Medical instrument and method for operating thereof

Abstract

FIELD: medical equipment.SUBSTANCE: medical instrument for treating structures of the human or animal body and a method for operating the medical instrument. A medical instrument for treating structures of the human or animal body, wherein the treatment includes: holding, grasping, clamping, separating or cutting the structure or bringing the structures together, has a tool head, an elongated tool shaft, at least one drive device, and an image forming device. The head of the instrument is designed to contact the structure of the human or animal body and to process this structure. The elongated shaft of the instrument has a proximal end and a distal end. The head of the instrument is located at the distal end. At least one drive device is located at the proximal end of the instrument shaft and is designed to drive the instrument. The imaging device is located on or in the shaft of the instrument and is equipped with at least one image sensor and at least one lens. The instrument head and the image forming device are located on the shaft without the possibility of displacement in the longitudinal direction of the shaft. The lens and the end portion of the instrument head facing away from the shaft are constantly oriented relative to each other so that the image forming device continuously creates an image of this end portion of the head. The head of the instrument, at least in a separate section, is curved or inclined relative to the longitudinal axis of the shaft of the instrument and is oriented in the direction of the lens. The method for operating the above-mentioned medical instrument is characterized in that the images obtained using the image-forming device are processed and output to the image output device, wherein the images are processed in such a way that the shaft of the instrument and / or the section of its head facing the shaft are hidden in the images output to the image output device.EFFECT: ensuring optical capture of predominantly the end portion of the head with the structure or structures being processed by it.18 cl, 13 dwg

Description

[0001] A medical instrument for working with the structures of the human or animal body is proposed.

[0002] Medical instruments are inserted into the body of a person or animal for examination or treatment. Examination or treatment often occurs in cavities or recesses. This is especially true for minimally invasive surgery. In many cases, endoscopes are used to examine the area into which medical instruments are inserted. They have a shaft (or rod) containing an imaging system. The distal end of the endoscope shaft is inserted into the body of a person or animal. The endoscope is typically equipped with an illumination system that illuminates the structure in the corresponding cavity to be examined or treated. Light generated by the light source is typically directed to the distal end of the endoscope shaft through optical fibers. The imaging system is used to capture the information contained in the light reflected from the structure in the form of an image. Image sensors are often image converter chips, such as CMOS or CCD.An image sensor, also known as an image signal generator or image converter, converts the optical image into electrical signals, which are then displayed on a screen or monitor. An imaging system can be equipped with one image sensor to create a two-dimensional image of the structure being treated. Alternatively, the imaging system can be equipped with two image sensors to create a three-dimensional image of the structure being treated. Such endoscopes are also known as 3D endoscopes or stereo endoscopes.

[0003] Endoscopes may be equipped with a working channel into which a medical instrument is inserted. Such instruments include, for example, grasping or cutting instruments for obtaining tissue samples or removing thin layers of soft tissue or cartilage, injection cannulas, or wire electrodes for electrical coagulation. The working channel has an opening at the distal end of the endoscope shaft. The medical instrument carrying the instrument head emerges from this opening. The medical instrument can be moved longitudinally within the working channel to direct it toward the structure being treated in the cavity. Using an imaging system, the structure in the body cavity can be treated with the medical instrument under visual control. The instrument can be moved relative to the endoscope to orient it relative to the structure being treated and relative to the field of view displayed by the endoscope.

[0004] A disadvantage is that the medical instrument can be moved within the endoscope's imaging system's field of view, obscuring the user's view of the structure being treated. In this case, the user cannot see the portion of the medical instrument that contacts the human or animal body structure being treated. This significantly complicates the treatment process and poses a risk to the person or animal, as visual inspection is impossible or at least hindered. Although the user can, in principle, at least temporarily, orient the endoscope's shaft, carrying the image signal generator, and the medical instrument being guided into the endoscope's working channel relative to each other so that the view of the structure being treated is unobstructed, this requires considerable effort on the user's part.In addition, such orientation cannot be maintained for a long period of time when using a medical instrument, since the medical instrument is subject to movement during the processing of the structure, as a result of which its orientation relative to the endoscope shaft and, thus, relative to the imaging system changes.

[0005] The invention is based on the task of creating a medical instrument that provides visual control of the area being treated, in which the instrument comes into contact with the body of a person or animal, also in the case when the area being treated is located in a cavity or in an invisible recess of the body of a person or animal.

