Adaptable working channel device, tissue clamp action adapter, and surgical procedure apparatus system

Abstract

An adaptable working channel device for adaptable mounting on an endoscope, having at least one outer working channel, which on its proximal end section is connected to a first mounting coupling, a handle mounting collar constructed separately from the working channel, which is designed for collar-like surrounding of an endoscope shaft or an endoscope handle, and which on its radially outer peripheral side has at least one second mounting coupling, which is configured for detachable mounting engagement with the first mounting coupling. The first mounting coupling has two clamping branches, which are spring-preloaded in a clamping engagement, which are articulated like a clothespin to one another and which here each form a clamping branch section and a manually operable handling branch section. The second mounting coupling has a mounting track, which extends in the longitudinal direction of the handle mounting collar and which has or is configured with at least one side recess, which is dimensioned such that the side recess can be form-fittingly surrounded by the clamping branches of the first mounting coupling.

Description

Technical Field

[0001] This disclosure relates to an adaptable working channel device for adaptable mounting on an endoscope, having at least one external working channel connected at its proximal end section to a first mounting coupler, a handle mounting collar separately configured to loop around an endoscope shaft or endoscope handle, and the handle mounting collar having at least one second mounting coupler on its radially outer circumferential side, the second mounting coupler being configured to detachably engage with the first mounting coupler. This disclosure also relates to a distal tissue clip action adapter, and a surgical device system for an endoscope having the adaptable working channel device and the tissue clip action adapter. Background Technology

[0002] Medical endoscopes are used in many different patient procedures and are subject to a variety of requirements accordingly. To accommodate a wide range of highly specialized procedures, highly specialized endoscope and / or adapter systems exist for attaching working channels, enabling the provision of additional instruments and / or functions. These adapter systems are configured, in particular, to equip standard endoscopes. They must be able to be quickly and easily mounted on the endoscope and reliably secured thereto. Preferably, they can be manufactured inexpensively as disposable components and are therefore simple to construct.

[0003] An example of an additional flexible hose assembly is given in DE 10 2009 014 178 A1, which can be coupled to an endoscope handle via a proximal connector. This disclosure discloses a clamping sleeve that clamps onto the endoscope handle and has a clamping gap with a knot, and an external working channel having flaps with engagement grooves for engagement with the knot for mounting on the clamping gap. However, such a connection is either rigid and therefore difficult to operate and prone to jerking, or smooth and unstable. Because back pressure must be established during connection, two hands are required to secure the external working channel to the endoscope handle. Furthermore, the rotating ring can wear and cause additional instability. However, in many patient treatments or surgeries, not only high stability of the connection but also simple and safe installation and removal are necessary.

[0004] Furthermore, adapter systems known in the prior art often fail to meet the requirements defined by specific surgical procedures. For example, an adapter system for a distal endoscope tip is known from publication DE 10 2017 112 896 A1, which has an attachment with a tissue clip supported thereon and capable of sliding downwards. However, this attachment is significantly limited in its feasibility. Moreover, it has been found that this adapter system can be problematic, for example, when performing artificial anastomosis (i.e., establishing a connection between two anatomical cavities, such as between the stomach and small intestine). In particular, when establishing an anastomosis surgically, the opening of the connection may be too large. Therefore, in a gastrointestinal anastomosis, for example, food may be transported further within the digestive tract too quickly and thus consequently underdigested. On the other hand, the opening may be too small. Then food may be transported further too slowly. In both cases, this can lead to digestive problems. Summary of the Invention

[0005] The objective of this disclosure is to improve upon or eliminate the shortcomings of the prior art. In particular, it aims to provide an adaptable working channel system and / or tissue clip action adapter and / or surgical device system for endoscopes, which can be easily, cost-effectively, and safely installed and removed and / or reliably and simply provide additional functionality.

[0006] The objective of this disclosure is achieved by an adaptable working channel device according to the features of the invention.

[0007] More specifically, the object of the present invention is achieved by an adaptable working channel device for adaptive mounting on an endoscope. The adaptable working channel device has at least one external working channel connected to a first mounting coupler at its proximal end section. Furthermore, the adaptable working channel device has a handle mounting collar separately constructed from the working channel, the handle mounting collar being configured to loop around the endoscope shaft or endoscope handle. At least one second mounting coupler is provided on the radially outer circumferential side of the handle mounting collar, the second mounting coupler being configured for detachable mounting engagement with the first mounting coupler. The first mounting coupler has two spring-preloaded clamping branches in a clamping engagement, the clamping branches being hinged to each other in a clothespin-like manner and forming a clamping branch section and a manual operation branch section, respectively. The second mounting coupler has a mounting track extending in the longitudinal direction of the handle mounting collar and at least one side recess. The side recess is designed and sized such that its shape can be fitted around the clamping branches of the first mounting coupler. The adaptable working channel device enables a simple, shock-free, and stable coupling between the external working channel and the endoscope handle in an advantageous manner.

