ENDOSCOPIC INSTRUMENT

Description

[0001] The disclosure relates to an endoscopic instrument for insertion into a patient's body, preferably as a disposable article for disposal after a single use and preferably for minimally invasive diagnostics of kidneys and ureters as well as for kidney or urinary stone removal.

[0002] The invention is based on ureterorenoscopes such as those known from EP 2 986 237 B1. A shaft of the ureterorenoscope is inserted into a patient's body via the ureter in order to capture and remove a kidney or urinary stone using a distal grasping device such as a basket or a Dormia snare. Such ureterorenoscopes can, however, be used not only therapeutically but also purely diagnostically, as they allow the treating person to directly view and diagnose the kidney or ureter. Visibility is usually improved by irrigating fluid, which exits through a irrigating line at the distal end of the shaft and washes away tissue obstructing the view. US 2009 / 0270812 A1 describes a surgical instrument with a pistol grip for handling.

[0003] There is a constant effort to reduce the shaft diameter of such instruments in order to make the medical procedure as minimally invasive as possible, or to make better use of the available cross-section in order to offer more or improved functionalities with the same cross-section.

[0004] The endoscopic instrument disclosed herein can be designed with a smaller shaft diameter than known endoscopic instruments of this type or makes better use of the available cross-section in order to be able to offer more or improved functionalities with the same cross-section.

[0005] According to the present invention as defined in claim 1, an endoscopic instrument for insertion into a patient's body is provided, the instrument comprising a tubular shaft which is coupled or can be coupled to a handling device, and at least two electrical, mechanical, and / or optical lines extending through the shaft. The handling device comprises a housing having, at a proximal end, two legs which are arranged at an angle to one another and enclose a contact surface, with at least one line leading out of one of the legs from the handling device. The handling device can therefore be configured like a Y or a V at a proximal end. A user is able to grip the handling device in such a way that the ball of a thumb of one hand rests on the contact surface and two other fingers of the hand, for example the index finger and middle finger, can be used for pulling or pulling.The housing is designed such that the ball of the thumb rests on the contact surface, so that the handling device forms a direct extension of the user's forearm. Twisting the forearm leads to a direct and exclusive twisting of the handling device, which also twists the shaft attached to it.

[0006] According to the invention, at least one guide roller or control disc follows distally from the two legs, which is coupled radially to pull wires and at least two triggers or operating levers for moving the at least one control disc. The guide roller or control disc is rotatable in two directions about an axis of rotation in the housing of the handling device within an angular range, with the axis of rotation running essentially perpendicular to a plane spanned by the legs.

[0007] The guide roller or control disc can optionally be fixed in its current position using a locking device. The locking device could, for example, be implemented in the form of a knurled screw, with which a user can lock the adjusted position of at least one control disc. Any deflection caused by the pull wires can thus remain in its current state without the need for laborious, continuous manual intervention.

[0008] Optionally, a fluid channel can be formed in the shaft, directly surrounding each of the at least two lines running through the shaft. "Individually directly surrounded" here means that the lines do not have a common sheath within the fluid channel, but are individually directly surrounded by the fluid in the fluid channel. The lines can each be individually sheathed and, for example, insulated. "Directly" should therefore not be misunderstood here to mean that the lines must not have a sheath. The lines can be optical in nature, for example, as light guides for coupling and / or coupling light at the distal end. In particular, the lines can have one or more laser light guides, for example, to bombard a kidney or urinary stone with laser light and thus vaporize it.Alternatively or additionally, one or more of the lines can transmit electrical signals and / or electrical power and be connected to a distal LED and / or a distal image sensor. Alternatively or additionally, the lines can have one or more working channels through which shaft tools and / or a laser light guide can be pushed to the distal shaft tip. Alternatively or additionally, the lines can transmit mechanical control signals for bending and / or controlling the distal shaft end, for example, as cables guided laterally within the shaft. All lines are individually directly surrounded by the fluid channel. "Surrounded" here means that the lines are at least largely surrounded by fluid in their cross-section. They do not have to be completely surrounded by fluid in their cross-section over 360°, but can be laterally adjacent to the shaft or to one or more of the other lines.

[0009] Firstly, the endoscopic instrument disclosed herein eliminates the need for a fluid line routed through the shaft. Furthermore, the entire cross-section of the shaft's internal volume not occupied by the lines is utilized as a fluid channel, thus better utilizing the available cross-section. This allows for a shaft outer diameter of 3 mm or less.

[0010] Optionally, the fluid channel can serve as a supply and / or discharge channel. Depending on the need, irrigation fluid can be supplied distally to improve visibility at the distal end of the shaft, or irrigation fluid with disruptive tissue suspension can be discharged proximally. Fluid can be returned proximally through active suction or passively without active suction, for example, through positive pressure in the patient's body.

[0011] Optionally, the fluid channel can have a distal fluid channel opening and a proximal fluid channel opening, with the proximal fluid channel opening being located laterally on the shaft and capable of being subjected to fluid pressure or negative fluid pressure. For this purpose, a pressure or suction pump can be connected to the proximal fluid channel opening, or a fluid reservoir located at a height above the instrument can be connected, similar to a drip, so that hydrostatic pressure is applied to the proximal fluid channel opening. Saline solution, for example, can be used as the rinsing fluid.

[0012] Optionally, the instrument can have a sealing device that forms a proximal end of the fluid channel and has passages for the lines. The sealing device can, for example, have an elastomer cellular foam block that is arranged in a proximal end region of the shaft and / or in a handling device that is connected or connectable to a proximal end region of the shaft. The cellular foam block is preferably designed with closed cells. The lines can be guided through passages through the sealing device, wherein the passages each originally have a smaller diameter than the associated line passed through, but are elastically expanded by the line passed through. This can achieve a sealing effect so that no fluid can flow proximally through the passages axially out of the shaft to the outside or into the handling device.The fluid should preferably not flow axially, but laterally through a proximal fluid channel opening provided for this purpose, which is arranged laterally on the shaft and preferably distally from the sealing device.

[0013] Optionally, the instrument can have a handling device that is permanently connected or detachably connectable to a proximal end of the shaft. The handling device can preferably be ergonomically designed so that it can be comfortably gripped by a treating person and lies well in the hand for manually controlling the instrument. According to the invention, the handling device is essentially Y-shaped with two rigid handle limbs that converge distally towards the shaft. The handling device can then be gripped either by grasping both handle limbs like pliers or by placing the ball of the thumb between the handle limbs. In the first position, the index finger can be placed under the shaft on a firearm-like trigger to pull a cable.In the second position, the index finger can be placed over the shaft on an upper trigger to pull an upper cable, and the middle finger can be placed under the shaft on a lower trigger to pull a lower cable. The upper cable and the lower cable can be designed as sections of a cable that is deflected via a guide roller that is mounted in the handling device so that it can rotate about a axis transverse to the longitudinal axis of the shaft. Depending on the direction of rotation of the guide roller, the upper or lower cable is pulled proximally while the other cable gives way distally. According to the invention, the upper trigger and the lower trigger are each directly connected to one another via the guide roller or indirectly coupled, so that they move in opposite directions when actuated.The second position in particular is ergonomically advantageous because the longitudinal axis of the shaft is essentially coaxial with the longitudinal axis of the forearm, so that the instrument can be easily rotated about its longitudinal axis by supination and pronation of the forearm. In addition, by simply pulling the upper or lower trigger with the index or middle finger, the distal end of the shaft can be bent in two opposite directions using the upper or lower cable. In the first position, the handling device can be turned 180° in order to pull the other trigger with the index finger, or the instrument can be rotated 180° about its longitudinal axis in order to bend the distal end of the shaft in two opposite directions using the upper or lower cable. The cables can be guided through one or both of the handle arms of the handling device and connected to a proximal end of the or lower trigger.The handle limbs each have a proximal connection. Preferably, a working channel is routed through one handle limb of the handling device, and other lines are routed through the other handle limb of the handling device.

[0014] Optionally, the shaft can be elastically bent by more than 270° without a joint, at least in one section. High torsional rigidity with a certain degree of flexural flexibility is particularly advantageous for precise control of the distal shaft end. Flexural rigidity can be quantitatively measured by the depth at which the distal shaft end hangs downward under the weight of the shaft alone when the instrument is in a horizontal position. It has been found that it is particularly advantageous if the distal shaft end hangs downward by 5% to 60% of the shaft length when the instrument is in a horizontal position under the weight of the shaft alone. Within this range of flexural rigidity, the shaft is flexible enough to penetrate the kidneys and ureters as deeply and minimally invasively as possible, and rigid enough to allow controlled control of the distal shaft end.

[0015] Optionally, the instrument, or at least the shaft, can be designed as a disposable item for disposal after a single use. This is a particularly advantageous embodiment, as cleaning the instrument for subsequent uses is eliminated, and the components and materials only need to be designed for a single use. The lines, which are individually directly surrounded by the fluid channel, can be designed very delicately and routed through the fluid channel without considering the formation of difficult-to-clean corners, edges, and / or dead spaces. Due to the delicate design of the lines and the shaft itself, a shaft outer diameter of 2.7 mm or less can be achieved.

