Needle holder with device for adjusting the position and / or rotation and / or orientation of a surgical needle

Abstract

2.1. Particularly in minimally invasive surgery, including robotic surgery, and / or in confined spaces, changing the position, rotation, and / or orientation of the surgical needle is difficult and time-consuming. The needle must usually be adjusted using a second instrument. This often requires multiple needle transfers between the needle holder and the second instrument. The new needle holder is designed to enable one-handed, stepless adjustment of the needle. 2.2. The needle holder has an adjusting element (31, 6) which is arranged in and / or on a handle part (4), wherein from a metered gripping force the adjusting element can adjust the position and / or rotation and / or orientation of the surgical needle by its movement, wherein the adjusting element is connected to a drive element (11, 12), wherein the drive element is controlled by a user and drives the movement of the adjusting element, wherein when the metered gripping force is exceeded the handle part (4) grips the surgical needle and prevents adjustment of the surgical needle. 2.3. The invention significantly simplifies the most time-consuming step of surgical suturing. Furthermore, the invention enables the needle to be adjusted without shifting the position of the handles relative to each other. This allows the needle to be clamped as distally as possible to the handles. The invention can be applied to known needle holder designs, including robotic needle holders, with minor modifications.

Description

The invention relates to a needle holder which enables one-handed, continuous displacement of a surgical needle.Needle holders are used in open and minimally invasive surgery to grip a surgical needle in a slip-proof and rotation-proof manner, which facilitates the guidance of a surgical suture arranged on the surgical needle during a surgical suture. During the surgical suture, depending on the location and / or property of the tissue and / or the desired suture technology and / or preference of the surgeon, changing position and / or rotation and / or orientation of the surgical needle to be clamped is required. In minimally invasive surgery and / or in a narrow space, in particular, a change in the position and / or rotation and / or alignment of the surgical needle is difficult and time-consuming. For this purpose, in open surgery, the surgical needle must usually be grasped with the second hand of the surgeon and manually adjusted in its position and / or rotation and / or orientation. In minimally invasive including robotic surgery, the surgical needle usually has to be corrected in its position and / or rotation and / or orientation by means of a second instrument. In this case, multiple transfer of the surgical needle between the needle holder and the second instrument is often required until the desired position and / or rotation and / or alignment of the surgical needle can be reached and the needle can be finally clamped.A needle holder with a possibility for twisting a surgical needle has been described in the document DE102010055806A1. The needle holder shown therein, however, permits only a very limited amount of twisting. An important disadvantage of the design described therein is that the needle is no longer clamped far at the distal end of the grip parts after correction of its position, which in most cases represents an unfavourable condition for sewing. In the above-mentioned prior art document, moreover, the adjustment of the needle is possible only along one axis. No application in robotic surgery has also been described.The technical object of the invention is to provide a needle holder which enables a one-handed, continuously variable adjustment of the position and / or rotation and / or orientation of a surgical needle.The technical object is achieved by the present invention in that the needle holder has an adjusting element 3 which is arranged in and / or on a handle part 4 of the needle holder 1, wherein, starting from a dosed gripping force of the needle holder 1, the adjusting element 3 can adjust the position and / or rotation and / or alignment of the surgical needle 2 by means of its movement, wherein the adjusting element 3 is connected to a drive element 5, wherein the drive element 5 is controlled by a user and drives the movement of the adjusting element 3, wherein, when the dosed gripping force is exceeded, the handle part 4 of the needle holder 1 grips the surgical needle 2 and prevents an adjustment of the position and / or rotation and / or alignment of the surgical needle 2.As a possible practical embodiment, it is proposed that the adjusting element 3 has a rubber band 31 which is tensioned on a holding element 6, in particular between two wheels which are arranged in and / or on the grip part 4 (FIGS. 1, 2, 4, 5, 6, 7, 8, 9, 10, 14). At least one wheel is connected to the drive element 5, for example by a further rubber band or by a gearwheel or by toothing.In order to limit the pressure on the adjusting element 3 and on the holding element 6 when closing the grip parts 4, it is proposed that the adjusting element 3 and the holding element 6 are coupled to a spring mechanism 7, wherein the spring mechanism 7 yields after the dosed grip force has been exceeded (FIG. 3 ).In one embodiment, it is proposed that the holding element 6 together with the adjusting element 3 and the spring mechanism 7 can be inserted and removed, wherein the holding element 6 can latch on the grip part 4 for example by means of a receptacle 8 fitting the holding element 6 or the spring mechanism 7, in particular a groove and / or rail and / or indentation (FIGS. 3, 10 ).Depending