Endoscopic instrument system

Abstract

The invention relates to an endoscopic instrument system in which sound that is produced on the distal end by coupling in HF current in tissue is transmitted proximally via a structure-borne sound transmitting element and is then converted on the proximal end by an electroacoustic converter device. The resulting signal can be used in many ways to draw conclusions about the situation on the distal end.

Description

[0001] Endoscopic instrument system

[0002] FIELD OF THE INVENTION

[0003] The present invention relates to an endoscopic

[0004] Instrument system, particularly for minimally invasive surgery on a human body.

[0005] TECHNICAL BACKGROUND

[0006] In surgery and especially in minimally invasive surgery

[0007] (MIC) is the problem that an exact characterization of tissue, especially of deeper tissue structures, during surgery is difficult or only possible with great effort and sufficient information. Furthermore, with MIS, the surgeon is not able to determine the

[0008] To examine the consistency of a tissue area. It is primarily

[0009] Line depends on the endoscopic image, which shows the surface of the

[0010] organs or the intracorporeal cavity. Even more difficult is the continuous monitoring of a

[0011] Tissue interaction, such as treating the tissue via

[0012] Microwave or radiofrequency (HF) surgical systems consisting of a generator and an instrument with which electrical

[0013] Energy is supplied to the tissue.

[0014] With HF surgery systems, electrically applied energy is spontaneously converted into heat, depending on the mode for

[0015] Cutting, coagulating, or welding tissue. While it is possible to use intraoperative imaging techniques such as magnetic resonance imaging or X-ray computed tomography to determine the condition of non-visible tissue areas, this is costly and time-consuming.

[0016] Real-time procedure that allows intraoperative control of HF

[0017] Interaction is therefore not possible. In addition, there are endoscopically applicable procedures such as optical coherence tomography (OCT) or intracorporeally applicable scanners that enable intracorporeal imaging.

[0018] Tissue imaging behind the endoscopically displayed tissue

[0019] surfaces. However, these methods are also cost-intensive and cannot be used for special characterizations and monitoring, e.g., in thermally induced

[0020] Tissue manipulations are not used or are used only to a limited extent due to the space required and the limited, non-specific information.

[0021] Frequently performed tissue manipulations include the closure of vessels, e.g., using bipolar or monopolar

[0022] High-frequency instruments that are electrically powered by a high-frequency

[0023] Generator. Relevant and for the successful

[0024] The outcome of the operation is the knowledge whether such

[0025] Vascular closures are performed safely and sufficiently firmly. There is a requirement and need for quantitative statements about the

[0026] Condition of the tissue during and after the corresponding

[0027] Manipulation can be made.

[0028] DE 10 2019 108 140 Al describes a bipolar electrosurgical instrument from the state of the art.

[0029] US 2010 / 0168572 Al describes a system for removing

[0030] tissue. The system comprises a catheter with an elongated

[0031] Body which has a high frequency electrode for removing the

[0032] tissue and an acoustic transducer in the distal

[0033] end region of the elongated body. With the acoustic

[0034] Transducers can capture acoustic signals. A monitoring unit can capture electrical signals from the transducer and interpret them as therapeutic parameters. These parameters can be presented to a user graphically, visually, or haptically.

[0035] SUMMARY OF THE INVENTION

[0036] The inventors have found that the detection and direct

[0037] The processing of sound inside the human body has a low signal-to-noise ratio. One reason for this has been identified as electromagnetic fields and

[0038] Signals associated with a high-frequency electrical current coupled into the body in an undesirable

[0039] way interfere with piezoelectric elements, which are used to

[0040] Converting sound into electrical signals.

[0041] The present invention therefore at least solves the problem of how to couple electrical current into the human body with high precision and effectiveness, while simultaneously performing precise recordings and conversions of sound to provide feedback to a user. Furthermore, increased design freedom is desired for those elements that are inserted into a patient.

[0042] This problem is solved at least by the subject matter of independent patent claim 1.

[0043] Accordingly, an endoscopic instrument system for minimally invasive surgery on a human body is provided, comprising: an endoscopic instrument comprising at least: a distal functional device comprising a

[0044] (preferably bipolar) electrode arrangement designed to deliver a high-frequency electrical current, HF-

[0045] current into organic tissue (especially soft tissue) within the human body and further comprising a structure-borne sound recording element for recording a

[0046] Structure-borne sound response of the organic tissue to the coupled RF current; a proximal actuation device for handling the

[0047] Instrument system (especially the endoscopic

[0048] Instrument) and for actuating the functional device from outside the human body; and an elongated connecting device which

[0049] Functional device mechanically and functionally with the

[0050] Actuating device, whereby the

[0051] Connecting device comprises a structure-borne sound transmission element which is designed to transmit the

[0052] acoustically transmit the structure-borne sound response recorded by the structure-borne sound recording element in the direction of the actuating device; and an acoustic-electrical transducer device which is designed to be arranged outside the human body when the instrument system is in use, and which is also designed to record the structure-borne sound response at the transmission element and to convert it into an electrical

[0053] to convert response signal.

[0054] An endoscopic instrument system is understood to mean, in particular, an instrument system that has a part that is inserted into a human body for treatment or examination. Minimally invasive surgery in this context can mean, for example, that no large-scale opening of the body is made, but rather the surgeon operates through a minimal opening. The terms "distal" and "proximal" are always used here from the perspective of the user, i.e., the surgeon or

[0055] surgeon. Accordingly, the proximal side is a side that is closer to the surgeon, while the distal side is a side that is

[0056] surgeon is oriented towards the patient.

[0057] Accordingly, the functional device which

[0058] Electrode arrangement, arranged distally on the instrument, while the actuating device for handling the

[0059] Instrument system is arranged proximally to the instrument.

[0060] The endoscopic instrument system according to the invention can be operated and / or handled equally by human surgeons and by robots. Accordingly, the proximal side is also the side at which a robot would engage the endoscopic instrument system, in particular the proximal actuating device. Whenever reference is made herein to use by a surgeon and / or by a robot, it is understood, unless explicitly or implicitly stated otherwise, that the operation and / or handling can also be performed by the other.

[0061] A robot is understood to mean, for example, a robot arm which handles and / or operates the endoscopic instrument system in a controlled manner.

[0062] Handling is understood to mean, in particular, the spatial movement and alignment of the instrument. Operating the instrument includes, in particular, triggering, changing, or deactivating a mechanical, electrical, electronic, or other energy-emitting function (e.g., lighting) of the instrument.

[0063] The coupling of high-frequency electrical current, HF-

[0064] Current takes place intracorporeally and is primarily used to couple or introduce heat. This, in turn, is particularly useful for tissue fusion, i.e., for example, to permanently join two different pieces of tissue together.

[0065] For example, a damaged or malignant piece of tissue can be surgically removed by a surgeon, and the remaining incision edges can then be

[0066] Electrode arrangement are fused together to close the gap created during the operation.

[0067] High frequency current is a current with a

[0068] A frequency of at least 300 kHz is understood. Frequency ranges above 300 kilohertz have the advantage that they trigger no, or fewer, critical nerve impulses. Tissue fusion can be used, for example, in the context of vascular sealing, i.e., closing an opening in a vessel.

[0069] Structure-borne noise refers to any type of

[0070] Objects - including organic tissue - propagating acoustic longitudinal and / or transverse waves, covering a wide frequency spectrum.

[0071] Frequency spectrum can include especially human audible sound and / or ultrasound. Sound propagation within organic soft tissue is often more like the

[0072] Sound propagation in liquids is similar to sound propagation in classical solids. Sound transmitted within organic tissue can also be referred to as intra-tissue sound.

[0073] A structure-borne sound response of organic tissue to the coupled RF current is understood to be a signal mediated by structure-borne sound as a carrier, which is generated in the organic tissue as a reaction to the coupled RF current and is transported through it as structure-borne sound. For example, the application of RF energy, i.e. the coupling of RF current into the organic tissue and its spontaneous conversion into heat, can cause cells, cell clusters, and / or fluid bubbles to rupture and burst. The resulting noises ("bursting") are transmitted, among other things, or exclusively, through the organic tissue as structure-borne sound and can thus be recorded by the structure-borne sound recording element as a structure-borne sound response. They thus provide valuable information about the processes in the organic tissue that are usually invisible to the surgeon.

[0074] tissue .

[0075] The structure-borne sound recording element is preferably made of an electrically insulating ceramic material and has an acoustic impedance of preferably between 15 * 10 6 and 35 * 10 6 [kg / (s * m' ) ] on .

[0076] The fact that the connecting device should be elongated means in particular that the device is elongated in the longitudinal direction, which extends between the proximal

[0077] side and the distal side, is longer than in a direction perpendicular to it. A mechanical

[0078] Connection of the functional device with the

[0079] Actuating device may comprise a structural connection so that the actuating device and the

[0080] The functional device is arranged in particular rigidly to each other. The mechanical connection can also include the possibility of mechanical manipulation, for example, of a trigger or

[0081] Handle on the operating device mechanically to the

[0082] Functional device is transferred.

[0083] For example, by operating a wire pull, a

[0084] The jaw part of the functional device can be opened or closed. A functional connection between the

[0085] The functional device and the actuating device should, in particular, include the fact that a function of the functional device can be triggered, modified, or terminated by means of the actuating device. For example, this function can involve opening or closing a jaw part of the functional device, delivering an electrical HF current through the electrode arrangement, or the like.

[0086] As already explained at the beginning, the inventors have found that in the vicinity of the distal functional device, an acoustic-electrical conversion of structure-borne sound signals into electrical signals is subject to considerable interference, which is generated, among other things, by the electromagnetic signals emanating from the electrode arrangement.

[0087] According to the invention, it is therefore provided that the acoustic-electrical transducer device when using the

[0088] Instrument system is arranged outside the human body, that is to say at a position which is advantageously arranged away from the sources of interference within the human body.

[0089] A decisive advantage of this spacing is that thermal and electromagnetic influences or disturbances of the converter device due to the RF

[0090] Energy coupling in the area of ​​the functional device can be reduced or even completely avoided. This also applies to disturbances due to, for example, mechanical

[0091] Deformations of organic tissue caused by

[0092] Functional device, such as a jaw part, in a

[0093] Compression of organic tissue.

[0094] The spacing of the acoustic-electrical transducer device from the distal working elements, i.e. the

[0095] Functional device as well as the organic tissue (to be treated) also has the advantage that it allows for a prolonged

[0096] The sound propagation time between the structure-borne sound pickup element and the acoustic-electrical transducer device is . Thus, the structure-borne sound response can be measured, for example, after switching off the HF

[0097] electricity can be converted more smoothly.

[0098] In particular, the RF current coupled distally can cause considerable electrical interference in the state of the art, since, for example, RF-induced electrical

[0099] Breakdowns, such as arcs, such as electrical

[0100] Jammers work . In addition, the arrangement of the

[0101] The advantage of a converter device on the proximal part of the endoscopic instrument is that the

[0102] Converter device can be designed with lower requirements and thus greater design freedom and also the

[0103] Cleaning and maintenance is easier. In addition, a

[0104] Shielding against electromagnetic interference can be achieved using a shielding housing.

