• 专利附录
  • 专利说明
  • 权利要求
  • 类似技术
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    • 专利摘要:
    surgical system and control method for a surgical instrument and method for joining parts of body tissue. in order to improve a surgical system for joining body tissue comprising a surgical instrument with two tool elements movable relative to each other, which respectively comprise a high frequency electrode, and which define a minimum distance from each other in a approaching position of the tool elements, are opposite and opposite each other, in such a way that a simple and secure union of the fabric parts to be joined to each other is possible. it is suggested that at least one of the high frequency electrodes be divided into at least two electrode segments and that the at least two electrode segments are electrically isolated from each other.
    公开号:BR112012014296B1
    申请号:R112012014296-8
    申请日:2010-12-17
    公开日:2021-08-24
    发明作者:Dieter Weisshaupt；Anton Keller；Christoph Rothweiler
    申请人:Aesculap Ag；
    IPC主号:
    专利说明:

    The present invention relates to a system for joining body tissue comprising a surgical instrument with two tool elements movable relative to each other, which respectively comprise a high frequency electrode, and which define a minimum distance from each other in an approach position of the tool elements, are opposite each other and opposite each other.
    Furthermore, the invention relates to a control method for a surgical instrument with two tool elements, which respectively comprise a high-frequency electrode and are opposite each other and one above the other in an approximation position.
    Furthermore, the invention relates to a method for joining two parts of body tissue, in which the two parts of body tissue to be joined are held in contact with each other between two high frequency electrodes.
    For the union of body tissue, it is known, in particular, end-to-end anastomoses for joining the tissue parts to be joined together with the help of suturing instruments by means of staples. In addition, it is known to coagulate tissues with a high-frequency current, for example, while the tissue is energized, between two high-frequency electrodes, with a high-frequency current.
    The use of suturing instruments has, in particular, the disadvantage that the staples remain in the patient's body. A fabric closure by means of high frequency current is, as opposed to fabric stapling, advantageous.
    However, it is difficult to precisely control the method parameters when closing with high frequency current.
    Therefore, it is the task of the present invention to improve a surgical system for joining body tissue, a control method for a surgical instrument, as well as a method for joining two parts of body tissue, such that a simple and secure joining of the parts of fabrics to be joined together is made possible.
    This task, when in a surgical system of the technique described in the beginning, is solved by the fact that at least one of the high frequency electrodes is divided into at least two electrode segments and by the fact that the at least two electrode segments are electrically isolated from each other.
    The division of at least one of the high frequency electrodes into two or more electrode segments has, in particular, the advantage that the method parameters for joining, also referred to below as closure or fusion, of the tissue parts to be joined each other can be controlled in a significantly simple way. The smaller the surfaces between which high frequency current is applied, the simpler the method parameters can be controlled. The temperature, pressure, as well as the impedance of the fabric have, in particular, an essential influence on the result of the union. It is also possible, for example, to adjust the method parameters optimally according to the nature of the fabric and especially to adjust automatically. Thus, unlike when using a suture instrument, staples are unnecessary, which remain in the body as a foreign body. The electrode or electrodes to be divided into electrode segments enable, in particular, a segmented energization of the high-frequency electrode, in such a way that the tissue parts to be joined together can be fused or closed with each other. segmented way. A possibly sequential energizing of the high frequency electrodes through segmentation allows, during the closing or joining process, to introduce less current into tissue parts than similar non-segmented high frequency electrodes. In addition, segmentation has the advantage that between regions joined by means of high frequency energizing of the tissue parts to be joined together, tissue regions remain unchanged and essentially unharmed, such that from these regions new cell growth is made possible, which makes possible, in addition to the union caused by the high frequency current, a permanent union of the tissue parts by means of their joint growth.
    In order to be able to further improve the controllability of the method parameters, it is advantageous when each of the high frequency electrodes is divided into at least two electrode segments, which are electrically isolated from each other. At least two electrode segments, in the context of the present patent application, means two or more electrode segments, therefore especially three, four, five, six, seven, eight, new, ten, eleven or twelve. However, 20, 25, 30 or 40 electrode segments are also possible, mainly depending on the size of the tool elements.
    At least one of the high frequency electrodes is advantageously divided into a plurality of electrode segments. It is understood by a plurality of electrode segments, in the context of the present patent application, more than two electrode segments, which enable an even more improved controllability of the method parameters.
    Electrode segments which are placed opposite each other and one above the other in the approach position advantageously form a pair of electrode segments. Such a pair of electrode segments can, for example, be controlled as a unit. In this way, especially local boundary conditions in the region of both electrode segments can ideally be considered, in particular temperature, pressure and tissue tissue impedance held between the pair of electrode segments.
    In order to be able to conduct the high-frequency current in a specially defined manner for tissue joining of an electrode segment of the electrode segment pair to the corresponding electrode segment, it is advantageous when the electrode segments forming the electrode segment pair electrode are geometrically similar.
    Furthermore, the function of the system can be improved by the fact that the electrode segments that make up the electrode segment pair are the same size or essentially the same size, for example. In this way, especially current densities can be optimally specified.
    The at least two electrode segments can be set up especially simply when they are set up in stripe shape or essentially stripe shape.
    According to a preferred embodiment, it can be provided that each of the tool elements defines a surface of the tool element and that the high frequency electrodes form a part of the surface of the tool element. This configuration makes it possible to configure the tool elements in a virtually bump-free way.
    Depending on the purpose of employing the surgical system, that is, especially depending on the tissue parts to be joined, it can be advantageous when the surface of the tool element is configured rectangular, circular or U-shaped. Especially a surface of the element of a circular tool makes it possible, in a simple way, to perform end-to-end anastomoses.
    It is advantageous when the at least two electrode segments are arranged close together in at least two electrode rows. At least two rows of electrodes make it possible to manufacture at least two joining lines that run close together. With this, an improved bonding and especially an ideal sealing of the bonding site between the fabric parts can be achieved. Between the rows of electrodes, after joining the tissue parts, it is possible to obtain, through high frequency energization, especially complete or essentially unharmed cells, which can result in new cell growth. This allows, in addition to the joining of the tissue parts by means of fusion, a long and permanent joining of the tissue parts by means of joint growth of intact cells.
    In order to avoid short circuiting, it is advantageous when the at least two rows of electrodes are electrically isolated from each other. Furthermore, it is also possible in this way to energize the rows of electrodes separately from each other with a current of high frequency, so as to produce a union between the tissue parts one after the other or also simultaneously.
    Each row of electrodes preferably comprises at least two electrode segments, which are electrically isolated from each other. Thus, at least one sequenced power-up can be performed.
    According to another preferred embodiment of the invention, at least one electrode segment can be provided to have a first electrode segment section, which is part of a first electrode row, and a second electrode segment section, the which is part of a second electrode row. In this way, a tissue joint in two lines can be generated, especially two joint lines comprising or defining, whereby through the specially formed electrode segment sections an even better overlap between both joint lines is achieved. especially in an improved sealing of the fabric joint.
    In order to be able to configure the desired joining lines, it is advantageous when the at least two rows of electrodes are configured straight and/or curved. This means, in particular, that they can be configured completely straight or completely curved, or sectionally linear and curved.
    In order to be able to join tissues together in a circular fashion, which is especially necessary for end-to-end anastomoses, it is advantageous when the at least two electrode rows are configured in a closed circular fashion.
    Thus, each electrode segment, if necessary, can be individually energized, which is advantageous when each electrode segment is connected in an electrically conductive manner to a connection contact. The connecting contact may, in turn, be mated to other connecting contacts or be mated or capable of mating to a current source.
    Furthermore, it can be advantageous when the high frequency electrode defines a centerline of electrodes and when contiguous electrode segments are displaceable from each other in a direction defined by the centerline of electrodes. By displaceable arrangement of the electrode segments in a direction transverse to the electrode centerline, an optimal overlap of tissue joints or tissue joint lines can be achieved, which are generated by means of the high-frequency electrodes. With this, a risk of non-sealing can be objectively minimized.
    According to another preferred embodiment of the invention, it can be provided that the at least one high-frequency electrode divided into at least two electrode segments defines an electrode length and that each of the at least two electrode segments defines an electrode length segment, which is smaller than the length of the electrodes. Through this construction it can be ensured, in particular, that with each electrode segment only one section of the tissue parts to be joined together can be joined, which section is smaller than a full extension of the high frequency electrode.
    For improving a density of a joint site, produced by means of a surgical system, between two pieces of tissue, it is advantageous when the sum of all segment extensions is greater than the electrode extension. This guarantees at least partially an overlap of the tissue joints produced with the electrode segments.
