Instrument device, in particular medical instrument device

Abstract

Instrument device (101), in particular a medical instrument device, for guiding a guide thread (103) and / or a replacement material through a tubular cavity (153), wherein the instrument device (101) comprises the guide thread (103) with two thread ends (105, 107), an elongated feeder instrument (111) with a hollow shaft (119) having an opening (121) at its distal end, and an elongated retrieval instrument (131) with a distal end section (139) for retrieving the guide thread (103) and with a hollow guide shaft (137) for inserting the feeder instrument (111), wherein a clamping element (109) is arranged on the guide thread (103), and the distal end section (139) of the retrieval instrument (131) has a clamping receptacle (147) which has a recess and / or a cavity in at least one surface of the distal End section (139) is designed to clamp the clamping body (109),so that, in the event of positioning the distal end section (139) of the retrieval instrument (131) below a distal opening of the tubular cavity (153), arranging the clamping body (109) at and / or in the opening (121) at the distal end and / or in the hollow shaft (119) of the feeding instrument (111), and inserting the feeding instrument (111) through the guide shaft (137) of the retrieval instrument (131) and the tubular cavity (153), the clamping body (109) can be force-fitted to the clamping receptacle (147) of the retrieval instrument (131), wherein the clamping body (109) and / or the clamping receptacle (147) is or are elastically deformable.

Description

[0001] The invention relates to an instrument device, in particular a medical instrument device, for guiding a guide thread and / or a replacement material through a tubular cavity, wherein the instrument device comprises the guide thread with two thread ends, an elongated feed instrument with a hollow shaft with an opening at its distal end and an elongated retrieval instrument with a distal end section for retrieving the guide thread and with a hollow guide shaft for inserting the feed instrument.

[0002] In both medical and non-medical technical applications, it is often necessary to guide an elongated object, such as a thread, wire, or cable, through a narrow cavity and retrieve the end. In industrial and technical settings, a cavity might be, for example, a cable duct or a pipe. In medical applications, the cavity might be naturally present inside a long bone or created by drilling through a bone.For example, in the case of a dislocated shoulder joint due to injury and / or tearing of ligaments located between the acromioclavicular joint (consisting of the clavicle and part of the scapula) and the coracoid bone below, it is necessary to replace these ligaments with an implant and / or stabilize the joint. For this purpose, a tunnel is drilled through the coracoid, and then a replacement material, such as a tilting anchor with several connected sutures, is inserted through the tunnel using an agent and tilted in width on the underside of the coracoid below the lower drill hole (see Wolf Petersen, Thore Zantop: Minimally Invasive AC Joint Reconstruction (MINAR®), first edition 2017, Endo:Press GmbH).

[0003] A disadvantage of such surgical methods, as well as in technical applications, is that due to the small diameter of the borehole and / or cavity, and the surrounding environment and / or installation situation, there is no direct visual control. Therefore, when inserting a thread through the cavity, the user cannot see the thread end and cannot manipulate and / or retrieve it.

[0004] While it is common practice in the medical and industrial fields to use additional equipment, such as an endoscope for arthroscopy of the joint being treated or for visual inspection of the technical device, this, even though performed as a minimally invasive procedure in medicine, inherently carries a risk of additional tissue damage and increases the complexity of the procedure. Furthermore, suture retrieval devices with a retractable loop, familiar from arthroscopic visual control, can be used to capture the thread end, but this further increases the instrumental complexity.

[0005] From US patent 8,801,727 B2, a suture guide with a drill guide and a method for guiding a suture through a tunnel in a bone are known, wherein the suture guide comprises a suture retrieval device and a suture. The suture retrieval device has a hook-shaped foot with an opening, which can be positioned under a bone. Furthermore, the suture retrieval device has a guide tube for guiding the drill and for guiding the suture. The suture has a stopper at its distal end, which is bendable at its opposite ends perpendicular to the longitudinal direction of the suture. A drill can be inserted through the guide tube of the suture retrieval device to bore through the bone, and subsequently the suture is inserted through the guide tube until the stopper is pushed through the opening in the foot of the suture retrieval device and bends back on the underside of the suture retrieval device.The thread retrieval device is then released and retracted below the bone, allowing the user to manage both thread ends. In an alternative embodiment, the foot of the thread retrieval device has two opposing jaws. The first jaw is pivoted relative to the second jaw, allowing the second jaw to swivel away. The thread is then gathered in the resulting space and secured by closing the first jaw. A control cable is mounted in the foot and operated remotely to move the first jaw. A disadvantage of this design is that, due to the lack of visibility on the underside of the bone, the user cannot reliably see or detect whether the thread is securely held, whether using the flexible stopper or the thread retrieval device with the swiveling jaw.

[0006] From CN 102 038 547 A, an instrument is known comprising a feeder, a suture retrieval device, and a suture. The suture retrieval device has a C-shaped base with a round opening slotted on one side, which can be positioned over a tunnel inserted into a bone. The C-shaped base has a screw at one distal end opposite the opening, which can be positioned below the tunnel. The feeder has a hollow shaft in which the suture can be arranged. The suture has a cross nut at one end that fits onto the screw of the suture retrieval device. During a procedure, the suture is inserted into the hollow shaft, and the cross nut is securely fastened to a distal end of the shaft. The feeder is then guided through the round opening in the base of the suture retrieval device and through the tunnel in the bone. By rotating the feeder, the cross nut is screwed onto the screw.The cross nut can then be retracted using the thread retractor, so that both ends of the thread are available for further processing.

[0007] US Patent 2016 / 0183934 A1 discloses an instrument for administering suture material. The instrument comprises a guide handle with a proximal end for grasping and a distal end for engaging with a bone to which suture material is to be attached. The bone is provided with a through-hole, and a suture retrieval arm, mounted on the distal end of the guide handle, is provided with a distal tip sized to fit within the through-hole.

[0008] All known state-of-the-art systems have the disadvantages that they either require additional instruments, such as an endoscope, to compensate for the lack of visibility in the area below the cavity, thereby increasing the risk of tissue damage, or that, without an additional optical device, the user cannot reliably detect when the thread has been attached to a retrieval instrument. The latter often leads to numerous attempts until the thread is successfully attached to the retrieval instrument, which can also result in further tissue damage and a prolonged period before the thread is successfully attached.

[0009] The purpose of the invention is to improve the state of the art.

