Probe device for a resectoscope or other microinvasive instrument

Description

[0001] The present invention relates to a probe device for a resectoscope or other microinvasive medical instrument for processing or manipulating tissue and to a microinvasive instrument with such a probe device.

[0002] A resectoscope for transurethral resection or for gynecological or other applications comprises a resectoscope shaft that can be inserted, for example, into the urethra. The shaft of an endoscope and the shaft of a probe assembly are arranged within the resectoscope shaft. The probe assembly shaft can be moved within the resectoscope shaft by means of a device at the proximal end of the resectoscope shaft, referred to as the working element. At the distal end of the probe assembly, and thus also in the region of the distal end of the resectoscope shaft, an action device is provided, which can be moved relative to the distal end of the resectoscope shaft by means of the working element. The action device comprises, for example, one or more electrodes for monopolar or bipolar radiofrequency surgery and the electrocauterization of severed tissue.Alternatively, the working device can, for example, have a light-emitting surface through which the intense light of a laser can escape.

[0003] Such a resectoscope is typically highly disassemblable to facilitate thorough cleaning, replacement of a defective component, or adaptation to the habits of medical personnel or the specific requirements of a medical procedure. In particular, the proximal end of the resectoscope shaft can usually be separated from the distal end of the working element, and the endoscope and probe assembly can be removed from the resectoscope shaft, separated from the other components, and replaced. Even during a medical procedure, the proximal end of the resectoscope shaft can be temporarily separated from the distal end of the working element, for example, to drain some of the irrigation fluid used in the procedure.

[0004] Despite the extensive disassembly and mobility of the probe shaft within the resectoscope sheath, the proximal end of the sheath must be sealed fluid-tight. In a conventional resectoscope, this is achieved using a sealing device made of an elastic material. The sealing device comprises a channel for the probe shaft and a slot extending from its circumference to the channel, through which the probe shaft can be inserted laterally. When the proximal end of the resectoscope sheath is connected to the distal end of the working element, the sealing device is compressed axially, closing the slot and creating a seal against the probe shaft and sealing surfaces at both the proximal end of the resectoscope sheath and the distal end of the working element.

[0005] One disadvantage of this arrangement is that force is required to compress the sealing device when connecting the proximal end of the resectoscope shaft to the distal end of the working element. Resulting involuntary movements of the resectoscope shaft can injure the patient. Another disadvantage is that friction between the elastic sealing device and the shaft of the probe assembly creates resistance to movement of the probe assembly shaft relative to the sealing device, and thus relative to the resectoscope shaft, making precise movement of the probe assembly difficult.

[0006] CN105250023A shows a probe assembly for a resectoscope comprising an instrument shaft and a probe shaft therein, wherein the distal end of the instrument shaft is adjacent to the distal end of the probe shaft with an action device. The resectoscope further comprises a sealing device with a channel in which the probe shaft is arranged, wherein the probe shaft is displaceable relative to the sealing device along the probe shaft axis, and the sealing device is connected to the probe shaft.

[0007] One object of the present invention is to provide an improved probe device for a resectoscope or for another microinvasive medical instrument for processing or manipulating tissue and an improved microinvasive medical instrument.

[0008] This task is solved by the subject matter of the independent claims.

[0009] Further training opportunities are listed in the dependent requirements.

[0010] Conventionally, the reliable sealing effect of the sealing device relies on its elasticity. Only this elasticity allows the probe shaft to be inserted into the designated channel in the sealing device through a slot from the side (i.e., in a radial direction). Embodiments of the present invention are based on the idea of ​​providing a sealing device made of a metal, a ceramic, or another non-elastic material instead of an elastic one, thereby accepting, unlike a conventional resectoscope, that the probe shaft can no longer be removed radially from the probe shaft channel in the sealing device through a slot.

[0011] A probe device for a resectoscope or other microinvasive medical instrument for processing or manipulating tissue comprises a probe shaft with a cylindrical section for arrangement in an instrument shaft and with a distal end for arrangement near a distal end of the instrument shaft, an acting device at the distal end of the probe shaft, and a sealing device with a probe shaft channel in which the cylindrical section of the probe shaft is arranged, wherein the probe shaft is displaceable relative to the sealing device parallel to the longitudinal axis of the probe shaft and parallel to the longitudinal axis of the probe shaft channel, wherein the sealing device is formed of metal or ceramic or of another non-elastic material and is permanently connected to the probe shaft.

[0012] The probe assembly is specifically designed and intended for use with a resectoscope for the transurethral resection of diseased tissue from the bladder or prostate, or for gynecological or other applications. The cylindrical, and therefore straight, section of the probe shaft is designed to be rigid, enabling it to absorb and transmit not only tensile but also shear forces to the operating mechanism. The cross-sectional area of ​​the cylindrical section of the probe shaft and the cross-sectional area of ​​the probe shaft channel of the sealing device are largely identical. The cross-sectional area of ​​the cylindrical section of the probe shaft is only slightly smaller than the cross-sectional area of ​​the probe shaft channel to ensure smooth and frictionless guidance of the probe shaft within the channel.The cross-sectional area of ​​the cylindrical section of the probe shaft and the corresponding cross-sectional area of ​​the probe shaft channel are, in particular, each circular. Alternatively, the cross-sectional area of ​​the cylindrical section of the probe shaft and the corresponding cross-sectional area of ​​the probe shaft channel can each be non-circular, for example, polygonal or elliptical.

[0013] The working device may comprise a high-frequency electrode for the electrosurgical cutting of tissue and / or for the electrocauterization of cut tissue and / or a laser probe with a light-emitting surface for laser light. The probe assembly has a larger cross-sectional area, particularly at the working device, than at the cylindrical section of the probe shaft. Specifically, a high-frequency electrode (for example, in the form of a loop) may have a width that is significantly larger than any linear dimension of the cross-sectional area of ​​the cylindrical section of the probe shaft.

