of an exemplary embodiment
of an endoscopic instrument which is disclosed herein;
[0061] FIG. 8a, 8b, 8c, 8d, 8e are further views on the shank and
in particular a bendable shank section of an exemplary embodiment
of an endoscopic instrument which is disclosed herein;
[0062] FIG. 9a, 9b, 9c, 9d are different views on an embodiment
example of an endoscopic instrument which is disclosed herein;
and
[0063] FIG. 10a, 10b, 10c are further views of the embodiment
example according to FIG. 9a-d.
DESCRIPTION OF PREFERRED EMBODIMENTS
[0064] Referring to the drawings, FIG. 1 by way of example shows an
endoscopic instrument 1 which comprises a tubular shank 3 for
insertion into a body cavity. The shank 3 is connected to a
handling device 5 at a proximal end 4 and in its inner lumen forms
a fluid channel 7. The shank 3 furthermore at a distal, bendable
shank section 9 is configured in at least partly flexible manner,
in order when necessary to be bent by way of the action of the
handling device 5.
[0065] It is evident in a part-section A-A through the shank 7 that
by way of example a first optical and/or electrical lead 11 for the
illumination at the distal shank end 17, a second optical and/or
electrical lead 13 for taking pictures at the distal shank end 17,
a first working channel 15 and a second working channel 19 run in
the fluid channel 7. An LED as a light source can be arranged at
the distal end of the first lead 11, wherein the lead 11 serves as
an electrical electricity supply lead to the LED. Alternatively or
additionally, a fiber optic outcoupling as a light source can be
arranged at the distal end of the first lead 11, wherein the lead
11 serves as an optical fiber optic. Analogously to this, an
objective with a picture senor for taking pictures can be arranged
at the distal end of the second lead 13, wherein the lead 11 serves
as an electrical electricity supply lead of the picture sensor and
for signal transmission. Alternatively or additionally, a fiber
optic incoupling can be arranged at the distal end of the second
lead 13, wherein the lead 13 serves as an optical fiber optic.
[0066] The first working channel 15 preferably has at least double
the cross section of the second working channel 19. The first
working channel 15 can selectively serve as an insert channel for a
shank tool, for example a capture basket, a scissors or a forceps.
Alternatively or additionally, even given an inserted shank tool,
the first working channel 15 can serve as a feed or discharge
conduit of rinsing fluid. The second working channel 19 can
preferably serve as an insert channel for a laser fiber optic, in
order to be able to destroy kidney stones or urinary stones with
laser light. The inner diameter of the second, smaller working
channel 19, at least in the bendable shank section 9 should exceed
the outer diameter of the laser fiber optic by 30% at the most, in
order to ensure a secure leading-through of the laser fibber
optic.
[0067] All leads 11, 13, 15 and 19 are individually surrounded by
the fluid channel 7 in a direct manner. The particularity of this
arrangement lies in the fact that the four exemplary leads 11, 13,
15 and 19 are individually arranged in the fluid channel 7 and, if
fluid flows there, are consequent peripherally rinsed by the fluid
in a direct manner. The complete remaining cross-sectional area of
the fluid channel 7 can consequently be used for a fluid. The
cross-sectional area of the fluid channel 7 consequently
corresponds to the cross-sectional area of a shank interior which
is formed by the shank 3 minus the sum of cross-sectional areas of
all leads 11, 13, 5, and 19 which run through the shank interior as
well as of all further leads which are to be considered. A separate
fluid channel which always demands an independent sheathing within
the shank 3 is not necessary, since the first working channel 15
can itself be used as a feed or discharge conduit for rinsing fluid
even in the case of an inserted shank tool. The shank 3 can
consequently be provided with a particularly small outer diameter.
With this construction, the possible problem of a more difficult
cleaning ability or sterilization ability can be solved by way of
the complete endoscopic instrument 1 preferably being configured as
a disposable article for disposal after single use, thus does not
need to be sterilized at all after use.
[0068] Of course, other, less or more leads which can run in the
fluid channel 7 in this manner are also conceivable. For instance,
leads for transmitting electrical signals and/or electrical power
are conceivable. Furthermore, distally arranged light diodes can be
provided with electrical power via these, or picture signals can be
transmitted from a distally arranged picture sensor. The leads 11,
13, 15 and 19 as well as all alternative or additional leads can
each comprise an individual encasing. This can be important
particularly in the case of electrical leads, in order to insulate
these. Additionally, mechanical leads in the form of control cables
can be led in the shank, in order to jointlessly bend the bendable
shank section 9 or to control it in is shape in another manner. The
mechanical leads for instance can be pull cables or pull wires
which are led on lateral inner surfaces in the shank 3.
[0069] The distal bendable shank section 9 as a distal region is
provided with several slots 33 which give the bendable shank
section 9 its movability. The distal bendable shank section 9 is
consequently flexible or at least partly flexible, thus
semi-flexible. Instead of the use of individual links which are
connected to one another in an articulated manner, the shank
section 9 can be rendered flexible about at least one axis of
curvature by way of a targeted slotting. For this, the slots are
preferably incorporated into the shank in the circumferential
direction, extend over the complete material thickness of the shank
jacket and run over more than half the circumference, for example
up to 270.degree.. Two lamella-like parts of the shank 3 which are
consecutive along the extension direction of the shank 3 and
between which a slot 33 is located in a peripheral surface 35 of
the shank 3 are consequently connected to one another by a web
which in this case extends in the circumferential direction by way
of example by at least 90.degree.. On account of the single-piece
configuration, the webs which remain between the individual
lamella-like parts always have the tendency to assume an initial,
unloaded position, in which the shank 3 preferably runs in a
straight line. If the preferably metallic shank 3 is consequently
bent by way of a pull cable due to the action of a tensile force,
the distal bendable shank section 9 can be jointlessly bent by up
to 300.degree.. After the release of the pulling force, by way of
the webs which spring back, the shank 3 strives to return back into
its straight shape. In order to achieve a uniform flexibility, the
slots 33 are arranged axially to one another in a manner such that
they lie alternately on a first lateral side of the shank 3 and on
a second lateral side of the shank 3 which is diametrical opposite
to the first side.