    In order to be able to simply and safely connect the instrument to a high frequency generator or other suitable high frequency current source, it is advantageous when the instrument comprises at least two high frequency connecting contacts, which are or can be joined in an electrically conductive manner to at least two electrode segments.
    In order to be able to retain fabric between both tool elements and to be able to maintain it if necessary during the joining process, it is advantageous when the tool elements are designed to be rotatable and/or displaceable with respect to one another. In general, a movable arrangement of the tool elements with respect to one another is therefore desirable.
    It is advantageous when the tool elements form distal ends or end regions of bearing sectors (124, 126) rotatable or movable with each other. This modality makes it possible, in particular, to configure an instrument in the form of tweezers, which makes it possible to maintain stapled parts of the fabric to be joined between the tool elements.
    According to another preferred embodiment, the instrument can be provided with an axis, at the distal end of which at least one of the tool elements is configured or arranged. In this way, the instrument can be configured particularly compactly. Furthermore, by arranging or configuring at least one tool element at the distal end of the shaft, the stability of the instrument can generally be increased. Therefore, it is also particularly advantageous to simply configure one of the tool elements to be immobile in relation to the axis.
    It is advantageous when a first tool element comprises an edge surface of the shaft pointing in a distal direction or in an essentially distal direction. In this way, for example, a distal end of the shaft can be held or pressed against a piece of tissue in a simple manner. Furthermore, in this way a surface of the tool element can also be simply and reliably specified.
    According to another preferred embodiment of the invention, it can be provided that a second tool element comprises an electrode element that can move away from the direction of the first tool element and be movable in the axis direction. This mode allows, for example, to move both tool elements in such a way that parts of fabric to be joined together can be held together in a defined way and can be joined to each other through the corresponding high frequency current flow admission.
    It is advantageous when on the shaft and/or on the first tool element, towards the second tool element, contact members protrude, which can be brought into contact in an electrically conductive manner in a position of joining fabric with the segments. electrode segments of the second tool element, and are spaced apart in a tissue grip position from the electrode segments of the second tool element. With the contact members it is possible to contact the electrode segments of the second tool element and to connect a high-frequency generator, for example, via an electrically conducted coupling provided on the shaft, for example, with a current source. Furthermore, the suggested configuration has the advantage that simply in the tissue binding position a contact between the electrode segments of the second tool element and the contact members can be produced, such that in the tissue clamping position the electrode segments of the second tool element cannot be inadvertently energized. In general, the handling of the surgical system becomes safer.
    Thereby, the tool elements can be moved with respect to one another in a simple manner, it being advantageous when the instrument comprises an operating device for moving the tool elements with respect to one another.
    In order to further improve the maneuverability of the surgical instrument, the operating device is preferably configured or arranged at a proximal end of the instrument. body opening, in which then the tool elements can be operated with respect to one another by means of the operating device, which preferably still remains outside the patient's body. Generally speaking, a minimally invasive and endoscopic surgical instrument can be set up in a simple way.
    The maneuverability of the instrument can be especially improved for an operation by the fact that the operating device comprises two operating members that can be rotated with respect to each other, which remain in operative union with at least one of the tool elements for transmission. of an operating force to move at least one of the tool elements with respect to another tool element. The operating members can also basically be configured only movable with respect to one another, that is, they can be alternatively arranged with respect to an arrangement which can be rotated, for example displaceable, or which can be rotated and shifted.
    According to another preferred embodiment, it is advantageous to provide that the instrument comprises a high frequency cutting element for cutting tissue. The provision of a high-frequency cutting element, which can be part of a cutting device of the instrument, allows, in particular, to prepare tissue parts joined together in the desired shape. This may be the case, for example, when end-to-end anastomoses are generated with the system, where free ends of the tubular-shaped tissue can be joined in a circular fashion by means of the instrument and then protruding tissue can be separated by means of the element. cutting device or cutting device.
    The high-frequency cutting element preferably has a cutting edge, which defines a cutting plane inclined with respect to a longitudinal axis of the instrument, especially in the region of the high-frequency cutting element. Through the inclined cutting plane a high-frequency current can, for example, be conducted along the cutting element in order to cut the fabric. The cutting edge configured in this way has, only in a small region, a minimum distance of a counter-electrode, which defines a plane transverse to the longitudinal axis of the instrument. In this way, a cutting spark can be definitively generated in the region of the shortest distance between the high frequency cutting element and a corresponding counter electrode, where the cutting spark can then move in a defined manner along of the slanted cutting edge.
    In order to be able to carry out, simply and safely, a cut in a circular shape, the cutting edge is advantageously closed in a circular shape.
    Thereby, the cut-off element can be energized, in a definite way, with a high-frequency current, which is advantageous when the instrument has a high-frequency cut-off connection connected in an electrically conductive manner to a high-frequency cut-off element. The high-frequency cutting element, in particular, can be energized in a defined way, in the case of such a modality, with a high-frequency current for tissue cutting, preferably independent and temporally separated from an energization of the electrode segments for joining the pieces of tissue to each other with a high frequency current.
    It is advantageous when the cutting element is movably arranged with respect to at least one of the tool elements. This allows, for example, to move the cutting element in relation to the tool elements in such a way that the cutting element is able to come into contact with the fabric parts to be connected to each other, when these are connected to each other by through electrode segments configured on the tool elements. Instead, it is possible, for example, to place the cutting element, only after joining the fabric parts, in a position in which these fabric parts can be trimmed into the desired shape and/or partially or completely cut.
    In order to be able to energize the high-frequency instrument, in the desired form, with a high-frequency current, the surgical system preferably comprises at least one high-frequency current generator, which can optionally be coupled to the high-frequency electrodes and/or to the cutting element in an electrically conductive manner. The ideal chain for joining or cutting, respectively, the fabric can be adjusted.
    According to another preferred embodiment, the system can be provided to comprise at least one control and/or regulation device, with a switching device for sequential energizing with high frequency current of the electrode segments of at least one high-frequency electrode. frequency. Optionally with the control and/or regulation device, another high frequency electrode can also be energized with high frequency current. Through the switching device configured in the described manner, especially the electrode segments of a high-frequency electrode can be energized, one after the other, therefore, in a sequential order, with a high-frequency current, in order to sectionally join the parts. of fabric to be joined together.
    It is advantageous when the surgical system comprises a control and/or regulation device with a switching device for simultaneous energizing of at least two electrode segments of at least one high frequency electrode with high frequency current. In this way, the joining or closing process can be carried out expedited or faster, since two pieces of fabric to be joined together over two sections can be joined together. It is also especially possible to energize, respectively, two electrode segments simultaneously and other electrode segments sequentially with a high frequency current.
    In order to avoid short circuit when two electrode segments are simultaneously energized with high frequency current, it is advantageous when at least one other electrode segment is arranged between the at least two electrode segments.
    It is advantageous when the switching device is configured to switch at least one high frequency output of the at least one current generator. Two, three or even more high frequency outputs can also be provided, which can be controlled and/or regulated by the switching device in order to objectively energize, with a high frequency current of desired forces, individual electrode segments of the electrodes high frequency.
    It is advantageous when the surgical system comprises a high frequency generator, which can optionally be joined to the high frequency electrodes or the cutting element in an electrically conductive manner and comprises the control and/or regulation device. In this way, several functions of the system can be housed in one instrument, a fact that improves both its manufacture and its handling.
    The control and/or regulation device is advantageously configured in such a way that an energizing force and/or an energizing duration for the individual electrode segments is adjustable. In this way, especially the method parameters, such as temperature, pressure, as well as tissue impedance can be directly or indirectly maintained in the desired region by means of the control and/or regulation device.
    In order to avoid strong heating of the tissue parts to be joined together, which would result in a destruction of the cells, it is advantageous when the control and/or regulation device comprises a temperature measuring device for measuring a temperature of the electrode segment and/or of a tissue temperature.
    Furthermore, it is advantageous when the control and/or regulation device comprises an impedance measuring device for measuring a tissue impedance of tissues held between the tool elements. The determination of tissue impedance offers the possibility, regardless of its value, to regulate the current or the high frequency generator, especially the performance provided by it. In this way, the chain to be introduced for joining the fabric parts can be simply and safely regulated. For tissue impedance measurement, especially high-frequency electrodes can be used. A measurement can also take place between individual tissue segments, which are opposite each other. Tissue impedance is preferably measured when the high frequency electrodes are de-energized. It is especially advantageous to measure the tissue impedance at pauses, when the polarity transition of the high frequency current. Thus, tissue alteration can be well monitored in real time and other current input can be inhibited or even targeted.
    The task presented at the beginning is solved with a control method, in the technique described initially and according to the invention, by the fact that at least one of the high frequency electrodes is divided into at least two electrode segments, due to the fact that at least two electrode segments are electrically isolated from each other, in that one of the at least two electrode segments is energized with a high frequency current and at least one of the at least two electrode segments is thereby left de-energized.
