Shaft instrument for laparoscopic and / or endoscopic procedures

Abstract

The invention relates to a shaft instrument (10) for laparoscopic and / or endoscopic procedures, comprising a proximal shaft section (28) having a proximal shaft section longitudinal axis, and a distal shaft section (30) having a distal shaft section longitudinal axis and having an applicator (20) at its distal end, wherein the two shaft sections are connected to each other in the region of a connecting joint (32) and are rotatable relative to each other, wherein at least one of the end faces of the two shaft sections facing the connecting joint is oriented at an angle deviating from 90° relative to the respective shaft section longitudinal axis, and wherein an angle between the two shaft section longitudinal axes is variable, and wherein the shaft instrument comprises at least one transmission device.which is displaceable along or parallel to an actuating axis by one actuating stroke and is coupled at a distal end to the applicator of the shaft instrument, wherein the transmission device transmits axial forces along the actuating axis and torques around the actuating axis, wherein the applicator is rotatable around the distal longitudinal axis of the shaft section and the transmission device is rotationally fixed to the applicator.

Description

[0001] The invention relates to a shaft instrument for laparoscopic and / or endoscopic procedures, comprising a proximal shaft section having a proximal shaft section longitudinal axis, and a distal shaft section having a distal shaft section longitudinal axis and having an applicator arranged at its distal end, wherein the two shaft sections are connected to each other in the region of a connecting joint and are rotatable relative to each other.

[0002] Shaft instruments are used particularly in minimally invasive surgery to perform operations through tiny skin incisions or natural body openings. Various applicators, such as scissors, forceps, or cameras, can be attached to the distal end of a shaft instrument. These applicators are inserted into the body. Typical applications of such instruments include gallbladder or appendix removal, hernia repair / surgical treatment, temporary clamping of blood vessels, and diagnostic examinations. Compared to traditional, open procedures, minimally invasive techniques reduce postoperative pain, prevent scarring, and shorten postoperative recovery time.

[0003] The invention is based on the objective of providing a shaft instrument that is particularly ergonomic to handle and precise to use.

[0004] This problem is solved in a shaft instrument of the type mentioned above by the fact that at least one of the end faces of the two shaft sections facing the connecting joint is oriented relative to the respective shaft section longitudinal axis at an angle deviating from 90° and wherein an angle between the two shaft section longitudinal axes is changeable, wherein the shaft instrument has at least one (preferably mechanical) transmission device which is displaceable along or parallel to an actuating axis by one actuating stroke and is coupled at a distal end to the applicator of the shaft instrument, wherein the transmission device transmits axial forces along the actuating axis and torques around the actuating axis, wherein the applicator is rotatable around the distal shaft section longitudinal axis and wherein the transmission device is rotationally fixed to the applicator.

[0005] The shaft instrument according to the invention has a simple structure. It comprises a proximal shaft section, which has a proximal longitudinal axis and at least one end face, and a distal shaft section, which has a distal longitudinal axis and at least one end face. Both shaft sections are connected to each other in the region of a connecting joint and are rotatable relative to each other. At least one of the end faces of the two shaft sections facing the connecting joint is oriented at an angle other than 90°. Preferably, both end faces of the two shaft sections facing the connecting joint are oriented at an angle other than 90° in order to be able to change an angle limited between the two shaft section longitudinal axes.

[0006] An applicator is located at the distal end of the distal shaft section. This applicator can be, for example, scissors, a clamp, grasping forceps, a needle holder, a "seal and cut" jaw, a clip applicator (clip application forceps), or even an endoscopic camera.

[0007] The shaft instrument features a mechanical transmission device that can be displaced along an actuating axis by one actuating stroke and transmits axial forces along the actuating axis. The transmission device is coupled at its distal end to the applicator of the shaft instrument in order to actuate the applicator, for example, to open and / or close the jaw of a clip application forceps.

[0008] The transmission device also serves to transmit torques acting around the actuation axis to the applicator. For this purpose, the transmission device is rotationally fixed to the applicator. The applicator is rotatable around the distal longitudinal axis of the shaft section.

[0009] According to the invention, a rotation of the transmission device about the actuating axis results in a rotation of the applicator about the distal longitudinal axis of the shaft section. This allows the orientation (in terms of the rotational position or alignment of the applicator about the distal longitudinal axis of the shaft section) to be precisely adjusted. The orientation of the applicator can be set independently of the angle between the distal and proximal longitudinal axes of the shaft section. In particular, the applicator can be rotated about the distal longitudinal axis of the shaft section even if the two longitudinal axes of the shaft section are oriented at an angle to each other, i.e., not at 180°.

[0010] This allows a surgeon to easily and optimally align the applicator. For example, it is advantageous for a cut to be made essentially perpendicular to the plane of extension of the tissue to be cut, or for a vessel to be clamped essentially perpendicular to its longitudinal extent. A particular advantage is that, to adjust the rotational position of the applicator around the distal longitudinal axis of the shaft section, a surgeon only needs to rotate the transmission device, not the entire shaft instrument (which would otherwise place the shaft instrument in an ergonomically unfavorable position).