[0070] The slots 33 can be incorporated into the shank by way of a
machining device which preferably uses a laser. By way of this, a
rapid, inexpensive machining can be effected, and such is no
obstacle to a configuration of the instrument 1 as a disposable
article. Very delicate structures can be created by way of a
suitable leading of the beam of the laser. The clear width of the
slots 33 can be dimensioned so small, that tissue does not
penetrate into the slots 33 and an unhindered displacement of the
shank 3 into the operation region can be effected. The slots 33 can
be rounded in their profile. Optionally, a coating of the shank 3
can be effected with a lubricative coating. The slotted, bendable
shank section 9 is preferably surrounded by a protective tube 199
(see FIG. 7f). The protective tube can for example be
fabric-reinforced and/or shrunk on. The protective tube can
comprise for example bio-compatible plastic.
[0071] The fluid channel 7 in the inner lumen of the shank 3 can
serve as a feed channel and/or discharge channel for a rinsing
fluid which is delivered through the free residual cross section.
It is conceivable for rinsing fluid to be fed distally out of the
slots which then act as distal fluid channel openings or for
rinsing fluid with an annoying tissue suspension to be led away
proximally, in accordance with requirements for improving the view
at the distal end 17. Given the subsequent use of the fluid channel
7 without the first working channel 15 as a feed channel and/or
discharge channel, it is conceivable to temporarily either only
feed rinsing fluid or only discharge it. The feeding of the rinsing
fluid can be effected for example actively by way of an external
pump or passively by way of the hydraulic pressure from a drip
which is connected and suspended at a higher level. The discharging
can be effected by way of an overpressure in the operation region
being generated by the rinsing, by way of which overpressure
rinsing fluid can subsequently exit proximally at the outer side
along the shank 3. The first working channel 15 however preferably
serves as a feed channel and the fluid channel 7 as a discharge
channel, or vice versa. By way of this, an undesired fluid flow at
the outside on the shank 3 can be largely reduced or completely
avoided.
[0072] Hence for the continuous rinsing, it can make sense to use
the first working channel 15 which extends distally through the
fluid channel 7 and which comprises a first distal working channel
opening 18 as a feed and/or discharge channel. The cross section of
the first distal working channel opening 18 can be smaller than the
cross section of the first working channel 15, so that the blocking
of the first working channel 15 by tissue which enters via the
distal working channel opening 18 is prevented. Alternatively or
additionally to this, the cross section of the first working
channel 15 can taper towards the distal working channel opening 18.
The first working channel 19 can be continuously supplied with
rinsing fluid by way of an external pump or one which is arranged
in the handing device 5 or from a connected drip which is suspended
at a higher level, said rinsing fluid being led distally and
exiting directly at the distal shank end 17. The first working
channel 15 is consequently a feed channel. On account of the
overpressure which sets in, the rinsing fluid gets through the
slots 33 and/or lateral rinsing openings 203 (see FIG. 7b,c) into
the fluid channel 7 and flows proximally back from there. This is
indicated in FIG. 1 by the flow lines 21 which lead from a purely
axial, distally directed outflow from the distal shank end 17 to a
lateral inflow through the slots 33 and/or lateral rinsing
openings. The flow direction in the first working channel 15 is
consequently in opposite directions to that of the fluid channel 7.
Of course, this could also be effected in a reverse constellation
by way of rinsing fluid exiting out of the slots 33 and/or the
lateral rinsing openings in the distal bendable shank section 9 and
being led back at the distal shank end 17 via the first working
channel 15. If the slots 33 are surrounded by a protective tube 199
and/or a lubricative coating, then the leading of the fluid can be
effected exclusively via lateral rinsing openings 203.
[0073] The handling device 5 is merely represent by way of example
in FIG. 1. Further handling devices are shown in the FIGS. 6a-c .
All variants of handling devices can be combined with the
advantageous configurations of the shank 3 which are outlined here.
Furthermore, other handling devices which in their shape differ
from the variants which are shown here are also conceivable.
[0074] Concerning the handling device 5 in FIG. 1, a housing 23 is
shown, said housing by way of example having a grip opening 25 for
leading through a thumb and being configured such that the ball of
the thumb of a hand then lies on a contact surface 27 which is
directed to the shank 3. Two operating levers or triggers 29, 31
which are arranged on lateral sides of the housing 23 which are
opposite one another connect directly in grip reach of the other
finger of the hand. If the ball of the thumb is located on the
contact surface 27 then for instance the lower trigger 29 can be
operated by a middle finger whilst the index finger lies on the
upper trigger 21. By way of pulling the triggers 29 and 31 to the
grip opening 25, the pull cables 11 and 13 which are coupled
thereto are pulled. In order to avoid stresses within the shank 3
and to carry out a harmonic movement of the distal bendable shank
section 9, the two pull cables could each be configured as a
section of an individual pull cable which runs between the two
triggers 29, 31 via a guide roller. If therefore for instance the
lower trigger 29 is moved, then for example the first pull cable 11
is pulled, wherein the upper trigger 31 is moved in the opposite
direction and herein relaxes the second pull cable 13. For this,
both triggers 29, 31 could be connected to one another via the
guide roller which is not shown here or be coupled to one another
in an indirect manner so that they automatically move in opposite
directions on actuation.
[0075] The first, larger working channel 15 can run on a side 37 of
the handling device 5 which faces the upper trigger 31, so that a
first proximal working channel opening 39 for the selective
introduction of a rinsing fluid, for example NaCl solution or of a
shank tool is present there. Other leads, for example the second,
smaller working channel 19 for a laser fiber optic can run out into
a respective second proximal working channel opening 43a or 43b at
a side 41 which faces the lower trigger 20. The fluid channel 7
comprises a proximal fluid channel opening 45 in the form of a pipe
stub which runs transversely to the shank 3 and out of which the
rinsing fluid which flows back then finally exits.