on the number and arrangement of the adjusting element 3, different effects can be achieved on the surgical needle 2. In one possible embodiment, adjusting elements 3 are arranged on opposite grip parts 4 (FIGS. 8 and 9 ). As long as the adjusting elements 3 on opposite grip parts 4 have the same direction of movement on their side facing the surgical needle 2, a displacement of the position of the surgical needle 2 relative to the grip parts 4 is achieved without changing the rotation of the surgical needle 2. If the adjusting elements 3 on opposite gripping parts 4 have opposite directions of movement on their side facing the surgical needle 2, then a change in the rotation of the surgical needle 2 is achieved without displacing the position of the surgical needle 2 with respect to the gripping parts 4. Whether the movement directions of the adjusting elements are the same or opposite can be modified by changing the connection of the drive element 5 to the adjusting element 3. In a further embodiment, an adjusting element 3 is arranged on each of the two sides of a grip part 4 (FIG. 14 ). An adjustment of the alignment of the surgical needle 2 is hereby achieved as long as the adjusting elements 3 located on the two sides of the grip part are not moved in exactly the same direction and the same extent. When the adjusting members 3 located on both sides of the grip member are moved in exactly the same direction and the same amount, a simultaneous adjustment of the rotation and position of the surgical needle is achieved without changing the orientation of the surgical needle.In a more cost-effective embodiment, an adjusting element 3 is arranged only on one of the two grip parts 4. On the grip part 4, where no adjusting element 3 is arranged, there is instead a rubber support 9 (FIGS. 6, 7 ). Alternatively, instead of the rubber support 9, a further adjusting element 3 can be arranged without connection to the drive element 5 (FIG. 9 a). Here too, the rubber support 9 and / or adjusting element 3 is coupled to a spring mechanism 7. Since in this embodiment an adjusting element 3 is driven only on one of the two grip parts 4, the movement of the driven adjusting element 3 results in a "rolling" of the surgical needle 2 on the rubber support 9 and / or on the non-driven adjusting element 3, so that a simultaneous adjustment of the rotation and the position of the surgical needle 2 takes place. If a non-driven adjusting element 3 is arranged instead of a simple rubber support 9, this adjusting element 3 can also be connected to the drive element 5 at any time (FIGS. 8, 9 ), for example by a rubber band, so that the effect on the surgical needle 2 can be modified if desired.In a space-saving embodiment, as shown in FIG. 10, the adjusting element 3 is arranged within one of the grip parts 4. The adjusting element 3 can be inserted into the grip part 4 through a matching groove and / or rail and / or indentation in the grip part 4. The adjusting element 3 can be docked in its place within the grip part 4 by the introduction of one or more connecting elements 18. At least one connecting element 18 is, for example, a gearwheel which, after being introduced into the grip part 4, latches both into the holding element 6, in particular into the proximal wheel portion 61 of the holding element 6 which has a gearwheel pattern in its interior, and comes directly into contact with the rotating element 11, such that the movement of the transmission element 12 is now transmitted via the rotating element 11 and via the connecting element 18 to the holding element 6 of the adjusting element 3. In this exemplary embodiment, the drive element 5 has the transmission element 12 and the rotary element 11.In one exemplary embodiment, the drive element 5 has, at a distal end of a shaft 10 of the needle holder 1, a rotary element 11, for example a wheel or a gearwheel, which can be controlled by the user via a transmission element 12, in particular a further shaft, rotor, pole, a wheel, gearwheel or a set screw or a cable, on a further rotary element 13 arranged on a handle 14 of the needle holder 1 (FIG. 2 ). The rotary element 11 located at the distal end of the shaft 10 of the needle holder 1 is connected to the adjusting element 3 and drives this adjusting element 3 (FIGS. 1, 6, 7, 8, 9, 10, 14), for example by gearwheels or by toothing (FIG. 13 ).In an embodiment in robotic and / or robot assisted surgery (FIGS. 4, 5 ), an adjustment element 3 is arranged in or on one of the two handle parts 4 of the robotic needle holder 16, wherein the drive element 5 with its transmission element 12 of this handle part 4 is used for controlling the adjustment element 3. This embodiment example enables a cost-effective modification of the robotic needle holder 16 used in robotic surgery, where the pivoting movement of one of the two grip parts 4 of the robotic needle holder 16 is dispensed with and this grip part 4 remains in the closed position, whereby the driving element 5 becoming free is used with its transmission element 12 for controlling an adjusting element 3. The adjusting element 3 can be removable and removable or instead it can be permanently installed, which can be less expensive to produce.The advantages achieved with the invention consist in particular in that the most time-consuming step of a surgical suture can be significantly facilitated by simplifying the adjustment of the position and / or rotation and / or alignment of a surgical needle. In addition, the invention enables the adjustment of the surgical needle without displacing the position of the grip parts relative to one another. This allows the surgical needle to be clamped as close as possible to the distal end of the grip parts, which improves