[0008] In other words, an adaptable working channel device with an external working channel is provided, which can be selectively fastened to or detached from the endoscope handle via a simple mounting system. The (external) working channel and the handle mounting collar fastened to the endoscope handle respectively have first and second mounting couplings configured to be detachably coupled to each other. The first mounting device on the working channel forms a clamp with two clamping branches that are elastically angle-adjustable to each other via a rocking hinge (i.e., connected in a clothespin-like manner). These clamping branches each have a first free end that protrudes beyond the rocking hinge on the clamping side to form a clamping branch section with at least one first engaging element, such as a protrusion or opening. The second free end of the clamping branch forms an operating branch section configured to be opened by the user by manual pressing operation of the opposing clamping branch section, and the operating branch section is opposite the clamping branch section with respect to the rocking hinge. The second mounting coupling has a clamp-shaped or sleeve-shaped section that can be fastened / mounted around the endoscope handle or endoscope shaft. This clamp-shaped or sleeve-shaped section has a longitudinal strip / mounting track with at least one second engaging element in the form of an opening or protrusion, configured to engage with a compatible first engaging element of the clamping branch. The clamping branch sections and operating branch sections of each clamping branch are particularly rigidly connected to each other.

[0009] Advantageous design options are described in more detail below.

[0010] The rocking hinge or articulation can be provided directly on the working channel or on the connecting sleeve of the working channel, or it can be spaced radially relative to the working channel by a spacer. This spacer ensures that the proximal entrance of the working channel is spaced from the endoscope, making the endoscope easily accessible. Furthermore, the manipulatory branch sections are preferably arranged such that they can be operated with one hand to open and / or close.

[0011] The clamping branches of the first mounting coupler preferably have facing interlocking elements, such as hook-shaped protrusions or openings, constructed on their clamping branch sections. These interlocking elements are configured to engage behind at least one side recess of the second mounting coupler. In particular, the contact surfaces of the side recesses and the interlocking elements can be configured to extend perpendicular to the clamping branches, thereby creating a stable abutment between the mounting couplers. This is particularly possible because the two clamping branches perform a sweeping motion via a clothespin-like hinge, causing each interlocking element to perform a large lateral movement and thus allowing the interlocking elements to have a relatively large extension transverse to the longitudinal direction of the clamping branches, providing a relatively large contact / abutment surface. Particularly preferred is that the protrusions are constructed along the entire width of the respective clamping branch sections to provide the longest possible and thus most stable interlocking edge.

[0012] Furthermore, it has proven advantageous that the free ends of the clamping branch sections are inclined on the end sides on the edges facing each other, so as to construct an introduction wedge between these edges.

[0013] Preferably, at least two side recesses are provided, arranged opposite each other on two circumferentially oriented flanks of the mounting track. One or more side recesses are preferably configured as through holes extending tangentially through the handle mounting collar in the longitudinal direction. This allows for simple manufacturing and provides a particularly stable coupling structure. Preferably, the handle mounting collar can have a generally cylindrical or tapered segment shape, radially outwardly curved to form the mounting track. This results in a simple structure, and the handle mounting collar can be manufactured simply and inexpensively.

[0014] More preferably, the clamping branch sections extend obliquely away from each other from the hinge or rocking hinge. In other words, these clamping branch sections form an acute angle between them. Accordingly, the clamping branch sections may also surround the mounting rail, which is constructed to be particularly wide and stable. Anti-slip structures, such as grooves or tabs, may be constructed on the outer side (i.e., away from each other) of the operating branch sections to provide reliable retention when the operating branch sections are manually operated.

[0015] It has proven advantageous that the first mounting coupling is constructed as a connecting sleeve, with the working channel connected to the distal end of this connecting sleeve. Furthermore, preferably, a Luer adapter or Luer lock adapter is connected to the proximal end of the connecting sleeve. The Luer (lock) adapter can be equipped with a biopsy valve. Alternatively, the connecting sleeve can be constructed as a complete biopsy valve. This, for example, allows for sealing of the external working channel during biopsy examination or irrigation and expands the possible functionality of current adaptable working channel devices. The connecting sleeve particularly forms a longitudinal passage / channel that connects the working channel to the proximal inlet opening of the connecting sleeve.

[0016] Preferably, the clamping branches are elastically connected to each other at positions between the clamping branch section and the corresponding operating branch section of the clamping branch via connecting plates, the connecting plates extending at an angle to or perpendicular to the clamping branches. This connecting plate enables a simple, integrated, installation-free design for the hinge or rocking hinge that connects the two clamping branches. Furthermore, the connecting plate allows the two clamping branches to be spaced apart. This allows for a greater operating stroke through the operation of the operating branch sections when opening and closing the clamping branches.

[0017] More preferably, the connecting piece and the connecting sleeve are connected, for example, by a central beam serving as a spacer retainer, which is centrally positioned on the connecting piece. The length of the spacer retainer is preferably determined such that it spacees the connecting piece and the connecting sleeve to allow unobstructed free manipulation of the operating branch section through the connecting sleeve. Furthermore, the length of the spacer retainer is determined such that the free end of the operating branch section is close to the connecting sleeve, allowing the user to apply pressure to the operating branch section by wrapping their hand around the connecting sleeve. The spacer retainer can also serve as an end stop for the operating branch section to prevent over-manipulation and consequently damage to the first mounting coupling.

