Medical instrument and method for manufacturing a medical instrument

Abstract

The invention relates to a medical instrument, in particular for handling a medical clamping device, which clamping device has two clamping arms that are movable relative to each other and connected to each other via a pre-tensioning clamping device element, wherein the medical instrument comprises two tool elements that are movable relative to each other, wherein a receiving element rotatable about an axis of rotation is arranged on each of the two tool elements, wherein the receiving elements are designed to cooperate and together form a clamping device receptacle for receiving at least one part of the clamping device, wherein the two receiving elements bear directly or indirectly against the tool element on which they are arranged. Furthermore, an improved medical system and an improved procedure for manufacturing a medical instrument are proposed.

Description

[0001] The invention relates to a medical instrument, in particular for handling a medical clamping device, which clamping device has two clamping arms that are movable relative to each other and connected to each other via a pre-tensioning clamping device element, wherein the medical instrument comprises two tool elements that are movable relative to each other, wherein a receiving element rotatable about an axis of rotation is arranged on each of the two tool elements, wherein the receiving elements are designed to cooperate and together form a clamping device receptacle for receiving at least one part of the clamping device, wherein the two receiving elements bear directly or indirectly against the tool element on which they are arranged.

[0002] Furthermore, the invention relates to a medical system comprising at least one medical instrument for handling a medical clamping device and at least one medical clamping device with two clamping arms that are movable relative to each other and connected to each other via a pre-tensioning clamping device element.

[0003] Furthermore, the invention relates to a method for manufacturing a medical instrument, in particular an instrument for handling a medical clamping device, which clamping device has two clamping arms movable relative to each other and connected to each other via a pre-tensioning clamping device element, wherein two tool elements of the instrument are arranged relative to each other movable, wherein a receiving element rotatable about an axis of rotation is arranged on each of the two tool elements, which receiving elements are designed to work together and together form a clamping device receptacle for receiving at least one part of the clamping device, wherein the two receiving elements are brought into contact with the tool element on which they are arranged, either directly or indirectly.

[0004] A medical instrument of the type described above is known, for example, from DE 10 2010 060 322 A1. In such instruments, the rotatable receiving elements are usually riveted to the tool elements. These rotatable receiving elements, also known as rotating plates, can loosen over the instrument's service life. In other words, the receiving elements can then be rotated more easily. If a medical clamping device, for example in the form of an aneurysm clip, is used with such an instrument and is placed in a patient, particularly for the treatment of an aneurysm in a hollow organ, it can happen that when the instrument is removed from the clamping device, one of the two rotatable receiving elements is slightly twisted due to external forces, for example, when an edge of the rotatable receiving element comes into contact with the applied clamping device.If the two receiving elements are not coupled together, they must be realigned to re-engage the clamping device so that it can be received in the clamping device receptacle.

[0005] It is therefore an object of the present invention to improve the handling and manufacture of a medical instrument.

[0006] This problem is solved according to the invention in a medical instrument of the type described above by the fact that the medical instrument has a friction enhancement device for increasing a static friction force between at least one of the two receiving elements and the tool element on which the at least one receiving element is arranged.

[0007] The friction enhancement device makes it possible, in particular, to hold corresponding receiving and tool elements against each other with greater force, thereby increasing the static frictional force between the tool element and the corresponding receiving element. Rotating the receiving element on the tool element then requires the application of a greater force or torque. In this way, unintentional rotation of the receiving element, for example when removing the instrument from the applied clamping device, can be permanently prevented compared to known instruments. Specifically, the friction enhancement device can compensate for loosening of the connection between the receiving element and the tool element, thus permanently hindering rotation of at least one receiving element on the tool element.In other words, the friction enhancement device counteracts the known loosening effect, particularly of a receiving element attached to the tool element by rivets, over the instrument's service life. The proposed improvement facilitates the re-engagement of the clamping device for a surgeon using the improved medical instrument, as it reduces the risk of unintentional rotation of one or both receiving elements. The friction enhancement device can be specifically designed to increase the static frictional force between one or both receiving elements and the associated tool elements. The interaction of the friction enhancement device with both receiving elements has the particular advantage that, unlike in DE 10 2010 060 322 A1, they do not need to be coupled to maintain their alignment.If both components are only made more difficult to rotate in a defined manner, the risk of one or both receiving elements rotating is significantly reduced. The friction enhancement device allows a minimum torque to be specified, particularly when the materials of the tool element and the associated receiving element are known, to rotate the receiving element on the tool element. This torque can be reliably and permanently specified, unlike with the conventional method of simply riveting the receiving element to the tool element. Such a friction enhancement device makes it possible, in particular, to design the medical instrument in such a way that the rotational position of the receiving elements on the respective tool elements can be continuously adjusted. This gives the surgeon complete freedom in handling the medical clamping device with the medical instrument.

[0008] It is advantageous if the friction enhancement device includes a preloading mechanism to increase the contact force between the tool element and the receiving element attached to it. Increasing the contact force also increases the static friction force between the tool element and the receiving element, thus making it more difficult for the receiving element to rotate on the tool element. Such a preloading mechanism can be implemented simply, for example, using suitable spring elements.

[0009] It is advantageous if the preloading device includes at least one preloading element to increase the contact force between the tool element and the receiving element attached to it. With such a preloading element, the receiving element can be pressed or preloaded against the tool element, thereby increasing, for example, a normal force between the two elements and thus also a static friction force proportional to the normal force. This static friction force must be overcome to rotate the receiving element on the tool element.

[0010] The medical instrument can be manufactured simply and cost-effectively if at least one pre-tensioning element is designed in the form of a spring element. The spring element can be designed, in particular, as a compression or tension spring.

[0011] Preferably, the spring element is designed in the form of a leaf spring or a disc spring. Such spring elements are easy to manufacture and allow for a compact design of the medical instrument.

[0012] The medical instrument can be made particularly compact if the tool element includes the pre-tensioning element.

[0013] Preferably, the tool element and the pre-tensioning element are formed in one piece. In particular, they can be monolithic. Such a design has the particular advantage that the pre-tensioning element cannot unintentionally detach from the medical instrument.

[0014] According to a further preferred embodiment, a gap extending proximally from a distal end of the tool element can be provided, separating the tool element into a first and a second tool element part, with the first and / or the second tool element part forming the preloading element. In other words, the preloading element can thus form part of or be encompassed by the tool element. In particular, the preloading element can be easily integrated into the tool element in this way. One or both tool element parts can thus be easily used as leaf springs. For example, a desired spring force can be specified by the thickness of the respective tool element part in order to increase the static friction force between the receiving element and the associated tool element.

[0015] Preferably, the gap defines a gap plane that extends transversely, and in particular perpendicularly, to the axis of rotation. This makes it possible, in particular, to exert a force in the direction of the axis of rotation with the preloading element, i.e., with one or both tool element parts, in order to increase a static friction force between the tool element and the receiving element arranged on it.

[0016] The spring force of the preloading element can be easily and precisely defined if a weakening zone is formed on the first and / or second part of the tool element to create the preloading element. This weakening zone can thus serve, in particular, as a deformation zone that can define an elastic deformation of the preloading element, especially spatially and with respect to the desired spring force.

[0017] According to a further preferred embodiment, the at least one receiving element may have at least one receiving element contact surface, the tool element may have at least one tool element contact surface, and the at least one receiving element contact surface and the at least one tool element contact surface may abut each other. In particular, the at least one receiving element contact surface and the at least one tool element contact surface may abut each other over a flat area. In particular, a flat contact area can, under a correspondingly acting normal force, generate a desired and defined static friction force between the receiving element and the associated contact element.

[0018] A simple way to increase the static friction force between the at least one receiving element and the at least one associated tool element is to use a friction enhancement device that pre-tensions the at least one receiving element contact surface and the at least one tool element contact surface against each other. The greater the pre-tensioning force, and thus the normal force acting on the contacting surfaces, the greater the static friction force between the two surfaces, which makes it more difficult to rotate the receiving element on the associated tool element.

[0019] The medical instrument can be formed in a simple and compact manner if the at least one pre-tensioning element is located on the at least one receiving element contact surface or on the at least one tool element contact surface.

[0020] In order to achieve the greatest possible static friction force with the lowest possible spring force of the preloading element, it is advantageous if the axis of rotation runs transversely, in particular perpendicularly to the receiving element contact surface and / or to the tool element contact surface.

[0021] It is advantageous if the preloading device defines a force direction and if the force direction is parallel or substantially parallel to the axis of rotation. This alignment of the force direction makes it possible, in particular, to maximize static friction with a given preloading device, especially a given preloading element.