[0016] Optionally, the cross-sectional area of the fluid channel can correspond to the cross-sectional area of the shaft interior formed by the shaft minus the sum of the cross-sectional areas of all lines running through the shaft interior. This means that there is no unused cross-sectional area in the shaft, thus optimally utilizing the shaft interior.

[0017] Optionally, the shaft can have a plurality of slots in a distal region. The slots can extend circumferentially over only part of the shaft circumference. This allows the flexibility of the shaft to be locally increased, i.e., the bending radius can be locally reduced, in order to achieve a jointless bending of a distal shaft end by up to 300°. Alternatively or additionally, the slots can be arranged axially relative to one another such that they lie alternately on a first lateral side of the shaft and a second lateral side of the shaft diametrically opposite the first. This allows the distal shaft end to be bent in two opposite directions without a joint and, with correspondingly independently actuated cables, can even execute two opposite S-shaped bends.To create a curve toward a first side, the slots on the first side are compressed, and the slots on a second side opposite the first side are pulled apart. Similarly, to create a curve toward the second side, the slots on the second side are compressed, and the slots on the first side are pulled apart. The cables then preferably run along the first or second side of the shaft and engage the distal end of the shaft to bend the distal end of the shaft toward the corresponding side without a joint using tensile force.

[0018] Optionally, the slots can serve as a distal fluid channel opening for the fluid channel and, at the same time, to locally increase the flexibility of the shaft for jointless bending of a distal shaft end. The irrigation fluid can then exit laterally from the shaft proximally from the distal shaft end. This has the advantage, among other things, of providing more cross-section at the distal shaft end for functions such as an image sensor and / or at least one illumination LED.

[0019] Optionally, the instrument can have at least one working channel running through the shaft and directly surrounded by the fluid channel. Such a working channel can be used in a variety of ways. On the one hand, such a working channel can be suitable for passing through a shaft tool, such as a collecting basket insert or a forceps instrument. If the instrument does not already have an optical line in the form of a laser light guide guided through the fluid channel, such a laser light guide can be introduced through, preferably another working channel, from a proximal working channel opening, for example at a proximal axial end of a handle limb of the handling device, and pushed through the working channel to a distal working channel opening at the distal shaft end.Laser light can be coupled in using the laser light guide, for example to vaporize a kidney or urinary stone and flush it out of the irrigation channel using rinsing fluid. The laser light guide can be withdrawn from the working channel when not in use to free it up for possible other uses. For example, a collecting basket insert or a Dormia loop insert can be pushed through the working channel to collect a kidney or urinary stone at the distal end of the shaft. The proximal working channel opening, for example at a proximal axial end of a handle limb of the handling device, can have a Luer-Lock connection to fix a sheath of the collecting basket insert or the Dormia loop insert relative to the instrument and to open the collecting basket or the Dormia loop by pushing a wire through the sheath, which forms the collecting basket or the Dormia loop on the distal side.The collecting basket or Dormia loop closes when the wire is pulled, provided the sheath is locked in the Luer-Lock connector. However, it is preferred to provide a first, preferably larger, working channel for a shaft tool and a second, preferably smaller, working channel for a laser light guide. This allows the shaft tool and laser light guide to be used in parallel.

[0020] Optionally, a working channel can serve as a supply and / or discharge channel with flow in the opposite direction to that of the fluid channel. This is particularly advantageous when, during longer treatment times and larger quantities of irrigating fluid must be drained from the body without interrupting the treatment. Returning irrigating fluid on the outside of the shaft or through an additionally inserted auxiliary shaft leads to additional tissue expansion and is disadvantageous in terms of a minimally invasive procedure. In addition, excess pressure can build up, which counteracts the flow of irrigating fluid. The working channel can preferably be used as a supply line for irrigating fluid, which is drained via the fluid channel as a discharge line. Alternatively, the flow of irrigating fluid can be reversed, so that the working channel serves as the discharge channel and the fluid channel as the supply channel.Using the working channel as a supply and / or discharge channel can facilitate continuous flushing.

[0021] Optionally, the at least one working channel can extend axially through a sealed proximal end of the fluid channel. Thus, similar to the other lines, the working channel can be routed through an associated axial passage in the sealing device, which is designed, for example, in the form of an elastomer cellular foam block.

[0022] Optionally, the proximal working channel opening can be located proximal to the proximal end of the fluid channel, preferably at a proximal axial end of a handle limb of the handling device. This allows the working channel to be as versatile as possible and is as straight as possible or has only relatively large bending radii.

[0023] Optionally, the distal working channel opening can be positioned distally from a distal fluid channel opening of the fluid channel. This allows, in particular, a crushed kidney or urinary stone to be drained through the working channel, with the lateral outflow or discharge of irrigation fluid through the fluid channel opening ensuring clear visibility.

[0024] Optionally, the cross-section of the distal working channel opening can be smaller than the cross-section of the working channel. This reduces the risk of clogging of the working channel, as the smaller working channel opening acts as a filter for oversized tissue fragments, preventing them from passing through the working channel opening.

[0025] Optionally, the cross-section of the working channel can taper toward the distal working channel opening. This avoids an internal step or edge in front of the smaller working channel opening, which could be encountered by a laser light guide, a retrieval basket insert, or a Dorma loop insert inserted through the working channel.

[0026] Optionally, a flow direction and / or flow rate through the fluid channel can be selectable or adjustable. This can be achieved, for example, via pressure control and / or by opening and closing a valve, preferably at the proximal fluid channel opening.

[0027] Optionally, a distal shaft end can be controllably and jointlessly angled. This can preferably be achieved, as described above, by locally increasing the bending flexibility of the shaft through lateral slots in the shaft and at least one cable acting laterally on the distal shaft end.

[0028] According to a further aspect of the present disclosure, when using a light guide, and in particular a laser light guide, with an outer diameter of significantly less than 1 mm in a shaft of an endoscopic instrument with a jointlessly bendable distal tip, a dedicated working channel with an inner diameter that is significantly smaller than the inner diameter of a conventional working channel can be inserted. It is preferred that the inner diameter of a working channel for a light guide exceeds the outer diameter of a light guide by a maximum of 30%. This allows a light guide to be displaced within its working channel even with a jointlessly bendable distal tip of the endoscopic instrument. Due to the specified diameter ratio, a relatively sharp-edged end of the light guide experiences only a relatively small angle of attack to its surface, even with a curved course of the working channel, and does not damage it.The working channel and the endoscopic instrument therefore do not leak and can be used for a longer period of time. Flushing performance is further improved by replacing a conventional working channel with a significantly narrower working channel. The outer diameter of the light guide can be in a range from 0.4 mm to 0.7 mm, preferably in a range from 0.45 mm to 0.6 mm and particularly preferably from 0.45 to 0.5 mm. It is particularly suitable to equip an endoscopic instrument with such a separate working channel in which a fluid channel is formed in the shaft that directly surrounds at least two lines running through the shaft. In particular, it is suitable to use this separate working channel in a distal region equipped with slots in order to further optimize the size of the fluid channel formed therein.Due to the small diameter, very little space is required within the fluid channel's interior volume. As mentioned above, the light guide can, in particular, be a laser light guide.

[0029] Optionally, the material of the separate working channel for the light guide is polyimide or polyamide. The working channel for the light guide should be made of a material that is as hard as possible and should change its cross-section as little as possible when bent. This significantly reduces the risk of the light guide penetrating the inner surface of the working channel. The material for the working channel can be polyimide or polyamide (also known as nylon) of the appropriate hardness.

[0030] Optionally, the wall of the separate working channel for the light guide can be reinforced. These can be applied circumferentially, preventing the cross-section of the separate working channel from buckling.

[0031] Optionally, the material of the separate working channel can also be made of a metallic material. This could include Nitinol, a nickel-titanium alloy with superelastic properties at room temperature. This material can provide the required and necessary elasticity / flexibility / bending capability for the aforementioned small diameters.

[0032] According to a further aspect of the present disclosure, when using an endoscopic instrument with a shaft having a distal tip that can be bent without a joint, an arrangement of first slots can be provided, which are optionally located alternately on a first lateral side of the shaft and a second lateral side of the shaft diametrically opposite the first. This allows for a jointless bending in a main bending plane without having to create individual segments connected by a joint that partially extend into the inner lumen of the shaft. To further improve mobility, a plurality of second slots, offset by 90° to the first slots, can optionally be arranged proximally to the region with first slots. The second slots can preferably extend only over part of the shaft circumference in the circumferential direction.Further preferably, the second slots are arranged axially relative to one another such that they alternately lie on a third lateral side of the shaft and a fourth lateral side of the shaft diametrically opposite the third. This forms a second deflection plane that lies transversely to the main deflection plane.

[0033] Depending on the number of second slots, the mobility in the second deflection plane can be adjusted. It is particularly advisable to select the number of second slots such that the distal end of the shaft can be moved in the second deflection plane through an angular range of at least + / -15° and preferably + / -20°. This can improve accessibility, particularly to kidney stones in the lower calyces of the kidneys.