[0014] The probe assembly may further comprise a clamp or other guiding device for positively interlocking guidance of the probe assembly on the shaft of an endoscope or on a tube in which the shaft of an endoscope may be arranged, or on another device acting as a guide rail in an instrument shaft. This clamp or other guiding device is arranged, in particular, near the distal end of the probe assembly between the working element and the cylindrical section of the probe shaft. In the region of the clamp or other guiding device, the probe assembly has a larger cross-section than in the cylindrical section of the probe shaft.

[0015] The probe assembly may further include a flexible conductor section proximal to the cylindrical section for transmitting electrical or optical power. A connector for electrical and / or optical coupling to a power source may be provided at the proximal end of the flexible conductor section.

[0016] The non-elastic material of the sealing device is non-elastic in particular in that the sealing device is not deformed, or not significantly deformed, during its intended use. The elastic material of the sealing device has, in particular, a modulus of elasticity (Young's modulus) greater than 5 GPa, 10 GPa, 20 GPa, or 50 GPa, or a shear modulus (G-modulus) greater than 1 GPa, 5 GPa, 10 GPa, or 20 GPa. The sealing device is, in particular, not made of rubber, silicone rubber or elastomer, or any other elastomer.

[0017] The sealing device made of the non-elastic material is not deformed, or not significantly deformed, when the proximal end of the instrument shaft is connected to the distal end of the working element.

[0018] The inner surface of the probe shaft channel of the sealing device does not fully contact the outer surface of the cylindrical section of the probe shaft. Instead, a small annular gap remains between the outer surface of the cylindrical section of the probe shaft and the inner surface of the probe shaft channel of the sealing device. Due to the non-elastic material of the sealing device and its resulting dimensional stability, this annular gap can be made so narrow that, on the one hand, low-friction movement of the cylindrical section of the probe shaft within the probe shaft channel of the sealing device is possible, and on the other hand, only a very small amount of flushing fluid or other fluid can pass through the annular channel.

[0019] The probe shaft and the sealing element of the probe assembly are permanently connected in that they cannot be separated non-destructively. In particular, the probe shaft cannot be completely withdrawn from the probe shaft channel of the sealing element, for example, because it has a cross-section both distal to and proximal to its cylindrical section that is larger than the cross-section of the probe shaft channel. Distally, this larger cross-section may be present, for example, at the actuating element and / or at the aforementioned clamp or other guiding element. Proximally, this larger cross-section may be present, for example, at a connector for a detachable mechanical, electrical, and / or optical connection to a power source.

[0020] Since the sealing effect of the non-elastic sealing device does not rely on compression and deformation of the device, the probe assembly, the proximal end of the instrument shaft, and the working element can be designed such that connecting the proximal end of the endoscope shaft to the distal end of the working element requires little or no force—especially compared to a conventional sealing device made of an elastic material. This significantly reduces the likelihood of involuntary movement of the instrument shaft when opening and closing the connection to the working element, and thus the potential for patient injury.

[0021] In a probe device such as the one described here, the sealing device is not slotted.

[0022] Due to the non-elastic material of the sealing device, a gap cannot be closed by compression and elastic deformation of the sealing device. Therefore, inserting the cylindrical section of the probe shaft into the probe shaft channel in the sealing device from the side is not possible. Instead, the sealing device remains permanently connected to the probe shaft.

[0023] In a probe device such as described here, the sealing device further comprises, in particular, an endoscope shaft channel for receiving an endoscope shaft or for receiving a tube in which an endoscope shaft may be arranged.

[0024] The cross-section of the endoscope shaft channel is adapted to the cross-section of the tube for receiving an endoscope shaft or to the cross-section of an endoscope for which the microinvasive instrument and thus the probe device are intended, in such a way that the endoscope shaft or the tube for receiving an endoscope shaft is guided in the endoscope shaft channel of the sealing device with minimal play and friction, and only a small amount of liquid or other fluid can pass through a remaining annular channel.

[0025] In a probe device such as the one described here, the endoscope shaft channel has, in particular, an annular extension in which a sealing element is arranged.

[0026] The sealing element is designed, in particular, as an O-ring made of Teflon, nitrile rubber, silicone rubber, silicone elastomer, or another elastomer or elastic material. The sealing element has, in particular, a toroidal shape or another ring-shaped form with a circular, round, or angular cross-section.

[0027] In a probe device such as described here, the sealing device has in particular a conical sealing surface which is provided and designed for sealing contact with a corresponding conical sealing surface on an instrument shaft.

[0028] The diameter of the conical sealing surface decreases, particularly distally. Many conventional instrument shafts feature a conical sealing surface at their proximal ends. The probe attachment can be combined with such a conventional instrument shaft.

[0029] In a probe device such as the one described here, the probe shaft channel has, in particular, an annular extension in which a sealing element is arranged.

[0030] The sealing element is specifically designed as an O-ring made of Teflon, nitrile rubber, silicone rubber, silicone elastomer, or another elastomer or elastic material. The sealing element is specifically shaped like a toroid or another ring with a circular, round, or angular cross-section. The sealing element can close the annular gap between the outer surface of the cylindrical section of the probe shaft and the inner surface of the probe shaft channel of the sealing device, thus further improving the sealing effect.

[0031] Since the sealing element in the sealing device is not deformed when the proximal end of an instrument shaft is connected to the distal end of a working element, it offers no resistance to this connection. Since the sealing element is also not pressed against the outer surface of the cylindrical section of the probe shaft, it does not significantly increase the friction between the cylindrical section of the probe shaft and the sealing device.

