Method for mounting and / or securing guiding elements on a spatially adjustable panel by means of at least one clamping element, guiding elements for moving a distal joint mechanism, medical instrument, and robot

Abstract

The invention relates to a method for mounting and / or securing guiding elements on a spatially adjustable panel, wherein the spatially adjustable panel has, at least partially, an internal cavity, an outer surface, an inner surface and a deflecting contour for deflecting the guiding elements, comprising the following steps: – passing the guiding elements by means of a respective guiding element end through a respective hole in the spatially adjustable panel, so that each passed-through section of the guiding elements is arranged with the respective guiding element end on the proximal side of the spatially adjustable panel, – guiding the passed-through sections of the guiding elements at least partially along the outer surface, the deflection contour and / or the inner surface of the spatially adjustable panel, and – clamping the passed-through sections (106) of the guiding elements by means of at least one clamping element to the outer surface, the deflection contour and / or the inner surface of the spatially adjustable panel, so that the guide elements are secured in a force-fitting manner on the spatially adjustable panel. The invention also relates to guide elements, a medical instrument and a robot.

Description

[0001] Method for mounting and / or fastening steering elements to a spatially adjustable disc by means of at least one clamping element, steering elements for moving a distal joint mechanism, medical instrument and robot

[0002] The invention relates to a method for mounting and / or fastening steering elements to a spatially adjustable disc, wherein a distal-side joint mechanism for angling a distal end portion of a medical instrument is movable by means of the steering elements, and the spatially adjustable disc has, for each steering element, a hole with a cross-section through a thickness of the spatially adjustable disc, at least partially an internal cavity, an outer surface, an inner surface, and a deflection contour for deflecting the steering wires. Furthermore, the invention relates to steering elements for moving a distal-side joint mechanism for angling a distal end portion of a medical instrument, a medical instrument, and a robot.

[0003] Articulated instruments are frequently used in medical and non-medical applications and can be hand-held and / or robotic. To enable articulation of the shaft of a medical instrument, four or more external steering wires and / or steering cables are typically arranged around pivoting links of a distal joint mechanism. For precise and homogeneous control of the distal, articulating end of the shaft and / or the robot arm, the use of a large number of thin steering wires is advantageous in order to enable uniform movement and force distribution in all directions of articulation. To achieve this, the steering wires must be fixed in a taut state on the distal side (far from the user) and on the proximal side (near the user).

[0004] US 2017 / 0281296 A1 discloses a medical instrument with steering cables for moving an end effector. The steering cables are guided through openings in a gimbal plate and a locking plate, each of which has locking wedges on opposite sides. These wedges clamp the steering cables when the gimbal plate and the locking plate are pushed together. The gimbal plate and the locking plate are then screwed together for fixation. A disadvantage here is that manufacturing tolerances during the manufacture of the gimbal plate and the locking plate can lead to variations in the tension with which the steering cables are fixed. There is also a risk that the steering cables could be damaged by sharp edges on the gimbal plate and the locking plate and / or by clamping.The disadvantage of this is that the individual strands of the steering cable fray, significantly disrupting or complicating installation. Due to the necessary handling of several components and the screw connections, installation is very complex.

[0005] It is also known to screw the steering wires to a proximal, drivable swashplate. For this, each steering wire must first be individually pre-tensioned and then screwed to the swashplate. In addition to being time-consuming, this can also lead to damage to the steering wires. Furthermore, the threaded holes on the swashplate and the corresponding screws, which are typically installed in and on the radially surrounding side wall of the swashplate, require a large amount of installation space.

[0006] The object of the invention is to improve the state of the art.