[0034] The movement of the distal end of the shaft in the second angulation plane can be achieved by separate mechanical lines, particularly pull wires. These are coupled to the shaft directly distal to the area equipped with second slots. A handling device mentioned above can be used to move the pull wires.

[0035] According to a further aspect of the present disclosure, when using an endoscopic instrument having a shaft that can be coupled to a handling device and has a distal tip that can be bent without a joint, and in which a fluid channel is formed that directly surrounds at least two lines running through the shaft, a sealing device or a sealing means can be provided to seal the lines from the handling device. The sealing means thus forms a proximal end of the fluid channel. Preferably, the sealing means is coupled to the shaft in a rotationally fixed manner. Consequently, rotating the shaft leads to rotating the lines and the sealing means, so that the relative positions of the lines passing through the sealing means to the sealing means remain unchanged.The sealant is therefore not subjected to transverse forces that could elastically deform the sealant material to such an extent that the sealing effect is at least partially eliminated. The rotationally fixed coupling can be achieved by positive locking means that are configured to correspond to one another in the sealant and in a seal receptacle.

[0036] Optionally, the sealant has a disc-shaped, round shape. The sealant can be easily pressed into a seal receptacle.

[0037] Optionally, the positive locking means can be implemented in the form of a circumferential tongue and groove arrangement. The groove can extend into a circumferential surface of the sealant or be formed in the seal receptacle. The tongue could be formed as a radial projection in the seal receptacle or in the sealant. Preferably, the positive locking means are arranged exclusively in a single circumferential position, ensuring correct positioning of the sealant even with an asymmetrically designed sealant.

[0038] Optionally, the sealant can have at least two slots as feedthroughs, which penetrate a circumferential surface of the sealant and each extend partially through the sealant. The slots can be provided to pass mechanical lines, such as pull wires, through the sealant. The pull wires extend from the handling device to the distal end of the shaft and can be used to bend the distal tip without a hinge. If the pull wires are designed as flat wires, they can also be reliably guided through the sealant to form a seal.

[0039] Optionally, the sealant can have four slots as passages, which are arranged at a distance from one another in the sealant. The sealant can therefore also be used to seal a fluid channel in a shaft of an endoscopic instrument in which the tip can be bent without a joint in a main deflection plane and is additionally movable in a second deflection plane. The endoscopic instrument can therefore have four mechanical lines in the form of pull wires or the like, which are passed through the four slots and extend through the shaft. The size and orientation of the slots depend on the type and arrangement of the pull wires.

[0040] Optionally, the slots can be based on parallel radial lines offset by at least 90° from each other on a surface covered by the sealant. The slots can extend beyond a centerline perpendicular to the respective slot and intersecting a center point of the sealant. If four pull wires are used, four slots are required, which are then offset by 90° from each other, for example. With only two pull wires, two slots may be sufficient, which are then offset by 180° from each other, for example.

[0041] Optionally, the sealant can be made of a material comprising polyethylene or cellular rubber. Cellular rubber can, for example, be based on a fluoropolymer.

[0042] Optionally, the endoscopic instrument comprising the sealing means described above can comprise a shaft connection part that is rotatable in a control housing and can be firmly connected to the shaft. The shaft connection part can optionally comprise a connection piece that extends radially outward from a shaft connection axis. A sealing ring can optionally be arranged between a seal receptacle for receiving the sealing means and the shaft connection part to achieve a seal.

[0043] The shaft connection part can also optionally have guide devices for guiding pull wires. By guiding the pull wires, they can directly follow any rotation of the shaft connection part. Interlocking of the pull wires and the associated slots in the sealant can be prevented, so that the sealing effect is not impaired. The seal receptacle can also be supplemented with a cover facing away from the shaft connection part in the distal direction, wherein the cover is also coupled to the shaft connection part in a rotationally fixed manner. The cover can also have guide devices with which pull wires can be guided. The guide devices in the cover and in the shaft connection part are preferably aligned so that the sealant is only subjected to axial forces from the pull wires.

[0044] According to a further aspect of the present disclosure, in an endoscopic instrument having a shaft that can be coupled to a handling device, a shaft tool, for example, with a collecting basket or forceps integrated therein, can be pushed through a working channel of the instrument to the distal end of the instrument. For this purpose, the handling device can preferably have a working channel inlet, a first rotatable receiving part, and a second receiving part connected in a rotationally fixed manner to the first receiving part. The first receiving part can be fixedly coupled to a jacket element of the shaft tool, for example, via a Luer connection, but can also be displaceably mounted relative to the working channel inlet for precise axial positioning.The second receiving part can be coupled to a distal tool head, for example a collecting basket or forceps jaws, via a control wire guided through the casing element of the shaft tool and mounted for axial displacement relative to the first receiving part. The shaft tool can be pushed into different axial positions in the instrument by the first receiving part. This makes it possible to insert the shaft tool through the shaft, positioned at the distal shaft tip, so that it initially does not protrude beyond it. The distal shaft tip can therefore be moved unhindered to an operating area, and the risk of injury from a sharp-edged tool head is avoided. After reaching the operating area, the shaft tool can be pushed out of the distal shaft end by moving the first receiving part in the distal direction.The wire, which is coupled to the tool head, for example, the collecting basket or the jaws of the pliers, can then be pushed out of the casing element of the shank tool by sliding the second receiving part. The shank tool can be rotated by a rotationally fixed coupling of the shank tool and the first receiving part, as well as a rotationally fixed coupling between the second receiving part and the first receiving part. This design also makes it very easy for a single user to position and operate the shank tool. Coordination with a second user is therefore not necessary.

[0045] The first receiving part can optionally be moved relative to the working channel inlet by a first displacement path. The second receiving part can be moved relative to the first receiving part by a second displacement path. The length of the second displacement path can optionally be longer or shorter than the length of the first displacement path. The first displacement path is intended exclusively to bring the shaft tool into a position axially outside the distal shaft tip. This allows the tool head to be moved out of the distal tip without interference. The length of the first displacement path could be just a few millimeters. It is conceivable to provide a displacement path of approximately 5 mm. Depending on the design of the endoscopic instrument, the first displacement path can also be in a range of 2 mm to 10 mm. The second displacement path, however, depends on the type and size of the tool head and can, for example, be up to 20 or 25 mm.

[0046] The first receiving part and / or the second receiving part can optionally be held in a momentary axial and / or rotated position via locking means. The first receiving part and / or the second receiving part could, for example, have a lateral surface equipped with circumferential grooves arranged parallel to one another, each with a rounded profile cross-section. If these grooves are guided through an appropriately dimensioned opening, locking can occur between two consecutive grooves. However, the locked position can also be released again by applying appropriate force transverse to the grooves.

[0047] The first receiving part and / or the second receiving part can also be equipped with a knurled shoulder. This allows a user to easily grip the respective receiving part and perform a rotation sensitively and with direct, haptic feedback.

[0048] Although the above-described aspects of the present disclosure are preferably used in any combination in the embodiments of an endoscopic instrument disclosed herein, they can also be advantageously used independently of one another without the other aspects.

[0049] The invention is explained in more detail below with reference to exemplary embodiments illustrated in the drawings. They show: Fig. 1 shows a perspective view of an example of an embodiment of an endoscopic instrument disclosed herein; Fig. 2a, b shows perspective views of a distal end portion of an exemplary embodiment of an endoscopic instrument disclosed herein; Fig. 3a-c shows exploded views of parts of an exemplary embodiment of an endoscopic instrument disclosed herein; Fig. 4a, b shows schematic cross-sectional views of a distal end portion of a working channel of an exemplary embodiment of an endoscopic instrument disclosed herein; Fig. 5 shows a cross-sectional view of a proximal connection portion of an exemplary embodiment of an endoscopic instrument disclosed herein; Fig. 6a-c shows side views of a handling device with detailed views of the distal shaft end of an exemplary embodiment of an endoscopic instrument disclosed herein; Fig.7a-f show various views of the shaft, and in particular the distal shaft end, of an exemplary embodiment of an endoscopic instrument disclosed herein; Fig. 8a-e show further views of the shaft, and in particular a bendable shaft portion, of an exemplary embodiment of an endoscopic instrument disclosed herein; Fig. 9a-d show various views of an exemplary embodiment of an endoscopic instrument disclosed herein; and Fig. 10a-c show further views of the exemplary embodiment according to . Fig. 9a-d .

[0050] Fig. 1 shows, by way of example, an endoscopic instrument 1 having a tubular shaft 3 for insertion into a body cavity. The shaft 3 is connected at a proximal end 4 to a handling device 5 and forms a fluid channel 7 in its inner lumen. At a distal, bendable shaft portion 9, the shaft 3 is further configured to be at least partially flexible so that it can be bent as needed by the action of the handling device 5.

[0051] In a partial section AA through the shaft 3, it can be seen that, for example, a first optical and / or electrical line 11 for illumination at the distal shaft end 17, a second optical and / or electrical line 13 for image acquisition at the distal shaft end 17, a first working channel 15, and a second working channel 19 run in the fluid channel 7. An LED can be arranged as a light source at the distal end of the first line 11, with the line 11 serving as the electrical power supply line for the LED. Alternatively or additionally, a fiber optic output can be arranged as a light source at the distal end of the first line 11, with the line 11 serving as an optical fiber. Analogously, a lens with an image sensor for image acquisition can be arranged at the distal end of the second line 13, with the line 11 serving as the electrical power supply line for the image sensor and for signal transmission.Alternatively or additionally, a light guide coupling can be arranged at the distal end of the second line 13, wherein the line 13 serves as an optical light guide.