[0010] The problem is solved by an instrument device, in particular a medical instrument device, for guiding a guide thread and / or a replacement material through a tubular cavity, wherein the instrument device comprises the guide thread with two thread ends, an elongated feed instrument with a hollow shaft having an opening at its distal end, and an elongated retrieval instrument with a distal end section for retrieving the guide thread and with a hollow guide shaft for inserting the feed instrument, wherein a clamping element is arranged on the guide thread and the distal end section of the retrieval instrument has a clamping receptacle for clamping the clamping element, so that in the event of positioning the distal end section of the retrieval instrument below a distal opening of the tubular cavity,a positioning of the clamping body on and / or in the opening at the distal end and / or in the hollow shaft of the feeding instrument and an insertion of the feeding instrument through the guide shaft of the retrieval instrument and the tubular cavity of the clamping body can be force-fitted to the clamping receptacle of the retrieval instrument.

[0011] Thus, an instrument device is provided with which a guide thread can be easily and reliably passed through a tubular cavity and securely connected to the distal end of the retrieval instrument by means of its clamping element. The connected guide thread can then be removed and retrieved by the user from below the tubular cavity. Subsequently, the two thread ends of the passed guide thread can be used by the user, for example, to pull several sutures through the tubular cavity in a medical application or a wire rope through a technical application.Thus, despite limited accessibility and lack of visual control, a guide thread can be easily and reliably passed through a tubular cavity and captured and retrieved at the far end of the tubular cavity using the retrieval instrument.

[0012] In medical applications, it is particularly advantageous that no additional instruments, such as an endoscope for arthroscopy or a separate suture guide, are required, as the force-fit connection between the clamping body and the clamping receptacle eliminates the need for visual control. Furthermore, for example, in the repair of a joint such as the acromioclavicular joint, knotless fixation of a replacement material to the joint is possible. This eliminates the need for an anchor, which would otherwise remain below the distal opening of the tubular cavity of the corresponding bone. This reduces both tissue damage during the insertion of the replacement material using the guide suture and long-term tissue damage. Moreover, this, along with the absence of additional instruments, allows for a smaller surgical incision and a shorter treatment time.

[0013] It is particularly advantageous that the clamping body can be connected to the clamping receptacle only mechanically and / or passively. This eliminates the need for additional, complex articulation with control cables and control technology, and consequently, the need for complicated operation by the user to catch the guide thread.

[0014] Furthermore, the use of only two individual instruments, the retrieval instrument with the hollow guide shaft and the feed instrument, which is passed through the hollow guide shaft and pushed further through the tubular cavity, ensures concentricity, guaranteeing that the clamping body is precisely aligned with the clamping receptacle of the distal end section of the retrieval instrument and consequently a successful, secure connection between the clamping body and the clamping receptacle is established.

[0015] In principle, the instrument device is suitable for any type of passage of an elongated object through a tubular cavity and for retrieving the end of the object. It should be emphasized that the medical instrument device can also be used for non-medical applications, for example, in the technical field. For instance, the instrument device and / or the medical instrument device can be used underwater to guide a rope through an existing cavity or a cavity drilled specifically underwater and to retrieve the rope end to the surface, for example, to secure an underwater structure to land and / or to anchor it underwater.

[0016] A key aspect of the invention is that the clamping element of a guide thread, which is arranged on and / or in the distal opening and / or in the hollow shaft of the delivery instrument, can be precisely, securely, and reliably connected to the clamping receptacle of the retrieval instrument below the lower opening of the tubular cavity by inserting and sliding the delivery instrument with the clamping element through the guide shaft of the retrieval instrument and through the hollow cavity of the clamping element, without the user of the retrieval instrument and the delivery instrument having a view into the tubular cavity, in the area around and / or below the tubular cavity.Because the user of these two instruments has to exert an additional force to form the force-fit connection between the clamping body and the clamping receptacle compared to the previous pushing of the feed instrument with the arranged clamping body through the tubular cavity, the user is directly shown tactilely and / or haptically that the force-fit connection is reliably formed, so that a visual inspection is not required in any case.

[0017] The following terms will be explained:

[0018] An "instrument device" is, in particular, a device for guiding a guide thread and / or elongated object through a tubular cavity. The instrument device comprises, in particular, a feeder instrument and a retrieval instrument. In addition to these two instruments, the instrument device comprises, in particular, a guide thread with an integrated clamping element. The instrument device is also, in particular, an instrument kit or kit of parts. Optionally, the instrument device may also include a plunger and / or a push-through element for use when the clamping element is partially or completely located within the hollow shaft of the feeder instrument, in order to push the clamping element out of the hollow shaft and through the subsequent tubular cavity into the clamping receptacle of the retrieval instrument.

[0019] A "guide thread" is, in particular, a long structure, material, and / or object. The guide thread may, in particular, consist of several fibers and / or filaments that are interwoven, twisted, woven, and / or twisted. The guide thread may, in particular, consist of a natural and / or organic material, such as silk or yarn, a synthetic material, and / or a metallic material. A synthetic guide thread, in particular, consists of plastic. The synthetic guide thread may, in particular, be absorbable or non-absorbable. For example, nylon, polyester, PTFE, or polypropylene and / or stainless steel may be used as materials for a non-absorbable guide thread. However, a guide thread may also be a wire, a rope, and / or a cable. The guide thread is, in particular, a single thread to which the clamping element is connected and / or attached.The guide thread is, in particular, a surgical suture material. The guide thread is, in particular, a single surgical suture and / or pull thread. The guide thread has, in particular, two opposite ends. One end of the guide thread is, in particular, a proximal end, which remains within the user's reach and / or attached to a thread clamp of the delivery instrument, and the other end is, in particular, a distal end, which is guided by the clamping body, in particular, through the tubular cavity and / or retrieved back to the user. The length and diameter of the guide thread depend, in particular, on the specific application. In the case of a medical suture material, the guide thread may, for example, have a diameter of 2.0 mm.

[0020] A "clamping body" is, in particular, a physical body with mass and volume. The clamping body has, in particular, a spatial and / or three-dimensional shape. A clamping body can be, in particular, a rigid body and / or a deformable body. The clamping body can also have a partially rigid shape and a partially deformable section. In principle, the clamping body can have any geometric shape. For example, the clamping body can have a round, oval, triangular, polygonal, rectangular, square, pyramidal, and / or conical shape. The clamping body can also have a combination of different shapes; for example, it can have a semicircular shape at its distal end and a square shape at its proximal end.Similarly, the clamping element can have a structured surface to improve the static friction of the force-fit connection with the clamping receptacle. For example, the clamping element can have spaced-apart fixed and / or deformable ribs on its surface. The shape of the clamping element is designed to be precisely and / or approximately complementary to the shape of the clamping receptacle.

