Docking device and surgical holding device

Description

[0001] The invention relates to a docking device and a method for connecting a surgical instrument to a holding arm of a surgical holding device, as well as to a surgical holding device with such a docking device.

[0002] Assistive systems are increasingly being used in surgical procedures to relieve the burden on medical staff and to perform operations reliably and with minimal patient impact. State-of-the-art technology includes the use of surgical holding devices and even surgical robots to hold and position surgical instruments, allowing actions to be performed on the patient's body via connected tools. It is common practice for the surgical instrument to already be placed in the patient's body before it is connected to the holding device.

[0003] EP 2 246 006 A2 describes a surgical assistance system in which a surgical instrument, such as an endoscope, is connected to a robot arm so that it can be moved using its kinematics. For this purpose, an instrument carrier is provided, which is detachably connected to a kinematic arm via a pivot joint and is further pivotally connected to an instrument holder. The surgical instrument is snapped onto this instrument holder. There is no pre-positioning necessary for the subsequent procedure.

[0004] DE 10 2014 116 103 A1 discloses a surgery assistance system comprising multiple robot arms, each of which represents pivot axes extending in different directions. The robot arms are connected to each other at their ends, with a support column supporting a first robot arm and a second robot arm being hinged to the latter. A joint piece is inserted at a free end of the second robot arm, which is connected to an instrument carrier to which an endoscope can be coupled. Pre-positioning of the endoscope to be coupled is not provided.

[0005] JP2006061272A and WO2009005921 A1 disclose further prior art.

[0006] In other devices, the surgical instrument used to treat a body, or the trocar used to guide it, is clamped directly to the holding arm or robot head. In both cases, clamping the instrument involves significant movement of the instrument; repositioning can cause damage to the body entry site, which can be even more severe if the pivot point is not precisely registered.

[0007] In a microsurgical procedure, particularly a laparoscopic one, in which access for the microsurgical instrument is created via a trocar inserted into the patient's abdominal wall, the trocar point—i.e., the center of the trocar located in the abdominal wall—forms a pivot point around which the instrument can be moved. This pivot point must be held as fixed as possible to minimize stress on the patient's tissue. Therefore, especially with driven kinematics, it is necessary to register this pivot point in the control system. This allows the movements to be coordinated around the fixed pivot point when movements are transmitted to the surgical instrument to position it as desired in the patient's body.

[0008] EP 2 254 735 B1 describes the advance registration of a planned trocar point as the origin of a coordinate system for a surgical assistance system using a registration sensor. However, the trocar must then be placed at the planned, registered point either freehand or using templates or projections, which is not precise and does not correspond to the natural workflow.

[0009] In some cases, the pivot point can be set first and subsequently registered. For this purpose, trocars are available whose position is recorded using two perpendicular laser lines projected onto the abdominal wall. These lines must be moved to the trocar point, with the third dimension only being detectable via depth markings provided on the trocar. Furthermore, it is possible to manually move a measuring tip mounted on the robot to the trocar point and trigger a registration at this point, as disclosed in US Pat. No. 6,201,984 B1, which further describes the further movement and positioning of a trocar at one end of a robotic holding arm. However, this workflow is also complex and error-prone.

[0010] Based on this prior art, it is the object of the present invention to provide a gentle way of connecting a surgical instrument to a holding arm and holding it stably in the body of a patient, adapted to the usual workflow before and during a surgical procedure.

[0011] This object is achieved by a docking device having the features of claim 1.

[0012] The further object of favorably pre-positioning a surgical instrument for a surgical procedure and being able to move it to a correctly registered pivot point is achieved by the surgical holding device with the features of claim 10. Yet another object is to quickly and gently connect a surgical instrument to a holding arm of a surgical holding device in an orientation suitable for the operation. This object is achieved by a method described here but not claimed. This method is not part of the present invention.

[0013] Further training is described in the respective subclaims.

[0014] A first embodiment of a docking device, which is designed to connect a surgical instrument to a holding arm of a surgical holding device in a docking situation, comprises a two-part adapter device. This is designed such that it can be connected to the holding arm at its proximal end and to the surgical instrument at its distal end. The surgical instrument has a rod-shaped shaft and, proximally adjoining thereto, a handle and is designed to be guided through a trocar. The two-part adapter device comprises a first adapter with an elongated section, which accordingly has a longitudinal axis; moreover, the first adapter has a connecting body. The connecting body is located at a distal end of the first adapter and has a first engagement element with a terminal connecting surface.The two-part adapter device further comprises a second adapter. The second adapter is designed to be arranged on the shaft of the surgical instrument. It has an engagement element that, in the docking situation, points toward and corresponds to the terminal connection surface. The connecting body of the first adapter forms a detachable connection with the corresponding engagement element of the second adapter in the docking situation. The terminal connection surface of the first adapter is inclined with respect to its longitudinal axis by a predetermined first angle, which lies in a range of 45° to 75°.

[0015] In a further embodiment of the invention, the angle of inclination may preferably be in a range of 55° to 65°, most preferably 60°.

[0016] The terms "proximal" and "distal" refer to the position relative to the operator, so "proximal" means closer to the operator and "distal" means further away from the operator.

[0017] The term "docking situation" refers to the state in which the holding arm is completely connected to the surgical instrument via the docking device according to the invention and which thus simultaneously represents the starting situation for the use of the surgical instrument in a subsequent surgical procedure.

[0018] Surgical holding devices are defined herein as both passive holding devices that merely hold the surgical instrument in a preset position, and active holding devices that also allow the surgical instrument to be operated, particularly repositioned. This also includes complete surgical robots that can be used to perform a surgical procedure remotely. The surgical instrument can specifically be a laparoscope; in general, it also includes other surgical instruments used in microsurgery and, in particular, laparoscopy.

[0019] Advantageously, the second adapter of the two-part adapter device is attached directly to the surgical instrument, which can be done during preparation for a surgical procedure. This subsequently makes it significantly easier to couple the instrument, which is already equipped with the second adapter, to the first adapter, since only the first engagement element needs to be connected to the corresponding engagement element. This is done with little effort and, in particular, with the least possible movement of the instrument itself, and consequently with little stress on the patient's tissue. The inclination of the terminal connection surface has this advantage, in particular compared to the prior art represented by DE 10 2014 116 103 A1 and EP 2 246 006 A2, both of which have horizontal connection surfaces between holding components and where maintaining the pivot point at the puncture site of the trocar is not a priority.With the solution according to the invention, an endoscope can be connected directly and specifically to the holding arm while maintaining the defined pivot point.