[0006] This problem is solved by a medical instrument having the features of claim 1. The instrument includes a head of the instrument that contacts a structure of the human or animal body and processes this structure, an elongated shaft of the instrument having a proximal end and a distal end, wherein the head of the instrument is located at the distal end, a drive device at the proximal end of the shaft of the instrument, with the help of which the instrument can be actuated, and an image forming device located on the shaft of the instrument and having at least one image sensor and at least one lens. Moreover, the head of the instrument and the image forming device are located on the shaft of the instrument without the possibility of displacement in the longitudinal direction of the shaft of the instrument.The imaging device lens and the end of the instrument head facing away from the instrument barrel are constantly aligned relative to each other, so that the imaging device continuously creates an image of this end of the instrument head. The portion of the instrument head that interacts with the human or animal body structure at the site of application of the medical instrument and acts upon this structure in the desired manner remains continuously within the imaging device's field of view, even when the user moves the instrument to treat the structure. The portion of the structure acted upon by the instrument during treatment is also within the imaging device's field of view. This prevents the instrument barrel from obscuring the view of the structure being treated.

[0007] The imaging device has an optical axis. First, the lens has an optical axis. This axis extends as a geometric straight line from the lens toward the tool head. The imaging device is oriented relative to the tool head such that the optical axis constantly and consistently maintains its orientation relative to the portion of the tool head used for processing. This means that the optical axis of the lens, which forms a geometric straight line, intersects the tool head. As a result, the imaging device is permanently positioned and oriented such that it continuously captures an image of at least the surface of the tool head that contacts the structure of the human or animal body during processing, as well as the surrounding area of ​​this surface.Thus, the image captured by the imaging device continuously and reliably shows the area of ​​the instrument head in contact with the structure being treated, as well as its surroundings. The surroundings primarily include the structure being treated if the instrument is located close enough to the structure at the point of use. The imaging device is positioned so that the instrument head does not obscure the view of the area where the instrument head contacts the structure. This area is typically located at the tip of the instrument head. This allows the user to approach the instrument to the structure being treated and perform treatment under reliable visual control. Thanks to the imaging device, the user has a constant and reliable view of the area where the instrument contacts the human or animal body.

[0008] To obtain an image of the main part of the instrument head, the imaging device requires a one-time setup. This setup is performed during instrument manufacture and is then saved and cannot be changed. The user does not need to make any adjustments or settings. The image generated by the imaging device continuously displays the surface of the instrument head intended for contact with the human or animal body structure during treatment, regardless of the position and orientation of the medical instrument and the location of the user.

[0009] The instrument head is specifically designed for processing and has, for example, one or two blades or cutting edges, a clamp, a grasping instrument, a cannula, or wire electrodes. Processing includes holding, grasping, clamping, separating, or cutting a structure, or bringing structures together. If the instrument head is designed, for example, as a grasping instrument, this grasping instrument must be opened and closed during processing. For this purpose, the grasping instrument is equipped with, for example, gripping jaws or cutting edges. One or two gripping jaws or cutting edges are movably mounted on the instrument head so that the medical instrument intended for grasping can be opened and closed. Each gripping jaw or cutting edge forms part of a lever. The two levers are movably connected to each other via a hinge.To open and close the tool, either both gripping jaws or both cutting edges can be moved. Alternatively, one gripping jaw can be rigidly connected to the tool head, while only the second gripping jaw can be movably attached to the tool head.

[0010] The tool barrel and drive device serve to guide the tool head to the point of use and move it in a manner that enables the desired processing of the structure. This includes guiding the tool head toward and away from the structure being processed, as well as moving the tool head during processing when required by a specific type of processing. If the tool has at least one movable part mounted on the tool head, such as in the case of pliers, the drive device is also used to move this part relative to the tool barrel. The drive device may be equipped, for example, with at least one handle. The handle may be moved manually or with a manipulator.

[0011] The image can be transmitted from the imaging device to the data processing device via a signal line or radio channel, and finally to an image output device. Such a device can be, for example, a display device, primarily a monitor or virtual reality glasses.

[0012] A medical instrument can be combined with an endoscope. For this purpose, it can be inserted into the working channel of the endoscope. In this case, images can be generated by the imaging device of the medical instrument and by the imaging device of the endoscope. This can be useful when the endoscope is first used to inspect the structure to be treated with the medical instrument and its surroundings, and then the structure is treated with the medical instrument. The imaging device of the endoscope provides an overview of the entire structure and its surroundings, while the imaging device of the medical instrument only images the portion of the instrument and the part of the structure that interact with each other during treatment.