[0021] The clamping element can be attached to the guide thread using any connection technique. For example, the guide thread and the clamping element can be connected by a material-bonded, force-fit, and / or form-fit connection. The clamping element could, for instance, be an injection-molded ball that is bonded to the thread by overmolding. Alternatively, the clamping element could be bonded to the guide thread using adhesive. The clamping element could also be formed directly from the guide thread, for example, as a knot in the shape of a monkey's fist. If the clamping element is not formed directly from the same material as the guide thread, it can, in principle, be made of any material, such as plastic and / or metal.

[0022] The clamping element is specifically located at a distal end section of the guide thread. The clamping element can also be located directly at the distal end of the guide thread, but it does not necessarily have to be at the distal end.

[0023] A "replacement material" is, in particular, a material and / or an elongated object that can be pulled into and / or through the tubular cavity using the inserted guide thread. A replacement material could be, for example, a thread and / or wire with a larger diameter, greater material thickness, and / or higher tensile strength. In a technical application, the guide thread could be a nylon rope and the replacement material a strong wire section for securing an underwater structure. In a medical application, a replacement material could be a suture or sutures, a toggle anchor, a bone anchor, and / or another implant. It is important to emphasize, however, that inserting the replacement material is only optional after inserting the guide thread.

[0024] A "feeding instrument" is, in particular, an instrument and / or tool for pushing the clamping element arranged on the guide thread through the guide shaft of the retrieval instrument and through the tubular cavity, and for forming a force-fit connection between the clamping element and the clamping receptacle of the retrieval instrument. The feeding instrument has, in particular, a hollow shaft with a distal opening and, especially at its proximal end, a handle. The hollow shaft may extend to the proximal end of a handle or may have an opening beforehand for threading the guide thread. In the latter case, in particular, the guide thread may be guided in a groove in the outer surface of the handle in a proximal direction. A thread holder and / or a thread clamp may, in particular, be arranged on the handle to hold the guide thread proximally. The handle of the feeding instrument may, in particular, be made of plastic.In the loaded state, the guide thread is at least partially positioned within the hollow shaft of the delivery instrument, and the clamping element is positioned at least partially or completely on the outside of the distal opening of the hollow shaft of the delivery instrument and / or partially or completely within the hollow shaft of the delivery instrument. In the loaded state, the proximal end of the guide thread extends proximally out of the hollow shaft and is held or manipulated by the user and / or the thread holder and / or the thread clamp. By means of the thread holder and / or the thread clamp, or by the user pulling, a tensile force can be applied to the guide thread, in particular such that the clamping element is flush and firmly positioned against and / or within the distal opening or the hollow shaft before the force-fit connection is formed.This precise positioning of the clamping element at and / or within the distal opening and / or the hollow shaft ensures, in particular, accurate alignment with the clamping receptacle and precise insertion of the clamping element into the clamping receptacle. The feeding instrument is reusable. The hollow shaft of the feeding instrument is made of metal, a metal alloy, and / or stainless steel. The hollow shaft is electropolished and passivated. The length of the hollow shaft of the feeding instrument is adapted to the length of the guide shaft of the retrieval instrument, the length of the tubular cavity, and / or the material thickness of the distal end of the retrieval instrument. Similarly, the outer diameter of the shaft of the feeding instrument depends on the inner diameter of the hollow guide shaft of the retrieval instrument and on the intended application.For a concentric arrangement, the outer diameter of the hollow shaft of the feeder is only slightly smaller than the inner diameter of the hollow guide shaft of the retrieval instrument, allowing the hollow shaft of the feeder to be inserted flush into the hollow guide shaft of the retrieval instrument. To use the feeder with different retrieval instruments with varying guide shaft diameters, the hollow shaft of the feeder can also have a significantly smaller outer diameter than the inner diameter of the respective guide shaft of the retrieval instrument.

[0025] A "retrieval instrument" is, in particular, an instrument and / or tool with at least one tool shaft and a hollow guide shaft, as well as a modified distal end section. The retrieval instrument is, in particular, reusable. The hollow guide shaft of the retrieval instrument may, in particular, be formed as part of a main shaft of the retrieval instrument or be arranged on a main shaft of the retrieval instrument. The hollow guide shaft is, in particular, designed such that its proximal opening is accessible to the feed instrument and its distal opening can be positioned above an object in which the tubular cavity is naturally present or intentionally formed. At the distal end of the guide shaft, the retrieval instrument has, in particular, a shaped outer rim.The distal end of the guide shaft can, for example, have an engagement ring with teeth that grip the object with the tubular cavity. This prevents the distal end of the guide shaft from slipping on the object's outer surface during the insertion of a drill, feeder, and / or plunger. The hollow guide shaft is typically straight. In addition to inserting the loaded feeder, a drill can also be inserted through the hollow guide shaft of the retrieval instrument to precisely create the tubular cavity by drilling an elongated borehole. It is particularly advantageous that, after removing the drill, the loaded feeder can then be directly inserted into the guide shaft of the retrieval instrument and into the drilled tubular cavity.However, drilling the tubular cavity, for example into a bone or an underwater structure, is only optional.

[0026] In particular, the longitudinal orientation of the main shaft above the hollow guide shaft of the retrieval instrument can differ from the longitudinal orientation of the hollow guide shaft itself. This simplifies access to and insertion of the feed instrument into the proximal opening of the hollow guide shaft. Preferably, the hollow guide shaft is oriented vertically and / or distally, while the main shaft deviates from a vertical orientation in the region of the proximal end section of the hollow guide shaft and further proximally. Preferably, the main shaft is arranged obliquely at an angle of 10° to 70° from the vertical axis and thus from the longitudinal orientation of the hollow guide shaft in the proximal end region of the hollow guide shaft.Furthermore, the main shaft can be bent once or several times to create a distance between it and the guide shaft, particularly in the area of ​​the proximal end section and / or the proximal opening of the guide shaft. In principle, the main shaft and the hollow guide shaft can also be formed in one piece and bent and / or aligned in different spatial directions section by section. The main shaft and / or the guide shaft are preferably made of metal and / or stainless steel and are preferably electropolished and passivated.

