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DE69603095T2 - Chirurgisches Instrument mit einem ausweitbaren, schneidenden Element - Google Patents

Chirurgisches Instrument mit einem ausweitbaren, schneidenden Element

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Publication number
DE69603095T2
DE69603095T2 DE69603095T DE69603095T DE69603095T2 DE 69603095 T2 DE69603095 T2 DE 69603095T2 DE 69603095 T DE69603095 T DE 69603095T DE 69603095 T DE69603095 T DE 69603095T DE 69603095 T2 DE69603095 T2 DE 69603095T2
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cutting element
instrument according
tissue
cutting
elements
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DE69603095T
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DE69603095D1 (de
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William D. Fox
Dale Schulze
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Ethicon Endo Surgery Inc
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Ethicon Endo Surgery Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1402—Probes for open surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2945—Curved jaws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00404—Blood vessels other than those in or around the heart
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00601—Cutting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/1425—Needle
    • A61B2018/1432—Needle curved
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
    • A61B2018/1455—Probes having pivoting end effectors, e.g. forceps including means for cutting having a moving blade for cutting tissue grasped by the jaws

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Otolaryngology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Plasma & Fusion (AREA)
  • Physics & Mathematics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Description

    Fachgebiet der Erfindung
  • Diese Erfindung betrifft ein chirurgisches Instrument zum Schneiden von Gewebe im Verlauf chirurgischer Eingriffe, insbesondere ein elektrochirurgisches Instrument zur elektrochirurgischen Behandlung von Gewebe.
    • Hintergrund der Erfindung
  • Der Fachwelt sind einfache Klemm- und Schneidvorrichtungen bekannt und sie werden auch bei chirurgischen Eingriffen verwendet. Beispielsweise sind bei einem Linear-Schneid- und Klammerinstrument zwei Klemmelemente und ein Endeffektor vorgesehen, um das Gewebe zu ergreifen und zu halten, wenn Klammern angebracht werden und ein Messer durch das Gewebe geführt wird. Bei einem solchen Instrument werden die Klemmelemente typischerweise mittels eines Spaltstiftes soweit geschlossen, daß sie sich in einem Abstand gegenüber stehen. Das Messer wird durch einen Messerkanal vorwärts bewegt, der in den Klemmelementen ausgebildet ist, um das Gewebe zu schneiden, wenn es geklammert wird.
  • Elektro-Kauterisations-Vorrichtungen sind zur besseren Blutstillung verwendet worden, um das Gewebe zu erhitzen und Blutgefäße zur Koagulation oder Kauterisation zu veranlassen. Monopolare Vorrichtungen verwenden eine an das Schneid- oder Kauterisations-Instrument angeschlossene Elektrode und eine entfernte Rückleitungselektrode, die gewöhnlich außen am Körper des Patienten haftet. In der letzten Zeit sind bipolare Instrumente eingesetzt worden, da bei diesen der Kauterisationsstrom grundsätzlich auf das Gewebe zwischen den zwei Elek troden eines Gewebe-Behandlungsteiles eines Instrumentes begrenzt wird.
  • Bei verschiedenen Eingriffen wurden bipolare Zangen zum Schneiden und/oder zur Koagulation eingesetzt. Bipolare Zangen ergreifen das Gewebe grundsätzlich zwischen zwei Polen und leiten einen elektrischen Strom durch das ergriffene Gewebe.
  • Das US-Patent Nr. 4.655.216 beschreibt eine elektrochirurgische Greifvorrichtung mit einer Gewebeproben-Schneidvorrichtung, welche so angeordnet ist, daß sie eine scherenartige Schwenkbewegung ausführt, um die Gewebeprobe zu erhalten. Die Greif-Klemmelemente leiten Elektro-Kauterisations-Energie in das ergriffene Gewebe.
  • Die Patentanmeldung EP-A-0 640 317, die nach dem für diese Erfindung beanspruchten Prioritätsdatum veröffentlicht wurde, beschreibt eine elektrochirurgische Vorrichtung mit zwei Klemmelementen, welche geschlossen werden, um das dazwischen befindliche Gewebe zusammenzudrücken und diesem Gewebe elektrochirurgische Energie zuzuführen. Es wird dort auch ein Schneidelement beschrieben, welches derart angeordnet ist, daß es durch die Klemmelemente hindurch geführt wird, um das dazwischen anliegende Gewebe zu trennen.