[0007] The object is achieved by a method for mounting and / or fastening steering elements to a spatially adjustable disc, wherein a distal-side joint mechanism for bending a distal end section of a medical instrument is movable by means of the steering elements, and the spatially adjustable disc has, for each steering element, a hole with a cross-section through a thickness of the spatially adjustable disc, at least partially an internal cavity, an outer surface, an inner surface and a deflection contour for deflecting the steering elements, with the following steps:

[0008] Passing the steering elements with a respective steering element end through the respective hole of the spatially adjustable disc, so that a respective passed-through section of the steering elements with the respective steering element end is arranged on a proximal side of the spatially adjustable disc,

[0009] Guiding the guided sections of the steering elements at least partially along the outer surface, the deflection contour and / or the inner surface of the spatially adjustable disc, and

[0010] Clamping the guided sections of the steering elements by means of at least one clamping element on the outer surface, the deflection contour and / or the inner surface of the spatially adjustable disc, so that the steering elements are non-positively fastened to the spatially adjustable disc.

[0011] This provides a method with which the steering elements are quickly and easily mounted on a spatially adjustable disc and the steering element ends which pass through the spatially adjustable disc are fastened to the spatially adjustable disc by means of the at least one clamping element. It is particularly advantageous that the steering elements are thereby force-fitted to the spatially adjustable disc in a tensioned state. Consequently, steering elements are provided which are optimally fixed to the spatially adjustable disc with a fixed, predetermined tension in the tensioned state. By clamping them using the at least one clamping element, the steering elements are uniformly fastened and thus homogeneously pretensioned. It is particularly advantageous that only one clamping element is required for this, so that all passed-through sections of the steering elements can be clamped simultaneously.

[0012] Consequently, a proximal drive movement on the spatially adjustable disc is optimally transferred to the distal components of a distal joint mechanism for angling the distal end section of the medical instrument by means of the force-locking connected and tensioned steering elements.

[0013] Because the steering elements are force-fitted to the spatially adjustable disc by means of at least one clamping element, the materials of the connecting partners can be freely selected. For example, the steering elements can be made of a nickel-titanium alloy, and the spatially adjustable disc can be made of chromium-nickel-molybdenum stainless steel. In contrast, a material-to-material connection using welding would require both the steering wires and the spatially adjustable disc to be made of a nickel-titanium alloy. Consequently, the steering wires can be made of Nitinol as a nickel-titanium alloy without requiring increased effort in forming the connection between the steering elements and the spatially adjustable disc. Compared to other materials, such as stainless steel, Nitinol offers the advantage of being very elastic and very robust under alternating stress.The force-locking connection enables quick and easy assembly without the steering elements cutting into and / or settling in the joint mechanism after clamping. It is particularly advantageous that the clamping of the guided sections of the steering elements is carried out flexibly by means of the at least one clamping element on the outer surface, the deflection contour, and / or the inner surface of the spatially adjustable disc. Thus, both a flat and a contoured outer surface and / or inner surface and / or a specific deflection contour can be used to guide and clamp the guided sections of the steering elements.As a result, the at least one clamping element presses the passed-through sections of the steering elements against the outer surface, the deflection contour and / or the inner surface of the spatially adjustable disc, whereby the clamping force of the at least one clamping element fastens the steering elements to the spatially adjustable disc in such a way that, depending on the friction coefficients of the respective materials, they are firmly fixed in and / or on the spatially adjustable disc. Consequently, clamping by means of the at least one clamping element prevents the steering elements from slipping up to a defined load. In addition to clamping, the tensile load on the steering elements can also be increased additionally by frictional forces and / or deflection along the outer surface, the deflection contour and / or the inner surface by selecting the materials of the connection partners.

[0014] Because the guided sections of the steering elements are guided at least partially along the outer surface, the deflection contour, and / or the inner surface of the spatially adjustable disc and are clamped between the clamping element and the outer surface, the deflection contour, and / or the inner surface, there is little or no risk of the strands of the steering elements fraying and complicating assembly, or even requiring a new steering element to be passed through and / or threaded through a hole in the spatially adjustable disc. Consequently, the assembly of the steering elements within the joint mechanism is significantly simplified and can be carried out more quickly.