[0027] The distal end section of the retrieval instrument is shaped in such a way that it passes laterally by and / or rests against the object in which the tubular cavity is formed or inserted, and at least partially or completely encircles the underside of this object from below. The distal end section is particularly hook-shaped.

[0028] The "clamp receptacle" is a recess and / or cavity in at least one surface of the distal end section. Preferably, the clamp receptacle has a proximal opening on an upper surface of the distal end section. Adjoining this proximal opening is a cavity within the material thickness of the distal end section, in which the clamping element can be at least partially received and / or is received during force-fit connection. In particular, the clamp receptacle itself is not completely continuous in the vertical direction and thus in the insertion direction of the delivery instrument, but rather does not penetrate an underside of the distal end section.However, a gap can be provided in the distal end section of the retrieval instrument, whereby the gap can be connected to the cavity of the clamping receptacle or the gap can be provided in the distal end section independently of the cavity of the clamping receptacle. Preferably, the gap is provided on the underside of the distal end section and thus on its distal side. In particular, the gap extends proximally through the distal end section and is thus also connected to the clamping receptacle. The distal end section can have two clamping jaws due to the gap. The gap can be formed partially or completely along the longitudinal direction of the distal end section and can extend partially or completely to the region of the proximal end of the distal end section, which transitions proximally into the main shaft. This allows the distal end section to be configured, in particular, as two terminal clamping jaws.The transition from the proximal, straight end of the main shaft to the curved end section can also be designed mechanically as a spring, for example, by using a thinner material in this area, allowing the distal end section and / or the two clamping jaws to move with spring action. However, the spring-loaded and / or clamping function of the mechanical end section is provided solely mechanically; there is no articulation or actuation by means of a control and / or actuating element and / or by means of a drive and / or motor. The clamping receptacle can, in particular, have any shape as described above for the clamping body, and in particular, the clamping receptacle can have a shape complementary to the clamping body. The cavity of the clamping receptacle can, in particular, have a partially or completely smaller diameter than the outer diameter of the clamping body.

[0029] The term "force-fit" or "force-fit connection" refers specifically to a connection in which a normal force acts on the connecting surfaces of the clamping element and the clamping receptacle. In a force-fit connection, mutual displacement of the contacting surfaces of the clamping element and the clamping receptacle is prevented, as long as the opposing force caused by static friction is not exceeded. Specifically, the static friction between the contacting surfaces prevents the clamping element from slipping out of the clamping receptacle or from moving within it. A force-fit connection is essentially a clamping connection. However, in addition to a force-fit connection, a positive locking mechanism may also be present, or a form-fit connection may be established instead.Establishing the force-fit connection means inserting the clamping body arranged on and / or in the feeder instrument through the guide shaft and the tubular cavity into the clamping receptacle of the distal end section of the retrieval instrument located below, pressing the clamping body into the clamping receptacle, snapping it into place and / or clamping it.

[0030] A "tubular cavity" is, in particular, a recessed space within an object. The tubular cavity is specifically continuous through two opposite sides and the intervening material of the object. Specifically, the continuous cavity extends from a proximal opening through the object's material to a distal opening. The tubular cavity can be natural or artificial. For example, it could be the air-filled space of a tube or the cavity of a long bone. The cavity of the long bone may already be open or partially open before the delivery instrument with the attached clamping element is inserted, regardless of its intended use.Even in the case of a shoulder joint injury, drilling through the coracoid to create the tubular cavity is performed, in particular, before the instrument device and the claimed method for guiding the guide thread are used and / or carried out. In a medical application, the tubular cavity can, for example, have a diameter in the range of 1.0 mm to 5.0 mm, preferably in the range of 2.0 mm to 3.5 mm. In technical applications, the diameter of the cavity can also be significantly larger.

[0031] The term "longitudinal direction" refers in particular to the direction of the longest extension and / or dimension of an object or the respective component of the instrument device. When using the instrument device, the longitudinal direction of the feeding instrument and the hollow guide shaft of the retrieval instrument is specifically aligned vertically and / or distally.

[0032] The term "elongated" is understood to mean, in particular, that the longitudinal dimension of a given instrument or object is significantly larger than its cross-section. Specifically, the longitudinal dimension of the elongated feeder and the elongated retrieval instrument is each at least five times, particularly ten times, and preferably twenty times, longer than the cross-section of the respective instrument. For example, the main shaft of the retrieval instrument has a diameter of 5.0 mm and the retrieval instrument has a total length of 250.0 mm. In technical applications, the diameter and length of the retrieval instrument and / or the feeder may be considerably longer.

[0033] The terms "distal" and "distal" refer to an arrangement close to the patient's body and / or therefore farther from the user, and / or a corresponding end or section. Similarly, "proximal" or "proximal" refers to an arrangement close to the user and / or therefore farther from the patient's body, and a corresponding end or section.

[0034] According to the invention, the instrument device or the clamping body and / or the clamping receptacle are elastically deformable.

[0035] This allows the clamping element and / or the clamping receptacle to deform under the force applied when the clamping element is inserted and / or pushed into the clamping receptacle. After the pressure is released, the clamping element returns to its original shape, thus achieving a clamping action. In principle, both the clamping element and the clamping receptacle can be elastically deformable. However, preferably either only the clamping element or the clamping receptacle is elastically deformable, or vice versa. With a rigid clamping element, the force applied when inserting the clamping element into the clamping receptacle can be used more effectively to create the positive connection. An elastic clamping receptacle expands laterally and / or in the direction of pressure until the clamping element is engaged and the elastic clamping receptacle springs back to its original shape.

[0036] The term "elastic" refers in particular to a property of a body or material to change its shape under the influence of a force and to return to its original shape when the force is removed. Elastic deformability can be achieved, in particular, through the material properties and / or the design of the clamping element and / or the clamping receptacle.

[0037] To facilitate the insertion of the clamping element into the clamping receptacle and thus the formation of the force-fit connection between the two, the clamping receptacle may have an outwardly expanding opening in an outer surface of the distal end section.

[0038] Because the opening of the clamp receptacle is slightly enlarged directly on the outer surface of the distal end section, this not only facilitates insertion and centering of the clamping element into the proximal opening of the clamp receptacle, but also prevents material wear on the outer surface around the outwardly widening opening of the distal end section. This allows the retrieval instrument to be reused for a very long time.