[0105] The aim is usually to make the functional device as small as possible so that many different functionalities are arranged in a small space.

[0106] In addition, the functional device comes into constant contact with liquids, heat fluctuations, fluctuations in the electromagnetic field and the like, depending on the application.

[0107] An electro-acoustic transducer device in the

[0108] Integrating, designing and miniaturising functional equipment in such a way that it functions perfectly and reproducibly in this environment is a complex

[0109] Challenge, which leads to complex and on the one hand much more error-prone and on the other hand significantly more cost-intensive

[0110] Therefore, according to the invention, the transducer device is arranged outside the human body when using the instrument system, in particular the instrument, and does not necessarily have to be specially insulated or protected against the influences mentioned. Even with a proximal arrangement, a certain (lesser) protection, shielding and electrical decoupling is required. However, this protection can be implemented much more easily on the proximal side. The electro-acoustic transducer device can be

[0111] housing, for example in a handle.

[0112] The handle is usually already hermetically sealed, on the one hand to protect against external influences and on the other hand for hygienic reasons. Furthermore, the installation space on the proximal side is not limited and therefore no

[0113] Miniaturization is required and can therefore (cost-effectively)

[0114] (electrical) standard parts, assemblies and components are installed.

[0115] The structure-borne sound receiving element and / or the structure-borne sound transmission element are designed and configured in particular for receiving or transmitting audible sound and / or ultrasound. As a particularly preferred

[0116] The inventors have identified the following frequency ranges for the structure-borne sound to be recorded and transmitted: 1-20 kHz and 20-80 kHz.

[0117] The electrical response signal generated by the

[0118] converter device can be supplied to a variety of applications and / or used to control a variety of

[0119] functions are used, as will be described in more detail below.

[0120] The functional device can be designed in particular for coupling RF current into soft tissue, particularly preferably vessels and / or tubular organs. The electrode arrangement for energy application by coupling RF current can be designed and configured in particular for vessel sealing by applied electrical monopolar RF energy and / or for vessel sealing by applied electrical bipolar RF energy.

[0121] According to some preferred embodiments, variants or

[0122] Further developments of design forms are shown by the

[0123] Functional device a first jaw part and a second

[0124] jaw part, which are designed to be

[0125] Relative movement to each other to grip the organic tissue. The first jaw part can be arranged rigidly with respect to the connecting device. Preferably, the structure-borne sound receiving element is arranged on this rigidly arranged first jaw part, which has the advantage that the transmission of the structure-borne sound is less disturbed by movements of the first jaw part itself and that the transmission element can be designed comparatively simpler. The receiving element and the transmission element can be designed as one piece, which leads to optimal structure-borne sound transmission proximally.

[0126] For example, the transmission element can preferably be designed as a rigid, elongated element. Alternatively, it is also possible for the structure-borne sound receiving element to be arranged on a movable second jaw part or on both

[0127] Jaws each have structure-borne sound recording units of the

[0128] structure-borne sound pickup element. The

[0129] In order to adapt to the movement of the movable jaw part, the transmission element can also be designed to be flexible, articulated, bendable or similar.

[0130] If the structure-borne sound recording unit and the structure-borne sound transmission unit are not designed as a single piece, or cannot be designed as a single piece due to their design, the individual units are preferably connected to each other in a form-fitting manner and by appropriate forces that maintain the form-fitting connection even during sound transmission. Such a form-fitting, force-loaded

[0131] Connection could e.g. be a standard pin-hole joint

[0132] Connection in the distal mechanics for closing jaw parts, whereby pins and holes have tensile forces with which the

[0133] Jaw parts are closed and are connected to each other in a force-locking and form-locking manner.

[0134] Jaw parts are usually referred to as distal-side actuator elements, which can be moved relative to each other in a jaw-like or flat-toothed manner in order to open the "mouth" or the

[0135] "forceps" to open or close . In this way, organic tissue can be grasped and held . This allows the RF current to be coupled into the organic tissue with high precision, for example to

[0136] to fuse tissue or the like.

[0137] It is particularly preferred if the electrode arrangement is arranged on the first and / or the second jaw part, preferably only on one jaw part, particularly preferably on the rigid first jaw part. In combination with a structure-borne sound recording element arranged on the first jaw part, this has the effect that the structure-borne sound response of the organic

[0138] Tissue's response to the coupled RF current can be tapped as close as possible to where it is induced by the coupling of the RF current.

[0139] Accordingly, according to some preferred embodiments,

[0140] Variants or further developments of embodiments, the electrode arrangement on the first jaw part and / or the second

[0141] Jaw part arranged, in particular on a respective inner side of the first jaw part and / or the second jaw part. The inner sides of the jaw parts are those sides of the jaw parts which move towards each other when the jaw parts are closed and, if necessary,

[0142] Contact . Preferably, the structure-borne sound recording element is spatially arranged between a first electrode of the electrode arrangement and a second electrode of the electrode arrangement, wherein the first electrode and the second electrode of the

[0143] Electrode arrangement particularly preferably on a rigid first

[0144] jaw part are arranged.

[0145] The structure-borne sound pickup element is thus positioned in maximum proximity to the point where the RF current is coupled into the organic tissue. The structure-borne sound response can thus be recorded with particular precision and thus also has a particularly good

[0146] Signal-to-noise ratio on .

[0147] The structure-borne sound pickup element is generally advantageously arranged in a functional area of ​​the instrument in such a way that when the instrument is in use it is as directly as possible connected to the

[0148] Place of origin of sound events, i.e. in particular in contact with the tissue to be treated. Some variants of the

[0149] Instruments have a bridge on one jaw part to

[0150] Pressing the jaws together creates increased pressure in a

[0151] to create an area through which the coupled RF current flows. This creates an area of ​​highly compressed, compressed tissue with a low volume through which the coupled RF current can be conducted. This combination ensures an efficient effect of the RF current. This is particularly advantageous for so-called vessel-sealing instruments, i.e.

[0152] Vessel sealing instruments, which are used to seal vessels, are compressed in the tissue and are sealed by means of the HF

[0153] current. In such instruments with a bridge, the structure-borne sound

[0154] The receiving element should preferably be arranged in the functional surface of the web, i.e. in or on the surface with which the fabric can be compressed. This surface can also be called a gripping surface. Alternatively or additionally, the structure-borne sound

[0155] Receiving element can also be arranged on a surface of a jaw part, which is opposite the functional surface of the web (contact surface) and interacts with it.

[0156] The structure-borne sound pickup element can be made of an electrically insulating material and / or be provided with electrical insulation. This is particularly advantageous if the structure-borne sound pickup element is arranged in such a way that it can be connected to a

[0157] adjacent to the tissue area through which electrical current is conducted. Alternatively, the structure-borne sound pickup element can also be made of electrically conductive materials.

[0158] (e . g . steel etc . ) or include such . In these cases, it is advantageous if the proximal side of the instrument has a

[0159] A compensation device is arranged which is designed to avoid, reduce or compensate for disturbing electrical influences and couplings. For example, the structure-borne sound transmission element can be designed from distal to proximal in such a way that disturbing electrical influences or

[0160] Couplings are avoided, zz .. BB .. in that the structure-borne sound transmission element is made entirely or partially from non-conductive material and / or is electrically insulated or shielded accordingly.

[0161] The structure-borne sound pickup element can generally be advantageously designed so that sound events in the tissue are picked up with as little loss as possible (e.g., due to reflections) and transmitted from distal to proximal with as little loss as possible. For this purpose, the acoustic impedance (or acoustic impedance) can preferably be selected so that it is as close as possible to that of the tissue to be treated. In some

[0162] In some embodiments, a sound characteristic impedance

[0163] An adaptation device may be provided which is designed to adapt the acoustic characteristic impedance of the structure-borne sound recording element, either automatically or due to a manual

[0164] Attitude .

[0165] Values ​​between 1.4 Ns / m 3 and 104 Ns / m 3 proven, preferably between 20 Ns / m 3 and 80 Ns / m3 , particularly preferably between 40 Ns / m 3 and 60 Ns / m 3 . The

[0166] Structure-borne sound absorption element can be thin and flat, which is useful for absorbing transverse, longitudinal and additional vibrations (e.g.

[0167] Bending vibrations) can be advantageous. Such a thin and flat structure-borne sound absorption element can, for example, have wall thicknesses in the range of 0.2 mm to 1.0 mm.

[0168] The structure-borne sound recording element can, for example, comprise or consist of one or more of the following materials:

[0169] Steel (e.g. surgical steel);

[0170] ceramic material;

[0171] Plastic material (in particular with a Shore A value of less than 70, see below); a reinforced, electrically insulating

[0172] Plastic material comprising glass beads, glass fibers,

[0173] Carbon fibers, quartz, ceramics and / or other fillers and / or reinforcing materials; and / or the like. According to some preferred embodiments, variants or

[0174] Further developments of embodiments can also use one or both electrodes of the electrode arrangement as structure-borne sound

[0175] receiving element or part of a

[0176] Form a structure-borne sound recording element.

[0177] According to some preferred embodiments, variants or

[0178] Further training of design forms can also be an entire

[0179] The jaw part must be designed as a structure-borne sound pickup element.

[0180] According to some preferred embodiments, variants or

[0181] Further developments of design forms are shown by the

[0182] Transducer device comprises a piezoelectric element, particularly preferably a piezoelectric element which is arranged in the proximal region in such a way that it

[0183] Use of the instrument is arranged outside the body.

[0184] Piezoelectric elements are particularly well suited to detecting acoustic vibrations, whether longitudinal and / or

[0185] Transverse waves, into electrical signals.

[0186] In principle, all piezoelectric materials known in the state of the art can be used. A piezoelectric

[0187] The element can be made of lead zirconate titanate (PZT) or contain PZT. Piezoelectric elements are also possible.

[0188] Elements made of zinc oxide ceramic, or flexible piezopolymers such as piezoelectric foils made of PVDF (polyvinylidene fluoride or polyvinylidene difluoride) and / or composites thereof and / or of

[0189] PZT .

[0190] Piezoelectric fibers, which may comprise and / or consist of PVDF nanofibers or PZT fibers, are also possible. The preferred shape and arrangement of the one or more piezoelectric elements depends on the desired application, the properties (frequencies) of the structure-borne sound response, and whether transverse and / or longitudinal vibrations and / or other

[0191] Structure-borne sound waves such as "bending waves" are to be recorded and converted. Such additional structure-borne sound waves can be created, for example, by coupling longitudinal and transverse waves.

[0192] PVDF has the advantage of a very high dynamic and frequency range (10~ 8 up to 10 5 N / cm 2 or 0 .1 Hz - 1 GHz) and is therefore well suited for detecting low

[0193] (Body) sound pressures in a wide frequency range. In addition, temperature changes also lead to charge changes in the

[0194] PVDF foil material. This makes it possible to measure the temperature distally with a PVDF element and the structure-borne sound response proximally at the structure-borne sound transmission element by means of

[0195] PVDF element , e . g . a PVDF film, to capture . Even a

[0196] Temperature sensor of the instrument system, especially the

[0197] Instruments, a piezo element, in particular a PVDF

[0198] foil, have .