    With such a control method it is possible to energize the at least two electrode segments at least partially sequenced, that is, one after the other. Thus, current densities for tissue binding can be reduced, a fact that has a positive effect on the method parameters, such as temperature, pressure and tissue impedance, as well as its controllability. The fabric parts to be joined together can in this way be joined together in an evidently simple way. By corresponding energizing of the electrode segments, then different sections of the tissue parts to be joined together can be joined one after another.
    In order to reduce the time required for joining the tissue parts, it is advantageous when at least two electrode segments are energized simultaneously. These, preferably, are not directly adjacent to each other and are not in contact with each other. Thus, short circuits and unwanted increases in temperature in certain regions of the tissue can be avoided.
    Electrode segments adjacent to each other are preferably energized one after the other. In this way, clearly and evidently delimited sections of the fabric parts to be joined together can be joined together in a definite way.
    The task presented at the beginning is solved with a method for joining two parts of body tissue, in the technique described initially and according to the invention, by the fact that the two parts of body tissue to be joined are kept in contact with one another. another between two high-frequency electrodes, of which at least one is divided into at least two electrode segments, which electrode segments are electrically isolated from each other, and a method in which body tissue parts are fused to one another by means of high-frequency current along a splice line, by energizing at least two electrode segments with a high-frequency current.
    The suggested method offers a simple alternative to the use of suturing instruments and makes the use of staples and, thus, the eventual risks when these staples remain, something superfluous. By means of the described method, two pieces of tissue can still, in a specially defined and secure way, be joined together with partially vital body cells.
    In order to avoid short circuit and cell destruction, it is advantageous when the at least two electrode segments are energized one after the other with the high frequency current.
    Thereby, an operator can join both parts of tissue along a defined joining line, which is advantageous when the high frequency electrodes predetermine a joining line. Thus, he can already define, when placing an instrument on the tissue parts to be joined together, along which line these parts are to be joined.
    The following description of the preferred embodiments of the invention serves, in connection with the figures, for a more detailed clarification. The figures show:
    Figure 1: a general schematic view of a surgical instrument for joining parts of body tissue;
    Figure 2: an enlarged view, in perspective, partially sectioned and punctuated, of region A in figure 1;
    Figure 3: a longitudinal sectional view of the instrument from figure 1 in region A before joining two pieces of tissue in tubular form;
    Figure 4: a visualization analogous to Figure 3 during fusion of tissue parts to produce an end-to-end anastomosis;
    Figure 5: a top view of a tool element surface with a high frequency electrode divided into four electrode segments;
    Figure 6: a schematic perspective view of a second modality of a surgical instrument for joining parts of body tissue;
    Figure 7: an upper view of a schematically represented tool element surface of the instrument from figure 6 in the direction of arrow B;
    Figure 8: a schematic view similar to Figure 2 of an alternative embodiment of the instrument in a tissue clamping position;
    Figure 9: a view corresponding to Figure 8 of the instrument shown there with a second tool element partially bent;
    Figure 10: a sectional view along line 10 - 10 in figure 8; Figure 11: a schematic sectional view similar to figure 10 of the second tool element folded together in a position shown as in figure 9;
    Figure 12: an alternative embodiment of a second tool element in schematic perspective representation;
    Figure 13: an exploded representation of a part of the second tool element shown in Figure 12;
    Figure 14: a sectional view along line 14 - 14 in Figure 12; Figure 15: a schematic sectional view analogous to Figure 14 of the embodiment shown there with partially bent second tool element;
    Figure 16: a schematic perspective representation similar to Figure 12 of another embodiment of a second tool element;
    Figure 17: an enlarged representation of the second tool element from figure 16 in a partially inclined position;
    Figure 18: a sectional view along line 18 - 18 in Figure 16; eFigure 19: a view analogous to figure 18 of the second tool element partially tilted in a position as represented in figure 17.
    In figure 1 a surgical system for joining body tissue is schematically represented and generally designated with the reference number 10. It comprises a surgical instrument 12 with two tool elements 14 and 16 movable relative to one another. Furthermore, system 10 comprises a current generator in the form of a high frequency current generator, which can be coupled to instrument 12 in a manner better explained below.
    The tool elements 14 and 16 form a part of a joining device provided with reference numeral 20 for joining body tissue. The first tool element 14 comprises an edge surface 20 pointing distally to a longitudinally stretched, casing-shaped axis 24 of the instrument 12. Thus, the first tool element is disposed or configured at an end 26 of the instrument 12 .
    The first tool element 14 comprises a high-frequency electrode 28. It is divided, in the case of the modality shown schematically in figures 2 to 5, into at least two, into four electrode segments 30, which are electrically isolated from one another. . Electrode segments 30 are configured in stripe shape or essentially stripe shape. The first tool element 14 defines a surface of the tool element 32 in such a way that the high frequency electrode 28 forms a part thereof. Generally, the surface of the tool element 32 is shaped flat and circular.
    The four electrode segments 30 define two electrode rows 34 and 36. Each electrode row thereby respectively comprises a part of the four electrode segments 30. As can be seen from Figure 5, for example, each electrode segment 30 has a first electrode segment section 38, which forms a part of the first electrode row 34, and a second electrode segment section 40, which forms a part of the second electrode row 36. Both electrode rows 34 and 36 are generally configured with a curved shape, wherein electrode segment sections 38 and 40, respectively, define circular sections with electrical conductivity. Generally speaking, the at least two electrode rows, which are respectively defined by four electrode segment sections 38 or 40, are configured in a closed circular shape. In order to be able to contact the electrode segments 30 in the desired manner, each electrode segment 30 is joined in an electrically conductive manner with a connecting contact 42, which is disposed in a joining region between the electrode segment sections 38 , 40. Between the electrode rows also remain maintained, even after the union of tissue parts through high frequency energization, complete or essentially unharmed cells, from which new cell growth can occur. Regarding the joining of tissue parts by long-term fusion, this additionally makes possible a permanent union of tissue parts by means of the joint growth of intact cells.
    The high frequency electrode 28 defines a centerline of electrodes 44 that runs between the electrode segment sections 38 and 40. Contiguous segments 30 are therefore displaceably disposed relative to one another in a direction defined by the centerline of electrodes 44. Generally speaking, the high frequency electrode 28 divided into four electrode segments 30 defines a segment span 46, wherein each of the four electrode segments 30 defines a segment span 48 which is less than than the electrode extension 46. As shown, for example, in Figure 5, the electrode segments 30 extend over an angulation region of about 140° and thus have an extension corresponding to 40% of the extension of the electrode segment. However, this adds up to the sum of all 48 segment spans with a factor 1.6 greater than the 46 electrode span.
    In the region of a proximal end of the shaft 24 high frequency connecting contacts 50 are arranged, which are joined in an electrically conductive manner, for example guides running along the shaft, to the electrode segments 30. The number of contacts of high frequency connection 50 preferably corresponds to the number of electrode segments 30, therefore four high frequency connection contacts 50 for the four electrode segments 30 of the first tool element 14.
    The second tool element 16 is essentially disk-shaped and comprises an electrode element 52 which can move away from the direction of the first tool element 14 and be movable therefrom and parallel to a longitudinal axis 54 of the axis 24 in the region of the tool elements 14, 16, which define a direction of the axis 56. The tool elements 14, 16 are displaceable with respect to one another, i. of tool 32 of first tool element 14 and a first surface of tool element 60 of second tool element 16 is changeable.
    Electrode element 52 comprises a high frequency electrode 29 which corresponds in construction to electrode 28. This means that the electrode also comprises four electrode segments 31 which curve along the surface of the tool element 60. Two electrode rows 35 and 37 are also defined, wherein the first electrode segment sections 39 define electrode row 35 and the second electrode segment sections 41 define electrode row 37. Connection contacts 43 also are provided which by conduction respectively unite an electrode segment section 39 to an electrode segment section 41 with respect to a configuration of an electrode segment 31. The high frequency electrodes 28 and 29 are configured in a symmetrical mirror fashion to a mirror plane running vertically with respect to a longitudinal axis 54 between tool element surfaces 32 and 60. 62 are defined, of which one corresponds respectively to an electrode segment 30 and an oppositely situated electrode segment 31. Generally speaking, the embodiment shown in figures 1 to 5 thus comprises four pairs of electrode segments 62. Electrode segments 30, 31 are not only similar, but are of the same size or relatively the same size.
    In an approach position of the tool element 14, 16 the high frequency electrodes 14,16 define a minimum distance 58 from each other. The approach position is schematically represented in figure 4. In the approach position the high frequency electrodes 28 and 29 are opposite each other and one above the other.