[0039] The outwardly widening opening can be achieved, for example, by chamfering the outer surface of the distal end section around the opening. Alternatively, regardless of the actual shape of the clamping receptacle, a conically tapered drill bit can be inserted concentrically to the clamping receptacle into the distal outer surface of the distal end section to create the outwardly widening opening.

[0040] In another embodiment of the instrument device, the clamping receptacle has a larger dimension along a longitudinal direction of the distal end section of the retrieval instrument than its dimension transverse to the longitudinal direction.

[0041] With a clamping element that is symmetrical or at least nearly symmetrical in cross-section, a certain degree of longitudinal play is provided, thus allowing for movement when inserting the clamping element into the clamping receptacle. Particularly with clamping elements that have a small cross-section, this eliminates the need for precise longitudinal positioning within the clamping receptacle, and clamping occurs at least in the transverse direction. Similarly, the clamping element can be longer in the longitudinal direction of its distal end section than in the transverse direction, thereby improving the force-fit connection due to the longer contact surfaces in the longitudinal direction.

[0042] To further improve the clamping of the clamping body and / or to make it haptically perceptible to the user, the distal end section of the retrieval instrument has two clamping jaws and the clamping receptacle is at least partially located on and / or in one or both clamping jaws.

[0043] The pressure applied by the user to the delivery instrument forces the clamping element into the clamping receptacle, causing the two clamping jaws to be forced outwards and / or at least partially away from the clamping element. When the user releases the clamping element and thus the pressure, the clamping jaws snap back together into their original position, clamping the element and generating a vibration and / or impact. This vibration and / or impact is preferably transmitted through a hard material, such as metal, of the retrieval instrument, particularly via the main shaft of the instrument, to the handle, and is perceived by the user as haptic feedback.

[0044] It is particularly advantageous that the opening and closing of the clamping jaws is purely mechanical. The opening and closing of the clamping jaws can occur laterally to the longitudinal direction of the distal end section, so that the two clamping jaws meet, especially in the region of the longitudinal center axis of the distal end section and / or a gap. Alternatively, or additionally, the transition from the distal end of the main shaft to the curved distal end section can also be designed as a spring, for example, by means of a material taper. In the latter case, when the clamping body is inserted into the clamping receptacle in a distal direction, and thus from above, the clamping jaws are pressed downwards and spring back upwards in a proximal direction when the applied force is released.This causes the clamping jaws to strike the clamping body from below, and thus the feeding instrument, so that haptic feedback can be felt by the user not only at the feeding instrument but also at the instrument itself, in addition to the transmission of the vibration through the retrieval instrument.

[0045] In another embodiment of the instrument device, a gap is arranged at least partially between the two clamping jaws.

[0046] A gap improves the spring-like movement of the clamping jaws apart and together. When this gap is connected to the clamping receptacle, the receptacle is at least partially enlarged by the gap as the jaws move apart, making it easier for the user to insert the clamping body into the receptacle. Since the gap also amplifies the spring action of the clamping jaws, they collide with a greater force and / or strike the clamping body when they return to their original position. This increases the resulting vibration and consequently enhances tactile, haptic, and / or auditory feedback.

[0047] In order to guide the guide thread through very narrow tubular cavities, the clamping body can have an outer diameter in a range of 0.2 mm to 4.0 mm, in particular from 0.5 mm to 3.0 mm, preferably from 1.5 mm to 2.5 mm.

[0048] In another embodiment of the instrument device, the outer diameter of the clamping body can be larger than a complementary inner diameter of the clamping receptacle, resulting in an interference fit.

[0049] This allows the clamping recess to expand further when the larger clamping body is inserted, and / or the clamping jaws to move further apart and then snap back into place. In addition to the increased force exerted when expanding the clamping recess and / or pushing the clamping jaws apart, the interference fit also provides an improved, positive-locking connection between the clamping body and the clamping recess.

[0050] Furthermore, the at least partial oversize of the clamping body simultaneously provides a sufficient holding force for the clamping body in the clamping receptacle, thus preventing the clamping body from coming loose from the clamping receptacle of the distal end section of the retrieval instrument when the retrieval instrument with the clamping body and the guide thread attached to it is pulled away from the underside of the object with the tubular cavity and moved in a proximal direction towards the user.

[0051] In principle, it should be noted that the clamping element can be larger throughout, and thus in both the transverse and longitudinal directions, than the complementary inner diameter of the clamping receptacle. Likewise, the clamping element can have a larger outer diameter only in a specific area. A larger outer diameter can also be arranged regularly or irregularly across the outer surface of the clamping element, for example, by means of spaced-apart, projecting ribs on the outer surface of the clamping element.This requires the user to apply a specific force to the feeding instrument to press the clamping element into the clamping receptacle, whereby, due to the clamping of the clamping element in the clamping receptacle and the associated vibration and / or a clicking function, tactile, haptic and / or auditory feedback is enhanced, and the successful capture of the clamping element of the guide thread by means of the clamping receptacle is indicated to the user.

[0052] In order to ensure and indicate a secure connection between the clamping body and the clamping receptacle to the user, despite the lack of visual control on the underside of the object with the tubular cavity, the clamping body and the clamping receptacle can be designed in such a way that haptic feedback can be transmitted to a user during force-fit connection.

[0053] Thus, the dimensions, material properties, and / or design of the force-acting surfaces of the clamping body, the clamping receptacle, and / or the clamping jaws are specifically designed to generate a haptic signal and transmit haptic feedback to the user. The transmission of haptic feedback occurs particularly along the retrieval instrument and / or the feeder, which is / are also specifically designed to transmit the resulting vibration and / or impact. Preferably, the vibration and / or impact is transmitted via the respective shaft of the retrieval instrument and / or the feeder to the respective handle held by the user, so that the user directly perceives the tactile and / or haptic feedback at the handle.

[0054] Haptic feedback refers specifically to the user's perception, through touch, of the successful formation of a positive-locking connection between the clamping element and the clamping receptacle. This haptic feedback can be perceived by the user either passively or actively through touch.

[0055] In another embodiment of the instrument device, the clamping body and the clamping receptacle are designed in such a way that, during force-fit connection, an auditory feedback can be transmitted to a user or the user.

