Endoscopic instrument system

Abstract

An endoscopic instrument system is provided in which sound generated by distally inputting an HF current into tissue is transmitted in a proximal direction via a structural sound transmission element to be proximally converted by an acoustoelectric converter mechanism. The resulting signal can be used in a variety of ways to draw conclusions about the situation on the distal side.

Description

Technical Field

[0001] The present invention relates to an endoscopic instrument system, in particular for performing minimally invasive surgery on the human body. Background Art

[0002] In surgery and in particular in minimally invasive surgery (MIC), there is the problem that it is difficult to characterize tissues and in particular deep tissue structures accurately during surgery, or a sufficient amount of information can only be obtained with great effort. In MIC, it is also not possible for the surgeon to check the consistency of tissue areas by direct palpation. This is mainly based on endoscopic images showing the surface of organs or body cavities. Even more difficult is the continuous control of tissue interactions, such as the treatment of tissues by microwave or high-frequency (HF) surgical systems, which consist of a generator and an instrument for supplying electrical energy to the tissue.

[0003] HF surgical systems spontaneously convert electrically applied energy into heat and in particular perform the conversion according to a pattern of cutting, coagulating or welding tissue. Although the condition of invisible tissue areas can be described by intraoperative imaging methods (such as magnetic resonance or X-ray computed tomography), this can be costly and time-consuming. Therefore, there is no real-time method that allows intraoperative control of HF interactions.

[0004] In addition, there are also endoscopically applicable methods, such as optical coherence tomography (OCT) or in vivo applicable scanners, which can image tissue in vivo behind the tissue surface shown by the endoscope. However, these methods are also cost-intensive and, for example, cannot be used for specific characterization and monitoring in thermally induced tissue manipulations due to the required installation space and limited, imprecise specifications, or can only be used to a limited extent.

[0005] Frequently performed tissue manipulations include, for example, vessel sealing by means of bipolar or monopolar high-frequency instruments, which are powered by a high-frequency generator. It is important for a successful outcome of the operation to know whether this type of vessel sealing is performed in a safe and sufficiently secure manner. There is a demand and a need to be able to quantitatively describe the state of the tissue during and after the corresponding manipulation of the tissue structure thus manipulated.

[0006] DE 10 2019 108 140 A1 describes a bipolar electrosurgical instrument from the prior art.

[0007] US2010 / 0168572 A1 describes a system for removing tissue. The system comprises a catheter having an elongated body, a high-frequency electrode for removing tissue and an acoustic transducer in the distal end region of the elongated body. Acoustic signals can be detected by means of the acoustic transducer. A monitoring unit can detect the electrical signals of the transducer and present them as treatment parameters. These parameters can be provided to the user in a graphical, optical or tactile manner. Summary of the invention

[0008] The inventors have found that sound detection and direct processing inside the human body has a low signal-to-noise ratio. The reason for this has been found to be that the electromagnetic fields and signals that accompany the high frequency current input into the body interfere in an undesirable way with the piezoelectric elements used to convert sound into electrical signals.

[0009] Therefore, the present invention at least achieves the following purpose, namely how to input high-precision and effective electric current into the human body, and at the same time accurately receive and convert sound to provide feedback to the user. In addition, it is necessary to improve the design freedom for such elements introduced into the patient's body.

[0010] This object is achieved at least by the subject matter of the following technical solution.

[0011] Accordingly, an endoscopic instrument system is provided for performing minimally invasive surgery on a human body, comprising:

[0012] Endoscopic instruments, including at least:

[0013] a distal functional device comprising a (preferably bipolar) electrode arrangement which is designed to introduce high-frequency current, HF current, into organic tissue (especially soft tissue) in the human body and also comprises a structure-borne sound receiving element To receive the structure-borne acoustic response of organic tissue to the input HF current

[0014] - proximal operating mechanisms for manipulating instrument systems (especially endoscopic instruments) and operating functional mechanisms from outside the human body; and

[0015] an elongated connecting means which mechanically and functionally connects the functional means to the operating means, wherein the connecting means comprises a structure-borne sound transmitting element which is designed to acoustically transmit a structure-borne sound response received by the structure-borne sound receiving element in the direction of the operating means; and

[0016] The acoustic-electrical converter device is designed to be arranged outside the human body when the instrument system is in use and is also designed to detect a structure-borne acoustic response at the transmission element and convert it into an electrical response signal.

[0017] An endoscopic instrument system is understood in particular to be an instrument system having components that are introduced into the human body for treatment or examination. In this context, minimally invasive surgery can mean, for example, that the body is not opened over large areas, but rather the surgeon operates through the smallest openings.

[0018] The terms "distal" and "proximal" are always used in this document from the perspective of the user, i.e. the surgeon or operating physician. Accordingly, the proximal side is the side that is arranged closer to the surgeon, while the distal side is the side that is oriented from the surgeon toward the patient. Accordingly, the functional mechanism including the electrode arrangement is arranged on the distal side of the instrument, while the operating mechanism for controlling the instrument system is arranged on the proximal side of the instrument.

[0019] The endoscopic instrument system according to the present invention can be operated and / or manipulated by a human surgeon as well as a robot. Accordingly, the proximal side is also the side where the robot acts on the endoscopic instrument system, especially the operating mechanism of the proximal side. When it is mentioned in this article that it is used by a surgeon and / or a robot, unless otherwise explicitly or implicitly stated, it should be understood that the operation and / or manipulation can also be performed by the other party accordingly.

[0020] A robot is understood, for example, to be a robot arm that manipulates and / or operates an endoscopic instrument system in a controlled manner. Manipulation is understood, in particular, to be the spatial movement and orientation of an instrument. Manipulation of an instrument includes, in particular, the triggering, changing or shutting down of mechanical, electrical, electronic or other energy-generating functions (e.g., lighting) of the instrument.

[0021] The introduction of high-frequency current, HF current, takes place in the body, primarily for the purpose of introducing or introducing heat. This in turn is used in particular for tissue fusion, i.e., for example, to permanently connect two different tissue parts to one another. For example, a surgeon can surgically remove a damaged or malignant tissue part and then fuse the remaining incision edges together with the aid of an electrode arrangement in order to close the gap created during the operation again.

[0022] A high frequency current is understood here to be a current with a frequency of at least 300 kHz. A frequency range of more than 300 kHz has the advantage that it does not trigger or triggers less critical nerve stimulation. For example, tissue fusion can be used within the scope of vessel closure, ie when closing an opening in a vessel.

[0023] Structure-borne sound is understood herein to be any type of longitudinal and / or transverse sound wave propagating in an object (including organic tissue), covering a wide frequency spectrum. The frequency spectrum may include, in particular, human-audible sound and / or ultrasound. Sound propagation inside organic soft tissue is usually more like sound propagation in a liquid than sound transmission in a typical structure. Sound transmitted inside an organic tissue may also be referred to as intra-tissue sound.

[0024] The structure-borne sound response of organic tissue to an input HF current should be understood as a signal conveyed by structure-borne sound as a carrier, which is generated as a reaction to the input HF current in the organic tissue and is transmitted as structure-borne sound through it. For example, when HF energy is applied, that is, when HF current is input into the organic tissue and is spontaneously converted into heat, tearing and rupture of cells, cell clusters and / or vacuoles may occur. The noise generated thereby ("rupture sound") is also transmitted through or only through the organic tissue as structure-borne sound and can therefore be received as structure-borne sound response by the structure-borne sound receiving element. Therefore, they provide valuable information about processes in the organic tissue that are usually invisible to the surgeon.

[0025] The structure-borne sound receiving element is preferably made of an electrically insulating ceramic material and has a thickness of preferably 15*10 6 and 35*10 6 [kg / (s*m 2 )] between the acoustic impedance.

[0026] In the case where the connecting mechanism should be configured as elongated, it should be understood in particular that the device is configured to be longer in a longitudinal direction extending between the proximal side and the distal side than in a direction perpendicular thereto. The mechanical connection of the functional mechanism to the operating mechanism may include a structural connection, whereby the operating mechanism and the functional mechanism are in particular arranged rigidly relative to each other. The mechanical connection may also include mechanically transmitting a mechanical manipulation, for example of a trigger or a grip at the operating mechanism, to the functional mechanism.

[0027] For example, the jaws of the functional mechanism can be opened or closed by operating the pull wire. The functional connection between the functional mechanism and the operating mechanism should in particular include that the function of the functional mechanism can be triggered, changed or terminated by means of the operating mechanism. For example, the function can be the opening or closing of the jaws of the functional mechanism, the output of HF current through the electrode device, or more similar functions.

[0028] As explained at the outset, the inventors have found that in the vicinity of the distal functional mechanism, the acoustic-to-electric conversion of structure-borne sound signals into electrical signals is subject to significant interference, which is primarily caused by the electromagnetic signals emitted by the electrode device. Therefore, according to the invention, it is provided that, during use of the instrument system, the acoustic-to-electric converter mechanism is arranged outside the human body, i.e., at a location advantageously far from interference sources inside the human body.

[0029] An important advantage of this spacing is that thermal and electromagnetic influences or disturbances on the converter mechanism due to the RF energy input in the region of the functional mechanism can be reduced or even completely avoided. This also applies to disturbances caused by mechanical deformation of the organic tissue, for example by the functional mechanism, such as the jaw parts, during compression of the organic tissue.

[0030] Furthermore, the spacing of the transducer mechanism from the distal working element, i.e. the functional element, and from the organic tissue (to be treated) has the advantage that there is a prolonged sound propagation time between the structure-borne sound receiving element and the transducer mechanism. Thus, for example, after the HF current has been switched off, the structure-borne sound response can be converted in a more non-interfering manner.

[0031] In particular, due to the HF current fed in at the distal end, considerable electrical interference can occur in the prior art, since, for example, HF-induced electrical breakdowns, such as in the form of arcs, can act as electrical interference transmitters. Furthermore, the arrangement of the converter mechanism at the proximal part of the endoscopic instrument has the advantage that the converter mechanism can be designed there with lower requirements and thus greater design freedom, and is also easier to clean and maintain. Furthermore, shielding against electromagnetic interference can be achieved via a shielded housing.

[0032] The goal is usually to design the functional unit as small as possible, so that a large number of different functions are arranged in a narrow space. In addition, depending on the application, the functional unit is in constant contact with liquids, thermal fluctuations, electromagnetic field fluctuations, etc. Integrating, designing and miniaturizing the acoustic transducer device into the functional unit so that it functions perfectly and reproducibly in such an environment is a complex challenge, which leads to complex and, on the one hand, significantly more error-prone and, on the other hand, significantly more cost-effective solutions.