[0015] A core idea of ​​the invention is that the proximal steering element ends are individually guided through the respective hole of the spatially adjustable disc and are guided on the proximal side of the spatially adjustable disc at least partially along the outer surface, the deflection contour and / or the inner surface of the spatially adjustable disc and the guided sections of the steering elements are clamped by means of the at least one clamping element in a local position on the outer surface, the deflection contour and / or the inner surface to form a force-locking connection and the steering elements are thereby fastened to the spatially adjustable disc without further auxiliary materials and / or fastening means being required in addition to the at least one clamping element.Depending on the shape of the outer surface, the inner surface, and / or the deflection contour, a targeted change in the direction of the guidance of the steering elements along the surface of the spatially adjustable disc can be utilized, thereby improving the strength of the force-locking connection and preventing slippage of the steering elements. This allows both friction between the materials of the steering elements and the spatially adjustable disc and a surface-wide transfer of the clamping force by guiding the steering elements along the outer surface, the deflection contour, and / or the inner surface to the spatially adjustable disc to be utilized for stationary fixation.

[0016] The following terminology is explained:

[0017] A "steering element" is, in particular, a thin, long, shaped, flexible element. The elongated steering element comprises, in particular, a metal and / or a metal alloy. A steering element can be a steering wire and / or a steering cable. A steering wire is, in particular, a thin, long, shaped, flexible metal. A steering element comprises, in particular, a nickel-titanium alloy and thus nitinol, stainless steel, and / or tungsten. A steering wire is preferably made entirely of nitinol. The steering wire, in particular, has a smooth surface. A steering cable is an elongated, tensile-resistant element consisting of twisted or braided wires. Corresponding to the twisting or braiding, a steering cable, in particular, has a structured surface. A steering cable, for example, comprises a stainless austenitic chromium-nickel-molybdenum steel (1.4401).In principle, a steering element can have any cross-sectional shape, for example, a circular, oval, and / or curved cross-section, a flat-edged, square, or profiled wire cross-section. The steering element preferably has a round cross-section. Typically, >3 or 4, preferably 10, or any number of steering elements are used in a joint mechanism inside the shaft. In addition to the proximal attachment of the steering element ends to the spatially adjustable disc, the opposite distal steering element ends are each fixed internally to the bendable distal end section.

[0018] In the area of ​​the distal, bendable end section, the steering elements are arranged, in particular, radially encircling the outside of pivoting members and / or member bodies, by means of which a fine bending of the distal end section is realized. A movement of the spatially adjustable disc, brought about by means of a proximal drive, is translated into a corresponding relative movement of the distal-side pivoting members via the steering elements connected to the disc, which are stretched along the longitudinal direction of the shaft up to the distal steering element ends fixed in the distal end section, thus causing the distal end section to bend. For fine motor control of the distal end section of the medical instrument, a large number of thin steering elements are used in particular in order to achieve a more even force distribution and thus relative movements in all possible bending directions.

[0019] A “joint mechanism” has, in particular, a “distal-side joint mechanism” and a “proximal-side joint mechanism”. The “proximal-side joint mechanism” has, in particular, the at least one clamping element, the spatially adjustable disc, associated shafts, and the proximal-side steering element sections. On the distal side of the proximal-side joint mechanism, the steering elements are brought together, for example via a guide ring or a fan-shaped disc, in the direction of the distal tip at a closer distance of the steering elements from the longitudinal axis of the shaft, so that they enter essentially parallel at the proximal end of the shaft and are guided within the shaft to the distal end section. For example, the diameter of the steering elements radially surrounding the longitudinal axis of the shaft is narrowed from 18 mm to 4 mm.On the distal side of the proximal joint mechanism, the associated shaft of the spatially adjustable disc is connected in the distal direction to a main shaft, via which the rotation of the shaft is realized. The proximal joint mechanism can be arranged in particular in the transition between the hand and / or holding part of the medical instrument and the shaft, or in the hand and / or holding part. The "distal joint mechanism" has in particular the distal steering element sections and the pivoting members, by means of which an angling of the distal end section can be realized.