[0056] Thus, auditory feedback can be provided to the user of the instrument device, either alone or in addition to haptic feedback.

[0057] Audible feedback to the user can be provided in particular by a clicking sound when the clamping body is pressed into the clamping receptacle, when one or both clamping jaws snap back against the clamping body after being moved apart, and / or when the clamping jaws meet.

[0058] Thus, simple haptic and / or auditory feedback is provided to the user in every case, without the need for a controller, electronic components, and / or a sensor for the feedback. However, it should be emphasized that, of course, a pressure sensor can also be arranged in the clamping receptacle, which, based on the pressure exerted when the clamping element is inserted into the receptacle, detects a successful force-fit connection. This can then be indicated to the user conventionally as an auditory and / or visual signal, for example, by emitting a sound or by the handle lighting up.

[0059] In order to press the clamping body directly into the clamping receptacle using the feeding instrument, the clamping body can have a maximum outer diameter larger than the inner diameter of the hollow shaft of the feeding instrument, so that the clamping body can be arranged at least partially end-to-end on the outside and / or below the distal opening of the feeding instrument.

[0060] Because the clamping body is at least partially or completely located at the end on the outside of and / or below the distal opening of the delivery instrument, the clamping body can also be inserted directly and centered into the proximal opening of the distal end section of the retrieval instrument.

[0061] Due to the larger maximum outer diameter of the clamping body than the inner diameter of the hollow shaft, the feeding instrument is loaded with the guide thread and the clamping body attached to it by pushing the guide thread with its proximal end from below through the distal opening of the hollow shaft of the feeding instrument until the proximal end of the guide thread exits the handle, and then by pulling on the proximal end section of the guide thread and / or securing it with a thread clamp on the handle, the clamping body is pulled from below against the distal opening of the hollow shaft of the feeding instrument and secured there.

[0062] In a further embodiment of the instrument device, the clamping body can have a maximum outer diameter smaller than an inner diameter of the hollow shaft of the feeding instrument, so that the clamping body can be arranged inside the hollow shaft and / or in the opening at the distal end of the feeding instrument and can be pressed into the clamping receptacle by means of an associated plunger that can be inserted into the hollow shaft.

[0063] In this variant, the hollow shaft of the feeding instrument is designed such that it has a proximal opening through which an identifiable or associated plunger can be inserted into the hollow shaft of the feeding instrument to press the clamping element from the hollow shaft into the clamping receptacle of the distal end section of the retrieval instrument. Furthermore, in this case, the loading of the feeding instrument with the clamping element connected to the guide thread can also be carried out through the proximal opening and / or from above via the handle.

[0064] In order to position and hold the clamping element precisely on the delivery instrument, the delivery instrument may have a holding receptacle on and / or in the opening at its distal end for holding the clamping element, whereby a holding force of the holding receptacle is less than a clamping force of the clamping receptacle of the retrieval instrument.

[0065] This ensures that the clamping element is securely held in position by the retaining device when pressed into the clamping receptacle, thus preventing lateral slippage. Furthermore, the clamping element is held directly at the distal end of the hollow shaft of the delivery instrument by the retaining device and does not need to be held solely by proximal pulling force from the user or a thread clamp on the handle of the delivery instrument. Instead, the clamping element is pulled proximally against the distal opening of the hollow shaft of the delivery instrument.

[0066] A "retaining element" is, in particular, at least one component or part of the hollow shaft of the delivery instrument that exerts a holding force on the clamping element. A retaining element can, for example, be a clamping lug or several clamping lugs on the inner wall of the hollow shaft in the region of the distal opening, whereby the clamping element is at least partially clamped. The retaining element can also be designed as a partial constriction within the shaft.

[0067] The problem is solved by a non-inventive method for guiding a guide thread and / or a replacement material through a tubular cavity by means of an elongated feeding instrument with a hollow shaft and an opening at its distal end, a guide thread on which a clamping element is arranged, and an elongated retrieval instrument with a distal end section for retrieving the guide thread, with a hollow guide shaft for inserting the feeding instrument and with a clamping receptacle for clamping the clamping element in and / or on the distal end section, in the following steps: - Threading the guide thread through the hollow shaft of the delivery instrument so that the clamping element of the guide thread is positioned at and / or in the opening at the distal end and / or in the hollow shaft of the delivery instrument, - Positioning the distal end section of the retrieval instrument below a tubular cavity, - Inserting the feeding instrument with the arranged clamping body through the guide shaft of the retrieval instrument and through the tubular cavity, - Clamping the clamping body in the clamping receptacle of the retrieval instrument, - Removing the feeding instrument from the guide shaft so that a free thread end of the guide thread is present, and - Removing the retrieval instrument with the clamped clamping body from the tubular cavity, so that the guide thread is pulled through the tubular cavity, and optionally - Pulling the replacement material into and / or through the tubular cavity using the guide thread.

[0068] This provides a method for easily and safely threading a guide thread through a tubular cavity, even without visual inspection. On the opposite side, the thread can be reliably retrieved by pulling it proximally around the object containing the tubular cavity using the retrieval instrument. This allows the user to then manipulate and / or use both ends of the guide thread. For example, in a medical application, the user can then use the guide thread to pull multiple sutures through the tubular cavity in a bone to replace torn ligaments and / or to thread a bone anchor through the cavity.Similarly, in the case of an industrial technical application, a user can, for example, use the guide wire to pull a fastening rope or fastening wire through the cavity of a technical object.

[0069] In another embodiment of the procedure, the tubular cavity has been formed by drilling a bone tunnel before carrying out the procedure, or the tubular cavity is a cavity of a long bone.

[0070] Therefore, in the case of a medical application of the procedure, surgical steps such as opening the body surface, drilling a bone tunnel, or opening a long bone to allow free access to the natural cavity of the long bone are explicitly not steps of the claimed procedure and are performed prior to the execution of the claimed procedure. In the case of a long bone, the natural canal is used as the tubular cavity in the procedure.