[0033] Therefore, according to the present invention, in the use of the instrument system, in particular the instrument, the converter mechanism is arranged outside the human body and does not have to be specially isolated or protected against the above-mentioned influences. Even when installed on the proximal side, a certain (less) protection, shielding and electrical disconnection are required. However, this protection can be achieved significantly more easily on the proximal side. The acoustic-electric converter mechanism can be placed in the instrument housing, for example in the handle. In any case, the handle is usually tightly sealed and isolated, on the one hand to resist external influences, and on the other hand for hygienic reasons. In addition, the installation space is not limited on the proximal side and therefore does not need to be reduced, so (electrical) standard components, assemblies and parts can be installed (in a low-cost manner).

[0034] The structure-borne sound receiving element and / or the structure-borne sound transmitting element are in particular designed and arranged to receive or transmit audible sounds and / or ultrasonic waves. The inventors have identified the following frequency ranges for structure-borne sound to be detected and transmitted as particularly preferred frequency ranges: 1 to 20 kHz and 20 to 80 kHz. The electrical response signal generated by the transducer mechanism can be transmitted to various applications and / or used to control various functions, as will be described in more detail below.

[0035] The functional means can be designed in particular to introduce HF current into soft tissue, particularly preferably into vessels and / or flexible organs. The electrode device for applying energy by introducing HF current can be designed and configured in particular to perform vessel sealing by applying electrical monopolar HF energy and / or by applying electrical bipolar HF energy.

[0036] According to some preferred embodiments, variants or improvements of the embodiments, the functional mechanism has a first jaw part and a second jaw part, which are designed to clamp organic tissue by relative movement relative to each other. The first jaw part can be rigidly arranged relative to the connecting mechanism. Preferably, the structure-borne sound receiving element is arranged at the rigidly arranged first jaw part, which has the advantage that the transmission of the structure-borne sound is less disturbed by the movement of the first jaw part itself, and the transmission element can be relatively simply constructed. The receiving element and the transmission element can be embodied as a one-piece, which achieves optimal structure-borne sound transmission toward the proximal side.

[0037] For example, the transmission element can preferably be configured as a rigid, elongated element. Alternatively, the structure-borne sound receiving element can also be arranged at the movable second jaw part, or the structure-borne sound receiving units of the structure-borne sound receiving element can also be arranged at the two jaw parts. In order to adapt to the movement of the movable jaw part, the transmission element can also be configured as flexible, articulated, bendable, etc.

[0038] If the structure-borne sound receiving unit and the structure-borne sound transmitting unit cannot be designed as one piece or cannot be implemented as one piece for structural reasons, the individual units are preferably connected to one another in a form-fitting manner and by corresponding forces which maintain the form-fitting connection even during sound transmission. Such a form-fitting, force-loaded connection can be, for example, a pin-and-hole articulated connection, which is common in distal mechanisms for closing the jaw parts, in which the pin and the hole are connected to one another in a force-fitting and form-fitting manner via a tensile force which closes the jaw parts.

[0039] The jaw parts, which are often referred to as distal actuator elements, can be moved relative to one another in the shape of jaws or pincers to open or close the "jaws" or "pincers". In this way, organic tissue can be grasped and held. For example, this enables the introduction of HF currents into organic tissue in a highly precise manner, for example in order to fuse the grasped tissue, etc.

[0040] It is particularly preferred that the electrode device is arranged at the first jaw part and / or the second jaw part, preferably only at one jaw part, and particularly preferably at the rigidly constructed first jaw part. In combination with the structure-borne sound receiving element arranged at the first jaw part, the structure-borne sound response of the organic tissue to the input HF current can be acquired as close as possible to the place where the structure-borne sound response is caused by the input of the HF current.

[0041] Accordingly, according to some preferred embodiments, variants or improvements of the embodiments, the electrode device is arranged at the first jaw part and / or the second jaw part, in particular at the corresponding inner sides of the first jaw part and / or the second jaw part. The inner sides of the jaw parts should be understood as those sides of the jaw parts that move toward each other when the jaw parts are closed and contact each other when necessary. Preferably, the structure-borne sound receiving element is spatially arranged between the first electrode of the electrode device and the second electrode of the electrode device, wherein the first electrode and the second electrode of the electrode device are particularly preferably arranged at the rigid first jaw part.

[0042] The structure-borne sound receiving element is therefore arranged in the closest possible proximity to the location at which the HF current is introduced into the organic tissue. The structure-borne sound response can thus be detected particularly precisely and thus also with a particularly good signal-to-noise ratio.

[0043] The structure-borne sound receiving element is usually advantageously arranged in the functional area of ​​the instrument in such a way that it is in direct contact with the location of the occurrence of the sound event, in particular the tissue to be treated, as far as possible during the use of the instrument. Some variants of the instrument have ribs at the jaw parts so that when the jaw parts are pressed together, an increased pressure is generated in the area through which the input HF current flows. This creates an area of ​​the tissue that is strongly compressed and pressed together with a small volume, through which the input HF current is guided. This combination ensures an efficient effect of the HF current. This is particularly advantageous for so-called vessel sealing instruments, i.e. vessel sealing instruments, which are used to seal vessels in which tissue is pressed together and heated by means of HF current.

[0044] In such an instrument with ribs, the structure-borne sound receiving element can preferably be arranged in the functional surface of the rib, i.e., in or at the surface with which the tissue can be pressed. This surface can also be referred to as a clamping surface. Alternatively or additionally, the structure-borne sound receiving element can also be arranged at the surface of the jaw part which is opposite to the functional surface (pressing surface) of the rib and interacts with it.

[0045] The structure-borne sound receiving element can be made of an electrically insulating material and / or be provided with an electrically insulating portion. It is particularly advantageous if the structure-borne sound receiving element is arranged so that, during use of the instrument, it is adjacent to a tissue region through which an electric current is conducted. Alternatively, the structure-borne sound receiving element can also be made of or include an electrically conductive material (e.g. steel, etc.). In these cases, it is advantageous if a compensation mechanism is arranged on the proximal side of the instrument, which is configured to avoid, reduce or compensate for interfering electrical influences and couplings. For example, the structure-borne sound transmission element from the distal side to the proximal side can be configured so that interfering electrical influences or couplings are avoided, for example, in which the structure-borne sound transmission element is completely or partially made of a non-conductive material and / or is correspondingly electrically insulated or shielded.

[0046] The structure-borne sound receiving element can generally be advantageously configured so that sound events in the tissue are received with as little loss as possible (e.g. due to reflection) and are transmitted as losslessly as possible from the distal side to the proximal side. To this end, the acoustic characteristic impedance (or: acoustic impedance) can preferably be selected so that it is located as close as possible to the tissue to be treated. In some embodiments, an acoustic characteristic impedance adaptation mechanism can be provided, which is configured to adapt the acoustic characteristic impedance of the structure-borne sound receiving element automatically or due to manual adjustment.

[0047] At 1.4Ns / m 3 and 104Ns / m 3 Between, preferably 20Ns / m 3 and 80Ns / m 3 between 40Ns / m 3and 60Ns / m 3 The value between 0.2 mm and 1.0 mm has been shown to be a favorable value for the acoustic characteristic impedance of the structure-borne sound receiving element. The structure-borne sound receiving element may be configured to be thin and flat, which may be advantageous for receiving lateral, longitudinal and additionally generated vibrations (e.g., bending vibrations). For example, such a thin and flat structure-borne sound receiving element may have a wall thickness in the range of 0.2 mm to 1.0 mm.

[0048] For example, the structure-borne sound receiving element may comprise or consist of one or more of the following materials:

[0049] - steel (e.g. surgical steel);

[0050] - Ceramic materials;

[0051] - plastic materials (in particular plastic materials with a Shore A hardness value of less than 70, see below);

[0052] - Reinforced, electrically insulating plastic materials including glass spheres, glass fibers, carbon fibers, quartz, ceramics and / or other fillers and / or reinforcing materials;

[0053] - and / or more similar ones.

[0054] According to some preferred embodiments, variants or improvements of embodiments, one or both electrodes of the electrode arrangement can also be designed as a structure-borne sound receiving element or form part of a structure-borne sound receiving element.

[0055] According to some preferred embodiments, variants or improvements of the embodiments, the entire jaw part can also be designed as a structure-borne sound receiving element.

[0056] According to some preferred embodiments, variants or improvements of embodiments, the converter means has a piezoelectric element, particularly preferably a piezoelectric element which is arranged in the proximal region such that it is arranged outside the body during use of the instrument.

[0057] Piezoelectric elements are particularly suitable for converting acoustic vibrations (whether longitudinal or transverse waves) into electrical signals. In principle, all piezoelectric materials known from the prior art can be used. For example, the piezoelectric element can consist of lead zirconate titanate (PZT) or comprise PZT. Piezoelectric elements made of zinc oxide ceramics or flexible piezoelectric polymers such as piezoelectric films made of PVDF (polyvinylidene fluoride or polyethylene difluoride) and / or composites thereof and / or PZT are also conceivable.

[0058] Furthermore, it is also possible to have piezoelectric fibers that can have PVDF nanofibers or PZT fibers and / or consist of them. The preferred shape and arrangement of one or more piezoelectric elements is determined by the desired application and the properties (frequency) of the structure-borne sound response and whether transverse vibrations and / or longitudinal vibrations and / or other structure-borne sound waves, such as "bending waves", are to be detected and converted. For example, such other structure-borne sound waves can be generated by coupling longitudinal and transverse waves.

[0059] PVDF advantageously has a very high dynamic and frequency range (10 -8 Up to 10 5 N / cm 2 or 0.1 Hz to 1 GHz) and is therefore very suitable for detecting low (body) sound pressures over a wide frequency range. Moreover, temperature changes also lead to charge changes in the PVDF film material. Thus, the temperature can be detected on the far side with a PVDF element and the structure-borne sound response can be detected on the near side at the structure-borne sound transmission element with the aid of a PVDF element, for example a PVDF film. Furthermore, the temperature sensor of the instrument system, in particular the instrument, can have a piezoelectric element, in particular a PVDF film.

[0060] For example, for the conversion of transverse vibrations, a piezoelectric film arranged concentrically around the connecting means is advantageous. For the conversion of longitudinal vibrations, a piezoelectric element (or other transducer means) mounted at the proximal end of the connecting means is advantageous.