    The electrode segments 31 can be joined in an electrically conductive manner to another four connecting contacts 50, of which, for the sake of clarity, only two are shown in Fig. 1. By means of the respective connecting guides 64 the connecting contacts of high frequency 50 can be joined to the respective contacts 66 of the current generator 18. As already stated, the high frequency connecting contacts 50 are joined in an electrically conductive manner directly to the electrode segments 30. In order to be able to join the contacts of high frequency connection 50 to the electrode segments 31, are arranged on the axis 24 or on the first tool element 14, towards the second tool element 16, protruding contact members 68, which have a short, cylindrical section 70 and a cone-shaped section 72 defining a free end. In a fabric joining position, as shown schematically in Figure 4, a position in which the tool elements 14 and 16 are in the approach position, hence the free ends of the sections 72 of the contact members 68 se project into the respective bearing-shaped inlets 74 of the electrode element 52 and remain in contact in an electrically conductive manner therewith. Contact members 62, in turn, are joined along axis 24, via electrical guides not shown, to high-frequency connecting contacts 50. Inlets 74, in turn, remain in contact in an electrically conductive manner with the connecting contacts 43. In this way a contact can also be produced in an electrically conductive manner, in the tissue joining position or approaching position, between the high-frequency connecting contacts 50 and the electrode segments 31.
    Obviously the contact members 68, which divide the electrode segments 30 in the region of their connecting contacts 42, are isolated from these, in such a way that no short circuit occurs. To that end, sections 70 of contact members 68 are provided with an electrically insulated casing or casing.
    In order to be able to move the tool elements 14, 16 of the instrument 12 with respect to one another, an operating device 76 is disposed at a proximal end or end region of the instrument. The operating device 76 comprises two operating members 78 rotatable with respect to one another, which are movably coupled to a force transmitting member 80 movably bearing within the shaft, such that this member, in As a function of a pivotal movement of the operating member 78, it may be pivoted in a distal or proximal direction.
    The force transmitting member 80 defines at its distal end an inlet 82 in the form of a blind hole, in which a retaining member 84 is insertable into a first free end and fits into the inlet 82. The second free end of the member The essentially rod-shaped retaining bar 84 is immovably joined to the second tool element 16. In this way, as a function of a displacement of the force transmitting member 80, the second tool element 16 can be moved away in the distal direction. of the first tool element 14. Preferably, the instrument 12 is configured such that the second tool element 16, from a tissue clamping position, as it is schematically represented in Figures 2 and 3 in which the elements tools 14, 16 have a maximum distance 58 from each other, can be brought over each other to the fabric joining position or approach position by a rotation of the tool element. operation 78, which results in a movement of the force transmitting member 80 in the proximal direction.
    In addition, the instrument 12 comprises a cutting device 86 for cutting tissue. The cutting insert comprises a cutting element 88 with a closed circular shaped cutting edge 90. The cutting edge 90 defines a cutting plane 92 inclined to the longitudinal axis 54 of the instrument 12. The cutting plane 92 is inclined by about 10° to a reference plane running vertically to the longitudinal axis 54 , which reference plane runs parallel to the tool element surfaces 32 and 33. Laterally proximally, on the axis 24, another high-frequency cutting connection 94 is provided, which is joined in an electrically conductive manner, in the case of a variant of the instrument 12, to the cutting element 88. With this, for example, a monopolar cutting device 86 can be realized, in which, for a monopolar cut in the patient's body, a neutral electrode would be used, in a conventional manner. . A bipolar cutting device 86 is, for example, realized by the fact that, opposite the cutting edge 90, a circular electrode 96 is arranged on the second tool element 16, which is joined by a coupling in an electrically manner. conductive not shown in more detail and which, for example, passes through the force transmitting member 80 through a manner not shown, to the other high frequency cut-off connection 94. The circular electrode 96 itself can also be optionally segmented, e.g. similarly to the high frequency electrodes 28 and 29. It would also be possible to use the high frequency electrode 29 as a counter electrode instead of the circular electrode 96.
    The cutting element 88 is preferably movably bearing with respect to both tool elements 14, 16. The cutting edge configured concentrically about the longitudinal axis 54 can thus be moved with respect to the high frequency electrodes 28 and 29. For operating the cutting device 86 a cutting operating device 98 is provided, with an operating member 100 protruding from the proximal end of the instrument. That member is mechanically coupled to the cutting element 88 along a mechanism not shown, for example another force transmitting member running within the shaft 24, such that as a function of a movement of the operating member 100° cutting element 88 is also moved. The operating member 100 is preferably arranged movably and rotatably with respect to the axis 24, such that the cutting element 88 can be moved not only parallel to the longitudinal axis 54, but can also be rotated about. relation to this.
    In order to be able to energize the electrode segments 30, 31 in the conventional manner with a high frequency current, a control and/or regulation device 102 is provided with a switching device 104. The control and/or regulation device 102 is preferably arranged in a housing of the high frequency current generator 18 and forms a part thereof. The switching device 104 is specially configured for sequentially energizing the electrode segments 30, 31 with a high frequency current. The switching device 104 serves in particular for actuating the contacts 66, as well as other contacts 106, which can be joined via other joining guides 108 to the high-frequency cut-off connectors 94 of the instrument 12. In this way, the switching device 86 cutting can be operated with the high frequency current generator in monopolar or bipolar way. For monopolar operation only the cutting element 88 is energized with a high frequency current and as a counter electrode a neutral electrode is placed on the patient's body. For bipolar cutting a circular-shaped counter-electrode may be especially provided in the second tool element 16, for example in the form of the circular electrode 96, such that a high-frequency current can flow between the counter-electrode and the element. cutoff 88. Alternatively, the high frequency electrode can also be used as a counter electrode. If you forgo energizing the cutting device 86, then this can also be used purely and mechanically to split the fabric, and also by means of the preferably sharp cutting edge 90.
    The switching device 104 can also additionally be configured such that at least two electrode segments 30, 31 of a high frequency electrode 28, 29 can be energized simultaneously with a high frequency current. In this sense, it is advantageous when respectively between two electrode segments 30, 31 simultaneously energized with high frequency current another electrode segment 30, 31, not energized, however, is arranged. In this way, for example, the electrode segments 30 opposite each other of the high frequency electrodes 28 shown in Figure 5 could be simultaneously energized, whereby both other electrode segments 30 would remain de-energized.
    In order to be able to individually adjust an energizing force and/or an energizing duration for the individual electrode segments 30, 31, the control and/or regulation device 102 is configured comprising an adjustment device 110. By means of the adjustment device setting 110, for example, a power and/or frequency of the high frequency current can be set, and likewise an energizing duration. In addition, the adjustment device 110 can also be optionally configured to be able to individually adjust the power-up sequences.
    Furthermore, the control and/or regulation device 102 preferably comprises a temperature measuring device 112 for measuring a temperature of the electrode segment and/or a temperature of the tissue. The temperature measuring device 102 serves in particular to supply the control and/or regulation device with the control variable necessary for an automatic regulation of an energization of the high frequency electrodes 28, 29, namely a tissue temperature, for example, indirectly via a temperature measurement of electrode segments 30, 31. Electrode segments 30, 31 not energized, for example, can serve as measurement contacts for recording temperature via a tissue impedance measurement. In this way, it can be safely proposed that the temperature necessary for tissue bonding is reached in the desired way and in a highly accurate way through the respective energization of the high frequency electrodes 28, 29, and, however, an unwanted overheating of the tissue parts to be joined together is avoided.
    Furthermore, the control and/or regulation device 102 optionally comprises an impedance measuring device 113 for measuring a tissue impedance of the tissue held between the tool elements 14 and 16. The determination of the tissue impedance offers the possibility, regardless of its value, to regulate the high frequency generator 18, especially the parameters provided by it, such as voltage, current and efficiency. In this way, the current applied to the fabric parts for joining them can be simply and safely regulated. For tissue impedance measurement, the high-frequency electrodes 28 and 29 can especially be used. A measurement can also take place between individual electrode segments 30 and 31, which are opposite each other. Tissue impedance measurement can optionally take place while energizing high frequency electrodes 28 and 29 or when high frequency electrodes 28 and 29 are being energized. Thus, tissue change can be well monitored, practically in real time, and other current input can be measured, inhibited or even targeted.