[0076] A shank 47 of an endoscopic instrument is shown in a part
view in FIGS. 2a and 2b. The view is concentrated onto a flexible
distal bendable shank section 49 with a distal end 51 of the shank
3, on which a first distal working channel opening 52 is arranged.
The cross section of this first distal working channel opening 52
can be smaller than that of the first working channel 15 which is
not shown here. Alternatively or additionally to this, the cross
section of the first working channel 15 can taper to the first
distal working channel opening 52. The shank 47 proximally
comprises a rigid, tubular section which is not visible here and
which is connectable to a handling device 5. This can correspond to
the handling device 5 of FIG. 1 or be configured as a handling
device which is represented in FIG. 6a-c.
[0077] A fluid channel 53 which is formed in the shank 47 can be
recognized with a distal viewing direction. The distal, bendable
shank section 49 is configured such that it can be bent in the
simplest manner without necessitating dedicated joints which
project into the fluid channel 53 or lead to an enlarged outer
diameter of the shank 47. For this, the distal, bendable shank
section 49 as a distal region is provided with several first slots
55 which run parallel to one another, are distanced to one another
and locally completely penetrate the material of the shank 47. The
first slots 55 by way of example extend over an angle of
270.degree. in the circumferential direction and herein run around
a main extension direction of the shank 47 which runs from a
proximal end to the distal end 51. By way of example, slots 55
which are adjacent which is to say are consecutive are offset to
one another in the circumferential direction by 180.degree.. The
first slots 55 are accordingly arranged axially to one another in a
manner such that they alternately lie on a first lateral side of
the shank 47 and on a second lateral side of the shank 47 which
lies diametrically opposite the first side. As a result, the distal
bendable shank section 49 has a very flexible shape. Individual
lamella-like parts of the shank 47 which are separated from one
another by way of slots 55 can change in their alignment to one
another by way of widening or compressing the slots 55. By way of
this, the bendable shank section 49 undergoes a jointless bending
of up to 300.degree.. This movement of the bendable shanks section
49 can be influenced by mechanical pulls wires 57 and 59 which run
in the fluid channel 53. Herewith, a pulling and relaxing of
lateral sections of the bendable shank section 40 can be effected
in a targeted manner.
[0078] The complete shank 47 can be configured in a single-part
manner by way of this advantageous configuration, which has a
positive effect on the achievable minimal outer diameter of the
shank 47. As in the representation of FIG. 1, here too there are
two lamella-like parts which are consecutive along the direction of
extension of the shank 47 and between which a slot 55 is located,
and are consequently connected to one another by a web which in
this case extends over 270.degree. in the circumferential
direction. On account of the single-piece configuration, the webs
which remains between the individual parts tend to assume an
initial unloaded position, in which the shank 47 preferably runs in
a straight line. If the shank 49 is subsequently bent by way of the
action of a tensile force by one of the mechanical leads 57 or 59,
the shank 47 after releasing the tensile force has a tendency to
return into its straight shape by way of the webs which spring
back. The bendable shank section 49 therefore acts like a spring. A
protective tube which surrounds the bendable sank section 49 can
assist this spring effect which forces it into the initial straight
shape.
[0079] On account of this arrangement of the first slots 55, a
bending can be carried out on a single plane which is spanned by
the peripheral side middle points of the slots 55. Concerning the
special application in the field of the destruction of kidney
stones, the distal bendable shank section 49 is jointlessly
bendable by up to 300.degree. on account of the required ability of
the stones in the lower caliceal group of the kidneys to be
reached.
[0080] It is advantageous to be able to also laterally bend the
bendable shank section 49 in two opposite directions for example by
up to 20 or 25, in order to enlarge the spatial region, in which in
particular one can machine the respective stone or another object
with a laser. This is achieved by way of subdividing the distal
bendable shank section 49 into a first region 61 and into a second
region 63, in which differently aligned slots 55 are arranged. In
the first region 61 which extends up to the distal end 51, the
first slots 55 are each offset to one another by 180.degree.. By
way of this, as described above, one realizes a main bending plane.
Two slots 64 which in the circumferential direction are offset to
the first slots by 90.degree. in the first region are provided in
the second region 63 which extends proximally from the first region
61. The second region 63 extends over a significantly shorter
stretch that the first region 61, wherein the distances of the
slots 55 and 64 in both regions 61 and 63 are preferably identical.
The second slots 64 are arranged axially to one another in a manner
such that they lie alternately on sides of the shank 47 which are
diametrically opposite one another. As a result, on account of the
second region 63 which is configured in such a manner, a limited
movability in a plane which runs perpendicularly to the main
bending plane is possible. The movability can be limited by way of
the number of the second slots 64, for example to an angle range of
about +/-20. A movement can be realized by two further mechanical
leads 65 and 67 which are coupled to the shank 47 distally in front
of the second region 63 in a direct manner and can likewise be
configured as pull wires. It is by way of the combination of these
two bends that it is rendered possible for a laser fiber to exactly
scan a recognized object in a relatively large working region.
[0081] In FIG. 2a, a slight offset to the left in the plane of the
drawing is achieved, as is indicated by the angle . Here,
consequently the first region 61 and herewith the main bending
plane is pivoted to a side by about 20. In FIG. 2b, a pivoting in
the other direction is shown, as is indicated by the angle . The
distal end 51 of the shank 47 can be moved in a significantly
improved manner due to the second region 63 with the slots 55 which
are arranged therein as well as due to the additional mechanical
leads 65 and 67. On account of the single-piece configuration, one
can simultaneously further succeed in the shank 47 having an
adequate strength, in order to move the distal end 51 in a direct
manner by way of rotating the shank 47.