[0061] According to some preferred embodiments, variants or improvements of the embodiments, the converter mechanism comprises an optical detection system, for example based on time-resolved distance measurement by measuring the runtime of the laser beam in the manner of an “optical microphone”. In this way, a mechanical decoupling between the converter mechanism and the transmission element can be advantageously achieved, which can further increase the degree of freedom in design, since the converter mechanism does not necessarily have to rest against the transmission element in a perfectly fitting manner.

[0062] According to some preferred embodiments, variants or improvements of the embodiments, the converter mechanism comprises a MEMS sensor, in particular a MEMS accelerometer, i.e., an acceleration measuring device. Such high-precision MEMS accelerometers known in the prior art can also be used to accurately detect and convert the structure-borne sound response transmitted via the transmission element.

[0063] According to some preferred embodiments, variants or improvements of the embodiments, the converter device is configured to detect structure-borne sound shear waves and / or to detect structure-borne sound longitudinal waves and / or other structure-borne sound waves at the structure-borne sound transmission element. The structure-borne sound transmission element can have various sound transmission units, of which, for example, one is configured to transmit structure-borne sound longitudinal waves and / or a next one is configured to transmit structure-borne sound shear waves and / or another one is configured to transmit other structure-borne sound waves, such as bending waves.

[0064] The converter arrangement can also have two or more converter units, for example a first converter unit which is constructed and equipped for detecting structure-borne sound shear waves, and a second converter unit which is constructed for detecting structure-borne sound longitudinal waves at the structure-borne sound transmission element, as well as another converter unit for detecting other structure-borne sound waves, such as bending waves, for example.

[0065] The first converter unit, the second converter unit and / or more converter units can be integrated with each other, adjacent to each other or can also be constructed and arranged separately from each other. Since different processes and events in organic tissue can generate different types of structure-borne sound waves, the separate detection of structure-borne sound shear waves on the one hand and structure-borne sound longitudinal waves on the other hand can provide valuable indications for these events and draw corresponding conclusions. A common electrical response signal can be generated, or the electrical response signal can include a first electrical response signal generated by the electrical conversion of the structure-borne sound shear waves and a second electrical response signal generated by the electrical conversion of the structure-borne sound longitudinal waves.

[0066] In order to detect the longitudinal waves of structure-borne sound, the piezoelectric element of the converter mechanism can be arranged in the cross-sectional area of ​​the proximal end side or proximal region of the rod of the connecting mechanism or the working element located inside. This can be achieved, for example, by means of a PZT ceramic disk, a PVDF film, etc.

[0067] The working element located inside can be understood as, for example, a pulling and / or pressurizing element for moving a distal actuator such as a jaw member, a cutting blade, etc. Examples of pulling and / or pressurizing elements are, for example, pulling rods and / or pressurizing rods or pulling ropes / lines.

[0068] It is also conceivable that the piezoelectric element of the converter mechanism is integrated into the component for transporting the current. In another embodiment, the above-mentioned elements such as the suction irrigation tube integrated into the rod or located inside or the like can also be used as the structure-borne sound transmission element and the converter mechanism is installed in its proximal area.

[0069] In another embodiment, at least one additional structure-borne sound transmission element can be integrated as a linear or strip-shaped element located inside or integrated in the instrument shaft, to which one or more converter units are mounted proximally. This embodiment has the advantage that the structure-borne sound transmission can then be completely decoupled from other (mechanical) functions. This also makes it possible to adapt the linear or strip-shaped structure-borne sound transmission element in terms of cross section and length to the most important frequencies to be transmitted, so that the resonance effect can be fully utilized in a targeted manner for specific frequency ranges.

[0070] According to some preferred embodiments, variants or improvements of the embodiments, the converter mechanism is integrated into the endoscopic instrument. This enables a particularly compact arrangement and easy control, since no other instruments or elements besides the endoscopic instrument must be controlled.

[0071] According to some preferred embodiments, variants or improvements of the embodiments, the structure-borne sound transmission element is designed to be thin and narrow. For example, the structure-borne sound transmission element can have a cross section of 0.05 mm to 10 mm, preferably between 0.2 mm and 5 mm, particularly preferably between 0.3 mm and 0.5 mm.

[0072] The structure-borne sound transmission element can be fastened or mounted flexibly and / or movably, so that it can vibrate freely in the transverse and longitudinal directions.

[0073] For example, unnecessary "reinforcement" and / or contact and / or fastening between the sound transmitting element and other components may be intentionally structurally avoided.

[0074] According to some preferred embodiments, variants or improvements of the embodiments, the structure-borne sound transmission element consisting of a relatively hard material can be completely or partially embedded in a relatively soft medium or surrounded by it. In this way, the structure-borne sound transmission element can vibrate as undamped as possible. Preferably, the relatively soft medium has a hardness of 1000 MPa or less (for example, a thin plastic sheath) and / or a Shore A hardness of less than 70 (preferably less than 50, particularly preferably less than 30) and / or a volume mass (in the case of foam), preferably in the case of open-cell foam, of less than 30 kg / cbm.

[0075] According to some preferred embodiments, variants or improvements of the embodiments, the endoscopic instrument system also includes a trocar sleeve, through which at least the functional mechanism can be guided and can be introduced into the human body during minimally invasive surgery. The converter mechanism can advantageously be integrated into the trocar sleeve. This has the advantage that the endoscopic instrument can therefore be constructed in a simpler manner. In addition, a correspondingly constructed trocar sleeve can be used with a large number of different endoscopic instruments, which accordingly only have to ensure that the structure-borne sound response can be detected at the transmission element by the converter mechanism integrated into the trocar sleeve.

[0076] According to some preferred embodiments, variants or improvements of the embodiments, the converter mechanism is mounted at the sealing mechanism of the trocar sleeve, which seals and isolates the distal space in the trocar sleeve from the proximal space in the trocar sleeve. Of course, the sealing mechanism is constructed and arranged so that it fits particularly tightly to the endoscopic instrument guided through the trocar sleeve to ensure a particularly good seal. This close contact also facilitates reliable and accurate detection of the structure-borne sound response transmitted by the structure-borne sound transmission element by the converter mechanism mounted at the sealing mechanism.

[0077] In this case, it is advantageous if the structure-borne sound transmission element is arranged at least partially on the outside of the endoscopic instrument in such a way that when the endoscopic instrument is introduced through the trocar sleeve at least the part arranged on the outside comes into contact with the converter means arranged on the sealing means.

[0078] According to some preferred embodiments, variants or improvements of the embodiments, the converter mechanism is supported on the trocar sleeve in such a way that it is pressed or can be pressed against the structure-borne sound transmission element when the functional mechanism is guided through the trocar sleeve. As already mentioned above, this can be achieved by mounting the converter mechanism on the sealing mechanism of the trocar sleeve.

[0079] According to other variants, the movable mounting can also be realized by using elastic elements such as springs or leaf springs, for example. A further advantage is that by pressing the converter means against the structure-borne sound transmission element (or at least a part thereof), a particularly good structure-borne sound transmission can be achieved between the structure-borne sound transmission element and the converter means, whereby in turn a response signal can be generated by the converter means in a particularly precise manner and with a high signal-to-noise ratio.

[0080] According to some preferred embodiments, variants or improvements of the embodiments, the structure-borne sound transmission element has a rigid structure, a hollow waveguide and / or a prestressed wire. This involves various implementation possibilities that have both reliable structure-borne sound transmission and good compatibility with the requirements of endoscopic instrument systems, in particular endoscopic instruments.

[0081] Examples of structure-borne sound transmission elements, in particular for rigidly constructed devices, are also:

[0082] - Rigid, elongated metal strips;

[0083] - a rigid, elongated, metallic, tension-pressure transmitting element; and / or

[0084] - A rigid, elongated instrument rod (eg a rod of a connecting mechanism).

[0085] Examples of structure-borne sound transmission elements, in particular for flexibly constructed devices, are also:

[0086] - Flexible wire with preload;

[0087] - a flexible tension-pressure transmission element, which is realized, for example, in the form of a Bowden cable;

[0088] - a flexible light conductor; and / or

[0089] A hollow waveguide, for example a flexible sound transport body in the form of a hose, which is filled with a liquid, for example water, oil, or a metallic liquid such as a gallium alloy.

[0090] According to some preferred embodiments, variants or improvements of the embodiments, the instrument system further comprises a computing mechanism configured to acquire the electrical response signal and generate an output signal at least based thereon. The output signal can be designed in various ways and can be configured, for example, to control an output mechanism such as a screen and / or a speaker.

[0091] The output signal advantageously enables, in particular, monitoring and / or quantitative tissue characterization of the manipulated tissue, for example during HF current-supported tissue fusion by an endoscopic (HF current) instrument. Such monitoring is particularly advantageous for determining whether the thermally induced closure of the blood vessel is sufficiently stable to withstand a corresponding maximum pressure (greater than the maximum systolic pressure). Thus, the output signal can generally indicate a quantitative tissue characterization or can also specifically indicate whether the tissue closure is sufficiently stable.

[0092] It has been found that the acoustic information contained in the structure-borne acoustic response depends critically on the type of tissue (especially soft tissue), the incoming energy density, the temperature induced by it, the fluid content of the tissue and the number of denatured tissue areas or cell clusters. This acoustic information is not only in the frequency range of human hearing (below 20 kHz) but also above it (ultrasound, starting from 20 kHz) due to the cavitation effect that occurs (pops / cracking sounds).

[0093] It has also been shown that the more intense the cavitation events ("cracking sounds") are and the closer they occur to the end of the vessel sealing process, the worse the vessel sealing is classified as. Thus, based on the analysis of the structure-borne acoustic response, the tissue state can be characterized by a computational mechanism during and shortly after the treatment (i.e., input of HF current). Thus, the output signal can indicate the current tissue state of the organic tissue.

[0094] The computing mechanism may in particular be a general-purpose computer specially configured for this application. The computing mechanism may be completely local, completely remote (e.g., a cloud computing platform, a remote server), or partially local and partially remote (e.g., a local terminal connected to a remotely connected server). In particular, the computing mechanism may include one or more central processing units (CPUs in English), one or more graphics processing units (GPUs in English), memory (RAM in English), non-volatile data storage, and input interfaces and / or output interfaces, all of which are interconnected.

[0095] The computing mechanism may also have one or more application-specific integrated circuits (ASICs), field-programmable gate arrays (FPGAs), microprocessors, and / or more of the like. The computing mechanism may be implemented entirely in hardware, or partially in hardware and partially in software.