[0022] The medical instrument can be formed simply if the at least one receiving element contact surface and / or the at least one tool element contact surface are flat. Alternatively, it is also possible to form the tool element contact surface and / or the receiving element contact surface curved, for example, concave and / or spherical, so that a flat contact between the at least one receiving element contact surface and the at least one tool element contact surface is again possible.

[0023] It is advantageous if a first receiving element contact surface of the at least one receiving element points away from the other receiving element and interacts with a first tool element contact surface of the associated tool element that points towards the other tool element, and / or if a second receiving element contact surface of the at least one receiving element points towards the other receiving element and interacts with a second tool element contact surface of the associated tool element that points away from the other tool element. The proposed refinement makes it possible, in particular, to ensure that at least one receiving element contact surface and at least one tool element contact surface interact and generate a static friction force that counteracts rotation of the receiving element on the tool element.In particular, the mounting element contact surfaces and the associated tool element contact surfaces can be stop surfaces that prevent movement of the mounting element relative to the tool element in a direction parallel to the axis of rotation, both towards and away from the other tool element. In this way, these surfaces can be used to hinder not only movement in the direction of the axis of rotation, but also rotation of the mounting element on the tool element around the axis of rotation.

[0024] It is advantageous if at least one of the two receiving elements comprises a receiving body and if an engagement element for force-fit and / or form-fit engagement with at least one part of the medical clamping device is arranged or formed on the receiving body. Such a receiving body particularly facilitates the grasping and handling of the clamping device with the medical instrument. Particularly simple and safe handling of a clamping device with the medical instrument is made possible if both receiving elements comprise such a receiving body.

[0025] For easy and secure engagement of the medical instrument with a clamping device, it is advantageous if the engagement element is designed in the form of an engagement projection or a recess. For example, the engagement recess can be designed as a groove into which a connecting section of the clamping device, formed between the pre-tensioning clamping element and a clamping arm connected to it, is received. The orientation of the engagement projection or recess can then also determine the orientation of the clamping device relative to the medical instrument. This orientation can be changed, in particular, by rotating the receiving elements relative to the tool elements.

[0026] Preferably, the first receiving element contact surface is arranged or formed on the receiving body. This allows, in particular, a compact design of the medical instrument. For example, the receiving body can rest directly against the associated tool element.

[0027] Furthermore, it is advantageous if the receiving body and the first tool element part are in contact with each other. For example, as explained, the first tool element part can form a preloading element, so that a force increasing static friction between the receiving body and the first tool element part can be exerted directly by the first tool element part. Alternatively, the first tool element part can also be designed to be essentially indeformable, so that the receiving body is then pulled or pushed against the first tool element part by the friction enhancement device.

[0028] According to a further preferred embodiment, the at least one receiving element comprises a bearing shaft defining the axis of rotation, a bearing shaft opening corresponding to the bearing shaft is arranged or formed on the associated tool element, and the bearing shaft engages in or passes through the bearing shaft opening. This design allows for a simple rotary bearing arrangement of the at least one receiving element on the tool element. In particular, the bearing shaft can be bolt-shaped, specifically in the form of a cylindrical bolt. The bearing shaft opening can, for example, be formed as a bore in the tool element.

[0029] The medical instrument can be manufactured simply, particularly the mounting of the receiving element to the tool element, if the receiving body and the bearing shaft are formed in one piece. Specifically, they can be monolithic. For example, the receiving body can be formed by a suitably shaped head of a screw bolt, thus enabling a monolithic formation of the receiving body and bearing shaft. Alternatively, the receiving body can be formed separately from the head of such a screw bolt and connected to the head by force-fit, form-fit, and / or material-fit to achieve a connection between the screw head and the receiving body that is both rotationally fixed and axially immovable. In such a case, the receiving body and the screw head are then formed in one piece, but not monolithically.

[0030] It is advantageous if the preloading element has an opening and if the bearing shaft extends through this opening. This easily prevents the preloading element from unintentionally detaching from the medical instrument.

[0031] For a reliable arrangement of the receiving element on the associated tool element, it is advantageous if the at least one receiving element includes a retaining body and if the retaining body is arranged or formed at an end of the bearing shaft pointing away from the receiving element. According to such a design, the bearing shaft is thus formed between the receiving element and the retaining body. In this way, both the receiving element and the retaining body can each form a stop that limits movement of the receiving element relative to the tool element in a direction parallel to the axis of rotation. In particular, this makes it possible to arrange or form the tool element between the retaining body and the receiving element.

[0032] For the reliable functioning of the medical instrument, it is advantageous if the retaining body is rotationally fixed to the bearing shaft. Such a rotationally fixed connection can be achieved, in particular, by positive locking, force locking, and / or material locking. The rotationally fixed connection prevents, in particular, the increasing gap between the receiving body and the retaining body, which could, for example, lead to an undesirable loosening of the connection between the receiving element and the tool element, and thus to easier rotation of the receiving element on the tool element.

[0033] The retaining body can be easily and permanently connected to the bearing shaft in a rotationally fixed manner by screwing, riveting, gluing, or welding it. Specifically, it is possible to screw or rivet the retaining body to the bearing shaft. Additionally or alternatively, the parts can also be glued and / or welded together.

[0034] Preferably, the retaining body and the bearing shaft are formed integrally. In particular, the retaining body and the bearing shaft can be monolithic. This can be achieved, for example, by forming the receiving element as a solid rivet or a hollow rivet.

[0035] It is advantageous if the tool element incorporates a receptacle for the retaining element. In particular, the receptacle can be designed to provide a positive fit for the retaining element. This allows the medical instrument to be designed so that the retaining element does not protrude from the tool element. Specifically, a surface of the retaining element facing away from the receptacle can be flush with a side surface of the tool element. This can, for example, improve the haptics of the medical instrument and reduce the potential risk of tissue injury during use.

[0036] Advantageously, the retaining element is rotatably mounted in the retaining element receptacle. For example, the retaining element receptacle can be designed in the form of a cylindrical blind hole. The retaining element can be cylindrical and thus, in particular, positively fitted into the retaining element receptacle with some play to allow for rotation.

[0037] A particularly compact design of the medical instrument is made possible, in particular, by the fact that the bearing shaft opening leads into the retention body receptacle. Specifically, in a transition area from the bearing shaft opening to the retention body receptacle, the diameter of the bearing shaft opening can widen in a single stage to become the inner diameter of the retention body receptacle.

[0038] The friction enhancement device can function simply if the second tool element contact surface is formed in the retaining body receptacle. In particular, this can be an inner surface of the retaining body receptacle pointing away from the other tool element, extending directly from the bearing shaft opening in a radial direction.

[0039] For easy connection of the retaining body and the bearing shaft, it is advantageous if the retaining body has an internal thread and the bearing shaft has a corresponding external thread. This design makes it possible, in particular, to screw the retaining body onto the bearing shaft. Furthermore, this design allows the distance between the retaining body and the receiving body to be adjusted as desired during instrument assembly. With a suitable arrangement of the friction enhancement device, especially a preloading element thereof, the required torque for rotating the receiving element on the tool element can be precisely defined by adjusting the distance between the retaining body and the receiving body.

[0040] It is advantageous if the retaining body and the second tool element part are in contact with each other. This design is particularly advantageous regardless of whether the second tool element part or the first tool element part forms a preloading element.

[0041] The mounting element can be reliably positioned on the tool element if the first and / or second mounting element contact surfaces extend radially away from the bearing shaft. Such mounting element contact surfaces then also form stop surfaces in conjunction with the tool element to prevent or at least limit movement of the mounting element in a direction parallel to the axis of rotation.

[0042] Preferably, at least one of the two mounting elements is designed in the form of a solid rivet or a hollow rivet. For example, the receiving body can be pre-formed as desired, with the shank of the rivet extending away from it. The retaining element can then be formed during riveting, i.e., by deforming an end of the shank pointing away from the receiving body.

[0043] It is advantageous if the two receiving elements are rotationally fixed to each other via a coupling element, and if the friction enhancement device is designed to increase a static friction force between at least one, and in particular only one, of the two receiving elements and the tool element on which the at least one receiving element is arranged. This design makes it possible, in particular, to design the friction enhancement device as simply as possible. Especially when it only exerts its effect between one of the two receiving elements and the associated tool element, the coupling element can ensure synchronous alignment of the two receiving elements. Of course, the coupling element can also be provided if the friction enhancement device increases static friction between both receiving elements on the one hand and the associated tool elements on the other.In this way, the risk of a non-synchronous change in the orientation of the two recording elements relative to each other can be further minimized.