[0052] The first working channel 15 preferably has a cross-section at least twice as large as the second working channel 19. The first working channel 15 can optionally serve as an insertion channel for a shaft tool, for example a collecting basket, scissors, or forceps. Alternatively or additionally, even with the shaft tool inserted, the first working channel 15 can serve as a supply or discharge line for rinsing fluid. The second working channel 19 can preferably serve as an insertion channel for a laser light guide in order to fragment kidney or urinary stones with laser light. The inner diameter of the second, smaller working channel 19 should, at least in the bendable shaft section 9, exceed the outer diameter of the laser light guide by a maximum of 30% to ensure safe passage of the laser light guide.

[0053] All lines 11, 13, 15, and 19 are individually and directly surrounded by the fluid channel 7. The special feature of this arrangement is that the four exemplary lines 11, 13, 15, and 19 are individually arranged in the fluid channel 7 and, when a fluid flows there, are therefore directly surrounded by the fluid. The entire free remaining cross-sectional area of the fluid channel 7 can therefore be used for a fluid. The cross-sectional area of the fluid channel 7 therefore corresponds to the cross-sectional area of a shaft interior formed by the shaft 3 minus the sum of the cross-sectional areas of all lines 11, 13, 15, and 19 running through the shaft interior, as well as all other lines under consideration.A separate fluid channel, which always requires a separate sheath within the shaft 3, is not necessary, because the first working channel 15 can be used as a supply or discharge line for rinsing fluid even when the shaft tool is inserted. The shaft 3 can therefore be provided with a particularly small outer diameter. The potential problem of difficulty in cleaning or sterilizing can be solved with this design by designing the entire endoscopic instrument 1 as a consumable item for disposal after a single use, thus eliminating the need for sterilization after use.

[0054] Of course, other lines, fewer or more, are also conceivable, which could run in this way in the fluid channel 7. For example, lines for transmitting electrical signals and / or electrical power are conceivable. Via these lines, for example, distally arranged light-emitting diodes can be supplied with electrical power or image signals can be transmitted from a distally arranged image sensor. The lines 11, 13, 15 and 19 as well as all alternative or additional lines can each have their own sheath. This can be particularly important in the case of electrical lines in order to insulate them. In addition, mechanical lines in the form of control cables can be guided in the shaft, to bend the bendable shaft cut 9 without joints or to control its shape in some other way. The mechanical lines can be cables or pull wires guided on lateral inner surfaces in the shaft 3.

[0055] The distal, bendable shaft section 9, as the distal region, is provided with a plurality of slots 33, which impart mobility to the bendable shaft section 9. The distal, bendable shaft section 9 is therefore flexible or at least partially flexible, i.e., semi-flexible. Instead of using individual, articulated members, the shaft section 9 can be made flexible about at least one curvature axis by targeted slitting. For this purpose, the slots are preferably formed in the circumferential direction of the shaft 3, extend across the entire material thickness of the shaft jacket, and run over more than half the circumference, for example, by up to 270°.Two slat-like parts of the shaft 3, which follow one another along the direction of extension of the shaft 3 and between which there is a slot 33 in a circumferential surface 35 of the shaft 3, are consequently connected to one another by a web which, in this case, extends, for example, over at least 90° in the circumferential direction. Due to the one-piece design, the webs remaining between the individual slat-like parts always strive to assume an original, unloaded position in which the shaft 3 preferably runs in a straight line. If the preferably metallic shaft 3 is consequently bent by the action of a tensile force from a pull cable, the distal bendable shaft section 9 can be bent by up to 300° without a joint. After the tensile force is released, the shaft 3 strives to return to its straight shape due to the resilient webs.In order to achieve uniform flexibility, the slots 33 are arranged axially relative to one another in such a way that they lie alternately on a first lateral side of the shaft 3 and a second lateral side of the shaft 3 diametrically opposite the first.

[0056] The slots 33 can be introduced into the shaft 3 by a processing device, which preferably uses a laser. This allows for rapid, cost-effective processing, which does not preclude the design of the instrument 1 as a consumable. Very delicate structures can be produced by suitable laser beam guidance. The clear width of the slots 33 can be dimensioned so small that tissue does not penetrate into the slots 33 and an unhindered displacement of the shaft 3 into the surgical area can take place. The slots 33 can have a rounded profile. Optionally, the shaft 3 can be coated with a sliding coating. The slotted, bendable shaft section 9 is preferably protected by a protective tube 199 (see Fig. 7f ). The protective tube can be fabric-reinforced and / or shrink-fitted, for example. The protective tube can be made of biocompatible plastic, for example.

[0057] The fluid channel 7 in the inner lumen of the shaft 3 can serve as a supply and / or discharge channel for a rinsing fluid conveyed through the free remaining cross-section. It is conceivable that, as needed, rinsing fluid can be supplied distally from the slots 33, which then act as distal fluid channel openings, to improve visibility at the distal end 17, or that rinsing fluid with disruptive tissue suspension can be discharged proximally. When using the fluid channel 7 exclusively without the first working channel 15 as a supply and / or discharge channel, it is conceivable to temporarily either only supply or only discharge rinsing fluid. The supply of rinsing fluid can, for example, be carried out actively by an external pump or passively by hydraulic pressure from a connected drip suspended higher up.Drainage can be achieved by generating overpressure in the surgical area through flushing, through which the flushing fluid can then escape proximally along the outside of the shaft 3. Preferably, however, the first working channel 15 serves as the supply channel and the fluid channel 7 as the discharge channel, or vice versa. This allows undesired fluid flow on the outside of the shaft 3 to be largely reduced or completely avoided.

[0058] For continuous irrigation, it may therefore be expedient to use the first working channel 15, which extends distally through the fluid channel 7 and has a first distal working channel opening 18, as a supply and / or discharge channel. The cross-section of the first distal working channel opening 18 may be smaller than the cross-section of the first working channel 15, thus preventing clogging of the first working channel 15 by tissue entering via the distal working channel opening 18. Alternatively or additionally, the cross-section of the first working channel 15 may taper towards the distal working channel opening 18. The first working channel 19 can be continuously supplied with irrigation fluid by a pump external to the device or arranged in the handling device 5, or from a dripper suspended higher up, which is directed distally and exits directly at the distal shaft end 17. The first working channel 15 is therefore a supply channel.Due to the resulting overpressure, the rinsing liquid passes through the slots 33 and / or lateral rinsing openings 203 (see . Fig. 7b,c ) into the fluid channel 7 and flows back proximally from there. This is Fig. 1 indicated by the flow lines 21, which lead from a purely axial, distally directed outflow from the distal shaft end 17 to a lateral inflow through the slots 33 and / or lateral flushing openings. The flow direction in the first working channel 15 is therefore opposite to that of the fluid channel 7. Of course, this can also occur in the reverse constellation, with flushing fluid emerging from the slots 33 and / or the lateral flushing openings in the distal, bendable shaft section 9 and being returned to the distal shaft end 17 via the first working channel 15. If the slots 33 are surrounded by a protective tube 199 and / or a sliding coating, the fluid can be guided exclusively via lateral flushing openings 203.

[0059] The handling device 5 is in Fig. 1 shown only as an example. Further handling devices are described in the Figuren 6a-c ff. All variants of handling devices can be combined with the advantageous embodiments of the shaft 3 described here. Other handling devices are also conceivable, which differ in their form from the variants shown here.

[0060] In the handling device 5 in Fig. 1 A housing 23 is shown which, for example, has a handle opening 25 for passing a thumb through and is designed such that the ball of the thumb of one hand then rests on a support surface 27 directed towards the shaft 3. Two operating levers or triggers 29, 31 arranged on opposite lateral sides of the housing 23 are immediately within reach of the other fingers of the hand. If the ball of the thumb is on the support surface 27, the lower trigger 29 can be operated with a middle finger, while an index finger rests on the upper trigger 31. By pulling the triggers 29 and 31 towards the handle opening 25, the cables 11 and 13 coupled thereto are pulled.To avoid tension within the shaft 3 and to ensure a harmonious movement of the distal, bendable shaft section 9, the two cable pulls are each designed as a section of a single cable pull that runs via a guide roller between the two triggers 29, 31. Thus, if the lower trigger 29 is moved, for example, the first cable pull 11 is pulled, whereby the upper trigger 31 is moved in the opposite direction, thereby releasing the second cable pull 13. For this purpose, both triggers 29, 31 are connected to one another via the guide roller (not shown here) or indirectly coupled, so that they move independently in opposite directions when actuated.