[0013] Alternatively, a medical instrument can be used without an endoscope. This occurs when the instrument's imaging device is sufficient to provide the user with a visual representation of the site of application, and a second imaging device is not required. The medical instrument can be inserted into a human or animal body cavity using a trocar.

[0014] The medical instrument can be operated directly by a physician or healthcare professional. For this purpose, the instrument's drive unit can be manually operated by the person concerned.

[0015] Alternatively, the medical instrument can be integrated into a robotic surgical system. In this case, the medical instrument is controlled by a manipulator connected to the instrument's drive unit. The manipulator can then perform control based on image data obtained by an imaging device mounted on the instrument.

[0016] Furthermore, the tool head, at least in a specific section, is curved or inclined relative to the longitudinal axis of the tool barrel and oriented toward the lens. This allows the tool head to tilt toward the lens. This ensures that images of the tool barrel are transferred to the imaging device via the lens.

[0017] By flexing the instrument head, i.e., bending it smoothly, or tilting the instrument head, i.e., bending it at an angle (kink), optical capture is ensured, primarily, of the end portion of the head containing the structure or structures being processed. This allows for at least partial exclusion from the resulting image of the portion of the head that obscures the structure being processed, placing the area of ​​primary interest to the user within the field of view of the objective lens, particularly within the focus of the imaging device. This can reduce the cost of image processing, which is intended to conceal the barrel of the instrument and / or the section of the head facing the barrel in images output to the image output device. The image displayed to the user becomes more easily perceived.

[0018] According to another preferred embodiment of the invention, the lens and the image sensor are located on the holder of the image forming device, wherein the holder of the image forming device is located on the barrel of the tool and orients the lens in the direction of the end part of the head of the tool facing away from the barrel of the tool.

[0019] According to another preferred embodiment of the invention, a lighting device illuminating the head of the instrument is integrated into the instrument barrel. For this purpose, for example, a light source can be housed in the instrument barrel. The light source can be positioned at the distal end of the instrument barrel, at the proximal end of the instrument barrel, or between the two. If the light source is positioned at a distance from the distal end of the instrument barrel, light from the light source can be directed toward the distal end of the instrument barrel via an optical fiber. At the distal end of the instrument barrel, light is emitted toward the head of the instrument. A light-emitting diode is particularly suitable as a light source. The light source is preferably powered by a power source that can also be used to power an imaging device.

[0020] According to another preferred embodiment of the invention, the light source is rigidly and immovably mounted to the instrument. Thus, like the imaging device, it does not change its orientation or position on the instrument.

[0021] According to another preferred embodiment of the invention, at least one irrigation channel is located in the instrument shaft. The irrigation medium exits through the irrigation channel at the distal end of the instrument shaft. The irrigation medium can then be specifically diverted, for which purpose a second irrigation channel may be provided. Irrigation with the irrigation medium improves visibility of the structure being treated at the site of use of the medical instrument, for example, if blood is leaking from the structure being examined.

[0022] According to another preferred embodiment of the invention, an image sensor is designed to convert optical images into electrical signals. Such a sensor may be, for example, a semiconductor component, especially a CCD or CMOS. The imaging device is equipped with an electrical signal line through which electrical signals are transmitted to a data processing device and / or an image output device. The data processing device processes the electrical signal so that it can be displayed on a display device, and the user receives an idea of ​​the location of the medical instrument using the image output device, which is designed as a display device, and the image displayed on it. If the image output device is a display device, it can be represented, for example, by a display or virtual reality glasses.

[0023] According to another preferred embodiment of the invention, a signal line is located in the barrel of the medical instrument.

[0024] According to another preferred embodiment of the invention, the instrument shaft is provided with a longitudinally extending channel that has a first opening at the proximal end of the instrument shaft and a second opening at its distal end. The first opening is configured to allow an imaging device to be inserted into the channel through it and to advance the imaging device toward the distal end of the instrument shaft, i.e., the imaging device can be inserted into the channel through the first opening and advanced toward the distal end of the instrument shaft. At the distal end of the instrument shaft, the channel has a translucent second opening. In addition, the instrument shaft is equipped with a locking device configured to secure the imaging device positioned in the channel and to firmly connect it to the instrument shaft.By releasing the locking device, the imaging device can be detached and removed from the instrument. This allows the imaging device to be inserted into, for example, different instruments. Thus, only one imaging device is required for working with several different medical instruments. Furthermore, the imaging device can be detached from the medical instrument for sterilization and reuse. The instrument can be sterilized without the imaging device. This applies to reusable or multiple-use medical instruments. Alternatively, the medical instrument may be single-use, while the imaging device can be reused.In this case, it is also preferable when the imaging device can be removed from the medical instrument.