[0011] In a preferred embodiment, the shaft instrument has a shaft that is bendable at least at the level of the connecting joint. Furthermore, it is advantageous if a distal shaft section is rotationally fixed to a shaft receptacle of the distal shaft section, and if a proximal shaft section and the proximal shaft section are rotatable relative to each other. A relative rotation between the proximal shaft section and the proximal shaft section thus results in a relative rotation between the proximal shaft section and the shaft receptacle of the distal shaft section. Due to the inclination of the end faces of the shaft sections, this relative rotation causes a change in the angle between the two shaft section longitudinal axes, allowing this angle to be precisely adjusted.The shaft instrument can therefore be angled at the connecting joint, and the applicator can be moved around the connecting joint in a circular path.

[0012] By adjusting both the angle between the two shaft section longitudinal axes and the rotation of the applicator around the distal shaft section longitudinal axis, the position and spatial orientation of the applicator can be precisely and extensively adjusted. This allows the surgeon to hold the shaft instrument in an ergonomically advantageous position and maintain this position regardless of any desired rotation of the applicator.

[0013] It is preferred that the shaft is designed as a hollow shaft and has a shaft cavity in which the transmission device is arranged. This allows for a compact design of the shaft instrument.

[0014] Furthermore, it is preferred that the shaft instrument has an actuating device for generating the actuating stroke along the actuating axis. This enables actuation of the applicator. Alternatively or additionally, it is advantageous if the actuating device generates a rotation of the transmission device about the actuating axis. This allows for rotation and precise alignment of the applicator about the distal longitudinal axis of the shaft section.

[0015] It is preferred that the actuating device be arranged on a handling section of the shaft instrument. This has the advantage that the actuating device is easily accessible to a surgeon.

[0016] A preferred embodiment provides that the actuating device has a stroke element for generating the actuating stroke along the actuating axis. This allows for easy actuation of the applicator. Additionally, it is preferred that the actuating element has a rotation element for rotating the transmission device about the actuating axis. This allows for easy adjustment of the rotational position of the applicator about the distal longitudinal axis of the shaft section.

[0017] It is possible for the lifting element and the twisting element to be provided by the same component. In this way, a simple and compact actuating device can be provided.

[0018] Alternatively, the lifting element and the rotation element can be provided by separate components. This allows for an ergonomically advantageous separation of the two functions: "generating the actuation stroke" and "adjusting the rotational position of the applicator around the distal longitudinal axis of the shaft section".

[0019] It is preferred that the transmission device has a transmission section that is rotationally fixed to the rotating element. This allows the rotating element to be positioned largely freely along the length of the transmission device, for example at a proximal end of the handling section, and thus in a particularly ergonomically advantageous position.

[0020] In a preferred embodiment, the transmission section is displaceable along the actuating axis relative to the rotating element. This allows the rotating element to be decoupled from the actuating stroke of the transmission device. Furthermore, it is possible to position the rotating element immovably along the actuating axis, for example, at the handling section. This also contributes to ergonomic operation of the shaft instrument.

[0021] Another embodiment provides that the transmission device extends through the connecting joint. Furthermore, the transmission device has a sleeve that can be adapted by bending to the angle (between the longitudinal axes of the shaft sections), at least at the level of the connecting joint. This sleeve transmits a torque from a section of the transmission device proximal to the connecting joint to a section distal to the connecting joint. Alternatively or additionally, the sleeve transmits a torque from the distal to the proximal section of the transmission device. This has the advantage that the orientation of the applicator around the distal longitudinal axis of the shaft section – even with an angled shaft instrument – ​​can be adjusted from a proximal end of the transmission device.

[0022] It is further advantageous if a chain of force transmission elements is arranged within the housing of the transmission device. The force transmission elements, arranged successively along the actuation axis, transfer an axial force exerted on the proximal section of the transmission device to the distal section. This has the advantage that the applicator can be actuated from a proximal end of the transmission device even if the angle between the longitudinal axes of the shaft sections deviates from 180°, i.e., if the shaft instrument is angled. Alternatively or additionally, the chain of force transmission elements transfers an axial force exerted on the distal section of the transmission device to the proximal section. The aforementioned axial forces can be compressive and / or tensile forces.

[0023] Furthermore, it is preferred that the shaft instrument for the rotational mounting of the applicator has a rotary bearing with preferably at least one bearing ring and more preferably with two bearing rings that can rotate relative to each other. This enables a low-friction and backlash-free (or at least low-backlash) rotational mounting of the applicator.

[0024] It is advantageous if the first bearing ring of the rotary bearing is rotationally coupled to the applicator. This allows for a particularly simple rotary bearing arrangement of the applicator.

[0025] It is further advantageous if a second bearing ring of the rotary bearing is rotationally coupled to a segment of the distal shaft section that is rotationally fixed with respect to the distal shaft section's longitudinal axis, i.e., cannot be rotated around the distal shaft section's longitudinal axis. The segment thus defines the orientation of the distal shaft section's longitudinal axis, depending on the angle between the two shaft section longitudinal axes. Preferably, the segment includes the shaft receptacle of the distal shaft section described above, to which the distal shaft section of the shaft is rotationally fixed. The rotational coupling of the segment and the second bearing ring makes it possible to align the second bearing ring according to the orientation of the distal shaft section's longitudinal axis.In this way, a concentric alignment of the two bearing rings can be maintained, which is independent of an angle between the two shaft section longitudinal axes.