[0044] Preferably, the friction enhancement device is designed for stepless rotation and holding of at least one of the two receiving elements in any non-discrete rotational position. The special design of the friction enhancement device makes it particularly possible to rotate the receiving elements in any desired direction. The receiving elements are therefore not held in discrete, for example, detented positions on the tool element, but rather solely due to the static friction acting between the receiving element and the associated tool element in any orientation relative to the axis of rotation.

[0045] According to a further preferred embodiment, the friction enhancement device can be designed to increase the static friction force acting between the at least one receiving element and the associated tool element when the tool elements move towards each other, provided that a medical clamping device is received in the clamping device receptacle. Such a design can, in particular, ensure that rotation of the receiving elements is further impeded when a medical clamping device is received in the clamping device receptacle. The medical clamping device can, in particular, form an additional abutment for the friction enhancement device, thereby increasing the static friction between the at least one receiving element and the associated tool element.This design can further hinder the twisting of the clamping device when it is inserted into the clamping device receptacle of the instrument.

[0046] Furthermore, it is advantageous if the friction enhancement device is designed to define a minimum static friction force acting between the at least one receiving element and the associated tool element. This design makes it possible, in particular, to ensure that a minimum torque is required to rotate the at least one receiving element on the tool element. The minimum static friction force can be defined, in particular, by the material pairing, i.e., the materials from which the at least one receiving element and the associated tool element are made, as well as by the normal force acting between the at least one receiving element and the associated tool element. As explained above, a normal force can be set, in particular, by defining the distance between the receiving body and the retaining body.

[0047] Furthermore, it is advantageous if the friction enhancement device is designed to specify a maximum static friction force acting between the at least one receiving element and the associated tool element. This design makes it possible, in particular, to rotate the at least one receiving element on the tool element by applying a torque sufficient to overcome the maximum static friction force. This allows for easy adjustment of the alignment of the at least one receiving element on the associated tool element.

[0048] For ease of use by a user, it is advantageous if the medical instrument comprises two branches that are movable relative to each other, in particular pivotable about a pivot axis, and if the two tool elements are arranged or formed on distal elements of the branches or form the distal ends of the branches. Such an instrument can be designed, in particular, as a needle holder, a clip applicator, or tweezers.

[0049] Advantageously, the medical instrument includes an actuating device for a user to apply an actuating force to move the two tool elements towards or away from each other. A user can thus guide the tool elements into the instrument by applying force to the actuating device, for example, the proximal ends of the movably coupled branches of the instrument.

[0050] Preferably, the medical instrument includes a return mechanism for automatically moving the two tool elements away from each other. This design has the particular advantage that, in a home position in which no external forces are exerted on it by a user, the instrument assumes an open position, i.e., a position in which the tool elements are maximally separated. The tool elements can then be moved towards each other by a user against the action of the return mechanism. If a user releases the actuating device of such an instrument, the action of the return mechanism causes the tool elements to move away from each other and back into the open position.

[0051] The problem set out at the beginning is further solved according to the invention in a medical system of the type described at the beginning by the fact that the at least one medical instrument is designed in the form of one of the medical instruments described above.

[0052] A medical system comprising at least one of the instruments described above offers the advantages already outlined. In particular, it enables simple and safe handling of medical clamping devices by a user. The system can include two or more identical or differing instruments and / or clamping devices. Specifically, corresponding, and therefore also differing, instruments can be provided and included in the system for different clamping devices.

[0053] The problem set out at the outset is further solved according to the invention in a method of the type described at the outset by equipping the medical instrument with a friction enhancement device to increase a static friction force between at least one of the two receiving elements and the tool element on which the at least one receiving element is arranged.

[0054] The proposed further development of a known manufacturing process will enable the production of reliable, long-lasting medical instruments, particularly suitable for handling medical clamping devices.

[0055] It is advantageous if, starting from a distal end of at least one tool element, a gap extending proximally is formed, separating the tool element into a first and a second tool element part, and if, when arranging the receiving element on the associated tool element, a locking element is inserted into the gap to limit the movement of the first and second tool element parts towards each other. In this manner, the action of the locking element prevents the movement of the first and second tool element parts towards each other to the extent specified by the locking element. In particular, this allows the static friction force acting between the at least one receiving element and the associated tool element to be adjusted in a defined manner.Particularly when one of the two tool element parts forms a preloading element of the friction enhancement device, the locking element inserted into the gap can limit its effect when mounting the receiving element on the tool element. This allows for an optimal compromise between allowing the at least one receiving element to rotate relative to the associated tool element on the one hand, and reliably maintaining a predetermined orientation of the at least one receiving element relative to the associated tool element about the axis of rotation on the other.

[0056] Furthermore, the use of one of the described methods for manufacturing a medical instrument is proposed, in particular for manufacturing one of the medical instruments described above.