[0018] Suitably, the clamping branch and connecting sleeve can be oriented relative to each other such that the longitudinal axis of the connecting sleeve and the longitudinal axis of the handle adapter collar are oriented obliquely relative to each other while the first and second mounting couplers are coupled. Preferably, these longitudinal axes form an angle between them preferably 10° to 50°, more preferably 20° to 25°. Thus, the proximal working channel entrance is oriented away from the endoscope. Therefore, the proximal working channel entrance is more easily accessible to the user. In particular, this is advantageous with the aforementioned spacer combination, because the oblique arrangement of the connecting sleeve allows the working channel to be guided diagonally towards the endoscope axis from the maximum distance. The working channel is secured to the endoscope axis particularly on the outer side and guided in the distal direction.

[0019] Advantageously, the connecting tab is wider than the clamping branch, causing the connecting tab to protrude laterally (i.e., in the proximal and / or distal directions or in the longitudinal direction relative to the working channel) beyond the clamping branch. Particularly advantageously, the handle mounting collar also comprises at least two longitudinally spaced support edges extending transversely to its longitudinal direction, the distance between which substantially corresponds to the width of the connecting tab. Side recesses are preferably constructed between the support edges. In this way, the forces transmitted through the first and second mounting couplings can be distributed to different coupling elements. For example, forces acting in the longitudinal direction of the working channel or mounting sleeve can be transmitted through the support edges and side edges of the connecting tab without loading the clamping branch section. In this case, the clamping branch section only transmits forces acting radially between the first and second mounting sections.

[0020] Preferably, the mounting track of the handle mounting collar is configured with multiple side recesses arranged offset from each other in the longitudinal direction. This allows for the provision of working channels of different lengths, which can be individually combined with the same handle mounting collar. More precisely, for example, a relatively short working channel can be secured to the handle adapter collar via a side recess arranged more distally, and / or a relatively long working channel can be secured via a side recess arranged more proximally. In this way, the combination of adaptable working channel devices with endoscopes of different lengths is simplified.

[0021] Advantageously, the handle mounting collar is configured with multiple mounting tracks that are offset from each other in the circumferential direction of the handle mounting collar, preferably arranged diametrically opposed to each other. This allows for more flexible placement of the working channels on the endoscope. Furthermore, the adaptable working channel device can therefore have multiple working channels, each with a corresponding first mounting coupler.

[0022] According to another preferred aspect, the handle mounting collar has a receiving opening configured to receive a radial protrusion of the endoscope handle. The radial protrusion is, for example, the output end of the internal working channel of the endoscope itself on the endoscope handle. Therefore, the handle mounting collar is form-fitted to the endoscope handle at least in the longitudinal and / or circumferential directions of the handle adapter collar. This enables a particularly simple, stable, and abrasion-resistant connection between the handle mounting collar and the endoscope handle.

[0023] Furthermore, it is advantageous that the handle mounting collar has a continuous longitudinal gap and is at least partially elastically configured so that it can clamp onto the endoscope shaft / handle in a clamping manner. This allows the handle mounting collar to apply tension to the endoscope shaft / handle. In particular, the circumferential region of the handle mounting collar opposite the longitudinal gap may have one or more perforations to form a region that is at least partially elastic. In other words, the collar structure can be locally weakened to have higher elasticity than other areas of the handle mounting collar. It is particularly advantageous that the longitudinal gap is formed on the side opposite the receiving opening along the diameter, and the weakened collar structure is provided through the receiving opening.

[0024] According to another advantageous aspect, the handle mounting collar has a retainer on which a first end of the hook and loop fastener is mounted or can be mounted. Additionally, the handle mounting collar may have a fastening section configured to hold a closed section of the hook and loop fastener in a position where the fastener is positioned around the handle mounting collar such that it extends across the longitudinal gap. In other words, a hook and loop fastener is provided arranged on the handle mounting collar such that it encloses at least a portion of the longitudinal gap and the handle mounting collar to apply tension to an endoscope section disposed within the handle mounting collar. Preferably, the retainer and / or the fastening section are radially externally mounted on a mounting rail or correspondingly on two opposing mounting rails. This provides a lever that applies a large tension force to the hook and loop fastener around the handle mounting collar. The closed section can be constructed as a ratchet belt or a Velcro belt according to the principle of perforated belt, wherein the belt fastening section is adapted accordingly.

[0025] Alternatively or additionally, the task on which this disclosure is based is solved by an tissue clip action adapter according to the invention.

[0026] More precisely, a tissue clip action adapter is provided, constructed according to the type of cap attachment for a medical endoscope, that is, constructed separately from the medical endoscope. The tissue clip action adapter has a sleeve-shaped base. This base has a proximal endoscope holding section configured to be mounted on the distal head of the medical endoscope. Furthermore, the base has a tissue clip holding section configured to carry a tissue clip on its radially outer circumferential surface, such that the tissue clip can be removed distally from the tissue clip holding section. In particular, the base is open distally to allow instruments, etc., to be advanced through the base into the patient's treatment site / cavity, and / or patient tissue can be retracted / pulled into the base.