[0026] The shaft instrument can be a purely hand-operated medical instrument. Alternatively, the shaft instrument can be a robotic instrument in which the handling section includes an actuator unit that controls the instrument's movement functions and which is, for example, mounted or mountable on a robot arm.

[0027] The shaft instrument can also be a hybrid instrument, for example, one that has a handle but where certain movement functions are robotically or motor- / electrically controlled or supported. In all variants, it is possible to incorporate additional electrical components, such as sensors or electrical elements like ultrasonic or RF electrodes (RF: high frequency), which are arranged in or on the applicator (e.g., on the instrument's mouthpiece).

[0028] Further features and advantages of the invention are the subject of the following description of a preferred embodiment.

[0029] The drawing shows: Fig. 1 a perspective view of an embodiment of a shaft instrument in an angled state; Fig. 2 a side view of the shaft instrument according to Fig. 1; Fig. 3 a longitudinal section of the shaft instrument in a Fig. 2 proximal area of ​​the shaft instrument designated III; Fig. 4 a longitudinal section of the shaft instrument in a Fig. 2 distal area of ​​the shaft instrument designated IV, wherein an angle between a proximal and a distal shaft section longitudinal axis of the shaft instrument is 180°; Fig. 5 a longitudinal section of the shaft instrument in a Fig. 3. Area designated by V of an additional axial connection device; Fig. 6 a longitudinal section of the shaft instrument in a Fig. 4. Area of ​​a connecting joint designated VI; Fig. 7 a longitudinal section of the shaft instrument in a Fig. 6 area of ​​a transmission device designated VII; Fig. 8 a longitudinal section of the shaft instrument in a Fig. 4 area of ​​an applicator designated VIII and along a Fig. 4. Cutting plane designated A - A; and Fig. 9 one of the Fig. 8 corresponding views along a line Fig. 8 off-center cutting plane labelled B - B.

[0030] In the drawing, an embodiment of a shaft instrument is designated in its entirety by reference numeral 10. The shaft instrument 10 comprises an applicator 20, a housing 12, and a shaft 26 arranged between the applicator 20 and the housing 12 (see figure). Fig. 1).

[0031] The applicator 20 could, for example, be a clip applicator known per se, with jaw parts 22 and 24 that are movable relative to each other.

[0032] The shaft 26 comprises a distal shaft section 30 arranged adjacent to the applicator 20 and a proximal shaft section 28 following in the direction of the housing 12 (compare Fig. 1 and Fig. 2) The proximal shaft section 28 has a proximal shaft section longitudinal axis 34. The distal shaft section 30 has a distal shaft section longitudinal axis 36.

[0033] The proximal shaft section 28 and the distal shaft section 30 are connected to each other in the area of ​​a connecting joint 32 and are rotatable relative to each other.

[0034] The proximal shaft section 28 has an end face 38 facing the connecting joint 32. The distal shaft section 30 has an end face 40 facing the connecting joint 32 (compare Fig. 2).

[0035] The end face 38 of the proximal shaft section 28 extends within a connecting joint plane 42, which is inclined relative to the proximal shaft section longitudinal axis 34 by an angle 44 that deviates from 90°. The end face 40 of the distal shaft section 30 also extends within the connecting joint plane 42, which is inclined to the distal shaft section longitudinal axis 36 by an angle 46 that also deviates from 90° and is preferably equal in magnitude to the angle 44.

[0036] To adjust the inclination of the applicator 20 relative to the proximal shaft section 28, the angle 70 between the proximal shaft section longitudinal axis 34 and the distal shaft section longitudinal axis 36 can be changed. Due to the inclined end faces 38 and 40, the angle 70 changes through a relative rotation between the proximal shaft section 28 and the distal shaft section 30.

[0037] The housing 12 comprises a handling section 14, which is connected to a handle 16. Furthermore, an actuating device 13 for actuating and / or rotating the applicator 20 is arranged on the handling section 14.

[0038] The shaft 26 includes an additional shaft section 90 (compare Fig. 3), which is arranged between the handling section 14 and the proximal shaft section 28. The additional shaft section 90 has an additional shaft section longitudinal axis 92.

[0039] Furthermore, the shaft instrument 10 comprises a sleeve-shaped shaft guide element 15. This is arranged at a distal end of the handling section 14 and is connected to the handling section 14 in a rotationally and displacement-resistant manner, for example by means of a press fit 21.

[0040] The shaft guide element 15 forms an annular rotary bearing for the additional shaft section 90. The additional shaft section 90 is rotatably mounted within the shaft guide element 15 about the additional shaft section longitudinal axis 92 and is slidably mounted along the additional shaft section longitudinal axis 92.

[0041] At least the proximal shaft section 28 and the distal shaft section 30, preferably also the additional shaft section 90, are hollow and define a shaft cavity designated overall by reference numeral 48 (compare Fig. 3 and Fig. 4) A shaft 50 is arranged in the shaft cavity 48, which extends at least along the proximal shaft section longitudinal axis 34 and the distal shaft section longitudinal axis 36, preferably also along the additional shaft section longitudinal axis 92.

[0042] The shaft 50 has a proximal shaft section 54 which extends within the proximal shaft section 28 and at least partially also within the additional shaft section 90.

[0043] The shaft 50 is bendable at least at the level of the connecting joint 32. For this purpose, it is possible that the shaft 50 is formed, for example, from a thin-walled metal tube and has slots 52 at the level of the connecting joint 32, which weaken the structure of the shaft 50 in the area of ​​the connecting joint 32 (compare Fig. 4).

