SIN

Description

[0001] The invention relates to a probe for the electrosurgical treatment of tissue. The probe has a probe body with a movably arranged electrode. The probe can be a monopolar probe with a single electrode or a bipolar probe with multiple electrodes. Using an operating device, the electrode can be extended from or retracted into the probe body. In the extended state, a voltage can be applied to the electrode, particularly for cutting tissue.

[0002] Such probes are familiar from practice. Surgeons need to be able to precisely adjust the length of the distal end section of the electrode, which extends from the probe body. This prevents the electrode from penetrating deeper tissue layers when cutting tissue that should not be cut or damaged during the procedure.

[0003] US 8 814 856 B2 describes a probe with an operating device by means of which an electrode can be extended from a shaft. The movement coupling between the electrode and the operating device is achieved by a reduction gear designed as a lever mechanism.

[0004] US 2019 / 0328451 A1 describes a probe according to the preamble of patent claim 1, which is designed as a combined probe. The probe has two coaxially arranged, tubular elements. A fluid can be conveyed through the inner element and released at the distal end. The outer element can serve, for example, as an electrode. The two elements can be moved separately and individually relative to a common body and relative to each other. An operating device is provided for this purpose. US 2007 / 149968 A1 and US 2015 / 088130 A1 also describe combined probes.

[0005] Therefore, the object of the present invention is to provide a probe that enables improved handling for a surgeon.

[0006] This object is achieved with a probe according to patent claim 1.

[0007] The probe according to the invention is designed for the electrosurgical treatment of tissue. It has a probe body in which an electrode channel extends to a distal end of the probe body. At the proximal end, the probe body is connected to an operating device. The probe body can be designed as a rigid tube and preferably as a flexible hose. A rigid tube is understood to mean a probe body that cannot be bent under the forces typically encountered during use of the probe. In contrast, a flexible hose is understood to mean a probe body that can be bent relative to an original extension direction under the forces typically encountered during the intended use of the probe. A probe with a flexible hose as the probe body can, for example, be guided through an endoscope channel of an endoscope.

[0008] The operating device has a housing. An electrode operating element is arranged on the housing. The electrode operating element is movable, for example, linearly displaceable, between a first position and a second position. Alternatively, the electrode operating element can also be pivoted on the housing between the first position and the second position.

[0009] An electrode is arranged in the electrode channel of the probe body and is mounted for movement along the direction of extension of the electrode channel. The distal end of the electrode can be moved between a fully extended position and a fully retracted position. In the fully extended position, a distal end section adjacent to the distal end of the electrode, which is located outside the electrode channel, is the longest. In the fully retracted position, the distal end of the electrode is located inside the electrode channel.

[0010] The electrode operating element of the operating device is used to retract and extend the electrode. The electrode operating element is preferably coupled to the electrode by means of a reduction gear. The reduction gear is designed to reduce a movement of the electrode operating element into a movement of the electrode that is shorter according to the reduction ratio. This means that an operating path of the electrode operating element is greater than the path covered by the electrode when the electrode operating element is moved along the operating path. In particular, the maximum available operating path between the first position and the second position is greater than the path of the electrode between the fully extended position and the fully retracted position. The reduction ratio of the reduction gear is preferably constant and not position- or path-dependent.

[0011] Thanks to the gear reduction, the surgeon can achieve very precise positioning of the electrode using a long operating travel of the electrode control element. This allows the distal end of the electrode to be positioned easily and precisely, particularly with sub-millimeter accuracy.

[0012] It is advantageous if the reduction gear is a lever gear. In one embodiment, the lever gear can comprise a lever mounted on a pivot bearing point on the housing of the operating device. Preferably, the lever gear has only a single lever. A coupling point at which the electrode operating element is coupled to the lever is farther away from the pivot bearing point than a coupling point at which the lever is coupled to the electrode. In this way, a simply designed lever gear with a reduction ratio is achieved.

[0013] The pivot bearing point can be located at one end of the lever.

[0014] In one embodiment, the coupling point of the electrode with the lever is located between the pivot bearing point and the coupling point at which the electrode operating element engages the lever.

[0015] Instead of a lever gear, other types of gears can also be used, such as an eccentric gear, a gear with a rack and pinion, a gear drive, a belt drive, a friction gear, etc. Combinations of the described gear types are also possible. The reduction gear can have one or more gear stages.

[0016] In a further advantageous embodiment, which can also be implemented independently of the reduction gear, the probe has a locking device. The locking device can define several different positions of the electrode relative to the probe body. In particular, the locking device can define these positions by a respective locking position. The locking positions of the locking device allow defined, predetermined positions of the electrode and, in particular, the distance between the distal end of the electrode and the distal end of the probe body to be precisely adjusted, thus making it easier for the surgeon to position the electrode.

[0017] In one embodiment, the locking device defines a fully extended position of the electrode, a fully retracted position of the electrode, and at least one intermediate position of the electrode between the fully extended position and the fully retracted position.

[0018] In a preferred embodiment, the locking device has a locking element that is movably connected to the electrode operating element and a locking counter-element that is movably connected to the housing of the operating device. Preferably, the locking element is arranged immovably relative to the electrode operating element. Preferably, the locking counter-element is arranged immovably relative to the housing. In each predetermined, defined position of the electrode relative to the probe body, the locking element and the locking counter-element establish a locking position in which a releasable locking connection is established between the locking element and the locking counter-element.

[0019] The locking element can have at least one locking projection and / or at least one locking recess. The locking counter-element can have at least one locking recess and / or at least one locking projection for cooperation with the locking element. For example, a single locking projection can be provided, which engages in a respective associated locking recess in different defined positions of the electrode. Conversely, a single locking recess can be provided, into which one of several locking elements engages in the different defined positions of the electrode. In each locking position - with a releasable locking connection established - several locking projections can also engage in several associated locking recesses.