[0027] Furthermore, the tissue clip adapter has a first working channel connector with its own first internal channel. The first internal channel extends through the substrate such that its proximal first channel end is open on the outside of the substrate and its distal first channel end opens into the internal space inside the substrate. In other words, a passage connecting to or capable of connecting to a separate working channel extends diagonally from the radially external side of the substrate, starting proximally, that is, penetrating the wall of the substrate in a distal and radially internal direction. Optionally, an internal protrusion may be provided within a second internal channel to position the external working channel to be connected or already connected in the distal direction.

[0028] The advantage of this is that it provides an additional working channel through which instruments, irrigation hoses, etc., can be advanced directly into the space in front of the actual endoscope. In particular, the diagonal orientation of the first internal channel has already oriented the pushed-in instruments, etc., in the corresponding radial direction, which is advantageous, for example, for irrigation processes or for pulling tissue into the matrix.

[0029] In particular, this is advantageous for the targeted setting of the tissue clips. For this purpose, the grasping instrument can be advanced into the matrix through a corresponding external working channel and a first internal channel and extend distally from the matrix. There, the grasping instrument can specifically grasp the patient tissue in an area directly within the field of view of the endoscope's optics and pull the patient tissue into the interior of the matrix. If the tissue clip is subsequently removed / pushed downward in the distal direction from the tissue clip holding segment, targeted clamping of a specific segment of the patient tissue occurs. The grasping instrument can be mechanical, such as a clamp-like instrument or a suction instrument, capable of securing / grasping the patient tissue by suction pressure.

[0030] The tissue clip action adapter's adapter itself has a second working channel connector with a second internal channel extending along the base, such that the proximal and distal ends of the second internal channel are open on the outside of the base. Furthermore, the distal end of the second channel is positioned proximal to the tissue clip holding section. In other words, an (internal) channel is provided that extends substantially linearly along the outer circumferential surface of the sleeve-shaped base to connect (independent of the first internal channel) to, or be connectable to, an additional external working channel from the proximal direction to, or that can be connected to, the tissue clip action adapter. Optionally, an extension may be provided within the second internal channel to position and secure the external working channel to be connected or already connected in the distal direction.

[0031] Therefore, current tissue clip action adapters enable instruments, irrigation hoses, special optics, etc., to provide an environment for observing or manipulating patient tissue to be clipped, without limiting the functionality of the tissue clip action adapter used to clip patient tissue, or significantly limiting the compatible endoscopes. This is particularly advantageous when performing anastomosis, where a tissue opening of a specified size remains open near the tissue being clipped.

[0032] In this example application of setting up anastomosis, a dilator, such as a balloon catheter, can be advanced into the tissue opening to be set through a correspondingly connected external working channel and a second internal channel. There, the dilator can be expanded to a predetermined size / predetermined diameter. If the patient tissue to be clamped is subsequently grasped by a gripping instrument directly next to the dilator and pulled into the matrix as described above, the patient tissue is tensioned around the dilator. When the clamp is subsequently set and the dilator is removed, a tissue opening remains next to the clamped tissue site, which substantially corresponds to the predetermined size / predetermined diameter of the dilator in the expanded state.

[0033] Preferably, on the immediate proximal side of the tissue clip holding section, a sliding sleeve, acting as a tissue clip pushing device, is movably supported on the base in the longitudinal direction to push the tissue clip down from the tissue clip holding section in the distal direction. In other words, the sliding sleeve is provided to push the tissue clip between the tissue clip holding section and the distal end of the second internal channel. This makes it possible to push the tissue clip particularly simply, uniformly, and effectively. Because the sliding sleeve also requires only a small radial structural space, the tissue clip pushing device and the expansion device do not interfere with each other.

[0034] According to an advantageous aspect, the distal end edge of the substrate (i.e., the distal end where the tissue clip adapter is located) has two retractable portions, which are opposite each other (preferably diametrically) and extend or recess in the proximal direction. In other words, the end edge is configured in a mouth shape, wherein the retractable portions form mouth-shaped corners. This is particularly advantageous so as to enable the patient tissue to be pulled into the substrate in a particularly defined manner and folded therein into the retractable portions. This allows for the clamping of the patient tissue in a particularly defined longitudinal direction.

[0035] Particularly preferably, the retractable portions are arranged offset from the second working channel connector of the adapter itself in opposite circumferential directions of the substrate, preferably offset by 70° to 110°, more preferably offset by 90°. That is, one retractable portion is offset by a corresponding angle relative to the second working channel connector in the first circumferential direction, and the corresponding other retractable portion is offset by a corresponding angle in the opposite circumferential direction to the second working channel connector. Thus, the two retractable portions are substantially diametrically opposed, and the second working channel connector is arranged in a circumferential position between the two retractable portions. In other words, the second working channel connector and the retractable portions are aligned with each other such that, during anastomosis, the patient tissue to be grasped is folded substantially tangentially to the tissue opening to be set. This allows for particularly precise and targeted subsequent tissue grasping.