[0032] In a probe device such as described here, the sealing device includes in particular a coupling device for the detachable mechanical connection of the sealing device to the distal end of a working element of a resectoscope or other microinvasive instrument.

[0033] The mechanical connection between the sealing device and the working element, created by the coupling mechanism, prevents the sealing device from remaining attached to the proximal end of the instrument shaft when the distal end of the working element is separated. The mechanical connection between the sealing device and the working element, created by the coupling mechanism, ensures that the sealing device instead remains attached to the distal end of the working element, from which it can then be manually detached.

[0034] In a probe device such as that described here, the sealing device includes in particular an elastic locking device for forming a locking connection with the distal end of the working element of the resectoscope or other microinvasive instrument.

[0035] In a probe device such as described here, the coupling device has in particular a groove or other recess for receiving an elastic locking element at the distal end of a working element of a resectoscope or other microinvasive instrument.

[0036] The locking mechanism comprises, for example, a locking lug at one end of a flexible shaft that can engage in a groove or other recess at the distal end of the working element. The locking action can be adjusted via the elastic properties of the flexible shaft or other elastic locking mechanism so that, on the one hand, the sealing device remains securely attached to the working element when the instrument shaft is separated from the working element, but on the other hand, can subsequently be easily separated manually from the working element.

[0037] In a probe device such as described here, the sealing device includes in particular a lug or an L-shaped groove for forming a locking connection with the distal end of the working element of the resectoscope or other microinvasive instrument.

[0038] In order to enable the establishment and release of a locking connection between the sealing device and the distal end of the working element of the microinvasive instrument, the distal end of the working element is designed in such a way that the probe shaft and, if applicable, an endoscope shaft, which are each guided with minimal play in the sealing device, can be moved along arc-shaped paths relative to the distal end of the working element.

[0039] A microinvasive medical instrument for processing or manipulating tissue comprises an instrument shaft with a distal end and a proximal end, a working element for detachable connection with the proximal end of the instrument shaft and for detachable connection with a proximal end of an endoscope and for detachable connection with a proximal end of a probe shaft and for manual movement of the probe shaft relative to the instrument shaft, wherein a space for receiving the sealing device of a probe device according to one of the preceding claims is provided between the distal end of the working element and the proximal end of the instrument shaft.

[0040] The distal end of the working element has features that correspond to the described features of the probe device, especially the sealing device.

[0041] In a microinvasive instrument, such as the one described here, a conical sealing surface is provided at the proximal end of the instrument shaft, which corresponds at least partially to a conical sealing surface of a sealing device of a probe device, as described here.

[0042] The conical sealing surface at the proximal end of the instrument shaft does not correspond, or only partially corresponds, to a conical surface on the working element. Part of the conical sealing surface at the proximal end of the instrument shaft, or the entire conical sealing surface at the proximal end of the instrument shaft, corresponds to a conical sealing surface of a sealing device of a probe assembly, as described herein.

[0043] In a microinvasive instrument such as the one described here, an opening for the probe shaft or for the endoscope shaft is provided, in particular at the distal end of the working element, wherein the opening for the probe shaft or for the endoscope shaft has a cross-section that allows movement of the probe shaft or the endoscope shaft in the opening when the sealing device is rotated relative to the distal end of the working element.

[0044] The opening has, in particular, a cross-section which is created by shifting the cross-section of the probe shaft or the endoscope shaft along a circular arc segment whose center point is on the axis about which the sealing device is to be rotated when making or loosening a re-entry connection with the distal end of the working element.

[0045] The microinvasive instrument is, in particular, a resectoscope. Brief description of the characters

[0046] The following descriptions of the embodiments are explained in more detail with reference to the accompanying figures. They show: Figure 1 is a schematic representation of a longitudinal section through part of a resectoscope; Figure 2 is a schematic representation of a longitudinal section through the resectoscope made of Figure 1 in a different configuration; Figure 3 a schematic representation of a cross-section through the resectoscope from the Figures 1 and 2 Figure 4: a schematic representation of a longitudinal section through part of a resectoscope; Figure 5: a schematic representation of a longitudinal section through the resectoscope made of Figure 4 in other configurations; Figure 6 a schematic representation of a cross-section through the resectoscope from the Figures 4 and 5 Figure 7: a schematic representation of a longitudinal section through part of another resectoscope; Figure 8: a schematic representation of a longitudinal section through the resectoscope made of Figure 7in a different configuration; Figure 9 a schematic representation of a cross-section through the resectoscope from the Figures 7 and 8 Figure 10: a schematic representation of a longitudinal section through part of another resectoscope; Figure 11: a schematic representation of a longitudinal section through the resectoscope made of Figure 10 in another configuration; Figure 12 a schematic representation of a cross-section through the resectoscope from the Figures 10 and 11 . Description of the embodiments

[0047] Figure 1 shows a schematic representation of a longitudinal section through a middle region and through the distal (in Figure 1 The end of a resectoscope 10 (shown on the left) serves as an example of a microinvasive instrument in which an action unit is movable relative to a shaft to treat or manipulate tissue. The distal end of the resectoscope 10 is only partially shown in the section.

[0048] The resectoscope 10 comprises a substantially tubular resectoscope shaft 20 with a distal end 21 and a proximal end 23. The distal end 21 of the resectoscope shaft 20 is formed by a section 22 made of an electrically insulating material. The resectoscope shaft 20 is cup-shaped at its proximal end 23 and has a conical sealing surface 27 on its inner side. Two or more lugs 29 are provided at the extremely proximal edge of the resectoscope shaft 20, projecting radially outward.

[0049] The resectoscope 10 further comprises a working element 30, of which in Figure 1 only the distal end 32 is visible, which is mechanically connected to the proximal end 23 of the resectoscope shaft 20.