  • Ein Nachteil dieser bekannten Vorrichtungen besteht darin, daß diese Vorrichtungen nicht zum Einsatz in einer zangenartigen Gewebe-Koagulationsvorrichtung geeignet sind, in welcher Gewebe relativ unterschiedlicher Abmessungen (d. h. in bezug auf die Abmessungen der Endeffektor-Klemmelemente) behandelt (beispielsweise elektrochirurgisch) und geschnitten werden können. Ein zweiter Nachteil besteht darin, daß sich die Schneideinrichtungen der bekannten Vorrichtungen über die Fläche(n) der Zangen-Klemmelemente hinaus erstrecken, was die Möglichkeit offen läßt, daß unbeabsichtigt Gewebe außerhalb des Griffes der Klemmelemente geschnitten wird.
  • Weitere Hinweise zum Stand der Technik sind in DE-A-43 03 882 zu finden, worauf Anspruch 1 bezug nimmt.
  • Somit existiert ein Bedürfnis nach einer Klemm- und Schneidvorrichtung, welche an Gewebe unterschiedlicher Dicke angepaßt werden kann, um ein besseres Schneiden des Gewebes zu ermöglichen und dessen Schneidelement nicht in benachbartes Gewebe gelangen kann, das nicht geschnitten werden soll.
    • Zusammenfassung der Erfindung
  • Demzufolge wird durch diese Erfindung ein Instrument zum Greifen, Klemmen oder Annähern von Gewebe geschaffen, wie es in Anspruch 1 definiert ist. Der Endeffektor, d. h. der Teil des Instrumentes zum Klemmen, Greifen und Annähern von Gewebe, weist ein anpaßbares Schneidelement, wie beispielsweise ein expandierbares Messer auf, das in Abhängigkeit vom Umfang des von den Klemmelementen der Vorrichtung erfaßten bzw. eingeklemmten Gewebes durch Expandieren oder Kontraktieren in seiner Größe anpaßbar ist.
  • Weitere Ausführungsformen der Erfindung sind in den Unteransprüchen beschrieben.
  • Bei einer Ausführungsform umfaßt das Schneidelement sich überlappende Messerelemente, welche ein einziges Schneidmesser bilden. Die Messerelemente sind in Richtung voneinander weg in Nuten vorgespannt, die in den Klemmelementen geformt sind, so daß sich die Messerelemente beim Öffnen der Klemmelemente voneinander weg bewegen und dadurch den Überlappungsbereich verkleinern und die Größe des Schneidmessers vergrößern. Wenn die Klemmelemente geschlossen werden, dann vergrößert sich der Überlappungsbereich und die Größe des Schneidmessers verkleinert sich entsprechend, damit es am Ort des Schneidmessers in den Spalt zwischen den Klemmelementen paßt. Diese Vorrichtung ergibt auch ein Schneidelement, das sich an einen in Längsrichtung der Klemmelemente variablen Spalt anpaßt.
  • Bei einer bevorzugten Ausführungsform ist eine elektrochirurgische Gewebe-Behandlungsvorrichtung vorgesehen, von welcher dem von den Klemmelementen des Endeffektors erfaßten Gewebe elektrochirurgische Energie zugeführt wird. Es ist ein expandierbares Messer zum Schneiden des von den Klemmelementen erfaßten Gewebes vorgesehen, wobei das Schneiden vorzugsweise erfolgt, nachdem dem Gewebe elektrochirurgische Energie zugeführt worden ist.
  • Diese und andere Gegenstände der Erfindung werden aus der nachfolgend angefügten detaillierten Beschreibung der Zeichnungen in Verbindung mit der detaillierten Beschreibung der Erfindung besser verständlich.
    • Beschreibung der Zeichnungen
  • Fig. 1 ist eine geschnittene Seitenansicht der Klemm-, Schneid- und Koagulationsvorrichtung einer bevorzugten Ausführungsform der vorliegenden Erfindung.
  • Fig. 2 ist eine entlang der Linien 2-2 von Fig. 1 geschnittene Stirnseitenansicht der Vorrichtung.
  • Fig. 3 zeigt eine perspektivische Explosivdarstellung der Klemmelemente der in Fig. 1 gezeigten Vorrichtung.
  • Fig. 4 ist eine Seitenansicht des distalen Teiles der Vorrichtung von Fig. 1, wie sie bei dünnem Gewebe angewandt wird.
  • Fig. 5 ist eine Seitenansicht des distalen Teiles der Vorrichtung von Fig. 1, wie sie bei dickem Gewebe angewandt wird.
  • Fig. 6 ist eine Stirnseitenansicht von Fig. 4.
  • Fig. 7 ist eine Stirnseitenansicht von Fig. 5.
  • Fig. 8 zeigt eine geschnittene Seitenansicht des distalen Abschnittes einer alternativen Ausführungsform der vorliegenden Erfindung.