[0020] The connecting body of the first adapter can form the first engagement element entirely or only partially, or the first engagement element can be arranged thereon. Thus, by engaging the first engagement element of the first adapter with the corresponding engagement element of the second adapter, a connection can be established that can be released without the aid of a tool.

[0021] The terminal connection surface, which is inclined by the predetermined first angle – this means the smallest angle enclosed between the longitudinal axis of the elongated section of the first adapter and the terminal connection surface of the first adapter – ultimately determines the orientation of the shaft of the surgical instrument. "Terminal" refers to the distal end of the first adapter and thus to the side of the connecting body oriented away from the elongated section. The corresponding engagement element of the second adapter is aligned according to the terminal connection surface when the connection between the first and second adapter is established, and consequently also the surgical instrument. Advantageously, the surgical instrument can thus be skillfully pre-positioned for a surgical procedure. Here, "predetermined" means that advantageously, depending on the desired docking situation to be brought about, which may, for example,Depending on the type of surgical procedure or the type of surgical instrument, docking devices with larger or smaller first angles can be provided.

[0022] In a further embodiment, the connecting body with the section having the connecting surface is designed as a slide. The corresponding engagement element of the second adapter is correspondingly designed as a rail element for receiving the slide. This means that the connection of the first and second adapters takes place via a movement parallel to the connecting surface, parallel to the longitudinal axis of the rail element. The slide can, for example, have a trapezoidal or dovetail-shaped cross-section and the rail element can have a corresponding trapezoidal or dovetail contour, thus creating a positive connection. Of course, other geometries or engagement cross-sections known to those skilled in the art can also be selected other than the dovetail shape and the corresponding negative thereof for the slide and rail.The carriage and rail are flat, preferably with a height of only a few millimeters to one centimeter.

[0023] Yet another embodiment of the adapter device according to the invention provides that the connecting body of the first adapter has a first opening. The opening, or its edges, can be chamfered, cut, or inclined at an angle that corresponds to the first angle that the terminal connecting surface has with respect to the longitudinal axis of the first adapter. In other words, an imaginary axis runs through the first opening parallel to the longitudinal axis of the rail element and thus, in the docking situation, parallel to the longitudinal axis of the surgical instrument or its shaft.

[0024] The first opening may be formed as a hole in the wall of the connecting body or as a through-opening or as a cylindrical recess whose orientation is parallel to the terminal connecting surface.

[0025] The first opening serves to allow a laser beam, which may also be understood as a bundle of parallel laser beams, to emerge at the first angle from a laser device arranged at the opening. If the opening is even part of a cylindrical recess, this can house the laser device.

[0026] Furthermore, the elongated portion of the first adapter has a second opening that is inclined at a second angle relative to the longitudinal axis of the first adapter. The second opening can also be a "hole," possibly with angled chamfered edges, in the wall of the first adapter or in the shell of a cylindrical body of the adapter, or a cylindrical recess therein (possibly also chamfered), and also forms a receptacle for a second laser device. The second opening also serves to allow a laser beam to emerge from the second laser device at the second angle.

[0027] The second angle is smaller than the first angle and ranges from 20° to 80°. Imaginary axes along these angles are aligned to intersect at a predetermined intersection point, which is determined by the first and second angles, as well as the distance between the two openings, measured along the longitudinal axis of the elongated section of the first adapter. This "predetermined" point is determined by the shaft length of the surgical instrument to be connected.

[0028] The openings through which laser light can emerge can also have windows that are transparent to the laser light used. The openings are thus designed to allow laser devices to emit laser beams radiating from the first adapter at the appropriate angles, both of which intersect at a predetermined intersection point, which corresponds to the pivot point in an operating configuration of the docking device.

[0029] The point at which the laser beams from the two openings intersect also determines the distance of the intersection point from the docking device and consequently from the holding arm.

[0030] Each of the laser devices can be a laser fiber that can be connected to a laser beam source. The laser beam source can be located outside the docking device, so that only those fibers that emit laser light at the opening are routed inside the adapter.

[0031] Alternatively, the laser devices could also be laser modules with their own laser beam source that generate the laser beam themselves.

[0032] The windows that close the openings are advantageous, diffractive elements that allow the respective laser beam to exit in a cross shape, for example.

[0033] The "pivot point" refers here to the fixed point in space in which the trocar is held. The trocar or surgical instrument can be pivoted around this pivot point. Translation along the longitudinal axis of the shaft and rotation about it are possible independently. During a surgical procedure, a desired pivot point is defined by the trocar point, the puncture point of the trocar into a body to be inserted, which, in a very abstract sense, can be any solid body. in praxi but will be the patient's body tissue. However, this point will be shifted if the movement of the surgical instrument is not correctly coordinated with this desired pivot point, which could result in injuries to the tissue around the puncture site. The docking device according to the invention advantageously avoids this in that the predetermined intersection point can be aligned so that it lies at the pivot point of the trocar through which the held surgical instrument is guided. This sets a predetermined distance (dependent on the length of the shaft of the surgical instrument) between the holding arm and the pivot point. The surgical instrument has a fixed length, according to which the pivot point is determined according to this fixed length. Consequently, after the connection is complete, the surgical instrument can be moved around this pivot point.

[0034] According to a further embodiment, the first opening is adjacent to the terminal connection surface. This achieves the smallest possible distance between the first opening and the shaft of the surgical instrument connected to the second adapter, so that the first laser beam emanating from the first laser device is not only parallel, but also only slightly offset from the longitudinal axis of the shaft of the surgical instrument in the docking situation.

[0035] This is also made possible by the flat carriage and rail, so that the instrument axis is as close as possible to the laser axis of the first laser device.

[0036] In a further embodiment, at least one electrical connection line can be present in the first adapter and at least one electrical contact surface for the laser device(s) or the second adapter can be present on the surface of the proximal end and / or distal end of the first adapter.

[0037] It is conceivable that each laser device has an electrical connection cable and an electrical contact surface.