[0050] Furthermore, the resectoscope 10 includes an endoscope 40, of which in Figure 1Only one endoscope shaft 42 is visible. The endoscope shaft 42 is predominantly located within the resectoscope shaft 20. The distal end 41 of the endoscope 40 is located in or near the distal end 21 of the resectoscope shaft 20. The distal region of the endoscope shaft 42, unlike the rest of the endoscope shaft 42 and other components of the resectoscope 10, is not shown in the section.

[0051] Furthermore, the resectoscope 10 includes a probe assembly 50, of which in Figure 1 Only a distal end 51 and – partially – a probe shaft 60 are visible. The probe shaft 60 is located predominantly within the resectoscope shaft 20. The probe shaft 60 comprises a cylindrical section 66 that extends over a large part of the length of the resectoscope shaft 20. The distal region of the probe shaft 60, unlike the cylindrical section 66 of the probe shaft 60, is not shown in section.

[0052] In the illustrated example, the distal end 51 of the probe assembly 50 is formed by a loop- or coil-shaped electrode 52 for electrosurgical applications, serving as the active device. The electrode 52 has dimensions that significantly exceed the cross-section of the cylindrical section 66 of the probe shaft 60. Alternatively or additionally, a light-emitting surface of a fiber optic cable, through which intense laser light can exit for cutting, ablating, or cauterizing tissue, can be provided at the distal end 51 of the probe assembly as an active device.

[0053] Furthermore, in the illustrated example, the probe assembly 50 has a guide element 54. The guide element 54 has the form of a clamp that is rigidly connected to the probe shaft 60 and encompasses more than half of the endoscope shaft 42. The guide element 54 is positively guided on the endoscope shaft 42, so that the probe assembly 50 can be moved relative to the endoscope shaft 42 parallel to the longitudinal axis of the endoscope shaft 42, but not, or only to a limited extent, in other directions. This differs from the illustration in Figure 1 The guide device 54 can completely encircle the endoscope shaft 42. The dimensions of the guide device 54 also significantly exceed the cross-section of the cylindrical section 66 of the probe shaft 60.

[0054] The endoscope shaft 42 and the probe shaft 60 extend essentially over the entire length of the resectoscope shaft 20. The cross-section of the resectoscope shaft 20 is designed such that the resectoscope shaft 20 can accommodate the endoscope shaft 42 and the probe shaft 60 and that a rinsing fluid or other fluid can be passed through the resectoscope shaft 20.

[0055] In the distal end 32 of the working element 30, a first opening 34 in the form of a cylindrical passage channel for the endoscope shaft 42 and a second opening 36 in the form of a cylindrical passage channel for the cylindrical section 66 of the probe shaft 60 of the probe assembly 50 are provided. Both openings 34, 36 run parallel to each other and parallel to the longitudinal axis of the resectoscope shaft 20. Furthermore, an annular collar 37 is provided at the distal end 32 of the working element 30.

[0056] At the distal end 32 of the working element 30, a coupling ring 38 with two or more lugs 39 is also provided. The coupling ring 38 is rotated about an axis of rotation in the plane of the drawing. Figure 1 rotatable. The lugs 39 on the coupling ring 38 correspond to the lugs 29 on the proximal end 23 of the resectoscope shaft 20. In the Figure 1 In the configuration shown, the lugs 39 on the coupling ring 38 engage the lugs 29 on the proximal end 23 of the resectoscope shaft 20, so that the proximal end 23 of the resectoscope shaft 20 is positively locked to the distal end 32 of the working element 30. This connection can be released by rotating the coupling ring 38. Thus, a locking connection is formed between the proximal end 23 of the resectoscope shaft 20 and the distal end 32 of the working element 30 by the lugs 29 on the proximal end 23 of the resectoscope shaft 20 and the lugs 39 on the coupling ring 38.

[0057] The sealing device 70 has a conical sealing surface 72, the diameter of which increases distally (in Figure 1 ( : left) decreases, and corresponds to the conical sealing surface 27 at the proximal end 23 of the resectoscope shaft 20. Furthermore, the sealing device has an annular step 73 that corresponds to the annular collar 37 at the distal end 32 of the working element 30. The in Figure 1 The shown engagement of the collar 37 at the distal end 32 of the working element into the step 73 on the sealing device 70 results in a positive locking mechanism that ensures correct positioning of the sealing device 70 relative to the distal end 32 of the working element 30.

[0058] Furthermore, the resectoscope 10 includes a sealing device 70. The sealing device 70 has an endoscope shaft channel 74 for receiving the endoscope shaft 42 and a probe shaft channel 76 for receiving the cylindrical section 66 of the probe shaft 60. The cross-section of the endoscope shaft channel 74 is adapted to the cross-section of the endoscope shaft 42 such that only a small annular gap remains between the inner surface of the endoscope shaft channel 74 and the outer surface of the endoscope shaft 42, and the endoscope shaft 42 is guided in the endoscope shaft channel 74 with minimal play and friction.The cross-section of the probe shaft channel 76 is adapted to the cross-section of the cylindrical section 66 of the probe shaft 60 in such a way that only a narrow annular gap remains between the inner surface of the probe shaft channel 76 of the sealing device 70 and the outer surface of the cylindrical section 66 of the probe shaft 60, and the cylindrical section 66 of the probe shaft 60 is guided in the probe shaft channel 76 with minimal play and friction.

[0059] The sealing device 70 is made of a metal, a ceramic, or another non-elastic material and is not deformed, or only minimally deformed, during its intended use in the resectoscope 10. The low elasticity of the sealing device allows for precise adherence to the intended geometries of the annular gap around the endoscope shaft 42 in the endoscope shaft channel 74 and the intended gap around the cylindrical section 66 of the probe shaft 60 in the probe shaft channel 76. Both annular gaps can therefore be so narrow that only a small amount of fluid can pass through them.