[0020] A "spatially adjustable disc" (also called a "swash plate") is, in particular, a disc which is mounted in such a way that, when moved by a proximal drive relative to the disc center, it executes an outward pivoting movement transverse to the longitudinal axis through the disc and thus an up and down movement (wobbling movement) on both sides. The swash plate in particular has a cardanic bearing. To transmit the respective proximal and distal side movements, the spatially adjustable disc is connected in particular to a distal side ball shaft or a distal side ball joint and a proximal side ball shaft or a distal side ball joint. The steering elements are guided through the thickness of the spatially adjustable disc.Thus, for example, when viewing the shaft in longitudinal cross-section, the upper section of the swash plate lying transversely to the longitudinal direction of the shaft is displaced towards the distal end, while the lower section is displaced towards the proximal end, whereby the distal end section is angled downwards due to the corresponding movement of the steering elements fixed to the swash plate. Consequently, depending in particular on the arrangement of the tensioned and fixed steering elements on the swash plate, some steering elements are pushed and others pulled simultaneously by the pivoting movement of the swash plate. The spatially adjustable disc is made in particular of stainless steel, a stainless steel alloy, aluminum and / or plastic. The diameter of the spatially adjustable disc depends in particular on the desired angle of deflection of the distal-side joint mechanism.For example, the swash plate may have a diameter in a range from 10 mm to 50 mm, in particular from 15 mm to 40 mm, preferably from 20 mm to 30 mm.

[0021] A “medical instrument” is, in particular, any mechanical or mechanical-electrical unit suitable for the diagnosis and / or treatment of humans or animals. The medical instrument is used, in particular, for the inspection of a human or animal body cavity and / or for the manipulation of human or animal tissue. The medical instrument has, in particular, a handle or handle part, a shaft and a tool and / or an optical system for viewing a field of view. The medical instrument can, in particular, have a grasping tool, a cutting tool, a needle holder, a clip applicator and / or another type of tool. A medical instrument is, for example, an endoscope with a long shaft and an angularly adjustable end section. The medical instrument can be a handheld and / or hand-guided instrument.The medical instrument can also be arranged as an end effector on a robotic arm of a surgical robot, thus being a robot-assisted instrument. The medical instrument, in particular, has a flexible or rigid shaft.

[0022] The "shaft" of the medical instrument is particularly designed as an elongated tube. The shaft has a diameter in a range of 2 mm to 10 mm. The shaft can, in particular, have further components, such as an optical fiber for illuminating the object field, one or more working channels for supplying irrigating fluid or a tool, such as a biopsy needle or an electrode. Particularly in the case of a rigid shaft, a central actuating element, for example a push / pull cable, for actuating a tool, for example a jaw part, can be arranged at the bendable, distal instrument tip from its proximal to distal end inside the shaft.

[0023] "Distal" and "distal" refer to an arrangement close to the patient's body and thus far from the user, and / or a corresponding end or section. Accordingly, "proximal" or "proximal" refers to an arrangement close to the user and thus far from the patient's body, or a corresponding end or section.

[0024] A "proximal drive" is a drive unit for acting on and thus pivoting the spatially adjustable disc. Thus, the drive movement of the proximal drive is translated into a pivoting movement of the spatially adjustable disc and, via the steering elements attached to the spatially adjustable disc, into a corresponding relative movement of the distal pivoting members and / or member bodies for pivoting the end section of the medical device. The proximal drive can be a manual drive, for example, based on the rotary movement of an actuating element, or a motorized drive. In the case of a motorized drive, this comprises one or more motors and / or a transmission, such as driven gears. The proximal drive is arranged in particular in the hand and holding part.

[0025] An "actuating unit" is, in particular, a component or consists of several components that act on the proximal drive. An actuating unit can, in particular, have one or more actuating elements. The actuating elements can, for example, be a push button or a rotary dial, by means of whose movement the proximal drive is actuated. However, an actuating element of the actuating unit can also be an electronic control signal. Thus, the actuating unit can be a manually operable handle or a structural unit designed for robotic use and operable without manual intervention.