[0082] FIGS. 3a to 3c show a detail of an endoscopic device which
comprises a fluid channel which as in the preceding figures can be
configured as a fluid channel 7 or fluid channel 53. However, only
a small part of the device is represented in the figures, so that a
shank and a fluid channel are not visible. A part of a control
housing 69 is shown, into which control housing a shank connection
part 71, with which a shank can be coupled is integrated. This
shank is not represented here and can be configured according to
the principles of FIGS. 1, 2a, and 2b. However, it can also lend
itself to couple a conventional shank to the shank connection part
71, as long as it comprises an aforementioned fluid channel.
[0083] A proximal fluid channel opening in the form of a connection
pipe stub 73 is arranged on the shank connection part 71, said stub
extending outwards transversely to a shank connection axis 75 on an
outer periphery. Rinsing fluid which comes from the fluid channel
7, 53 can exit via the connection pipe stub 73. The shank
connection part 71 is configured for the integration into a cavity
77 of the control housing 69. A lateral opening 79, through which
the connection pipe stub 73 extends outwards connects onto the
cavity 77. A radial projection 81 which can latch into
correspondingly shaped latching openings 83 and 85 of a radial
contour 87 of the cavity 77 is shaped out on a side of the shank
connection part 71 which by way of example lies opposite the
connection pipe stub 73. The latching openings 83 and 85 by way of
example are offset to one another by 90.degree. in a manner in
which they run around the shank connection axis 75. As a result,
the shank connection part 71 can latch in two rotation positions
which are distanced to one another by for example 90.degree.. The
lateral opening 79 can be shaped out in a manner corresponding to
this.
[0084] The shank (not shown) is coupled to the shank connection
part 71 in a rotationally fixed manner so that the shank is also
rotated by way of rotating the shank connection part 71. By way of
this, the direction of the bending of the distal bendable shank
section can be influenced. Since on using a fluid channel 7, 53
which is merely defined by a shank jacket, several leads must be
led outwards through the control housing 69 without connecting the
inner lumen of the fluid channel 7, 53 to the inner lumen of the
control housing 69, a sealing means in the form of a seal device 89
is provided. This is shaped in a disc-like manner and is insertable
into a seal receiver 91 which in turn is fixedly connected to the
shank connection part 71.
[0085] The seal device 89 comprises four feed-throughs in the form
of slots 93 for leading through mechanical leads, for example pull
wires. In this example precisely four slots 93 are shown, so that a
shank according to the FIGS. 2a and 2b can also be coupled to this
seal device 89. If another shank is to be used, then of course
another number of slots 93 can be realized. The shown slots 93 are
based for example on radial lines which are shifted in parallel and
which are offset to one another by 90.degree. on a circular surface
which is covered by the seal device 89. The slots 93 pass through a
peripheral surface 95 of the seal device 89 and by way of example
project beyond a middle line which runs perpendicularly to the
respective slot 93 and intersects a middle point of the seal
device. If the pull wires are configured as flat wires, then these
can each run through a slot 93 between the shank and the control
housing 69 and are hereby gently embraced by the material of the
seal device 89.
[0086] In order to minimize a friction of the pull wires as much as
possible, the seal device 89 is preferably manufactured of a
closed-celled foam material. The dimensions of the seal device 89
in the non-inserted state is preferably somewhat larger than the
dimensions of the seal receiver 91, so that the seal device 89
needs to be compressed somewhat on insertion and constantly pushes
into a relaxed, expanded posture. Hereby, all elements which are
led through are sealingly embraced.
[0087] The seal device 89 further comprises further recesses 97,
99, 101 and 103 which in accordance with the leads 11, 13, 15 and
19 can have different dimensions. The seal device 89 has a largest
recess 97 which belongs to the first working channel 15 which can
extend along the extension axis 75 through the control housing 69
to the first proximal working channel opening 39. Three further
feed-throughs 99, 101 and 103 in the form of recesses which serve
for leading through the leads 11, 13 and the smaller second working
channel 19 are arranged adjacently to the largest recess 97. The
feed-though 103 which by way of example has the smallest dimensions
is suitable for instance for leading through the smaller second
working channel 19 with a dimension of significantly below 1 mm,
for example 55 mm or less. The two other feed-throughs 99 and 101
belong to the electrical leads 11, 13 which are connected to the
distal-side LED or to the picture sensor. The dimensions of the
recesses 97, 99, 101, 103 are each somewhat smaller than the cross
section of the associated led-through lead 11, 13, 15, and 19, in
order to achieve a sealing effect on the lead 11, 13, 15 and 19 at
the outside. The seal device 89 is preferably an elastic cell foam
block of ethylene-propylene-diene monomer (EPDM), so that the
recesses 97, 99, 101 and 103 on leading through the leads 11, 13,
15 and 19 accordingly expand and embrace these in a sealing
manner.
[0088] The seal device 89 comprises a radial deepening 105 which in
a manner corresponding to a radial projection 107 is formed in a
sleeve-like section 109 of the sealing receiver 91. By way of this,
the rotary position of the seal device 89 is always fixed, so that
the seal device 89 follows the rotation on rotating the shank
connection part 71.
[0089] It is usefully to arrange guide means for guiding the pull
wires in the seal receiver 91 and a cover 111 which is fastened
thereto, so that the slots 93 of the seal device 89 are always
flush with the pull wires on rotating the shank connection part 71.
The seal device 89 is therefore loaded exclusively by an axial
force of the pull wires. In order to further achieve an ideal
guiding of the pull wires, the cover 11 is arranged on the seal
receiver 91 in a rotationally fixed manner. For this, a radially
outer-lying tongue 113 which is aligned with a radially inner-lying
deepening 115 of the cover 111 can be provided on the sleeve-like
section 109.
[0090] As is represented in FIG. 3b, an additional sealing ring 117
which seals the seal receiver 91 on the shank connection part 71
can be provided. For this, the seal receiver 91 on a deepening 119
which is arranged opposite to the sleeve-like section 109 comprises
a sealing surface which can be brought to abut with the sealing
ring 117 and an annular surface 121 of the shank connection part
71. The rinsing fluid which flows into the shank connection part 71
via the rinsing channel cannot proximally pass the seal device 89
and flows away radially via the connection pipe stub 73.