[0038] A further embodiment of the docking device according to the invention provides that the second adapter has a tubular section next to the corresponding engagement element, wherein the corresponding engagement element of the second adapter is arranged above the tubular section of the second adapter in the docking situation. The tubular section has a cylindrical passage through which the shaft of the surgical instrument can be guided, wherein the passage should be only slightly larger in diameter than the diameter of the shaft so that the shaft has as little play as possible in the passage. The longitudinal axis of the cylindrical passage of the tubular section runs parallel to the corresponding engagement element, so that after arranging the second adapter on the shaft of the surgical instrument, moving the second adapter along the axis of the rail element corresponds to moving the shaft along its axis.A movement for connecting the two adapters along the longitudinal axis of the shaft of the surgical instrument has proven to be particularly advantageous and gentle, as this uses the degree of freedom that is already available with a surgical instrument guided by a trocar, and the operator can simultaneously view the adapters and the solid body in which the trocar is located, e.g. a patient.

[0039] In general, the handling of the adapters and thus of the docking device in relation to any solid body that has the pivot point is to be understood in technical-mechanical terms; the handling represents a purely technical-mechanical process.

[0040] Furthermore, the tubular section of the second adapter can have a coupling element that can be coupled to a corresponding coupling element at the proximal end of the shaft of the surgical instrument, preventing the second adapter from slipping off the shaft. Alternatively or additionally, the second adapter can also be screwed, clamped, or glued.

[0041] In another embodiment, the first adapter has a second engagement element at its proximal end, which is designed to be detachably connected to a corresponding engagement element of the support arm. To enable such a direct connection of the first adapter, the connection point of the intended support arm must be known in terms of its connection mechanism and dimensions so that the proximal end of the first adapter can be adapted to it. This is typically the case with approved assistance systems.

[0042] Yet another embodiment provides that the first adapter advantageously has a retaining cone located at the proximal end of the first adapter and tapering toward a proximal tip. This retaining cone can not only represent a second engagement element that can be engaged with a corresponding engagement element of the retaining arm or another corresponding connecting piece, but is also shaped such that its tip can pierce a sterile drape surrounding the retaining arm.

[0043] Piercing an existing sterile drape is not necessary if only mechanical holding without signal transmission is required, or if the drape has a special signal transmission adapter for attachment to a robot head, so that the barrier formed by the drape can be maintained. In this case, it is sufficient to leave a gap between the second engagement element of the first adapter and the holding arm.

[0044] In a further embodiment, the docking device has a flange piece designed to be arranged on a corresponding counterflange of the holding arm. The counterflange can be a standard flange of the holding arm, the shape of which is known to those skilled in the art for designing the flange piece of the docking device for arrangement thereon; a screw connection may be sufficient. The flange piece makes it possible to design the first adapter at its proximal end as desired, without being bound to the shape of existing connection options of the holding arm; the flange piece is designed accordingly. In a preferred embodiment, the flange piece therefore has a conical recess which corresponds to an outer circumferential shape of the holding cone for receiving the holding cone of the first adapter.A gap can also remain between the flange piece and the retaining cone, just wide enough to accommodate and clamp a single layer of sterile drape. In another embodiment, the retaining cone can be located on the flange piece, and the proximal end of the first adapter has the recess into which the retaining cone can be accommodated.

[0045] All connections that can be made with the docking device according to the invention, ie between the first adapter and the holding arm or the flange piece arranged on the holding arm, between the first adapter and the second adapter, and between the second adapter and the surgical instrument, can be made manually and can also be released manually.

[0046] In further embodiments, these connections are designed by alignment elements such that the interconnectable, corresponding elements can only be engaged in a unique alignment.

[0047] The docking device according to the invention can be designed as a disposable product. It can also be sterilized, preferably autoclavable, completely or partially, particularly the two adapters of the two-part adapter device.

[0048] The invention further relates to a surgical holding device with at least one holding arm, which can be connected to a surgical instrument via the docking device according to the invention or is connected to the latter in the docking situation. The surgical instrument has, as described above, a rod-shaped shaft and a handle and is designed to be guided through a trocar. Advantageously, the surgical instrument is connected to the surgical holding device in the docking situation in such a way that it is cleverly pre-positioned for a surgical procedure. It may be sufficient if the holding device only holds the surgical instrument in this preset position. However, the surgical instrument can also be moved via the holding device; both manual and driven systems are included.The holding device can have a plurality of holding arms, of which only some or all are connected to a surgical instrument via a docking device according to the invention.

[0049] In a further embodiment, the surgical holding device is a surgical robot with a robot head. A surgical robot is defined as a holding device that has a control device for the controlled movement of the holding arm. The robot head forms the end of the holding arm, to which an end effector, to which the kinematic movements are to be transmitted, can be connected. The holding arm can be controlled remotely; in this case, the control device comprises at least one control element via which operator inputs are recorded, or it can run completely automatically via corresponding programming stored in the control device.

[0050] According to a further embodiment of the surgical holding device according to the invention, the control device is connected to a first laser device and a second laser device. The laser devices are aligned with one another such that the laser beams emitted by them intersect at a predetermined intersection point. In a preferred embodiment, the first laser device is therefore arranged at the first opening of the first adapter and the second laser device is arranged at the second opening of the first adapter of the docking device, so that the beam direction is determined by the inclination of the openings. The two laser beams can have two different colors for easier differentiation. Each of the laser devices can be a laser fiber that can be connected to a laser beam source or a laser module with its own laser beam source.

[0051] "Controllable" here means that there is an operative connection between the laser devices and the control device, so that, for example, the laser devices can be activated and deactivated by the control device. For this purpose, a docking program can be stored in the control device, via which movements of the holding arm can be executed during the connection process or manual movement of the same can be permitted or blocked.

[0052] The surgical robot can be mounted on a mobile base and thus positioned freely in the room.

[0053] A method for connecting a holding arm of a surgical holding device in a docking situation by means of a docking device according to the invention with a surgical instrument having a rod-shaped shaft and a handle and designed to be guided over a trocar comprises the following steps: a) connecting the first adapter to the holding arm, b) arranging the second adapter on the surgical instrument, c) guiding the second adapter to the first adapter by moving the surgical instrument, and connecting the second adapter to the first adapter by engaging the terminal connecting surface of the first engagement element of the first adapter with the first corresponding engagement element of the second adapter, thereby overall connecting the holding arm to the surgical instrument.