[0057] The foregoing description therefore includes in particular the embodiments of medical instruments, medical systems and methods for manufacturing medical instruments defined below in the form of numbered sentences: 1. Medical instrument (12), in particular for handling a medical clamping device (14), which clamping device (14) has two clamping arms (18, 20) movable relative to each other and connected to each other via a pre-tensioning clamping device element (26), wherein the medical instrument (12) comprises two tool elements (36, 38) movable relative to each other, wherein a receiving element (72, 74) rotatable about an axis of rotation (76, 78) is arranged on each of the two tool elements (36, 38), wherein the receiving elements (72, 74) are designed to interact and together form a clamping device receptacle (70) for receiving at least one part of the clamping device (14), wherein the two receiving elements (72, 74) bear directly or indirectly against the tool element (36, 38) on which they are arranged, characterized in thatthat the medical instrument (12) has a friction enhancement device (80) for increasing a static friction force between at least one of the two receiving elements (72, 74) and the tool element (36, 38) on which the at least one receiving element (72, 74) is arranged. 2. Medical instrument according to sentence 1, characterized in that the friction enhancement device (80) comprises a pre-tensioning device (126, 128) for increasing a contact force between the tool element (36, 38) and the receiving element (72, 74) arranged on it. 3. Medical instrument according to sentence 2, characterized in that the pre-tensioning device (126, 128) comprises at least one pre-tensioning element (130, 132) for increasing the contact force between the tool element (36, 38) and the receiving element (72, 74) arranged on it. 4. Medical instrument according to sentence 3, characterized in that the at least one pre-tensioning element (130, 132) is designed in the form of a spring element (134, 136). 5. Medical instrument according to sentence 4, characterized in that the spring element (134, 136) is designed in the form of a leaf spring (138, 140) or a disc spring (180). 6. Medical instrument according to one of sentences 3 to 5, characterized in that the tool element (36, 38) comprises the pre-tensioning element (130, 132). 7. Medical instrument according to one of sentences 3 to 6, characterized in that the tool element (36, 38) and the pre-tensioning element (130, 132) are formed in one piece, in particular monolithically. 8. Medical instrument according to one of sentences 3 to 7, characterized in that a gap (142, 144) extends proximal from a distal end (44, 46) of the tool element (36, 38), separating the tool element (36, 38) into a first and a second tool element part (146, 148; 150, 152), and that the first and / or the second tool element part (146, 148; 150, 152) form the pre-tensioning element (130, 132). 9. Medical instrument according to sentence 8, characterized in that the gap (142, 144) defines a gap plane (154, 156) which extends transversely, in particular perpendicularly, to the axis of rotation (76, 78). 10. Medical instrument according to sentence 8 or 9, characterized in that a weakening area (168, 170) is formed on the first and / or on the second tool element part (146, 148) for forming the pre-tensioning element (130, 132). 11. Medical instrument according to one of the preceding sentences, characterized in that the at least one receiving element (72, 74) has at least one receiving element contact surface (160, 162), that the tool element (36, 38) has at least one tool element contact surface (164, 166) and that the at least one receiving element contact surface (160, 162) and the at least one tool element contact surface (164, 166) are in contact with each other, in particular over a surface. 12. Medical instrument according to sentence 11, characterized in that the friction enhancement device (80) holds the at least one receiving element contact surface (160) and the at least one tool element contact surface (164) pre-tensioned against each other. 13. Medical instrument according to sentence 11 or 12, characterized in that the at least one pre-tensioning element (130, 132) rests against the at least one receiving element contact surface (160) or against the at least one tool element contact surface (164). 14. Medical instrument according to one of sentences 11 to 13, characterized in that the axis of rotation (76, 78) runs transversely, in particular perpendicularly, to the receiving element contact surface (160, 162) and / or to the tool element contact surface (164, 166). 15. Medical instrument according to sentence 14, characterized in that the pretensioning device (126, 128) defines a force direction and that the force direction is parallel or substantially parallel to the axis of rotation (76, 78). 16. Medical instrument according to one of sentences 11 to 15, characterized in that the at least one receiving element contact surface (160, 162) and / or the at least one tool element contact surface (164, 166) are planar. 17. Medical instrument according to one of sentences 11 to 16, characterized in that a first receiving element contact surface (160) of the at least one receiving element (72, 74) points away from the other receiving element (72, 74) and interacts with a first tool element contact surface (164) of the associated tool element (36, 38) pointing towards the other tool element (36, 38) and / or that a second receiving element contact surface (162) of the at least one receiving element (72, 74) points towards the other receiving element (72, 74) and interacts with a second tool element contact surface (166) of the associated tool element (36, 38) pointing away from the other tool element (36, 38). 18. Medical instrument according to one of the preceding sentences, characterized in that at least one of the two receiving elements (72, 74) comprises a receiving body (82, 84) and that an engagement element (86, 88) for force-locking and / or form-locking engagement with at least one part of the medical clamping device (14) is arranged or formed on the receiving body (82, 84). 19. Medical instrument according to sentence 18, characterized in that the intervention element (86, 88) is designed in the form of an intervention projection or an intervention recess (90, 92). 20. Medical instrument according to sentence 18 or 19, characterized in that the first receiving element mounting surface (160) is arranged or formed on the receiving body (82, 84). 21. Medical instrument according to one of sentences 18 to 20, characterized in that the receiving body (82, 84) and the first tool element part (146, 148) are in contact with each other. 22. Medical instrument according to one of the preceding sentences, characterized in that the at least one receiving element (72, 74) comprises a bearing shaft (94, 96) defining the axis of rotation (76, 78), that a bearing shaft opening (98, 100) corresponding to the bearing shaft (94, 96) is arranged or formed on the associated tool element (36, 38) and that the bearing shaft (94, 96) engages in or passes through the bearing shaft opening (98, 100). 23. Medical instrument according to sentence 22, characterized in that the receiving body (82, 84) and the bearing shaft (94, 96) are formed in one piece, in particular monolithically. 24. Medical instrument according to sentence 22 or 23, characterized in that the pre-tensioning element (130, 132) has an opening (172, 174) and that the bearing shaft (94, 96) passes through the opening (172, 174). 25. Medical instrument according to one of sentences 22 to 24, characterized in that the at least one receiving element (72, 74) comprises a retaining body (102, 104) and that the retaining body (102, 104) is arranged or formed at an end of the bearing shaft (94, 96) pointing away from the receiving body (82, 84). 26. Medical instrument according to sentence 25, characterized in that the retaining body (102, 104) is connected to the bearing shaft (94, 96) in a rotationally fixed manner, in particular by form-fit and / or force-fit and / or material-fit. 27. Medical instrument according to sentence 25 or 26, characterized in that the retaining body (102, 104) is screwed or riveted and / or glued or welded to the bearing shaft (94, 96). 28. Medical instrument according to one of sentences 25 to 27, characterized in that the retaining body (102, 104) is formed in one piece, in particular monolithically, with the bearing shaft (94, 96). 29. Medical instrument according to one of sentences 25 to 28, characterized in that a retaining body receptacle (114, 116) is formed on the tool element (36, 38) for receiving, in particular for positively locking, the retaining body (102, 104). 30. Medical instrument according to sentence 29, characterized in that the retention body (102, 104) is rotatably mounted in the retention body receptacle (114, 116). 31. Medical instrument according to sentence 29 or 30, characterized in that the bearing shaft opening (98, 100) opens into the retaining body receptacle (114, 116). 32. Medical instrument according to one of sentences 29 to 31, characterized in that the second tool element contact surface (166) is formed in the retaining body receptacle (114, 116). 33. Medical instrument according to one of sentences 25 to 32, characterized in that the retaining body (102, 104) has an internal thread (110, 112) and that the bearing shaft (94, 96) has an external thread (106, 108) corresponding to the internal thread (110, 112). 34. Medical instrument according to one of sentences 25 to 33, characterized in that the retaining body (102, 104) and the second tool element part (150, 152) are in contact with each other. 35. Medical instrument according to one of sentences 22 to 34, characterized in that the first and / or the second receiving element mounting surface (160, 162) extend in a radial direction away from the bearing shaft (94, 96). 36. Medical instrument according to one of the preceding sentences, characterized in that at least one of the two attachment elements (72, 74) is designed in the form of a solid rivet or a hollow rivet. 37. Medical instrument according to one of the preceding sentences, characterized in that the two receiving elements (72, 74) are rotationally fixed to each other via a coupling element (182) and that the friction enhancement device (80) is designed to increase a static friction force between at least one, in particular only one, of the two receiving elements (72, 74) and the tool element (36 38) on which the at least one receiving element (72, 74) is arranged. 38. Medical instrument according to one of the preceding sentences, characterized in that the friction enhancement device (80) is designed for stepless rotation and holding at least one of the two receiving elements (72, 74) in any non-discrete rotational position. 39. Medical instrument according to one of the preceding sentences, characterized in that the friction enhancement device (80) is designed to increase the static friction force acting between the at least one receiving element (72, 74) and the associated tool element (36, 38) when moving the tool elements (36, 38) towards each other, provided that a medical clamping device (14) is received in the clamping device receptacle (70). 40. Medical instrument according to one of the preceding sentences, characterized in that the friction enhancement device (80) is designed to provide a minimum static friction force acting between the at least one receiving element (72, 74) and the associated tool element (36, 38). 41. Medical instrument according to one of the preceding sentences, characterized in that the friction enhancement device (80) is designed to specify a maximum static friction force acting between the at least one receiving element (72, 74) and the associated tool element (36, 38). 42. Medical instrument according to one of the preceding sentences, characterized in that the medical instrument (12) comprises two branches (40, 42) that are movable relative to each other, in particular pivotable relative to each other about a pivot axis (49), and that the two tool elements (36, 38) are arranged or formed at distal ends (44, 46) of the branches (40, 42) or form the distal ends (44, 46) of the branches (40, 42). 43. Medical instrument according to one of the preceding sentences, characterized in that the medical instrument (12) comprises an actuating device (58) for a user to initiate an actuating force to move the two tool elements (36, 38) towards each other and / or away from each other. 44. Medical instrument according to sentence 43, characterized in that the medical instrument (12) comprises a reset device (60) for automatically moving the two tool elements (36, 38) away from each other. 45. Medical system (10) comprising at least one medical instrument (12) for handling a medical clamping device (14) and at least one medical clamping device (14) with two clamping arms (18, 20) movable relative to each other and connected to each other via a pre-tensioning clamping device element (26), characterized in that the at least one medical instrument (12) is designed in the form of a medical instrument (12) according to one of the preceding sentences. 46. ​​Method for manufacturing a medical instrument (12), in particular an instrument (12) for handling a medical clamping device (14), which clamping device (14) has two clamping arms (18, 20) movable relative to each other and connected to each other via a pre-tensioning clamping device element (26), wherein two tool elements (36, 38) of the instrument (12) are arranged relative to each other so as to be movable relative to each other, wherein a receiving element (72, 74) rotatable about an axis of rotation (76, 78) is arranged on each of the two tool elements (36, 38), which receiving elements (72, 74) are designed to interact and together form a clamping device receptacle (70) for receiving at least one part of the clamping device (14), wherein the two receiving elements (72, 74) are brought into contact with the tool element (36, 38) on which they are arranged, characterized in thatthat the medical instrument (12) is equipped with a friction enhancement device (80) to increase a static friction force between at least one of the two receiving elements (72, 74) and the tool element (36, 38) on which the at least one receiving element (72, 74) is arranged. 47. Method according to sentence 46, characterized in that, starting from a distal end (44, 46) of at least one tool element (36, 38), a gap (142, 144) extending in a proximal direction is formed, which separates the tool element (36, 38) into a first and a second tool element part (146, 148; 150, 152), and that when arranging the at least one receiving element (72, 74) on the associated tool element (36, 38), a blocking element (176, 178) is inserted into the gap (142, 144) to limit a movement of the first and second tool element parts (146, 148; 150, 152) towards each other. 48. Use of a process according to paragraph 46 or 47 for the manufacture of a medical instrument (10) according to any of paragraphs 1 to 44.