[0199] For converting transverse vibrations, a piezoelectric foil arranged concentrically around the connecting device is advantageous. For converting longitudinal

[0200] Vibrations is a at a proximal end of the

[0201] Piezoelectric element attached to the connecting device

[0202] (or another converter device) is advantageous.

[0203] According to some preferred embodiments, variants or

[0204] Further training of design forms includes the

[0205] Converter device an optical detection system, for example based on a time-resolved

[0206] Distance measurement, which is realized by measuring the time of flight of a laser beam in the manner of an "optical microphone". In this way, a mechanical decoupling between the converter device and the transmission element can be advantageously provided, which can further increase the design freedom, since the

[0207] The converter device does not necessarily have to be fitted perfectly to the transmission element.

[0208] According to some preferred embodiments, variants or

[0209] Further training of design forms includes the

[0210] Converter device a MEMS sensor, in particular a MEMS

[0211] Accelerometer, i.e., an acceleration sensor. Such high-precision MEMS accelerometers, which are known from the state of the art, can also be used to precisely record and convert the structure-borne sound response transmitted via the transmission element.

[0212] According to some preferred embodiments, variants or

[0213] In further developments of embodiments, the transducer device is designed to detect structure-borne sound transverse waves and / or to detect structure-borne sound longitudinal waves and / or other structure-borne sound waves on the structure-borne sound transmission element. The structure-borne sound transmission element can have individual sound transmission units, of which, for example, one is designed to transmit structure-borne sound longitudinal waves and / or the next to transmit structure-borne sound transverse waves and / or another to transmit further

[0214] Structure-borne sound waves such as bending waves are formed.

[0215] The converter device can also have two or more

[0216] converter units, for example a first

[0217] Transducer unit used to detect structure-borne sound

[0218] Transverse waves and a second transducer unit which is designed to detect structure-borne sound longitudinal waves on the structure-borne sound transmission element and, for example, a further transducer unit for

[0219] Detection of further structure-borne sound waves such as flexural waves. The first, the second and / or several transducer units can be integrated into one another, adjacent to one another or arranged separately. Since different processes and events within the organic tissue produce different types of

[0220] can generate structure-borne sound waves, the separate recording of structure-borne sound transverse waves on the one hand and structure-borne sound

[0221] Longitudinal waves, on the other hand, provide valuable clues to this

[0222] events and allow for corresponding conclusions. A common electrical response signal can be generated, or the electrical response signal can be a first electrical

[0223] response signal, which is generated by electrical conversion of the

[0224] structure-borne sound transverse waves and comprise a second electrical response signal which is generated by electrical

[0225] Converting the structure-borne sound longitudinal waves was generated.

[0226] For detecting structure-borne sound longitudinal waves, a piezoelectric element of a transducer device can be arranged in a proximal end face or in a cross-sectional area of ​​a proximal region of a shaft of the

[0227] connecting device or an internal working element. This can be, for example, a PZT ceramic

[0228] pane, a PVDF film or the like.

[0229] An internal working element can be understood as, for example, pulling and / or pushing elements for moving distal actuators such as jaw parts, cutting blades, etc.

[0230] Examples of tension and / or compression elements are e.g.

[0231] Pull rod and / or push rod or a pull rope / wire.

[0232] It is also conceivable that a piezoelectric element of a

[0233] A transducer device is integrated into a component for transmitting the electrical current. In a further embodiment, a suction-irrigation tube or similar device integrated into or located inside the shaft can be used as a structure-borne sound transmission element, and a transducer device can be mounted in its proximal area.

[0234] In a further embodiment, at least one internal

[0235] Additional structure-borne sound transmission element located or integrated in the instrument shaft as a wire or rod-shaped

[0236] Element to which one or more

[0237] Converter units are mounted. This design has the

[0238] The advantage is that the structure-borne sound transmission can then be completely decoupled from other (mechanical) functions. This also allows the wire- or rod-shaped structure-borne sound transmission element(s) to be adapted in cross-section and length to the most important frequencies to be transmitted, in order to specifically exploit resonance effects for certain frequency ranges.

[0239] According to some preferred embodiments, variants or

[0240] In further developments, the transducer device is integrated into the endoscopic instrument. This allows for a particularly compact arrangement and easy handling, since no additional device or element needs to be handled in addition to the endoscopic instrument.

[0241] According to some preferred embodiments, variants or

[0242] In further developments of the design, the structure-borne sound transmission element is designed to be thin and slender. For example, the structure-borne sound transmission element can have a cross-section of

[0243] 0.05 mm to 10 mm, preferably between 0.2 mm and 5 mm, particularly preferably between 0.3 mm and 0.5 mm.

[0244] The structure-borne sound transmission element can be mounted or supported flexibly and / or movably, allowing it to vibrate freely both transversely and longitudinally. For example, unnecessary "stiffeners" and / or contact and / or attachments between the sound-transmitting element(s) and other components can be deliberately avoided by design.

[0245] According to some preferred embodiments, variants or

[0246] In further developments of embodiments, a structure-borne sound transmission element made of a relatively harder material can be fully or partially embedded in or surrounded by a relatively softer medium. In this way, the structure-borne sound transmission element can vibrate with as little damping as possible. The relatively softer medium preferably has a hardness of 1000 MPa or less (e.g. a thin plastic sheathing) and / or a Shore A hardness of less than 70 (preferably less than 50, particularly preferably less than 30) and / or a density (in the case of foams) of less than 30 kg / cbm with the preferred use of open-pore foams.

[0247] According to some preferred embodiments, variants or

[0248] Further developments of embodiments include the endoscopic

[0249] The instrument system also comprises a trocar sleeve through which at least the functional device can be guided and introduced into the human body during minimally invasive surgery. The converter device can advantageously be integrated into the

[0250] A trocar sleeve can be integrated. One advantage of this is that the endoscopic instrument can be designed more simply.

[0251] In addition, the correspondingly designed trocar sleeve can be used together with a variety of different endoscopic instruments, whereby it must only be ensured that the structure-borne sound response at the transmission element can be detected by the transducer device integrated into the trocar sleeve. According to some preferred embodiments, variants or

[0252] In further developments of the embodiments, the converter device is attached to a sealing device of the trocar sleeve, which seals a distal space within the trocar sleeve from a proximal space within the trocar sleeve. Sealing devices are naturally designed and configured in such a way that they fit particularly closely to the endoscopic instrument passed through the trocar sleeve in order to ensure a particularly good seal. This close contact is also advantageous for

[0253] Sealing device mounted transducer device which transmits the structure-borne sound transmission element

[0254] To record structure-borne sound response reliably and accurately.

[0255] In this case, it is advantageous if the structure-borne sound transmission element is arranged at least partially on an outer side of the endoscopic instrument in such a way that at least the part arranged on the outer side is in contact with the

[0256] Sealing device arranged transducer device is in contact, while the endoscopic instrument is passed through the

[0257] trocar sleeve is passed through.

[0258] According to some preferred embodiments, variants or

[0259] In further developments of the embodiments, the transducer device is mounted on the trocar sleeve in such a way that it is pressed or can be pressed against the structure-borne sound transmission element, while the functional device is guided through the trocar sleeve. As already mentioned above, this can be achieved by mounting the transducer device on a

[0260] Sealing device of the trocar sleeve is attached.

[0261] According to other variants, a movable mounting can also be provided, for example, using a spring element such as a coil or leaf spring. An advantage of this is that the pressing of the transducer device against the structure-borne sound transmission element (or at least a part thereof) enables particularly good structure-borne sound transmission between the structure-borne sound transmission element and the transducer device, whereby the response signal is in turn

[0262] Converter device particularly accurate and with high signal

[0263] noise ratio can be generated.

[0264] According to some preferred embodiments, variants or

[0265] In further developments of the embodiments, the structure-borne sound transmission element comprises a rigid solid body, a hollow waveguide, and / or a prestressed wire. These are various implementation options that provide both reliable structure-borne sound transmission and good compatibility with the requirements of an endoscopic instrument system, in particular an endoscopic instrument.

[0266] Examples of structure-borne sound transmission elements, particularly for rigid instruments, are: a rigid, elongated, metallic rod; a rigid, elongated metallic tension-compression transmission element; and / or a rigid, elongated instrument shaft (e.g. shaft of the connecting device).

[0267] Examples of structure-borne sound transmission elements, particularly for flexible instruments, are: a flexible wire with pre-tension; a flexible tension-compression transmission element, e.g. implemented in the form of a Bowden cable; a flexible light guide; and / or a flexible sound conductor in the form of a

[0268] Hollow waveguide, e.g. a tube filled with a liquid, e.g. water, oil, or a metallic liquid such as a gallium alloy.

[0269] According to some preferred embodiments, variants or

[0270] Further training of design forms includes the

[0271] The instrument system further comprises a computing device configured to receive the electrical response signal and to generate an output signal based at least thereon.

[0272] The output signal can be designed in a variety of ways and can, for example, be designed to control an output device such as a screen and / or a loudspeaker.

[0273] The output signal can advantageously be a quantitative

[0274] Tissue characterization and / or monitoring, especially of manipulated tissue, for example in

[0275] RF current-assisted tissue fusion through an endoscopic (RF-

[0276] Current) instrument. Such monitoring is particularly advantageous to decide whether the thermally induced

[0277] Occlusion of a blood vessel is sufficiently stable to withstand the corresponding maximum pressure (greater than the maximum systolic blood pressure). The output signal can therefore generally indicate a quantitative tissue characterization or specifically indicate whether a

[0278] Tissue closure is sufficiently stable.

[0279] It has been found that the acoustic information contained in the structure-borne sound response depends, among other things, on the type of tissue (especially soft tissue), on the introduced energy density, on the resulting

[0280] Temperature, the fluid content of the tissue and the

[0281] The number of denatured tissue areas or cell clusters depends on this. Due to the resulting cavitation effects (bangs / bursts), this acoustic information lies not only within the frequency range of human hearing (below 20 kilohertz), but also above it (ultrasound, from 20 kilohertz).

[0282] It has also been shown that the more intensive the vascular sealing, the worse it is to be classified.

[0283] Cavitation events (“bursts”) and the closer to the end of the

[0284] vessel sealing process these occur.

[0285] The computing device can therefore be based on an analysis of the

[0286] Structure-borne sound response is a characteristic description of the

[0287] Tissue condition during and shortly after treatment (i.e.

[0288] Coupling of RF current). The output signal can therefore indicate the current tissue condition of the organic tissue.

[0289] The computing device may in particular be a

[0290] A general-purpose computer that is specifically configured for this application. The computing device can be completely local, completely remote (e.g., cloud computing platform, remote server), or partially local and partially remote.

[0291] (e.g. local terminal connected to remote

[0292] Server). The computing device can in particular have one or more central processors (CPU,

[0293] Central Processing Unit), one or more

[0294] Graphics processing units (GPU, Graphics Processing

[0295] Unit), a RAM (Random Access Memory), a non-volatile data memory and input and / or

[0296] Have output interfaces, all of which are effectively connected to one another.