[0044] The proximal shaft section 28 comprises a proximal tube element 27, which faces the handling section 14 at one proximal end (compare Fig. 3) A distal end of the pipe element 27 is connected – for example via a weld 31 – to a coupling element 29 of the proximal shaft section 28 (compare Fig. 4) The coupling element 29 borders the connecting joint 32 on a proximal side.

[0045] The distal shaft section 30 comprises, at its proximal end, a hollow cylindrical shaft receptacle 55, which borders the connecting joint 32 from a distal side. The shaft receptacle 55 is formed by a segment 61 of the distal shaft section 30. Adjoining the segment 61 in a distal direction and along the distal shaft section longitudinal axis 36 are a first distal tubular element 41 and a second distal tubular element 43 (compare Fig. 4).

[0046] Furthermore, the shaft instrument 10 comprises an applicator coupling element 85, which is arranged within the tube elements 41, 43 and which is coupled to the applicator 20 at its distal end (compare Fig. 4).

[0047] In the region of a proximal end of the applicator coupling element 85, a return coupling element 69 is arranged within the first distal tube element 41. The return coupling element 69 and the applicator coupling element 85 are connected to each other in a displacement-resistant manner along the actuating axis 17, for example by a thread 71. The return coupling element 69 and the first distal tube element 41 are displaceable relative to each other along the actuating axis 17.

[0048] The first distal pipe element 41 and the second distal pipe element 43 are connected to each other in a rotationally and displacement-resistant manner via a thread 53 of a shaft connecting element 49 and via a weld 51.

[0049] The shaft receptacle 55 and the first distal tube element 41 are rotatably mounted relative to each other via a rotary bearing 57 and are secured against displacement (compare Fig. 4 and Fig. 6).

[0050] The coupling element 29 and the shaft receptacle 55 are connected in the area of ​​the connecting joint 32 so that they can rotate relative to each other. A distal shaft section 56 of the shaft 50 is connected to the shaft receptacle 55 in a rotationally fixed manner.

[0051] The proximal shaft section 54 of the shaft 50 and the proximal shaft section 28 are rotatable relative to each other. The additional shaft section 90 and the handling section 14 are rotatable relative to each other.

[0052] The shaft 50 is designed as a hollow shaft and has a shaft cavity 77 in which a transmission device 78 is arranged. The transmission device 78 comprises a proximal transmission section 79 and a distal transmission section 81 (see Figure 1). Fig. 4) The proximal transmission section 79 and the distal transmission section 81 are connected to each other in a rotationally and laterally fixed manner via a transmission joint device 83.

[0053] Within the proximal shaft section 54 of the shaft 50, a guide ring 198 is arranged, which is connected to the shaft 50 in a rotationally and displacement-resistant manner, for example via an interference fit 200. The actuating device 78 is displaceable relative to the guide ring 198 along the actuating axis 17 and rotatable about the actuating axis 17. The guide ring 198 improves the centering of the actuating device 78 within the shaft 50, particularly in the case of an angled shaft 26.

[0054] The distal transmission section 81 of the transmission device 78 is connected at its distal end to the applicator coupling element 85 in a rotationally fixed manner via a positive locking connection 87 (compare Fig. 4).

[0055] The positive locking connection 87 can be provided, for example, by multi-sided surfaces of the distal transmission section 81 and the applicator coupling element 85, which enable the transmission of torques around the actuating axis 17.

[0056] Furthermore, the adjacent arrangement of the distal transmission section 81 and the applicator coupling element 85 enables the transmission of pressure forces along the actuating axis 17.

[0057] A proximal end of the transmission device 78, facing away from the distal end of the transmission device 78, is coupled to an actuating device 13 (compare Fig. 3).

[0058] The actuating device 13 comprises an actuating transmission section 89, which has an actuating axis 17.

[0059] In distal extension to the actuation transmission section 89, the actuation axis 17 essentially follows the longitudinal extension of the shaft 26. Thus, in the region of the proximal shaft section 28, the actuation axis 17 essentially corresponds to the proximal shaft section longitudinal axis 34, and in the region of the distal shaft section 36, it essentially corresponds to the distal shaft section longitudinal axis 36.

[0060] A distal end of the actuating transmission section 89 is, for example, pressed and / or welded to a proximal end of the transmission device 78 in a connection area 91, i.e., connected in a rotationally and displacement-resistant manner.

[0061] The actuating device 13 further comprises a lifting element 18 for generating an actuating stroke 80 along the actuating axis 17 (compare Fig. 4) The lifting element 18 is pivotably mounted in the handling section 14. The applicator 20 can be actuated by the actuating stroke 80.

[0062] Furthermore, the actuating device 13 has a rotating element 19 for rotating the applicator 20 about the distal longitudinal axis 36 of the shaft section. The rotating element 19 is arranged at a proximal end of the handling section 14 and is rotatable about the actuating axis 17 relative to the handling section 14. The rotating element 19 is also connected to the actuating transmission section 89 via a positive-locking connection 93, preventing rotation and allowing displacement along the actuating axis 17 (see Figure 1). Fig. 5).