  • Fig. 9 zeigt eine Schnittansicht des distalen Abschnittes einer alternativen Ausführungsform der vorliegenden Erfindung von oben.
    • Detaillierte Beschreibung der Zeichnungen
  • Bezugnehmend auf die Fig. 1 bis 7 ist ein Klemm- und Schneidinstrument 0 nach der vorliegenden Erfindung dargestellt. Das Instrument 10 umfaßt ein Gehäuse 11, eine hohle Hülse 12, die vom Gehäuse 11 aus in distaler Richtung erstreckt, ein Klemmelementen-Schließrohr 15, das aus einem elektrisch isolierendem Material besteht und sich durch die Hülse 12 erstreckt sowie Klemmelemente 16 und 17, die sich vom distalen Ende des Schließrohres 15 aus erstrecken. Die Klemmelemente 16 und 17 weisen einander gegenüber liegende Flächen 18 und 19 auf, welche derart angeordnet sind, daß sie sich beim Schließen dem dazwischen befindlichen Gewebe annähern, nachdem das Schließrohr 15 über Nockenflächen 16a und 17a der Klemmelemente 16 bzw. 17 vorwärts bewegt worden ist. Die Klemmelemente 16 und 17 weisen darin ausgebildete Nuten 20 und 21 auf, um das anpaßbare Schneidelement 22 aufzunehmen, wenn es durch die Klemmelemente 16 und 17 vorgeschoben wird. Das Schneidelement 22 weist Federorgane 23 bzw. 24 auf, die am distalen Ende des Schneidelementes 22 getrennt ange ordnet sind. Das distale Ende eines jeden Federorgans 23 und 24 ist zu einem Schneidmesser 25 bzw. 26 geformt.
  • Die Messer 25 und 26 sind derart angeordnet, daß sie in Nuten 20 und 21 gleiten, wenn das Schneidelement 22 mittels der Klemmelemente 16 und 17 vorgeschoben wird. Die Federorgane 23 und 24 überlappen einander, so daß sie zusammen mit den Messern 25 und 26 ein Scher- oder Schneidelement 50 zum Schneiden des Gewebes bilden. Die Messer 25 und 26 stehen im Winkel zueinander, so daß sie ein V-förmiges Scherelement bilden, wenn sie von den Federorganen 23 und 24 überlappt werden. Die Federorgane 23 und 24 sind in Richtung von den Messern 25 und 26 weg vorgespannt, so daß sie das Bestreben haben, sich weiter voneinander weg zu bewegen, wenn sich der Spalt zwischen den Klemmelementen 16 und 17 vergrößert, d. h. bei dickerem Gewebe. Wenn sich der Spalt vergrößert, wird der Überlappungsbereich kleiner, und die Größe des Schneidelementes 50 wird größer, wie es in Fig. 5 dargestellt ist. Wenn der Spalt kleiner wird, wird der Überlappungsbereich größer, und die Größe des Schneidelementes 50 zieht sich zusammen bzw. wird kleiner, wie es in Fig. 4 dargestellt ist.
  • Die Klemmelemente 16 und 17 weisen elektrisch leitfähige Abschnitte auf, welche Elektroden 33 und 34 bzw. Oberflächenabschnitte 18 und 19 bilden. Bei dieser bevorzugten Ausführungsform sind die Elektroden zueinander versetzt, so daß sie einander nicht berühren, wenn das Gewebe dünn ist und/oder sie verhindern die Ausbildung von Lichtbogen zwischen den Elektroden. Die Elektrode 33 hat ein anderes elektrisches Potential als die Elektrode 34. Ein Generator 35 liefert elektrochirurgische Energie an die Elektroden 33 und 34 und wird vom Benutzer mittels eines Fußschalters 36 gesteuert. Der Generator 35 ist vorzugsweise eine elektrochirurgische Einheit zur Lieferung bipolarer Energie. Die Energie wird über Drähte 37 zugeführt und durch das Gehäuse 11 hindurch an Kontakte 38 und 39 angekoppelt, die mit elektrisch voneinander isolierten leitfähigen Abschnitten 48 und 49 des Schließrohres 15 verbunden sind.
  • Durch das Gehäuse 11 hindurch erstreckt sich ein Drehknopf 28. Der Drehknopf steht mit der Hülse 12 und dem Schließrohr 15 im Eingriff, welches seinerseits mit den Klemmelementen 16 und 17 im Eingriff steht. Der Knopf 28 kann benutzt werden, um die Klemmelemente 16 und 17 in eine Position zu drehen, wo sie Gewebe ergreifen und klemmen.