[0297] The computing device may also comprise one or more application-specific integrated circuits (ASICs).

[0298] Application-Specific Integrated Circuit), field programmable

[0299] Logic gates (FPGAs, Field-Programmable Gate Arrays), microprocessors, and / or the like. The computing device can be implemented entirely in hardware, or partly in hardware and partly in software.

[0300] According to some preferred embodiments, variants or

[0301] In further developments of embodiments, the computing device is designed to generate the output signal in real time.

[0302] In this way, the output signal for a user of the endoscopic instrument system, in particular a

[0303] Surgeons, valuable real-time feedback on the

[0304] events in the organic tissue. The

[0305] The instrument system can thus include an improved and controlled human-machine interaction, which enables the

[0306] Users are allowed to obtain information about internal processes or conditions in the instrument system based on the output signal

[0307] To become aware of it and to respond appropriately.

[0308] According to some preferred embodiments, variants or

[0309] In further developments of embodiments, the output signal comprises an audible acoustic output signal. Such an acoustic

[0310] The output signal can advantageously represent different states of the organic tissue into which the electrical RF current has been or is currently being coupled, and / or

[0311] The audible acoustic output signal may comprise spoken speech, which may be generated, for example, by a speech generator. The speech may be

[0312] They can be generated and output in quasi-real time, or after each RF coupling process, for example with the aim of evaluating and / or identifying possible problems that may have occurred.

[0313] However, the audible acoustic output signal can also be an accurate reproduction or a frequency-shifted reproduction of the structure-borne sound pickup element in a defined

[0314] Frequency range, for example in the ultrasound range, similar to how a false colour image comprises a frequency-shifted representation of an electromagnetic spectrum that is actually imperceptible to humans and is visible to a human.

[0315] As a further alternative, the audible acoustic

[0316] Output signal may also include a continuous sound output with different acoustic frequencies audible to humans, each of which indicates a condition or process in the organic tissue, i.e. communicates it to the user.

[0317] For example, the computing device can determine, based on the electrical response signal of the acoustic-electrical transducer device, whether the coupling of the RF current is currently within acceptable parameters. If, for example, too much heat is coupled in at a specific point, the undesirable effects described above can occur.

[0318] A pitch (corresponding to a frequency) of the audible acoustic output signal can indicate, discretely or continuously, whether the function currently performed by the functional device is completely within the acceptable range (for example

[0319] Example low frequency) , completely in the unacceptable

[0320] range (for example, high frequency) , or in between (frequency interpolated between the high frequency and the low frequency).

[0321] The particular advantage of an audible acoustic output signal is that the user of the endoscopic

[0322] Instrument system usually on the one hand by the

[0323] View of the patient and the instrument a visual

[0324] receives feedback on the course of the surgical procedure and, if the endoscopic instrument is guided manually, also experiences haptic feedback.

[0325] An audible acoustic output signal extends these feedbacks with an acoustic feedback, which thus opens up an additional information channel for the user to use without impairing the visual and / or haptic feedback channel.

[0326] According to some preferred embodiments, variants or

[0327] In further developments of embodiments, the computing device and / or the converter device are configured such that the

[0328] Output signal is based only on response signals which are based on a structure-borne sound response which was recorded while no electrical RF current was coupled.

[0329] In other words, a measurement of the structure-borne sound response is carried out intermittently (or alternating) to a pulsed RF

[0330] Energy application . Switching off the pulsed electrical

[0331] HF current can be used to measure, i.e. in particular

[0332] Evaluating the electrical response signal of the

[0333] converter device, trigger (or : trigger).

[0334] For example, the entire endoscopic instrument system can be designed and configured in such a way that phases of

[0335] Alternate the coupling of the electrical RF current with phases of evaluating the response signal. For the timing of the

[0336] Coupling and e.g. evaluation, a signal exchange between a high-frequency generator of the instrument system and the computing device can be provided. Due to the temporal

[0337] Voting can ensure that the

[0338] The response signal generated by the converter device is disturbed or distorted as little as possible by the coupling of the electrical RF current.

[0339] Due to the inventive distance between distal

[0340] However, in many cases, the signal-to-noise ratio is already excellent between the structure-borne sound pickup element and the proximal transducer device. In these cases, a continuous analysis of the response signal from the transducer device can be performed, which in turn allows for continuous measurement

[0341] Control of the surgical procedure (e.g.

[0342] tissue fusion process). In other words, the analysis of the response signal can proceed continuously.

[0343] According to some preferred embodiments, variants or

[0344] Further training of design forms includes the

[0345] Functional device at least one further sensor which is designed to generate at least one sensor signal.

[0346] The computing device can also be designed to

[0347] Output signal additionally based on the at least one

[0348] It is understood that the

[0349] Output signal can also consist of several sub-signals, which are transmitted independently of each other and, under certain circumstances, even evaluated independently of each other. These sub-

[0350] Signals are - merely for simplified representation and

[0351] Description - referred to herein collectively as “the

[0352] output signal".

[0353] The at least one further sensor can be, for example, a temperature sensor, an electrical impedance sensor, a tissue thickness sensor and / or a

[0354] The generation and evaluation of additional sensor signals has the advantage that the

[0355] Computing device additional information about the conditions or processes in the organic tissue or internal

[0356] Conditions or processes in the endoscopic instrument system, in particular the endoscopic instrument itself, during

[0357] Generation of the output signal can be taken into account. This can be due, for example, to predetermined evaluation rules,

[0358] Simulation models, digital twins (for example, of the endoscopic instrument) and the like. One or more of the at least one further sensor may also comprise piezoelectric elements or be designed as such, for example from the previously described

[0359] Materials and material combinations. In particular

[0360] Temperature sensors or sensors for mechanical forces advantageously comprise piezoelectric elements. Particularly preferably, one or more piezoelectric elements can be used to

[0361] A sensor can be implemented which measures one or more forces which are currently exerted on organic tissue by the jaw parts of the functional device.

[0362] According to some preferred embodiments, variants or

[0363] In further developments of embodiments, the computing device is designed to generate the output signal at least partially based on an artificial intelligence entity (AI). AIs have proven increasingly capable of receiving complex data sets and, especially after prior training, of quickly and reliably

[0364] To draw conclusions, which sometimes happen faster or more

[0365] take into account connections than would be possible for a human being.

[0366] The use of a KIE is particularly advantageous if, as described above, at least one additional sensor is provided which generates a sensor signal, so that the KIE records the largest and most diverse number of input data and generates the output signal based on this. In particular, the KIE should

[0367] converter device as input, preferably further

[0368] Input data are provided, for example temperature data from a temperature sensor, impedance data from an electrical impedance sensor, tissue thickness data from a tissue thickness sensor and / or pressure force data from a pressure force sensor.

[0369] According to some preferred embodiments, variants or

[0370] In further developments of embodiments, the output signal comprises a control signal which is designed to control a function of the functional device. The output signal can also consist of the control signal. It is thus possible that the

[0371] Output signal, without first being displayed or otherwise brought to the attention of a human user (or in addition thereto), directly assumes partial or complete control of the endoscopic instrument.

[0372] This can be particularly advantageous if the endoscopic instrument system comprises a robot device (e . g . a robot arm) which is used to handle the endoscopic instrument and to actuate the

[0373] The functional device is designed and configured via the actuating device. If the output signal indicates, for example, that a piece of tissue is currently being burned, the electrode arrangement can be immediately controlled to reduce the coupled RF current or to switch it off completely. This can be done, in particular, more quickly than a human user would be able to.

[0374] In particular, if the output signal comprises a control signal which is designed to control (or drive) the electrode arrangement, a control loop can be formed: the coupled RF current induces a structure-borne sound response of the organic tissue, which is determined by the structure-borne sound

[0375] Recording element and transmitted through the structure-borne sound transmission element to the acoustic-electrical

[0376] The converter device generates an electrical response signal based on this, on the basis of which the computing device generates the output signal, which comprises the control signal for the electrode arrangement. Thus, the electrode arrangement can advantageously be controlled in a closed control loop.

[0377] The above embodiments and further developments can be combined with each other as desired, where appropriate. Further possible embodiments, further developments and implementations of the invention also include not explicitly mentioned

[0378] Combinations of the above or below regarding the

[0379] Features of the invention described in embodiments.

[0380] In particular, the expert will also consider individual aspects as

[0381] Add improvements or additions to the respective basic form of the present invention.

[0382] TABLE OF CONTENTS OF THE DRAWING

[0383] The present invention is explained in more detail below with reference to the exemplary embodiments shown in the schematic figures. They show:

[0384] Fig . 1 a schematic representation of an endoscopic

[0385] Instrument system according to an embodiment of the present invention;

[0386] Fig . 2 is a schematic representation of a

[0387] Functional device of an endoscopic instrument according to an embodiment of the present invention;

[0388] Fig . 3 a perspective partial view of the

[0389] Functional device according to Fig. 2;

[0390] Fig . 4 is a schematic plan view of a part of the

[0391] Functional device according to Fig. 2; Fig. 5 is a schematic cross-sectional view of an endoscopic instrument system according to a variant of the instrument system from Fig. 1;

[0392] Fig. 6 is a schematic representation of an endoscopic

[0393] Instrument system according to a further

[0394] Embodiment of the present invention;

[0395] Fig . 7 schematically shows a possible variant of the endoscopic

[0396] Instrument system from Fig. 6;

[0397] Fig . 8a and Fig . 8b show schematic longitudinal sections through

[0398] Components of an endoscopic instrument system according to a further embodiment of the present

[0399] invention; and

[0400] Fig. 9 shows a schematic representation of an endoscopic instrument system according to another

[0401] Variant of an embodiment.

[0402] The enclosed figures are intended to provide a further understanding of the

[0403] Embodiments of the invention. They illustrate

[0404] Embodiments and serve in connection with the

[0405] Description of the explanation of principles and concepts of

[0406] Invention . Other embodiments and many of the mentioned

[0407] Advantages arise with regard to the drawings. The

[0408] Elements of the drawings are not necessarily shown to scale.

[0409] In the figures of the drawing, identical, functionally identical, and acting elements, features, and components are provided with the same reference symbols unless otherwise stated. The numbering of process steps serves primarily to distinguish them and is not necessarily intended to imply a chronological order, unless explicitly stated otherwise.

[0410] DESCRIPTION OF EMBODIMENTS

[0411] Fig. 1 shows a schematic representation of an endoscopic

[0412] Instrument system 1000 for minimally invasive surgery in a human body according to an embodiment of the present

[0413] Invention. The endoscopic instrument system 1000 comprises an endoscopic instrument 1100. The endoscopic instrument

[0414] 1100 is shown in Fig . 1 as partially inserted into a human body, wherein a limitation of the human

[0415] Body, for example an abdominal wall 1, is shown schematically and dashed. On the left side, marked IN, is the inside of the human body, on the right side, marked OUT, is the

[0416] Environment of the human body . Here, the

[0417] The arrow marked "OUT" in the proximal direction, P, and the arrow marked

[0418] Arrow marked "IN" in distal direction, D .