    With the surgical system 10 described above it is especially possible to join tissue parts 116 in tubular form directly to each other, wherein these parts are fused or closed to one another by energizing by high frequency current. In some cases, for example, it was carried out in the following way:
    For production of an end-to-end anastomosis of two pieces of tissue 116 in tubular form, such as is required, for example, after an intestinal operation in which a piece of intestine is separated, free ends of the pieces of tissue 116 are brought to together, in such a way that they are close together in a flat circular fashion, pointing towards the longitudinal axis with their free ends, as shown, for example, in Figures 3 and 4. The free ends meet, therefore, between both tool elements 14, 16, in such a way that the fabric portions 116 stapled between the tool elements 14, 16 can be held together in the fabric clamping position 1.
    The tool elements 14, 16 are moved relative to each other in the tissue joining position, such that the electrode segments 31 are also joined in an electrically conductive manner, in the manner described above, to the high connection contacts. frequency 50. For casting the tissue parts 116 the individual electrode segment pairs 62 are preferably energized with a high frequency current, which flows through the tissue part sections held between the tool elements 14, 16 and heats them . At a temperature of from about 50°C to about 80°C, preferably from about 65°C to about 70°C, such a change occurs in the cells that the tissue parts 116 staple together. . The splicing method is preferably carried out in such a way that only one pair of electrode segments 62 is always energized simultaneously, especially in a sequential order. In this way, a union line 114 in circular shape is produced, which essentially predetermines through the high frequency electrodes 28, 29, respectively its electrode center lines 44, 45.
    Because not all high frequency electrodes 28, 29 are energized with a high frequency current, the temperature for joining the tissue parts 116 can be much better controlled and a destruction of the cells is avoided. The electrode segments 30, 31 are preferably energized one after the other, i.e. sequentially, in such a way that the tissue parts 116 are fused together along the joining line in a sectioned manner. By arranging in two rows of the electrode segment sections 38, 39, 40 and 41, a double joint between the fabric parts 116 is also produced, which can ensure an ideal sealing and a permanent and stable joining of the parts. of fabric 116 each other.
    Alternatively in relation to a sequenced energizing, as already indicated above, electrode segments 30, 31 opposite each other can also be energized simultaneously, with which the duration for joining the tissue parts 116, in the modality shown schematically in Figures 1 to 5, can be halved.
    After joining the tissue parts 116, the remaining tissue is removed by means of the cutting device 86. In this regard, the cutting device 86 is preferably used in a bipolar manner, i.e., the cutting element 88 and the circular electrode 96 are coupled to the high-frequency current generator 18 and a high-frequency current is conducted to divide the tissue along both tissue parts 116. Through the slanted cutting edge 90 a defined cutting spark is generated, just in the region. where the distance between the cutting edges 88 and the circular electrode 96 is minimal. From this region the cutting spark travels in a circle, then automatically along the cutting edge 90 in both directions, until the fabric is completely split. The use of the cutting device 86 in the bipolar mode of operation has, in particular, the advantage that the tissue parts 116 during division can also be simultaneously coagulated, in order to directly extinguish unwanted bleeding upon division.
    After joining and thinning of the tissue parts 116, the instrument 12 can then be removed from the patient's body, for example, his intestine, by withdrawing the shaft 24, for example.
    The shaft 24 is, depending on the modality of the instrument 12, preferably so long that, when using the instrument 12, both the operating device 76 and the cutting operating device 98 protrude out of the patient's body. so they can be operated by an operator.
    Alternatively or additionally, the surgical system 10, in place of the instrument 12, may also comprise, for example, a surgical instrument in the form of an instrument schematically shown in Figures 6 and 7. The instrument 120 comprises two bearing sectors 124 and 126 together with a to the other and rotatable with respect to one another about an axis of rotation 122. At a proximal end of the sectors 124, 126 are configured finger rings 128, 130, which together define an operating device 132 for operating the instrument. 120.
    From the free and distal ends 134 and 136 of sectors 124 and 126, tool elements 138 and 140 are configured facing each other within the sectors. The tool elements 138 and 140 are identically configured and are in an approach position of the ends 134 and 136, opposite each other, and have, in that position, a minimum distance from each other. Each tool element 138, 140 comprises a high frequency electrode 142, 144 which are identical and are essentially U-shaped. Each high frequency electrode 142, 144 comprises two electrode sections 146 running parallel to one another. to the other and extending in a vertical direction with respect to the axis of rotation 122, as does an electrode section 148 adjacent to the ends 134,136 and running vertically with respect to those sections.
    The construction of electrodes 142, 144 will be described in more detail below in connection with figure 7, for example, and based on the high frequency electrode 142.
    The high frequency electrode 142 generally comprises 30 electrode segments 150, in which respectively 15 electrode segments displaceable with respect to each other are arranged in two rows of electrodes 152, 154, parallel to each other, to the along each electrode section 146 and are electrically isolated from one another. Electrode segments 150 are configured in a straight and striped shape. They define between them a central line of electrodes 156, whose U-shape also corresponds to the shape of the high-frequency electrode 142. In the region of the electrode section 148, two other electrode segments 151 are arranged, which respectively complete the electrode rows. 152 or 154 of the electrode sections 146. The electrode segments 150 and 151 are thereby displaceable relative to one another in a defined direction of the centerline of electrodes 156.
    In order to be able to energize the electrode segments 150, 151 with a high frequency current, these segments are respectively arranged in an electrically conductive manner with a high frequency connection 158 in the proximal end regions of sectors 124, 126 adjacent to the rings of finger 128, 130. The high frequency connections 158 can be spliced to corresponding splicing guides or cables with the high frequency current generator 18.
    In the approximation position, depending on the identical configuration of high frequency electrodes 142 and 144, electrode segments 150 or 151 which are the same size or essentially the same size and which are placed opposite each other and one on the other . They generally form a pair of electrode segments designated with the reference number 168.
    Tool elements 138 and 140 also define flat tool element surfaces 170, which are U-shaped. Electrode segments 150 and 151 do not arch over the surface of tool element 170.
    The generally tweezer-shaped instrument 120 can also be used for joining the tissue parts, where these parts are held clamped between the tool elements 138, 140 and then are fused or closed to each other through corresponding energization. of the electrode segments 150, 151. Furthermore, as described in connection with the instrument function 12, an energization of the electrode segments 150 may occur sequentially, that is, after energizing of an electrode segment 150, the segment of electrode 150 closest to adjacent electrode row 152, 154 is energized in U-shaped circulation, until all electrode segments 150, 151 are energized once. In this way, a two-row joining line for joining two pieces of fabric can be produced. It is also possible, in the case of instrument 120, a simultaneous energization of two or also more electrode segments 150, 151, in which preferably contiguous electrode segments 150, 151 are not energized at the same time, but preferably at least one and, better further, two or three electrode segments 150, 151 remain de-energized between electrode segments 150,151 simultaneously energized.
    The instrument 120 may also optionally comprise a cutting device 160, as shown in Fig. 6. Respectively between the electrode sections 146 a groove 162 is configured in the tool elements 138, 140. In the groove 162 in the sector 162 a cutting element 164 is maintained with a cutting edge 166 projecting towards the groove 162 of the sector 124 and optionally movable with respect to the tool element 136. fabric held between the tool elements can be split. Cutting element 164 can also optionally be used in monopolar or bipolar form, whereby high frequency electrode 142 can be used as a counter electrode for cutting element 164 when using bipolar. For monopolar operation only the cutting element 164 is energized with a high-frequency current and placed, as a counter-electrode, a neutral electrode on the patient's body. In both cases the cutting element 164 is also preferably joined in an electrically conductive manner to a contact of the high frequency connection 158.
    In figures 8 to 11 a variant of the instrument 12 is shown, which differs in terms of the modality of the second tool element which is designated in figures 8 to 11 with the reference numeral 16'. The tool element 16' takes on an annular shape in an operating position in which it can be brought to the approach position described above. It comprises two annular sections 180 and 182, which respectively extend about an angle of about 180° with respect to the longitudinal axis 54. Free ends of the annular sections 180, 182 are only half the width of the annular sections 180, 182 at the remaining region and serve as bearings 184 and 186. Bearings 184 and 186 are respectively provided with a transverse hole 188 and 190, in which a rod 192 is inserted. Bearings 184 are opposed to each other in bearings 186 about their longitudinal axis. Stem 192 is fixed so that it cannot be rotated in the transverse holes 190 of the annular section 182. The transverse hole 188 is so dimensioned on its inner diameter that the annular section 180 can be rotated with respect to the shank 192 about an axis of rotation 242 defined by the rod and thus can be rotated with respect to the annular section 182.