[0026] A “hole” is in particular a usually round opening through a thickness and / or a section of the spatially adjustable disc. The respective hole can be formed, for example, by a steering ring of the spatially adjustable disc. The hole is in particular formed continuously essentially in the longitudinal direction of the shaft and / or a shaft of the proximal-side joint mechanism. The hole can be made in the spatially adjustable disc, for example, by laser or water jet cutting, erosion or drilling. The holes can also be made directly during manufacture of the spatially adjustable disc and thus during the shaping process, such as casting or sintering. However, the hole does not necessarily have to have a round cross-section, but can also have a non-circular shape or a shape adapted to the shape of the steering element.Each hole has a cross-section that is larger than the outer diameter of the steering element passing through the respective hole.

[0027] A "clamping element" is, in particular, a component with which the proximal steering element ends are non-positively connected to the spatially adjustable disc. A clamping element is, in particular, any component that exerts a clamping force and / or spring force and thereby clamps the sections of the steering elements or the steering element ends. Preferably, the sections of the guided steering elements are clamped between a surface of the clamping element and a surface of the spatially adjustable disc. In principle, the clamping element can have any shape and / or any clamping mechanism. The clamping element serves, in particular, to form a detachable and / or non-positive connection between the guided sections of the steering elements and the spatially adjustable disc. A clamping element can, for example, be a screw clamp, a terminal block, a spring clamp, or a retaining ring.A clamping element can be designed in one piece, two pieces, or multiple pieces. For example, the clamping element can comprise two half rings with a tension spring arranged between them. A "positive connection" is, in particular, a detachable connection in which a normal force acts on the surfaces to be connected. Mutual displacement of the connected surfaces is prevented, in particular, as long as the counterforce caused by static friction is not exceeded. The positive connection between the respective guided section of the steering element and the swash plate is achieved, in particular, by means of the at least one clamping element.

[0028] The "outer surface" is, in particular, a surface or a section of a surface on the outside of the spatially adjustable disc. The "inner surface" is, accordingly, a surface or a section of a surface on an inside of the spatially adjustable disc. Thus, the inner surface is arranged on a side facing an enclosing space. In particular, the inner surface is a surface adjacent to the internal cavity of the spatially adjustable disc.

[0029] A "deflection contour" is, in particular, a region of the outline of the spatially adjustable disc that stands out from the surface of the spatially adjustable disc. The deflection contour has, in particular, a specific shape, such as a curvature, an S-shape, and / or a rib shape. By means of the deflection contour, in particular, the direction of the steering elements guided in the proximal direction is changed. The steering elements are, in particular, guided around the deflection contour and accordingly run around the outline of the deflection contour. The deflection contour can be formed and / or arranged on the outer surface, the proximal end, the end face, and / or on the inner surface of the spatially adjustable disc.

[0030] In a further embodiment of the method, the clamping of the guided sections of the steering elements is carried out by means of a second clamping element, a third clamping element and / or further clamping elements.

[0031] Thus, the guided sections of the steering elements can be clamped to the spatially adjustable disc at different positions along the outer surface, deflection contour and / or inner surface by means of two or optionally more clamping elements, thus increasing the holding force and reducing the risk of the steering elements slipping.

[0032] The second, third, and / or further clamping elements are functionally a clamping element as defined above. However, the clamping elements can have different shapes, clamping mechanisms, and / or clamping forces. In order to clamp all of the through-passing sections of the steering elements simultaneously, one retaining ring or two or more retaining rings can be used as the at least one clamping element, the second clamping element, the third clamping element, and / or as further clamping elements.

[0033] Consequently, all steering elements can be attached to the spatially adjustable disc at the same time using a single locking ring.

[0034] A "retaining ring" (also called a "grooved ring") is, in particular, a component for securing the position and thus for fastening the guided sections of the steering elements to the spatially adjustable disc. A retaining ring can, in particular, be an external retaining ring, which is placed on a section of the outer surface of the spatially adjustable disc and clamps the guided sections of the steering elements between its inner surface and the outer surface of the spatially adjustable disc. The retaining ring can also be an internal retaining ring, the outer surface of which presses the sections of the steering elements against the inner surface of the spatially adjustable disc.An external retaining ring and an internal retaining ring can also be used to clamp the sections of the steering elements onto the deflection contour, depending on the position and / or shape of the deflection contour on the spatially adjustable disc. A retaining ring is, in particular, a standard part. A retaining ring can also be a snap ring, a lamellar ring, or a lock washer. Accordingly, retaining ring pliers are not required for the assembly and / or disassembly of the lamellar ring and the lock washer. The retaining ring is preferably positioned in a groove in the surface of the spatially adjustable disc. The force-fitting clamping and fixing of the sections of the steering elements depends in particular on the respective clamping force of the retaining ring.Two or more retaining rings may differ from one another in their shape, diameter, material thickness and / or clamping force, as well as in other properties.