[0025] According to another preferred embodiment of the invention, the imaging device is equipped with an interface through which image data can be output to a data processing device via a radio channel. This eliminates the need for a cable signal transmission line, thereby facilitating handling of the medical instrument. The data processing device is used to process the data generated by the imaging device and output it to a display device for the user.

[0026] According to another preferred embodiment of the invention, the medical instrument is equipped with an energy storage device. This can be in the form of a rechargeable battery or a battery. This eliminates the need for a power cable to supply power to the imaging device. This can facilitate handling of the medical instrument at the point of use.

[0027] According to another preferred embodiment of the invention, the imaging device is designed as a stereo imaging device, also known as a 3D imaging device. Using a suitable display device, the user can be provided with a three-dimensional image of the instrument head and its surroundings. This facilitates orientation at the instrument's location and determination of the distance between the structure being treated and the instrument head. This can be accomplished both qualitatively, relative to a reference point, and quantitatively, if the imaging device is appropriately calibrated. In this case, special display devices are required that separately display image data for the left eye and image data for the right eye.

[0028] According to another preferred embodiment of the invention, the 3D imaging device includes a left image sensor and a right image sensor. Thus, two images can be generated that are combined in the display device to form a three-dimensional image. Alternatively, an image sensor can be used that has a first set of pixels for the left image and a second set of pixels for the right image.

[0029] According to another preferred embodiment of the invention, the focus of the imaging device can be set such that the end of the tool head facing away from the tool barrel is at the focal point of the imaging device. The focus is determined by an objective lens and, if necessary, additional lenses of the imaging device. The focus of the objective lens is selected such that it corresponds to the distance between the objective lens and the end of the tool head.

[0030] According to another preferred embodiment of the invention, the instrument is a cutting instrument. The instrument may be shaped like a scalpel, or like scissors. Alternatively, the instrument may be shaped like a shaver. A shaver is used to remove thin layers of soft tissue or cartilage and is primarily used in arthroscopy.

[0031] According to another preferred embodiment of the invention, the instrument is in the form of a gripper. For example, the instrument could be a pair of pliers. It could also be a pair of tweezers.

[0032] According to another preferred embodiment of the invention, the tool is designed as a holding tool. For example, it may include a clamp.

[0033] According to another preferred embodiment of the invention, the instrument is designed as a trocar. The trocar is used to create sharp or blunt access into a body cavity, such as the abdominal or thoracic cavity. This access is held open by a sheath. An imaging device on the trocar facilitates positioning at the site of use.

[0034] According to another preferred embodiment of the invention, the instrument is in the form of a cannula.

[0035] According to another preferred embodiment of the invention, the instrument includes at least one wire electrode for coagulation with electric current.

[0036] According to another preferred embodiment of the invention, the instrument is intended for single use. Therefore, it can be disposed of after use, eliminating the need for sterilization for reuse.

[0037] According to another preferred embodiment of the invention, the instrument is reusable. It is sterilizable, particularly autoclavable.

[0038] According to another preferred embodiment of the invention, the medical instrument is equipped with a lens hood that excludes the instrument barrel and / or the barrel-facing portion of the instrument head from images captured by the imaging device. Thus, the user's visual perception of the displayed images is not impaired by the presence of the instrument barrel or the barrel-facing portion of the instrument head.

[0039] According to the method of the invention for operating a medical instrument, images obtained using an imaging device are processed and displayed on an image output device. The images are processed such that the instrument barrel and / or the section of the instrument head facing the instrument barrel are hidden from the images displayed on the image output device. Thus, the instrument barrel or the section of the instrument head facing the instrument barrel are not visible in the images displayed by the image output device. Therefore, the user's attention is drawn not to the instrument barrel or the section of the instrument head immediately adjacent to it, but only to the distal end of the instrument head facing away from the instrument barrel, which interacts with and specifically processes the structure being processed.

[0040] Other advantages and preferred embodiments of the invention are presented in the claims.