[0020] In all of the embodiments described, the locking projection can, for example, be mounted for elastic movement, so that the locking projection enables relative movement of the electrode operating element relative to the housing of the operating device from a locking position. For example, an elastically or spring-loaded ball or other body can form a locking projection, which, due to the spring tension, engages in a recess or hole that constitutes a locking recess. The locking projection can be preloaded by a spring or by an elastically deformable element and can be mounted for movement in and against this preload force, for example, by a type of film hinge.

[0021] In a preferred embodiment, the probe has a pretensioning device. The pretensioning device applies a pretensioning force to the electrode relative to the probe body in the direction of extension of the electrode or the electrode channel. The pretensioning device can comprise one or more pretensioning elements, in particular at least one spring and preferably a helical spring. The pretensioning force can eliminate any play in the electrode's movement in the direction of extension.

[0022] It is preferred if the biasing force of the biasing device urges the electrode towards the fully extended position.

[0023] It is also particularly advantageous if the pre-tensioning force has an amount that is greater than the counterforce acting on the electrode when using the probe to cut tissue.

[0024] In a preferred embodiment, the pretensioning device or at least one pretensioning element of the pretensioning device is arranged in the probe body or in the electrode channel and can, for example, be supported on the one hand on the probe body and on the other hand on the electrode. Preferably, the pretensioning device or at least one pretensioning element is arranged distally, in particular either directly behind a distal end piece of the probe body or at a distance of, for example, 10-15 cm from the end piece, i.e., set back proximally, so to speak. Such a distance can prevent the pretensioning device or the at least one pretensioning element from becoming jammed when the probe body or an endoscope is bent in the distal end region.

[0025] Alternatively or additionally, the pretensioning device or at least one pretensioning element of the pretensioning device can be arranged in the housing of the operating device.

[0026] According to the invention, the probe is designed as a combined probe or hybrid probe. In this embodiment, the probe has, in addition to the electrode, a water jet probe body in which a water channel runs to a distal end of the water jet probe body. The water jet probe body extends, for example, essentially parallel to the probe body with the electrode channel. The probe body, which has the electrode channel and can be referred to as the electrode probe body, can be arranged together with the water jet probe body in an outer body, for example an outer tube or an outer hose. Analogous to the probe body, the water jet probe body and / or the outer body can each be designed in the form of a rigid tube or a flexible hose. In one embodiment, the probe body having the electrode channel can also form the outer body, in which a channel for the water jet probe body is provided.

[0027] In such a combined probe or hybrid probe, the water jet probe body is arranged so as to be displaceable along its direction of extension relative to the housing of the operating device and / or an outer body. The operating device is designed to only enable movement of the water jet probe body towards an extended position when the electrode is outside the fully extended position or when the electrode is in the fully retracted position. This can be achieved in that the water jet probe body can only be extended by means of the operating device at the same time as the electrode is retracted, or alternatively can only be extended when the electrode is partially or fully retracted. This aspect of the design of the combined probe orThe hybrid probe can also be used regardless of how the electrode control unit is coupled to the electrode, i.e., regardless of whether a reduction gear is present or not, and regardless of the presence of a locking device.

[0028] In one embodiment, the operating device comprises a water jet probe operating element. The water jet probe operating element is configured to move or displace the water jet probe body relative to the housing in the direction of extension. The water jet probe operating element is arranged on the housing of the operating device and can be formed, for example, by a slider.

[0029] The electrode operating element and the water jet probe operating element can be arranged adjacent to the housing such that the electrode operating element forms a stop for the water jet probe operating element in the first position. In the first position of the electrode operating element, the electrode is, for example, fully extended. In this first position, the water jet probe operating element cannot be moved. The movement of the water jet probe operating element is preferably blocked in one direction by the housing and in the other direction by the electrode operating element arranged in the first position. The extension of the water jet probe body is thus prevented when the electrode is operated.

[0030] In another preferred embodiment, the electrode control element can be configured to move both the electrode and the water jet probe body. In this embodiment, the electrode control element is motion-coupled to both the electrode and the water jet probe body.

[0031] It is advantageous if the electrode operating element is designed to initially cause the electrode to retract when moving from the first position towards the second position. Only after the retraction movement has begun or after the electrode has been reached in its fully retracted position does continued movement of the electrode operating element away from the first position cause the water jet probe body to extend. Thus, in a first movement section immediately following the first position, the electrode operating element can only move the electrode. In a movement range immediately following the second position, the electrode operating element can only cause the water jet probe body to move. The two movement ranges can be spatially spaced, directly adjacent to one another, or partially overlap.

[0032] It is also advantageous if a deflection device is present in the housing, which is designed to couple the water jet probe body to an associated operating element of the operating device in such a way that the directions of movement of the water jet probe body arranged outside the housing and the operating element are opposite to one another. For example, the water jet probe body can be deflected by a deflection device within the housing. Preferably, the deflection device deflects the water jet probe body by approximately 180°, so that it has a U-shaped configuration in the region of the deflection device. As a result of the deflection, the sections of the water jet probe body adjoining the deflection device are moved in opposite directions.This makes it possible to move the water jet probe body arranged outside the housing and, for example, the distal end of the water jet probe body in the opposite direction by moving the proximal end of the water jet probe body in one direction.