[0054] This makes it extremely easy to create the connection that allows the surgical instrument to be held directly at a specific penetration depth (depending on the length of the shaft) and tilted at the predetermined first angle. The order in which steps a) and b) are performed is irrelevant, as long as they occur before step c).

[0055] In a further development of the procedure, the following steps are carried out after step b) but before step c): b1) Positioning the surgical instrument by inserting the shaft into the trocar, which is pivotally mounted around a predetermined / fixed pivot point, b2) Emitting a first laser beam in a predetermined direction using the laser device arranged at the first opening and aligning the first laser beam to the pivot point by moving the holding arm and thus the first adapter, b3) Emitting a second laser beam in a predetermined direction using the second laser device arranged at the second opening of the first adapter, which intersects the first laser beam at a predetermined intersection point, and aligning the second laser beam to the pivot point by moving the holding arm parallel to the first laser beam, thereby aligning the first adapter and consequently the holding arm to the pivot point,

[0056] Step a) can optionally be carried out after step b1), whereby the remaining steps should preferably be carried out in the order shown.

[0057] This corresponds to the usual workflow for a microsurgical procedure assisted by holding devices, in which the instrument is first inserted into a trocar, thus establishing its pivot point, before being attached to a holding arm. The pivot point is determined by the positioning of the trocar, and the surgical instrument can be pivoted or tilted around the pivot point, thereby pivoting or tilting the trocar.

[0058] Steps a) to b1) are carried out manually, whereas the movement of the holding arm in steps b2) and b3) can be done manually or by electronic control. When aligning the second laser beam to the pivot point in step b3), the alignment of the first laser beam to the pivot point is maintained by simply moving the holding arm, which is already connected to the first adapter, parallel to the first laser beam, i.e. in the direction in which the laser beam travels. After that, the position of the holding arm with the first adapter is no longer changed. Thus, in step c), the intersection point of the laser beams lies at the pivot point and thus at a predetermined distance from the holding arm and the first adapter. The surgical instrument, which is now connected and pre-positioned, can be repositioned from there using movements transmitted by the holding arm.

[0059] After connecting the holding arm to the surgical instrument, the laser beams can be switched off again.

[0060] The method may further comprise step a0) before step a), namely the attachment of a flange piece of the docking device to the holding arm or a counter-flange attached thereto, so that the first adapter does not have to be connected directly to the holding arm, but the connection is made by engaging in the flange piece.

[0061] In a further embodiment, when connecting the first adapter in step a), a sterile drape enclosing at least the holding arm can be pierced with the tip of the first adapter, allowing contact, including electrical contact, while maintaining a sterile operating space. Furthermore, such a drape can also be clamped between the holding arm or the flange piece arranged thereon and the first adapter.

[0062] In a further embodiment of the method, the surgical instrument is connected to a holding arm of a surgical robot according to the invention with a control device.

[0063] Preferably, the following additional steps are then carried out: b2'), after step b2), blocking in the control device movements of the holding arm which are not parallel to the first laser beam, b3'), after step e) registering the pivot point by registering the intersection point of the first and second laser beams in the control device, and storing the registered pivot point in the control device in order to carry out movements of the holding arm in relation to the registered pivot point.

[0064] Advantageously, step b3') stores the pivot point to which the holding arm is aligned in the control device, providing the surgical robot with a reference point relative to an external body and thus allowing it to coordinate movements around it. The external body can be a patient's body for a surgical procedure. Precise prepositioning ensures that the registered pivot point coincides with the target pivot point, thus reducing damage to the patient's tissue. A minor system-inherent error due to the fact that the first laser beam does not exactly map the path of the instrument shaft, but rather runs at a slight offset, can be compensated for by calculation.

[0065] The optional step b2') simplifies the movement of the holding arm parallel to the first laser beam and ensures that the alignment of the first laser beam to the pivot point is maintained in the subsequent steps.

[0066] These and other embodiments of the docking device and method, as well as some of the advantages associated with these and other embodiments, will become clearer and more easily understood from the following detailed description with reference to the accompanying figures. Items or parts thereof that are substantially the same or similar may be provided with the same reference numerals. The figures are merely a schematic representation of one embodiment of the invention.

[0067] Showing: Fig. 1 a perspective view of the docking device, connected to a counter flange of a holding arm and to a surgical instrument, Fig. 2 a perspective view of the docking device, connected to a counter flange of a holding arm, Fig. 3 a perspective view of the first adapter and the flange piece of the docking device, connected to a counter flange of a holding arm, Fig. 4 a further perspective view of the first adapter and the flange piece of the docking device, connected to a counter flange of a holding arm, Fig. 5 a perspective view of the first adapter, Fig. 6 a longitudinal sectional view through the first adapter and the flange piece of the docking device, connected to the counter flange of the holding arm, Fig. 7 a detailed view of the second adapter, Fig. 8 another detailed view of the second adapter, Fig. 9 the second adapter, arranged on a surgical instrument, Fig. 10 a detailed partial view of the proximal end of a shaft of a surgical instrument to which the second adapter of the docking device can be attached, Fig. 11 in a) to g) several intermediate steps in connecting a surgical instrument to a holding arm by means of the docking device.

[0068] The invention comprises a docking device with a two-part adapter device, wherein the first adapter can be connected directly or via a flange piece of the docking device to a holding arm of a surgical holding device, and the second adapter can be connected to a surgical instrument such that the latter is held by the holding arm when the first and second adapters are engaged with each other. The invention also relates to a surgical holding device that is connected to a surgical instrument via the docking device, and to a method for connecting the surgical instrument to the holding arm using the docking device according to the invention. The holding arm can belong to a surgical robot.

[0069] Fig. 1 bis Fig. 10 show an embodiment of the docking device 1 according to the invention in various connected and unconnected states of the individual parts. The holding arm of the holding device, to which the docking device 1 docks the surgical instrument 2, is not shown figuratively. Instead, the screw connections 17 are still visible, via which a counterflange 16 is attached to the holding arm. In practice, these screw connections naturally disappear into corresponding holes or other connection points of the holding arm or robot head, if the holding arm is a surgical robot.