[0035] In a further embodiment of the method, the deflection contour is arranged at a proximal end of the spatially adjustable disc, and the guided sections of the steering elements are deflected along and / or around the deflection contour of the spatially adjustable disc. By arranging the deflection contour at the proximal end of the spatially adjustable disc, the guided sections of the steering elements can initially be guided in a proximal direction along the outer surface of the spatially adjustable disc and then, by means of the terminal, proximal-side deflection contour, can be guided in the opposite distal direction along the inner surface of the spatially adjustable disc. Consequently, a change in the direction of guidance of the sections of the steering elements of essentially 180° can be realized by means of the deflection contour.Because a deflection takes place and the sections of the steering elements that are guided through and along the surface can have opposite directions on the outer surface and the inner surface, slipping of the clamped sections of the steering elements is additionally prevented and the steering elements can be optimally fixed both on the outside of the deflection contour and, in the case of an encompassing design of the deflection contour, on the inside in the region of the cavity from the outer surface via the proximal end to the inner surface.

[0036] Thus, the clamping action, the effect of the frictional force between the steering elements and the spatially adjustable disc, and the change in direction due to the deflection result in a fixed positioning and force-locked connection of the guided sections of the steering elements along the spatially adjustable disc. These three mechanisms prevent the steering elements from slipping, even under high tensile and / or compressive loads when operating the proximal joint mechanism.

[0037] In order to position the clamping element and / or the retaining ring precisely on the spatially adjustable disc and / or to receive the proximal ends of the steering elements in a precisely positioned manner, at least one groove is introduced into the outer surface, the deflection contour and / or the inner surface and the clamping of the passed-through sections of the steering elements by means of the clamping element and / or the respective clamping element takes place between a wall of the groove and the clamping element and / or the respective clamping element.

[0038] Thus, after the steering elements have been passed through a respective hole in the spatially adjustable disc and guided along the passed-through sections of the steering elements, a clamping element and / or a retaining ring can be inserted into a preferably circumferential groove, whereby the guided steering elements are pressed into this groove. The respective corresponding section of the steering elements is guided along the surface of the spatially adjustable disc and along the shape of the groove. By clamping, the steering element sections are locally fixed in the groove such that they are firmly attached to and / or in the spatially adjustable disc depending on the clamping force of the clamping element and / or the spring force of the retaining ring and the friction coefficients of the materials of the steering elements, the spatially adjustable disc, the clamping element and / or the retaining ring.Consequently, the frictional fixing of the steering elements by the clamping element and / or the retaining ring in combination with a preferably circumferential groove increases the static friction of the steering elements and thus prevents the steering elements from slipping up to a defined load.

[0039] A “groove” is in particular an elongated depression in the surface of the spatially adjustable disc. A respective groove can in particular be arranged on the outer surface, the deflection contour or the inner surface of the spatially adjustable disc. The groove can in particular be circumferential, continuous or stepped. The groove can have a rectangular cross-section, a trapezoidal shape or the shape of a dovetail and / or another shape. The clamping element and / or the retaining ring can be inserted and / or positioned in the groove. The ends of the steering elements can be received in the groove and arranged on a wall of the groove. Depending on the position of the groove in the surface of the spatially adjustable disc, the groove can be introduced horizontally, vertically or obliquely into the respective surface of the spatially adjustable disc.

[0040] In a further embodiment of the method, the inner surface and / or the groove has at least one receiving element or one receiving element each for receiving the steering element ends or a respective steering element end.