[0091] A further aspect of the endoscopic instrument is shown in
FIGS. 4a and 4b. A fiber optic 123 which in particular is a laser
fiber optic in the form of an individual fiber and has an exemplary
diameter of 0.45 mm is represented in FIG. 4a. This diameter can
preferably include a protective layer of the fiber optic 123,
wherein the light-leading core diameter can be for example only
0.272 mm. Of course, the fiber optic 123 can also have an even
smaller or a somewhat larger diameter. The fiber optic 123
comprises a light exit end 125 which for optimal radiation
characteristics runs in a sharp-edged as possible manner and
perpendicularly to the extension axis of the fiber optic 123.
However, the pushing of such a fiber optic 123 through a working
channel 127 which for instance has a diameter of 1.2 mm or more
entails difficulties. The sharp-edged light exit end 125 could jam
with the inner wall 129 of the working channel 127 on being pushed
through this and could prevent the pushing-through or the fiber
optic could 123 even kink. Furthermore, the wall 129 could also be
destroyed on jamming if the light exit end 125 bores into the inner
wall 129.
[0092] In order to prevent this, as is represented in FIG. 4b, an
alternative working channel 131 as a second, smaller working
channel 19 is provided for the fiber optic 123, and this at least
in a bendable section has an inner diameter of only a little more
than the diameter of the fiber optic 123 (here 0.45 mm) and by way
of example is 0.55 mm. The fiber optic 123 at its light exit end
125 only experiences a very small angle of engagement to an inner
wall 133 of the working channel 133, so that a jamming is reliably
prevented.
[0093] The mentioned diameters in the bendable section are merely
to be understood as example. The inner diameter of the working
channel 131 for leading through the fiber optic 123, at least in
the bendable section should have an inner diameter which does not
exceed the outer diameter of the fiber optic 123 by too much. The
difference between the two diameters in the bendable section should
not be too large since otherwise there is the danger of jamming
and/or damage of the working channel 131. It has been found that a
diameter difference in the bendable section of maximally 30% can
prevent the damaging of the working channel 131. The inner diameter
of the working channel 131 should therefore exceed the outer
diameter of the fiber optic 123 at the most by 30% at least in the
bendable section, which is the case with the mentioned exemplary
diameters.
[0094] A further aspect for realizing an endoscopic instrument 134
is shown in FIGS. 5 to 6c. FIGS. 6a to 6c show a handling device
135, onto which a proximal end 138 of a shank 137 is connected.
This comprises a distal end 139 which in the plane of the drawing
at the left is represented in a somewhat enlarged manner and by way
of example comprises a first distal working channel opening 140. A
proximal fluid channel opening 142 as well as an electrical
connecting cable 146 is arranged on a side which is at the bottom
in the plane of the drawing, wherein a rinsing fluid or the like
can exit out of the proximal fluid channel opening 142. Here, a
separate fluid inlet 148, through which the first working channel
15 can be rinsed with rinsing fluid is arranged on the upper side.
Of course, the shank 137 can likewise comprise a distal bendable
shank section which is provided with slots as is represented in the
preceding figures. It is generally advantageous to configuration
the shank in a jointlessly bendable manner towards the distal end
139.
[0095] A first limb 141 and a second limb 143 are provided in a
Y-arrangement at a proximal end of the handling device 135, between
which limbs a contact surface 145 for applying a ball of the thumb
of a hand is provided. By way of example, a second proximal working
channel opening 144 is provided on the second limb 143. The
alignment of the two limbs 141 and 143 to one another as well as
the dimensioning of the contact surface 145 are selected such that
on gripping the handling device 135, the ball of the thumb bears on
the contact surface 145 in a manner such that the handling device
135 forms a direct extension of a lower arm of the user. The user
can consequently very comfortably rotate the handling device 135
exclusively by way of supination and pronation of the lower arm
about the longitudinal axis of the shank 137, without having to
carry out a more complex arm movement. In particular, this is not
the case with conventional pistol-like handling devices.
[0096] An upper trigger 147 and a lower trigger 149 follow distally
on two sides of the handling device 135 which are opposite one
another, said triggers being able to be actuated by two fingers of
the hand by way of proximal pulling and each being connected to a
distally running pull wire. As in the embodiment example in FIG. 1,
the upper trigger 147 and the lower trigger 149 could also be
coupled to one another, so that both triggers 147 and 149 execute
opposite movements. It is conceivable for a guide roller to be
present between the triggers 147 and 149, around which guide roller
mentioned pull wires configured as a section of a common pull wire
are led. However, a cam disc which is coupled to both triggers 147
and 149 as well as a separate pull wire would also be conceivable.
An arresting device 151 could be provided for arresting a momentary
position of the guide roller or of the individual pull wires. In
the represented case, the arresting device 151 is configured as a
knurled screw which for example projects into a cam disc and is
clamped onto the outer surface of the handling device 135 by way of
tightening.
[0097] By way of example, a working channel inlet 153 is located on
the first limb 141 according to a further aspect of this
disclosure, as part of a Luer lock connection, on which working
channel inlet a first closure thread 153 is proximally arranged. A
shank tool in the form of a capture basket insert is inserted into
the instrument 1 through the working channel inlet 153 and is
connected. The capture basket insert comprises a connection element
157 which is connected via a second closure thread 159 which is
shaped in a manner corresponding to the first closure thread 155. A
first rotatable receiving part 161 which is connected to a tube 163
as a jacket element of the capture basket insert is mounted on the
connection element 157 of the capture basket insert. The jacket
element 163 of the capture basket insert extends through the first
working channel 15 through the shank 3. The first receiving part
161 comprises a first displacing section 165 which is provided with
a peripheral-side detent 167. This permits the latching in
different positions in an opening contour 169 of the connection
element 157. By way of displacing the first receiving part 161 in
the distal direction along the first displacing section 165,
consequently the tube 163 can be distally displaced in the first
working channel 15. A first shoulder 171 in the form of a
peripheral collar which has a peripheral knurling 173 is arranged
on an end of the first displacing section 165 which is opposite to
the connection element 157. By way of this, the first receiving
part 161 can be gripped and rotated. The peripheral-side detent 167
is therefore preferably configured in the form of grooves which are
arranged parallel to one another and which have a rounded profile
cross section. A manual displacing in the distal or proximal
direction can lead to the release and the reaching of a
latching.