[0060] At the in Figure 1In the illustrated example, an annular groove 84 is additionally provided in the endoscope shaft channel 74, which locally enlarges the cross-section of the endoscope shaft channel. An O-ring 85 made of Teflon, nitrile rubber, silicone rubber, silicone elastomer, or another elastomer or elastic material is arranged in the annular groove 84 in the endoscope shaft channel 74. The O-ring 85 is dimensioned and its elastic properties are selected such that it elastically and fluid-tightly seals the annular gap between the outer surface of the endoscope shaft 42 and the inner surface of the endoscope shaft channel 74.

[0061] At the in Figure 1In the illustrated example, an annular groove 86 is further provided in the probe shaft channel 76, which locally increases the cross-section of the probe shaft channel 76. An O-ring 87 made of Teflon, nitrile rubber, silicone rubber, silicone elastomer, or another elastomer or elastic material is arranged in the annular groove 86 in the probe shaft channel 76. The O-ring 87 is dimensioned and its elastic properties are selected such that the O-ring 87 bears against the outer surface of the cylindrical section 66 of the probe shaft 60 and elastically seals the annular gap between the outer surface of the cylindrical section 66 of the probe shaft 60 and the inner surface of the probe shaft channel 76 in a fluid-tight manner.

[0062] When disassembling the resectoscope 10, the endoscope shaft 42 is moved proximally (into Figure 1(right) from the resectoscope shaft 20, the sealing device 70, and the working element 30. This is possible because the endoscope shaft 42 has a consistently cylindrical shape. In contrast to the endoscope shaft 42, the probe device 50 has a significantly larger cross-section at or near its distal end 51 due to a guide device 54 and / or an action device 52 compared to the cylindrical section 66 of the probe shaft 60. Therefore, removal of the probe shaft 60 proximally is impossible. Unlike a conventional sealing device made of an elastic material, the sealing device 70 remains attached to the probe shaft 60 and thus forms a unit with it that cannot be separated without damage.

[0063] The working element 30 has a feature near its distal end 32 that is Figure 1a non-visible slot extending from an outer circumference of the working element 30 to the second opening 36, allowing the cylindrical section 66 of the probe shaft 60 to be inserted into the working element 30 from the side.

[0064] Figure 2 shows another schematic representation of a longitudinal section through the middle region of the resectoscope 10. Figure 1 The section plane II-II of the Figure 2 corresponds to the cutting plane of the Figure 1 The representation in Figure 2 differs from the representation in Figure 1 by showing a different configuration. The one in Figure 2 The configuration shown is present, for example, when assembling or disassembling the resectoscope 10.

[0065] Starting from the in Figure 1 The configuration shown creates the one in Figure 2The configuration shown is achieved by rotating the coupling ring 38 so that the lugs 39 on the coupling ring 38 are removed from the lugs 29 on the proximal end 23 of the resectoscope shaft 20, and the Renk connection between the proximal end 23 of the resectoscope shaft 20 and the distal end 32 of the working element 30 is separated. Afterwards, the resectoscope shaft 20 and the sealing device 70 can be displaced distally relative to the working element 30, for example, to the points shown in Figure 2 positions shown.

[0066] Starting from the in Figure 2 In the configuration shown, the resectoscope shaft 20 can be withdrawn distally, the endoscope shaft 42 can be pulled out proximally, and then the cylindrical section 66 of the probe shaft 60 can be extended in a movement, for example, orthogonal to the plane of the drawing. Figure 2 through a Figure 2The part is removed from the working element 30 via the non-visible slot. As mentioned, the cylindrical section 66 of the probe shaft 60 remains in the probe shaft channel 76 of the sealing device.

[0067] Figure 3 shows a schematic representation of another section through the resectoscope 10 from the Figures 1 and 2 in the Figure 2 configuration shown. Section plane III-III of the Figure 3 is orthogonal to the cutting plane II-II of the Figure 2 The position of the cutting plane II-II of the Figure 2 is in Figure 3 indicated. The section plane III-III of the Figure 3 is in Figure 2 hinted at.

[0068] The section plane III-III of the Figure 3The sealing device 70 only cuts through, specifically in the area of ​​the annular groove 84 in the endoscope shaft channel 74 and the O-ring 85 in the annular groove 84. The cross-sections of the endoscope shaft 42 and the cylindrical section 66 of the probe shaft 60 are shown in Figure 3 simplified and indicated as homogeneous hatched areas. Figure 3 Furthermore, the lugs 39 on the coupling ring 38 are located at the distal end 32 of the working element 30 (cf. Figures 1, 2 ) visible. The coupling ring has a slot, the function of which is explained by the Figure 9 and 12 becomes clear.

[0069] Unlike conventional sealing devices for resectoscopes, the sealing device 70 has no slot through which the cylindrical section 66 of the probe shaft 60 could be inserted into the sealing device 70 from the side. Therefore, no compression or elastic deformation of the sealing device 70 is required to reliably close such a slot. The sealing device 70 can therefore be made of a metal, a ceramic, or another non-elastic material. On the other hand, if the probe shaft 60 is compressed at its distal end—as in the case of the Figures 1 and 2 described - has an enlarged cross-section, on which the cylindrical section 66 of the probe shaft 60 remains. The probe shaft 60 and the sealing device 70 therefore form a unit that cannot be separated without damage.

[0070] Contrary to the representation in the Figures 1 to 3The sealing device can only have either an annular groove 84 in the endoscope shaft channel 74 and an O-ring 85 in the annular groove 84 or an annular groove 86 in the probe shaft channel 76 and an O-ring 87 in the annular groove 86.