[0419] The endoscopic instrument 1100 comprises a distal

[0420] Functional device 1110, which in the example of Fig. 1 was thus introduced into the human body. The distal

[0421] Functional device 110 has an electrode arrangement 1115, which is designed to couple a high-frequency electrical current, HF current, into organic tissue 2 within the human body. Furthermore, the distal functional device 1110 has a structure-borne sound

[0422] Receiving element 1116, which is used to receive a

[0423] Structure-borne sound response of the organic tissue 2 to the coupled RF current is designed and arranged. The endoscopic instrument 1100 also comprises a proximal actuating device 1150, by means of which the

[0424] Instrument 1100 is manageable, whether by a human

[0425] Surgeon and / or by a robotic device such as

[0426] Example: a surgical robot. The actuating device 1150 can also be designed to actuate the functional device 1110 from outside the human body. This

[0427] In particular, activation or deactivation of the

[0428] Electrode arrangement 1115, moving a mechanical part of the functional device 1110, switching an endoscopic camera of the functional device 1110 on or off and / or the like.

[0429] The proximal actuating device 1150 is connected to the distal

[0430] Functional device 1110 via an elongated

[0431] Connecting device 1130 mechanically and functionally connected.

[0432] Actuations or manipulations of the actuating device 1150 for handling the instrument 1100 and for actuating the

[0433] Functional device 1110 are thus by means of the

[0434] Connecting device 1130 to the functional device 1110. The transmission can be electrical, mechanical, and / or optical, for example.

[0435] Connecting device 1130 comprises a structure-borne sound transmission element 1132, which is designed and arranged to transmit the structure-borne sound

[0436] 1115 recorded structure-borne sound response acoustically in the direction of

[0437] Actuator 1150. The structure-borne sound

[0438] Transmission element 1132 is preferably configured for transmission in

[0439] It is designed for a frequency range from 20 kHz to 80 kHz and has particularly low losses in this range compared to airborne sound.

[0440] The endoscopic instrument system 1000 also includes an acoustic-electrical transducer device 1140, which is designed and arranged to, when using the

[0441] Instrument system 1000 to be arranged outside the human body, and which is also designed and arranged to measure the structure-borne sound response at the structure-borne sound

[0442] transmission element 1132 and convert it into an electrical

[0443] To convert response signal 1171 .

[0444] The conversion can be direct, i.e., a conversion can be carried out directly from (structure-borne) sound into electrical signals, for example by means of a piezo element. Alternatively or additionally, an indirect conversion can take place, for example via an intermediate medium such as a light or laser beam or the like. The converter device 1140 can be arranged either in or on the endoscopic instrument 1100, as shown by way of example in Fig. 1. The

[0445] However, converter device 1140 can also be used in another

[0446] Part of the instrument system 1000 or represent a separate element. In particular,

[0447] The following examples are described in which the

[0448] Transducer device part of a trocar sleeve of the

[0449] instrument system is .

[0450] The elongated connecting device 1130 preferably has a

[0451] Length of between 15 and 50 cm, particularly preferably between 25 and 40 cm, especially preferably about 30 cm. The

[0452] Converter device 1140 is advantageously slightly further from the

[0453] Electrode arrangement 1115 arranged as the length of the

[0454] connecting device 1130. The converter device 1140 is preferably between 32 cm and 52 cm from the

[0455] Electrode arrangement 1115, and particularly preferably arranged between 40 cm and 45 cm away. This contributes to the fact that the functional device 1110, in particular the

[0456] Electrode arrangement 1115, generated interference or

[0457] Interference signals have as little effect as possible on the converter device 1140 and thus possibly the electrical response signal

[0458] 1171 can falsify .

[0459] By arranging the converter device 1140 outside the human body during use of the

[0460] Instrument system 1000, especially during the endoscopic

[0461] Instrument 1100 is introduced into the human body, causes the abdominal wall 1 to represent an additional signal insulation or signal attenuation between the functional device 1110 and the transducer device 140. This increases a

[0462] Signal-to-noise ratio of the signal transmitted by the structure-borne sound transmission element 1132, realized in the structure-borne sound, i.e. the structure-borne sound response.

[0463] Fig. 2 shows a schematic representation of a distal

[0464] Functional device 1210 of an endoscopic instrument 1200 according to an embodiment of the present invention. The

[0465] Functional device 1210 can, for example, be combined with the endoscopic instrument system 1000 and / or the endoscopic instrument 1100 from Fig. 1.

[0466] While Fig. 2 is a schematic side view, which partially shows a longitudinal section, Fig. 3 and Fig. 4 are further, partially perspective, views of the

[0467] Functional device 1210 .

[0468] As can be seen in Fig. 2, the functional device

[0469] 1210 comprises a first jaw part 1211 and a second jaw part 1212, which are coupled to each other at the proximal side at the joint G in such a way that the distal ends of the first and second jaw parts 1211, 1212 can move towards and away from each other. In this way, a

[0470] The "mouth" of the functional device 1210 can be closed (distal ends of the jaw parts 1211, 1212 move towards each other) or opened (distal ends of the jaw parts 1211, 1212 move away from each other). With this mouth of the functional device 1210, the organic tissue can thus be grasped, pinched, touched, squeezed or the like, in particular

[0471] Inside 1217 of the first jaw part 1211 and an inside

[0472] 1218 of the second jaw part 1212 with the organic tissue in

[0473] Contact and, for example, pressure on the organic

[0474] tissue. The basic structure of such

[0475] Jaw parts 1211, 1212 are in principle known from the prior art.

[0476] In the example shown, part 1211 is a rigid

[0477] jaw part, while the second jaw part 1212 is designed as a jaw part opposite the first jaw part 1211 and opposite the

[0478] Connecting device 1230 is designed to be movable relative to it.

[0479] An actuation of a movement of the second jaw part 1212 relative to the first jaw part 1211 and the

[0480] Connecting device 1230 can, for example, be mechanically connected using a wire 1231 or rod.

[0481] Alternatively, electrical actuation is also conceivable, for example using an electric motor.

[0482] On the inside 1218 of the second jaw part 1212 there is a web

[0483] 1213, which is shown in Fig. 3 in perspective from below, that is to say from the direction of the first jaw part 1211 with a view of the inner side 1218 of the second jaw part 1212.

[0484] Such a web 1213 can be particularly advantageous, as explained above, for so-called vessel sealing instruments. The web 1213 is formed, for example, from an electrically insulating material. The web constricts the organic tissue 2, the current density of the

[0485] RF current in the tissue 2, and the thermal effect is focused on the acoustic reaction induced thereby in this area. The design of the first jaw part 1211 is shown in plan view in

[0486] Fig. 4 shown. The general structure of the first jaw part

[0487] 1211 is an electrical insulator area 1214 in the inside

[0488] 1217 of the first jaw part 1211. Fig. 2 shows the first jaw part 1211 in longitudinal section (longitudinal direction), wherein a longitudinal section through the insulator region 1214 can also be seen. Within the insulator region 1214, separated from each other, a first electrode 1215-1 and a second electrode

[0489] 1215-2 of an electrode arrangement 1215-i.

[0490] As shown in Fig. 4, these two electrodes can be 1215-

[0491] 1, 1215-2 may be arranged in particular parallel to one another and may be elongated, wherein their longitudinal direction extends along a longitudinal direction of the elongated first and second jaw parts 1211, 1212 and, advantageously, also along a longitudinal direction of the elongated

[0492] Connecting device 1230. By means of electrical

[0493] Lines which are guided through the first jaw part 1211

[0494] (not shown in the figures) the electrode arrangement

[0495] 1215-i with high frequency electrical current, HF current. The HF current can be

[0496] High frequency generator of the endoscopic instrument system 1000 outside the patient. This RF current can be applied to organic tissue, which is connected to the electrodes 1215-1, 1215-2 in

[0497] As already described in detail above, this can be used for cutting, coagulating, welding etc. of the organic

[0498] tissue.

[0499] To ensure that the RF current flows only through the organic tissue, the electrodes 1215-1, 1215-2 are in the electrical

[0500] Insulator region 1214 is arranged. Preferably, the

[0501] Insulator region 1214 is formed from a ceramic material, which is integrated into the metallic structure of the first

[0502] jaw part 1211 is embedded.

[0503] As can be seen particularly well in Fig . 4 and in Fig . 2 in

[0504] As indicated in the cross section through the first jaw part 1211, a structure-borne sound recording element 1216 is arranged on the first jaw part 211 between the electrodes 1215-1, 1215-2, which

[0505] Recording of a structure-borne sound response of the organic tissue 2 to the coupled RF current is arranged and designed.

[0506] For this purpose, the structure-borne sound receiving element 1216 is preferably made of an electrically insulating ceramic material.

[0507] The induced or generated in the organic tissue 2

[0508] Structure-borne sound can be recorded by the structure-borne sound recording element 1216, for example, as a longitudinal wave and / or as a transverse wave. Via a structure-borne sound transmission element 1232, which is at least partially in the

[0509] Connecting device 1230 runs, the

[0510] Structure-borne sound response transmitted in the proximal direction. As in

[0511] As already explained above, the

[0512] The structure-borne sound response is then converted outside the human body into an electrical response signal by the acoustic-electrical transducer device 1140.

[0513] The structure-borne sound receiving element 1216 and the structure-borne sound transmission element 1232 can, as shown schematically in Fig. 2 and Fig. 4, be identical to one another and in particular formed in one piece. This has the advantage that there are no edges or gaps between them at which structure-borne sound waves could be reflected or broken. This simple and efficient design is made possible by the fact that the first jaw part 1211 and the elongated

[0514] Connecting device 1230 are rigidly connected to one another, for example, are also formed integrally with one another, and the structure-borne sound receiving element 1216 is arranged on this first jaw part 1211.

[0515] Alternatively, it would also be conceivable that the structure-borne sound

[0516] Receiving element 1216 is arranged on the movable second jaw part 1212. The structure-borne sound transmission element 1232 can, in particular in this case, comprise a movable, articulated or bendable section which is

[0517] Movement of the second jaw part 1212 can be adapted and followed. However, the structure-borne sound receiving element 1216 and the structure-borne sound transmission element 1232 can also be designed differently. As already described above, the structure-borne sound transmission element 1232 can be designed to be flexible or rigid in a variety of ways, or can have both flexible and rigid components or sections.

[0518] Fig. 5 shows a schematic cross-sectional view of an endoscopic instrument system 1000 ' according to a variant of the instrument system from Fig. 1 . All details, variations and options described with respect to this instrument system 1000 ' are also applicable to the instrument system 1000 from Fig. 2-4 and vice versa.

[0519] In the 1000 ' instrument system, the endoscopic

[0520] Instrument 1100 ' differs from the endoscopic

[0521] Instruments 1100 of the instrument system 1000, that it has an integrated scalpel 1225, which along the

[0522] The longitudinal axis of the instrument 1100' is movable to enable the severance of held (or grasped) and / or sealed tissue. The general arrangement of such a scalpel 1225 is described, for example, in DE 10 2019

[0523] 108 140 A1, to which reference is hereby made and whose contents are intended to be fully incorporated by reference in the present application.