    Both the annular sections 180 and 182 are respective and additionally coupled, through handlebars 194, to a retaining member 84', which together with the longitudinal axis 54 defines the declining longitudinal axis of the retaining member. The retaining member 84' is, similarly to the retaining element 84, coupled to the force transmitting member 80 or can be coupled thereto, and thus can be moved with respect to the axis 24 in a distal and proximal direction. To couple the handlebar 194 to the retaining member 84', a groove 204 is finally provided in the region of its distal end, which extends transversely to a longitudinal axis defined by the rod 192. In this way, two legs are formed. 206, which are provided with an aligned transverse hole 208, into which a bearing pin 210 is inserted without being able to be rotated. The handlebars 194 are provided at their first ends with an intake hole 212, through which the bearing pin 210 extends and which has an internal diameter to allow a rotational movement of the handlebar 194 about an axis of rotation defined by the bearing pin 210.
    Relatively close to the side of the slot 204 extends, in the retaining member 84', in the proximal direction, a longitudinal slot or an elongated hole 214, which is traversed by the rod 192. In this way, the rod 192 is defined and can be rotated parallel to itself table in a direction parallel to longitudinal axis 54. A proximal end of elongated hole 214 forms a proximal stop for stem 192, a distal end 218 of elongate hole 214 and a distal stop for stem 192.
    For moving the rod 192 an operating mechanism 222 is served, which comprises a shell-shaped force transmitting element 220, the inner diameter of which is combined with the outer diameter of the retaining member 84' and thus can be rotated. on the retaining member 84' in a distal and proximal direction. The force transmitting element 220 is provided, adjacent its distal end 224, with a hole 226, which the rod 192 passes through. Stem 192 can be rotated with respect to hole 226. Operating mechanism 222 may further form a part of operating mechanism 76 described above. This means that a movement of the rod 192, for example, is also possible through a rotation of the operating members 100 with respect to each other. It would alternatively be possible to provide another operating device analogous to operating mechanism 76, which comprises one or two other operating members similar to operating members 100, in order to effect a relative movement between the force transmitting element 220 and the retaining member 84'.
    On the upper sides of the annular sections 180 and 182 are respectively arranged two bearings 228 parallel to each other, which are provided parallel to the transverse hole 208 with holes 230. Between the bearings 228 it is respectively bearing in such a way as can rotate, another free end of the handlebars 194 about the axis of the bearing 200 introduced into the holes 230. By means of the described arrangement of the handlebars 194, which may also be referred to as coupling members, it is ensured that they join with one end on the second tool element 16' at a junction point or pivot point which is spaced from the axis of rotation 242.
    By means of the operating mechanism 222 the second tool element 16' can be brought from the aforementioned operating position, which is schematically represented in Figures 8 and 10, to the removal position, which is shown, for example, in figure 11. Figure 9 schematically represents an intermediate position, therefore a position between the operating position and the removal position. As can be easily recognized by comparing both Figures 10 and 11, a surface region of a vertical projection of the second tool element 16' onto a projection plane 234, which runs vertically with respect to the longitudinal axis 54, therefore , with respect to the axis direction in the region of the second tool element 16', is smaller in the removal position than in the operating position. This is achieved by a movement of the shell-shaped power transmission element 220 from the operating position, in which the rod 192 attaches to the proximal end 216 and extends to the undersides 236 and 238 of the annular sections 180 and 182 parallel to the projection plane 234. If the force transmitting element 220 is moved in the distal direction, the rod 192 in the hole 214 is positively driven in the distal direction. Through the pivotal union of the annular sections 180 and 182 with respect to each other and through both handlebars 194 with the retaining member 84', the annular sections rotate around the axis of rotation 242 in the direction of the longitudinal axis 54. The second tool element 16' is thus bent together or is bent. Therefore, through the articulated arrangement of the annular sections 180 and 182, by means of the handlebars 194, a bending mechanism 240 is configured for transferring the second tool element 16' from the operating position to the withdrawn position.
    Hitherto not mentioned is the configuration of the undersides 236 and 238 of the second tool element. These can have any single and essentially continuous annular electrode, which forms a single counter electrode with respect to the high frequency electrode 287 of the first tool element 14. Alternatively, it can also be configured, on the undersides 236 and 238, analogous to the high-frequency electrode 29, a high-frequency electrode with two or more electrode segments 31, preferably corresponding to the high-frequency electrode 29. This then allows a joining of the tissue parts 116, in the desired manner, in the position of operation.
    After joining the fabric parts together, the folding mechanism 240 can be operated, for example, by corresponding operation of the described operating mechanism 222, whereby the retaining member 84' is moved in a distal direction. If the force transmitting element 220 is arranged, for example, immobile with respect to the axis 24, then the second tool element 16' can be bent automatically upon movement in the distal direction of the force transmitting member 80. By the evidently reduced need for surface in the removal position, the second tool element can be realized through a joining position configured by joining the fabric parts 116, when removing the instrument 12, and can extend without the joining position. , which is obviously simpler than making the second tool elements in the operating position via the union position.
    Needless to say, electrically conducted couplings of electrode 29 with high frequency connecting contacts 50, for example through handlebars 94 and retaining member 84' with high frequency connecting contacts 50 in the proximal end region of the 24 axis can be driven.
    Another variant of a second tool element is generally designated in figures 12 to 15 with the reference numeral 16". It replaces, for example, the 16 and 16” tool elements described above for instrument 12.
    The second 16” tool element is configured essentially disc-shaped, with an outer side 250 projecting in a distal direction, slightly convexly curved.
    On an underside of the second tool element 16" is configured an annular groove 252, which is open and projecting in a proximal direction. An essentially circular shaped recess 254 is centrally shaped, in which an essentially cuboid shaped bearing shoulder 256 is arranged and which is shaped coaxially with respect to the longitudinal axis 54, moving proximally away from the underside of the second tool element 16". The bearing shoulder 256 is provided with a transverse hole 258, which runs obliquely with respect to the longitudinal axis 54. Furthermore, in the bearing shoulder 256 a curved guide groove 260 is configured, which protrudes in a proximal direction in a proximal manner. convexly curved. A proximal end of bearing boss 256 has a rounded outer contour.
    The second 16” tool element is pivoted so that it can be rotated into an 84” housing-shaped retaining member. To that end the retaining member 84" is provided with a transverse hole 262 which passes through a wall 264 of the retaining member 84" at two locations. A bearing pin 266 is inserted into the transverse hole 262 which cannot be rotated. It simultaneously passes through the transverse hole 258 in such a way that the bearing shoulder 256 can be rotated about an axis of rotation 284 defined by the bearing pin 266. In order to also be able to operate a bending mechanism 270 provided on the second element of tool 16", a force transmitting element 268 is provided, which is essentially rod-shaped and passes coaxially through the retaining member 84" with respect to the longitudinal axis 54. From a laterally distal end surface 272 of the force transmission element 268 there are arranged parallel to each other and spanning distally two bearing legs 274, which are respectively traversed by an aligned hole 276. In the holes 276 is inserted so that another bearing pin 278 cannot be rotated, which is oriented parallel to the bearing pin 266. An outer diameter of the bearing pin 278 is dimensioned in such a way that it traverses the groove of guide 260 and can be moved relative to it.
    A proximal end 280 of the force transmitting member 268 is preferably engageable with the force transmitting member 80 such that the second tool element 16" can also be moved as a function of a movement of the force transmitting member.
    In the annular groove 252 a circular electrode element 282 is introduced, which preferably comprises a high frequency electrode 29 in the form described above, which is not shown in detail in Figures 12 to 15 for the sake of clarity. Alternatively, a single through ring electrode can also be configured on electrode element 282.
    For transferring the second tool element 16" from the operating position to the withdrawn position, the force transfer element 268 is moved in a distal direction. Through the specially curved guide groove 260, the bearing pin is positively driven in the groove and thus effects a positively driven rotation of the second tool element 16" around the axis of rotation 284. Thus, the second tool element 16" it can be essentially rotated close to 90°, such that also in this variant of the tool element 16" a vertical projection 232 of the tool element 16" on the projection plane 234 in the withdrawn position is smaller than in the operating position , as this is schematically represented in Figures 14 and 15. In this way, in the removal position, upon removal of the instrument 12, an excessive expansion of the joining position between the tissue parts 116 to be joined together is avoided. .
    Another embodiment of a second tool element, generally provided with reference numeral 16"', is shown in figures 16 to 19. It can be used in instrument 12 in place of second tool element 16, 16' and 16 ” described so far.
    The second 16'" tool element is essentially disk-shaped and comprises a disk 300. This is provided, at its center, with a longitudinally oval and transversely running groove 302. A hole 304 passes through the disc 300 somewhat laterally displaced with respect to the center thereof, which is in the region of the groove 302. In the hole 304 a bearing pin 306 is introduced, so that it cannot be rotated, which it also passes through the slot 302. In the region of the slot 302 a distal end of the retaining member 84'" protrudes, which is shaped in the form of a casing. The 84'" retaining member is provided, laterally proximal to its end, with a hole 310, the inner diameter of which so combines with the outer diameter of bearing pin 306, that bearing pin 306 can be rotated relative to the hole 310. This therefore makes it possible to rotate disc 300 about a longitudinal axis defined by bearing pin 306.