[0071] The invention will now be explained in more detail using exemplary embodiments. These will show... Fig. 1 A highly schematic, three-dimensional representation of an instrument kit with a feeding instrument, a guide thread and arranged clamping ball, and a retrieval instrument. Fig. 2 a highly schematic, three-dimensional representation partially in longitudinal section of the distal end of the feeding instrument, Fig. 3 a highly schematic, three-dimensional representation of the retrieval instrument with the inserted feeding instrument, Fig. 4 a highly schematic, three-dimensional representation of an arrangement of the retrieval instrument on a bone, Fig. 5 A highly schematic, three-dimensional representation of the retrieval instrument arranged on the bone before the insertion of the delivery instrument into a guide shaft of the retrieval instrument, Fig. 6 a highly schematic, three-dimensional representation of the arranged retrieval instrument during the insertion of the feed instrument into the guide shaft of the retrieval instrument, Fig. 7 A highly schematic, three-dimensional representation of a distal area of ​​the retrieval instrument and the feeder instrument when the clamping ball is applied to the distal end section of the retrieval instrument, Fig. 8 A highly schematic, three-dimensional representation of the distal area of ​​the retrieval instrument and the feeding instrument with the clamping ball held in the distal end section of the retrieval instrument, Fig. 9 A highly schematic cross-sectional view of the distal area of ​​the retrieval instrument and the delivery instrument, Fig. 10 a highly schematic, three-dimensional representation of the distal end section of the retrieval instrument and, with the feeding instrument removed, an external view, Fig. 11 a highly schematic cross-sectional view of the distal area of ​​the retrieval instrument from Fig. 10 in cross-section, Fig. 12 a highly schematic, three-dimensional representation of the retrieval instrument after removal of the distal end section from the bone, and Fig. 13 a flow diagram of a non-inventive method for carrying out a guide thread with associated steps.

[0072] An instrument kit 101 comprises a delivery instrument 111, a guide thread 103 with a clamping ball 109 arranged at its distal thread end 107, and a retrieval instrument 131. The clamping ball 109 has an outer diameter of 2.0 mm and is permanently attached to the distal thread end 107 by injection molding. The guide thread 103 has a proximal thread end 105 opposite the distal thread end 109.

[0073] The delivery instrument 111 has a handle 113 and a shaft 117. The shaft 117 has a cavity 119 which terminates in a distal opening 121. The shaft 117 has a retaining receptacle 123 in the region of the distal opening 121, which extends partially into the cavity 119. The shaft 117 with the cavity 119 extends proximally through the handle 113 and terminates at the top in a proximal opening 122. A suture clamp 115 is arranged on the outside of the handle 113.

[0074] The retrieval instrument 131 has a handle 133 with a main shaft 135 attached to it. The main shaft 135 is curved in a first proximal section and then transitions into a straight distal section. A hollow guide shaft 137 is arranged on the straight distal section. The guide shaft 137 has an engagement ring 149 at its distal end. Before a distal end of the guide shaft 137, the main shaft 135 transitions into a curved distal end section 139. The distal end section 139 is hook-shaped ( Fig. 1).

[0075] The distal end section 139 of the retrieval instrument 131 has a first clamping jaw 141 and a second clamping jaw 143 at its end. A partially circular clamping receptacle 147 is arranged in the two clamping jaws 141 and 143. The clamping receptacle 147 has a proximal opening 148 on an upper surface 145 of the distal end section 139, and thus of the two clamping jaws 141 and 143. A chamfer is formed around the proximal opening 148 of the clamping receptacle 147 on the upper surface 145. A gap 146 is arranged in the distal end section 139 between the first clamping jaw 141 and the second clamping jaw 143, which connects a bottom surface of the clamping receptacle 147 opposite the proximal opening 148 with a bottom surface of the distal end section 139 and thus of the first clamping jaw 141 and the second clamping jaw 143 ( Fig. 10 and Fig. 11). The gap 146 has a gap dimension of 0.5 mm and the clamping receptacle 147 has a diameter of 1.25 mm.

[0076] Using the instrument kit 101, a user performs the following operations in a non-inventive method 200 to guide a guide thread 103.

[0077] As a first step 201, the guide thread 103 is threaded and the clamping ball 109 is positioned on the delivery instrument 111. To do this, the user threads the proximal end 105 of the guide thread 103 through the distal opening 121 of the shaft 117 and pushes the guide thread 103 in a distal direction 159 through the cavity 119 in the shaft 117 until it emerges at the proximal opening 122 in the handle. The user then grasps the proximal end 105 of the thread and secures it to the thread clamp 115 on the handle 113. The user applies sufficient force to partially draw the clamping ball 109 into the cavity 119 of the shaft 117, where it is held by the retaining receptacle 123. The feeder 111 is thus loaded for further use with the guide thread 103 and the arranged clamping ball 109.As the next procedural step 203, the distal end section 139 of the retrieval instrument 131 is positioned on an object through which the guide thread 103 is to be passed. In the . Fig. Figure 4 shows, as an example, a bone 151 with a pre-existing bone tunnel 153, which extends completely through the bone 151 in a distal direction 159. Alternatively, this object could also be a technical object, for example, an underwater structure with a continuous tubular cavity.

[0078] The user guides the retrieval instrument 131 with the distal end section 139 laterally and below the bone 151 until the distal end of the guide shaft 137 is positioned above a proximal opening of the bone tunnel 153 and the distal end section 139 lies below a bottom surface 155 of the bone 151 ( Fig. 4) By applying slight pressure to the handle 133 of the retrieval instrument 131, the user engages the engagement ring 149 at the distal end of the guide shaft 137 with the bone 151, thereby securing the retrieval instrument 131 against displacement on the bone 151. The feeder instrument 111 is then inserted 205 with its shaft 117 into the guide shaft 137 of the retrieval instrument 131. The user grasps the feeder instrument 111 by its handle 113 and pushes it distally 159 into the cavity of the guide shaft 137. Fig. 5 and Fig. 6) The user pushes the shaft 117 with the clamping ball 109 held completely through the cavity of the guide shaft 137 and further through the bone tunnel 153 of the bone 151. As soon as the clamping ball 109 strikes the upper surface 145 of the distal end section 139, the user notices increased resistance and then pushes the shaft 117 with the clamping ball 109 held further in a distal direction 159 ( Fig. 7).