[0041] Thus, at least one receiving element or several receiving elements can be specifically inserted into the groove before the clamping element and / or the securing element are inserted. A receiving element can, for example, be a slot and thus a further recess in the groove or drilled holes in the wall of the groove into which the respective steering element ends are inserted before the clamping element and / or the securing ring are inserted into the groove. Thus, the proximal ends of the steering elements can either rest butt-on against a wall of the groove or be received in one or more receiving elements of the inner surface and / or the groove.

[0042] In order to utilize the entire radially circumferential outer surface and / or inner surface of the spatially adjustable disc for clamping, a swash plate is used as the spatially adjustable disc. To enable stress-free assembly and subsequent preloading, in a further embodiment of the method, the spatially adjustable disc with a distal-side ball shaft is inserted into a main shaft of the proximal-side joint mechanism before clamping. After the force-locking attachment has been formed, the spatially adjustable disc with the distal-side ball shaft is partially pulled out of the main shaft in the proximal direction to preload the force-lockingly attached steering elements.

[0043] A "ball shaft" is, in particular, a shaft with a ball joint. The spatially adjustable disc (swash plate) has, in particular, a proximal-side ball shaft for transmitting the drive movement of the proximal drive to the spatially adjustable disc in the form of a pivoting movement. For this purpose, the swash plate has, in particular, a mount for sliding on the ball head of the ball shaft and thus a movable mount about all axes. Furthermore, the spatially adjustable disc has a distal-side ball shaft for preloading the fixed steering elements on the spatially adjustable disc for connecting to the main shaft and / or for transmitting the movement to the main shaft.

[0044] In a further aspect of the invention, the object is achieved by steering elements for moving a distal-side joint mechanism for bending a distal end section of a medical instrument, wherein the steering elements are fastened to a spatially adjustable disc by means of a method described above.

[0045] Thus, force-locking connected steering elements are provided which, when used in a shaft in a medical instrument, enable a continuous and very smooth control of the distal joint mechanism for angling the distal end section of the medical instrument.

[0046] Furthermore, a shaft with steering elements, which are attached according to the method described above, is provided, which, due to the reliable force-locking connection by means of clamping, rubbing, and / or deflection, and the uniform, defined tension, enable an optimal, reliably controllable joint mechanism in the shaft. The shaft is, in particular, detachably connectable to the hand and / or holding part of a medical instrument and / or reusable and / or designed for single use. In an additional aspect of the invention, the object is achieved by a medical instrument with an elongated shaft, wherein an actuating unit for actuating a proximal drive is arranged at a proximal end of the shaft and an end section is arranged at a distal end, and the end section is bendable relative to a longitudinal axis of the shaft by means of a distal-side joint mechanism.a plurality of steering elements are guided through the elongated shaft and connect the proximal-side drive to the distal-side joint mechanism, wherein the proximal-side drive can act on a spatially adjustable disc and the steering elements are guided with a respective proximal steering element end through a respective hole through a thickness of the spatially adjustable disc, wherein sections of the steering elements arranged proximal to the spatially adjustable disc are arranged along an outer surface, a deflection contour and / or an inner surface of the spatially adjustable disc and are non-positively connected to the spatially adjustable disc by means of at least one clamping element.

[0047] In a further embodiment of the medical instrument, the steering elements comprise a nickel-titanium alloy and the spatially adjustable disc and / or the at least one clamping element comprise a material with a higher material hardness than the nickel-titanium alloy.

[0048] Preferably, at least the spatially adjustable disc has a higher material hardness than the steering elements. The clamping element and / or the retaining ring can have the same or higher material hardness than the steering elements. The retaining ring comprises, for example, hardened steel. Likewise, the retaining ring and / or the clamping element can also be made of the same or a different nickel-titanium alloy as the steering elements.