[0524] Both the first jaw part 1211 ' and the second jaw part

[0525] 1212 'therefore each have a corresponding groove 1223, 1224, which are aligned with each other and within which the scalpel

[0526] 1225 with cutting edge 1226 is movable, especially when the two jaw parts 1211 ', 1212 ' are completely closed against each other, as shown in Fig. 5. While the scalpel 1225 is attached to the first jaw part 1211 'and is also actuated from there, the majority of the scalpel 1225 is in the groove

[0527] 1224 of the second jaw part 1212'. Accordingly, the groove 1224 in the second jaw part 1212' is also larger, preferably more than 50% deeper, particularly preferably more than 100% deeper than the groove 1223 in the first jaw part 1211'.

[0528] The first jaw part 1211 ' comprises at least two components: a first, externally arranged metallic component 1221-1, for example made of surgical steel, and a second, internally

[0529] (i.e. facing the second jaw part 1212 ') arranged electrically insulating component 1221-2, for example made of a

[0530] Ceramic material. In the second component 1221-2, the groove 1223 is provided in the inwardly directed surface 1227 with the scalpel

[0531] 1225, and symmetrical to both sides are the

[0532] Electrodes 1215-1, 1215-2 are arranged. In between, in each case adjacent to the surfaces of the web 1213, with which the tissue is gripped or pressed, a structure-borne sound sensor is arranged between the groove 1223 and one of the electrodes 1215-1, 1215-2.

[0533] Receiving section 1216-1, 1216-2. The two

[0534] Structure-borne sound recording sections 1216-1, 1216-2 can be two separate structure-borne sound recording elements or tips of a single, distally forked

[0535] structure-borne sound recording element 1216'. This means that the two structure-borne sound recording sections 1216-1, 1216-2 can either each transmit structure-borne sound to a respective transducer unit of the transducer device 1140, or a common transducer unit can be provided.

[0536] The second jaw part 1212 ' also comprises at least two components: a first, externally arranged metallic component 1222-1, for example made of surgical steel, and a second, internally

[0537] (i.e. facing the first jaw part 1211') arranged electrically insulating component 1222-2, for example made of a

[0538] Ceramic material, which has the web 1213 with the groove 1224 formed therein. The web 1213 is also formed symmetrically around the groove 1224 and shaped so that

[0539] Tissue between the jaw parts 1211 ' , 1212 ' , in particular (or exclusively) where on the first jaw part

[0540] 1211 'the structure-borne sound recording sections 1216-1, 1216-2 of the

[0541] Structure-borne sound recording element 1216 ' .

[0542] Based on Fig. 6, it is easy to imagine how a tissue is first grasped between the bridge 1213 and the surface 1227 and then an RF current is coupled into the grasped tissue between the electrodes 1215-1, 1215-2. In the area of ​​the plateau of the bridge 1213, i.e. at its highest elevation, the

[0543] Tissue is thus particularly strongly compressed and a very high current per volume flows, i.e. there is a high current density.

[0544] This also means that the heat input per volume of the

[0545] (ungrip) fabric is very high, and thus also the sound generated there, which is caused by the precisely fitting

[0546] Structure-borne sound recording sections 1216-1, 1216-2 are ideally recorded. As described above, a cleverly selected sound characteristic impedance of the structure-borne sound

[0547] Recording sections 1216-1, 1216-2 can improve the sound recording. For example, the structure-borne sound

[0548] Receiving sections 1216-1, 1216-2 are substantially filled with liquid, wherein the liquid is retained at the surface 1227 by a membrane.

[0549] Structure-borne sound can then be transmitted within the liquid.

[0550] Fig. 6 shows a schematic representation of an endoscopic

[0551] Instrument system 5000 according to another embodiment of the present invention. The endoscopic instrument system

[0552] 5000 comprises an endoscopic instrument 5100, which is shown in Fig.

[0553] 6 is shown only in a few details. Unless explicitly or implicitly described otherwise, the endoscopic instrument 5100 may be designed as shown in

[0554] As described above with reference to Figures 1 to 5. In particular, the instrument 5100 also has a

[0555] Functional device 5210 with a first jaw part 5211 and a second jaw part 5212.

[0556] While the functional device 5210 is located at the distal end of the

[0557] Instrument 5100 is located at the proximal end of the

[0558] Instruments 5100 the (here again shown schematically)

[0559] Actuating device 5150 is arranged.

[0560] The main difference between endoscopic

[0561] Instrument system 5000 and the endoscopic instrument system 1000 shown in Fig . 1 is that in the instrument system 5000 the acoustic-electrical

[0562] Transducer device 5540 not in the endoscopic instrument

[0563] 5100 itself is integrated.

[0564] Instead, the endoscopic instrument system 5000 includes the endoscopic instrument 5100 as well as a trocar sleeve

[0565] 5500 . As shown in Fig . 1 as an example, a

[0566] Trocar sleeve 5500 is used to be inserted into the human body, here through an abdominal wall 1, in order to create a continuous connection between the inner and

[0567] external space of the human body so that the endoscopic instrument 5100 can be inserted through the trocar sleeve 5500 into the human body and can be moved back and forth there.

[0568] Instruments can be moved with little friction and quick instrument changes are possible without any problems if necessary, i.e.

[0569] Instruments such as scissors can be removed and replaced with, for example, forceps.

[0570] In the 5100 instrument, the structure-borne sound transmission element

[0571] (not shown) designed such that the transmitted

[0572] Structure-borne sound response at the outer shell of the connecting device

[0573] 5230 can be recorded, in particular mechanically tapped.

[0574] The transducer device 5540 is therefore arranged on the trocar sleeve 5500 and is designed and configured such that it

[0575] Structure-borne sound response at the outer shell of the connecting device

[0576] 5230 mechanically picks up .

[0577] In Fig . 6 it is shown schematically that the

[0578] Transducer device 5540, which for example is a piezo element

[0579] 5541, is mounted on the trocar sleeve 5500 in such a way that it is pressed against the structure-borne sound transmission element, while the functional device 5210 is

[0580] Trocar sleeve 5500 is passed through. The structure-borne sound

[0581] In this embodiment, the transmission element can be

[0582] Range in which the converter device 5540 when properly

[0583] will be used, to the outside of the

[0584] Connecting device 5230. Alternatively or additionally, the outer shell of the

[0585] Connecting device 5230 itself may be wholly or partly a component of the structure-borne sound transmission element.

[0586] The pressing of the converter device 5540 can, for example, as shown schematically in Fig . 6, by a

[0587] A pressure element 5542, for example a spring element such as a spring element, can be realized by means of which the piezo

[0588] Element 5541 of the transducer device 5540 can be pressed against the structure-borne sound transmission element. To prevent the instrument 5100 from resting on one side within the trocar sleeve 5500 due to the contact force, additional contact forces can be applied to the same

[0589] Place (along the longitudinal direction along the

[0590] Connecting device 5230 ) such as the converter device 5540 act on the elongated connecting device 5230 so that it has a spring-loaded central position within the trocar sleeve

[0591] 5500 occupies .

[0592] In the embodiment shown in Fig . 6, the

[0593] Trocar sleeve 5500 has a projection in the radial direction at its proximal end, which not only supports the transducer device

[0594] 5540, but also over the abdominal wall 1 a gentle

[0595] represents completion .

[0596] Fig. 7 shows schematically a possible variant of the endoscopic instrument system 5000, wherein an endoscopic instrument 5300 of the instrument system 5000 is in

[0597] Essentially through the design of the acoustic-electrical

[0598] Converter device 5640 from the converter device 5540 of Fig .

[0599] 6 differs .

[0600] In Fig . 7 is a shaft tube 5333 of a connecting device

[0601] 5330 of the endoscopic instrument 5300 of the instrument system

[0602] 5000 . The left part of Fig . 7 shows a

[0603] Longitudinal section through the connecting device 5330, the right

[0604] Part of Fig. 7 shows a corresponding cross section. A

[0605] Working element or pulling element 5331 for mechanical deflection or movement of the distal jaw parts. Around the outer surface of the shaft tube 5333, a piezoelectric element 5641 is mounted, in particular a piezoelectric element arranged concentrically with the connecting device 5330.

[0606] PVDF foil, which in turn is concentrically connected on both sides with a respective conductive metal layer 5642. These conductive

[0607] Metal layers 5642 or coatings electrically contacted.

[0608] Thus, the electrical response signal 1171 of the

[0609] converter device 5640 via the electrical lines 5644, for example to a computing device of the instrument system 5000.

[0610] As an alternative, the assembly consisting of piezoelectric element 5641 (e . g . PVDF foil) could be arranged

[0611] (sandwiched) between the conductive metal layers 5642 instead also on the inner surface of a trocar sleeve of the

[0612] Instrument system 5000. The shaft tube 5333 of the connecting device 5330 is then advantageously designed so that it fits as positively as possible all around the

[0613] Trocar sleeve is in place.

[0614] In both variants, instead of a continuous piezoelectric element 5641, several piezoelectric

[0615] Elements 5641 can be arranged, which can be read out separately, in order to be able to detect, for example, longitudinal wave propagation or bending waves. The plurality of piezoelectric elements 5641 can, for example, be arranged concentrically and in a matrix-like manner on

[0616] The sensors can be arranged on the inner or outer surface of the casing and read out in a matrix. In this way, all

[0617] Wave types of the transmitted structure-borne sound must be precisely detectable.

[0618] Fig . 8a and Fig . 8b show schematic

[0619] Longitudinal sectional views through components of an endoscopic instrument system 5000 according to a further embodiment of the present invention. In this

[0620] In this embodiment, the 5000 instrument system includes a

[0621] Trocar sleeve 5700 and an endoscopic instrument 5300 .

[0622] Fig. 8a shows a situation in which the trocar sleeve 5700 is partially passed through an abdominal wall 1 of a human patient without an endoscopic instrument

[0623] 5300 was introduced .

[0624] In Fig . 8b the state can be seen in which the endoscopic instrument 5300 was inserted through the trocar sleeve 5700, of which only the

[0625] Connecting device 5330 is shown schematically. The

[0626] Trocar sleeve 5700 includes an upper guide device 5701, which facilitates the insertion of the endoscopic instrument 5300 into the

[0627] Trocar sleeve 5700 guides and supports. Guided by the upper

[0628] Guide device 5701 can thus connect the device

[0629] 5330, as shown in Fig . 8b, by an annular

[0630] Seal 5703 must be passed through.

[0631] In distal direction D starting from the annular seal

[0632] 5703 a lower guide device 5702 is arranged.

[0633] Distal therefrom, in turn, is arranged a sealing device 5710, which sealingly abuts the connecting device 5330 when the latter is guided through the trocar sleeve 5700. The sealing device 5710 can, for example, be formed from an elastic material and, for example, comprise or consist of silicone. The sealing device

[0634] 5710 can, as in the essentially rotationally symmetric

[0635] Longitudinal section is shown, be substantially conical, with a conical tip pointing in the distal direction D and a passage arranged at the conical tip. When, as shown in Fig. 8b, the endoscopic instrument 5300 is guided through the trocar sleeve 5700, this expands due to the elasticity of the sealing device 5710.