[0096] According to some preferred embodiments, variants or improvements of the embodiments, the computing device is configured to generate output signals in real time. In this way, the output signals can provide valuable real-time feedback about events occurring in the organic tissue to the user of the endoscopic instrument system, especially the surgeon. The instrument system can include improved and controlled human-machine interaction in this way, which enables the user to obtain information about internal processes or states in the instrument system based on the output signals and to react appropriately thereto.

[0097] According to some preferred embodiments, variants or improvements of the embodiments, the output signal comprises an audible acoustic output signal. Such an acoustic output signal can advantageously indicate different states of the organic tissue into which the HF current has been or is being fed, and / or indicate the process therein. The audible acoustic output signal can comprise a spoken language, which can be generated, for example, by a speech generator. The language can be generated and output in a quasi-real-time manner, or it can be generated and output after the HF input process in a manner that respectively has the target of evaluation and / or the naming of possible problems.

[0098] However, the audible acoustic output signal may also represent an exact reproduction or a frequency-shifted reproduction of a structure-borne sound response received by the structure-borne sound receiving element in a defined frequency range, for example in the ultrasonic range, similar to the human-visible display of a false color image comprising a frequency shift of the electromagnetic spectrum which is practically imperceptible to humans.

[0099] As a further alternative, the audible acoustic output signal can also have a continuous acoustic output with different acoustic frequencies audible to humans, which frequencies respectively indicate a state or process in the organism, i.e. inform the user. For example, it can be provided that the calculation device determines based on the electrical response signal of the acoustic-electric converter device whether the input of the HF current is currently operating within acceptable parameters. If too much heat is input, for example in a point-like manner, the undesirable effects already described may occur.

[0100] The pitch (corresponding to the frequency) of the audible acoustic output signal can discretely or steplessly indicate whether the function currently applied by the functional mechanism is completely within the acceptable range (e.g., low frequency), completely within the unacceptable range (e.g., high frequency), or in between (interpolation frequency between high and low frequencies).

[0101] A particular advantage of an audible acoustic output signal is that the user of the endoscopic instrument system usually obtains visual feedback about the progress of the surgical intervention by observing the patient and the instrument, and can also experience tactile feedback when manually guiding the endoscopic instrument. The audible acoustic output signal expands this feedback by acoustic feedback, thus opening up an additional information channel for the user using it, without thereby compromising the visual and / or tactile feedback channels.

[0102] According to some preferred embodiments, variants or improvements of embodiments, the calculation device and / or the converter device is configured such that the output signal is based only on a response signal based on a structure-borne sound response received without an HF current input. In other words, the measurement of the structure-borne sound response is performed intermittently (or alternately) with respect to the pulsed HF energy application. The switching off of the pulsed HF current can hereby correspondingly trigger (or: stimulate) the measurement, i.e., in particular the evaluation of the electrical response signal of the converter device.

[0103] For example, the entire endoscopic instrument system can be constructed and configured so that phases of inputting HF current alternate with phases of evaluating the response signal. In order to coordinate the input and, for example, the evaluation in time, a signal exchange can be provided between the high-frequency generator and the computing device of the instrument system. The temporal coordination can ensure that the response signal generated by the converter device is disturbed or distorted as little as possible due to the input of the HF current.

[0104] However, due to the distance according to the invention between the distal structure-borne sound receiving element and the proximal transducer mechanism, the signal-to-noise ratio is already very good in many cases. Therefore, in these cases, the response signal of the transducer mechanism can be continuously analyzed, which in turn enables continuous measurement-technical control of the surgical intervention (e.g., tissue fusion process). In other words, the analysis of the response signal can be carried out continuously.

[0105] According to some preferred embodiments, variants or improvements of the embodiments, the functional mechanism includes at least one other sensor, which is configured to generate at least one sensor signal. The computing mechanism can also be configured to additionally generate an output signal based on at least one sensor signal. It should be understood that the output signal can also be composed of a plurality of sub-signals, which are transmitted in a mutually independent manner and can even be evaluated in a mutually independent manner. Only for the purpose of simplifying the representation and description, these sub-signals are collectively referred to as "output signals" in this article.

[0106] The at least one further sensor may be, for example, a temperature sensor, an electrical impedance sensor, a tissue thickness sensor and / or a pressure sensor. The generation and evaluation of further sensor signals has the advantage that the computing device can take into account additional information about states or processes in the organic tissue or about internal states or processes in the endoscopic instrument system, in particular the endoscopic instrument itself, when generating the output signal. This can be done, for example, based on predetermined evaluation rules, simulation models, digital twins (e.g. endoscopic instruments), etc.

[0107] One or more of the at least one other sensor can also include a piezoelectric element or be configured as a piezoelectric element, such as a piezoelectric element composed of the materials and material combinations described above. In particular, a temperature sensor or a sensor for mechanical forces advantageously has a piezoelectric element. Particularly preferably, the sensor can be implemented by means of one or more piezoelectric elements, which measure one or more forces currently applied by the jaw part of the functional mechanism to the organic tissue.

[0108] According to some preferred embodiments, variants or improvements of the embodiments, the computing device is designed to generate the output signal at least partially based on an artificial intelligence entity (KIE). KIEs are increasingly being shown to be able to acquire extensive amounts of data and, especially after previous training, to quickly and reliably draw conclusions based on these data, which sometimes can be drawn faster than humans or take into account more interrelationships than humans.

[0109] The use of a KIE is particularly advantageous if, as already described above, at least one further sensor generating a sensor signal is provided so that the KIE detects as much and as diverse input data as possible and generates an output signal based thereon. In particular, the KIE should receive as input an electrical response signal of an acoustic-electrical transducer mechanism, wherein further input data are preferably provided, such as temperature data of a temperature sensor, impedance data of an electrical impedance sensor, tissue thickness data of a tissue thickness sensor, and / or pressure data of a pressure sensor.

[0110] According to some preferred embodiments, variants or improvements of the embodiments, the output signal comprises a control signal, which is configured to control the function of the functional mechanism. The output signal may also consist of a control signal. Thus, the output signal may directly partially or completely take over the control of the endoscopic instrument without previously being displayed to a human user or otherwise (or in addition thereto) making the human user aware.

[0111] This is particularly advantageous if the endoscopic instrument system comprises a robotic mechanism (e.g. a robotic arm) which is designed and equipped to manipulate the endoscopic instrument and to operate the functional mechanisms via the operating mechanism. If the output signal indicates, for example, that a tissue section is currently being burned, the electrode arrangement can be controlled directly, for example, so that the incoming HF current is reduced or completely switched off. In particular, this can be done faster than a human user could.

[0112] In particular, when the output signal includes a control signal configured to control (or drive) the electrode device, a control loop can be formed: the input HF current causes a structure-borne acoustic response of the organic tissue, which is received by the structure-borne acoustic receiving element and transmitted by the structure-borne acoustic transmitting element to the acoustic-electric converter mechanism. Based on this, the converter mechanism generates an electrical response signal, and the calculation mechanism generates an output signal based on the electrical response signal, which output signal includes a control signal for the electrode device. Thus, the electrode device can be advantageously controlled in a closed control loop.

[0113] The above-mentioned designs and improvements can be combined with each other when necessary. Other possible designs, improvements and embodiments of the present invention also include combinations of features of the present invention described above or below with reference to the embodiments that are not explicitly mentioned. In particular, those skilled in the art will also add various aspects as improvements or supplements to the corresponding basic forms of the present invention. BRIEF DESCRIPTION OF THE DRAWINGS

[0114] The present invention will be explained in more detail below based on the embodiments given in the schematic diagrams. In the drawings:

[0115] Figure 1 A schematic diagram of an endoscopic instrument system according to an embodiment of the present invention is shown;

[0116] Figure 2 A schematic diagram showing a functional mechanism of an endoscopic instrument according to an embodiment of the present invention;

[0117] Figure 3 Shown according to Figure 2 A partial stereogram of the functional mechanism;

[0118] Figure 4 Shown according to Figure 2 A schematic top view of a portion of a functional mechanism;

[0119] Figure 5 Shown according to Figure 1 A schematic cross-sectional view of an endoscopic instrument system of a variant of the instrument system;

[0120] Figure 6 A schematic diagram of an endoscopic instrument system according to another embodiment of the present invention is shown;

[0121] Figure 7 Schematically shows Figure 6 Possible variations of the endoscopic instrument system;

[0122] Figure 8a and Figure 8bshows a schematic longitudinal section through components of an endoscopic instrument system according to another embodiment of the present invention; and

[0123] Fig. 9 A schematic diagram of an endoscopic instrument system according to another variant of an embodiment is shown.

[0124] The accompanying drawings should provide a further understanding of the embodiments of the present invention. They illustrate the embodiments and are used to explain the principles and concepts of the present invention in conjunction with the description. Other embodiments and many of the advantages mentioned are derived with reference to the accompanying drawings. The elements in the drawings are not necessarily shown to scale.

[0125] In the figures, identical, functionally identical and identically acting elements, features and components are provided with the same reference numerals, unless otherwise indicated. The numbering of the method steps serves primarily to distinguish them and does not necessarily imply a chronological arrangement, unless explicitly indicated otherwise. DETAILED DESCRIPTION

[0126] Figure 1 FIG. 1 is a schematic diagram of an endoscopic instrument system 1000 for performing minimally invasive surgery in a human body according to an embodiment of the present invention. The endoscopic instrument system 1000 includes an endoscopic instrument 1100. The endoscopic instrument 1100 is Figure 1 1 is shown partially introduced into a human body, wherein the boundaries of the human body, for example the abdominal wall 1, are drawn schematically and in dashed lines. The interior of the human body is located on the left side marked with IN, and the surroundings of the human body are located on the right side marked with OUT. An arrow in the proximal direction P marked with "OUT" and an arrow in the distal direction D marked with "IN" are shown here.

[0127] The endoscopic instrument 1100 includes a distal functional mechanism 1110, which is thus Figure 1 The distal functional mechanism 110 has an electrode device 1115, which is designed to input a high-frequency current, HF current, into the organic tissue 2 in the human body. In addition, the distal functional mechanism 1110 has a structure-borne sound receiving element 1116, which is constructed and equipped to receive the structure-borne sound response of the organic tissue 2 to the input HF current.