[0041] Drawing

[0042] The drawing shows examples of the implementation of the subject of the invention. Shown on:

[0043] Fig. 1 - the first example of the implementation of a medical instrument in perspective view,

[0044] Fig. 2 - the proximal end of the instrument shaft and the instrument drive device according to Fig. 1,

[0045] Fig. 3 - the distal end of the instrument shaft and the instrument head according to Fig. 1,

[0046] Fig. 4 - an image of the tool head according to Fig. 1, obtained using an image forming device and output to a visualization device,

[0047] Fig. 5 - an image according to Fig. 4, in which the head of the tool is partially hidden,

[0048] Fig. 6 - an image of the instrument head of the second embodiment of a medical instrument, obtained by an imaging device and output to a visualization device,

[0049] Fig. 7 - an image according to Fig. 6, in which the head of the tool is partially hidden,

[0050] Fig. 8 - a third example of the implementation of a medical instrument in a perspective view,

[0051] Fig. 9 - the proximal end of the instrument barrel and the instrument drive mechanism according to Fig. 8, when the image forming device is installed and fixed in the instrument barrel,

[0052] Fig. 10 - the proximal end of the instrument shaft according to Fig. 9, when the imaging device is unlocked and partially detached from the instrument shaft,

[0053] Fig. 11 - top view of the instrument head and the distal end of the shaft of the medical instrument according to Fig. 8,

[0054] Fig. 12 - the head of the instrument and the distal end of the instrument shaft of the medical instrument according to Fig. 8 in a perspective view,

[0055] Fig. 13 - the head of the instrument and the distal end of the instrument shaft of the medical instrument according to Fig. 8 in a front view.

[0056] Description of implementation examples

[0057] Fig. 1-5 shows a first embodiment example of a medical instrument 1. The instrument is a pair of pliers made in the form of a double-arm instrument and equipped with two gripping jaws 2, 3. Both gripping jaws 2, 3 are made in the form of levers. Both gripping jaws 2, 3 have a serrated surface on the sides facing each other. Both gripping jaws are connected to each other by means of a hinge 4 and are located on the head 5 of the instrument. The instrument 1 has an elongated barrel 9 of the instrument. The head 5 of the instrument is located on the barrel 9 of the instrument at its first end, which is called the distal end. At the second end, which is called the proximal end of the barrel of the instrument, two ring-shaped handle parts 7, 8 are located. These handle parts 6, 7 are part of the drive device 6, with the help of which the medical instrument 1 can be controlled manually. The first handle part 7 is movably connected to the barrel 9 of the instrument by means of a hinge.The second handle part 8 is rigidly connected to the barrel 9 of the tool. Two gripping jaws 2, 3 can be moved by moving the two handle parts 7, 8. The gripping jaws 2, 3 and the handle parts 7, 8 have an open position and a closed position. The movement of the handle parts 7, 8 is transmitted to the gripping jaws 2, 3 by means of mechanical means. The mechanical means are partially located in the barrel 9 of the tool. The two gripping jaws 2, 3, the hinge 4 and the mechanical means 10 are located on the head 5 of the tool. In addition, an image forming device 11 and a lighting device 12 are located in a fixed position on the barrel 9 of the tool. The image forming device 11 includes an image sensor and a lens 11b, which are located in a housing 11a of the image forming device. The image sensor is completely covered by the housing 11a of the image forming device, therefore the image sensor is not visible from the outside and is not shown in the drawing.The lens 11b is placed in the viewing window of the housing 11a of the imaging device. In Fig. 3, the observer looks into this viewing window equipped with the lens 11b. The imaging device 11 and the lighting device 12 are placed and adjusted on the barrel 9 of the tool so that the lens 11b and the lighting device maintain a constant orientation relative to the two ends of the gripping jaws 2, 3 of the head 5 of the tool facing away from the barrel 9 of the tool. In this way, the imaging device captures images of the two gripping jaws 2, 3 in their open position, in their closed position and in all positions of the gripping jaws 2, 3 between them. If any structure, for example tissue, is captured by the two gripping jaws 2, 3 of the head 5 of the tool, then this structure can also be recognized in the images obtained by the imaging device.

[0058] The objective 11b has an optical axis 11c, which extends as a geometric straight line in the direction of the gripping jaws 2, 3. The head 5 of the instrument has a curvature in the direction of this optical axis 11c. For this purpose, the gripping jaws 2, 3 are curved. The optical axis 11c intersects both gripping jaws 2, 3 at their ends facing away from the barrel 9 of the instrument, which are also called the distal ends of both gripping jaws 2, 3. Due to this, optical gripping is ensured, first of all, of the distal ends of the two gripping jaws 2, 3.