[0636] Passage just enough so that the sealing device 5710 fits tightly all around the connecting device 5330. The

[0637] Sealing device 5710 may also function as a check valve or be referred to as a non-return valve.

[0638] As shown in Fig . 8a, in the area of

[0639] One or more piezo elements 5741 may be arranged at the tip of the conical shape of the sealing device 5710, in such a way that, when the connecting device 5330 is

[0640] Trocar sleeve 5700 is passed through, the piezo elements 5741 rest on the endoscopic instrument 5300 in such a way that structure-borne sound can be detected by means of the piezo elements 5741 on at least a part of the structure-borne sound transmission element.

[0641] As already described with reference to Fig . 6 and Fig . 7, it is advantageous if at least a part of the structure-borne sound transmission element is located on the outside of the

[0642] Connecting device 5330 is arranged so that the piezo

[0643] Elements 5741 are in direct contact with at least this part of the structure-borne sound transmission element when the endoscopic instrument 5300 is properly inserted into the trocar sleeve

[0644] 5700 is introduced . Via electrical contacts not shown in Fig . 8a and Fig . 8b, the piezo elements can thus

[0645] 5741 generated electrical signals as the response signal of a

[0646] Transducer device 5740, which at least the piezo elements

[0647] 5741, output and optionally further processed.

[0648] Fig. 9 shows a schematic representation of an endoscopic

[0649] Instrument system 5000 according to another variant of a

[0650] Embodiment. Fig. 9 serves primarily to explain the possible evaluation and further processing of the response signal

[0651] 1171 by a computing device 5660. The instrument system 5000 comprises an endoscopic

[0652] Instrument 5300, which can be designed as in

[0653] As described above with reference to Fig. 6 and Fig. 7, i.e., an acoustic-electrical transducer device 5640 is not integrated into the endoscopic instrument 5300, but instead into a trocar sleeve 5600 of the endoscopic

[0654] Instrument system 5000. On an actuating device 5650 for actuating and handling the functional device 5210 of the endoscopic instrument 5300, a robot arm is, for example,

[0655] 5690 as part of a robotic device.

[0656] The exact design of the endoscopic instrument 5300 and / or the trocar sleeve 5600 is important for the description of the

[0657] The embodiment according to Fig. 9 is not limited. In particular, the endoscopic instrument 5300 can also be designed with an integrated converter device, which

[0658] Actuating device 5650 can be designed to be guided by a person, the functional device 5210 can be connected to other

[0659] functions (or additional) than a jaw part, and / or the like.

[0660] In contrast to the illustration in Fig . 7, the

[0661] Transducer device 5640 also as an elastic, on the inner

[0662] Surface of the trocar sleeve 5600 concentrically arranged PVDF

[0663] The material can be made of a film, layered PVDF films, or a bundle of elastic piezoelectric fibers. This elasticity ensures that a portion of the structure-borne sound transmission element fits particularly tightly against the PVDF film as a piezoelectric element (good "form fit").

[0664] Alternatively, the trocar sleeve 5600 itself can be made of an elastic, sound-conducting material, e .g .

[0665] fiber composite material, and the

[0666] Transducer device 5640 (or at least one piezo element thereof) can be arranged on the outer surface of the trocar sleeve 5600. The structure-borne sound response transmitted by the structure-borne sound transmission element can thus be transported radially outwards through the sound-conducting trocar sleeve 5600 and there in turn by the piezo element of the

[0667] Converter device 5640 can be converted.

[0668] In any case, the electrical response signal 1171 generated by the converter device 5640 is transmitted to the computing device 5660. This can be done, for example, by electrical

[0669] Lines 5644, but also wirelessly, e .g . via

[0670] Ethernet, ZigBEE, Bluetooth, LoRaWAN or another wireless

[0671] Signal protocol. The computing device 5660 may be integrated into the endoscopic instrument 5300, the trocar sleeve 5600, or another part of the endoscopic instrument system 5000, or may be arranged in a separate housing.

[0672] Even a partial implementation - in addition to e . g . local

[0673] Power electronics - through a remotely connected

[0674] Computing facility is possible, for example through a cloud computing

[0675] platform, a server or the like.

[0676] The computing device 5660 comprises, in the embodiment shown in Fig. 9, an analog amplifier module 5661, an analog-to-digital converter module 5662, an analysis module 5663 and a fast Fourier transformation module 5664. These modules can

[0677] Be part of an integrated circuit and / or be partially implemented by one or more microprocessors.

[0678] When reference is made herein to "modules," it is understood that this does not necessarily mean that such modules are designed as separate units.

[0679] In cases where modules are implemented as software, the modules can be implemented as program code sections or program code components, which can be distinguishable from one another, but which can also be interwoven.

[0680] Likewise, in cases where one or more modules are implemented as hardware, the functions of one or more

[0681] Modules can be implemented using one and the same hardware component.

[0682] Alternatively or additionally, different functions of a single module, or different functions of different modules, can be mapped to one or more separate hardware

[0683] Components can be realized. In this sense, each

[0684] Device, system, process etc. which all

[0685] Features and functions that determine

[0686] Module, be understood as comprising, representing, or implementing such a module.

[0687] In particular, it may be possible that all modules are

[0688] program code, which is implemented by a

[0689] computing device, e.g. a server or a cloud computing platform.

[0690] The analysis module 5663 can be designed in particular to, based on the signal received by the converter device 5640, amplified by the amplifier module 5661 and converted by the analog

[0691] Digital converter module 5662 amplified response signals 1171 a

[0692] To generate control signal 5671 for a frequency converter 5665.

[0693] The frequency converter 5665 generates digital frequency signals, which are converted into analogue signals by a digital-to-analog converter 5667.

[0694] frequency signals. These can then be used as an acoustic output signal 5672 - through a loudspeaker

[0695] 5668, preferably in a format suitable for

[0696] Users of the endoscopic instrument system 5000 audible

[0697] Sound frequency spectrum. Audible sound can be defined as sound waves with a frequency of less than 20 kilohertz (kHz). Particularly preferred is an output or conversion in a sound frequency range from 20 kilohertz to

[0698] 80 kilohertz .

[0699] As explained above, such a

[0700] Output signal 5672 (whether acoustic, optical, haptic...) provides the user of the endoscopic instrument system 5000 and in particular the endoscopic instrument 5300 with valuable additional information in quasi-real time. The acoustic output can be an unadulterated or frequency-adjusted output of the structure-borne sound.

[0701] recording element, or in an abstract way a state or process on or in the

[0702] Index functional device 5210 .

[0703] In a simple variant, the output signal 5672 can be a quiet, comparatively deep and constant

[0704] Frequency value when the functional device 5210 interacts with the organic tissue 2 in the desired manner.

[0705] However, if an unwanted interaction occurs, such as a

[0706] Bursting or tearing of tissue can be indicated by a warning tone with a higher frequency. The evaluation of the

[0707] Structure-borne sound response and the generation of

[0708] Control signals 5671 by the analysis module 5663 can be carried out, for example, using rule-based algorithms.

[0709] The analysis module 5663 can be used to analyze the data generated by the analog-digital

[0710] Converter 5562 digitized signals advantageously in quasi-

[0711] Real-time analysis can be performed, for example by counting acoustic events and their intensity per time interval.

[0712] Additionally or alternatively, the FFT module (Fast-

[0713] Fourier transform) perform an extraction of frequency-dependent spectral parameters per time interval by a (particularly continuous) fast Fourier analysis (FFT). The extracted spectral parameters can in turn be

[0714] Analysis module 5663 can be taken into account when generating the control signal 5671.

[0715] It is also conceivable to use an artificial intelligence

[0716] Module, KIEM 5669, which is designed and arranged to implement a trained artificial intelligence entity, for example an artificial neural

[0717] Network . Such an artificial intelligence entity receives as

[0718] Input signals (input) Signals from the computing device 5660 itself, for example signals in the form of short-time spectra of the

[0719] Fast Fourier transform module 5664, or directly

[0720] Signals from the analog-to-digital converter module 5662 and / or the

[0721] Analysis module 5663. The spectral parameters extracted by the FFT module 5564 can also be used as input signals for the

[0722] serve as an artificial intelligence entity.

[0723] In addition, as described above, it may be advantageous if the endoscopic instrument

[0724] 5300 preferably in the distal area and / or the trocar sleeve

[0725] 5600 additional sensors, which provide additional

[0726] Sensor signals 5673 generate. These sensor signals 5673 can thus be used as additional input for the artificial intelligence

[0727] Entity can be used. The additional sensors can be, for example, a temperature sensor, an electrical impedance sensor, a tissue thickness sensor and / or a pressure force sensor or the like. It is particularly advantageous, for example, if a distal-side piezoelectric sensor detects pressure forces (e.g., on one of the jaw parts 5211, 5212) and / or the temperature. The values ​​measured or indicated by the sensor signals 5673

[0728] Parameters are preferably recorded over time intervals. In order for the parameters from the individual time intervals to be statistically

[0729] have significance, the time intervals with corresponding

[0730] Duration to choose . In addition, can be beneficial for the

[0731] Analysis can use not only the current parameters, but also parameters from previous time intervals. For example, real-time signal processing

[0732] Technique of continuous averaging with “infinite

[0733] Memory" (weighted average over all

[0734] time intervals) , with limited memory" (balanced

[0735] average over a predefined number of time intervals) and / or with "fading memory" (weighted average, where the time intervals are weighted less and less as the time elapses).

[0736] For this purpose, it can be defined recursively if X (m) is the current running mean value of a measured value or parameter in

[0737] Time interval m and Y (m) is the current measured value in

[0738] Time intervals m is :

[0739] Average with infinite memory:

[0740] X (m) = X (ml) + 1 / m [Y (m) -X (m-1) ]

[0741] Average with limited memory:

[0742] X (m) = X (ml) + 1 / L [Y (m) ~ Y (mL) ]

[0743] Average with declining memory:

[0744] X (m) = X (ml) + (1 -a) Y (m) , 0 < a < 1 . The time intervals of RF energy application and the

[0745] Time intervals of rest between are advantageous in their

[0746] Duration is chosen so that the signal sections are quasi-stationary and the parameters derived from them are statistically significant, i.e., in particular, not too noisy. The time intervals can be longer than the

[0747] Pulse-pause duration of the injected RF energy in a pulsed RF current injection mode.

[0748] From the - according to one of the above-mentioned

[0749] Averaging method - averaged parameter curves can be used to make predictive statements about an ongoing process, e.g. an estimate of the time until a stable

[0750] Vascular occlusion. Such statements can also be found in the

[0751] output signal, be contained in it, or be indexed by it.

[0752] In addition to the function of generating an output signal 5672 that is audible, in particular understandable, by the user of the endoscopic instrument system 5000 (or alternatively thereto), the computing device 5660 can also have the function of generating control signals 5674 for one or more components of the endoscopic instrument system 5000.

[0753] For example, the control signals 5674, as shown in Fig . 9, a high frequency generator 5800 of the endoscopic

[0754] Control instrument system 5000. The high frequency generator 5800 serves to generate the electrical RF current, which can be coupled into the organic tissue 2 through the electrode arrangement of the functional device 5210. As shown in Fig. 9, electrical lines for conducting the RF current can be arranged over the

[0755] Connecting device 5330 .