    A bending mechanism 312, which pivotally couples the disc 300 through a handlebar 314 with a distal end 316 of a force transmitting element 318, serves the purpose of operating the rotation of the disc 300. The element The force transmitting member 318 has a longitudinally extended rod-shaped section 302, the proximal end of which 322 can be coupled to a force transmitting member 80. The end 316 is thickened, as opposed to the section 320, shaped like a head and formed almost like a cube. On one side of this, a laterally open slot 324 is configured. In addition, a transverse hole 326 is provided, which transversely traverses the groove 324. In the transverse hole 326 a bearing pin 328 is introduced which cannot be rotated. The rod-shaped handlebar 314 is also provided with a hole 330 and is pivotable, pivotable, in the bearing pin 328. Adjacent to one end of the handlebar 314, which is oppositely located, another hole 332 is provided. for bearing the handlebar 314 on another bearing pin 334. This pin is inserted into another hole 336 of the disc 300. The hole 336 is oriented parallel to the hole 304, is disposed outside the groove 302, adjacent to an edge 338 of disc 300, and is in fact opposite hole 304 in relation to longitudinal axis 54. On an upper side 340 of disc 300, starting from edge 338, a recess 342 is incorporated, into which the end of handlebar 314 penetrates with its hole 332. In this way, handlebar 314 is pivoted to bearing pin 334. Thereby, handlebar 314 couples with one end, on the second tool element 16"', at a joint or pivot point, which is spaced apart from an axis of rotation 334 defined by the longitudinal axis of bearing pin 306.
    The bending mechanism 312 is operated, while the force transmitting element 318 is moved in a distal direction. This results in the fact that handlebar 314 is angled relative to disc 300. The more force transmitting member 318 is moved in the distal direction, the more handlebar 314 pulls the region of disc 300 in the distal direction. that recess 342 is provided. In an extreme position, the disc 300 is fitted almost parallel to the longitudinal axis 54. In general, with this it is also possible, in the case of the tool element 16"', to realize a removal position, in which a projection 232 The vertical of the element in the projection plane 234 running vertically with respect to the longitudinal axis 54 is less than in the operating position.
    In the second tool element 16'" a high frequency electrode 29 can also be arranged or configured in a manner as described above, in the case of the second tool element 16. It is also possible, alternatively, to provide an electrode in closed circular shape , which is not divided into electrode segments. Similarly as the second tool element 16" comprises the electrode element 282, electrode elements may also be provided in the second tool elements 16' and 16'" for example in the form of the electrode element 282, but also in the electrode element 52.
    As already mentioned above, in connection with the second tool element 16', the high-frequency electrodes provided on the second tool element 16" and 16'" can be joined, in a conventional manner, through the provision of the respective conducted couplings electrically in instrument 12, to high frequency connection contacts 50.
    All first and second tool elements 14, 16, 16', 16", 16"' described above, as well as 138 and 140, are preferably constructed from either electrically conductive building components or electrically insulating building components . Construction components that are partially electrically conductive and partially electrically insulating are also possible. The building components themselves can be manufactured specially and completely from electrically conductive or electrically insulating materials, whereas the electrically insulating building components can also be manufactured from an electrically conductive material, which is specially provided with an electrically conductive outer casing or coating. As electrically insulating or electrically non-conductive materials, plastics can be used, in particular, which have sufficient stability at temperatures occurring in the use of the surgical system 10. For example, both thermoplastic and thermoset are suitable. Alternatively, ceramic material can also be used as an insulating material. The construction components of the 14,16, 16’, 16”, 16’” tool elements as well as those of the 138 and 140 can be specially manufactured from a ceramic. Using a ceramic, especially as opposed to many plastics, has the advantage that it also has sufficient stability at high temperatures. High frequency electrodes 28 and 29 are preferably made of a metal or metal alloy. Alternatively, the use of electrically conductive ceramics is also possible to configure the high frequency electrodes 28 and 29, as long as they meet the requirements of using high frequency current.
    Tool elements 14, 16, 16", 16", 16", as well as 138 and 140 can be manufactured, for example, as described below. The individual parts, construction components or components of the tool elements 14, 16, 16', 16", 16'", as well as those of 138 and 140 can be, in particular, manufactured separately and can therefore be joined by glue . Alternatively, it is also possible, for example, to insert the electrically conducting parts of the high frequency electrodes 28 and 29 as insert parts in a plastic injection tool and mold with a plastic. As already mentioned, electrodes can be configured from a metal or electrically conductive ceramic. In the case of a segmentation of electrodes 28 and 29, as described above, for example, a corresponding number of electrically conductive electrode segments, made of a metal, or an alloy of metal or an electrically conducting ceramic, must be 5 inserted into the plastic injection tool before molding with a suitable plastic.
    In the case of a ceramic-free mode of tool elements 14, 16, 16', 16", 16"' as well as 138 and 140, a ceramic powder injection molding method is offered in particular. , for example, the 10 so-called “2K CIM” technology, a micro-component ceramic powder injection molding method. With this, two different ceramics, in an injection process, are injected, which configure, in the case of the ready tool elements 14, 16, 16', 16", 16'", as well as in the 138 and 140, the electrically conductive portions as well as electrically insulating portions.
    After injection, the two different ceramics are sintered together. In this sense, it can be, for example, an AI2O3 ceramic and a ceramic mixed from AI2O3 and TiN.
    权利要求:
    Claims (17)
    [0001]
    1. Surgical instrument (12; 120) for joining body tissue with two tool elements (14, 16; 138, 140), which are movable relative to each other, which respectively comprise a high-frequency electrode ( 28, 29; 142, 144), and which define a minimum distance (58) from each other in an approximation position of the tool elements (14, 16; 138, 140), are opposite each other and opposite each other , wherein at least one of the high frequency electrodes is divided into at least two electrode segments (30, 31; 150, 151) and wherein the at least two electrode segments (30, 31; 150, 151) are insulated electrically from each other, characterized by the fact that: the at least two electrode segments are arranged close to each other and form at least two rows of electrodes (34, 36; 35, 37; 152, 154); at least one segment electrode (30, 31) has a first electrode segment section (38, 39), which is part of a first row of electrodes (34, 35), and a second electrode segment section (40, 41), which is part of a second row of electrodes (36, 37); the high frequency electrode (28, 29; 142, 144), which can be supplied by current in segments, defines an electrode centerline (44, 45; 156) that runs between the at least two electrode segments (30, 31; 150, 151), and which Electrode segments adjacent to each other (30, 31; 150, 151) are disposed offset relative to one another in a direction defined by the electrode centerline (44, 45; 156) such that at least a partial overlap of tissue seams is guaranteed and the sum of the extensions (48) of all electrode segments is greater than the electrode extension (46) defined by the electrode centerline (44, 45; 156).
    [0002]
    2. Surgical instrument according to claim 1, characterized in that the electrode segments (30, 31; 150, 151), which are opposite each other and opposite each other in the approximation position, form a pair of electrode segments (62; 168).
    [0003]
    3. Surgical instrument according to claim 2, characterized in that the electrode segments (30, 31; 150, 151) that form the pair of electrode segments (62; 168) have the same size or have, in essence the same size.
    [0004]
    4. Surgical instrument according to any one of claims 1 to 3, characterized in that each of the tool elements (14, 16; 138, 140) defines a surface of the tool element (32, 60; 170) and that the high frequency electrode (28, 29; 150, 151) forms a part of the surface of the tool element (32, 60; 170).
    [0005]
    5. Surgical instrument according to any one of claims 1 to 4, characterized in that the central line (44, 45; 156) of the at least one high-frequency electrode (28, 29; 142, 144) divided into at least two electrode segments (30, 31; 150, 151) defines an electrode length (45), and that each of the at least two electrode segments (30, 31; 150, 151) defines a segment length ( 48) which is less than the electrode extension (46) defined by the electrode centerline (44, 45; 156).
    [0006]
    6. Surgical instrument according to any one of claims 1 to 5, characterized in that the instrument (12) has an axis (24) at whose distal end (26) at least one of the tool elements (14) is arranged or configured, and a second tool element (16) comprises an electrode element (52) which can be moved in the direction of the axis (56) and can be moved and away from it in the direction of the first tool element (14) .
    [0007]
    7. Surgical instrument according to claim 6, characterized in that the contact members (68) pointing towards the second tool element (16), which can be brought into contact in an electrically conductive manner, in a fabric bonding position, with the electrode segments (31) of the second tool element (16), and are spaced, in a fabric clamping position, from the electrode segments (31) of the second tool element (16) ), protrude on the shaft (24) and/or on the first tool element (14).