[0063] Preferably, the twisting element 19 is designed as a star-shaped rotary handle. Such a rotary handle has grip ribs 101 and grip recesses 103 arranged along its circumference around the actuating axis 17 (compare Fig. 1) The grip bars 101 and the grip recesses 103 are arranged alternately along the circumference of the rotary handle. For example, such a rotary handle has five grip bars 101 and five grip recesses 103.

[0064] The actuating device 13 further comprises a coupling element 160, the longitudinal extent of which follows the actuating axis 17. The coupling element 160 is displaceable relative to the handling section 14 along the actuating axis 17. A distal end of the coupling element 160 is arranged adjacent to a proximal end of the proximal transmission section 79.

[0065] The coupling element 160 has a lifting element coupling element 162, which is, for example, bolt-shaped. The lifting element 18 has a recess 164, which is bounded by coupling surfaces 166 and 168. The lifting element coupling element 162 is arranged in the recess 164 of the lifting element 18.

[0066] A proximal end of the coupling element 160 interacts with a positioning element 170, which is designed, for example, as a compression spring and exerts a compressive force in a distal direction on the transmission device 78 (compare Fig. 5).

[0067] In the distal shaft section 30, a return element 161 (e.g., in the form of a compression spring) is arranged, which is supported at its distal end by the shaft connecting element 49. The return element 161 is supported at its proximal end by the return coupling element 69, which in turn is connected to the applicator coupling element 85 in a displacement-resistant manner. The return element 161 generates a compressive force, which is transmitted via the return coupling element 69 and a force transmission surface 63 of the applicator coupling element 85 to a force receiving surface 65 of the transmission device 78; the transmission device 78 is thus subjected to a compressive force acting in the proximal direction (compare Fig. 4 and Fig. 6).

[0068] As already described, the distal shaft section 56 is rotationally fixed to the shaft receptacle 55 of the distal shaft section 30. The proximal shaft section 54 of the shaft 50 is rotationally fixed to the additional shaft section 90, preferably via an interference fit 59, see Figure 1. Fig. 3. In this way, the additional shaft section 90 and the shaft receptacle 55 are coupled to each other in the direction of rotation. The relative rotation necessary to adjust the angle 70 can therefore also occur between the proximal shaft section 28 and the additional shaft section 90.

[0069] The shaft instrument 10 has a proximal rotation device 94 with a proximal rotation element 98 for rotating the proximal shaft section 28 about the proximal shaft section longitudinal axis 34, compare Fig. 3. The proximal twisting element 98 is connected to the proximal shaft section 28 in a rotationally fixed manner and preferably also in a displacement-fixed manner along the proximal longitudinal axis 34 of the shaft section via a connecting device 116.

[0070] Furthermore, the shaft instrument 10 has an additional rotation device 96 with an additional rotation element 100 for rotating the additional shaft section 90 about the additional shaft section longitudinal axis 92.

[0071] The additional torsion element 100 is rotationally fixed to the additional shaft section 90 via a positive-locking connection 105. The positive-locking connection 105 can, for example, be provided by polygonal surfaces of the additional shaft section 90 and the additional torsion element 100, which allow for the transmission of torques but also simultaneously permit the additional torsion element 100 to move relative to the additional shaft section 90 in a direction parallel to the longitudinal axis 92 of the additional shaft section (compare Fig. 3).

[0072] The additional twisting element 100 is rotatably mounted on a radially outward-facing annular surface of the shaft guide element 15 and is displaceable along the additional shaft section longitudinal axis 92 relative to the shaft guide element 15.

[0073] Setting the angle 70 requires a relative rotation between the proximal shaft section 28 and the additional shaft section 90. This relative rotation can be generated by rotating the proximal twisting element 98 and the additional twisting element 100 differently in the direction and / or speed of rotation.

[0074] Changing the angle 70 results in a movement of the tip of the applicator 20 on an inclined circular path around the connecting joint 32. The radius of the circular path corresponds to the distance between the tip of the applicator 20 and the connecting joint 32.

[0075] To extend the working area of ​​the applicator 20, it is possible to rotate the proximal shaft section 28 and the additional shaft section 90 about their respective longitudinal axes at the same rotational speed and in the same direction (preferably by rotating the proximal rotational element 98 and the additional rotational element 100 relative to the handling section 14 with identical rotational direction and speed). With the handling section 14 at rest, this results in a rotation of the entire shaft assembly, i.e., the distal shaft section 30, the proximal shaft section 28, and the additional shaft section 90, relative to the handling section 14 and about the additional shaft section longitudinal axis 92. The angle 70° between the proximal shaft section longitudinal axis 34 and the distal shaft section longitudinal axis 36 remains unchanged.

[0076] Optionally, the shaft instrument 10 includes a proximal axial connection device 106 for the detachable axial connection of the proximal shaft section 28 and the additional shaft section 90, compare Fig. 3.

[0077] The proximal axial connection device 106 comprises a locking element 138 and a proximal return element 132, which acts between the locking element 138 and the additional twisting element 100. To release the proximal axial connection device 106, the additional twisting element 100 is displaced proximally along the longitudinal axis 92 of the additional shaft section, against the force of the proximal return element 132. This moves the proximal axial connection device 106 into a release position, allowing separation of the proximal shaft section 28 and the additional shaft section 90.