[0070] Fig. 1 shows (without depicting the holding arm) the docking device 1 in the fully connected state, connected at a proximal end to the counter flange 16 of a holding arm via a flange piece 4, and connected at a distal end to a surgical instrument 2. The first adapter 5 is connected to the flange piece 4 and to the second adapter 6. In this state, the surgical instrument 2 is ready to be held by the holding arm and, if necessary, repositioned.

[0071] The surgical instrument 2, which is to be coupled to the holding arm via the docking device 1, has an elongated shaft 2a, which is connected to a handle 2b at its proximal end and can accommodate a tool (not shown) such as a manipulator or a camera (endoscope) at its distal end. The corresponding connections for mechanical and / or electrical contact and handling of the tool to the handle 2b run via the shaft 2a.

[0072] In Fig. 2 For the sake of clarity, the docking device 1 is shown without the surgical instrument 2, although the first adapter 5 is nevertheless connected to the second adapter 6, a state which is not usually achieved since the second adapter 6 is always connected to the surgical instrument 2 before it docks to the first adapter 5.

[0073] In the Fig. 2 The docking device 1 is provided with a special holder for the holding cone 18, which is Fig. 5 and 6 shown, connected to the flange piece 4 formed on the first adapter 5. This flange piece 4 is easily attached, for example by screw connections 17, to the corresponding (standard) connections of a counter-flange 16 of the holding arm, so that the flange piece 4 provides the corresponding engagement element, in the embodiments shown the recess 23, for the proximal end 5a of the first adapter 5.

[0074] However, the holding arm can also have a standardized flange, such as those known in particular for various surgical robot systems and are located on the robot head of the respective holding arm, on which there is an engagement element of the holding arm corresponding to a suitably designed first engagement element of the first adapter, so that the first adapter can be coupled directly.

[0075] In Fig. 2 , 3 , 4 und 5As shown, the first adapter 5 has a proximal end 5a for connection to the holding arm and a distal end 5b for connection to the second adapter 6, and an elongated section 5c between them. At the distal end 5b, there is a connecting body 8 which widens from a side 8" facing the elongated section 5c towards a terminal connecting surface 8' and thus forms a type of slide or dovetail with a trapezoidal or dovetail-shaped cross-section. Thus, a first engagement element of the first adapter 5 is provided by the connecting body 8. Alternative embodiments not shown can provide the first engagement element as a part of the connecting body or an element arranged thereon. The connecting body 8 fits with its connecting surface 8' into a corresponding engagement element 11 on the second adapter 6, which here is a slide receptacle in the form of a rail element 11.

[0076] It is conceivable that the corresponding elements are interchanged, i.e., the first adapter 5 comprises a rail element and the second adapter 6 comprises a slide. It is understood that the illustrated connecting mechanisms are merely examples of other, corresponding engagement elements.

[0077] The first adapter 5 further comprises a longitudinal axis Z of the elongated section 5c, which, after coupling to the support arm (at a 90° angle to its end face), can run vertically as shown. This corresponds to a frequently encountered coupling situation, but can also deviate from the vertical. When connecting the first adapter 5 to the support arm, a clear orientation of this longitudinal axis Z is thus established.

[0078] The entire connecting body 8, and thus in particular its terminal connecting surface 8', is arranged at an angle α relative to the longitudinal axis Z of the elongated section 5c, so that the connection to the second adapter 6 is made at precisely this angle. This ultimately creates a fixed connection angle between the surgical instrument 2 and the holding arm. Docking devices 1 can be provided with different angles; for the illustrated docking situation, an angle in a range of 30° to 90°, according to the invention in a range of 45° to 75°, in particular of approximately 60° or 45°, has proven to be useful, whereby the surgical instrument 2 is brought into a conventional position for use in a laparoscopic procedure.

[0079] In the Fig. 2 , 3 und 5The connecting body 8 of the first adapter 5 has a first opening 3 for the exit of a first laser beam 41'. A first laser device 41, for example in the form of a laser fiber (in Fig. 3 und 5 shown as a dot). The first opening 3 can be closed by a transparent window, not shown figuratively here. The first opening 3 is inclined at a first angle α, wherein in the Fig. 2 , 3 und 5 The first opening 3 is shown as a through-hole with chamfered edges. For a better understanding, Fig. 3 und 5the laser beam 41' is drawn backwards in dashed lines up to the longitudinal axis Z in order to show the angle α. The laser beam 41' radiates away from the first adapter 5 along the angle of inclination of the first opening 3 in a direction angled by the first angle α relative to the longitudinal axis Z, i.e. parallel to the terminal connecting surface 8' and parallel to the connecting direction between the connecting body 8 of the first adapter 5 and the rail element 11 of the second adapter 6. In its elongated section 5c, the first adapter 5 has a second opening 7 for a second laser device 42 as just described for the first laser device 41, which emits a second laser beam 42'. The second opening 7, like the first opening 3, is shown in the figures as a through opening. In order to determine the angle β in Fig. 3 und 5To illustrate, the second laser beam 42' is also extended by dashed lines to the longitudinal axis Z of the adapter 5. The second laser beam 42' radiates in the direction of inclination of the second opening 7 in a direction angled by the second angle β relative to the longitudinal axis Z away from the first adapter 5, wherein the second angle β is smaller than the first angle α. The second laser beam 42' extends in the plane defined by the longitudinal axis Z and the first laser beam 41' and intersects the first laser beam 41' at a predetermined intersection point 44. Their function is described in connection with the Figuren 11a bis 11g described in more detail.

[0080] From the sectional view in Fig. 6 , in which the openings 3, 7 are through openings, it becomes clear that in this case the direction of the laser beams 41', 42' results from the alignment of the openings 3, 7.

[0081] Fig. 3 und 4show the first adapter 5 as it should be for the detachable connection with the second adapter 6, namely already connected to the flange piece 4 and ready to be brought into engagement with the rail element 11 of the second adapter 6 via the connecting body 8, on which the first engagement element is present or which itself forms the first engagement element.

[0082] In Fig. 5 and 6 At the proximal end 5a of the first adapter 5, the retaining cone 18 is formed as a second engagement element, tapering from the elongated section 5c into a tip 18'. On its broad side, the retaining cone 18 is defined by a circumferentially projecting collar 21. The retaining cone 18 serves for connection to a flange piece 4 attached to the counterflange 16 of the retaining arm, the conical recess 23 of which can accommodate the retaining cone 18. The retaining cone 18 has a recess in the form of a circumferential annular groove 20.