[0128] The endoscopic instrument 1100 also includes a proximal operating mechanism 1150, by means of which the instrument 1100 can be manipulated, and should be manipulated by a human surgeon and / or a robotic mechanism such as a surgical robot. The operating mechanism 1150 can also be configured to operate the functional mechanism 1110 from outside the human body. This operation can include, in particular, activating or deactivating the electrode device 1115, moving a mechanical part of the functional mechanism 1110, switching an endoscopic camera of the functional mechanism 1110 on or off, and / or more similar operations.

[0129] The proximal operating mechanism 1150 is mechanically and functionally connected to the distal functional mechanism 1110 via an elongated connecting mechanism 1130. Therefore, the actuation or manipulation of the operating mechanism 1150 for controlling the instrument 1100 and for operating the functional mechanism 1110 is transmitted to the functional mechanism 1110 by means of the connecting mechanism 1130. For example, the transmission can be performed electrically, mechanically and / or optically. The connecting mechanism 1130 includes a structure-borne sound transmission element 1132, which is designed and configured to transmit the structure-borne sound response received by the structure-borne sound receiving element 1115 in an acoustic manner in the direction of the operating mechanism 1150. The structure-borne sound transmission element 1132 is preferably designed for transmission in the frequency range of 20 kHz to 80 kHz and advantageously has particularly low losses in this range compared to airborne sound transmission.

[0130] The endoscopic instrument system 1000 also includes an acoustic-to-electrical transducer mechanism 1140 , which is designed and configured to be arranged outside the human body when the instrument system 1000 is in use, and which is also designed and configured to detect the structural acoustic response at the structural acoustic transmission element 1132 and convert it into an electrical response signal 1171 .

[0131] The conversion can be performed directly, i.e., a direct conversion from (structure) sound into an electrical signal can be performed, for example, by means of a piezoelectric element. Alternatively or in addition, an indirect conversion can be performed, for example, via an intermediate medium, such as a light beam or laser beam, etc. Figure 1 As shown in the exemplary embodiment, the converter mechanism 1140 can be arranged in or at the endoscopic instrument 1100. However, the converter mechanism 1140 can also be arranged in another component of the instrument system 1000, or represent a separate element. In particular, an example in which the converter mechanism is part of the trocar sleeve of the instrument system will be described below.

[0132] The elongated connecting means 1130 preferably has a length of between 15 and 50 cm, particularly preferably between 25 and 40 cm, and particularly preferably about 30 cm. The converter means 1140 is advantageously arranged at a distance from the electrode device 1115 that is slightly longer than the length of the connecting means 1130. The converter means 1140 is preferably arranged at a distance from the electrode device 1115 of between 32 cm and 52 cm, and particularly preferably between 40 cm and 45 cm. This helps to ensure that disturbances or interference signals generated by the functional means 1110, in particular the electrode device 1115, can act on the converter means 1140 as little as possible, and thus distort the electrical response signal 1171 as little as possible.

[0133] By arranging the transducer means 1140 outside the human body during use of the instrument system 1000, in particular during the introduction of the endoscopic instrument 1100 into the human body, the abdominal wall 1 provides additional signal isolation or signal attenuation between the functional means 1110 and the transducer means 140. This increases the signal-to-noise ratio of the signal transmitted by the structure-borne sound transmission element 1132 and realized in the structure-borne sound, i.e., the signal-to-noise ratio of the structure-borne sound response.

[0134] Figure 2 FIG. 1 is a schematic diagram of a distal functional mechanism 1210 of an endoscopic instrument 1200 according to an embodiment of the present invention. For example, the functional mechanism 1210 may be Figure 1 The endoscopic instrument system 1000 and / or the endoscopic instrument 1100 combination. Figure 2 A schematic side view is shown, which partially shows a longitudinal section, and Figure 3 and Figure 4 It is another partial perspective view of the functional mechanism 1210 .

[0135] As in Figure 2 As can be seen in FIG. 1 , the functional mechanism 1210 has a first jaw part 1211 and a second jaw part 1212, which are connected to each other proximally at the hinge G in such a way that the distal ends of the first jaw part 1211 and the second jaw part 1212 can be moved toward and away from each other. In this way, the "jaws" of the functional mechanism 1210 can be closed (the distal ends of the jaw parts 1211, 1212 move toward each other) or opened (the distal ends of the jaw parts 1211, 1212 move away from each other). Thus, the jaws of the functional mechanism 1210 can be used to clamp, pinch, contact, squeeze, etc., organic tissue, wherein in particular the inner side 1217 of the first jaw part 1211 and the inner side 1218 of the second jaw part 1212 are in contact with the organic tissue and, for example, exert pressure on the organic tissue. In principle, the basic structure of such jaw parts 1211, 1212 is known from the prior art.

[0136] In the example shown, part 1211 is configured as a rigid jaw part, while second jaw part 1212 is configured to be movable relative to first jaw part 1211 and relative to connecting mechanism 1230. The actuation of the movement of second jaw part 1212 relative to first jaw part 1211 and connecting mechanism 1230 can be performed mechanically, for example, by means of wire 1231 or a rod. Alternatively, electrical actuation, for example using an electric motor, is also conceivable.

[0137] A rib 1213 is arranged on the inner side 1218 of the second jaw member 1212. Figure 3 12 is shown in three dimensions from below, i.e., from the direction of the first jaw part 1211 looking toward the inner side 1218 of the second jaw part 1212. As described above, such ribs 1213 can be particularly advantageous for so-called vessel sealing instruments. For example, the ribs 1213 consist of an electrically insulating material. The organic tissue 2 is contracted by the ribs, the current density of the HF current in the tissue 2 is increased, and the thermal effect is concentrated in the acoustic response (reaktion) caused thereby to this area.

[0138] The design of the first jaw member 1211 is Figure 4 In the general structure of the first jaw member 1211 , the electrical insulator region 1214 is embedded in the inner side 1217 of the first jaw member 1211 . Figure 2 A longitudinal section (longitudinal direction) through the first jaw part 1211 is shown, wherein a longitudinal section through the insulator region 1214 can also be seen. Within the insulator region 1214, a first electrode 1215-1 and a second electrode 1215-2 of an electrode arrangement 1215-i are arranged in a manner separated from one another.

[0139] like Figure 4 As shown, the two electrodes 1215-1, 1215-2 can be arranged in parallel to each other and be constructed as an elongated shape, wherein the longitudinal direction thereof extends along the longitudinal direction of the first jaw part 1211 and the second jaw part 1212 constructed as an elongated shape, and advantageously also extends along the longitudinal direction of the elongated connecting mechanism 1230. The electrode device 1215-i can be loaded with a high-frequency current, HF current, by means of an electrical line (not shown in the figure) guided through the first jaw part 1211. The HF current can be generated outside the patient by a high-frequency generator of the endoscopic instrument system 1000. The HF current can be input into the organic tissue in contact with the electrodes 1215-1, 1215-2. As described in detail above, for example, the organic tissue can be cut, coagulated, welded, etc.

[0140] In order for the HF current to flow only on organic tissue, the electrodes 1215-1, 1215-2 are arranged in an electrical insulator region 1214. Preferably, the insulator region 1214 consists of a ceramic material which is embedded in the metal structure of the first jaw part 1211, for example.

[0141] As in Figure 4 This can be seen particularly clearly in Figure 2 As shown in the cross section through the first jaw part 1211 in FIG. 1 , the structure-borne sound receiving element 1216 is arranged between the electrodes 1215 - 1 and 1215 - 2 at the first jaw part 211 and is configured and constructed to receive the structure-borne sound response of the organic tissue 2 to the input HF current.

[0142] For this purpose, the structure-borne sound receiving element 1216 is preferably made of an electrically insulating ceramic material. The structure-borne sound caused or generated in the organic tissue 2 can be received by the structure-borne sound receiving element 1216, for example, as a longitudinal wave and / or a transverse wave. The structure-borne sound response is transmitted in the proximal direction via the structure-borne sound transmission element 1232 extending at least partially in the connecting mechanism 1230. As already explained above, the structure-borne sound response is then converted into an electrical response signal outside the human body by the acoustic-electrical converter mechanism 1140.

[0143] As in Figure 2 and Figure 4 As schematically shown in FIG, the structure-borne sound receiving element 1216 and the structure-borne sound transmitting element 1232 can be designed to be identical to one another and in particular to be integral. This has the advantage that there are no edges or gaps between them at which structure-borne sound waves could be reflected or refracted. This simple and efficient design can be achieved in that the first jaw part 1211 and the elongated connecting means 1230 are rigidly connected to one another, for example also formed in one piece, and the structure-borne sound receiving element 1216 is arranged on the first jaw part 1211.

[0144] Alternatively, it is also conceivable that the structure-borne sound receiving element 1216 is arranged at the movable second jaw part 1212. In this case, the structure-borne sound transmitting element 1232 can include a movable, articulated or bendable section, which can adapt to and follow the movement of the second jaw part 1212. However, the structure-borne sound receiving element 1216 and the structure-borne sound transmitting element 1232 can also be constructed differently. As already described above, the structure-borne sound transmitting element 1232 can be constructed in various ways to be flexible or rigid, or to have flexible and rigid components or sections.

[0145] Figure 5 Shown according to Figure 1Schematic cross-sectional view of an endoscopic instrument system 1000' of a variant of the instrument system of FIG. All details, variants and options of the instrument system 1000' also apply to Figures 2 to 4 The device system 1000 in FIG. 1 and vice versa.

[0146] In the instrument system 1000', the endoscopic instrument 1100' differs from the endoscopic instrument 1100 of the instrument system 1000 in that it has an integrated scalpel 1225 that can be moved along the longitudinal axis of the instrument 1100' in order to be able to cut the tissue that is held (or: gripped) and / or closed. For example, the general arrangement of such a scalpel 1225 is described in DE 10 2019 108 140 A1, which is hereby cited and its content should be fully included in the present application by reference.

[0147] Therefore, the first jaw member 1211' and the second jaw member 1212' respectively have corresponding grooves 1223 and 1224. In particular, when the two jaw members 1211' and 1212' are completely closed to each other, the corresponding grooves are aligned with each other, and the scalpel 1225 with the knife 1226 can move inside the corresponding grooves. Figure 5 As shown. The scalpel 1225 is fastened to the first jaw part 1211' and actuated therefrom, while the majority of the scalpel 1225 is placed in the groove 1224 of the second jaw part 1212'. Accordingly, the groove 1224 in the second jaw part 1212' is also larger than the groove 1223 in the first jaw part 1211', preferably more than 50% deeper, particularly preferably more than 100% deeper.