[0098] A second receiving part 177 is arranged in an inner lumen
175 of the first receiving part 161. This comprises a second
displacing region 179, with which the relative position of the
second receiving part 177 to the first receiving part 161 can be
adjusted. The second receiving part 177 is simultaneously connected
to the first receiving part 161 via a rotationally fixed,
displaceable connection. The second receiving part 177 therefore
directly follows the movement of the first receiving part 161. The
second receiving part 177 is connected to a pull wire 181 which
extends through the jacket element of the capture basket insert
which is configured as a flexible tube 163. The second receiving
part 177 further at an end of the second displacing section 179
which is away from the first receiving part 161 comprises a second
shoulder 183 in the form of a peripheral collar which is likewise
provided with a knurling 185. A user can consequently easily grip
and rotate the receiving parts 161 and 177. On account of the fixed
connection between the components, the flexible tube 163 and the
pull wire 181 are also rotated. The second receiving part 177
likewise comprises a detent 187 which can latch with an opening
contour 189 of the first receiving part 161. The position of the
second receiving part 17 can consequently always be set in a fixed
manner with respect to the first receiving part 161.
[0099] As is represented in the FIGS. 6a to 6c, on account of this
configuration a particular advantageous construction of a capture
basket 191 can be realized, said capture basket being arranged in
the jacket element 163 of the capture basket inert and being
protected by this. The capture basket 191 is configured in such an
elastic manner that it can be completely retracted into the jacket
element 163 and can be pushed out of this by way of a distal
movement, where it expands to its full size. A kidney stone or the
like can be gripped by way of a targeted movement of the capture
basket 191, wherein the gripping is effected by way of a proximal
pulling of the pull wire 181 and the capture basket is compressed
again by way of this. FIG. 6a shows the first receiving part 161
and the second receiving part 177 in the proximal position. This
means that an actuation grip 193 is pulled out of the handling
device 135 as far as possible.
[0100] As is evident in the enlarged representation of the distal
tip 139 of the shank 137, the jacket element 163 of the capture
basket insert does not extend beyond the distal shank tip 139. By
way of moving the first receiving part 161 over the complete first
displacement path 165 in the distal direction, so that the first
shoulder 71 lies on the connection device 157 in a flush manner,
the flexible tube 163 projects out of the distal shank tip 139 for
example by about 5 mm. By way of pushing in the second receiving
part 177 in the distal direction, the capture basket 191 can be
pushed out of the flexible tube 163, so that it unfolds. 5 mm can
be suitable as a displacement path for the flexible tube 163. It is
conceivable to provide a significantly greater length, for example
20 mm, for the unfolding of the capture basket 191.
[0101] The particular advantage of this arrangement with the
distally displaceable jacket element 163 of the capture basket
insert and the rotatable connection lies in the fact that the
capture basket 191 by way of acting upon the handle 193 can be
easily rotated in all unfolding states. Simultaneously, by way of
actuating the handle 193, an advancing and unfolding of the capture
basket 191 by the hand which indeed does not grip the handling
device 135 is permitted. If an object is gripped by the wire
capture basket 191, then the object can be firmly held by way of
retracting the second receiving part 177. On account of the detent
187, the object remains caught, without it having to be actively
firmly held. The capture basket can accordingly be very easily
actuated by an individual user, and a second user, with whom one
must intensively communicate during the operation, is not
necessary.
[0102] On account of the second, smaller working channel 19, a
laser fiber optic 123 can be led onto the distal shank tip 17
parallel to the capture basket insert in the first working channel
15, in order for example to be able to smash a kidney stone by way
of laser light. The second, smaller working channel 19 ends at the
proximal side on the second proximal working channel opening 144 on
the second limb 143 of the handling device 135.
[0103] In FIGS. 7a-f, the shank 3, in particular the bendable shank
section 9, 49 of the shank 3 and the distal shank end 17, 51, 139
are shown in more detail. A distal end sleeve 195 is not shown in
FIGS. 7a-c, and this is shown in more detail in FIGS. 7d-f. The
distal shank end 17, 51, 139 comprises a connection sleeve 197, by
way of which the end sleeve 195 is positively fastened to the shaft
3 in a rotationally fixed manner (see FIG. 7f). The end sleeve 195
comprises a recess 199 and the connection sleeve 197 an indentation
201 which is shaped in a manner which correspondingly matches the
recess 199, by which means a rotationally fixed positive connection
between the end sleeve 195 and the connection sleeve 197 is
achieved.
[0104] The connection sleeve 197 in an overlapping section overlaps
the distal end of the slotted bendable shank section 9, 49. Lateral
rinsing openings 203 here in the form of eight radial through-bores
which are distributed circumferentially are present in the
overlapping section. Since the slots 33, 55, 64 of the bendable
shank section 9, 49 are here surrounded by a protective flexible
tube 205 (see FIG. 7f, not shown in FIG. 7a-e), the rinsing
openings 203 serve as a distal rinsing outlet or rinsing inlet of
the fluid channel 7, 53. The thickness of the connection sleeve 197
corresponds roughly to the thickness of the protective sleeve 205,
so that the radial outer surfaces of the protective flexible tube
205, connecting sleeve 197 and end sleeve 195 when abutting one
another are flush with one another without edges (see FIG. 7f).