[0033] Advantageous embodiments of the invention will become apparent from the dependent claims, the description, and the drawings. Preferred embodiments of the invention are explained below with reference to the accompanying drawings. They show: Figure 1 a schematic, block diagram-like representation of an embodiment of a probe with extended electrode and retracted water jet probe body, Figure 2 a schematic block diagram-like principle representation of an operating device of the probe from Figure 1 with an electrode control element in a first position, Figure 3the operating device Figure 2 , wherein the electrode control element is in a second position, Figure 4 the operating device according to the Figures 2 and 3 in a modified embodiment, wherein the electrode control element is in a first position, Figures 5 to 7 each a schematic diagram of a deflection device for the operation or movement of the water jet probe body of the probe, Figure 8 a schematic diagram of an operating device of a probe with a locking device, Figure 9 a perspective partial view of an embodiment of a housing of an operating device of a probe with a locking device, Figures 10-12 a schematic diagram of a further embodiment of an operating device with an electrode operating element, which is designed to move the electrode and the water jet probe body in different positions, Figure 13a schematic diagram of a coupling device of the operating device according to the Figures 10-12 , Figure 14 a schematic diagram of a coupling body connected to the proximal end of the electrode, Figure 15 a distal end portion of the electrode and the probe body in a fully extended position of the electrode with a pretensioning device arranged in the probe body, Figure 16 the arrangement of Figure 15 with the electrode fully retracted, Figure 17 a modified embodiment of the probe body, wherein the pretensioning device is arranged further away from the distal end of the probe body, Figure 18 a schematic representation of the principle of a stop for the distal end of the electrode in an end piece of the probe body, for example having a recess into which the distal end of the electrode can at least partially engage, Figure 19a schematic diagram of an embodiment of an operating device in side view, wherein the water jet probe can be moved, for example, via a pressure element, Figure 20 another embodiment of an operating device in a partially sectioned, perspective view and Figure 21 an embodiment of a rotating mechanism of an operating device.

[0034] In Figure 1 1 schematically illustrates a probe 10 used in combination with an endoscope 11. The probe 10 is designed as a combined probe or hybrid probe and comprises a probe body 12 having a distal end 13 and a proximal end 14. An electrode channel 15 ( Figures 15-17 ), in which an electrode 16 is arranged displaceably in an extension direction R of the electrode channel 15. The electrode 16 can be moved up to a fully extended position A ( Figures 1 , 15, 17, 18) can be moved out of the probe body 12, wherein in the fully extended position A a distal end 17 of the electrode 16 has the greatest distance to the distal end 13 of the probe body 12. In a fully retracted position E ( Figure 16 ), the electrode 16 is preferably located within the probe body 12, and the distal end 17 of the electrode 16 is arranged in the region of the distal end 13 of the probe body 12. In a modified embodiment, the distal end 17 could also protrude slightly from the electrode channel 15 or the probe body 12 when the electrode 16 is in the fully retracted position E.

[0035] The probe body 12 can be designed as a rigid tube or, as in the exemplary embodiment, as a flexible hose. When designed as a flexible hose, the probe body 12 is flexible and bendable under the forces typically encountered during use and can be used in particular in combination with an endoscope 11, as shown in Figure 1 is shown.

[0036] At the proximal end 14, the probe body 12 is connected to an operating device 20. The operating device 20 has a housing 21. For example, the probe body 12 can be attached to the housing 21 and open to an interior region of the housing 21. The electrode 16 can be guided out of the electrode channel 15 or the probe body 12 in the interior region of the housing 21 with a proximal end section 22.

[0037] An electrode control element is arranged on the housing 21 in a movable and, for example, displaceable manner. In the exemplary embodiment, the electrode control element 23 has two engagement openings 24, allowing it to be grasped with two fingers and, in the exemplary embodiment, displaced along the housing 21.

[0038] To move the electrode 16 between the fully extended position A and the fully retracted position E, the electrode control element 23 can be moved between a first position I ( Figures 2 and 4 ) and a second position II. The electrode control element 23 is motion-coupled to the electrode 16. In the first position I, the electrode 16 is in the fully extended position A, and in the second position II, the electrode 16 is in the fully retracted position E.

[0039] In a preferred embodiment of the probe 10 or the operating device 20, the electrode operating element 23 is coupled in motion to the electrode 16 by means of a reduction gear 25. The reduction gear 25 is designed such that a traveled operating path b of the electrode operating element 23 is greater than a path s traveled by the electrode 16 in the extension direction R. Figure 3 The maximum available operating path b between the first position I and the second position II and the path s covered by the electrode 16 are schematically illustrated.

[0040] It should be noted at this point that the drawings are only schematic representations and are not to scale. In particular, the reduction ratio via the reduction gear 25 may have a different reduction ratio than that shown schematically in Figure 3symbolized by the operating path b and the path s.

[0041] In the preferred embodiment, the reduction gear 25 is designed as a lever gear 26, in particular as a single-arm lever gear 26. The lever gear 26 has one, and preferably exactly one, lever 27, which is pivotably mounted on the housing 21 at a pivot bearing point 28. The pivot axis is oriented perpendicular to the direction of movement of the electrode operating element 23.

[0042] A first groove 29 and a second groove 30 are provided in the lever 27 at a distance from the pivot bearing point 28. A first sliding block 31 projects into the first groove 29 and is arranged immovably relative to the electrode operating element 23 on the electrode operating element 23. A second sliding block 32 projects into the second groove 30 and is arranged immovably relative to the proximal end section 22 of the electrode 16 on the proximal end section 22. The two grooves 29, 30 extend parallel to one another and, for example, each in a straight line and preferably along a common straight line that can run through the pivot bearing point 28. The second groove 30 is located, for example, between the first groove 29 and the pivot bearing point 28. The second sliding block 32 is displaceable along the second groove 30 and the first sliding block 31 is arranged displaceably along the first groove 29.

[0043] As an alternative to this design with two separate grooves 29, 30, a common groove for the T-nuts 31, 32 could also be provided. Thus, at least one groove is present.

[0044] When the electrode operating element is moved along an operating path b between the first position I and the second position II, the lever 27 is pivoted about the pivot bearing point 28. The position of the first sliding block 31 in the first groove 29 corresponds to a coupling point between the electrode operating element 23 and the reduction gear 25 or the lever gear 26. The position of the second sliding block 32 in the second groove 30 corresponds to a coupling point between the electrode 16 or the proximal end section 22 and the reduction gear 25 or lever gear 26. Since this latter coupling point is arranged closer to the pivot bearing point 28, a reduction is effected by the lever gear 26, whereby the following applies: the operating path b is greater than the path s.

[0045] Preferably, the pivot bearing point 28 is located at one end of the lever 27, as illustrated in the drawings. Alternatively, the pivot bearing point 28 could also be arranged between the first groove 29 and the second groove 30, with the distance from the sliding blocks 31, 32 being selected such that the operating movement is converted into the displacement movement of the electrode 16.