[0083] The connection with a flange piece 4 specially designed for the adapter device 1 is shown in the sectional view in Fig. 6 shown. The flange piece 4 has a flange body 4' connected, for example, by screwing, to the counterflange 16. The flange body 4' contains a conical recess 23 that corresponds to the shape of the retaining cone 18. One or more movably mounted retaining rails 24 extend into the recess 23 and are guided by a guide 25. If the retaining cone 18 of the first adapter 5 is inserted into the recess 23, the retaining rail 24 is pushed outward from the tip 18' and a sleeve 4" movable relative to the flange body 4' is pushed downward. When the retaining cone 18 is pushed in far enough that the annular groove 20 is at the level of the retaining rail 24, the retaining rail 24 can move inward again, thereby locking the retaining cone 18 and consequently the first adapter 5 to the flange piece 4. A spring 26 guided by a pin 27 causes the sleeve 4" and the retaining rail 24 to return to their original position.To release the first adapter 5, the reverse procedure can be followed, i.e. by gripping the sleeve 4", the retaining rail 24 is forced out of the annular groove 20 and thus the path of the retaining cone 18 out of the recess 23 is released.

[0084] Furthermore, an alignment pin 22 is arranged on the protruding collar 21, pointing toward the tip 18'. This pin is intended to be inserted into a pin-shaped recess (not visible in the sectional view) on the flange piece 4, so that the first adapter 5 can only be connected in a clear alignment with respect to the flange piece 4 and thus to the holding arm. These or similar alignment aids for a clear alignment are optional and further simplify the connection process.

[0085] The holding arm and the flange piece 4, if this is to be used as part of the docking device 1, can be covered by a sterile drape (disposable sheath) for a sterile surgical setting. To ensure that the first adapter 5 can still be coupled without problems, the tip 18' of the holding cone 18 can pierce the drape when inserted into the conical recess 23, thus opening the way to the flange. The tip 18' is nevertheless slightly rounded to prevent injury to medical personnel during handling. This not only enables a purely mechanical connection, but also allows electrical contact points in the holding cone 18, which are then contacted by parts of the holding arm and ensure an electrical or electronic coupling. These can be, for example, power supply lines for the laser devices 41, 42.The portion of the drape around the retaining cone 18 of the first adapter 5 can also be accommodated in a narrow gap remaining between the first adapter 5 and the flange piece 4. The remaining parts of the docking device 1, in particular the first and second adapters 5, 6, are located in the sterile space and must therefore themselves be sterile. The docking device 1 is therefore designed as a disposable product that is disposed of after use, or as a sterilizable, reusable product, with at least the two-part adapter device being sterilizable.

[0086] Fig. 7 and Fig. 8 show that the second adapter 6 has a rail section 6a and a tube piece 6b. On the rail section 6a there is a rail element 11 which, in the docking situation, points upwards, i.e. towards the terminal connecting surface 8' of the connecting body 8 of the first adapter 5 and is open on this side. The tube piece 6b adjoins the closed, lower side. The rail element 11 corresponds to the terminal connecting surface 8' in such a way that it forms a receiving space 11a for the connecting body 8 of the first adapter 5. For this purpose, the side walls 11' of the rail element 11 diverge towards the tube piece 6b of the second adapter 6, resulting in a trapezoidal or dovetail-shaped contour of the rail element 11. The adapters 5, 6 can therefore only be connected to one another along a longitudinal axis of the rail element 11.For this purpose, the connecting body 8 is pushed from one longitudinal end of the rail element 11 into the receiving space 11a so that the first adapter 5 and the second adapter 6 are clearly aligned with each other. A connection rotated by 180° is not possible because only one longitudinal end of the rail element 11 is exposed for inserting the first adapter when the second adapter 6 is already arranged on the surgical instrument 2. Furthermore, the side walls 11' can diverge towards this exposed longitudinal end to facilitate insertion. At a second longitudinal end of the rail element 11, it is delimited by rear walls 11" so that the slide 8 cannot slip through. The connection is released simply by longitudinal displacement in the opposite direction.

[0087] At the second longitudinal end of the rail element 11, a securing clip 10 is arranged with a nose 10a pointing toward the receiving space 11a, which can engage in a corresponding notch 9 on the connecting body 8 of the first adapter 5 to prevent accidental release. To release the securing clip, pressure can be applied to the securing clip 10, which then bends open so that the nose 10a is lifted out of the notch 9. The connecting body 8 of the first adapter 5 can be provided with securing projections 15, which can additionally ensure a firm hold within the rail element 11.

[0088] The rail section 6a is followed by a pipe section 6b, which has a through-opening 12 that runs parallel to the rail element 11, more precisely parallel to its longitudinal axis, along which the two adapters 5, 6 are connected to each other. Fig. 8 It is shown that at the distal end of the tube section 6b, a coupling element 13 in the form of a connecting ring with a gripping nipple 14 is provided, wherein the connecting ring 13 has a shaped recess 29 on its inner circumference, as well as an alignment pin 28. The connecting ring 13 is rotatable, wherein the gripping nipple 14 facilitates the rotation of the connecting ring 13 in order to couple the adapter to the endoscope. The gripping nipple 14 can also have a pin to assist in guiding the coupling inside the connecting ring 13 and to limit the rotation radius of the connecting ring 13. In order to connect the second adapter 6 with the surgical instrument 2 to the Fig. 9 To connect the surgical instrument 2 in the arrangement shown, the shaft 2a of the surgical instrument 2 is pushed from its distal end through the through-opening 12 until the coupling element 13 of the second adapter 6 abuts the handle 2b of the surgical instrument 2. There, further connecting elements are present on the instrument 2, as well as Fig. 10 shows, namely a corresponding coupling element 30, which protrudes corresponding to the shaped recess 29, so that they engage with each other when the coupling element 13 is practically slipped over during coupling. The adapter 6 cannot slip over the handle 2b. Furthermore, the alignment of the second adapter 6 on the surgical instrument 2 is clearly determined by the groove 31 on the projection 30, into which the alignment pin 28 must be inserted when slipping over. The alignment can also be determined by the shaped recess 29 and the projection 30 alone, and the alignment pin 28 is not necessary. Preferably, the shaped recess 29 and the projection 30 are rotationally symmetrical to each other by 180°, the combination of the alignment pin 28 and the groove 31 determines the alignment, as well as Fig. 10 combined with Fig. 8 shows. Disconnection is carried out analogously by pushing the pipe section 6b back over the shaft 2a.