[0105] The pull wires 57, 59, 65, 67 which in a manner lying
diametrically opposite (here: at the top 57,65 and at the bottom
59, 67) extend through the shank 3 on the shank inner surface in
order to be able to bend the bendable shank section 9, 49
jointlessly upwards or downwards are shown in FIG. 7b. For this,
the slots 33, 55, 64 are configured in a wedge-like manner, so that
the clear width of the slots 33, 55, 64 is largest at the middle
where the pull wires 57, 59, 65, 67 run, and taper in the
circumferential direction towards the ends. The ends of the slots
33, 55, 64 comprise round recesses, in order, given the bending of
the shank material, to reduce the stresses and to reduce material
tears or the risk of plastic deformations of the shank material.
The jointless bending of the shank section 9, 49 should be effected
by way of an elastic as possible deformation of the slotted shank
material which has a restoring effect into the straight shank
shape.
[0106] The arrangement of a light source in the form of an LED 207,
an objective 209 with a picture sensor lying therebehind, the first
distal working channel opening 18, 52, 140 of the first working
channel 15 and a second distal working channel opening 211 of the
second working channel 19 in the distal end sleeve 195 are shown in
a front elevation in FIG. 7d. The extremely small size conditions
are to be noted. The outer diameter of the distal end sleeve 195
can be 3 mm or less. The LED 207 can be 0.55 mm wide and the
picture sensor 209 less than 1 mm wide. The first distal working
channel opening 18, 52, 140 can have an inner diameter of 1.2 mm or
less and the second distal working channel opening 211 an inner
diameter of 0.55 mm or less. The distal-side light outcoupling of a
laser fiber optic 123, said fiber optic being pushed through the
second working channel 19, can be placed on the second distal
working channel opening 211. The tool head of a shank tool, for
example a capture basket insert or a forceps or scissor instrument,
these being able to be pushed through the first working channel 15,
can be led out of the first distal working channel opening 18, 52,
140. The first working channel 15 can moreover be used as a feed
conduit or discharge conduit of rinsing fluid which is accordingly
led away or fed via the lateral rinsing openings 203 and the fluid
channel 7, 53. A feed of clear rinsing fluid via the first working
channel 15 and a discharge via the lateral rinsing openings 203 and
the fluid channel 7, 53 is preferred, in order to obtain a clear
distal view.
[0107] It is shown in FIG. 7e that the distal end sleeve 195 is
beveled at the front side, so that in particular the first distal
working channel opening 18, 52, 140 runs at an angle to the
longitudinal axis of the shank 3. Preferably, the second distal
working channel opening 211 is also beveled (not visible in FIG.
7e). The respective distal openings in the end sleeve 195 for the
LED 207 and the objective 209 can also be beveled, in order to
improve the respective illumination or the viewing angle. The one
or more bevelings of the distal shank tip 17, 51, 139 have the
further advantages that the distal shank tip 17, 51, 139 can be led
more simply through a ureter or kidney tube or a trocar or
catheter.
[0108] FIGS. 8a-e show the single-part metallic tubular main body
of the shank 3, 47 which comprises the rinsing openings 203, the
slots 33, 55, 64 and the proximal fluid channel opening 45, 73,
142. The bendable shank section 9, 49 with the slots 33, 55, 64
preferably comprises at least two sub-sections Y, Z, wherein the
axial distances between the slots 33, 55, 64 are different in the
sub-sections X, Z. Preferably, the distances between the slots 33,
55, 64 in a first sub-section Y is smaller than in a second
sub-section Z, wherein the first sub-section Y is arranged distally
of the second sub-section Z. By way of this, a greater curvature
can be achieved in the first sub-section Y than in the second
sub-section Z. Furthermore, the first sub-section Y is less
flexurally rigid than the sub-section Z, so that the bendable shank
section 9, 49 rolls in given bending from the distal tip 17, 51,
139. By way of this, a particularly good mobility of the distal tip
17, 51, 139 and a particularly large bending range of up to
300.degree. can be achieved in a small space. As is shown in FIG.
8c,d shows, the clear width of the slots 33, 55, 64 in the first
sub-section Y can be larger than in the second sub-section Z. This
can likewise assist the bending ability of the shank section 9, 49
which is improved in the distal direction. The clear width and/or
the slot distances can gradually vary within and/or between the
sub-sections Y, Z, so that the sub-sections Y, Z can run into one
another. The sub-sections Y, Z can be arranged adjacently to one
another or separately from one another.
[0109] FIGS. 9a,b show a further configuration of the Y-shaped
handling device 5, 135. The instrument which is shown in FIG. 9b
can be inexpensively manufactured as a sterilized disposable
product which is preassembled on the part of the factory. Once
again, it is emphasized how the distal shank tip 17, 51, 139 can be
bent upwards or downwards by up to 300.degree. by way of pulling
the triggers 147, 149. FIG. 9c shows the distal shank tip 17, 51,
139 in a perspective view with beveled working channel openings 18,
52, 140, 144. FIG. 9d illustrates how a shank tool in the exemplary
form of a forceps instrument 213 can be pushed through the first
working channel 15 and is axially positionable given a bent shank
section 9, 49.
[0110] In inner workings of the Y-shaped handling device 5, 135 is
shown in more detail in a longitudinal section in FIGS. 10a,b. FIG.