[0078] Optionally, the shaft instrument 10 includes an additional axial connection device 112 for the detachable axial connection of the additional shaft section 90 and the handling section 14 (compare Fig. 3) In a locked state, the additional axial connection device 112 prevents the additional shaft section 90 from shifting along the longitudinal axis 92 of the additional shaft section, thus preventing the shaft 26 from being separated from the handling section 14. This is only possible when the additional axial connection device 112 is moved into an unlocked state.

[0079] The additional axial connection device 112 can simultaneously serve as a locking device to prevent the proximal axial connection device 106 from loosening. Therefore, the additional axial connection device 112 must first be loosened before the proximal axial connection device 106 can be unlocked.

[0080] The coupling element 29 of the proximal shaft section 28 has a pin-shaped area 190 (compare Fig. 6) The cone-shaped section 190 extends vertically from the end face 38, which runs in the plane of the connecting joint 42. The segment 61 of the distal shaft section 26 has a receiving area 192 for receiving the cone-shaped section 190.

[0081] The distal wave section 56 of the wave 50 has a longitudinal extent of varying size along its circumference and includes a projection 194 that extends into the wave receptacle 55 and secures the distal end of the wave 50 in the wave receptacle 55 against relative rotation to the segment 61.

[0082] Optionally, the shaft instrument 10 includes a shaft connection device 196 for the detachable connection of the two shaft sections 28, 30.

[0083] The cone-shaped area 190 of the coupling element 29 has annular sliding areas 197 which, in a coupling state of the proximal shaft section 28, the distal shaft section 30 and the shaft 50, enable low-friction relative movement between the coupling element 29 and the segment 61 as well as between the coupling element 29 and the shaft 50.

[0084] The rotary bearing 57 comprises a first bearing ring 202, which is connected to the first distal pipe element 41 in a rotationally and laterally fixed manner, for example via a press fit 208. Furthermore, the rotary bearing 57 comprises a second bearing ring 204, which is connected to the segment 61 in a rotationally and laterally fixed manner, for example via a press fit 210 and an axial locking element 212.

[0085] As already described, the transmission device 78 comprises a proximal transmission section 79, a distal transmission section 81, and a transmission joint device 83 arranged between the two transmission sections 79 and 81. The transmission joint device 83 connects the two transmission sections 79 and 81 in a rotationally and laterally fixed manner (compare Fig. 7).

[0086] The transmission joint assembly 83 has a shell 107 that is bendable at least at the level of the connecting joint 32. For this purpose, it is possible that the shell 107 is formed from a thin-walled metal tube and has slots 109 at the level of the connecting joint 32, which weaken the structure of the shell 107 in the area of ​​the connecting joint 32.

[0087] A proximal end of the sleeve 107 is connected to a distal end of the proximal transmission section 79 in a rotationally and laterally fixed manner, for example by an interference fit 117. A distal end of the sleeve 107 is connected to a proximal end of the distal transmission section 81 in a rotationally and laterally fixed manner, for example by an interference fit 119.

[0088] Within the casing 107, a force transmission chain is arranged, which enables the transmission of compressive forces from the proximal transmission section 79 to the distal transmission section 81 and vice versa. The casing 107 prevents radial displacement of the components of the force transmission chain. A subset of the components of the force transmission chain is preferably formed by force transmission spheres 113.

[0089] Between each pair of force transmission balls 113, intermediate elements 115 are arranged, each of which has two mutually opposing, partially spherical recesses for the partial reception of one force transmission ball 113.

[0090] The power transmission chain has two power transmission elements 111 arranged at each end, each with a semi-spherical recess for partially receiving a power transmission ball 113. A first power transmission element 111 is arranged between the proximal transmission section 79 and the first power transmission ball 113 in the distal direction. A second power transmission element 111 is arranged between the last power transmission ball 113 in the distal direction and the distal transmission section 81.

[0091] The two force transmission elements 111 each have an outer surface 119, wherein the outer surface 119 of the first force transmission element 111 interacts with an end face 121 of the proximal transmission section 79 and wherein the outer surface 119 of the second force transmission element 111 interacts with an end face 123 of the distal transmission section 81.

[0092] The proximal transmission section 79, the components of the force transmission chain, and the distal transmission section 81 are directly adjacent to one another along the actuation axis 17, or at least with minimal clearance, thus enabling the transmission of an axial force along the actuation axis 17. The described design of the components of the force transmission chain makes it possible to transmit axial forces along the actuation axis 17 even at an angle 70 deviating from 180°, i.e., even with an angled shaft 26.

[0093] As already described, the distal transmission section 81 is rotationally fixed to the applicator coupling element 85 at its distal end via a positive locking connection 87 (compare Fig. 4).

[0094] The applicator coupling element 85 extends along the actuation axis 17. The applicator coupling element 85 has at least in its distal region two flattenings 220 which are arranged offset from each other by 180° with respect to the actuation axis 17.

[0095] An actuating recess 222 adjoins at least one of the two flattened surfaces 220 and extends perpendicularly to the flattened surface 220 and perpendicular to the actuating axis 17. The circumferential surface of the actuating recess 222 is formed at least partially by a proximal cam surface 224 and a distal cam surface 226 (compare Fig. 9).

[0096] The two backdrop surfaces 224, 226 are inclined relative to the actuation axis 17, see Fig. 9. The two backdrop surfaces 224, 226 therefore extend at least partially along the actuation axis 17 and at least partially perpendicular to the actuation axis 17.