  • Nachdem das Gewebe zwischen den Klemmelementen 16 und 17 positioniert worden ist, werden die Klemmelemente 16 und 17 geschlossen, um das zwischen ihren beiden einander gegenüber liegenden Flächen zu erfassen. Ein Schwenkgriffelement 30 ist mit dem Schließrohr 15 gekoppelt und so angeordnet, daß es um den Zapfen 41 schwenkt, um dem Schließrohr 15 über die Nockenflächen 16a und 17a eine Längsbewegung zu übertragen und dadurch die Klemmelemente zu schließen. Durch Betätigung des Fußschalters 36 kann dann elektrochirurgische Energie zugeführt werden.
  • Nachdem die elektrochirurgische Energie zugeführt und das Gewebe im gewünschten Umfang behandelt wurde, wird das Schneidelementen 22 vorgeschoben, um das erfaßte Gewebe zu schneiden. Das Schneidelement wird durch den Stößelknopf 31 betätigt, der sich von außerhalb des Gehäuses 11 in das Schließrohr 15 im Gehäuse 11 erstreckt. Der Stößelknopf 31 wird dann mit einem Antriebsstab 29 gekoppelt, welcher sich durch das Schließrohr 15 erstreckt und an ihrem distalen Ende mit dem Schneidelement 22 gekoppelt ist. Eine im Schließrohr 15 angeordnete Feder 32 liegt am distalen Ende des Stößelknopfes 31 und am proximalen Ende 27 der Klemmelemente 16 und 17 an. Die Feder 32 ist für das automatische Zurückziehen des Schneidelementes 22 vorgesehen, wenn der Stößelknopf 31 losgelassen wird.
  • Bezugnehmend auf Fig. 8 ist eine alternative Ausführungsform der vorliegenden Erfindung dargestellt. Nuten 120 und 121 in Klemmelementen 116 und 117 weisen gewellte Flächen 141 und 142 auf. Wenn das anpaßbare Schneidelement 122 in distaler Richtung vorwärts bewegt wird, stehen die Schneidmesser 125 und 126 des Schneidelementes 122 mit den Flächen 141 und 142 im Kontakt, was die Messer 125 und 126 veranlaßt, in sich bezug auf eine Längsachse 150 aufeinander zu und voneinander weg zu bewegen. Somit erzeugen die Flächen 141 und 142 eine verstärkte Schneidwirkung, deren Art von der Größe und der Form der Wellen abhängt (d. h. kleinere Wellen mit höherer Frequenz ergeben mehr eine Schwingungswirkung, längere Wellen ergeben eine mehr scherenartige Schneidwirkung).
  • Nunmehr bezugnehemd auf Fig. 9 ist eine andere alternative Ausführungsform der vorliegenden Erfindung dargestellt. Die Hülse 212 umschließt eine Längsachse, die sich vom proximalen Ende zum distalen Ende durch das Instrument 210 hindurch erstreckt. Die Klemmelemente 216 und 217 sind zur Achse gekrümmt, um zur besseren Handhabung und Beobachtung einen gekrümmten Endeffektor zu erhalten. An die Hülse 212 ist ein Drehknopf 228 gekoppelt. Das anpaßbare Schneidelement 222 steht mit der Hülse 212 im Reibeingriff. Wenn daher die Hülse 212 gedreht wird, dann geschieht dies auch mit dem Schneidelement 222. Damit ergeben sich auch gekrümmte Klemmelemente, die immer von neuem orientiert werden können, um das Gewebe in geeigneter Weise zu erfassen.
  • Im Zusammenhang mit verschiedenen chirurgischen Klemm- und Schneidelementen wurden verschiedene Varianten dieser Erfindung beschrieben. Selbstverständlich kann die Erfindung in zahlreichen Anwendungsfällen angewandt werden, wo Klemmen und Schneiden oder Klemmen, Schneiden und Koagulation gewünscht werden. Dementsprechend versteht es sich für den Fachmann, daß zahlreiche Änderungen an der Erfindung vorgenommen werden können, ohne ihren Schutzumfang zu verlassen, wie er in den folgenden Ansprüchen definiert ist.