the precision of the suture process and facilitates sewing in a narrow space. Due to the rubber band design of the adjusting element, a very wide range of displacement is possible. By different arrangement of the adjusting elements, needle holders with different adjustment possibilities can be provided on different axes. Not least, the invention can be applied to existing needle holder designs, including robotic needle holders, by minor modifications.List of reference characters1 Needle holder 2 surgical needle 3 adjusting element 4 grip part 5 drive element, comprising rotating element 11, transmission element 12 and rotating element on a handle 13 6 holding element 7 spring mechanism 8 receptacle 9 rubber support 10 shaft 11 rotating element 12 transmission element 13 rotating element on a handle 14 handle 15 rubber band between rotating element 111 and adjusting element 3 16 robotic needle holder 17 locking rod 18 connecting element 31 rubber band 61 in its interior a proximal wheel portion of holding element 6 111 rotating element on the pivotable grip part having a gearwheel patternFigure DescriptionsFIG. 1 shows a needle holder with an adjusting element arranged laterally on a grip part. The handle and the transmission element are not shown.1a) Top view, without rubber band.1b) Top view with rubber band.1c) Side view. FIG. 2 shows a laparoscopic needle holder with a rotating element arranged on a handle for controlling the movement of the adjusting element and with locking rods arranged on the handle, a view from the side. FIG. 3 shows a grip part with laterally arranged adjusting element, embodiments for spring mechanism, without rubber band. FIG. 4 shows a three-dimensional representation of a robotic needle holder with an adjusting element arranged within a grip part. FIG. 5 Robotic needle holder, side view. FIG. 6 shows laparoscopic needle holders with an adjusting element arranged laterally on one grip part and a rubber support arranged on an opposite grip part. The handle and the transmission element are not shown. FIG. 7 shows laparoscopic needle holders with an adjusting element arranged laterally on a handle part and a rubber support arranged on an opposite handle part, handle parts closed, shown with a surgical needle, handle and transmission element not shown. FIG. 8 shows laparoscopic needle holders with a laterally arranged adjusting element on each of the two grip parts. The handle and the transmission element are not shown. In the top view: View from above, without rubber band 15. FIG. 9 : Representation of the distal end of a laparoscopic needle holder, view from above, with a laterally arranged adjusting element on each of the two grip parts; different effects on the movement directions on the adjusting elements are made possible by connecting the rubber band 15 to different positions on the rotating element 111:9a) Rubber tape 15 is not connected.9b) rubber band 15 is connected in such a way that the adjusting elements on opposite grip parts have the same direction of movement on their side facing the surgical needle 2, so that a displacement of the position of the surgical needle relative to the grip parts is achieved without changing the rotation of the surgical needle.9c) rubber band 15 is connected in such a way that the adjusting elements on opposite gripping parts have opposite directions of movement on their side facing the surgical needle, so that a change in the rotation of the surgical needle is achieved without displacing the position of the surgical needle with respect to the gripping parts. FIG. 10.10a) Three-dimensional representation of the distal end of a laparoscopic needle holder with an insertable and removable adjusting element arranged within a grip part.10b) Two-dimensional view from the side, in this case with a rubber support arranged on the pivotable grip part. FIG. 11 shows a holding element for adjusting elements with a proximal wheel portion having a toothed wheel pattern in its interior. The representations correspond to an adjusting element, the rubber band of which has been removed.11a) Side view, the dashed drawing in the middle of the middle rod, points to the abbreviated representation.11b) Top view. The center of the wheels is not movable, but serves as a rail for the four movable wheel portions, two per wheel. One of the movable wheel portions has a gear pattern in its interior, whereby the connection to the rotary member can be made. FIG. 12 is a three-dimensional enlarged view showing the connection between the transmission member and the rotating member shown in FIG. 10. FIG. 13 shows examples of a connection between the holding element and the rotating element.13 a) Proximal wheel portion of the holding element and rotating element having a gearwheel pattern in its interior, view from the side.13b) Three-dimensional representation of the connection between the holding element and the rotating element.13c) Alternative example of a possible connection between the holding element and the rotating element, as shown in FIG. 1. FIG. 14 shows an embodiment with adjusting elements 3 arranged on both sides of a grip part 4, a view from above. An adjustment of the alignment of the surgical needle is hereby achieved as long as the adjustment elements 3 arranged on the two sides of the grip part are not moved in exactly the same direction and the same extent.References included in the specificationThis list of documents cited by the applicant has been produced in an automated manner and is only included for the better information of the reader. The list is not part of the German patent application or utility model application. The DPMA does not take any adhesion for any faults or omissions.Patent Literature citedDE 102010055806A1