[0046] The sliding blocks 31, 32 can be formed by pins of the other projections. The lever 27 can also be coupled to the electrode 16 and the electrode operating element 23 in another way that allows movement of the coupling points along the lever 27 when it is pivoted, for example, a coupling with a lever as shown schematically in Figure 20 is shown.

[0047] Instead of the preferred lever gear 26, other reduction gears 25 may also be used, for example, rack and pinion gears, gear drives, spur gear drives, friction gear drives, belt drives, and the like. The lever gear 26 illustrated here is preferred due to its simple design.

[0048] In the Figures 8 and 91 schematically illustrates an embodiment of the operating device 20 with a locking device 35. The locking device 35 is configured to specify defined positions of the electrode 16 relative to the probe body 12 through several different locking positions. Due to the movement coupling of the electrode operating element 23 to the electrode 16 via the reduction gear 25, the locking device 35 can act either directly between the proximal end section 22 of the electrode 16 and the housing 21 or, as in the exemplary embodiment, between the electrode operating element 23 and the housing 21. Alternatively, the locking device 35 could also cooperate with any component of the reduction gear 25 on the one hand and the housing 21 on the other.

[0049] In the exemplary embodiment, the locking device 35 has a locking element 36, which is arranged immovably on the electrode operating element 23 relative to the electrode operating element 23. The locking element 36 cooperates with a locking counter-element 37 to specify different locking positions corresponding to the defined positions of the electrode 16. The locking counter-element is arranged immovably on the housing 21 relative to the housing 21, for example.

[0050] In the exemplary embodiment, the locking element 36 has at least one locking projection 38 and the locking counter-element 37 has at least one locking recess 39. Conversely, the locking element 36 could also have at least one locking recess 39 and the locking counter-element 37 could have at least one locking projection 38.

[0051] In the embodiment illustrated here, the locking element 36 is formed by a single locking projection 38. The locking projection 38 has a locking body 40, for example a locking ball, and an elastic bearing 41 for the locking body 40. A spring, in particular a helical spring, can be used as the elastic bearing 41, which is supported on the one hand on the electrode operating element 23 and on the other hand carries the locking body 40 or the locking ball. The elastic bearing 41 enables the locking body 40 to engage in a locking recess 39 under an elastic preload force and, upon a relative movement between the locking element 36 and the locking counter-element 37, to be moved out of the locking recess 39 against the elastic force of the elastic bearing 41. As a result, the locking positions are releasable, and a relative movement of the electrode operating element 23 relative to the housing 21 is not excessively hindered or blocked by the locking device 35.For this purpose, the shape and depth of the recesses 39 can be selected accordingly.

[0052] In the embodiment of the locking device 35 shown here, one locking position defines the fully extended position A of the electrode 16, while another locking position indicates the fully retracted position E of the electrode 16. Between these two locking positions, at least one further locking position is defined, each of which indicates an intermediate position of the electrode 16 between the fully extended position A and the fully retracted position E. For example, three, four, or more locking positions can be defined by the locking device 35 and thus a corresponding number of positions of the electrode 16.

[0053] The locking device 35 provides a surgeon with haptic feedback during the handling of the probe 10, indicating how far the distal end 17 of the electrode 16 has extended from the probe body 12. This information is important to the surgeon, at least in some surgical applications. Additionally or alternatively, one or more markings may be provided, for example, on the housing 21, which indicate the position of the control element 23 to the surgeon and thus indicate how far the distal end 17 of the electrode 16 protrudes from the probe body 12.

[0054] As shown schematically in Figure 1As illustrated, the probe 10 is configured using the electrode 16 for the electrosurgical treatment of tissue 44 and, in particular, is intended to penetrate the tissue 44 only far enough to severe a defined, outer tissue layer 45 by means of the electrode 16. The electrode 16 serves as a cutting instrument. The distal end 17 of the electrode 16 is not visible to the surgeon and is located within the tissue 44. Therefore, it is important and advantageous for the surgeon to know the distance between the distal end 17 of the electrode 16 and the distal end 13 of the probe body 12. The defined locking positions are helpful here.

[0055] As it is in Figure 9 As is illustrated schematically, the locking counter-element 37 can, for example, be a strip-shaped element with holes of a defined size, each of which forms a locking recess 39.

[0056] In one embodiment of the probe 10, a prestressing device 48 with at least one prestressing element 49 may be provided in order to exert a prestressing force F in the extension direction R on the electrode 16 ( Figures 15-18 ). The at least one prestressing element 49 can be, for example, a spring, in particular a helical spring. In the Figures 15-17In the illustrated embodiments, the at least one prestressing element 49 is arranged within the electrode channel 15 in the probe body 12. In these embodiments, the at least one prestressing element 49 exerts a force F on the electrode 16, which urges the electrode 16 into the fully extended position A. For this purpose, the at least one prestressing element 49 and, for example, the helical spring are supported on the one hand on a first support part 50 and on the other hand on a second support part 51. The first support part 50 is arranged immovably on the electrode 16 with respect to the electrode 16 and can, for example, be formed by a flange, annular body, or the like. The second support part 51 is arranged immovably on the probe body 12 relative to the probe body 12 and can, for example, be a hollow cylindrical body which provides an internal through-channel for the electrode 16 and is arranged in the electrode channel 15 of the probe body 12.The at least one prestressing element 49 can thus extend between the two support parts 50, 51 and cause a prestressing force F between the probe body 12 and the electrode 16.

[0057] As it is in the Figures 15 and 16 As shown, the at least one prestressing element 49 can be arranged directly adjacent to an end piece 52 of the probe body 12. The end piece 52 can, for example, be a ceramic end piece that protects the probe body 12 against sparking and light formation when a voltage is applied to the electrode 16. In the fully extended position A of the electrode 16, the first support part 50 can bear against an inner end of the end piece 52. However, such a bearing is not absolutely necessary, as can also be seen from the example in Figure 17 is illustrated.