[0071] Figure 4 shows a schematic representation of a longitudinal section through a central region of another resectoscope 10, which in some features, properties and functions resembles the one shown based on the Figures 1 to 3 The resectoscope depicted is similar, especially with regard to the in Figure 4 distal end of the resectoscope not shown 10.

[0072] The cutting plane of the Figure 4 corresponds to the cutting planes of the Figures 1 and 2 The in Figure 4 The configuration shown corresponds to the one in Figure 1 The following are in particular the features, properties and functions of the configuration shown. Figure 4The resectoscope shown is described, which differs from those of the one based on the Figures 1 to 3 differ from the resectoscope shown.

[0073] The in Figure 4 The resectoscope 10 shown differs from the one shown based on the Figures 1 to 3 The resectoscope shown is distinguished in particular by the fact that it includes a guide tube 14 for the endoscope shaft 42.

[0074] The in Figure 4 The resectoscope 10 shown differs from the one shown based on the Figures 1 to 3 The resectoscope shown is further distinguished by the fact that neither the endoscope shaft channel 74 nor the probe shaft channel 76 of the sealing device 70 has annular grooves or O-rings. The sealing effect of the sealing device 70 is thus based solely on the narrow widths of the annular gaps around the cylindrical section 66 of the probe shaft 60 and around the endoscope shaft 42 of the endoscope 40 or around the guide tube 14.

[0075] Figure 5shows a schematic representation of another section through the based on the Figure 4 The resectoscope shown is 10. The sectioning plane VV of the Figure 5 corresponds to the cutting plane of the Figure 4 The in Figure 5 The configuration shown corresponds to the one in Figure 2 configuration shown.

[0076] The guide tube 14 can be rigidly and permanently connected either to the resectoscope shaft 20 or to the sealing device 70 or to the working element 30.

[0077] Figure 6 shows a schematic representation of another section through the based on the Figures 4 and 5 The resectoscope shown is 10. The sectioning plane VI-VI of the Figure 6 is orthogonal to the cutting plane VV of the Figure 5 The position of the cutting plane VI-VI of the Figure 6 is in Figure 5 indicated. The position of the cutting plane VV of the Figure 5 is in Figure 6 hinted at.

[0078] The characteristics of the based on the Figures 1 to 3and the one based on the Figures 4 to 6 The resectoscopes shown are compatible with each other. In particular, this also applies to the one based on the Figures 1 to 3 The resectoscope shown has a guide tube 14, as can be seen from the Figures 4 to 6 As described, the O-ring 85 is provided for in the annular groove 84 in the endoscope shaft channel 74, in particular against the outer surface of the guide tube 14.

[0079] Furthermore, the following can be used in the Figures 1 to 3 The resectoscope shown is similar to the one based on the Figures 4 to 6 The resectoscope shown has the annular groove 84 in the endoscope shaft channel 74 and the O-ring 85 in the annular groove 84 and / or the annular groove 86 in the probe shaft channel 76 and the O-ring 87 in the annular groove 86 omitted.

[0080] Figure 7shows a schematic representation of a longitudinal section through a central region of another resectoscope 10, which in some features, properties and functions resembles the one based on the Figures 1 to 6 The resectoscopes depicted are similar, especially with regard to the in Figure 7 distal end of the resectoscope not shown 10. The sectioning plane of the Figure 7 corresponds to the cutting planes of the Figures 1, 2 , 4 and 5 The in Figure 7 The configuration shown corresponds to the one in the Figure 1 and 4 configurations shown. The following are, in particular, the features, properties, and functions of the configuration shown. Figure 7 described the resectoscope shown, in which these differ from those based on the Figures 1 to 6 The resectoscopes shown differ.

[0081] The in Figure 7 The resectoscope 10 shown differs from those shown based on the Figures 1 to 6The resectoscopes shown are distinguished in particular by the fact that the sealing device 70 is connected to the distal end 32 of the working element 30 by a swivel joint. At the distal end 32 of the working element 30, instead of an annular collar 37, or—in contrast to the example shown here—in addition to this, two or more lugs 88 are provided. A corresponding number of corresponding L-shaped grooves 89 are provided on the sealing device 70. Each L-shaped groove 89 has an axial section parallel to the longitudinal axes of the resectoscope shaft 20, the endoscope shaft 42, and the cylindrical section 66 of the probe shaft, and a section extending circumferentially. In the case of the Figure 7In the configuration shown, the lugs 88 at the distal end 32 of the working element 30 engage in the circumferentially extending sections of the L-shaped grooves 89 on the sealing device 70, thus forming a positive-locking connection between the distal end 32 of the working element 30 and the sealing device 70.

[0082] Figure 8 shows another schematic representation of a section through the based on the Figure 7 The resectoscope shown is 10. The sectioning plane VIII-VIII of the Figure 8 corresponds to the cutting plane of the Figure 7 and the cutting planes of the Figures 1, 2 , 4 and 5 The in Figure 8 The configuration shown corresponds to the one in the Figures 2 and 5 configurations shown.

[0083] At the in Figure 8In the arrangement of the sealing device 70 shown, spatially spaced from the distal end 32 of the working element 30, the L-shaped grooves 89 on the sealing device 70 are visible. The Figure 8 The configuration shown is based on the one in Figure 7 The configuration shown is achieved by first rotating the sealing device 70 relative to the distal end 32 of the working element 30 by a predetermined angle in order to move the lugs 88 at the distal end 32 of the working element 30 into the transition area between the circumferential sections and the axial sections of the L-shaped grooves 89 on the sealing device 70. The sealing device 70 can then be separated axially from the distal end 32 of the working element 30.