[0061] The first, larger working channel 15 can run along a side 37 of the handling device 5 facing the upper trigger 31, so that a first proximal working channel opening 39 is present there for the optional introduction of a rinsing fluid, for example, NaCl solution, or a shaft tool. Other lines, for example the second, smaller working channel 19 for a laser light guide, can open into a corresponding second proximal working channel opening 43a or 43b on a side 41 facing the lower trigger 29. The fluid channel 7 has a proximal fluid channel opening 45 in the form of a nozzle running transversely to the shaft 3, from which the returning rinsing fluid then ultimately exits.

[0062] In the Fig. 2a and 2bA shaft 47 of an endoscopic instrument is shown in a partial view. The view focuses on a flexible distal, bendable shaft section 49 with a distal end 51 of the shaft 3, at which a first distal working channel opening 52 is arranged. The cross-section of this first distal working channel opening 52 can be smaller than that of the first working channel 15 (not shown here). Alternatively or additionally, the cross-section of the first working channel 15 can taper towards the first distal working channel opening 52. The shaft 47 has a rigid, tubular section proximally (not visible here), which can be connected to a handling device 5. This can be assigned to the handling device 5 from the Fig. 1 correspond or like one in Fig. 6a-c The handling device shown must be designed.

[0063] Viewed distally, a fluid channel 53 formed in the shaft 47 can be seen. The distal, bendable shaft section 49 is designed so that it can be angled as simply as possible, without requiring dedicated joints that protrude into the fluid channel 53 or lead to an enlarged outer diameter of the shaft 47. For this purpose, the distal, bendable shaft section 49 is provided as a distal region with a plurality of parallel and spaced-apart first slots 55 that locally completely penetrate the material of the shaft 47. The first slots 55 extend, for example, over an angle of 270° in the circumferential direction and thereby encircle a main extension direction of the shaft 47, which runs from a proximal end to the distal end 51. For example, consecutive or adjacent slots 55 are offset from one another by 180° in the circumferential direction.The first slots 55 are therefore arranged axially relative to one another such that they alternate on a first lateral side of the shaft 47 and a second lateral side of the shaft 47 diametrically opposite the first. Consequently, the distal bendable shaft section 49 is given a very flexible shape. Individual, lamellar parts of the shaft 47 separated from one another by the slots 55 can change their orientation relative to one another by expanding or compressing the slots 55. As a result, the bendable shaft section 49 undergoes a jointless bend of up to 300°. This movement of the bendable shaft section 49 can be influenced by mechanical pull wires 57 and 59 that run in the fluid channel 53. This allows for targeted pulling and relief of lateral sections of the bendable shaft section 49.

[0064] The entire shaft 47 can be designed as a single piece due to this advantageous design, which has a particularly positive effect on the achievable minimum outer diameter of the shaft 47. As shown in the illustration of the Fig. 1 Here, too, two lamellar parts arranged successively along the direction of extension of the shaft 47, between which there is a slot 55, are consequently connected to one another by a web which, in this case, extends over 270° in the circumferential direction. Due to the one-piece design, the webs remaining between the individual parts strive to assume an original, unloaded position in which the shaft 47 preferably runs in a straight line. If the shaft 47 is consequently bent due to the action of a tensile force through one of the mechanical lines 57 or 59, the shaft 47 strives to return to a straight shape after the tensile force is released due to the resilient webs. The bendable shaft section 49 therefore acts like a spring. A protective tube surrounding the bendable shaft section 49 can support this spring action which urges the shaft back to its originally straight shape.

[0065] This arrangement of the first slots 55 allows for bending on a single plane defined by the circumferential centers of the slots 55. In the specific application in the field of kidney stone destruction, the distal bendable shaft section 49 can be bent without joints by up to approximately 300° due to the accessibility of the stones in the lower calyceal groups of the kidney.

[0066] It is advantageous to be able to bend the bendable shaft section 49 laterally by, for example, up to 20° or 25° in two opposite directions in order to enlarge the spatial area in which the stone or other object in question can be processed, in particular with a laser. This is achieved by dividing the distal bendable shaft section 49 into a first region 61 and a second region 63, in which differently aligned slots 55 are arranged. In the first region 61, which extends up to the distal end 51, the first slots 55 are each offset by 180° from one another. This creates a main bending plane, as described above. In the second region 63, which extends proximally from the first region 63, second slots 64 are provided, which are offset in the circumferential direction by 90° from the first slots 55 in the first region.The second region 63 extends over a significantly shorter distance than the first region 61, with the distances between the slots 55 and 64 in both regions 61 and 63 preferably being identical. The second slots 64 are arranged axially relative to one another such that they alternately lie on diametrically opposite sides of the shaft 47. Consequently, the second region 63 configured in this way enables limited mobility in a plane that runs perpendicular to the main angulation plane. The mobility can be limited, for example, to an angular range of approximately + / - 20° by the number of second slots 64. Movement can be realized by two further mechanical lines 65 and 67, which are coupled to the shaft 47 directly distally in front of the second region 63 and could also be designed as pull wires.The combination of these two angles makes it possible for a laser fiber, for example, to scan a detected object precisely in a relatively large working area.

[0067] In Fig. 2a For example, a slight offset in the drawing plane to the left is achieved, as indicated by the angle β. Consequently, the first area 61 and thus the main angle plane are tilted by approximately 20° to one side. Fig. 2b However, a pivoting in the other direction is shown, as indicated by the angle -β. The second region 63 with the slots 55 arranged therein, as well as the additional mechanical lines 65 and 67, allows the distal end 51 of the shaft 47 to be moved significantly more effectively. The one-piece design also simultaneously ensures that the shaft 47 has sufficient strength to directly move the distal end 51 by rotating the shaft 47.

[0068] The Figuren 3a bis 3c show a detail of an endoscopic device having a fluid channel, which, as in the previous figures, can be designed as fluid channel 7 or fluid channel 53. However, only a small part of the device is shown in the figures, so that a shaft and a fluid channel are not visible. A part of a control housing 69 is shown, into which a shaft connection part 71 can be integrated, to which a shaft can be coupled. This shaft is not shown here and can be designed according to the principles of Figuren 1, 2a and 2b However, it may also be appropriate to couple a conventional shaft to the shaft connection part 71, as long as it has a fluid channel as mentioned above.

[0069] A proximal fluid channel opening in the form of a connecting piece 73 is arranged on the shaft connection part 71, which extends outwards on an outer circumference transversely to a shaft connection axis 75. Flushing fluid originating from the fluid channel 7, 53 can exit via the connecting piece 73. The shaft connection part 71 is designed for integration into a cavity 77 of the control housing 69. A lateral opening 79, through which the connecting piece 73 extends outwards, adjoins the cavity 77. On a side of the shaft connection part 71 arranged, for example, opposite the connecting piece 73, a radial projection 81 is formed, which can engage in correspondingly shaped locking openings 83 and 85 of a radial contour 87 of the cavity 77. The locking openings 83 and 85 are, for example, offset from each other by 90° around the shaft connection axis 75.The shaft connection part 71 can thus lock into two rotational positions, for example, 90° apart. The lateral opening 79 can be shaped accordingly.

[0070] The shaft (not shown) is coupled to the shaft connection part 71 in a rotationally fixed manner, so that rotating the shaft connection part 71 also rotates the shaft. This allows the direction of the bending of the distal, bendable shaft section 9, 49 to be influenced. Since, when using a fluid channel 7, 53 defined only by a shaft jacket, several lines must be routed outward through the control housing 69 without connecting the inner lumen of the fluid channel 7, 53 to the inner lumen of the control housing 69, a sealing means in the form of a sealing device 89 is provided. This is disc-shaped and can be inserted into a sealing receptacle 91, which in turn is firmly connected to the shaft connection part 71.

[0071] For the passage of mechanical lines, for example tension wires, the sealing device 89 has four passages in the form of slots 93. In this example, exactly four slots 93 are shown so that a shaft according to the Fig. 2a and 2bcan be coupled to this sealing device 89. If a different shaft is used, a different number of slots 93 can of course also be realized. The slots 93 shown are based, for example, on parallel radial lines which are offset by 90° to one another on a circular area covered by the sealing device 89. The slots 93 penetrate a circumferential surface 95 of the sealing device 89 and, for example, protrude beyond a center line running perpendicular to the respective slot 93 and intersecting a center point of the sealing device. If the pull wires are designed as flat wires, they can each run through a slot 93 between the shaft and the control housing 69 and are gently enclosed by the material of the sealing device 89.

[0072] To minimize friction of the pull wires as much as possible, the sealing device 89 is preferably made of a closed-cell foam. The dimensions of the sealing device 89 in the uninserted state are preferably slightly larger than the dimensions of the seal receptacle 91, so that the sealing device 89 must be slightly compressed during insertion and then always returns to a relaxed, expanded position. This seals all inserted elements.