[0058] In the Figures 15 and 16In the embodiment shown, the at least one prestressing element 49 is positioned directly adjacent to the end piece 52, preferably in a region with a length of 10 mm to 20 mm adjacent to the end piece 52 within the electrode channel 15. In the embodiment shown in Figure 17 In the embodiment shown, the at least one prestressing element 49 is arranged at a distance from the end piece 52 or the distal end 13 of the probe body, which is greater than in the embodiment according to the Figures 15 and 16For example, the at least one prestressing element 49 can be spaced 10-15 cm from the end piece 52 or the distal end 13 of the probe body 12. In principle, the at least one prestressing element 49 can be arranged at any location within the probe body 12, with regions near the proximal end 14 or the distal end 13 being suitable for arranging the at least one prestressing element 49 or the second support part 51 as simply as possible within the probe body 12.

[0059] In a modification of the previously illustrated embodiments according to the Figures 15-17 , the pretensioning device 48 or the at least one pretensioning element 49 can also be arranged outside the probe body 12, and in particular in the housing 21, as is only shown schematically by way of example in Figure 19is illustrated. The second support part 51, on which the at least one prestressing element 49 is supported, is immovably connected to the housing 21 relative to the housing 21 in this arrangement.

[0060] In a modification of the previously presented embodiments, the pre-tensioning device 48 can also cause a pre-tensioning force F on the electrode 16, which urges the electrode 16 in the direction of its fully retracted position E, which can be exemplified in Figure 18 In this embodiment, the at least one biasing element 49 can urge (pull or push) the distal end 17 of the electrode 16 toward the distal end 13 of the probe body 12. Springs or coil springs and arrangements can also be used here, analogous to the illustration of the Figures 15-17 or 19, wherein, for example, the second support part 51 is arranged on the side of the first support part 50 that is closer to the distal end 17 of the electrode 16. Alternatively, the at least one biasing element 49 could also be attached to the support parts 50, 51 and cause a tensile force by urging the two support parts 50, 51 toward each other and not away from each other as in the previously described embodiments.

[0061] The probe 10 according to the invention is a combined probe or hybrid probe which, in addition to the electrode 16 for electrosurgical treatment, has a water jet probe body 60 extending from a proximal end 61 to a distal end 62. In the exemplary embodiment, the water jet probe body 60 and the electrode 16 can also be arranged in a common outer body 63, which can be formed, for example, by the probe body 12 and provides a lumen or channel for both the water jet probe body 60 and the electrode 16.

[0062] The water jet probe body 60 has a water channel extending to the distal end 62. The water channel can be fluidically connected, for example, via a supply line 64 to a water reservoir or a pressurized water source. A water jet can be ejected at the distal end 62 of the water jet probe body 60. This water jet can be used, for example, to inject an outer tissue layer 45, so that a fluid cushion 65 forms beneath the outer tissue layer 45. This fluid cushion separates the outer tissue layer 45 from deeper tissue layers of the tissue 44 and simplifies the excision of an area, particularly a pathologically altered area of ​​the outer tissue layer 45 (Figure 1).

[0063] The water jet probe body is arranged displaceably relative to the housing 21 in its extension direction R by means of the operating device 20. Analogously to the electrode 16, the position of the distal end 62 of the water jet probe body 60 can be changed in the extension direction R. In the exemplary embodiment, the extension direction R of the electrode 16 and the extension direction R of the water jet probe body 60 are substantially parallel, at least in the section adjoining the respective distal ends 17 and 62, respectively.

[0064] In one aspect of the invention, which can be implemented independently of other aspects, the operating device 20 is configured to enable the movement of the water jet probe body 60 in the extension direction R to the extended position or position only when the electrode 16 is not in the fully extended position A or, preferably, when the electrode 16 is in the fully retracted position E.

[0065] In the Figures 2 and 3 In the illustrated embodiment, the operating device 20 for displacing the water jet probe body 60 has a water jet probe operating element 66. The water jet probe operating element 66 is arranged adjacent to the electrode operating element 23. The water jet probe operating element 66 is in a starting position III when the water jet probe body 60 has reached its retracted position ( Figure 1). The initial position III of the water jet probe control element 66 is in the Figures 2 and 3 illustrated.

[0066] In the exemplary embodiment, the water jet probe operating element 66 is mounted on the housing 21 so as to be linearly displaceable in a direction parallel to the direction of displacement of the electrode operating element 23. If the electrode operating element 23 is in its first position I, it forms a stop for the water jet probe operating element 66 in its initial position III. If the electrode 16 is thus in its fully extended position A, the water jet probe operating element 66 cannot be moved out of the initial position III. This situation is in Figure 2 shown.

[0067] Only when the electrode operating element 23 has been moved away from the first position I, for example into the second position II, is the water jet probe operating element 66 given room to move in order to move it out of the starting position III and thus to bring the water jet probe body 60 from the retracted position into an extended position ( Figure 3 ). Thus, the Figures 2 and 3 illustrated embodiment of the operating device 20, the water jet probe body 60 can be extended simultaneously with the retraction of the electrode 16 or after the retraction of the electrode 16.

[0068] The terms "retract" and "extend" in the application refer to the probe body 12 (with respect to the electrode 16) and the common outer body 63 or the housing 21 with respect to the water jet probe body 60.

[0069] In an alternative embodiment not according to the invention, which is shown in Figure 4As shown, the water jet probe operating element 66 in the starting position III is at a sufficient distance from the electrode operating element 23 in the first position I, so that the water jet probe body 60 in this embodiment can be moved independently of the position of the electrode operating element 23 in order to extend and retract the water jet probe body 60.

[0070] Based on the illustrations in the Figures 5-7 Different possibilities for implementing a deflection device 69 are illustrated. The deflection device 69 arranged in the housing 21 is designed to couple the water jet probe body 60 to an associated operating element of the operating device 20 in such a way that the directions of movement of the water jet probe body 60 arranged outside the housing 21 and the operating element are opposite.