[0084] Figure 9 shows another schematic representation of a section through the resectoscope 10 from the Figures 7 and 8 The section plane IX-IX of the Figure 8is orthogonal to the cutting plane VIII-VIII of the Figure 8 and parallel to the cutting planes of the Figures 3 and 6 The position of section plane VIII-VIII of the Figure 8 is in Figure 9 indicated. The position of the cutting plane IX-IX of the Figure 9 is in Figure 8 hinted at.

[0085] In contrast to the section plane III-III of the Figure 3 and the cutting plane VI-VI of the Figure 6 intersects the cutting plane IX-IX of the Figure 9 not the sealing device 70, but the distal end 32 of the working element 30.

[0086] In Figure 9The previously mentioned slot 35 in the working element 30 is visible, which allows the cylindrical section 66 of the probe shaft 60 to be inserted laterally into the second opening 36 in the distal end 32 of the working element 30. The slot 35 extends from the circumference of the distal end 32 of the working element 30 to the second opening 36, which is designed as a through-channel. The cylindrical section 66 of the probe shaft 60 is inserted into or removed from the second opening 36 by a movement parallel to the section plane IX-IX of the Figure 9 The coupling ring 38 can be rotated into a position in which a slot in the coupling ring 38 is in alignment with the slot 35 in the distal end 32 of the working element 30.

[0087] In Figure 9 It is also apparent that, based on the Figures 7 to 9In the resectoscope 10 shown, both the first opening 34 and the second opening 36 in the distal end 32 of the working element 30 are each slightly larger than the cross-sections of the endoscope shaft 42 and the cylindrical section 66 of the probe shaft 60, respectively, so that the sealing device 70 together with the endoscope shaft 42 and the cylindrical section 66 of the probe shaft 60, which are located in the endoscope shaft channel 74 and the probe shaft channel 76 of the sealing device 70 (cf. Figures 7, 8 ) are guided with minimal play, can be rotated relative to the distal end 32 of the working element 30 by a predetermined angle in order to achieve the following based on the Figures 7 and 8 The described locking connection between the sealing device 70 and the distal end 32 of the working element 30 is to be formed or released. The positions of the cross-sections of the endoscope shaft 42 and the probe shaft 66 achievable during this rotational movement are shown in Figure 9 indicated by dashed lines.

[0088] Figure 10 shows a schematic representation of a longitudinal section through another resectoscope 10, which in some features, properties and functions resembles the one based on the Figures 1 to 9 The depicted resectoscopes resemble the one shown. The cutting plane of the Figure 10 corresponds to the cutting planes of the Figures 1, 2 , 4, 5 , 7, 8 The in Figure 10 The configuration shown corresponds to the one in the Figure 1 , 4 , 7 configurations shown. The following are, in particular, the features, properties, and functions of the configuration shown. Figure 10 described the resectoscope shown, in which these differ from those based on the Figures 1 to 9 The resectoscopes shown differ.

[0089] The in Figure 10 The resectoscope shown differs from those shown based on the Figures 1 to 9The resectoscopes shown are distinguished in particular by the fact that recesses 93 with steps 94 are provided at the distal end 32 of the working element 30, into which flexible stiles 97 on the sealing device 70 engage. Locking lugs 98 are arranged at the free ends of the flexible stiles 97 of the sealing device 70, which, when the Figure 10 In the configuration shown, the steps 94 engage in the recesses 93 and thus hold the sealing device 70 in a form-fitting manner at the distal end 32 of the working element 30.

[0090] Figure 11 shows another schematic representation of a section through the based on the Figure 10 The resectoscope shown is 10. The sectioning plane XI-XI of the Figure 11 corresponds to the cutting plane of the Figure 10 and the cutting planes of the Figures 1, 2 , 4, 5 , 7, 8 The in Figure 11 The configuration shown corresponds to the one based on the Figures 2 , 5 , 8 configurations shown.

[0091] Starting from the in Figure 10 The configuration shown requires the movement of the sealing device 70 into the Figure 11The position shown, relative to the distal end 32 of the working element 30, initially causes a deflection of the locking lugs 98 and thus an elastic deformation of the flexible stiles 97 against their elastic restoring forces. Manually pulling the sealing device 70 away from the distal end 32 of the working element 30 therefore requires a predetermined force, which depends on the precise geometry of the steps 94, the locking lugs 98, and the flexible stiles 97, as well as the elastic properties of the material forming the flexible stiles 97.The predetermined force is set in particular such that, on the one hand, when separating the proximal end 23 of the resectoscope shaft 20 from the distal end 32 of the working element 30, it is sufficiently safe to prevent the sealing device 70 from remaining on the proximal end 23 of the resectoscope shaft 20, and on the other hand, the sealing device 70 can subsequently be separated from the distal end 32 of the working element 30 with sufficient ease.

[0092] Figure 12 shows a schematic representation of another section through the based on the Figures 10 and 11 The resectoscope shown is 10. The sectioning plane XII-XII of the Figure 12 is orthogonal to the section plane XI-XI of the Figure 11 and corresponds to the section plane IX-IX of the Figure 9 The position of the cutting plane XII-XII of the Figure 12 is in Figure 11 indicated. The position of the sectioning plane XI-XI of the Figure 11 is in Figure 12 hinted at.