[0079] By pushing the clamping ball 109 further, it enters the clamping receptacle 147 through the proximal opening 148. Since the outer diameter of the clamping ball 109 is larger than the diameter of the clamping receptacle 147, the two clamping jaws 141, 143 are forced laterally apart (transverse to the distal direction 159) due to the central gap 146 between them. As soon as the clamping ball 109 is largely received in the clamping receptacle 147, the resistance of the clamping jaws 141, 143 is overcome and the two clamping jaws 141, 143 snap back to their initial position, thus clamping 207 of the clamping ball 109 in the clamping receptacle 147 has occurred. The recoil of the two clamping jaws 141, 143 creates a vibration which is transmitted as tactile, haptic feedback via the distal end section 139 and the main shaft 135 to the handle 133 of the retrieval instrument 131 and is perceived by the user.At the same time, a clicking sound occurs due to the meeting of the two clamping jaws 141, 143, which are made of stainless steel, and which is also audibly perceptible to the user.

[0080] In the next step of the procedure, the user removes 209 the feeder 111 from the guide shaft 137 of the retrieval instrument 131. The proximal thread end 105 is released from the thread clamp 115 on the handle 113, allowing the user to freely manipulate the proximal thread end 105. The retrieval instrument 131, with the clamped ball 109 attached, is then removed 211 from the bone 151. The user moves the retrieval instrument 131 laterally and proximally, pulling the guide thread 103 distally 159 through the bone tunnel 153. Once the distal end 139 is within the user's reach, the user can release the clamping ball 109 from the clamp receptacle 147 by pulling firmly with their hand and freely manipulate the distal thread end 107 with the attached clamping ball 109.Optionally, the user can then use the guide thread 103 to pull a replacement material into and / or through the bone tunnel 153 of the bone 151 (optional step 213).

[0081] Thus, an instrument kit and a procedure 200 are provided with which a user can efficiently and safely pass a guide thread 103 through a bone tunnel 153 or other tubular cavity despite the lack of visual control. Reference symbol list 101 Instrument Kit 103 Guide thread 105 proximal thread end 107 distal thread end 109 Clamping ball 111 Feeding instrument 113 Handle 115 Thread clamp 117 shaft 119 Cavity 121 distal opening 122 proximal opening 123 Holding device 131 Retrieval instrument 133 Handle 135 Main shaft 137 Leadership 139 distal end section 141 first clamping jaw 143 second clamping jaw 145 Top 146 gap 147 Clamping device 148 Opening 149 Intervention ring 151 bones 153 bone tunnels 155 Underside 159 distal direction 200 methods for carrying out a guide thread 201 Threading the guide thread and arranging the clamping body on the guide instrument 203 Arranging the distal end section of the retrieval instrument 205 Inserting the feeding instrument 207 Clamping the clamping body in the clamping receptacle 209 Removing the feeding instrument 211 Removing the retrieval instrument with the clamped clamping element 213 Pulling the replacement material into and / or through the tubular cavity using the guide thread

Claims

[1] Instrument device (101), in particular a medical instrument device, for guiding a guide thread (103) and / or a replacement material through a tubular cavity (153), wherein the instrument device (101) comprises the guide thread (103) with two thread ends (105, 107), an elongated feeder instrument (111) with a hollow shaft (119) having an opening (121) at its distal end, and an elongated retrieval instrument (131) with a distal end section (139) for retrieving the guide thread (103) and with a hollow guide shaft (137) for inserting the feeder instrument (111), wherein a clamping element (109) is arranged on the guide thread (103), and the distal end section (139) of the retrieval instrument (131) has a clamping receptacle (147) which has a recess and / or a cavity in at least one surface of the distal end section (139) is designed to clamp the clamping body (109),so that, in the event of positioning the distal end section (139) of the retrieval instrument (131) below a distal opening of the tubular cavity (153), arranging the clamping body (109) at and / or in the opening (121) at the distal end and / or in the hollow shaft (119) of the feeding instrument (111), and inserting the feeding instrument (111) through the guide shaft (137) of the retrieval instrument (131) and the tubular cavity (153), the clamping body (109) can be force-fitted to the clamping receptacle (147) of the retrieval instrument (131), wherein the clamping body (109) and / or the clamping receptacle (147) is or are elastically deformable. [2] Instrument device (101) according to claim 1, characterized by , that the clamping receptacle (147) along a longitudinal direction of the distal end section (139) of the retrieval instrument (131) has a larger dimension than its dimension transverse to the longitudinal direction. [3] Instrument device (101) according to any one of the preceding claims, characterized by , that the distal end section (139) of the retrieval instrument (131) has two clamping jaws (141, 143) and the clamping receptacle (147) is arranged at least partially on and / or in one or both clamping jaws (141, 143). [4] Instrument device (101) according to claim 3, characterized by , that a gap (146) is arranged at least partially between the two clamping jaws (141, 143). [5] Instrument device (101) according to any one of the preceding claims, characterized by , that the clamping body (109) has an outer diameter in a range of 0.2 mm to 4.0 mm, in particular from 0.5 mm to 3.0 mm, preferably from 1.5 mm to 2.5 mm. [6] Instrument device (101) according to any one of the preceding claims, characterized by, that an outer diameter of the clamping body (109) is larger than a complementary inner diameter of the clamping receptacle (147), so that an interference fit exists. [7] Instrument device (101) according to any one of the preceding claims, characterized by , that the clamping body (109) and the clamping receptacle (147) are designed in such a way that haptic feedback can be transmitted to a user during force-fit connection. [8] Instrument device (101) according to any one of the preceding claims, characterized by , that the clamping body (109) and the clamping receptacle (147) are designed in such a way that an auditory feedback can be transmitted to a user or the user during force-fit connection. [9] Instrument device (101) according to any one of the preceding claims, characterized by, that the clamping body (109) has a maximum outer diameter larger than an inner diameter of the hollow shaft (117) of the feeding instrument (111), so that the clamping body (109) can be arranged at least partially terminally on the outside of and / or below the distal opening (121) of the feeding instrument (111). [10] Instrument device (101) according to any one of claims 1 to 8, characterized by , that the clamping body (109) has a maximum outer diameter smaller than an inner diameter of the hollow shaft (117) of the feeding instrument (111), so that the clamping body (109) can be arranged inside the hollow shaft (117) and / or in the opening (121) at the distal end of the feeding instrument (111) and can be pressed into the clamping receptacle (147) by means of an associated plunger that can be guided in the hollow shaft (117). [11] Instrument device (101) according to any one of the preceding claims, characterized by, that the feeder instrument (111) has a retaining receptacle (123) at and / or in the opening (121) at its distal end for holding the clamping body (109), wherein a holding force of the retaining receptacle (123) is less than a clamping force of the clamping receptacle (147) of the retrieval instrument (131).

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