Claims (14)

1. Chirurgisches Instrument, umfassend einen Schaft mit einem distalen Ende und einem Endeffektor, der am distalen Ende des Schaftes angeordnet ist, wobei der Endeffektor umfaßt:
erste und zweite Elemente (16, 17), die erste und zweite, sich gegenüberliegende, jeweils Gewebe kontaktierende Flächen (18, 19) aufweisen, wobei die Elemente relativ zueinander aus einer offenen, beabstandeten Stellung zum Positionieren von Gewebe zwischen ihnen in eine geschlossene Stellung zum Annähern des Gewebes zwischen den Flächen bewegbar sind, und die geschlossene Stellung einen veränderlichen Zwischenraum zwischen den Flächen bildet; und ein Schneidelement (22), das in Bezug auf die genannten Flächen bewegbar ist, um zwischen den Flächen angenähertes Gewebe zu unterteilen, dadurch gekennzeichnet, daß
das Schneidelement in seiner Größe anpaßbar ist, um in den variablen Zwischenraum zwischen den ersten und zweiten Elementen zu passen.
2. Chirurgisches Instrument nach Anspruch 1, wobei eine der Flächen (18) einen ersten, elektrisch leitenden Abschnitt (33) aufweist, der zur Aufnahme durch diesen hindurch geleiteter elektrochirurgischer Energie vorgesehen ist.
3. Chirurgisches Instrument nach Anspruch 2, wobei die andere der Flächen (19) einen zweiten elektrisch leitenden Abschnitt (34) umfaßt; der zweite Abschnitt dem ersten elektrisch leitenden Abschnitt (33) elektrisch entgegengesetzt ist; die ersten und zweiten Abschnitte angeordnet sind, um durch sie hindurchgehende bipolare elektrochirurgische Energie aufzunehmen; und der zweite Abschnitt (34) gegenüber dem ersten Abschnitt (33) elektrisch isoliert ist.
4. Chirurgisches Instrument nach einem der Ansprüche 1 bis 3, wobei das Schneidelement erste und zweite Schneidmesser (25, 26) umfaßt.
5. Chirurgisches Instrument nach Anspruch 4, wobei das Instrument (10) angeordnet ist, um eine scherenähnliche Schneidwirkung zwischen den Messern (25, 26) zu erzielen, wenn das Schneidelement (22) vorwärts bewegt wird.
6. Instrument nach einem der Ansprüche 1 bis 5, wobei der Endeffektor ferner einen proximalen Abschnitt und einen distalen Abschnitt sowie eine Längsachse (150) umfaßt, die sich durch den Endeffektor vom proximalen Ende zum distalen Ende erstreckt, und wobei das Instrument (10) angeordnet ist, um eine Oszillation des Schneidelementes (22) um die Längsachse zu bewirken, wenn das Schneidelement (22) vorwärts bewegt wird.
7. Instrument nach einem der Ansprüche 1 bis 6, wobei das Schneidelement (22) zwei Federteile (23, 24) aufweist, die in einer das Schneidelement (22) expandierenden Richtung voneinander weg vorgespannt sind.
8. Instrument nach Anspruch 7, wobei jedes der Federorgane (23, 24) ein Messer (25, 26) aufweist, das an dessen distalen Ende ausgebildet ist.
9. Instrument nach einem der Ansprüche 1 bis 8, wobei mindestens eines der Elemente (16, 17) eine Nut (20, 21) zur Aufnahme des Schneidelementes (22) aufweist.
10, Instrument nach Anspruch 9, wobei jedes der ersten und zweiten Elemente (16, 17) eine darin enthaltene Nut (20, 21) aufweist.
11. Instrument nach Anspruch 9 oder Anspruch 10, wobei das Schneidelement (22) in der (den) Nut(en) bewegbar ist, um zwischen den Flächen (18, 19) angenähertes Gewebe zu unterteilen.
12. Instrument nach einem der Ansprüche 9 bis 11, wobei die Nut(en) (20, 21) eine oszillierende Fläche umfaßt (umfassen).
13. Instrument nach den Ansprüchen 7 und 12, wobei die Federteile (23, 24) in Richtung der oszillierenden Fläche vorgespannt sind.
14. Instrument nach einem der Ansprüche 1 bis 13, wobei der Schaft (212) ferner eine Längsachse umfaßt, und die ersten und zweiten Elemente (16, 17) in bezug auf die Längsachse gekrümmt sind.
DE69603095T 1995-02-01 1996-01-31 Chirurgisches Instrument mit einem ausweitbaren, schneidenden Element Expired - Lifetime DE69603095T2 (de)

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EP0724863A2 (de) 1996-08-07
AU704626B2 (en) 1999-04-29
JPH08252260A (ja) 1996-10-01
AU4227796A (en) 1996-08-08
EP0724863B1 (de) 1999-07-07
US5797941A (en) 1998-08-25
CA2168404A1 (en) 1996-08-02
EP0724863A3 (de) 1996-09-18
JP3895393B2 (ja) 2007-03-22
CA2168404C (en) 2007-07-10
DE69603095D1 (de) 1999-08-12

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