10b herein shows an enlarged detail X. FIG. 10c shows an enlarged
representation of the seal device 89 in the form of a cell foam
block which is seated in the seal receiver 91 and proximally seals
the fluid channel 7, 53. The seal device 89 comprises recesses 97,
99, 101 and 103 for leading through the leads 11, 13, 15 and 19
which in accordance with the leads 11, 13, 145 and 19 have
different dimensions. The seal device 89 has a largest recess 97
which belongs to the first working channel 15 which can extend
along the extension axis 75 through the control housing 69 to the
proximal working channel opening 39. Three further feed-throughs
99, 101 and 103 in the form of recesses are arranged adjacently to
the largest recess 97 and serve for leading through the leads 11,
13 and the smaller second working channel 19. The feed-through 103
which by way of example has the smallest dimensions, is suitable
for instance for leading through the smaller second working channel
19 with a dimension of significantly below 1 mm, for example 0.55
mm or less. The two other feed-throughs 99 and 101 belong to the
electrical leads 11, 13 which are connected to the distal-side LED
207 and the picture sensor 209 respectively. The dimensions of the
recesses 97, 99, 101 and 103 are each somewhat smaller than the
cross section of the associated led-through lead 11, 13, 15 and 19,
in order to achieve a sealing effect on the lead 11, 13, 15, and 19
at the outside. The seal device 89 is preferably configured as an
elastic cell foam block of ethylene-propylene-diene monomer (EPDM),
so that the recesses 97, 99, 101 and 103 accordingly expand on
leading through the leads 11, 13, 15 and 19 and embrace these in a
sealing manner. The two slots 93 which are arranged offset to one
another serve for the sealed leading-through of the two pull cables
57, 59. The radial deepening 105 serves for the rotation lock of
the seal device 89.
[0111] It is further illustrated in FIG. 10a how the first working
channel 15 can be supplied with rinsing fluid via the upper-side
fluid inlet 148, so that the first working channel 15 can serve as
a feed channel of rinsing fluid. For this, a T-connection piece 215
is arranged in the first working channel 15 within the handling
device 5 and is connected to the upper-side fluid inlet 148 via a
rinsing conduit 217. Herewith, a drip which is hung up or a pump
can be connected to the fluid inlet 148, so that rinsing fluid runs
through the rinsing conduit 217 into the first working channel
15.
[0112] It is to be noted that the features of the previously
described embodiment examples can be arbitrarily combined with one
another.
[0113] While specific embodiments of the invention have been shown
and described in detail to illustrate the application of the
principles of the invention, it will be understood that the
invention may be embodied otherwise without departing from such
principles.
LIST OF REFERENCE CHARACTERS
[0114] 1 endoscopic instrument [0115] 3 shank [0116] 4 proximal end
of the shank [0117] 5 handling device [0118] 7 fluid channel [0119]
9 bendable shank section [0120] 11 first optical or electrical lead
[0121] 13 second optical or electrical lead [0122] 15 first working
channel [0123] 17 distal end/distal tip of the shank [0124] 18.
first distal working channel opening [0125] 19 second working
channel [0126] 21 flow lines/backflow fluid [0127] 23 housing
[0128] 25 grip opening [0129] 27 contact surface [0130] 29 lower
trigger/operating lever [0131] 31 upper trigger/operating lever
[0132] 33 slot [0133] 35 peripheral surface [0134] 37 upper side of
the handling device [0135] 39 proximal end [0136] 41 lower side of
the handling device [0137] 43a, 43b second proximal working channel
opening [0138] 45 proximal fluid channel opening [0139] 47 shank
[0140] 49 bendable shank section [0141] 51 distal end of the shank
[0142] 52 first distal working channel opening [0143] 53 fluid
channel [0144] 55 first slot [0145] 57 mechanical lead (pull wire)
[0146] 59 mechanical lead (pull wire) [0147] 61 first region [0148]
63 second region [0149] 64 second slot [0150] 65 mechanical lead
(pull wire) [0151] 67 mechanical lead (pull wire) [0152] 69 control
housing [0153] 71 shank connection part [0154] 73 proximal fluid
channel opening/connection pipe stub [0155] 75 shank connection
axis [0156] 77 cavity [0157] 79 lateral opening [0158] 81 radial
projection [0159] 83 latching opening [0160] 85 latching opening
[0161] 87 radial contour [0162] 89 seal device [0163] 91 seal
receiver [0164] 93 slot/feed-through [0165] 95 peripheral surface
[0166] 97 feed-through [0167] 99 feed-through [0168] 101
feed-through [0169] 103 feed-through [0170] 105 radial deepening
[0171] 107 radial projection [0172] 109 sleeve-like section [0173]
111 cover [0174] 113 radially outer-lying tongue [0175] 115
radially inner-lying deepening [0176] 117 sealing ring [0177] 119
deepening [0178] 121 annular surface [0179] 123 fiber optic [0180]
125 light exit end [0181] 127 conventional working channel [0182]
129 inner wall [0183] 131 working channel [0184] 133 inner wall
[0185] 134 endoscopic instrument [0186] 135 handling device [0187]
137 shank [0188] 138 proximal end of the shank [0189] 139 distal
end of the shank [0190] 140 first distal working channel opening
[0191] 141 first limb [0192] 142 proximal fluid channel opening
[0193] 143 second limb [0194] 144 proximal second working channel
opening [0195] 145 contact surface [0196] 146 electrical connection
cable [0197] 147 upper trigger/operating lever [0198] 148 fluid
inlet [0199] 149 lower trigger/operating lever [0200] 151 arresting
device [0201] 153 working channel inlet [0202] 155 first closure
thread [0203] 157 connection element [0204] 159 second closure
thread [0205] 161 first receiving part [0206] 163 jacket element of
the shank tool [0207] 165 first displacing section [0208] 167
detent [0209] 169 opening contour [0210] 171 first shoulder/collar
[0211] 173 knurling [0212] 175 inner lumen [0213] 177 second
receiving part [0214] 179 second displacing section [0215] 181 pull
wire [0216] 183 second shoulder/collar [0217] 185 knurling [0218]
187 detent [0219] 189 opening contour [0220] 191 capture basket
[0221] 193 actuation grip [0222] 195 end sleeve [0223] 197
connection sleeve [0224] 199 recess [0225] 201 indentation [0226]
203 rinsing openings [0227] 205 protective sleeve [0228] 207 LED
[0229] 209 objective [0230] 211 second distal working channel
opening [0231] 213 forceps instrument [0232] 215 T-Connection piece
[0233] 217 fluid conduit [0234] angle (lateral offset)
* * * * *