[0058] The following description of a preferred embodiment of the invention, in conjunction with the drawing, serves for further explanation. The drawing shows: Fig. 1: A schematic perspective overview of a medical system during the application of a clamping device to a hollow organ using a medical instrument; Fig. 2: a schematic representation of a friction enhancement device in conjunction with a receiving element and a tool element associated with it; Fig. 3: An enlarged partial view of a distal end region of the arrangement made of Fig. 1; Fig. 4: an exploded view of the arrangement made of Fig. 3 without clamping device; Fig. 5: a partially cut-down view of the arrangement Fig. 3 when mounting the mounting elements using locking elements; Fig. 6: A partially cropped, enlarged partial view of the arrangement made of Fig. 1; Fig. 7: a view similar Fig. 6 with tool elements moving towards each other; Fig. 8: an enlarged partial view of the arrangement Fig. 7; Fig. 9: an enlarged partial view of a distal end region of a tool element of another embodiment of a medical instrument; Fig. 10: an enlarged partial view of a distal end region of a tool element of another embodiment of a medical instrument; and Fig. 11: a view similar Fig. 6 of another embodiment of a medical instrument.

[0059] In Fig. Figure 1 is an exemplary and schematic first embodiment of a medical system designated as a whole by reference numeral 10. It comprises one or more medical instruments 12, which are identical or different, and at least one or more medical clamping devices 14, which are identical or different.

[0060] The medical instrument 12 is designed for handling the medical clamping device 14, in particular for applying it to a hollow organ 16 in the body of a patient. The medical clamping device 14 is in particular designed in the form of a medical clip, which may in particular be designed as a so-called aneurysm clip.

[0061] The monolithic clamping device 14 comprises two clamping arms 18, 20 that are movable relative to each other and have clamping surfaces 22 and 24 facing each other, between which the hollow organ 16 can be clamped. The clamping arms 18 and 20 are connected to each other via a pre-tensioning clamping element 26, which is designed in the form of a helical spring 28 comprising at least one complete turn.

[0062] The figures show exemplary embodiments of clamping devices 14, which include a so-called through-connection 30. In this through-connection 30, a male connecting section 32, which connects the helical spring 28 to the clamping arm 20, passes through a female connecting section 34, which connects the helical spring 28 to the other clamping arm 18. As can be clearly seen in the figures, an opening is formed in the female connecting section 34 through which the male connecting section 32 extends.

[0063] The medical instrument 12 comprises two tool elements 36 and 38 that are movable relative to each other. These are arranged or formed at the distal ends 44 and 36, respectively, of two elongated branches 40 and 42, and thus form the distal ends 44 and 46 of the branches 40 and 42. The two branches 40 and 42 are held relative to each other so that they can pivot about a pivot axis 48. The pivot axis 48 is defined by a longitudinal axis of a locking screw 50, with which the two branches 40 and 42 are movably coupled to each other.

[0064] Proximal to the pivot axis 48, grip sections 52 and 54 are formed on branches 40 and 42, by which the instrument 12 can be grasped by a user with one hand 56. The grip sections 52 and 54 are encompassed by an actuating device 58 of the instrument 12.

[0065] The user can apply an actuating force to the instrument 12 via the actuating device 58 in order to move the tool elements 36, 38 towards each other or away from each other by moving the handle sections 52, 54 towards each other or away from each other.

[0066] The instrument 12 further comprises a return mechanism 60 for automatically moving the tool elements 36 and 38 away from each other. The return mechanism 60 comprises two leaf spring sections 62 and 64 formed integrally with the handle sections 52 and 54, the free ends 66 and 68 of which engage with each other. The leaf spring sections 62 and 64 hold the two handle sections 52 and 54 of the instrument 12 in a home position deflected as far apart as possible. In this position, the distance between the tool elements 36 and 38 is at its maximum.

[0067] A clamping device receptacle 70 is provided on the instrument 12. It serves to receive at least one part of the clamping device 14. The clamping device receptacle 70 is defined by two cooperating receiving elements 72 and 74.

[0068] The two receiving elements 72 and 74 are each rotatably arranged about a rotation axis 76 and 78 respectively on the tool elements 36, 38.

[0069] The receiving elements 72, 74 are designed to work together and define the clamping device receiving 70, as will be explained in detail below.

[0070] The two recording elements 72, 74 are located in the Fig. 1, Fig. 2, Fig. 3, Fig. 4, Fig. 5, Fig. 6, Fig. 7 to Fig. 8 schematically illustrated embodiment of the medical instrument 12 directly on the respective tool element 36, 38 on which they are arranged.

[0071] As schematically in Fig. As shown in Figure 2, the medical instrument 12 comprises a friction enhancement device 80 for amplifying the static friction force acting between the receiving elements 72, 74 on the one hand and the respective tool element 36, 38 on the other, on which the receiving elements 72 and 74 are arranged. The design and function of the friction enhancement device 80 will be explained in detail below.

[0072] To receive the clamping device 14 in the clamping device receptacle 70, the receiving elements 72, 74 each comprise a receiving body 82, 84. Each receiving body 82, 84 has an engagement element 86, 88 for engaging force-fit and / or form-fit with at least a part of the clamping device 14. In the case of the Fig. 1, Fig. 2, Fig. 3, Fig. 4, Fig. 5, Fig. 6, Fig. 7 to Fig. In the embodiment of instrument 12 shown in Figure 8, the engagement elements 86, 88 are designed in the form of groove-shaped engagement recesses 90, 92.

[0073] In embodiments not shown, the engagement elements 86, 88 are designed in the form of engagement projections.

[0074] The receiving elements 72, 74 are arranged on the tool elements 36 and 38 such that the receiving bodies 82, 84 with their groove-shaped engagement recesses 90 and 92 point towards each other. This makes it possible, as particularly in Fig. It is clearly visible that the connecting sections 32 and 34 can engage in the engagement recesses 90, 92 in the area between the through-hole 30 and the helical spring 28. This allows the clamping device 14 to be detected with the instrument 10 and, as will be described in more detail below, also easily handled.

[0075] The receiving elements 72, 74 each comprise a bearing shaft 94, 96 defining the axis of rotation 76, 78. Corresponding bearing shaft openings 98, 100 are arranged or formed on the tool elements 36, 38. The bearing shafts 94, 96 engage in or pass through the bearing shaft openings 98, 100.

[0076] The receiving bodies 82, 84 are each formed in one piece, i.e. monolithically, with the bearing shaft 94 and 96 respectively.

[0077] The receiving elements 72, 74 each further comprise a retaining body 102 or 104. The retaining bodies 102, 104 are arranged or formed at an end of the respective bearing shaft 94, 96 pointing away from the receiving body 82, 84.

[0078] The retaining elements 102, 104 are connected to the bearing shaft 94 and 96 respectively in a rotationally fixed manner. The rotationally fixed connection is, in particular, form-fit and / or force-fit and / or material-fit.

[0079] In the Fig. 1, Fig. 2, Fig. 3, Fig. 4, Fig. 5, Fig. 6, Fig. 7 to Fig. In the exemplary embodiment of instrument 12 shown in Figure 8, the retaining bodies 102, 104 are screwed to the respective bearing shafts 94, 96. For this purpose, external threads 106 and 108 are formed on the bearing shafts 94, 96, respectively, which correspond to internal threads 110, 112 of the retaining bodies 102, 104.

[0080] The retaining bodies 104, 104 are designed in the form of short cylindrical sleeves and have the function of a nut that can be screwed onto the bearing shafts 94, 96.

[0081] Retaining body receptacles 114 and 116, respectively, are formed on the tool elements 36 and 38 for receiving one of the two retaining bodies 102 and 104, respectively. The retaining body receptacles 114 and 116 are blind-shaped and open in the direction away from the other tool element 36 and 38. The retaining bodies 102 and 104 are positively engaged in the retaining body receptacles 114 and 116. In the assembled state of the instrument 10, an annular surface 118 or 120, pointing away from the other tool element 36 and 38, is flush with the side surfaces 122 and 124.

[0082] Due to the described design, the retaining bodies 102, 104 are rotatably mounted in the respective retaining body receptacle 114, 116.

[0083] The boreholes 98, 100 lead, as in particular in Fig. 5 clearly visible in the respective retaining body image 114, 116.

[0084] The friction enhancement device 80 comprises preload devices 126, 128, each of which is assigned to a receiving element 72, 74 and the respective associated tool element 36, 38, in order to increase a contact force between the tool elements 36, 38 on the one hand and the receiving elements 72, 74 arranged on them on the other.