[0036] Furthermore, it is advantageous that the tissue clip holding section comprises two diametrically opposed expansion support surfaces configured to hold the tissue clip expanded in a predetermined position, wherein one of the expansion support surfaces is aligned with, or arranged in the same circumferential position as the second working channel connector of the adapter itself. In other words, the tissue clip adapted to the tissue clip holding section is constructed in a bear trap shape and has two jaw-like claw segments oriented distally. One of the claw segments is arranged in the same circumferential position as the second working channel connector. This is advantageous because, during anastomosis, one of the claw segments (configured to securely grasp and clamp the patient tissue to be clipped) is directly embedded in the patient tissue next to the tissue opening to be set. In this way, the amount of "loose" tissue remaining between the tissue opening and the clipping portion, which can lead to inaccuracies in setting the size of the tissue opening, can be minimized, and digestive diseases of the patient can be avoided.

[0037] Alternatively or additionally, the objective of this disclosure is addressed by a surgical device system according to the invention.

[0038] More specifically, a surgical device system for endoscopy is provided, comprising the aforementioned adaptable working channel device and the aforementioned tissue clip action adapter. A first working channel connector of the adapter itself is coupled to a distal end section of the external working channel of the adaptable working channel device, which serves as a first external working channel. Furthermore, the device system includes a grasping instrument that is pushed into or configured to be pushed into the first external working channel in a distal direction. Thus, the grasping instrument can be advanced and moved through the internal space of the base of the tissue clip action adapter.

[0039] Furthermore, a second external working channel is provided, its proximal end section connected to a third mounting coupling for mounting on a handle mounting collar of an adaptable working channel device. The distal end section of the second working channel is coupled to the second working channel connector of the tissue clip action adapter itself. Additionally, the device system has a dilation instrument, particularly a balloon catheter, which is pushed into or configured to be pushed into the second external working channel in the distal direction. Thus, the dilation instrument can be provided radially outside the base of the tissue action adapter. With this device system, it is advantageous to achieve optimal positioning of the remaining tissue opening during anastomosis, as described in more detail above. Preferably, the first and second working channels and the respective first mounting couplings are marked differently, for example, by different colors, to distinguish the working channels.

[0040] In general, the objective of this invention is to solve the following problem. The handle (handle mounting collar) can have multiple functions. On one hand, the handle is preferably constructed like a clamp, which can be easily pushed onto or removed from the endoscope (especially the endoscope handle). With this design, the handle can be held in place on the endoscope handle by clamping. Furthermore, this design allows for the exploration of endoscope handles of different shapes. In particular, a recess in the middle (central region) of the handle allows for direct positioning at the entrance of the internal working channel of the endoscope (the recess can be positioned around the entrance). This positions the handle in height (or axial extension) (fixed position in the proximal-distal direction). Furthermore, a fastening strap (Hook and Loop fastener) can be used / provided to secure the handle entirely to the endoscope / endoscope handle.

[0041] Furthermore, the handle preferably has six locking positions (distributed in the longitudinal and / or circumferential directions) to which the connector (first mounting coupler) can be installed. These different positions should, on the one hand, compensate for different endoscope lengths (i.e., different locking positions relative to the axial extension of the handle are selected according to the length of the endoscope to be adapted), and on the other hand, provide the user with the possibility of satisfying their own preferences.

[0042] The connector forms an inlet for the external hose (working channel) and is advantageously configured with a Luer lock (Luer adapter). A biopsy valve, for example, can be located on this Luer lock. The connector is preferably secured to the handle via a catch (a first mounting coupler or clamping element for the branch section). This securing should be intuitive and simple in design. Furthermore, the securing / connection of the handle and connector can be opened via (preferably ribbed) flaps (operating branch section) to allow for repositioning of the connector.

[0043] Generally, the connector may have a Luer lock, optionally preferably with a biopsy valve that can be inserted into the Luer lock for securing the BARS system (i.e., tissue clip action adapter) and / or additional working channels (AWC system, "additional working channels"). This securing can be integrated as part of the BASE / AWC (i.e., forming a complete system). Furthermore, the connector may have an actuating clamping branch (i.e., a wing or actuating branch section). Attached Figure Description

[0044] The present disclosure will now be described according to preferred embodiments. However, these embodiments are merely illustrative and should not limit the scope of protection of the invention. Furthermore, in describing various embodiments, the same reference numerals are used for the same components to avoid repetitive descriptions thereof.

[0045] Figure 1An endoscope is shown, which has an adaptable working channel device fixed thereon according to the first aspect or preferred embodiment.

[0046] Figure 2 A top view of the handle mounting collar of an adaptable working channel device according to a preferred embodiment is shown.

[0047] Figure 3 A perspective view of the connector for the adaptable working channel device is shown.

[0048] Figure 4 A configurable configuration of an adaptable working channel device according to a first embodiment is shown.

[0049] Figure 5 Endoscopes according to the second aspect or other embodiments are shown, the endoscopes having tissue clip action adapters mounted thereon.