[0097] As already described, the applicator 20 can be a clip applicator of a type known per se, with jaw parts 22 and 24 that are movable relative to each other. Furthermore, the applicator 20 includes a bearing pin 228. The bearing pin 228 has a bearing axis 230 that extends perpendicular to the actuating axis 17 and perpendicular to the actuating recess 222.

[0098] The bearing bolt 228 is firmly connected to the second distal tube element 43, for example via at least one press fit 232.

[0099] The jaw parts 22, 24 are opposite to each other and can be pivoted around the bearing axis 230 of the bearing bolt 228.

[0100] At least one of the two jaw parts 22, 24 has a jaw part actuation section 234 at its proximal end, which extends in a proximal direction and is arranged at least partially within the second distal tube element 43.

[0101] At a proximal end of the jaw actuation section 234, an engagement element 236 is arranged which extends parallel to the bearing axis 230 and engages in the actuation recess 222 of the applicator coupling element 85.

[0102] In an unactuated initial state of the shaft instrument 10, the reset element 161 applies a pressure force to the reset coupling element 69, which is transmitted to the applicator coupling element 85, the transmission device 78, and the coupling element 160. This causes the transmission device 78 to assume a rest position facing the handling section 14, thus forcing the lifting element 18 into an unactuated rest position.

[0103] The lifting element 18 can be actuated by pivoting it (counterclockwise in the drawing) around the actuating element axis 158, thereby reducing the distance between the lifting element 18 and the handle 16 (compare Fig. 1, Fig. 2 and Fig. 5) This leads to a displacement of the recess 164 of the lifting element 18, which is effective along the actuation axis 17 in a distal direction (compare Fig. 5) This displacement is transmitted via the coupling surface 168 of the recess 164 to the lifting element coupling element 162 and thus to the coupling element 160. From the distal end of the coupling element 160, the displacement is transmitted in a transmission area 163 to a proximal end of the proximal transmission section 79.

[0104] Due to the non-displaceable connection between the proximal transmission section 79 and the actuating transmission section 89, the actuating transmission section 89 is also displaced distally along the actuating axis 17. This results in a relative movement along the actuating axis 17 between the actuating transmission section 89 and the rotating element 19. Therefore, the position of the rotating element 19 on the handling section 14 does not change even when the lifting element 18 is actuated.

[0105] The displacement of the proximal transmission section 79 in a distal direction along the actuation axis 17 results in the components of the force transmission chain, the distal transmission section 81 and the applicator coupling element 85 also being displaced in a distal direction.

[0106] By relocating the applicator coupling element 85 in a distal direction, the actuating recess 222 is also shifted in a distal direction.

[0107] The proximal cam surface 224 of the actuating recess 222, inclined relative to the actuating axis 17, causes the engagement element 236 of the jaw part 22 to move both along the actuating axis 17 and perpendicular to the actuating axis 17 (in Fig. 9 downwards). This causes the jaw part 22 to be shifted around the bearing axis 230 (in Fig. 9 is pivoted clockwise). This reduces the distance between the distal ends of the two jaw parts 22, 24.

[0108] As soon as no (hand) force is exerted on the lifting element 18, the pressure force of the return element 161 causes the return coupling element 69, and thus also the applicator coupling element 85 and the actuating device 78, to move in a proximal direction (compare Fig. 4).

[0109] In this way, the coupling element 160 is also displaced in the proximal direction. The movement of the coupling element 160 in the proximal direction results in contact between the coupling surface 166 and the lifting element coupling element 162, so that the lifting element 18 pivots back into its unactuated rest position (compare Fig. 5).

[0110] The movement of the applicator coupling element 85 in a proximal direction is accompanied by contact between the distal cam surface 226 and the engagement element 236 (compare Fig. 9) The distal cam surface 226, inclined relative to the actuation axis 17, causes the engagement element 236 of the jaw part 22 to move both along the actuation axis 17 and perpendicular to the actuation axis 17 (in Fig. 9 upwards). This causes the jaw part 22 to be shifted around the bearing axis 230 (in Fig. 9 is pivoted counterclockwise). This increases the distance between the distal ends of the two jaw parts 22, 24.

[0111] According to the invention, a rotation of the applicator 20 about the distal shaft section longitudinal axis 36 is possible independently of the setting of the angle 70.

[0112] The twisting element 19 can be actuated by twisting it around the actuating axis 17 (compare Fig. 5) Due to the rotationally fixed positive locking connection 93, the rotation of the rotating element 19 also results in a rotation of the actuating transmission section 89 about the actuating axis 17. This rotation is accompanied by a rotation of the proximal transmission section 79 due to the compression in the connection area 91. The torque, and thus also the rotation, is transmitted to the distal transmission section 81 via the sleeve 107, which is adaptable to the angle 70 (compare Fig. 4 and Fig. 7).

[0113] The rotation of the distal transmission section 81 is transmitted to the applicator coupling element 85 via the positive locking connection 87. The jaw actuation sections 234 and / or the engagement elements 236 transmit the rotation of the applicator coupling element 85 to the jaw sections 22, 24, so that the entire applicator 20 is rotated about the distal shaft section longitudinal axis 36.