[0003]

Claims

Needle holder (1) with a device for adjusting the position and / or rotation and / or alignment of a surgical needle (2), comprising an adjusting element (3) which is arranged in and / or on a handle part (4) of the needle holder (1), wherein, starting from a dosed gripping force of the needle holder (1), the adjusting element (3) can change the position and / or rotation and / or alignment of the surgical needle (2) by means of its movement, wherein the adjusting element (3) is connected to a drive element (5), wherein the drive element (5) can be controlled by a user and drives the movement of the adjusting element (3), wherein, when the dosed gripping force is exceeded, the handle part (4) grips the surgical needle (2) and prevents an adjustment of the position and / or rotation and / or alignment of the surgical needle (2).Needle holder according to claim 1, wherein the adjusting element (3) comprises in particular a rubber band (31), wherein the rubber band (31) is tensioned on a holding element (6), in particular between two wheels, wherein the holding element (6) is connected to the drive element (5), in particular by a further rubber band (15) or by toothed wheels or by toothing.Needle holder according to one of the preceding claims, wherein the holding element (6) and / or adjusting element (3) are coupled to a spring mechanism (7), wherein the spring mechanism (7) yields after the dosed gripping force is exceeded, such that the pressure on the adjusting element (3) is limited when closing the gripping parts (4).Needle holder according to one of the preceding claims, wherein the holding element (6) and / or the adjusting element (3) and / or the spring mechanism (7) can be installed and removed, wherein the holding element (6) and / or the adjusting element (3) and / or the spring mechanism (7) can latch in through a receptacle (8), wherein the receptacle (8) is in particular a groove and / or indentation and / or rail and / or magnetic mechanism matching the holding element (6) and / or the adjusting element (3) and / or the spring mechanism (7).Needle holder according to one of the preceding claims, wherein at least one adjusting element (3) is arranged on opposite handle parts (4), wherein the position of the surgical needle (2) can be displaced with respect to the handle parts (4) with constant rotation of the surgical needle (2), provided that the adjusting elements (3) have the same direction of movement on their side facing the surgical needle (2); wherein the rotation of the surgical needle (2) can be adjusted with constant position of the surgical needle (2) with respect to the handle parts (4), provided that the adjusting elements (3) have opposite directions of movement on their side facing the surgical needle (2).Needle holder according to one of the preceding claims, wherein the dosed gripping force is reproducibly retained by a mechanism, in particular by a locking mechanism, in particular by a first clicking of the locking mechanism, for example by extending the corresponding locking rods (17) of a conventional locking mechanism.Needle holder according to one of the preceding claims, wherein the adjusting element (3) and / or the holding element (6) and / or the spring mechanism (7) and / or the drive element (5) has a resorbable material and / or material degradable by the body.Needle holder according to one of the preceding claims, wherein the drive element (5) has a rotary element (11), in particular a wheel and / or a gearwheel and / or a set screw, which can be rotated via a transmission element (12), in particular a shank and / or pole and / or rotor and / or a further wheel and / or a further gearwheel and / or a further set screw and / or a cable and / or a band, wherein the transmission element (12) has a further rotary element (13) and / or a control element, which is arranged in particular on a handle (14).Needle holder according to one of the preceding claims, wherein at least one adjusting element (3) is arranged on both sides of the grip part (4), whereby an adjustment of the orientation of the surgical needle (2) is achieved as long as the adjusting elements (3) are not moved to exactly the same extent and the same speed and direction.Needle holder according to one of the preceding claims, wherein the needle holder is used in robotic surgery, wherein a drive element (5) of the robotic instrument is used with its transmission element (12) on one of the two grip parts (4) not for pivoting the grip part (4) but for controlling the adjustment element (3).

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