[0071] In the embodiments according to the Figures 5 and 6The deflection device 69 is configured to deflect or bend a proximal end portion 70 of the water jet probe body 60, which is arranged within the housing 21, by approximately 180°. For this purpose, the deflection device 69 may, for example, comprise an inner deflection body 71 curved with an inner radius and an outer deflection body 72 curved with an outer radius, between which the proximal end portion 70 of the water jet probe body 60 extends in a curved manner ( Figure 5 ). Alternatively, the deflection device 69 may, for example, comprise a curved deflection tube 73 through which the proximal end section 70 extends ( Figure 6 ).

[0072] At the proximal end 61, which is located within the housing 21, the water jet probe body 60 is motion-coupled to the water jet probe operating element 66 and, for example, is immovably or firmly connected. A movement of the water jet probe operating element 66 thus leads to a displacement of the water jet probe body 60. The regions of the proximal end section 70 extending adjacent to the deflection device 69 move in opposite directions. Thus, for example, moving the water jet probe operating element 66 out of the starting position III can cause an extension movement of the water jet probe body 60, and conversely, moving the water jet probe operating element 66 back toward the starting position III can cause a retraction movement of the water jet probe body 60.

[0073] Such an opposite movement can also be effected by another type of deflection device 69, as shown for example in Figure 7is illustrated. There, the deflection device 69 has a two-armed lever 74, which is pivotally mounted on the housing 21 at the connection point of its two arms and is supported with one arm on the water jet probe operating element 66 and with the other arm on the proximal end section 70 of the water jet probe body 60. The two-armed lever 74 or the water jet probe operating element 66 can be preloaded into the starting position III by a spring or another elastic or spring-elastic unit 77. The connection of the two-armed lever 74 to the water jet probe body 60 is made via a third groove 75 in the two-armed lever 74, into which a third sliding block 76 engages, which is arranged immovably or fixedly on the water jet probe body 60 or its proximal end section 70.A counter-rotating movement can also be achieved with the aid of this two-armed lever 74, so that a movement of the water jet probe operating element 66 out of the starting position III causes an extension movement of the water jet probe body 60 and conversely a movement back to the starting position III causes a retraction movement of the water jet probe body 60.

[0074] The transmission ratio of the deflection device 69 according to Figure 7 between the movement of the water jet probe operating element 66 and the movement of the water jet probe body 60 can be equal to 1 and alternatively can be selected to be less than 1 or greater than 1. For example, the transmission ratio can be selected by the length of the two arms of the two-armed lever 74.

[0075] When designing the deflection device 69 according to Figure 7An embodiment of the operating device 20 can also be realized in which a separate water jet probe operating element 66 can be dispensed with. A single operating element, for example, the electrode operating element 23, can be configured both to move the electrode 16 and to move the water jet probe body 60.

[0076] In the Figures 10-12 In the illustrated embodiment, a coupling device 80 is provided, by means of which the movement coupling between the electrode operating element 23 and the electrode 16 can be established and separated. The coupling device 80 can be configured for manual operation. In a coupling position C, a movement coupling exists between the electrode 16 and the electrode operating element 23 ( Figure 10 ) and in a decoupling position D the movement coupling between the electrode control element 23 and the electrode 16 is cancelled ( Figures 11 and12 ). In the coupling position C, for example, a force-locking and / or form-locking connection can be established between an actuatable coupling part 81 and a coupling body 82 that is immovably or firmly connected to the electrode 16, while this force-locking and / or form-locking connection is canceled in the decoupling position D, for example by a changed position of the coupling part 81. The coupling part 81 can be urged into the coupling position C via an elastic or spring-elastic element 83. The spring-elastic element 83 can be a helical spring, for example, which is supported on the one hand on the coupling part 81 and on the other hand on the electrode operating element 23.

[0077] By means of the electrode control element 23, the electrode 16 can first be moved from the extended position A toward the retracted position E by moving the electrode control element 23 from the first position I toward the second position II (Figure 10). During this movement, the electrode 16 is retracted. Preferably, the electrode 16 has reached its fully retracted position E before the electrode control element 23 comes into contact with the deflection device 69 and, for example, the two-armed lever 74. The electrode control element 23 can thus assume the second position II before it causes an extension movement of the water jet probe body 60 via the deflection device 69.Since the electrode 16 is already fully retracted, the coupling device 80 is switched to the decoupling position D in the second position II of the electrode operating element 23, so that a further movement of the electrode operating element 23 is possible. During this continued movement from the first position I beyond the second position II, the electrode operating element 23 comes into contact with the deflection device 69 and, for example, the two-armed lever 74, thereby causing an extension movement of the water jet probe body 60 (Fig. Figure 12 ).

[0078] The retraction movement of the water jet probe body 60 and the extension movement of the electrode 16 occur in the reverse order. In the exemplary embodiment, the water jet probe body 60 is urged into the retracted position by the elastic or spring-elastic unit 77 of the deflection device 69 and assumes this position as soon as the electrode operating element 23 is no longer in contact with the deflection device 69 or has reached the second position II ( Figure 11 ). Subsequently, the movement coupling between the electrode 16 and the electrode control element 23 can be re-established via the coupling device 80, so that an extension of the electrode 16 is possible upon further movement from the second position II to the first position I.

[0079] In the Figures 13 and 14, an embodiment of the coupling device 80 or the coupling body 82 is illustrated, in which a positive connection can be established between the coupling part 81 and the coupling body 82. For this purpose, the coupling part 81 has a through-opening with a first region 84 and a second region 85. The dimensions of the first region 84 are so large that no force-fitting or positive connection occurs between the coupling body 82 and the coupling part 81. The second region 85 is narrower than the first region 84 and can engage between two ribs 86 or extended sections of the coupling body 82 and thus establish a positive connection between the coupling part 81 and the coupling body 82 between two adjacent ribs 86 when the coupling device 80 is in the coupling position C.

[0080] In the Figure 13In the cross section shown, the coupling body 82 is located in the first region 84 of the opening, so that the coupling device 80 assumes the decoupling position D. By moving the coupling part 81, the second region 85 can be brought to the level of the coupling body 82 for switching to the coupling position C (in Fig. 13 upwards) to achieve a positive and / or non-positive coupling.