    [0008]
    8. Surgical system with a surgical instrument, as defined in any one of claims 1 to 7, characterized in that it has at least one high-frequency current generator (18), which can be selectively connected in an electrically conductive manner to the electrodes. high frequency (28, 29; 142, 144) and/or to the cutting element (88; 164).
    [0009]
    9. Surgical system according to claim 8, characterized in that it has at least one control and/or regulation device (102), with a switching device (104) for sequential energizing of the high frequency current of at least a high frequency electrode (28, 29; 142, 144) of the electrode segments (30, 31; 150, 151).
    [0010]
    10. Surgical system according to claim 8, characterized in that it has a control and/or command device (102), with a switching device (104) for simultaneous energizing of the high frequency current, of at least one electrode frequency (28, 29; 142, 144) of at least two electrode segments (30, 31; 150, 151).
    [0011]
    11. Surgical system according to claim 10, characterized in that between at least one other electrode segment (30, 31; 142, 144) is arranged between the at least two electrode segments (30, 31; 150 , 151).
    [0012]
    12. Surgical system according to any one of claims 9 to 11, characterized in that it is with a high-frequency current generator (18), which can be selectively joined to the high-frequency electrodes (28, 29; 142, 144) and/or to the cutting element (88; 164) in an electrically conductive manner and comprises the control and/or regulation device (102).
    [0013]
    13. Surgical system according to any one of claims 9 to 12, characterized in that the control and/or regulation device (102) is configured in such a way that an energizing force and/or an energizing duration for the individual electrode segments (30, 31) is adjustable.
    [0014]
    14. Surgical system according to any one of claims 9 to 13, characterized in that the control and/or regulation device (102) comprises a temperature measuring device (112) for measuring a segment temperature electrode and/or a tissue temperature.
    [0015]
    15. Control method for a surgical instrument (12; 120), as defined in any one of claims 1 to 14, characterized in that high frequency current is applied to one of the at least two electrode segments (30, 31; 150, 151), and at least one other of the at least two electrode segments (30, 31; 150, 151) is left de-energized.
    [0016]
    16. Control method according to claim 15, characterized in that at least two electrode segments (30, 31; 150, 151) are energized simultaneously.
    [0017]
    17. Control method according to claim 15 or 16, characterized in that contiguous electrode segments (30, 31; 150, 151) are energized successively.
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    同族专利:
    公开号 | 公开日
    AU2010340897A2|2012-07-12|
    JP2013514107A|2013-04-25|
    BR112012014296A2|2016-07-05|
    KR101830992B1|2018-02-21|
    RU2012130087A|2014-01-27|
    US9138231B2|2015-09-22|
    JP5490919B2|2014-05-14|
    CN102711646B|2016-06-22|
    CN102711646A|2012-10-03|
    ES2628958T3|2017-08-04|
    DE102009059192A1|2011-06-22|
    KR20120103666A|2012-09-19|
    AU2010340897A1|2012-07-05|
    DE202010013150U1|2011-03-03|
    EP2512358A1|2012-10-24|
    EP2512358B1|2017-04-26|
    MX2012006887A|2012-07-04|
    US20120323234A1|2012-12-20|
    WO2011083027A1|2011-07-14|
    CA2784111A1|2011-07-14|
    引用文献:
    公开号 | 申请日 | 公开日 | 申请人 | 专利标题
    US5403312A|1993-07-22|1995-04-04|Ethicon, Inc.|Electrosurgical hemostatic device|
    JP2001514541A|1997-03-05|2001-09-11|ザトラスティーズオブコロンビアユニバーシティーインザシティーオブニューヨーク|Electrothermal device for sealing and bonding or cutting tissue|
    US6626901B1|1997-03-05|2003-09-30|The Trustees Of Columbia University In The City Of New York|Electrothermal instrument for sealing and joining or cutting tissue|
    AT326913T|1997-08-13|2006-06-15|Solarant Medical Inc|NON-INVASIVE EQUIPMENT AND SYSTEMS FOR SHRINKING WOVEN FABRICS|
    US5957920A|1997-08-28|1999-09-28|Isothermix, Inc.|Medical instruments and techniques for treatment of urinary incontinence|
    US6395002B1|2000-01-18|2002-05-28|Alan G. Ellman|Electrosurgical instrument for ear surgery|
    US6623437B2|2001-08-28|2003-09-23|Rex Medical, L.P.|Tissue biopsy apparatus|
    US20060064086A1|2003-03-13|2006-03-23|Darren Odom|Bipolar forceps with multiple electrode array end effector assembly|
    WO2004082495A1|2003-03-13|2004-09-30|Sherwood Services Ag|Bipolar concentric electrode assembly for soft tissue fusion|
    DE102004040959B4|2004-08-24|2008-12-24|Erbe Elektromedizin Gmbh|Surgical instrument|
    US20080243121A1|2007-04-02|2008-10-02|Tomoyuki Takashino|Curative treatment system, curative treatment device, and treatment method for living tissue using energy|
    US20090048589A1|2007-08-14|2009-02-19|Tomoyuki Takashino|Treatment device and treatment method for living tissue|
    US7967181B2|2007-08-29|2011-06-28|Tyco Healthcare Group Lp|Rotary knife cutting systems|
    US8657174B2|2008-02-14|2014-02-25|Ethicon Endo-Surgery, Inc.|Motorized surgical cutting and fastening instrument having handle based power source|
    US8348947B2|2008-04-25|2013-01-08|Olympus Medical Systems Corp.|Treatment system, and treatment method for living tissue using energy|EP2015681B1|2006-05-03|2018-03-28|Datascope Corp.|Tissue closure device|
    DE102010020664A1|2010-05-05|2011-11-10|Aesculap Ag|Surgical system for connecting body tissue parts|
    DE202011000617U1|2011-03-17|2011-05-19|Aesculap AG, 78532|Surgical system for connecting body tissue|
    DE102011001372A1|2011-03-17|2012-09-20|Aesculap Ag|Surgical system for connecting body tissue and control methods for such a surgical system|
    DE102011055236A1|2011-11-10|2013-05-16|Aesculap Ag|Surgical instrument|
    DE102012100425A1|2012-01-19|2013-07-25|Aesculap Ag|TFT Koagulationssicherung|
    JP2015526190A|2012-08-20|2015-09-10|セルポノヴム アーベーＣａｒｐｏｎｏｖｕｍ Ａｂ|Anastomosis method and anastomosis apparatus|
    DE102012110312A1|2012-10-29|2014-04-30|Aesculap Ag|Anastomosis instrument with swiveling anvil|
    US10485545B2|2013-11-19|2019-11-26|Datascope Corp.|Fastener applicator with interlock|
    CN103876826A|2014-03-12|2014-06-25|张文伟|Hemorrhoid excision device|
    JP5945635B2|2014-03-12|2016-07-05|オリンパス株式会社|Treatment device and treatment system|
    DE202015003135U1|2015-04-28|2015-05-13|Ronchosan Gmbh|Protective cover for a surgical instrument|
    DE202015003133U1|2015-04-28|2015-06-03|Ronchosan Gmbh|Protective cover for a surgical instrument|
    WO2016174088A1|2015-04-28|2016-11-03|Ronchosan Gmbh|Protective cover for a surgical instrument|
    DE102015108078A1|2015-05-21|2016-11-24|Aesculap Ag|Electrosurgical coagulation instrument|
    CN109171952B|2018-08-07|2020-06-16|上海理工大学|Linkage type pressure controllable tissue welding electrode|
    EP3777739A1|2019-08-14|2021-02-17|Erbe Elektromedizin GmbH|Cutting electrode, surgical instrument and method of manufacturing the cutting electrode|
    法律状态:
    2019-01-08| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|
    2019-08-06| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|
    2021-06-01| B350| Update of information on the portal [chapter 15.35 patent gazette]|
    2021-06-22| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|
    2021-08-24| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 17/12/2010, OBSERVADAS AS CONDICOES LEGAIS. PATENTE CONCEDIDA CONFORME ADI 5.529/DF, QUE DETERMINA A ALTERACAO DO PRAZO DE CONCESSAO. |
    优先权:
    申请号 | 申请日 | 专利标题
    DE102009059192.3|2009-12-17|
    DE200910059192|DE102009059192A1|2009-12-17|2009-12-17|Surgical instrument surgical system and method and method for connecting body tissue parts|
    PCT/EP2010/070018|WO2011083027A1|2009-12-17|2010-12-17|Surgical system and control method for a surgical instrument and method for connecting bodily tissues|
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