[0085] The pre-tensioning devices 126, 128 each comprise at least one pre-tensioning element 130, 132 for increasing the contact force between the tool element 36, 38 on the one hand and the receiving elements 72, 74 arranged on them on the other hand.

[0086] The pre-tensioning element 130, 132 is designed in the form of a spring element 134, 136. The two spring elements 134 and 136 are located in the Fig. 1, Fig. 2, Fig. 3, Fig. 4, Fig. 5, Fig. 6, Fig. 7 to Fig. 8 exemplary embodiment of the instrument 12 in the form of a leaf spring 138 or 140.

[0087] In the exemplary embodiment of the Fig. 1, Fig. 2, Fig. 3, Fig. 4, Fig. 5, Fig. 6, Fig. 7 to Fig. 8 are formed on the tool elements 36, 38 columns 142, 144, which extend from the distal ends 44, 46 in a proximal direction, i.e. in the direction of the pivot axis 48.

[0088] Columns 142 and 144 separate the tool elements 36 and 38 into a first tool element part 146 and 148, and a second tool element part 150 and 152. As shown in particular in Fig. As can be clearly seen, the receiving bodies 82 and 84 are located against the first tool element parts 146, 148.

[0089] Columns 142 and 144 define slit planes 152 and 154, which extend transversely, namely perpendicularly, to the axes of rotation 76 and 78 respectively.

[0090] The two columns 142, 144 each have a gap width of 158, which corresponds to a distance between the first tool element parts 146, 148 and the second tool element parts 150, 152.

[0091] The two receiving elements 72, 74 each have a first receiving element mounting surface 160 and a second receiving element mounting surface 162. The first receiving element mounting surface 160 points away from the other receiving element 72, 74. The second receiving element mounting surface 162 points towards the other receiving element 72, 74.

[0092] The two tool elements 36, 38 each have a first tool element contact surface 164 and a second tool element contact surface 166. The first tool element contact surface 164 points towards the other tool element 72, 74. The second tool element contact surface 166 points away from the other tool element 72, 74.

[0093] The first and second receiving element contact surfaces 160, 162 and the first and second tool element contact surfaces 164 and 166 act together in pairs, namely the first receiving element contact surface 160 with the first tool element contact surface 164 and the second receiving element contact surface 162 with the second tool element contact surface 166.

[0094] The first receiving element mounting surfaces 160 are arranged or formed on the receiving bodies 82, 84.

[0095] Furthermore, the first and second receiving element mounting surfaces 160, 162 extend radially away from the respective bearing shaft 94, 96.

[0096] The second tool element contact surfaces 166 are formed in the retaining body receptacles 114 and 116, respectively. The second receiving element contact surfaces 162 are formed on the retaining bodies 102 and 104, respectively.

[0097] Thus, the medical instrument 12, as described above, has at least one receiving element contact surface 160, 162 encompassed by the receiving element 72, 74. The tool elements 36, 38 each have at least one tool element contact surface 164, 166. The at least one receiving element contact surface 160, 162 and the at least one tool element contact surface 164, 166 are in abutting each other. In the case described in the Fig. 1, Fig. 2, Fig. 3, Fig. 4, Fig. 5, Fig. 6, Fig. 7 to Fig. In the schematically illustrated embodiment of the instrument 12, the receiving element contact surfaces 160, 162 lie flat against the tool element contact surfaces 164, 166.

[0098] The axes of rotation 76, 78 run transversely, namely perpendicularly, to the receiving element contact surfaces 160, 162 and to the tool element contact surfaces 164, 166. The receiving element contact surfaces 160, 162 and the tool element contact surfaces 164, 166 are each planar.

[0099] Due to the described design of the tool elements 36, 38 with the columns 142, 144, the retaining bodies 102, 104 each abut the second tool element parts 150, 152.

[0100] In the Fig. 1, Fig. 2, Fig. 3, Fig. 4, Fig. 5, Fig. 6, Fig. 7 to Fig. In the schematically illustrated embodiment of the instrument 12, the tool elements 36, 38 each comprise a pre-tensioning element 130, 132. The tool elements 36, 38 and the pre-tensioning elements 130, 132 are also formed in one piece, namely monolithically.

[0101] To ensure a defined deformability of the first tool element parts 146, 148, weakening areas 168 and 170 respectively are formed on these areas in order to define the properties of the prestressing elements 130, 132.

[0102] The first tool element parts 146, 148 each have an opening through which the respective bearing shaft 94, 96 passes. In the case of the Fig. 1, Fig. 2, Fig. 3, Fig. 4, Fig. 5, Fig. 6, Fig. 7 to Fig. In the embodiment of instrument 10 shown in Figure 8, the openings 172, 174 each form a part or a section of the bearing shaft openings 98, 100.

[0103] The friction enhancement device 80 is designed such that it holds the first receiving element contact surface 160 and the first tool element contact surface 164 pre-tensioned against each other. Depending on whether a clamping device 14 is received in the clamping device receptacle 70 or not, the friction enhancement device 80 also holds the second receiving element contact surface 162 and the second tool element contact surface 166 pre-tensioned against each other, specifically when no clamping device 14 is received in the clamping device receptacle 70.

[0104] In the manner described, the prestressing elements 130, 132 are located on the first receiving element mounting surfaces 160.

[0105] The pre-tensioning devices 126, 128 each define a force or direction of action which runs parallel to the axis of rotation 76 or 78.

[0106] The friction enhancement device 80 is designed for stepless rotation and holding of the two receiving elements 72, 74 relative to the associated tool elements 36, 38 in any non-discrete rotational positions. This is achieved by pressing the first receiving element contact surface 160 and the first tool element contact surface 164, which abut each other on one side, and the second receiving element contact surface 162 and the second tool element contact surface 166, which abut each other on the other side, against each other with the friction enhancement device 80 and the preloading devices 126 and 128 encompassed by it. This increases the normal force acting between the abutting surfaces, thereby increasing static friction.

[0107] The action of the preloading elements 130 and 132 thus makes it intentionally more difficult for the receiving elements 72, 74 to rotate about the axes of rotation 76, 78 relative to the tool elements 36 and 38. Consequently, the static friction acting between the contacting surfaces, which must be overcome to rotate the receiving elements 72, 74 relative to the tool elements 36 and 38, is increased, or in other words, intensified.

[0108] The friction enhancement device 80 is also designed to specify a minimum static friction force acting between the receiving elements 72, 74 and the associated tool elements 36, 38. This minimum static friction force can be set during the assembly of the instrument 12. For this purpose, locking elements 176, 178 are inserted into the gaps 142, 144, thus limiting the movement of the first and second tool element parts 146, 150 and 148, 152, respectively, towards each other. The receiving elements 72 and 74 are then pushed through the openings 172, 174 of the preloading elements 130, 132, and the bearing shafts 94, 96 are screwed to the retaining bodies 102, 104.

[0109] The thickness of the locking elements 176 and 178 is selected such that the retaining bodies 102, 104 can be screwed to the bearing shafts 94, 96 in such a way that the torque required to overcome static friction between the first receiving element contact surfaces 160 and the first tool element contact surfaces 164 adjacent to them is minimal, for example, 7 Ncm. This means that a torque of at least 7 Ncm must be applied to the receiving elements 72, 74 to rotate them about the axes of rotation 76, 78.

[0110] As described at the outset, this design prevents the receiving elements 72, 74 from rotating unintentionally and undesirably relative to the tool elements 36 and 38 when the clamping device 14 is released from the instrument 12. This simplifies it for the operator to pick up the clamping device 14 with the instrument 12 again, since the engagement elements 86, 88 of the receiving elements 72, 74 remain unchanged, particularly in their alignment relative to each other. The connecting sections 32 and 34 can then re-engage in the engagement recesses 90, 92, and the operator can grasp the clamping device 14 by moving the tool elements 36 and 38 towards each other and, if necessary, also open it again, i.e., move the clamping arms 18 and 20 away from each other, as, for example, in Fig. 3 shown, so that the hollow organ 16 can be inserted between the clamping surfaces 22, 24.