[0050] Wherein: 1-Adaptable working channel device; 2-Endoscope; 3-Working channel; 3a-First external working channel of the surgical device system; 3b-Second external working channel of the surgical device system; 4-Connecting sleeve; 5-First mounting coupler; 6-Second mounting coupler; 7-Handle mounting collar; 8-Mounting rail; 9-Interlocking opening / interlocking element of the second mounting coupler; 10-Supporting edge; 11-Longitudinal clearance; 12-Lateral recess / accommodating opening; 13-Radial protrusion; 14-With retainer; 15-Hook and loop fastener; 16-With fastening section; 17-Closed section; 19-Biopseal valve; 20-Luer adapter; 21-Spacer retainer / central 22-Beam; 23-Connecting tab; 24-Clamping branch; 25-Clamping branch section; 26-Hook-shaped protrusion / interlocking element of the first mounting coupler; 27-Contact surface; 28-Manipulating branch section; 29-Protruding side edge of the connecting tab; 30-Tissue clip action adapter; 31-Sleeve-shaped base; 32-Proximal endoscope holding section; 33-Tissue clip; 34-Sliding sleeve; 35-First working channel connector of the adapter itself; 36-Internal space; 37-Grasping instrument; 38-Second working channel connector of the adapter itself; 39-Dilating instrument / balloon catheter; 40-Retracted portion of the distal end edge; 41-Dilution support surface. Detailed Implementation

[0051] Figure 1An adaptable working channel device 1 is shown, which enables the mounting or modification of a medical endoscope 2 having at least one external working channel 3. In this embodiment, two (identical) working channels 3 are provided exemplary. The working channels 3 are constructed separately from the endoscope 2. Each external working channel 3 has a proximal (i.e., facing the user or away from the patient) end section. This proximal end section connects to a connecting sleeve 4 of a first mounting coupling 5. The first mounting coupling 5 is configured to form a detachable retaining engagement with a second mounting coupling 6, which is mounted on the endoscope 2 and described in more detail below.

[0052] The second mounting coupling 6 is constructed on the radially outer side of the handle mounting collar 7. The handle mounting collar 7 is basically constructed in a sleeve or clamp-like shape and surrounds a portion of the endoscope 2 of the endoscope handle, especially as Figure 1 Presented in the image. The handle mounting collar 7 has radially outwardly projecting mounting rails 8 extending in the longitudinal direction of the handle mounting collar 7. In this embodiment, two (identical) opposing mounting rails 8 are provided. Figure 2 The image presents a top view of the handle mounting ring 7 from a near-side perspective, in which it can be clearly seen that the mounting rail 8 is constructed in the form of a raised circumferential wall of the handle mounting rail 8.

[0053] The mounting rail 8 has engagement openings 9 on its side wings or sides, the sides being oriented circumferentially along the handle adapter collar 7. The engagement openings 9 are configured / sized to engage with the first mounting coupling 5. Specifically, the engagement openings 9 extend continuously through the entire mounting rail 8, opening on both side wings of the mounting rail 8. The mounting rail 8 also has support edges 10 extending transversely to, and particularly orthogonally to, the longitudinal direction of the handle mounting collar 7. The support edges 10 are arranged such that, when viewed in the longitudinal direction, one support edge of the support edge 10 is present on each side of each engagement opening 9.

[0054] The handle mounting collar 7 has in Figure 2 The longitudinal gap 11 presents a gap that completely cuts / segments the handle mounting collar 7 along its longitudinal direction at a circumferential position. Therefore, the handle mounting collar 7 can be widened to accommodate and snap onto the endoscope handle through the longitudinal gap 11. Particularly on the side opposite the longitudinal gap 11, the handle mounting collar 7 has a receiving opening 12 configured to accommodate a radial protrusion 13 of the endoscope.

[0055] Furthermore, in the region between the two supporting edges 10 (where the interlocking opening 9 is preferably not provided), a strap retainer 14 for retaining the hook and loop fastener 15 is constructed on the radially outer side of one of the mounting tracks 8. Preferably, the hook and loop fastener 15 is translationally fixed on the strap retainer 14, but optionally it can rotate about an axis transverse to the longitudinal direction of the handle mounting collar 7. On the opposing mounting tracks 8, a strap fastening section 16 is constructed at the same height with respect to the longitudinal direction. The strap fastening section 16 is configured such that when the hook and loop fastener 15 crosses the longitudinal gap 11 and wraps around the handle mounting collar 7, the closed section 17 of the hook and loop fastener 15 can be fastened to the strap fastening section. Figure 1 The hook and loop fastener 15 is positioned in a fastened position across the longitudinal gap, where only the ends of the hook and loop fastener 15 are visible. These ends are held on the strap retainer 14 and the strap fastening section 16, respectively, and protrude from behind the endoscope. Figure 4 In this configuration, the hook and loop fastener 15 is positioned in a drooping position, in which it is not fastened to the fastening section. This is particularly evident from... Figure 2 As can be seen, the fastening section 13 and / or the retainer 14 can be provided in the form of a button.

[0056] The structure of the first mounting coupling 5 is particularly important in Figure 1 and Figure 3 This can be clearly seen in the image. More precisely, the first mounting coupler has a connecting sleeve 4, on the distal end of which is connected an external working channel 3. According to the presented configuration, a biopsy valve 19 is provided at the proximal end of the connecting sleeve 4. Alternatively or additionally, as in... Figure 4 As shown in the diagram, a Luer adapter 20 can be constructed.