[0059] The imaging device 11 includes an image sensor that converts optical signals into electrical signals. The instrument barrel 9 is provided with a channel 13. An electrical signal line of the imaging device 11 and a power supply line of the illuminating device 12 pass through this channel 13. The signal line and the power supply line are combined at the proximal end into a cable 14 having a cable connector housing 14a. This cable 14 can be connected to a visualization device that displays images created by the imaging device 11. The imaging device is not shown in the drawing.

[0060] Fig. 4 shows an image 15 of two gripping jaws 2, 3 in the open position, obtained using an image-forming device 11. This image, created by the image-forming device 11, is displayed on a visualization device not shown in the drawing. Also visible in the image 15 is a portion of the tool head 5, on which both gripping jaws 2, 3 are movably mounted.

[0061] When the user approaches the tool 1 to the structure at the place of its use and first opens both gripping jaws 2, 3, grips the structure at least in a separate area, and then closes the gripping jaws 2, 3 again, the gripping jaws 2, 3 and the structure accommodated in the gripping jaws remain continuously visible to the user by means of the imaging device 11. Since the positions of the hinge 4 of the gripping jaws 2, 3 and the imaging device 11 are fixed and do not change when the tool is actuated, the processing area of ​​the two gripping jaws is continuously and constantly visible by means of the imaging device. The viewing area shown in image 15 is not obscured by parts of the tool or the imaging device.

[0062] Figure 5 shows another image 16 of the gripping jaws 2, 3 of a medical instrument obtained by the imaging device. In this image 16, the section of the instrument head 5 facing the instrument barrel is obscured. To achieve this, region 23 is cropped out of image 16. This is achieved through image processing. Shielding the instrument head facilitates the user's work, since he or she is less distracted by the section of the instrument head 5 facing the instrument barrel.

[0063] Fig. 6 and 7 show images 17, 18 of a second embodiment of a medical instrument. These images 17, 18 are created in accordance with images 15, 16 using an image forming device, which is placed on the second embodiment of a medical instrument. The medical instrument is a shaver for removing thin layers of soft tissue or cartilage. The shaver comprises a housing 19 provided with an opening 20 on the head 25 of the instrument. A cutting tool 21 is rotatably placed in the housing 19. The medical instrument equipped with a shaver can be designed in the same way as the first embodiment of the medical instrument in Fig. 1-5, with the exception of the housing 19 provided with an opening 20 and a cutting tool 21. The housing 19 and the cutting tool 21 are placed on the head 25 of the instrument, which is partially visible in image 17 according to Fig. 6. In image 18 according to Fig. 7 the section of the head 25 of the instrument facing the barrel is hidden.For this purpose, section 24 is cut out from image 18 using image processing.

[0064] Figures 8-13 show a third embodiment of a medical instrument 31. In this case, we are talking about spoon-type forceps. They have two gripping jaws 32, 33, which are designed as levers, are located on the head 35 of the instrument and are rotatable around a hinge 34. Both gripping jaws 32, 33 are part of the head 35 of the instrument. They are curved in the direction of the optical axes 41 c of the image-forming device 41. The optical axes 41 c are geometric straight lines.

[0065] In contrast to the first embodiment according to Fig. 1-5, both gripping jaws of the medical instrument 31 according to Fig. 8-13 respectively have a recess on the sides facing each other. In accordance with the first embodiment, the medical instrument 31 according to the third embodiment has an elongated instrument shaft 39, at the distal end of which a head 35 is located, and at the proximal end - a drive device 36, which has two handle parts 37, 38. Both gripping jaws 32, 33 can be moved with the help of the two handle parts 37, 38. In contrast to the medical instrument 1 according to Fig. 1-5, in the medical instrument 31 according to Fig. 8-13, the image forming device 41 is dismountably accommodated in the instrument shaft 39. For this purpose, the instrument shaft 39 has a channel 43, which is respectively provided with an opening at its distal end and at its proximal end.In the opening at the proximal end, a locking device 45 having a locking pin 46 is accommodated. The imaging device 41 has a signal line, which is accommodated in a cable 44 having a cable connector housing 44a. The imaging device 41 is inserted by means of a cable 44 into the channel of the instrument shaft 39 and is advanced in the direction of the distal end of the instrument shaft 39 until the objectives 41a, 41b come to a predetermined end position at the distal end of the instrument shaft 39. As soon as this end position is reached, the imaging device 41 is fixed on the instrument shaft 39. For this, the locking pin 46 is brought to the locking position on the locking device 45. In this position, the locking pin 46 engages with the cable connector housing 44a. Due to this, the image forming device 41 is prevented from moving in the longitudinal direction of the instrument shaft 39. In fig.8 and 9 show the image forming device 41 in the locked final position in the tool barrel 39. In Fig. 10, the image forming device 41 is shown in the unlocked position and partially removed from the tool barrel 39.