[0073] The sealing device 89 further has further recesses 97, 99, 101, and 103, which can have different dimensions according to the lines 11, 13, 15, and 19. The sealing device 89 has a largest recess 97, which belongs to the first working channel 15, which can extend along the extension axis 75 through the control housing 69 to the first proximal working channel opening 39. Adjacent to the largest recess 97, three further passages 99, 101, and 103 are arranged in the form of recesses, which serve to pass through the lines 11, 13 and the smaller second working channel 19. The passage 103, which exemplarily has the smallest dimensions, is suitable for passing through the smaller second working channel 19 with a dimension of significantly less than 1 mm, for example 0.55 mm or less. The other two feedthroughs 99 and 101 belong to the electrical lines 11, 13, which are connected to the distal LED and the distal LED, respectively.are connected to the image sensor. The dimensions of the recesses 97, 99, 101, and 103 are each slightly smaller than the cross-section of the associated line 11, 13, 15, and 19 passing through in order to achieve a sealing effect on the outside of the line 11, 13, 15, and 19. The sealing device 89 is preferably designed as an elastic cellular foam block made of ethylene propylene diene rubber (EPDM), so that the recesses 97, 99, 101, and 103 expand accordingly when the lines 11, 13, 15, and 19 are passed through and each encloses them in a sealing manner.

[0074] The sealing device 89 has a radial recess 105, which is formed corresponding to a radial projection 107 in a sleeve-like portion 109 of the seal receptacle 91. This always fixes the rotational position of the sealing device 89, so that when the shaft connection part 71 is rotated, the sealing device 89 follows the rotation.

[0075] It is advisable to arrange guide means for guiding the pull wires in the seal receptacle 91 and a cover 111 to be attached thereto, so that the slots 93 of the sealing device 89 are always aligned with the pull wires when the shaft connection part 71 is rotated. The sealing device 89 is therefore loaded exclusively by an axial force of the pull wires. To further achieve ideal guidance of the pull wires, the cover 111 is arranged in a rotationally fixed manner on the seal receptacle 91. For this purpose, the sleeve-like section 109 can have a radially outer spring 113 that is aligned with a radially inner recess 115 of the cover 111.

[0076] As in Fig. 3b As shown, an additional sealing ring 117 can be provided, which seals the seal receptacle 91 on the shaft connection part 71. For this purpose, the seal receptacle 91 has a sealing surface on a recess 119 arranged opposite the sleeve-like section 109, which can be brought into contact with the sealing ring 117 and an annular surface 121 of the shaft connection part 71. The rinsing fluid, which flows proximally via the rinsing channel into the shaft connection part 71, cannot pass the sealing device 89 proximally and flows radially out via the connection piece 73.

[0077] In Fig. 4a und 4b Another aspect of the endoscopic instrument is shown. In Figur 4a A light guide 123 is shown, which is in particular a laser light guide in the form of a single fiber and has an exemplary diameter of 0.45 mm. This diameter can preferably include a protective layer of the light guide 123, wherein the light-guiding core diameter can be, for example, only 0.272 mm. Of course, the light guide 123 can also have an even smaller or a somewhat larger diameter. The light guide 123 has a light exit end 125, which, for optimal radiation properties, has the sharpest possible edges and runs perpendicular to the extension axis of the light guide 123. However, it is difficult to push such a light guide 123 through a working channel 127 that has a diameter of approximately 1.2 mm or more.The sharp-edged light exit end 125 could become jammed against the inner wall 129 of the working channel 127 when pushed through it, preventing passage, or the light guide 123 could even kink. Furthermore, the wall 129 could also be destroyed if the light exit end 125 bores into the inner wall 129.

[0078] To prevent this, as in Fig. 4b As shown, an alternative working channel 131 is provided as a second, smaller working channel 19 for the light guide 123, which, at least in a bendable section, has an inner diameter of only slightly more than the diameter of the light guide 123 (here 0.45 mm) and, for example, is 0.55 mm. At its light exit end 125, the light guide 123 experiences only a very small angle of attack with an inner wall 133 of the working channel 133, thus reliably preventing jamming.

[0079] The diameters mentioned in the bendable section are merely examples. The inner diameter of the working channel 131 should have an inner diameter that does not excessively exceed the outer diameter of the light guide 123, at least in the bendable section. The difference between the two diameters should not be too great in the bendable section, as otherwise there is a risk of jamming and / or damage to the working channel 131. It has been found that a diameter difference in the bendable section of a maximum of 30% can prevent damage to the working channel 131. The inner diameter of the working channel 131 should therefore, at least in the bendable section, exceed the outer diameter of the light guide 123 by a maximum of 30%, which is the case with the exemplary diameters mentioned.

[0080] In the Figuren 5 bis 6c another aspect of the realization on an endoscopic instrument 134 is shown. Fig. 6a bis 6c show a handling device 135 to which a proximal end 138 of a shaft 137 is connected. This shaft has a distal end 139, which is shown somewhat enlarged on the left in the drawing plane and has, by way of example, a first distal working channel opening 140. A proximal fluid channel opening 142 and an electrical connection cable 146 are arranged on a lower side in the drawing plane, from which a rinsing fluid or the like can emerge. Here, a separate fluid inlet 148 is arranged on the upper side, through which the first working channel 15 can be flushed with rinsing fluid. Of course, the shaft 137 can also have a distal, bendable shaft section, which is provided with slots as shown in the previous figures. In general, it is advantageous to design the shaft 3 so that it can be angled without a joint towards the distal end 139.

[0081] At a proximal end of the handling device 135, a first leg 141 and a second leg 143 are provided in a Y-arrangement, between which a contact surface 145 is provided for the placement of the thenar eminence of a hand. A second proximal working channel opening 144 is provided, for example, on the second leg 143. The alignment of the two legs 141 and 143 relative to one another and the dimensions of the contact surface 145 are selected such that when gripping the handling device 135, the thenar eminence rests against the contact surface 145 in such a way that the handling device 135 forms a direct extension of the user's forearm. The user can therefore very conveniently rotate the handling device 135 around the longitudinal axis of the shaft 137 solely by supination and pronation of the forearm, without having to perform a more complex arm movement.This is not the case, especially with conventional pistol-like handling devices.

[0082] Distally, on two opposite sides of the handling device 135, there are an upper trigger 147 and a lower trigger 149, which can be operated by two fingers of the hand by pulling proximally and are each connected to a distally extending pull wire. As in the embodiment in Fig. 1 The upper trigger 147 and the lower trigger 149 could also be coupled to one another, so that both triggers 147 and 149 execute opposing movements. It is provided that a guide roller is present between the triggers 147 and 149 and that the aforementioned pull wires are each designed as a section of a common pull wire that is guided around the guide roller. However, a control disk would also be conceivable, which is coupled to both triggers 147 and 149 and to a separate pull wire each. A locking device 151 could be provided to lock a current position of the guide roller or the individual pull wires. In the case shown, the locking device 151 is designed as a knurled screw, which projects, for example, into a control disk and is clamped to the outer surface of the handling device 135 when tightened.

[0083] By way of example, according to a further aspect of this disclosure, a working channel inlet 153 is located on the first leg 141 as part of a Luer-Lock connector, to which a first closure thread 155 is arranged proximally. A shaft tool in the form of a collecting basket insert is inserted into the instrument 1 through the working channel inlet 153 and connected. The collecting basket insert has a connecting element 157, which is connected via a second closure thread 159, which is shaped to correspond to the first closure thread 155. A first rotatable receiving part 161 is mounted on the connecting element 157 of the collecting basket insert and is connected to a hose 163 as a casing element of the collecting basket insert. The casing element 163 of the collecting basket insert extends through the first working channel 15 through the shaft 3. The first receiving part 161 has a first sliding section 165 which is provided with a circumferential grid 167.This allows locking in different positions in an opening contour 169 of the connecting element 157. By moving the first receiving part 161 in the distal direction along the first displacement section 165, the hose 163 can consequently be moved distally in the first working channel 15. At an end of the first displacement section 165 opposite the connecting element 157, a first shoulder 171 in the form of a circumferential collar is arranged, which has a circumferential knurling 173. This allows the first receiving part 161 to be gripped and rotated. The circumferential ratchet 167 is therefore preferably designed in the form of grooves arranged parallel to one another, which have a rounded profile cross-section. Manual displacement in the distal or proximal direction can each lead to release and achieving a locking engagement.

[0084] A second receiving part 177 is arranged in an inner lumen 175 of the first receiving part 161. This second receiving part 177 has a second displacement region 179 with which the relative position of the second receiving part 177 to the first receiving part 161 can be adjusted. At the same time, the second receiving part 177 is connected to the first receiving part 161 via a rotationally fixed, displaceable connection. The second receiving part 177 therefore directly follows the movement of the first receiving part 161. The second receiving part 177 is connected to a pull wire 181 that extends through the casing element of the collecting basket insert, designed as a tube 163. The second receiving part 177 also has, at an end of the second displacement section 179 facing away from the first receiving part 161, a second shoulder 183 in the form of a circumferential collar, which is also provided with a knurling 185. A user can therefore easily grip and rotate the receiving parts 161 and 177.Due to the fixed connection between the components, the tube 163 and the pull wire 181 are also rotated. The second receiving part 177 also has a detent 187 that can engage with an opening contour 189 of the first receiving part 161. The position of the second receiving part 177 can therefore always be fixed relative to the first receiving part 161.