[0111] In the Fig. 7 and Fig. Figure 8 schematically illustrates a further, optional, property of the friction enhancement device 80, namely that it increases the static friction force acting between the receiving elements 72, 74 and the associated tool elements 36, 38 when the tool elements 36, 38 move towards each other, provided that a medical clamping device 14 is received in the clamping device receptacle 70. As shown in the Fig. 7 and Fig. As can be seen in Figure 8, the gap width 158 decreases due to the deflection of the preloading elements 130, 132 towards the second tool element parts 150, 152. Since the retaining bodies 102 and 104 are mounted non-rotatably on the bearing shafts 94 and 96, the distance between the first and second mounting element contact surfaces 160, 162 remains constant. However, the deformation of the preloading elements 130, 132 reduces the gap width 158 of the gap 142, 144. The normal force acting between the adjacent first mounting element contact surfaces 160 and first tool element contact surfaces 164 increases as a result, which also intensifies the static friction. In this case, an even greater torque is required to rotate the mounting elements 72, 74 than if no clamping device 14 were mounted in the clamping device receptacle 70.

[0112] The described design of the medical instrument 12, in particular the friction enhancement device 80, further enables the specification of a maximum static friction force acting between the at least one receiving element 72, 74 and the respective associated tool element 36, 28. This force can be specified in particular by the gap width 158, which defines a maximum deflection of the preloading elements 130, 132.

[0113] Fig. Figure 9 schematically shows another embodiment of a medical instrument 12, specifically in the region of a distal end 46 of the tool element 38. It serves to illustrate the attachment of the receiving element 74 to the tool element 38. Instead of a connection as in conjunction with the Fig. 1, Fig. 2, Fig. 3, Fig. 4, Fig. 5, Fig. 6, Fig. 7 to Fig. In this embodiment, the receiving element 74 of the screw connection between the bearing shaft 96 and the retaining body 104 described in section 8 is monolithic, specifically in the form of a solid rivet. Alternatively, a hollow rivet can be used instead of the solid rivet.

[0114] Of course, the receiving element 72 on the tool element 36 can also be designed as a solid or hollow rivet in an analogous manner.

[0115] Even when using rivets, the gaps 142, 144 are blocked by blocking elements 176, 178 during the assembly of the mounting elements 72, 74.

[0116] Fig. Figure 10 shows a further embodiment of a medical instrument 12 partially, namely in the area of ​​the distal end 46 of the tool element 38.

[0117] In this embodiment, no gap 144 is formed. The pre-tensioning element 132 is not separated here by the first tool element part 148 as in the embodiments of the Fig. 1 to 8 and 9 are formed, but by a pre-tensioning element 132 formed separately from the tool element 38 in the form of a disc spring 180 having an opening 78. The bearing shaft 96 passes through the opening 78.

[0118] The disc spring 180 is supported on one side by the first mounting element contact surface 160 and on the other side by the first tool element contact surface 164. A minimum torque for rotating the mounting element 74 relative to the tool element 38 is determined by a distance between the first mounting element contact surface 160 and the first tool element contact surface 164. The smaller the distance, the more the preloading element 132 must be deformed, thus increasing the static friction between the preloading element 132 and the first mounting element contact surface 160 on the one hand, and the first tool element contact surface 164 on the other.

[0119] Even those in Fig. The configuration shown schematically only on tool element 38 can also be implemented analogously on tool element 36.

[0120] In Fig. Figure 11 is another embodiment of a medical instrument 12 shown schematically. Its construction is identical to the embodiment of the Fig. 1, Fig. 2, Fig. 3, Fig. 4, Fig. 5, Fig. 6, Fig. 7 to Fig. 8 is essentially the same. It differs only in that the two receiving elements 72, 74 are rotationally fixed to each other via a coupling element 182. In this way, it can be ensured, independently of the effect of the friction enhancement device 80, that the engagement elements 86, 88 of the receiving bodies 82, 84 remain aligned with each other, even if only one of the receiving elements 72, 74 is rotated relative to the associated tool element 36, 38 due to an acting force or torque.

[0121] In an embodiment of an instrument 12 not shown in the figures, the friction enhancement device 80 comprises only one of the two preload devices 126, 128 described above. Such a design, in conjunction with or in combination with the coupling element 182, is sufficient to ensure a permanently unchanging relative orientation of the engagement elements 86, 88 in the event of rotation of the receiving elements 72, 74 relative to the tool elements 36, 38.

[0122] The special design of all described embodiments of medical instruments 12, namely the provision of the friction enhancement device 80, ensures that a minimal static friction force prevails between the adjacent tool element contact surfaces 164, 166 and receiving element contact surfaces 160, 162. Unlike conventional instruments 12, in which the receiving elements 72, 74 can loosen relative to the tool elements 36, 38, leading to a reduction in static friction between the receiving elements 72, 74 and the tool elements 36, 38, this is precisely what is prevented by the friction enhancement device 80 with at least one preloading element 130, 132. The preloading elements 130, 132 maintain the desired minimal static friction permanently.

[0123] The interacting first and second receiving element contact surfaces 160, 162 on the one hand and the interacting first and second tool element contact surfaces 164, 166 on the other hand are made of the same material. In the embodiments shown in the figures, this is an instrument steel that can be sterilized with hot steam.

[0124] In embodiments not shown, the materials of the interacting contact surfaces 160, 162, 164, 166 may also differ. For example, the receiving elements 72, 74 may be made of titanium, the tool elements 36, 38 of an instrument steel – or vice versa.

[0125] As described above, the handling of medical instruments 12, especially intraoperatively, is improved in the above-explained embodiments, since the risk of the alignment of the intervention elements 86, 88 relative to each other changing is significantly reduced or even completely eliminated. Reference symbol list 10 medical system 12 medical instruments 14 medical clamping devices 16 Hollow organ 18 clamping arm 20 clamping arm 22 clamping surface 24 clamping surface 26 Pre-tensioning clamping device element 28 coil spring 30 Through-hole 32 male connecting section 33 female connecting section 36 Tool element 38 Tool element 40 industry 42 Industry 44 distal end 46 distal end 48 Swivel axis 50 final screw 52 Handle section 54 Handle section 56 Hand 58 Actuating device 60 Reset device 62 Leaf spring section 64 Leaf spring section 66 free ending 68 free ending 70 Clamping device holder 72 Recording element 74 Recording element 76 Rotation axis 78 Rotation axis 80 Friction amplification device 82 recording bodies 84 recording bodies 86 Interlocking element 88 Interlocking element 90 Intervention recess 92 Interventional recess 94 storage 96 storage 98 Bearing shaft breach 100 bearing shaft penetrations 102 retaining bodies 104 retaining bodies 106 external threads 108 external threads 110 internal threads 112 internal threads 114 Retaining body intake 116 Retaining body intake 118 ring area 120 ring area 122 side surface 124 side area 126 Pre-tensioning device 128 Pre-tensioning device 130 prestressing element 132 prestressing element 134 Spring element 136 Spring element 138 leaf spring 140 leaf spring 142 gap 144 gap 146 first tool element part 148 first tool element part 150 second tool element part 152 second tool element part 154 cleavage plane 156 cleavage plane 158 gap width 160 first receiving element mounting surface 162 second receiving element mounting surface 164 first tool element mounting surface 166 second tool element mounting surface 168 Weakening area 170 weakening area 172 Breakthrough 174 Breakthrough 176 Blocking element 178 Blocking element 180 Belleville washers 182 Coupling element QUOTES INCLUDED IN THE DESCRIPTION

[0000] This list of documents cited by the applicant was automatically generated and is included solely for the reader's convenience. The list is not part of the German patent or utility model application. The DPMA accepts no liability for any errors or omissions. Cited patent literature

[0000] DE 10 2010 060 322 A1 [0004, 0007]