[0066] Another difference between the first and third embodiments is that the medical instrument 31 according to Figs. 8-13 is equipped with flushing channels 47, 48. They have nozzles 49, 50, 51 at the proximal end of the instrument shaft 39 and openings 52, 53 at the distal end of the instrument shaft 39. Pipelines not shown in the drawing can be connected to the nozzles 49, 50, 51. They serve to supply and drain the flushing agent, which exits through one of the openings 52 and is sucked out through the other opening 53.

[0067] Another difference between the first and third embodiments is that the imaging device 41 of the medical instrument 31 according to Fig. 8-13 is a three-dimensional imaging device. It has a left image channel and a right image channel. Each image channel is associated with an objective 41a, 41b and an image sensor. The image sensors are located in the barrel 39 of the instrument and are therefore not visible in the drawing. The imaging device is also equipped with an illumination device 42. Each objective 41a, 41b is associated with an optical axis 41c, which corresponds to a geometric line. The optical axes 41c of both objectives 41a, 41b can be parallel to each other or oriented with respect to each other at an angle different from 0°. In the medical instrument 31, the optical axes are parallel to each other. In the example shown in Fig. In Figure 12, only one of the two optical axes 41c is visible.The other optical axis is placed in the illustration behind the optical axis 41c, so it is hidden.

[0068] The images obtained by the imaging device 41 are to be displayed using a display device capable of three-dimensional display. To this end, the images of the left channel of the image are to be displayed for the user's left eye, and the images of the right channel of the image are to be displayed for the right eye.

[0069] All features of the invention may be essential to the invention either individually or in any combination with each other.

[0070] Reference designations

[0071] 1 - Medical instrument

[0072] 2 - gripping jaw

[0073] 3 - gripping jaw

[0074] 4 - hinge

[0075] 5 - Tool head

[0076] 6 - drive device

[0077] 7 - handle part

[0078] 8 - handle part

[0079] 9 - Tool barrel

[0080] 10 - mechanical means

[0081] 11 - imaging device

[0082] 11a - Imaging device housing

[0083] 11b - lens

[0084] 11c - optical axis of the imaging device

[0085] 12 - Lighting fixture

[0086] 13 - channel

[0087] 14 - cable

[0088] 14a - Cable connector housing

[0089] 15 - image

[0090] 16 - image

[0091] 17 - image

[0092] 18 - image

[0093] 19 - case

[0094] 20 - hole

[0095] 21 - cutting tool

[0096] 23 - area cut out from image

[0097] 24 - area cut out from image

[0098] 25 - Instrument head 31 - Medical instrument

[0099] 32 - gripping jaw

[0100] 33 - gripping jaw

[0101] 34 - hinge

[0102] 35 - Tool head

[0103] 36 - drive device

[0104] 37 - handle part

[0105] 38 - handle part

[0106] 39 - Tool barrel

[0107] 41 - imaging device

[0108] 41a - lens

[0109] 41b - lens

[0110] 41c - geometric axis

[0111] 42 - lighting fixture

[0112] 43 - channel

[0113] 44 - cable

[0114] 44a - Cable connector housing

[0115] 45 - locking device

[0116] 46 - Locking pin

[0117] 47 - flushing channel

[0118] 48 - flushing channel

[0119] 49 - nipple

[0120] 50 - nipple

[0121] 51 - nipple

[0122] 52 - hole

[0123] 53 – hole.