[0085] As in the Figuren 6a bis 6c As shown, this configuration allows for a particularly advantageous design of a collecting basket 191, which is arranged in the casing element 163 of the collecting basket insert and protected thereby. The collecting basket 191 is designed to be elastic so that it can be completely retracted into the casing element 163 and pushed out of it by distal movement, expanding to its full size. By specifically moving the collecting basket 191, a kidney stone or the like can be grasped, with the grasping occurring by pulling the pull wire 181 proximally, causing the collecting basket to compress again. Fig. 6a shows the first receiving part 161 and the second receiving part 177 locked in the proximal position. This means that an actuating handle 193 is pulled out of the handling device 135 as far as possible.

[0086] As can be seen in the enlarged view of the distal tip 139 of the shaft 137, the sheath element 163 of the collecting basket insert does not protrude beyond the distal shaft tip 139. By moving the first receiving part 161 over the complete first displacement path 165 in the distal direction, so that the first shoulder 171 rests flush on the connecting device 157, the hose 163 protrudes, for example, by approximately 5 mm from the distal shaft tip 139. By pushing the second receiving part 177 in the distal direction, the collecting basket 191 can be pushed out of the hose 163 so that it unfolds. A displacement path of 5 mm could be suitable for the hose 163. It is conceivable that a significantly greater length, for example 20 mm, would be suitable for unfolding the collecting basket 191.

[0087] The particular advantage of this arrangement with the distally displaceable jacket element 163 of the collecting basket insert and the rotationally fixed connection is that the collecting basket 191 can be easily rotated radially in all deployment states by acting on the handle 193. At the same time, actuating the handle 193 also allows the collecting basket 191 to be advanced and unfolded by the hand that is not currently gripping the handling device 135. Once an object is grasped by the wire collecting basket 191, the object can be held by retracting the second receiving part 177. Due to the locking mechanism 187, the object remains trapped without the need to be actively held. The collecting basket can therefore be very easily operated by a single user, and a second user with whom intensive communication during the operation would be necessary is not required.

[0088] A laser light guide 123 can be guided through the second, smaller working channel 19, parallel to the collecting basket insert in the first working channel 15, to the distal shaft tip 17, for example, to fragment a kidney stone using laser light. The second, smaller working channel 19 ends proximally at the second proximal working channel opening 144 on the second leg 143 of the handling device 135.

[0089] In the Figuren 7a-f the shaft 3, in particular the bendable shaft section 9, 49 of the shaft 3 and the distal shaft end 17, 51, 139 are shown in more detail. In Figuren 7a-c a distal end sleeve 195 is not shown, which in Figuren 7d-f is shown in more detail. The distal shaft end 17, 51, 139 has a connecting sleeve 197, by means of which the end sleeve 195 is fastened to the shaft 3 in a rotationally fixed manner (see Fig. 7f ). The end sleeve 195 has a recess 199 and the connecting sleeve 197 has a bulge 201 shaped to correspond to the recess 199, whereby a rotationally fixed, positive connection between the end sleeve 195 and the connecting sleeve 197 is achieved.

[0090] The connecting sleeve 197 overlaps the distal end of the slotted, bendable shaft section 9, 49 in an overlapping section. Lateral flushing openings 203 are present in the overlapping section, here in the form of eight circumferentially distributed radial perforations. Since the slots 33, 55, 64 of the bendable shaft section 9, 49 are surrounded by a protective tube 205 (see Fig. 7f , not shown in Fig. 7a-e ), the flushing openings 203 serve as distal flushing outlet or flushing inlet of the fluid channel 7, 53. The thickness of the connecting sleeve 197 corresponds approximately to the thickness of the protective tube 205, so that the radial outer surfaces of the protective tube 205, connecting sleeve 197 and end sleeve 195 are flush with each other without any edges (see Fig. 7f ).

[0091] In Fig. 7b Also shown are the pull wires 57, 59, 65, 67, which extend diametrically opposite each other (here: top 57, 65 and bottom 59, 67) on the inner surface of the shaft through the shaft 3 in order to be able to bend the bendable shaft section 9, 49 upwards or downwards without a joint. The slots 33, 55, 64 are wedge-shaped for this purpose, so that the clear width of the slots 33, 55, 64 is largest in the center, where the pull wires 57, 59, 65, 67 run, and tapers towards the ends in the circumferential direction. The ends of the slots 33, 55, and 64 have round recesses to reduce stresses when the shaft material is bent, and to reduce material cracks and the risk of plastic deformation of the shaft material. The jointless bending of the shaft section 9, 49 is intended to be achieved by deforming the slotted shaft material as elastically as possible, which has a restoring effect to the straight shaft shape.

[0092] In Fig. 7d The arrangement of a light source in the form of an LED 207, a lens 209 with an image sensor located behind it, the first distal working channel opening 18, 52, 140 of the first working channel 15, and a second distal working channel opening 211 of the second working channel 19 in the distal end sleeve 195 is shown in a front view. Attention should be drawn to the extremely small dimensions. The outer diameter of the distal end sleeve 195 can be 3 mm or less. The LED 207 can be 0.55 mm wide, and the image sensor 209 can be less than 1 mm wide. The first distal working channel opening 18, 52, 140 can have an inner diameter of 1.2 mm or less, and the second distal working channel opening 211 can have an inner diameter of 0.55 mm or less. The distal-side light output of a laser light guide 123 pushed through the second working channel 19 can be placed at the second distal working channel opening 211.The tool head of a shafted tool, such as a collecting basket insert or a forceps or scissors instrument, can be guided out of the first distal working channel opening 18, 52, 140. The first working channel 15 can also be used as a supply or discharge line for irrigating fluid, which is discharged or supplied via the lateral irrigating openings 203 and the fluid channel 7, 53, respectively. A supply of clear irrigating fluid via the first working channel 15 and a discharge via the lateral irrigating openings 203 and the fluid channel 7, 53 is preferred in order to have a clear distal view.

[0093] In Fig. 7e It is shown that the distal end sleeve 195 is bevelled at the front, so that in particular the first distal working channel opening 18, 52, 140 runs at an angle to the longitudinal axis of the shaft 3. Preferably, the second distal working channel opening 211 is also bevelled (not visible in Fig. 7e ). The corresponding distal openings in the end sleeve 195 for the LED 207 and the lens 209 can also be beveled to improve the respective illumination or viewing angle. The one or more bevels of the distal shaft tip 17, 51, 139 have the further advantage that the distal shaft tip 17, 51, 139 can be guided more easily through a ureter or renal duct, or a trocar or catheter.

[0094] Figuren 8a-e show the one-piece metallic tubular main body of the shaft 3, 47, which has the flushing openings 203, the slots 33, 55, 64, and the proximal fluid channel opening 45, 73, 142. The bendable shaft section 9, 49 with the slots 33, 55, 64 preferably has at least two subsections Y, Z, wherein the axial distances between the slots 33, 55, 64 are different in the subsections X, Z. Preferably, the distances between the slots 33, 55, 64 are smaller in a first subsection Y than in a second subsection Z, wherein the first subsection Y is arranged distally from the second subsection Z. As a result, a stronger curvature can be achieved in the first subsection Y than in the second subsection Z. In addition, the first subsection Y is less rigid than the subsection Z, so that the bendable shaft section 9, 49 curls up from the distal tip 17, 51, 139 when curved.This allows for particularly good mobility of the distal tip (17, 51, 139) and a particularly large angulation range of up to 300° in a small space. As shown in . Fig. 8c,d As shown, the clear width of the slots 33, 55, 64 in the first subsection Y can preferably be larger than in the second subsection Z. This can also support the curvature of the shaft section 9, 49, which improves in the distal direction. The clear width and / or the slot spacing can vary gradually within and / or between the subsections Y, Z, so that the subsections Y, Z can run into one another. The subsections Y, Z can be arranged adjacent to one another or separately from one another.

[0095] Figuren 9a,b show another design of the Y-shaped handling device 5, 135. The Fig. 9b The instrument shown can be manufactured inexpensively as a factory-preassembled and sterilized disposable product. It is once again demonstrated how the distal shaft tip 17, 51, 139 can be curved upwards or downwards by up to 300° by pulling the triggers 147, 149. Fig. 9c shows the distal shaft tip 17, 51, 139 in perspective view with beveled working channel openings 18, 52, 140, 144. Fig.9d illustrates how a shaft tool in the exemplary form of a forceps instrument 213 can be pushed through the first working channel 15 and can be positioned axially with a curved shaft section 9, 49.