[0148] The first jaw part 1211' comprises at least two components: a first metal component 1221-1, for example made of surgical steel, arranged on the outside, and a second electrically insulating component 1221-2, for example made of ceramic material, arranged on the inside (i.e., toward the second jaw part 1212'). In the second component 1221-2, a groove 1223 is arranged together with a scalpel 1225 in a surface 1227 pointing inward, and electrodes 1215-1, 1215-2 are arranged symmetrically on both sides thereof. Between them, respectively against the surface of the rib 1213 with which the tissue is clamped or pressed, a structure-borne sound receiving section 1216-1, 1216-2 is arranged between the groove 1223 and one of the electrodes 1215-1, 1215-2. The two structure-borne sound receiving sections 1216-1 and 1216-2 may be two separate structure-borne sound receiving elements, but may also be the top of a single structure-borne sound receiving element 1216' that is separated in a fork-like manner at the distal end. In other words, the two structure-borne sound receiving sections 1216-1 and 1216-2 may respectively transmit the structure-borne sound to the corresponding converter units of the converter mechanism 1140, or a common converter unit may be provided.

[0149] Furthermore, the second jaw part 1212' comprises at least two components: a first metal component 1222-1, for example made of surgical steel, arranged on the outside, and a second electrically insulating component 1222-2, for example made of a ceramic material, arranged on the inside (i.e., toward the first jaw part 1211'), which comprises a rib 1213 having a groove 1224 formed therein. The rib 1213 is also symmetrically configured with respect to the groove 1224 and is shaped so that the tissue between the jaw parts 1211', 1212' is clamped particularly (or only) at this location, wherein the structure-borne sound receiving sections 1216-1, 1216-2 of the structure-borne sound receiving element 1216' abut against the first jaw part 1211'.

[0150] according to Figure 6It is easy to imagine how the tissue is first clamped between the rib 1213 and the surface 1227 and then the HF current is fed into the clamped tissue between the electrodes 1215-1, 1215-2. In the plateau region of the rib 1213, i.e. at its highest elevation, the tissue is therefore particularly strongly compressed and the current per unit volume is very high, i.e. the current density is very high. As a result, the heat input per unit volume of the (unclamped) tissue is also very high, and therefore the sound generated there is also high, which is ideally received by the structure-borne sound receiving sections 1216-1, 1216-2 that are precisely in contact. As already described above, the sound reception can be improved by cleverly selecting the acoustic characteristic impedance of the structure-borne sound receiving sections 1216-1, 1216-2. For example, the structure-borne sound receiving sections 1216-1, 1216-2 can be essentially filled with liquid, wherein the liquid is blocked by a membrane at the surface 1227. Thus, the structure-borne sound can be transmitted inside the liquid.

[0151] Figure 6 FIG. 5 is a schematic diagram of an endoscopic instrument system 5000 according to another embodiment of the present invention. The endoscopic instrument system 5000 includes an endoscopic instrument 5100. Figure 6 Unless otherwise expressly or implicitly described to the contrary, the endoscopic instrument 5100 can be used as previously described with reference to Figures 1 to 5 In particular, the instrument 5100 has a functional mechanism 5210 having a first jaw part 5211 and a second jaw part 5212 .

[0152] The functional mechanism 5210 is located at the distal end of the instrument 5100 , while the operating mechanism 5150 (shown again schematically here) is arranged at the proximal end of the instrument 5100 .

[0153] Endoscopic Instrument System 5000 and Figure 1 The main difference of the endoscopic instrument system 1000 shown is that in the instrument system 5000 the acoustic-to-electrical transducer mechanism 5540 is not integrated in the endoscopic instrument 5100 itself.

[0154] In contrast, the endoscopic instrument system 5000 includes a trocar sleeve 5500 in addition to the endoscopic instrument 5100. Figure 1As shown by way of example, the trocar sleeve 5500 is used to be guided through the abdominal wall 1 into the human body to form a continuous connection between the interior and exterior of the human body in the interior thereof, so that the endoscopic instrument 5100 can be introduced into the human body through the trocar sleeve 5500 and moved back and forth there. The instrument can be moved in a low-friction manner via the trocar sleeve, and rapid instrument exchange can be performed without problems if necessary, i.e. instruments, such as scissors, can be removed and replaced, for example, with clamps.

[0155] The structure-borne sound transmission element (not shown) is designed in the instrument 5100 such that the transmitted structure-borne sound response can be detected, in particular mechanically detected, at the housing of the connecting means 5230. Therefore, the converter mechanism 5540 is arranged at the trocar sleeve 5500 and is designed and configured such that it can mechanically detect the structure-borne sound response at the housing of the connecting means 5230.

[0156] exist Figure 6 , it is schematically shown that the converter mechanism 5540, which can include, for example, a piezoelectric element 5541, is supported on the trocar sleeve 5500 in such a way that it is pressed against the structure-borne sound transmission element, while the functional mechanism 5210 is guided through the trocar sleeve 550. In this embodiment, the structure-borne sound transmission element can be guided to the outside of the connecting mechanism 5230 in the region in which the converter mechanism 5540 is located during intended use. Alternatively or additionally, in this region, the housing of the connecting mechanism 5230 itself can also be completely or partially a component of the structure-borne sound transmission element.

[0157] For example, Figure 6 As shown schematically, the compression of the converter mechanism 5540 can be achieved by means of a compression element 5542, for example an elastic element, such as a spring elastic element, by means of which the piezoelectric element 5541 of the converter mechanism 5540 can be compressed against the structure-borne sound transmission element. In order to prevent the device 5100 from being pressed against one side inside the trocar sleeve 5500 due to the compression force, a further compression force can be applied to the elongated connecting mechanism 5230 at the same location (along the longitudinal direction of the connecting mechanism 5230), such as the converter mechanism 5540, so that it assumes a spring-loaded central position as far as possible inside the trocar sleeve 5500.

[0158] exist Figure 6 In the embodiment shown, the trocar sleeve 5500 has a cantilever in the radial direction at its proximal end, which cantilever not only contains the converter mechanism 5540 but also represents a safe termination above the abdominal wall 1 .

[0159] Figure 7A possible variant of the endoscopic instrument system 5000 is schematically shown, wherein the endoscopic instrument 5300 of the instrument system 5000 is basically connected to the endoscope through the design of the acoustic-electric converter mechanism 5640. Figure 6 The converter mechanism 5540 in is used to distinguish.

[0160] exist Figure 7 , a shaft tube 5333 of a connection mechanism 5330 of an endoscopic instrument 5300 of the instrument system 5000 is shown. Figure 7 The left side portion shows a longitudinal section of the connecting mechanism 5330, Figure 7 The right part of shows a cross section corresponding thereto. A working element or pulling element 5331 is arranged to be guided centrally through the connecting mechanism 5330 in order to mechanically deflect or move the distal jaw member.

[0161] A piezoelectric element 5641, in particular a PVDF film arranged concentrically with the connecting mechanism 5330, is mounted on the outer surface of the sheath surrounding the rod tube 5333, and the PVDF film is concentrically connected to corresponding conductive metal layers 5642 on both sides. These conductive metal layers 5642 or coatings are in electrical contact via electrical lines 5644. Therefore, the electrical response signal 1171 of the converter mechanism 5640 can be transferred via the electrical lines 5644, for example, to a computing mechanism of the instrument system 5000.

[0162] As an alternative, the assembly consisting of a piezoelectric element 5641 (e.g., a PVDF film) arranged (sandwiched) between conductive metal layers 5642 can also be arranged on the inner surface of the sheath of the trocar sleeve of the instrument system 5000. The shaft tube 5333 of the connecting mechanism 5330 is then advantageously designed so that it rests on the trocar sleeve as much as possible in a form-fitting manner around the circumference.

[0163] In both variants, instead of a continuous piezoelectric element 5641, a plurality of piezoelectric elements 5641 can also be arranged, which can be read individually, for example in order to be able to detect longitudinal wave propagation or bending waves. A plurality of piezoelectric elements 5641 can, for example, be arranged concentrically and in a matrix on the inner surface of the jacket or on the outer surface of the jacket and can be read in a matrix. In this way, all wave modes of the transmitted structure-borne sound can be detected accurately.

[0164] Figure 8a and Figure 8b A schematic longitudinal section through components of an endoscopic instrument system 5000 according to another embodiment of the present invention is shown. In this embodiment, the instrument system 5000 comprises a trocar sleeve 5700 and an endoscopic instrument 5300 .

[0165] Figure 8aThe trocar sleeve 5700 is shown partially guided through the abdominal wall 1 of a human patient without introducing the endoscopic instrument 5300 .

[0166] exist Figure 8b 53. The state in which the endoscopic instrument 5300 is introduced through the trocar sleeve 5700 can be seen in FIG. 53, wherein the connecting mechanism 5330 is only schematically shown. The trocar sleeve 5700 comprises an upper guide mechanism 5701, which guides and supports the introduction of the endoscopic instrument 5300 into the trocar sleeve 5700. Figure 8b As shown, the connecting mechanism 5330 can be guided through the annular seal 5703 by the guidance of the upper guide mechanism 5701 .

[0167] A lower guide mechanism 5702 is arranged in a distal direction D from the annular seal 5703. A sealing mechanism 5710 is arranged at the distal side, which abuts against the connecting mechanism 5330 in a sealed and insulating manner when the connecting mechanism is guided through the trocar sleeve 5700. The sealing mechanism 5710 can be formed, for example, from an elastic material and, for example, contain silicone or consist of silicone. As shown in the essentially rotationally symmetrical longitudinal section, the sealing mechanism 5710 can be constructed to be essentially conical, with the apex of the cone pointing in the distal direction D and a channel being arranged at the apex of the cone. Figure 8b As shown, when the endoscopic instrument 5300 is guided through the trocar sleeve 5700, due to the elasticity of the sealing mechanism 5710, the channel will expand just to the extent that the sealing mechanism 5710 abuts against the connecting mechanism 5330 in a sealed manner all around. The sealing mechanism 5710 can also be used as a non-return valve or is called a non-return valve.

[0168] In addition, if Figure 8a As shown, one or more piezoelectric elements 5741 can be arranged in the area of ​​the conical top end of the sealing mechanism 5710 and arranged in such a way that when the connecting mechanism 5330 is guided through the cannula needle sleeve 5700, the piezoelectric element 5741 is in contact with the endoscopic instrument 5300, so that structure-borne sound can be detected at at least a portion of the structure-borne sound transmission element with the help of the piezoelectric element 5741.