[0089] Alternatively, it is conceivable for the second adapter to be inserted laterally over the shaft, bent, or connected in some other way, such as with Velcro or adhesive tape. A different position of the second adapter on the shaft or even partially pushed over the handle is also possible. It is important to note that the corresponding engagement element of the second adapter is then positioned in such a way that it can be connected to the second engagement element in the intended orientation, thus also determining the direction of the shaft.

[0090] Fig. 11 a until 11gshow relevant steps of the inventive method for connecting the surgical instrument 2 to the holding arm, wherein both the holding arm and the instrument 2 are prepositioned in such a way that a low-stress connection and a sensible starting position for a subsequent surgical procedure are possible. The prepositioning can be assisted by the control device of the holding arm to further facilitate the method for connecting the surgical instrument 2 to the holding arm.

[0091] Movements are always carried out in the direction of the block arrow (also in a third dimension outside the drawing plane), whereby in a) and b) the surgical instrument is not yet fixed at a pivot point 43 relative to a body 45, so the movements have no influence on the body 45 and can thus be carried out almost freely. Fig. 11c In the docking situation shown, the surgical instrument 2 may only be moved relative to the body 45 around a fixed pivot point 43; therefore, in c) to e) the holding arm and the first adapter 5 are moved, and only in f) to g) the surgical instrument 2 and the second adapter 6.

[0092] In Fig. 11a The first adapter 5 is connected to the holding arm via the flange piece 4. For this purpose, the holding cone 18 is inserted into the recess 23 of the flange piece 4 and secured by the engagement of the holding rail 24 in the annular groove 22 of the holding cone 18. Alternatively, a second engagement element of the first adapter 5 can be connected directly to a corresponding engagement element of the holding arm, i.e., without the flange piece 4.

[0093] Fig. 11b shows the arrangement of the second adapter 6 on the surgical instrument 2, which can be done by inserting the shaft 2a of the surgical instrument 2 into the through-opening 12 of the tube piece 6b of the second adapter 6 and coupling the coupling element 13 to the corresponding coupling element 30 at the proximal end of the shaft 2a.

[0094] In Fig. 11c The surgical instrument 2 is placed in a trocar 40, which is mounted in a body 45. The puncture site of the trocar 40 in the surface of the body 45 (e.g., the patient's abdominal wall in a laparoscopic procedure) forms a pivot point 43 relative to the body 45, around which the instrument 2 (and the trocar 40) can be pivoted and moved and rotated along its longitudinal axis without damaging the body 45. However, the pivot point is fixed in that any displacement of the same would unnecessarily widen and injure the puncture site.

[0095] It is now possible to guide and connect the two adapters 5, 6 together, so that the surgical instrument 2 is connected to the holding arm and held by it. Thanks to the coordinated engagement elements of the two adapters 5, 6, this final connection step is particularly simple and reliable.

[0096] Particularly advantageously, however, the holding arm can be pre-positioned such that the first adapter 5 is brought into an ideal position for the final connection step and, at the same time, the location of the pivot point 43 in relation to the holding arm is known. For this purpose, a first laser device 41, which is already arranged at the first opening 3 of the first adapter 5 or is now being used, is activated, and the first laser beam 41' emitted along the direction predetermined by the first opening 3 becomes visible on the surface of the body 45. The holding arm and first adapter 5 are then positioned in space such that the first laser beam 41' passes through the pivot point 43, as Fig. 11d For this purpose, it may be necessary to tilt the surgical instrument 2 and the trocar 40 slightly so that the trocar head 40' does not block the path of the first laser beam 41'.

[0097] Subsequently, a second laser device 42, which is already arranged or is now inserted at the second opening 7 of the first adapter 5, is activated, as shown in Fig. 11e The second laser beam 42' emitted in a predetermined direction intersects the first laser beam 41' at an intersection point 44 predetermined by the angles α, β of the openings 3, 7 relative to the longitudinal axis Z of the elongated section 5c and by the distance between the openings 3, 7. In order to place this intersection point 44 on the pivot point 43, the holding arm and first adapter 5 are moved along the direction of the first laser beam 41', i.e. parallel to it, until the second laser beam 42' also passes through the pivot point 43, which consequently now lies at the intersection point 44 of the laser beams 41', 42', as Fig. 11f shows.

[0098] Now the laser devices 41, 42 can be deactivated again and the two adapters 5, 6 can be coupled to each other by guiding the surgical instrument 2 with the second adapter 6 to the position of the first adapter 5 on the holding arm, shown in Fig. 11g , wherein the surgical instrument 2 is pivoted about the fixed pivot point 43. The adapters 5, 6 are engaged by displacing the surgical instrument 2 along its longitudinal axis and threading the connecting body 8 into the receiving space 11a of the rail element 11. The connection can be secured by receiving the nose 10a of the securing clip 10 in the notch 9 of the connecting body 8.

[0099] The pivot point 43 is therefore located at a location known to the system without having to be specifically placed there.

[0100] The surgical holding device, to whose at least one holding arm the surgical instrument 2 is docked, can be part of a controllable surgical robot, in whose control device a docking program can be stored, so that the described steps can be carried out with the support of the holding device. Upon certain user inputs, e.g. pressing a button or entering software commands, the laser devices 41, 42 are then activated or deactivated, or movements of the holding arm connected to the first adapter 5 are blocked, so that when the Fig. 11d / 11e Once the intermediate position shown is reached, the holding arm can only be moved along an axis parallel to the first laser beam 41'. This ensures that the previously set position, in which the first laser beam 41' passes through the pivot point 43, is no longer departed from.

[0101] The correct positioning of the second laser beam 42' and thus the final docking situation can also be confirmed, so that the control device knows and stores the location of the pivot point 43 through the intersection point 44 of the laser beams 41', 42', so that further movements that the surgical instrument 2 is to perform are transmitted by movements of the holding arm in such a way that the pivot point 43 is not displaced.