[0057] On the side of the connecting sleeve 4, a beam-shaped spacer retainer 21 extends radially outward and preferably distally to provide an inclined arrangement for the working channel 3 and the handle mounting collar 7 when the first and second mounting couplers 5, 6 are connected to each other. A connecting tab 22 is arranged at the end of the spacer retainer 21 opposite to the connecting sleeve 4, extending in two directions transverse to the spacer retainer 21. That is, the spacer retainer 21 and the connecting tab 22 are configured in a T-shape. At the outer ends of the connecting tab 22, clamping branches 23 are respectively constructed, extending at least segmentally, substantially transverse to the connecting tab 22, or substantially parallel to the spacer retainer 21. The connecting tab 22 provides a rocking hinge around which the clamping branches 23 are elastically adjustable relative to each other.

[0058] Clamping branches 23 protrude from the rocking hinge or connecting tab 22 in a direction away from the connecting sleeve 4 (i.e., radially outward with respect to the connecting sleeve 4) to form clamping branch sections 24. The clamping branch sections 24 are bent slightly outward, i.e., away from each other. Furthermore, each clamping branch section 24 is constructed with a hook-shaped protrusion 25, which faces the corresponding other clamping branch section 24 and is configured to engage with the engagement opening 9 of the second mounting device 6. The clamping branches 23 are in a closed position in the rest position, in which the clamping branch sections 24 preferably move maximally toward each other. When the first and second mounting devices 5, 6 are coupled to each other, the contact surface 26 of the corresponding protrusion 25 facing the connecting sleeve 4 abuts against the corresponding contact surface of one of the engagement openings 9 of the second mounting device 6. The contact surface 26 of the protrusion 25 is constructed substantially perpendicular to the extending direction of the spacer retainer 21 to enable the transmission of the highest possible force.

[0059] Clamping branch 23 protrudes from the rocking hinge or connecting piece 22 in a direction toward the connecting sleeve 4 (i.e., radially inward with respect to the connecting sleeve 4) to form operating branch section 27. Operating branch section 27 and clamping branch section 24 are rigidly connected to each other. If operating branch section 27 is preferably pressed / moved toward each other by a single hand by the user, clamping branch 23 tilts about the connecting piece 22 or rocking hinge, and clamping branch section 24 moves away from each other to release its clamping engagement with the engagement opening 9. Operating branch section 27 has outer grooves that enable reliable, non-slip operation of operating branch section 27.

[0060] The connecting tab 22 has side edges 28 that protrude beyond the clamping branch 22 in a lateral direction, i.e., in the proximal and distal directions. The width of the connecting tab 22 in this direction substantially corresponds to the distance between the support edges 10 of the second mounting coupler 6. Therefore, in the connected state of the first and second mounting couplers 5, 6, when as in Figure 1 As can be seen, when the working channel 3 is under load in the longitudinal direction, the supporting edge 10 of the second mounting coupler 6 and the side edge 28 of the connecting piece 22 are directly adjacent and particularly abut against each other. The side edges of the clamping branch section 24, oriented in the proximal-distal direction, do not abut against one side of their respective interlocking openings 9, which improves the force transmission between the first and second mounting collars 5, 6.

[0061] Figure 1 and Figure 4 Different configurations of self-adaptive working channel devices with essentially the same construction are shown. Figure 1 In the middle, the two working channels 3 are connected to each other at the same height by the second mounting coupler 6. Figure 4In the middle, the working channel 3 is arranged at a position that is staggered from each other in the longitudinal direction in the grid defined by the interlocking opening 9.

[0062] Figure 5 Endoscope 2 is shown, more precisely, the endoscope axis, at its distal endoscope lens, is modified with a tissue clip action adapter 29 to extend the functionality of the endoscope 2 to clamp patient tissue. The tissue clip action adapter 29 is provided as a cap-like accessory and has a sleeve-shaped base 30. The base 30 has a proximal endoscope holding section 31 and a tissue clip holding section 32, the proximal endoscope holding section configured to be secured to the endoscope lens, and a tissue clip 33 supported on the tissue clip holding section. A sliding sleeve 34 is longitudinally movably supported on the base 30 directly proximal to the tissue clip 33 or the tissue clip holding section 32. If the sliding sleeve 34 moves distally, the sliding sleeve contacts the tissue clip 33 and pushes the tissue clip distally away from the tissue clip action adapter 29.

[0063] The adapter's own first working channel connector 35 has a first internal channel configured for coupling with a first external working channel 3a. The first internal channel extends radially inwardly through the wall of the base 30 from the outside of the base 30 in a proximal direction and into the internal space 36 of the base. That is, the proximal end of the first channel is open on the outside of the base 30 and the distal end is open on the inside of the base 30. Preferably, a gripping device 37 is provided, which is pushed into or can be pushed into the first working channel 3a to be advanced through the first internal channel into the internal space 36 and, if necessary, distally outward from the base 30.

[0064] The adapter's own second working channel connector 38 has a second internal channel configured for coupling with the second external working channel 3b. The second internal channel extends proximally along the outer side of the base 30 towards the distal side. The second internal channel opens on the outer side of the base 30 at a position proximal to the tissue clip holding section 32. That is, both the proximal and distal ends of the second channel are open on the outer side of the base 30. Preferably, an expansion device 39, such as a balloon catheter, is provided to be inserted into or capable of being inserted into the second working channel 3a, so that it can be laterally provided outside the base 30 and beside the tissue clip holding section 32 via the second working channel connector 35.