[0169] If already referred to Figure 6 and Figure 7 As described, it is advantageous for this purpose if at least a portion of the structure-borne sound transmission element is arranged on the outside of the connecting means 5330, so that when the endoscopic instrument 5300 is introduced into the trocar sleeve 5700 in a prescribed manner, the piezoelectric element 5741 is in direct contact with at least this portion of the structure-borne sound transmission element. The electrical signal generated by the piezoelectric element 5741 can thus be used as a response signal of the converter means 5740 via the Figure 8a and Figure 8b Electrical contacts not shown in the figure are output and optionally further processed, the converter mechanism comprising at least a piezoelectric element 5741.

[0170] Fig. 9 A schematic diagram of an endoscopic instrument system 5000 according to another variation of an embodiment is shown. Fig. 9 It is primarily used to explain a possible evaluation and further processing of response signal 1171 by calculation unit 5660 .

[0171] The instrument system 5000 includes an endoscopic instrument 5300, which can be described as previously described with reference to Figure 6 and Figure 7 The structure is described, that is, the acoustic-electric converter mechanism 5640 is not integrated into the endoscopic instrument 5300, but is instead integrated into the trocar sleeve 5600 of the endoscopic instrument system 5000. For example, a robot arm 5690 is installed as part of the robot mechanism on the operating mechanism 5650 of the functional mechanism 5210 for operating and manipulating the endoscopic instrument 5300.

[0172] The exact implementation of the endoscopic instrument 5300 and / or the trocar sleeve 5600 is not limited to Fig. 9 In particular, the endoscopic instrument 5300 may also be configured with an integrated converter mechanism, the operating mechanism 5650 may be configured for human guidance, the functional mechanism 5210 may be configured with other functions (or additional functions) in addition to the jaw member and / or more of the like.

[0173] and Figure 7 , the converter means 5640 can also be constructed as an elastic PVDF film, a layered PVDF film or a bundle of elastic piezoelectric fibers, which is arranged concentrically on the inner jacket surface of the cannula sleeve 5600. The elasticity makes it possible to ensure that a part of the structure-borne sound transmission element rests particularly tightly on the PVDF film as a piezoelectric element (good "form fit").

[0174] Alternatively, the trocar sleeve 5600 itself can consist of an elastic material that transmits sound well, such as a fiber composite material, and the converter mechanism 5640 (or at least one piezoelectric element thereof) can be arranged on the outer sheath surface of the trocar sleeve 5600. Thus, the structure-borne sound response transmitted by the structure-borne sound transmission element can be transmitted radially to the outside through the sound-transmitting trocar sleeve 5600 and converted there again by the piezoelectric element of the converter mechanism 5640.

[0175] In any case, the electrical response signal 1171 generated by the converter mechanism 5640 is transmitted to the computing mechanism 5660. For example, this can be achieved via the electrical line 5644, but can also be achieved wirelessly, for example via Ethernet, ZigBEE, Bluetooth, LoRaWAN or other wireless signal protocols. The computing mechanism 5660 can be integrated into the endoscopic instrument 5300, the cannula sleeve 5600 or other components of the endoscopic instrument system 5000, or can be arranged in a separate housing. In addition, in addition to, for example, local power electronics, it can also be partially achieved by a remotely connected computing mechanism, for example, via a cloud computing platform, a server, etc.

[0176] exist Fig. 9 In the illustrated embodiment, the computing mechanism 5660 includes an analog amplifier module 5661, an analog-to-digital converter module 5662, an analysis module 5663, and a fast Fourier transform module 5664. These modules may be part of an integrated circuit and / or implemented in part by one or more microprocessors.

[0177] When "modules" are mentioned herein, it should be understood that this does not necessarily mean that the modules are constructed as individual units in a manner separate from each other.

[0178] When the module is constructed as software, the module can be implemented as a program code segment or a program code component, which can be distinguished from each other, but can also be intertwined. Similarly, when one or more modules are implemented as hardware, the functions of one or more modules can be implemented by the same hardware component.

[0179] Alternatively or additionally, different functions of a single module can be implemented on multiple separate hardware components, or different functions of different modules can also be implemented. In this sense, each device, each system, each method, etc., which has all the performance and functions belonging to a specific module can be understood as having, representing or implementing such a module. In particular, all modules can be implemented as program codes, which are implemented by a computing mechanism, such as a server or a cloud computing platform.

[0180] The analysis module 5663 can be designed in particular to generate a control signal 5671 for the frequency converter 5665 based on the response signal 1171 received from the converter mechanism 5640, amplified by the amplifier module 5661 and amplified by the analog-to-digital converter module 5662. The frequency converter 5665 generates digital frequency signals, which are converted into analog frequency signals by the analog-to-digital converter 5667. These can then be output as acoustic output signals 5672 via the speaker 5668, particularly preferably in a sound spectrum that is audible to the user of the endoscopic instrument system 5000. Sound waves with a frequency below 20 kilohertz (kHz) can be referred to as audible sounds.

[0181] Output or conversion in the sound frequency range of 20 kHz to 80 kHz is particularly preferred.

[0182] As already explained above, such output signals 5672 (whether acoustic, optical, tactile, etc.) provide valuable additional information in a near real-time manner to the user of the endoscopic instrument system 5000 and in particular the endoscopic instrument 5300. The acoustic output may be an undistorted or frequency-adapted output of the structure-borne sound response received by the structure-borne sound receiving element, or may indicate a state or process at or in the functional mechanism 5210 in an abstract manner.

[0183] In a simple variant, when the functional mechanism 5210 interacts with the organic tissue 2 in a desired manner, the output signal 5672 may, for example, have a quiet, relatively low and constant frequency value. However, if an undesirable interaction occurs, such as tissue rupture or tearing, this may be indicated by a warning tone having a higher frequency. For example, the structure-borne sound response may be evaluated by the analysis module 5663 using a rule-based algorithm and the control signal 5671 may be generated based on the evaluation.

[0184] By means of the analysis module 5663, the signal digitized by the analog-to-digital converter 5562 can advantageously be analyzed in a quasi-real time manner, for example by counting acoustic events and their intensities for each time interval. Additionally or alternatively, by means of an FFT module (Fast Fourier Transformation), an extraction of frequency-dependent spectral parameters for each time interval can be performed by means of a (especially continuous) Fast Fourier analysis (FFT). The extracted spectral parameters can be taken into account by the analysis module 5663 when generating the control signal 5671.

[0185] It is also possible to use an artificial intelligence module KIEM 5669, which is designed and configured to implement a trained artificial intelligence entity, such as an artificial neural network. Such an artificial intelligence entity receives as input signals a signal from the calculation mechanism 5660 itself, for example a signal in the form of a short-term spectrum from a fast Fourier transform module 5664, or also a direct signal from an analog-to-digital converter module 5662 and / or an analysis module 5663. The spectrum parameters extracted by the FFT module 5564 can also be used as input signals for the artificial intelligence entity.

[0186] Additionally, it may be advantageous, as already described above, that the endoscopic instrument 5300 is preferably located in the distal region and / or that the trocar sleeve 5600 has additional sensors that generate additional sensor signals 5673. These sensor signals 5673 can thus be used as additional inputs for the artificial intelligence entity. The additional sensors may be, for example, temperature sensors, electrical impedance sensors, tissue thickness sensors and / or pressure sensors, etc. For example, it is particularly advantageous that a distal piezoelectric sensor detects pressure (for example at one of the jaw parts 5211, 5212) and / or temperature distally.

[0187] Preferably, the parameter measured or indicated by the sensor signal 5673 is detected in each time interval. In order for the parameters of the individual time intervals to be statistically significant, time intervals with corresponding durations must be selected. In addition, not only the current parameters, but also parameters from previous time intervals can also be advantageously used for the analysis. For example, a memory with "unlimited memory (unlimited memory)" can be used. )” (average over all time intervals), “limited memory (begrenztem )" (average value balanced over a predefined number of time intervals) and / or "decreasing memory (nachlassendem )" (weighted mean, in which the weight of time intervals becomes smaller and smaller as time goes by) to form a real-time signal processing technique.

[0188] If X(m) is the current running mean of a measurement or parameter in time interval m, and Y(m) is the current measurement in time interval m, then the definition can be made recursively:

[0189] Mean with infinite memory:

[0190] X(m)=X(m-1)+1 / m[Y(m)-X(m-1)]

[0191] Mean with limited memory:

[0192] X(m)=X(m-1)+1 / L[Y(m)-Y(m-1)]

[0193] Mean with decreasing memory:

[0194] X(m)=X(m-1)+(1-α)Y(m), 0<α<1.

[0195] The duration of the time intervals of the RF energy application and the time intervals of the pauses therebetween are advantageously selected such that the signal segments therein are quasi-stationary and the parameters derived therefrom are statistically significant, i.e., in particular, not excessively flattened. In the pulsed RF current supply mode, the time intervals can be longer than the pulse pause duration of the supplied RF energy.

[0196] From the averaged parameter curve according to one of the above-mentioned averaging methods, predictive statements can be derived about the ongoing process, such as an estimate of the duration before stable vessel closure. Such statements can also be output in the output signal or contained therein or indicated thereby.

[0197] In addition to (or as an alternative to) the function of generating an output signal 5672 that is audible and in particular understandable to a user of the endoscopic instrument system 5000, the computing device 5660 may also have the function of generating a control signal 5674 for one or more components of the endoscopic instrument system 5000. For example, Fig. 9 As shown, the control signal 5674 can control the high-frequency generator 5800 of the endoscopic instrument system 5000. The high-frequency generator 5800 is used to generate HF current, which can be input into the organic tissue 2 through the electrode device of the functional mechanism 5210. Fig. 9 As shown, electrical lines for conducting the HF current can run on the connecting device 5330 .

[0198] Likewise, signal 5675 of high-frequency generator 5800 can be received by computing device 5660 (for example at amplifier module 5661 and / or analog-to-digital converter module 5662) and taken into account by computing device 5660 when generating output signal 5672 or control signal 5674. In this way, a control loop can be produced in particular.

[0199] The signal exchange between the calculation device 5660 and the high-frequency generator 5800 can be used to coordinate in time the supply of HF current into the organic tissue 2 on the one hand and the analysis of the structure-borne sound response or the response signal 1171 on the other hand. As already explained above, this is advantageously achieved in that time periods for the supply of HF current alternate with time periods for the analysis of the response signal 1171 (with or without buffer times in between) in order to reduce possible disturbances of the structure-borne sound response by the HF current.