[0081] In Figure 19 An embodiment of the operating device 20 is illustrated in which the water jet probe operating element 66 is coupled in motion to the water jet probe body 60 via a deflection device 69. The deflection device 69 can be configured according to the embodiment according to Figure 7 The electrode operating element 23 is connected via a reduction gear 25 and, for example, a lever gear according to the Figures 2-4 coupled to the electrode 16.

[0082] In Figure 20A further embodiment of the operating device 20 is illustrated, in which the electrode operating element 23 is configured to move both the electrode 16 and the water jet probe body 60. To supply an electrical voltage or an electrical current, a contact spring 90 is located at the proximal end portion 22 of the electrode 16, which can be electrically connected to a voltage and / or current source via an electrical line 91. Such contacting can also be used in all other embodiments of the probe 10.

[0083] In this embodiment, the electrode operating element 23 is coupled for movement to the proximal end section 22 of the electrode 16 via an elastic or spring-elastic connecting element 92. For this purpose, the electrode operating element 23 rests against the connecting element 92, for example, by means of a transverse part 88 projecting into the housing 21. The connecting element 92 is supported on the opposite side by a stop part 89 immovably connected to the proximal end section 22 of the electrode 16. The connecting element 92 can be formed by a helical spring or the like.

[0084] The deflection device 69 is also provided inside the housing 21 to convert the movement of the electrode operating element 23 into a movement of the water jet probe body 60. The deflection device 69 and the operation of the water jet probe body 60 by means of the electrode operating element 23 corresponds to the embodiment according to the Figures 10-12, so that reference can be made to the above explanation. Also in the embodiment according to Figure 20 the electrode 16 is first retracted before an extension movement of the water jet probe body 60 takes place or vice versa.

[0085] Instead of the third groove 75 and the third sliding block 76, the lever 74 in the embodiment according to Figure 20 a slot through which the proximal end portion 70 of the water jet probe body 60 passes. Adjacent to the slot, a stop body 93 is immovably connected to the proximal end portion 70 relative to the proximal end portion 70, the dimensions of the stop body 93 being larger than those of the slot in the two-armed lever 74. In this embodiment, too, the two-armed lever 74 can cause a movement of the water jet probe body 60 via the stop body 93.

[0086] Instead of the coupling device 80, in the embodiment according to Figure 20 the elastically deformable connecting element 92 is present. As soon as the electrode operating element 23 has reached the second position II, in which the electrode 16 is fully retracted, the connecting element 92 is elastically deformed and thereby enables further movement of the electrode operating element 23 in order to carry out the movement of the water jet probe body 60 through contact with the deflection device 69. The electrode 16 can, for example, bear against a part of the housing 21 or the probe body 12 - for example, the stop part 89 can be on the counter-stop 94 and / or an extended distal end 17 can be on an end piece 52 ( Figure 18) - stops the further retraction movement of the electrode 16 and a continued movement of the electrode operating element 23 leads to the elastic deformation of the connecting element 92. In the movement range between the first position I and the second position II of the electrode operating element 23, the water jet probe body 60 remains in the retracted position and only the electrode 16 is retracted or extended.

[0087] Optionally, and depending on the design of the electrode 16, an adjustable counter-stop 94 for the stop part 89 may be provided. The second position II can be defined by means of the position of the counter-stop 94. As soon as the electrode 16 rests against a stop - for example, the stop part 89 against the counter-stop 94 and / or an extended distal end 17 against an end piece 52 ( Figure 18) - stops any further retraction movement of the electrode 16 and continued movement of the electrode operating element 23 leads to elastic deformation of the connecting element 92. To adjust the position of the counter-stop 94, for example, a rotatable adjustment screw 95 may be provided which is coupled to the counter-stop 94 via a threaded connection and, upon rotation, varies the position of the counter-stop 94 parallel to the direction of movement of the electrode operating element 23.

[0088] In Figure 211 illustrates a further optional design option for the operating device 20, which additionally includes a rotating mechanism 99 for rotating an electrode 16 about its own longitudinal axis or extension axis, for example, when the distal end 17 of the electrode 16 is not rotationally symmetrical. The rotating mechanism 99 can comprise a preferably non-circular rotating part 100, for example a tube with a non-circular internal cross-section, which can be rotated about a rotation axis X, and a preferably non-circular telescopic part 101, for example an insertion part. The rotating part 100 and the telescopic part 101 are telescopically displaceable and are connected to one another in a rotationally fixed manner. For example, the telescopic part 101 (insertion part) can be inserted into the non-circular rotating part 100, wherein the cross section of the telescopic part 101 can substantially correspond to the internal cross section of the tubular rotating part 100.When the tubular rotating part 100 rotates about the rotation axis X, the telescopic part 101 also rotates about the rotation axis X. The telescopic part 101 is in turn connected in a rotationally fixed manner to the electrode 16 or the proximal end section 22.

[0089] The rotating part 100 and / or the telescopic part 101 can be arranged telescopically parallel to the rotation axis X or displaceably along the rotation axis X in order to be able to extend and retract the electrode 16. The rotating part 100 can be connected to an externally accessible control element on the housing 21 in a rotationally fixed or drive-connected manner.