[0114] The rotation of the jaw parts 22, 24 also results in a rotation of the bearing bolt 228 about the distal longitudinal axis 36 of the shaft section. This leads to a rotation of the second distal tube element 43 and – due to the welding 51 – also to a rotation of the first distal tube element 41 and thus of the first bearing ring 202.

[0115] The rotation bearing 57 enables a relative rotation of the first bearing ring 202 relative to the second bearing ring 204, so that the two tube elements 41, 43 together with the applicator 20 and the applicator coupling element 85 are rotated around the distal shaft section longitudinal axis 36 relative to the second bearing ring 204 and the segment 61 with shaft receptacle 55.

[0116] The rotational position of the applicator 20 about the distal shaft section longitudinal axis 36 can be adjusted independently of the size of the angle 70 (i.e., especially also with an angled shaft 26).

Claims

[1] Shaft instrument (10) for laparoscopic and / or endoscopic procedures, comprising a proximal shaft section (28) having a proximal shaft section longitudinal axis (34), and a distal shaft section (30) having a distal shaft section longitudinal axis (36) and an applicator (20) arranged at its distal end, wherein the two shaft sections (28, 30) are connected to each other in the region of a connecting joint (32) and are rotatable relative to each other, wherein at least one of the end faces (38, 40) of the two shaft sections (28, 30) facing the connecting joint (32) is oriented at an angle other than 90° relative to the respective shaft section longitudinal axis (34, 36), and wherein an angle (70) between the two shaft section longitudinal axes (34, 36) is variable, wherein the shaft instrument (10) has at least one transmission device (78),which is displaceable along or parallel to an actuating axis (17) by an actuating stroke (80) and is coupled at its distal end to the applicator (20) of the shaft instrument (10), wherein the transmission device (78) transmits axial forces along the actuating axis (17) and torques around the actuating axis (17), wherein the applicator (20) is rotatable around the distal shaft section longitudinal axis (36) and wherein the transmission device (78) is rotationally fixed to the applicator (20). [2] Shaft instrument (10) according to claim 1, characterized by, that the shaft instrument (10) has a shaft (50) which is bendable at least at the level of the connecting joint (32), wherein a distal shaft section (56) of the shaft (50) is rotationally fixed to a shaft receptacle (55) of the distal shaft section (30), and wherein a proximal shaft section (54) of the shaft (50) and the proximal shaft section (28) are rotatable relative to each other, such that a relative rotation between the proximal shaft section (28) and the proximal shaft section (54) is accompanied by a change in the angle (70) between the two shaft section longitudinal axes (34, 36). [3] Shaft instrument (10) according to claim 2, characterized by , that the shaft (50) is designed as a hollow shaft and has a shaft cavity (77), wherein the transmission device (78) is arranged in the shaft cavity (77). [4] Shaft instrument (10) according to any one of the preceding claims, characterized by, that the shaft instrument (10) has an actuating device (13) for generating the actuating stroke (80) along the actuating axis (17) and for rotating the transmission device (78) about the actuating axis (17). [5] Shaft instrument (10) according to claim 4, characterized by , that the actuating device (13) is arranged on a handling section (14) of the shaft instrument (10). [6] Shaft instrument (10) according to claim 4 or 5, characterized by , that the actuating device (13) has a lifting element (18) for generating the actuating stroke (80) along the actuating axis (17) and a twisting element (19) for twisting the transmission device (78) about the actuating axis (17). [7] Shaft instrument (10) according to claim 6, characterized by , that the transmission device (78) has a transmission section (89) that is coupled to the twisting element (19) in a rotationally fixed manner. [8] Shaft instrument (10) according to claim 7, characterized by , that the transmission section (89) is displaceable along the actuating axis (17) relative to the twisting element (19). [9] Shaft instrument (10) according to any one of the preceding claims, characterized by , that the transmission device (78) penetrates the connecting joint (32) and has a shell (107) that can be adapted to the angle (70) by bending at least at the level of the connecting joint (32), which transmits a torque from a transmission section (79) of the transmission device (78) that is proximal to the connecting joint (32) to a transmission section (81) of the transmission device (78) that is distal to the connecting joint (32) and / or which transmits a torque from the distal transmission section (81) to the proximal transmission section (79) of the transmission device (78). [10] Shaft instrument (10) according to claim 9, characterized by, that within the shell (107) a chain of force transmission elements (111, 113, 115) is arranged which transmits an axial force exerted on the proximal transmission section (79) of the transmission device (78) to the distal transmission section (81) of the transmission device (78) and / or which transmits an axial force exerted on the distal transmission section (81) of the transmission device (78) to the proximal transmission section (79) of the transmission device (78). [11] Shaft instrument (10) according to any one of the preceding claims, characterized by , that the shaft instrument (10) for rotating the applicator (20) has a rotation bearing (57) preferably with at least one bearing ring (202, 204) and more preferably with two bearing rings (202, 204) that can be rotated relative to each other. [12] Shaft instrument (10) according to claim 11, characterized by, that a first bearing ring (202) of the rotary bearing (57) is rotaryally coupled to the applicator (20). [13] Shaft instrument (10) according to claim 11 or 12, characterized by , that a second bearing ring (204) of the rotational bearing (57) is rotationally coupled to a segment (61) of the distal shaft section (30), which is rotationally fixed with respect to the distal shaft section longitudinal axis (36).

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