[0065] The base 30 also has a distal end edge with two diametrically opposed retractable portions 40 extending proximally and capable of folding patient tissue into the internal space 36. A protrusion is provided between the retractable portions 40, the outer surface of which is configured as an expansion support surface 41 for open retention or expansion of a snap-fit ​​tissue clip 33. The tissue clip 33 has claw segments and is configured such that these claw segments snap together when the tissue clip 33 is pressed by a tissue clip holding segment 32. Thus, the claw segments are supported on the expansion support surface 41. One of the expansion support surfaces 41 is particularly arranged in a circumferential position, in which the distal second channel end is open.

[0066] The first and second external working channels 3a and 3b are preferably based on Figure 1 The external working channel 3 of the adaptable working channel device 1. Therefore, according to Figure 4 The adaptable working channel device 1 and tissue clip action adapter 29 form a surgical device system, which in particular also has a grasping instrument 37 and a dilator 39.

Claims

1. An adaptable working channel device (1) for adaptive mounting on an endoscope (2), having At least one external working channel (3) is connected to a first mounting coupler (5) at its proximal end section. A handle mounting collar (7) is constructed separately from the working channel (3). The handle mounting collar is configured to loop around the endoscope shaft or endoscope handle in a collar shape, and the handle mounting collar has at least one second mounting coupling (6) on its radially outer circumferential side. The second mounting coupling is configured to be detachably fitted into the first mounting coupling (5). Its features are, The first mounting coupling (5) has two spring-preloaded clamping branches (23) in a clamping engagement, the clamping branches being hinged to each other in a clothespin shape and forming a clamping branch section (24) and a manual operation branch section (27), respectively. The second mounting coupler (6) has a mounting track (8) that extends in the longitudinal direction of the handle mounting collar (7) and has or is constructed at least one side recess (9) that is sized such that it can be form-fitted by the clamping branch (23) of the first mounting coupler (5).

2. The adaptable working channel device (1) according to claim 1, wherein, The clamping branches (23) are elastically connected to each other by connecting tabs (22) at positions between the clamping branch section (24) and the corresponding operating branch section (27) of the clamping branch (23), the connecting tabs extending at an angle to or perpendicular to the clamping branches (23).

3. The adaptable working channel device (1) according to claim 2, wherein, The connecting tab (22) is wider than the clamping branch (23), such that the connecting tab protrudes laterally above the clamping branch (23), and The handle mounting collar (7) has at least two support edges (10) that extend laterally to its longitudinal direction and are spaced apart in the longitudinal direction, the distance between the support edges being substantially corresponding to the width of the connecting piece (22).

4. The adaptable working channel device (1) according to any one of claims 1 to 3, wherein, The first mounting coupling forms a connecting sleeve (4), the working channel (3) is connected to the distal end of the connecting sleeve and is configured with a Luer adapter (20) or an integrated biopsy valve (19) on the proximal end of the connecting sleeve.

5. The adaptable working channel device (1) according to any one of claims 1 to 3, wherein, The mounting track (8) of the handle mounting collar (7) is constructed with a plurality of side recesses (9), which are arranged in the longitudinal direction to be offset from each other.

6. The adaptable working channel device (1) according to any one of claims 1 to 3, wherein, The handle mounting collar (7) is configured with multiple mounting tracks (8), which are offset from each other in the circumferential direction of the handle mounting collar (7).

7. The adaptable working channel device (1) according to any one of claims 1 to 3, wherein, The handle mounting collar (7) has a receiving opening (), which is configured to receive a radial protrusion (13) of the endoscope shaft or endoscope handle.

8. The adaptable working channel device (1) according to any one of claims 1 to 3, wherein, The handle mounting collar (7) has a continuous longitudinal gap (11) and is at least partially elastically configured such that the handle mounting collar (7) can be clamped onto the endoscope handle or endoscope shaft in a clamping manner.

9. The adaptable working channel device (1) according to claim 8, wherein, The handle mounting collar (7) has The first end of the hook and loop fastener (15) is mounted on or can be mounted on the retainer (14), and The fastening section (16) is configured to hold a closed section (17) of the hook and loop fastener (15) in a position in which the hook and loop fastener (15) is positioned around the handle mounting collar such that the hook and loop fastener extends across the longitudinal gap (11).

10. A surgical device system for an endoscope (2), characterized in that... The adaptable working channel device (1) according to claim 1. The tissue clip action adapter (29) has its first working channel connector (35) coupled to the distal end section of the external working channel (3) of the adaptable working channel device (1) which serves as the first external working channel (3a). A gripping device (37), which is pushed into or configured to be pushed into the first external working channel (3a) in a distal direction, so as to be advanced through the internal space (36) of the base (30) of the tissue clip action adapter (29). The second external working channel (3b) has a third mounting coupling on its proximal end section for mounting on the handle mounting collar (7) of the adaptable working channel device (1), and is coupled via the distal end section of the second external working channel to the second working channel connector (38) of the adapter itself of the tissue clip action adapter (29). An expansion device (39) is inserted into the second external working channel (3b) in a distal direction or is configured to be inserted into the second external working channel (3b) so that it can be provided radially outside the base (30) of the tissue clip action adapter (29).

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