[0093] The recesses 93 at the distal end 32 of the working element 30 are each pocket-shaped with rectangular cross-sections in the example shown. Reference sign

[0094] 10 Resectoscope 14 Guide tube 20 Resectoscope shaft of the resectoscope 10 21 Distal end of the resectoscope shaft 10 22 Section of the resectoscope shaft 10 made of an electrically insulating material at its distal end 21 23 Proximal end of the resectoscope shaft 20 24 Guide tube in the resectoscope shaft 20 for receiving the shaft 40 of the endoscope 40 27 Conical sealing surface at the proximal end 23 of the resectoscope shaft 20 29 Lug at the proximal end 23 of the resectoscope shaft 20 30 Working element of the resectoscope 10 32 Distal end of the working element 30 34 First opening in the distal end 32 of the working element 30 for receiving the endoscope shaft 42 of the endoscope 40 35 Slot in the distal end 32 of the working element 30,from the circumference of the working element 30 to the first opening 34 36 second opening in the distal end 32 of the working element 30 for receiving the cylindrical section 66 of the probe shaft 60 37 collar at the distal end 32 of the working element 30, for centering the sealing device 70 38 coupling ring at the distal end 32 of the working element 30 39 lug on the coupling ring 38 40 endoscope of the resectoscope 10 41 distal end of the endoscope 10 42 endoscope shaft of the endoscope 40 50 probe assembly of the resectoscope 10 51 distal end of the probe assembly 50 52 electrode as the operating device of the probe assembly 50 54 guide device of the probe assembly 50 for guidance on the endoscope shaft 42 60 probe shaft of the probe assembly 50 66 cylindrical section of the probe shaft 60 70 sealing device of the probe device 50 72 conical sealing surface on the sealing device 70 73 circumferential step on the sealing device 70 74 endoscope shaft channel of the sealing device 70,for receiving the endoscope shaft 42 of the endoscope 40 76 Probe shaft channel of the sealing device 70, for receiving the probe shaft 60 84 annular groove in the endoscope shaft channel 74 85 O-ring in the annular groove 84 in the endoscope shaft channel 74 86 annular groove in the probe shaft channel 76 87 O-ring in the annular groove 86 in the probe shaft channel 76 88 lug at the distal end 32 of the working element 30 89 L-shaped groove on the sealing device 70, for receiving the lug 88 at the distal end 32 of the working channel 30 93 recess at the distal end 32 of the working element 30 94 step in the recess 93 97 flexible bar on the sealing device 70 98 locking lug on the flexible Holm 97,

Claims

1. A probe device< / b> (50) for a resectoscope (10) or other microinvasive medical instrument for processing or manipulating tissue, comprising: a probe shaft (60) having a cylindrical section (66) for arrangement in an instrument shaft (20) and a distal end for arrangement near a distal end of the instrument shaft (20); an effecting device (52) at the distal end of the probe shaft (60); a sealing device (70) with a probe shaft channel (76), in which the cylindrical section (66) of the probe shaft (60) is arranged, wherein the probe shaft (60) is displaceable relative to the sealing device (70) parallel to the longitudinal axis of the probe shaft (60) and parallel to the longitudinal axis of the probe shaft channel (76), characterised in that the sealing device (70) is made of metal or ceramic or another non-elastic material and is permanently connected to the probe shaft (60), wherein the non-elastic material has a modulus of elasticity greater than 10 GPa.

2. The probe device (50) according to one of the preceding claims, in which the sealing device (70) has a conical sealing surface (72) which is provided and designed for sealing contact with a corresponding conical sealing surface (27) on an instrument shaft (20).

3. The probe device (50) according to one of the preceding claims, in which the probe shaft channel (76) has an annular extension (86) in which a sealing element (87) is arranged.

4. The probe device (50) according to one of the preceding claims, in which the sealing device (70) has a coupling device (89; 97, 98) for detachable mechanical connection of the sealing device (70) to the distal end (32) of a working element (30) of a resectoscope (10) or another microinvasive instrument.

5. The probe device (50) according to the preceding claim, in which the sealing means (70) comprises an elastic latching device (97, 98) for forming a latched connection with the distal end (32) of the working element (30) of the resectoscope (10) or the other microinvasive instrument.

6. The probe device (50) according to claim 4, in which the coupling device has a groove or other recess for receiving a elastic latching element at the distal end (32) of the working element (30) of the resectoscope (10) or the other microinvasive instrument.

7. The probe device (50) according to claim 4, in which the sealing device (70) comprises a catch or an L-shaped groove (89) for forming a bayonet connection with the distal end (32) of the working element (30) of the resectoscope (10) or the other microinvasive instrument.

8. A microinvasive medical instrument for processing or manipulating tissue< / b> (10) comprising: a probe device (50) according to one of the preceding claims; an instrument shaft (20) having a distal end and a proximal end (23), for receiving the probe shaft (60) of the probe device (50); a working element (30) for detachably connecting to the proximal end (23) of the instrument shaft (20) and for detachably connecting to a proximal end of an endoscope (40) and for detachably connecting to a proximal end of the probe shaft (60) and for manually moving the probe shaft (60) relative to the instrument shaft (20), wherein a space for receiving the sealing device (70) of the probe device (50) is provided between the distal end (32) of the working element (30) and the proximal end (23) of the instrument shaft (20).

9. The microinvasive instrument (10) according to the preceding claim, in which at the proximal end (23) of the instrument shaft (20) is provided a conical sealing surface (27), which at least partially corresponds to a conical sealing surface (72) of a sealing device (70) of a probe device (50) according to one of claims 1 to 7.

10. The microinvasive instrument (10) according to the preceding claim, in which an opening (34, 36) for the probe shaft (60) or for the endoscope shaft (42) is provided at the distal end (32) of the working element (30), the opening (34, 36) for the probe shaft (60) or for the endoscope shaft (42) has a cross-section which allows a movement of the probe shaft (60) or of the endoscope shaft (42) in the opening (34, 36) when the sealing device (70) is rotated relative to the distal end (32) of the working element (30).

11. The microinvasive instrument according to one of the preceding claims, in which the microinvasive instrument is a resectoscope (10).