[0096] In Figuren 10a,b the interior of the Y-shaped handling device 5, 135 is shown in more detail in longitudinal section. Fig. 10b shows an enlarged section X. Fig. 10c shows an enlarged view of the sealing device 89 in the form of a cellular foam block, which sits in the seal receptacle 91 and seals the fluid channel 7, 53 on the proximal side. The sealing device 89 has recesses 97, 99, 101, and 103 for the passage of the lines 11, 13, 15, and 19, which have different dimensions according to the lines 11, 13, 15, and 19. The sealing device 89 has a largest recess 97, which belongs to the first working channel 15, which can extend along the extension axis 75 through the control housing 69 to the proximal working channel opening 39. Adjacent to the largest recess 97, three further passages 99, 101 and 103 are arranged in the form of recesses, which serve to pass through the lines 11, 13 and the smaller second working channel 19.The feedthrough 103, which has the smallest dimensions, is suitable for passing through the smaller second working channel 19 with a dimension of significantly less than 1 mm, for example, 0.55 mm or less. The other two feedthroughs 99 and 101 belong to the electrical lines 11, 13, which are connected to the distal-side LED 207 and the image sensor 209, respectively. The dimensions of the recesses 97, 99, 101, and 103 are each slightly smaller than the cross-section of the associated feedthrough lines 11, 13, 15, and 19 in order to achieve a sealing effect on the outside of the lines 11, 13, 15, and 19. The sealing device 89 is preferably designed as an elastic cellular foam block made of ethylene propylene diene rubber (EPDM), so that the recesses 97, 99, 101 and 103 expand accordingly when the lines 11, 13, 15 and 19 are passed through and each encloses them in a sealing manner.The two offset slots 93 serve to ensure the tight passage of the two cables 57, 59. The radial recess 105 serves to prevent rotation of the sealing device 89.

[0097] In Fig. 10a It also illustrates how the first working channel 15 can be supplied with rinsing fluid via the top-side fluid inlet 148, so that the first working channel 15 can serve as a supply channel for rinsing fluid. For this purpose, a T-connector 215 is arranged in the first working channel 15 within the handling device 5, 135, which is connected to the top-side fluid inlet 148 via a rinsing line 217. Thus, a suspended drip or a pump can be connected to the fluid inlet 148, so that rinsing fluid flows through the rinsing line 217 into the first working channel 15.

[0098] It should be noted that the features of the previously described embodiments can be combined with one another as desired. List of reference symbols:

[0099] 1Endoscopic instrument 3Shaft 4Proximal end of the shaft 5Handling device 7Fluid channel 9Bendable shaft section 11First optical or electrical line 13Second optical or electrical line 15First working channel 17Distal end / distal tip of the shaft 18First distal working channel opening 19Second working channel 21Flow lines / fluid backflow 23Housing 25Handle opening 27Support surface 29Lower trigger / operating lever 31Upper trigger / operating lever 33Slot 35Circumferential surface 37Upper side of the handling device 39Proximal end 41Lower side of the handling device 43a, 43bSecond proximal working channel opening 45Proximal fluid channel opening 47Shaft 49Bendable shaft section 51Distal end of the shaft 52First distal working channel opening 53Fluid channel 55First slot 57Mechanical conduit (pull wire) 59Mechanical conduit (pull wire) 61First area 63Second area 64Second slot 65Mechanical conduit (pull wire) 67Mechanical conduit (pull wire)69Control housing 71Shaft connection part 73Proximal fluid channel opening / connection piece 75Shaft connection axis 77Cavity 79Lateral opening 81Radial projection 83Locking opening 85Locking opening 87Radial contour 89Sealing device 91Seal receptacle 93Slot / feedthrough 95Circumferential surface 97Feedthrough 99Feedthrough 101Feedthrough 103Feedthrough 105Radial recess 107Radial projection 109Sleeve-like section 111Cover 113Radial outer spring 115Radial inner recess 117Sealing ring 119Recess 121Annular surface 123Light guide 125Light exit end 127Conventional working channel 129Inner wall 131Working channel 133Inner wall 134Endoscopic Instrument 135Handling device 137Shaft 138Proximal end of the shaft 139Distal end of the shaft 140First distal working channel opening 141First leg 142Proximal fluid channel opening 143Second leg 144Proximal second working channel opening 145Contact surface 146Electrical connection cable 147Upper trigger / Operating lever 148 Fluid inlet 149 Lower trigger / operating lever 151 Locking device 153 Working channel inlet 155 First locking thread 157 Connecting element 159 Second locking thread 161 First receiving part 163 Sheath element of the shaft tool 165 First sliding section 167 Ratchet 169 Opening contour 171 First shoulder / collar 173 Knurling 175 Inner lumen 177 Second receiving part 179 Second sliding section 181 Pull wire 183 Second shoulder / collar 185 Knurling 187 Ratchet 189 Opening contour 191 Catch basket 193 Operating handle 195 End sleeve 197 Connecting sleeve 199 Recess 201 Bulge 203 Flushing openings 205 Protective hose 207LED 209Lens 211Second distal working channel opening 213Forceps instrument 215T-connector 217Fluid line β angle (lateral offset)

Claims

1. An endoscopic instrument (1, 134) for introduction into a body of a patient, wherein the instrument (1, 134) has a tubular shaft (3, 47, 137), which is coupled or coupleable to a handling device (5, 135), and at least two electrical, mechanical and / or optical lines (11, 13, 15, 19, 57, 59, 65, 67, 123, 181) extending through the shaft (3, 47, 137), the handling device (5, 135) has a housing (23), which at a proximal end has two legs (141, 143), which are arranged at an angle to one another and enclose a contact face (145), wherein at least one of the lines (11, 13, 15, 19, 57, 59, 65, 67, 123, 181) is guided outwards from one of the legs (141, 143) from the handling device (5, 135), wherein the legs (141, 143) are formed as two rigid gripping legs, which converge substantially in a Y-shape towards the shaft (3, 47, 137), wherein the orientation of the two legs (141, 143) relative to one another and the dimensioning of the contact face (145) is selected in such a way that when the handling device (135) is grasped, optionally - either both gripping legs (141, 143) can be clasped like a pair of pliers, or - the ball of the thumb can be guided between the gripping legs, so that the ball of the thumb bears against the contact face (145) in such a way that the handling device (135) forms a direct extension of a lower arm of a user and the handling device (135) is rotatable about the longitudinal axis of the shaft (137) exclusively by means of supination and pronation of the lower arm, characterised in that the endoscopic instrument (1, 134) further has at least two triggers (29, 31, 147, 149) or operating levers, which can be actuated by two fingers of the hand of a user by being pulled proximally and are each connected to a distally extending tension wire (57, 59, 65, 67), wherein a control disc is arranged between the operating levers (29, 31, 147, 149), wherein the control disc is rotatable about a rotation axis in the housing (23) of the handling device (5, 135) in an angular range in two directions, wherein the rotation axis runs substantially perpendicular to a plane spanned by the legs (141, 143), wherein the at least two triggers (29, 31, 147, 149) or operating levers are in each case directly connected or indirectly coupled to one another via the control disc, so that they move in opposite directions when actuated.

2. The endoscopic instrument (1, 134) according to claim 1, wherein the respective tension wire (57, 59, 65, 67) is guided around the control disc as a portion of a common tension wire (57, 59, 65, 67), which is guided around the control disc.

3. The endoscopic instrument (1, 134) according to any one of the preceding claims, wherein the control disc is fixable in its current position via a locking device.

4. The endoscopic instrument (1, 134) according to claim 2, wherein the locking device has a knurled screw.

5. The endoscopic instrument (1, 134) according to any one of the preceding claims, wherein a fluid channel (7, 53) directly surrounding individually each of the at least two lines (11, 13, 15, 19, 57, 59, 65, 67, 123, 181) running through the shaft (3, 47, 137) is formed in the shaft (3, 47, 137).

6. The endoscopic instrument (1, 134) according to claim 4, wherein the fluid channel (7, 53) serves as a feed and / or discharge channel.

7. The endoscopic instrument (1, 134) according to claim 4 or 5, wherein the fluid channel (7, 53) has a distal fluid channel opening (33, 55, 64, 203) and a proximal fluid channel opening (45, 73, 142), wherein the proximal fluid channel opening (45, 73, 142) is arranged laterally on the shaft (3, 47, 137) and can be exposed to fluid pressure or fluid negative pressure.

8. The endoscopic instrument (1, 134) according to any one of the preceding claims, wherein the instrument (1, 134) has a sealing means (89), which forms a proximal end of the fluid channel (7, 53) and has feedthroughs (93, 97, 99, 101, 103) for the lines (11, 13, 15, 19, 57, 59, 65, 67, 123, 181).

9. The endoscopic instrument (1, 134) according to any one of the preceding claims, wherein the instrument (1, 134) has a handling device (5, 135), wherein the handling device (5, 135) is fixedly connected or releasably connectable to a proximal end (4, 138) of the shaft (3, 47, 137).

10. The endoscopic instrument (1, 134) according to any one of the preceding claims, wherein the shaft (3, 47, 137) can be bent elastically at least in one shaft portion (9, 49) joint-free through more than 270°.

11. The endoscopic instrument (1, 134) according to any one of the preceding claims, wherein the instrument (1, 134) or at least the shaft (3, 47, 137) is embodied as a disposable article for disposal after a single use.

12. The endoscopic instrument (1, 134) according to any one of the preceding claims, wherein the cross-sectional area of the fluid channel (7, 53) corresponds to the cross-sectional area of a shaft interior formed by the shaft (3, 47, 137) minus the sum of the cross-sectional areas of all of the lines (11, 13, 15, 19, 57, 59, 65, 67, 123, 181) extending through the shaft interior.

13. The endoscopic instrument (1, 134) according to any one of the preceding claims, wherein the shaft (3, 47, 137) in a distal shaft portion (9, 49) has a plurality of slots (33, 55, 64).