[0090] The invention relates to the probe 10 designed as a combined probe or hybrid probe and having a water jet probe body 60 which runs essentially parallel to the probe body 12 and is movable or displaceable in the extension direction R by means of the operating device 20. The operating device 20 can be designed such that an extension movement of the water jet probe body is only possible when the electrode 16 is retracted or is already in the fully retracted position E. An advantageous aspect relates to a probe 10 for the electrosurgical treatment of tissue 44. In a probe body 12, an electrode 16 is movably arranged in an extension direction R of an electrode channel 15. The probe body 12 is connected at the proximal end 14 to an operating device 20. This has an electrode operating element 23 for displacing the electrode 16 along the electrode channel 15.The movement coupling between the electrode operating element 23 and the electrode 16 is effected via a reduction gear 25, for example a lever gear 26. In a further advantageous aspect, a locking device 35 is provided which defines the two, three or more releasable locking positions, each of which corresponds to a predetermined position of the electrode 16 relative to the probe body 12. List of reference symbols:

[0091] 10Probe 11Endoscope 12Probe body 13Distal end of the probe body 14Proximal end of the probe body 15Electrode channel 16Electrode 17Distal end of the electrode 20Operating device 21Housing 22Proximal end section of the electrode 23Electrode operating element 24Engagement opening 25Reduction gear 26Lever gear 27Lever 28Pivot bearing point 29First groove 30Second groove 31First sliding block 32Second sliding block 35Locking device 36Locking element 37Locking counter element 38Locking projection 39Locking recess 40Locking body 41Elastic bearing 44Fabric 45Outer fabric layer 48Pre-tensioning device 49Pre-tensioning element 50First support part 51Second support part 52End piece 60Waterjet probe body 61Proximal end of the waterjet probe body 62Distal end of the waterjet probe body 63Outer body 64Supply line 65Fluid cushion 66Waterjet probe control element 69Deflection device 70Proximal end section of the water jet probe body 71Inner deflection body 72Outer deflection body 73Deflection tube 74Two-armed lever 75Third groove 76Third sliding block 77Elastic or spring-elastic unit 80Coupling device 81Coupling part 82Coupling body 83Elastic or spring-elastic element 84First area of ​​the through-opening 85Second area of ​​the through-opening 86Rib 88Cross section 89Stop part 90Contact spring 91Electrical cable 92Connecting element 93Stop body 94Adjustable counter stop 95Adjusting screw 99Rotating mechanism 100Rotating part 101Telescopic part First position II Second position III Starting position Afully extended position bOperating travel CCoupling position DEuncoupling position Efully retracted position FPreload force RExtension direction sTravel XAxis of rotation

Claims

1. A probe (10) for electrosurgical treatment of tissue (44), comprising: a probe body (12) in which an electrode channel (15) extends up to a distal end (13) of the probe body (12), an operating device (20) comprising a housing (21), wherein the operating device (20) is connected to a proximal end (14) of the probe body (12) and comprises an electrode operating element (23) on the housing (21), which is movable between a first position (I) and a second position (II), an electrode (16) which is arranged to be shiftable in the electrode channel (15) in an extension direction (R) of the electrode channel (15), movably coupled to the electrode operating element (23), a water jet probe body (60) in which a water channel extends up to a distal end (62) of the water jet probe body (60), wherein the water jet probe body (60) is shiftable in its extension direction (R) relative to the housing (21) of the operating device (20), characterized in that the operating device (20) is configured to allow a movement of the water jet probe body (60) in the direction of an extended position only when the electrode (16) is outside of the fully extended position (A) or when the electrode (16) is in a fully retracted position (E).

2. The probe according to claim 1, characterized in that the electrode (16) is movably coupled to the electrode operating element (23) by means of a reduction gear (25), so that a travelled operating path (b) of the electrode operating element (23) is larger than the path (s) that the electrode (16) thereby travels in the electrode channel (15).

3. The probe according to claim 2, characterized in that the reduction gear (25) is a lever gear (26) and that the lever gear (26) comprises a lever (27) that is pivotably mounted on the housing (21) of the operating device (20) at a pivot location, wherein a coupling location between the lever (27) and the electrode operating element (23) is further away from the pivot location (28) than a coupling location between the lever (27) and the electrode (16).

4. The probe according to anyone of the preceding claims, characterized in that a latch device (35) is provided which defines different positions of the electrode (16) relative to the probe body (12) by means of a respective latch position.

5. The probe according to claim 4, characterized in that the latch device (35) defines a fully extended position (A) of the electrode (16), a fully retracted position (E) of the electrode (16) and at least one intermediate position of the electrode (16) between the fully extended position (A) and the fully retracted position (E).

6. The probe according to claim 4 or 5, characterized in that the latch device (35) comprises a latch element (36) which is movably coupled to the electrode operating element (23) and a latch counter element (37) which is movably coupled to the housing (21), which assume a releasable latched connection in a plurality of different relative positions.

7. The probe according to claim 6, characterized in that the latch element (36) comprises at least one latch projection (38) and the latch counter element (37) comprises a plurality of latch recesses (39) or that the latch element (36) comprises a plurality of latch projections (38) and the latch counter element (37) comprises at least one latch recess (39).

8. The probe according to anyone of the preceding claims, characterized in that a biasing device (48) is provided which applies a biasing force (F) to the electrode (16) relative to the probe body (12) in the extension direction (R).

9. The probe according to claim 8, characterized in that the biasing force (F) of the biasing device (48) urges the electrode (16) in a direction toward a fully extended position (A).

10. The probe according to claim 8 or 9, characterized in that the biasing device (48) is arranged in the probe body (12) and / or in the housing (21).

11. The probe according to anyone of the preceding claims, characterized in that the operating device (20) comprises a water jet probe operating element (66) which is movably coupled to the water jet probe body (60) and is configured to shift the water jet probe body (60) in its extension direction (R) relative to the housing (21) of the operating device (20).

12. The probe according to claim 11, characterized in that the electrode operating element (23) provides a stop for the water jet probe operating element (66) in the first position (I).

13. The probe according to anyone of claims 1 to 10, characterized in that the electrode operating element (23) is configured both for moving the electrode (16) and for moving the water jet probe body (60).

14. The probe according to claim 13, characterized in that the electrode operating element (23) is configured to first cause a retraction movement of the electrode (16) and then to cause an extension movement of the water jet probe body (60) during a movement from the first position (I) in the direction toward the second position (II).

15. The probe according to anyone of the preceding claims, characterized in that a deflection device (69) is provided in the housing (21), which is configured to couple the water jet probe body (60) to an associated operating element (23, 66) of the operating device (20) such that the movement directions of the water jet probe body (60) arranged outside the housing (21) and of the operating element (23, 66) are opposite to one another.