Claims

1. A medical instrument for treating structures of the human or animal body, wherein the treatment includes: holding, grasping, clamping, separating or cutting the structure or bringing the structures together, having: the head (5, 25, 35) of the instrument, which is designed for contact with the structure of the human or animal body and for processing this structure, an elongated shaft (9, 39) of the instrument having a proximal end and a distal end, wherein the head (5, 25, 35) of the instrument is located at the distal end, at least one drive device (6, 36), which is located at the proximal end of the shaft (9, 39) of the instrument and is designed to drive the instrument (1, 31), an image forming device (11, 41) which is placed on the barrel (9, 39) of the tool or in it and is equipped with at least one image sensor and at least one lens (11b, 41a, 41b), wherein the head (5, 25, 29) of the tool and the image forming device (11, 41) are placed on the barrel (9, 39) of the tool without the possibility of displacement in the longitudinal direction of the barrel (9, 39) of the tool, wherein the lens (11b, 41a, 41b) and the end portion of the head (5, 25, 35) of the tool facing away from the barrel (9, 39) of the tool are constantly oriented relative to each other so that the image forming device (11, 41) continuously creates an image of this end portion of the head (5, 25, 35) of the tool, and wherein the head (5, 25, 35) of the instrument, at least in a separate section, is curved or inclined relative to the longitudinal axis of the barrel (9, 39) of the instrument and is oriented in the direction of the lens (11b, 41a, 41b).

2. A medical instrument according to claim 1, characterized in that the lens (11b, 30 41a, 41b) and the image sensor are placed on the holder of the image forming device, wherein the holder of the image forming device is placed on the barrel (9, 39) of the instrument, and the lens (11b, 41a, 41b) is oriented in the direction of the end part of the head (5, 25, 35) of the instrument facing away from the barrel (9, 39).

3. A medical instrument according to one of the preceding paragraphs, characterized in that a lighting device (12, 42) is placed in the barrel (9, 39) of the instrument, which illuminates the head (5, 25, 35) of the instrument.

4. A medical instrument according to one of the preceding paragraphs, characterized in that at least one flushing channel (47, 48) is located in the barrel (9, 39) of the instrument.

5. A medical instrument according to one of the preceding claims, characterized in that the image sensor is designed to convert optical images into electrical signals and that the image forming device (11, 41) is equipped with an electrical signal line through which electrical signals are fed to the data processing device and / or the image output device.

6. A medical instrument according to paragraph 5, characterized in that the signal line is located in the barrel (9, 39) of the instrument.

7. A medical instrument according to one of the preceding claims, characterized in that the barrel (9, 39) of the instrument is provided with a channel (13, 43) extending in the longitudinal direction, which has a first opening at the proximal end of the barrel (9, 39) of the instrument, configured to be inserted through it into the channel (13, 43) of the image forming device (11, 41) and to advance the image forming device (11, 41) to the distal end of the barrel (9, 39) of the instrument, and which has a light-transmitting second opening (52, 53) at the distal end of the barrel (9, 39) of the instrument, wherein the barrel (9, 39) of the instrument is provided with a locking device (45), configured to fix the image forming device (11, 41) placed in the channel (13, 43) and to be immovably connected to the barrel (9, 39) of the instrument.

8. A medical instrument according to one of the preceding paragraphs, characterized in that the image-forming device (41) is designed as a three-dimensional image-forming device.

9. A medical instrument according to one of the preceding claims, characterized in that it is equipped with a hood that excludes the barrel (9, 39) of the instrument and / or the section of the head (5, 25, 35) of the instrument facing the barrel (9, 39) of the instrument from the images captured by the imaging device (11, 41).

10. A medical instrument according to one of the preceding paragraphs, characterized in that it is made in the form of a scalpel.

11. A medical instrument according to one of paragraphs 1-9, characterized in that it is made in the form of a shaver (19, 20, 21).

12. A medical instrument according to one of paragraphs 1-9, characterized in that it is made in the form of forceps (1, 31).

13. A medical instrument according to one of paragraphs 1-9, characterized in that it is made in the form of scissors.

14. A medical instrument according to one of paragraphs 1-9, characterized in that it is made in the form of a clamp.

15. A medical instrument according to one of paragraphs 1-9, characterized in that it is made in the form of tweezers.

16. A medical instrument according to one of paragraphs 1-9, characterized in that it is made in the form of a trocar.

17. A medical instrument according to one of paragraphs 1-9, characterized in that it includes at least one wire electrode.

18. A method for operating a medical instrument according to one of the preceding claims, characterized in that the images (16, 18) obtained with the aid of the image forming device (11, 41) are processed and output to the image output device, wherein the images (16, 18) are processed so that the barrel (9, 39) of the instrument and / or the section of the head (85, 25, 35) of the instrument facing the barrel (9, 39) of the instrument are hidden in the images (16, 18) output to the image output device.

Images