[0756] Likewise, signals 5675 of the high-frequency generator 5800 can be received by the computing device 5660 (e.g. at the amplifier module 5661 and / or the analog-to-digital converter module

[0757] 5662 ) and by the computing device 5660 in generating the

[0758] Output signal 5672 or control signals 5674 are taken into account. In this way, a control loop can be created.

[0759] The signal exchange between the computing device 5660 and

[0760] High frequency generator 5800 can be used to

[0761] Coupling of RF current into the organic tissue 2 on the one hand and analyzing the structure-borne sound response or the

[0762] Response signals 1171 to be coordinated in time. As in

[0763] As already explained above, this is advantageously done in such a way that periods of coupling of the RF current with

[0764] Periods of analyzing the response signal 1171 alternate

[0765] (with or without buffer time in between) to reduce possible interference of the RF current on the structure-borne sound response.

[0766] The control signals 5674 of the computing device 5660 can, for example, also be configured and designed to set control variables of the endoscopic instrument system 5000, for example to set an electrical

[0767] Power, an electrical voltage, a pulse-pause duration of the coupling of RF current, a pressure force on the organic tissue 2, a position of the jaw parts 5211, 5212 and / or the like.

[0768] In the previous detailed description, various features are described to improve the stringency of the

[0769] representation has been summarized in one or more examples. However, it should be clear that the above

[0770] description is merely illustrative and not restrictive in nature. It is intended to cover all alternatives, modifications and equivalents of the various

[0771] Features and embodiments . Many other examples will be immediately and immediately clear to the person skilled in the art due to his technical knowledge in view of the above description . The embodiments were chosen and described in order to best illustrate the principles underlying the invention and their possible applications in practice . This allows

[0772] Experts the invention and its various

[0773] Examples of implementation in relation to the intended

[0774] Modify and use the intended purpose optimally.

[0775] List of reference symbols

[0776] 1 abdominal wall

[0777] 2 fabrics

[0778] 1000 endoscopic instrument system

[0779] 1000 ' endoscopic instrument system

[0780] 1100 endoscopic instrument

[0781] 1100 ' endoscopic instrument

[0782] 1110 Functional device

[0783] 1115 Electrode arrangement

[0784] 1130 connecting device

[0785] 1140 converter device

[0786] 1150 Actuating device

[0787] 1171 response signal

[0788] 1200 endoscopic instrument

[0789] 1210 Functional device

[0790] 1211 first jaw part

[0791] 1212 second jaw part

[0792] 1213 jetty

[0793] 1214 Insulator area

[0794] 1215-1 first electrode

[0795] 1215-2 second electrode

[0796] 1215-i electrode arrangement

[0797] 1216 Structure-borne sound recording element

[0798] 1216 ' Structure-borne sound recording element

[0799] 1216-1 Structure-borne sound recording section

[0800] 1216-2 Structure-borne sound recording section

[0801] 1217 Inside of the first jaw part

[0802] 1218 Inside of the second jaw part

[0803] 1221-1 First metallic component of the first jaw part

[0804] 1221-2 Second insulating component of the first jaw part

[0805] 1222-1 First metallic component of the second jaw part

[0806] 1222-2 Second insulating component of the second jaw part

[0807] 1223 Groove of the first jaw part 1224 Groove of the second jaw part

[0808] 1225 Scalpel

[0809] 1226 Scalpel blade

[0810] 1230 connecting device

[0811] 1213 wire

[0812] 5000 endoscopic instrument system

[0813] 5100 endoscopic instrument

[0814] 5210 Functional device

[0815] 5150 Actuating device

[0816] 5210 Functional device

[0817] 5211 first jaw part

[0818] 5212 second jaw part

[0819] 5230 connecting device

[0820] 5300 endoscopic instrument

[0821] 5330 connecting device

[0822] 5331 Tension element

[0823] 5333 shaft tube

[0824] 5540 converter device

[0825] 5541 Piezo element

[0826] 5542 pressure element

[0827] 5600 Trocar sleeve

[0828] 5640 converter device

[0829] 5641 Piezo element

[0830] 5642 metallic coating

[0831] 5644 electrical cables

[0832] 5650 Actuating device

[0833] 5660 computing device

[0834] 5661 amplifier module

[0835] 5662 Analog-to-Digital Converter Module

[0836] 5663 Analysis module

[0837] 5664 FFT module

[0838] 5665 frequency converter

[0839] 5667 Analog-to-digital converter

[0840] 5668 Loudspeaker 5671 Control signal

[0841] 5672 output signal

[0842] 5673 Sensor signal

[0843] 5674 control signal

[0844] 5675 signals

[0845] 5690 Robot arm

[0846] 5700 Trocar sleeve

[0847] 5701 upper guide device

[0848] 5702 lower guide device

[0849] 5703 Seal

[0850] 5710 Sealing device

[0851] 5740 converter device

[0852] 5800 high frequency generator

Claims

Patent claims 1. Endoscopic instrument system (1000; 5000) for minimally invasive surgery on a human body, comprising: an endoscopic instrument (1100; 1200; 5100; 5300), comprising at least: a distal functional device (1110; 1210; 5210), comprising an electrode arrangement (1115; 1215-i) designed to deliver a high-frequency electric current, RF current, to couple into organic tissue (2) within the human body and further comprehensively Structure-borne sound recording element (1116; 1216) for recording a Structure-borne sound response of the organic tissue (2) to the coupled RF current; a proximal actuating device (1150; 5150; 5650) for handling the instrument system (1000; 5000), in particular the instrument (1100; 1200; 5100; 5300), and for operating the functional device (1110; 1210; 5210) from outside the human body; and an elongated connecting device (1130; 1230; 5230; 5330), which the functional unit (1110; 1210; 5210) mechanically and functionally with the Actuating device (1150; 5150; 5650) connects, wherein the connecting device (1130; 1230; 5230; 5330) is a Structure-borne sound transmission element (1132) which is designed to transmit the structure-borne sound through the structure-borne sound receiving element (1116; 1216) recorded structure-borne sound response acoustically in direction of the actuating device (1150; 5150; 5650) to transmit; and an acoustic-electrical transducer device (1140; 5540; 5640; 5740), which is designed to, when using the Instrument system (1000; 5000) outside the human to be arranged in the body, and which is also designed to detect the structure-borne sound response at the transmission element (1132) and convert it into an electrical response signal (1171).

2. Instrument system (1000; 5000) according to claim 1, wherein the Functional device (1110; 1210; 5210) a first jaw part (1211; 5211) and a second jaw part (1212, 5212) which are designed to grasp the organic tissue (2) by a relative movement to each other, wherein the first jaw part (1211; 5211) is oriented with respect to the The connecting device (1130; 1230; 5230; 5330) is rigidly arranged and the structure-borne sound receiving element (1116; 1216) is arranged on the first and / or second jaw part (1211; 5211).

3. Instrument system (1000; 5000) according to claim 1 or 2, wherein the electrode arrangement (1215-i) is arranged on the first jaw part and / or the second jaw part, in particular on a respective inner surface of the first jaw part (1211; 5211) and / or the second jaw part (1212; 5212).

4. Instrument system (1000; 5000) according to one of claims 1 to 3, wherein the structure-borne sound receiving element (1216) is spatially located between a first electrode (1215-1) of the Electrode arrangement (1215-i) and a second electrode (1215-2) is arranged in the electrode arrangement (1215-i).

5. Instrument system (1000; 5000) according to one of claims 1 to 4, wherein the transducer device (1140; 5540; 5640; 5740) comprises at least one piezoelectric element (5541; 5641; 5741).

6. Instrument system (1000; 5000) according to one of claims 1 to 5, wherein the transducer device (1140; 5540; 5640; 5740) comprises an optical detection system and / or a MEMS sensor, in particular a MEMS accelerometer.

7. Instrument system (1000; 5000) according to one of claims 1 to 6, wherein the transducer device (1140; 5540; 5640; 5740) is for detecting structure-borne sound transverse waves and / or for The detection of structure-borne sound longitudinal waves is designed on the structure-borne sound transmission element (1132).

8. Instrument system (1000) according to one of claims 1 to 7, wherein the transducer device (1140) is integrated into the endoscopic Instrument (1100) is integrated.

9. Instrument system (5000) according to any one of claims 1 to 7, further comprising a trocar sleeve (5500; 5600; 5700) through which at least the functional device (1110; 1210; 5210) can be passed and inserted into the human body during minimally invasive surgery, wherein the Converter device (5540; 5640; 5740) into the trocar sleeve (5500; 5600; 5700) is integrated.

10. Instrument system (5000) according to claim 9, wherein the Converter device (5740) on a sealing device (5710) is attached to the trocar sleeve (5700), which seals a distal space within the trocar sleeve (5700) from a proximal space within the trocar sleeve (5700).

11. Instrument system (5000) according to claim 9 or 10, wherein the Converter device (5540; 5640; 5740) such as at the The trocar sleeve is mounted in such a way that it is pressed against the structure-borne sound transmission element, while the Functional device (1110 ; 1210 ; 5210 ) through the trocar sleeve (5500 ; 5600 ; 5700 ) is routed through.

12. Instrument system (1000; 5000) according to any one of claims 1 to 11, wherein the structure-borne sound transmission element (1132) comprises a rigid solid, a hollow waveguide and / or a prestressed wire.

13. Instrument system (5000) according to one of claims 1 to 12, further comprising a computing device (5660) configured to receive the electrical response signal (1171) and at least based thereon a To generate an output signal (5672, 5674).

14. Instrument system (5000) according to claim 13, wherein the The computing unit (5660) is designed to perform the To generate an output signal (5672, 5674) in real time or quasi-real time.

15. Instrument system (5000) according to one of claims 13 or 14, wherein the output signal (5672) is an audible acoustic The output signal includes various states of the organic tissue (2) into which the electrical RF current has been coupled, and / or processes on it.

16. Instrument system (5000) according to any one of claims 13 to 15, wherein the computing device (5660) and / or the converter device (5640) are configured such that the Output signal (5672, 5674) only on such electrical Response signals (1171) are based on a The structure-borne sound response is based on data recorded while no electrical RF current was coupled in.

17. Instrument system (5000) according to any one of claims 13 to 16, wherein the functional device (1110; 1210; 5210) comprises at least one further sensor which is designed to generate at least one sensor signal, and wherein the The computing unit (5660) is designed to perform the Output signal (5672, 5674) also based on at least one sensor signal.

18. Instrument system (5000) according to claim 17, wherein the at least one further sensor comprises a temperature sensor, an electrical impedance sensor, a tissue thickness sensor and / or a pressure force sensor.

19. Instrument system (5000) according to one of claims 13 to 18, wherein the computing device (5660) is configured to perform the to generate an output signal (5672, 5674) at least partially based on an artificial intelligence entity, KIE (5669).

20. Instrument system (5000) according to one of claims 13 to 19, wherein the output signal (5674) comprises a control signal configured to perform a function of the To control functional equipment (1110, 1210, 5210).

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