Claims

Medical instrument (12), in particular for handling a medical clamping device (14), which clamping device (14) has two clamping arms (18, 20) movable relative to each other and connected to each other via a pre-tensioning clamping device element (26), wherein the medical instrument (12) comprises two tool elements (36, 38) movable relative to each other, wherein a receiving element (72, 74) rotatable about an axis of rotation (76, 78) is arranged on each of the two tool elements (36, 38), wherein the receiving elements (72, 74) are designed to interact and together form a clamping device receptacle (70) for receiving at least one part of the clamping device (14), wherein the two receiving elements (72, 74) bear directly or indirectly against the tool element (36, 38) on which they are arranged, characterized in thatthat the medical instrument (12) has a friction enhancement device (80) for increasing a static friction force between at least one of the two receiving elements (72, 74) and the tool element (36, 38) on which the at least one receiving element (72, 74) is arranged. Medical instrument according to claim 1, characterized in that the friction enhancement device (80) comprises a pre-tensioning device (126, 128) for increasing a contact force between the tool element (36, 38) and the receiving element (72, 74) arranged on it. Medical instrument according to claim 2, characterized in that the pre-tensioning device (126, 128) comprises at least one pre-tensioning element (130, 132) for increasing the contact force between the tool element (36, 38) and the receiving element (72, 74) arranged on it, wherein in particular the at least one pre-tensioning element (130, 132) is designed in the form of a spring element (134, 136), wherein in particular the spring element (134, 136) is designed in the form of a leaf spring (138, 140) or a disc spring (180). Medical instrument according to claim 3, characterized in that a) the tool element (36, 38) comprises the pre-tensioning element (130, 132) and / or b) the tool element (36, 38) and the pre-tensioning element (130, 132) are formed in one piece, in particular monolithically, and / or c) a gap (142, 144) extends proximal from a distal end (44, 46) of the tool element (36, 38), separating the tool element (36, 38) into a first and a second tool element part (146, 148; 150, 152), and that the first and / or the second tool element part (146, 148; 150, 152) form the pre-tensioning element (130, 132), wherein in particular the gap (142, 144) a slit plane (154, 156) is defined which extends transversely, in particular perpendicularly, to the axis of rotation (76, 78) and / or a weakening area (168, 170) is formed on the first and / or on the second tool element part (146, 148) to form the pre-tensioning element (130, 132). Medical instrument according to one of the preceding claims, characterized in that the at least one receiving element (72, 74) has at least one receiving element contact surface (160, 162), that the tool element (36, 38) has at least one tool element contact surface (164, 166), and that the at least one receiving element contact surface (160, 162) and the at least one tool element contact surface (164, 166) abut each other, in particular planarly, wherein in particular a) the friction enhancement device (80) holds the at least one receiving element contact surface (160) and the at least one tool element contact surface (164) pre-tensioned against each other and / or b) the at least one pre-tensioning element (130, 132) abuts the at least one receiving element contact surface (160) or the at least one tool element contact surface (164) and / or c) the axis of rotation (76, 78) is transverse, in particular perpendicular, to the Mounting element area (160,162) and / or to the tool element contact surface (164, 166) and / or d) the preloading device (126, 128) defines a force direction and wherein the force direction is parallel or substantially parallel to the axis of rotation (76, 78) and / or e) the at least one receiving element contact surface (160, 162) and / or the at least one tool element contact surface (164, 166) are planar and / or f) a first receiving element contact surface (160) of the at least one receiving element (72, 74) points away from the other receiving element (72, 74) and interacts with a first tool element contact surface (164) of the associated tool element (36, 38) pointing towards the other tool element (36, 38) and / or wherein a second receiving element contact surface (162) of the at least one receiving element (72, 74) points towards the other receiving element (72, 38) 74) indicates and with a second, from the other tool element (36,38) away-pointing tool element mounting surface (166) of the associated tool element (36, 38) interacts. Medical instrument according to one of the preceding claims, characterized in that at least one of the two receiving elements (72, 74) comprises a receiving body (82, 84) and that an engagement element (86, 88) for force-fit and / or form-fit engagement with at least one part of the medical clamping device (14) is arranged or formed on the receiving body (82, 84), wherein in particular a) the engagement element (86, 88) is formed in the form of an engagement projection or an engagement recess (90, 92) and / or b) the first receiving element contact surface (160) is arranged or formed on the receiving body (82, 84) and / or c) the receiving body (82, 84) and the first tool element part (146, 148) abut each other. Medical instrument according to one of the preceding claims, characterized in that the at least one receiving element (72, 74) comprises a bearing shaft (94, 96) defining the axis of rotation (76, 78), that a bearing shaft opening (98, 100) corresponding to the bearing shaft (94, 96) is arranged or formed on the associated tool element (36, 38), and that the bearing shaft (94, 96) engages in or passes through the bearing shaft opening (98, 100), wherein in particular a) the receiving body (82, 84) and the bearing shaft (94, 96) are formed in one piece, in particular monolithically, and / or b) the preloading element (130, 132) has an opening (172, 174), and that the bearing shaft (94, 96) passes through the opening (172, 174). Medical instrument according to claim 7, characterized in that the at least one receiving element (72, 74) comprises a retaining body (102, 104) and that the retaining body (102, 104) is arranged or formed at an end of the bearing shaft (94, 96) pointing away from the receiving body (82, 84), wherein in particular a) the retaining body (102, 104) is rotationally fixed to the bearing shaft (94, 96), in particular by positive locking and / or force locking and / or by material locking, and / or b) the retaining body (102, 104) is screwed or riveted and / or glued or welded to the bearing shaft (94, 96) and / or c) the retaining body (102, 104) is formed in one piece with the bearing shaft (94, 96), in particular monolithically. Medical instrument according to claim 8, characterized in that a retaining body receptacle (114, 116) is formed on the tool element (36, 38) for receiving, in particular for positive locking, the retaining body (102, 104), wherein in particular a) the retaining body (102, 104) is rotatably received in the retaining body receptacle (114, 116) and / or b) the bearing shaft opening (98, 100) opens into the retaining body receptacle (114, 116) and / or c) the second tool element contact surface (166) is formed in the retaining body receptacle (114, 116). Medical instrument according to claim 8 or 9, characterized in that a) the retaining body (102, 104) has an internal thread (110, 112) and that the bearing shaft (94, 96) comprises an external thread (106, 108) corresponding to the internal thread (110, 112) and / or b) the retaining body (102, 104) and the second tool element part (150, 152) abut each other and / or c) the first and / or the second receiving element contact surface (160, 162) extend radially away from the bearing shaft (94, 96). Medical instrument according to one of the preceding claims, characterized in that at least one of the two attachment elements (72, 74) is designed in the form of a solid rivet or a hollow rivet. Medical instrument according to one of the preceding claims, characterized in that the two receiving elements (72, 74) are rotationally fixed to each other via a coupling element (182) and that the friction enhancement device (80) is designed to increase a static friction force between at least one, in particular only one, of the two receiving elements (72, 74) and the tool element (36 38) on which the at least one receiving element (72, 74) is arranged. A medical instrument according to one of the preceding claims, characterized in that the friction enhancement device (80) a) is configured for stepless rotation and holding at least one of the two receiving elements (72, 74) in any non-discrete rotational position and / or b) is configured for increasing the static friction force acting between the at least one receiving element (72, 74) and the associated tool element (36, 38) when moving the tool elements (36, 38) towards each other, provided that a medical clamping device (14) is received in the clamping device receptacle (70), and / or c) is configured for specifying a minimum static friction force acting between the at least one receiving element (72, 74) and the associated tool element (36, 38), and / or d) is configured for specifying a maximum static friction force acting between the at least one receiving element (72, 74) and the associated tool element (36, 38).38) acting static friction force., Medical system (10) comprising at least one medical instrument (12) for handling a medical clamping device (14) and at least one medical clamping device (14) with two clamping arms (18, 20) movable relative to each other and connected to each other via a pre-tensioning clamping device element (26), characterized in that the at least one medical instrument (12) is designed in the form of a medical instrument (12) according to one of the preceding claims. Method for manufacturing a medical instrument (12), in particular an instrument (12) for handling a medical clamping device (14), which clamping device (14) has two clamping arms (18, 20) movable relative to each other and connected to each other via a pre-tensioning clamping device element (26), wherein two tool elements (36, 38) of the instrument (12) are arranged relative to each other so as to be movable relative to each other, wherein a receiving element (72, 74) rotatable about an axis of rotation (76, 78) is arranged on each of the two tool elements (36, 38), which receiving elements (72, 74) are designed to interact together and together form a clamping device receptacle (70) for receiving at least one part of the clamping device (14), wherein the two receiving elements (72, 74) are brought into contact with the tool element (36, 38) on which they are arranged, characterized in thatthat the medical instrument (12) is equipped with a friction enhancement device (80) to increase a static friction force between at least one of the two receiving elements (72, 74) and the tool element (36, 38) on which the at least one receiving element (72, 74) is arranged. Method according to claim 15, characterized in that a gap (142, 144) extending in a proximal direction is formed starting from a distal end (44, 46) of at least one tool element (36, 38), which separates the tool element (36, 38) into a first and a second tool element part (146, 148; 150, 152), and that when arranging the at least one receiving element (72, 74) on the associated tool element (36, 38), a blocking element (176, 178) is introduced into the gap (142, 144) to limit a movement of the first and second tool element parts (146, 148; 150, 152) towards each other. Use of a method according to claim 15 or 16 for manufacturing a medical instrument (10) according to any one of claims 1 to 13.

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