[0200] For example, the control signal 5674 of the computing unit 5660 may also be configured and constructed to adjust adjustment variables of the endoscopic instrument system 5000, such as for adjusting the electrical power, voltage, pulse pause duration of the HF current input, pressure on the organic tissue 2, the position of the jaw parts 5211, 5212 and / or more similar things.

[0201] In the above detailed description, various features for improving the rigor of the diagram are summarized in one or more examples. However, it should be clear that the above description is only illustrative and not restrictive. It is used to cover all alternatives, modifications and equivalents of various features and embodiments.

[0202] In view of the above description, many other examples will immediately come to mind to a person skilled in the art based on his professional knowledge. The embodiments are selected and described in order to be able to present the basic principles of the invention and its application possibilities in practice in the best possible way. Thus, a person skilled in the art can modify and utilize the invention and its various embodiments in the best possible way for the intended application purpose.

[0203] Description of Reference Numerals

[0204] 1 Abdominal wall

[0205] 2 Organization

[0206] 1000 Endoscopic Instrument System

[0207] 1000' Endoscopic Instrument System

[0208] 1100 Endoscopic instruments

[0209] 1100'Endoscopic instruments

[0210] 1110 Functional Organization

[0211] 1115 electrode device

[0212] 1130 connection mechanism

[0213] 1140 Converter Mechanism

[0214] 1150 operating mechanism

[0215] 1171 Response Signal

[0216] 1200 Endoscopic instruments

[0217] 1210 Functional Organization

[0218] 1211 first jaw member

[0219] 1212 second jaw member

[0220] 1213 ribs

[0221] 1214 Insulator Area

[0222] 1215-1 First electrode

[0223] 1215-2 Second electrode

[0224] 1215-i Electrode Assembly

[0225] 1216 Structure-borne sound receiving element

[0226] 1216'Structure-borne sound receiving element

[0227] 1216-1 Structure-borne sound receiving section

[0228] 1216-2 Structure-borne sound receiving section

[0229] 1217 Inner side of the first jaw member

[0230] 1218 inner side of the second jaw member

[0231] 1221-1 Metal first member of the first jaw component

[0232] 1221-2 Insulated second member of the first jaw member

[0233] 1222-1 Metal first member of the second jaw member

[0234] 1222-2 Insulating second member of second jaw member

[0235] 1223 slot of first jaw member

[0236] 1224 slot of second jaw member

[0237] 1225 Scalpel

[0238] 1226 Scalpel Knife

[0239] 1230 connection mechanism

[0240] 1213 lines

[0241] 5000 Endoscopic Instrument System

[0242] 5100 Endoscopic Instruments

[0243] 5210 Functional Organization

[0244] 5150 operating mechanism

[0245] 5210 Functional Organization

[0246] 5211 first jaw component

[0247] 5212 second jaw member

[0248] 5230 connection mechanism

[0249] 5300 Endoscopic instruments

[0250] 5330 connection mechanism

[0251] 5331 pulling element

[0252] 5333 Rod Tube

[0253] 5540 converter mechanism

[0254] 5541 Piezoelectric Element

[0255] 5542 compression element

[0256] 5600 Trocar Sleeve

[0257] 5640 converter mechanism

[0258] 5641 Piezoelectric Components

[0259] 5642 Metal Coating

[0260] 5644 electric line

[0261] 5650 operating mechanism

[0262] 5660 Computing Agency

[0263] 5661 Amplifier Module

[0264] 5662 analog-to-digital converter module

[0265] 5663 Analysis Module

[0266] 5664FFT module

[0267] 5665 Inverter

[0268] 5667 Analog-to-Digital Converter

[0269] 5668 Speakers

[0270] 5671 control signal

[0271] 5672 output signal

[0272] 5673 sensor signal

[0273] 5674 control signal

[0274] 5675 Signal

[0275] 5690 Robot Arm

[0276] 5700 Trocar Sleeve

[0277] 5701 upper guide mechanism

[0278] 5702 lower guide mechanism

[0279] 5703 Seals

[0280] 5710 sealing mechanism

[0281] 5740 converter mechanism

[0282] 5800 High Frequency Generator

Claims

1. An endoscopic instrument system (1000; 5000) for performing minimally invasive surgery on a human body, comprising: Endoscopic instruments (1100; 1200; 5100; 5300), including at least: - distal functional mechanism (1110; 1210； 5210), including an electrode device (1115; 1215-i), the electrode device is designed to input a high frequency current, i.e., HF current, into the organic tissue (2) in the human body, and further comprises a structure-borne sound receiving element (1116; 1216) for receiving the structure-borne sound response of the organic tissue (2) to the input HF current; - a proximal operating mechanism (1150; 5150; 5650) for manipulating the instrument system (1000; 5000), in particular the instrument (1100; 1200; 5100; 5300), and for operating the functional mechanism (1110; 1210; 5210) from outside the human body; and - an elongated connecting mechanism (1130; 1230; 5230; 5330) which mechanically and functionally connects the functional mechanism (1110; 1210; 5210) to the operating mechanism (1150; 5150; 5650), wherein the connecting mechanism (1130; 1230; 5230; 5330) comprises a structure-borne sound transmission element (1132) which is designed to transmit a structure-borne sound response received by the structure-borne sound receiving element (1116; 1216) in an acoustic manner in the direction of the operating mechanism (1150; 5150; 5650); and Acoustic-electric converter mechanism (1140; 5540; 5640; 5740), the acoustic-to-electric converter mechanism is designed to be arranged outside the human body during use of the instrument system (1000; 5000), and the acoustic-to-electric converter mechanism is also designed to detect the structural acoustic response at the transmission element (1132) and convert it into an electrical response signal (1171).

2. An instrument system (1000; 5000) according to claim 1, wherein the functional mechanism (1110; 1210; 5210) has a first jaw part (1211; 5211) and a second jaw part (1212, 5212), the first jaw part and the second jaw part being designed to clamp the organic tissue (2) by relative movement relative to each other, wherein the first jaw part (1211; 5211) is rigidly arranged relative to the connecting mechanism (1130; 1230; 5230; 5330), and the structure-borne sound receiving element (1116; 1216) is arranged at the first jaw part and / or the second jaw part (1211; 5211).

3. An instrument system (1000; 5000) according to claim 1 or 2, wherein the electrode device (1215-i) is arranged at the first jaw part and / or the second jaw part, in particular at the corresponding inner side of the first jaw part (1211; 5211) and / or the second jaw part (1212; 5212).

4. An instrument system (1000; 5000) according to any one of claims 1 to 3, wherein the structure-borne sound receiving element (1216) is spatially arranged between a first electrode (1215-1) of the electrode device (1215-i) and a second electrode (1215-2) of the electrode device (1215-i).

5. The instrument system (1000; 5000) according to any one of claims 1 to 4, wherein the converter mechanism (1140; 5540; 5640; 5740) comprises at least one piezoelectric element (5541; 5641; 5741).

6. The instrument system (1000; 5000) according to any one of claims 1 to 5, wherein the converter mechanism (1140; 5540; 5640; 5740) comprises an optical detection system and / or a MEMS sensor, in particular a MEMS accelerometer.

7. The instrument system (1000; 5000) according to any one of claims 1 to 6, wherein the converter mechanism (1140; 5540; 5640； 5740) is constructed to detect structure-borne sound shear waves and / or structure-borne sound longitudinal waves at the structure-borne sound transmission element (1132).

8. The instrument system (1000) according to any one of claims 1 to 7, wherein the converter mechanism (1140) is integrated into the endoscopic instrument (1100).

9. The instrument system (5000) according to any one of claims 1 to 7, further comprising a trocar sleeve (5500; 5600; 5700), at least the functional mechanism (1110; 1210; 5210) being capable of being guided through the trocar sleeve and being capable of being introduced into the human body during the minimally invasive surgery, wherein the converter mechanism (5540; 5640; 5740) is integrated into the trocar sleeve (5500; 5600; 5700).

10. The instrument system (5000) according to claim 9, wherein the converter mechanism (5740) is installed at the sealing mechanism (5710) of the trocar sleeve (5700), and the sealing mechanism seals and isolates the distal space within the trocar sleeve (5700) from the proximal space within the trocar sleeve (5700).

11. An instrument system (5000) according to claim 9 or 10, wherein the converter mechanism (5540; 5640; 5740) is supported on the cannula sleeve in such a manner that the converter mechanism is pressed against the structure-borne sound transmission element when the functional mechanism (1110; 1210; 5210) is guided through the cannula sleeve (5500; 5600; 5700).

12. The instrument system (1000; 5000) according to any one of claims 1 to 11, wherein the structure-borne sound transmission element (1132) has a rigid structure, a hollow waveguide and / or a prestressed wire.

13. The instrument system (5000) according to any one of claims 1 to 12 further includes a computing device (5660), which is constructed to obtain the electrical response signal (1171) and generate an output signal (5672, 5674) at least based thereon.

14. The instrument system (5000) according to claim 13, wherein the computing device (5660) is constructed to generate the output signal (5672, 5674) in real time or quasi real time.

15. An instrument system (5000) according to claim 13 or 14, wherein the output signal (5672) includes an audible acoustic output signal, which indicates different states of the organic tissue (2) into which the HF current has been input and / or indicates a process therein.

16. An instrument system (5000) according to any one of claims 13 to 15, wherein the calculation device (5660) and / or the converter device (5640) are configured so that the output signal (5672, 5674) is based only on the following electrical response signal (1171), which is based on the structural sound response received in the absence of HF current input.

17. An instrument system (5000) according to any one of claims 13 to 16, wherein the functional unit (1110; 1210; 5210) includes at least one other sensor, which is designed to generate at least one sensor signal, and wherein the computing unit (5660) is constructed to generate the output signal (5672, 5674) additionally based on the at least one sensor signal.

18. The instrument system (5000) according to claim 17, wherein the at least one other sensor comprises a temperature sensor, an electrical impedance sensor, a tissue thickness sensor and / or a pressure sensor.

19. An instrument system (5000) according to any one of claims 13 to 18, wherein the computing unit (5660) is constructed to generate the output signal (5672, 5674) at least partially based on an artificial intelligence entity, namely a KIE (5669).

20. The instrument system (5000) according to any one of claims 13 to 19, wherein the output signal (5674) includes a control signal, which is configured to control the function of the functional mechanism (1110, 1210, 5210).

Images