[0102] After use of the surgical instrument, the connections established with the docking device 1 according to the invention can be released again. The flange piece, if used, can remain on the counterflange. The two-part adapter device can be disposed of and replaced or sterilized and prepared for further use. LIST OF REFERENCE SYMBOLS

[0103] 1Docking device 2Surgical instrument 2aShaft 2bHandle 3First opening 4Flange piece 4'Flange body 4"Sleeve 5First adapter 5Aproximal end of first adapter 5bDistal end of first adapter 5cElongated section of first adapter 6Second adapter 6aRail section of second adapter 6bTube section of second adapter 7Second opening 8Connecting body 8'Terminal connection surface of end section 8"Side facing the elongated section of end section 9Notch 10Securing clip 10aNose 11Rail element 11aReceiving space of rail element 11'Side wall of rail element 11"Rear wall of rail element 12Through opening 13Coupling element,Connecting ring 14Gripping nipple 15Securing projection 16Counter flange 17Screw connection 18Retaining cone 18'Tip of retaining cone (pin for piercing) 20Ring groove 21Collar 22Alignment pin first adapter 23Recess 24Retaining rail 25Guide of the retaining rail 26Spring 27Pin 28Alignment pin second adapter 29Shaped recess 30Protrusion 31Groove 40Trocar 40'Trocar head 41First laser device 41'First laser beam 42Second laser device 42'Second laser beam 43Pivot point 44Intersection of laser beams 45Body, ZLongitudinal axis αfirst angle βsecond angle

Claims

1. A docking device (1) which is designed to connect a surgical instrument (2) to a holding arm of a surgical holding device in a docking situation, wherein the surgical instrument (2) has a rod-shaped shaft (2a) and a handle (2b) and is designed to be guided by means of a trocar (40), wherein the docking device (1) has a two-part adapter device which can be connected at a proximal end to the holding arm and at a distal end to the surgical instrument (2), wherein the two-part adapter device has - a first adapter (5) with an elongated section (5c) having a longitudinal axis (Z), and a connecting body (8) which is present at a distal end (5b) of the first adapter (5) and which has a first engagement element with a terminal connection surface (8'), and - a second adapter (6), which is designed to be arranged on the shaft (2a) of the surgical instrument (2) and which has an engagement element (11) pointing towards and corresponding to the terminal connection surface (8') in the docking situation, wherein the connecting body (8) of the first adapter (5) forms a detachable connection with the corresponding engagement element (11) of the second adapter (6) in the docking situation, characterised in that the terminal connection surface (8') of the first adapter (5) is inclined in relation to its longitudinal axis (Z) by a predetermined first angle (α), which is in a range from 45° to 75°.

2. The docking device (1) according to claim 1, characterised in that the connecting body (8) of the first adapter (5) is designed as a slide (8), at least with its section having the connection surface (8'), and the corresponding engagement element (11) of the second adapter (6) is designed as a rail element (11) for receiving the slide (8).

3. The docking device (1) according to claim 1 or 2, characterised in that the connecting body (8) forms a receptacle for a first laser device (41) and has a first opening (3) as an exit opening for a first laser beam (41'), and the elongated section (5c) of the first adapter (5) forms a receptacle for a second laser device (42) and has a second opening (7) as an exit opening for a second laser beam (42'), wherein the laser beam (42') runs at a second angle (β) with respect to the longitudinal axis (Z) of the first adapter (5), which is smaller than the first angle (α) and lies in a range from 20° to 80° and wherein the first laser beam (41') emerging from the opening (3) intersects the second laser beam (42') emerging from the second opening (7) at a predetermined intersection point (44).

4. The docking device (1) according to claim 3, characterised in that the first opening (3) is a hole in the wall of the connecting body (8), a through-opening (3) or a cylindrical recess in the connecting body (8), wherein the first opening (3) preferably has edges bevelled at an angle, and / or the second opening (7) is a hole in the wall of the first adapter (5), a through-opening (7) or a cylindrical recess in the first adapter (5), wherein the second opening (7) preferably has edges bevelled at an angle, and / or wherein the first opening (3) preferably adjoins the terminal connection surface (8').

5. The docking device (1) according to at least one of claims 1 to 4, characterised in that the corresponding engagement element (11) of the second adapter (6) is arranged over a tubular piece (6b) with a cylindrical passage opening (12) of the second adapter (6), through which the shaft (2a) of the surgical instrument (2) can be guided.

6. The docking device (1) according to claim 5, characterised in that the tubular piece (6b) has a coupling element (13) which can be coupled to a corresponding coupling element (30) at the proximal end of the shaft (2a) of the surgical instrument (2).

7. The docking device (1) according to at least one of claims 1 to 6, characterised in that the first adapter (5) has, at its proximal end (5a), a second engagement element, which is designed to be detachably connected to a corresponding engagement element of the holding arm.

8. The docking device (1) according to at least one of claims 1 to 7, characterised in that the first adapter (5) has, at its proximal end, a holding cone (18), which tapers towards a proximal tip (18').

9. The docking device (1) according to at least one of claims 1 to 8, characterised in that the docking device (1) has a flange piece (4) which is designed to be arranged on a corresponding mating flange (16) of the holding arm, wherein the flange piece (4) preferably has a conical recess (23) which corresponds to an outer circumferential shape of the holding cone (18) for receiving the holding cone (18).

10. A surgical holding device which has at least one holding arm which is connected via a docking device in a docking situation to a surgical instrument (2) which has a rod-shaped shaft (2a) and a handle (2b) and is designed to be guided through a trocar (40), characterised in that the docking device is a docking device (1) according to at least one of claims 1 to 9.

11. The surgical holding device according to claim 10, characterised in that the surgical holding device is a surgical robot with at least one robot head, wherein the surgical robot has a control device for the controlled movement of the holding arm.

12. The surgical holding device according to claim 11, characterised in that the control device can be connected to a first laser device (41), which is preferably arranged at the first opening (3), and a second laser device (42), which is preferably arranged at the second opening (7) of the first adapter (5) of the docking device (1), wherein the laser devices (41, 42) are aligned with respect to one another such that their laser beams (41', 42') intersect at a predetermined intersection point (44), wherein the laser devices (41, 42) are laser fibres which can be connected to a laser beam source, or laser modules with their own laser beam source.