[0049] A "nickel-titanium alloy" is, in particular, a nickel-titanium intermetallic compound. A nickel-titanium alloy is, in particular, Nitinol. "Nitinol" is, in particular, an intermetallic phase NiTi with an ordered, cubic crystal structure, which differs from that of titanium and nickel. The nickel-titanium alloy and Nitinol usually have a somewhat larger proportion of nickel, for example, 55%, and titanium. However, Nitinol can also contain 50% nickel and 50% titanium and / or other alloy ratios and / or additional alloying components in small amounts. Nitinol, in particular, exhibits thermal shape memory and superelasticity. Nitinol returns to its original shape, especially after plastic deformation, when heated.This thermal shape memory and the mechanical shape memory as superelasticity are due in particular to a thermoelastic, martensitic transformation in the solid state. Conventional processes for component manufacturing at room temperature are generally unsuitable due to the extreme elasticity of Nitinol and / or its thermal shape memory. In principle, machining processes for shaping are possible, but these are associated with considerable tool wear. In this regard, it is advantageous that, if the steering elements and the clamping element are both manufactured from Nitinol, the swashplate can be manufactured and machined from a different material. The Nitinol steering elements are produced in particular by drawing, with the wire being annealed between drawing processes. Nitinol can be shaped, for example, by grinding or electrical discharge machining.Due to their superelastic properties, Nitinol steering elements can be bent to a greater extent than, for example, stainless steel steering elements. Furthermore, Nitinol steering elements can be bent multiple times while still remaining steerable. Furthermore, Nitinol maintains its shape even under tension and is kink-resistant.

[0050] In a further embodiment, the medical instrument has a second clamping element, optionally a third clamping element and / or further clamping elements for force-fitting fastening of the steering elements to the spatially adjustable disc and / or a second deflection contour, optionally a third deflection contour and / or further deflection contours for deflecting the steering elements.

[0051] Thus, two or more deflection contours can be arranged at different positions on the inner and / or outer surface of the spatially adjustable disc and have different shapes and / or material thicknesses compared to the surrounding surface of the spatially adjustable disc.

[0052] In order to clamp and fasten the steering elements radially and uniformly to the outer surface, the inner surface and / or the deflection contour, the clamping element, the respective clamping element or the clamping elements is / are designed as an outer retaining ring and / or as an inner retaining ring.

[0053] In a further embodiment of the medical instrument, the at least one deflection contour, the respective deflection contour or the deflection contours is or are a curved contour, a contour raised above the surface of the spatially adjustable disc and / or a curved and / or thickened edge at a proximal end of the spatially adjustable disc.

[0054] Of course, a deflection contour can also be designed differently in certain sections. For example, a deflection contour can initially be designed as a straight conical extension in the longitudinal direction of the steering elements and have a subsequent section with a curved contour or a terminal semicircular contour.

[0055] In a further aspect of the invention, the object is achieved by a robot having at least one robot arm for holding and / or positioning a medical instrument and / or having an actuator for controlling a distal-side joint mechanism of the medical instrument, wherein the medical instrument is a previously described medical instrument, so that the medical instrument can be positioned by means of the at least one robot arm and / or the distal-side joint mechanism can be actuated by the action of the actuator of the robot on the proximal drive of the medical instrument.

[0056] Thus, the steering elements attached to a spatially adjustable disc can be used not only in a hand-held medical instrument but also in a robotically guided instrument. The robot ensures, on the one hand, a firm hold of the medical instrument at the end of at least one robot arm and, on the other hand, precise positioning of the medical instrument. On the other hand, the joint mechanism and the angling of the distal end section of the medical instrument can be controlled very precisely as an end effector via an input device on the robot, for example, using a joystick on the control console and / or input handles attached to the robot's hand.In principle, the proximal drive of the medical instrument can also be arranged in the distal end of the robot arm and a coupling and / or interface between the distal end of the robot arm and the holding unit of the medical instrument can be designed accordingly.

[0057] A “robot” is a medical robot. A robot is, in particular, a surgical robot. The robot is typically a telemanipulator, which uses the surgeon’s input and / or control elements on one side to control the medical instrument as an end effector on the other side at the end of a robot arm. The robot preferably has multiple robot arms, with a camera, in particular a three-dimensional camera, arranged on one robot arm and one or more interchangeable medical instruments on the robot arm or the other robot arms. Each robot arm is designed to be movable in particular on 3 to 8 axes. Instead of one robot with multiple arms, it is of course also possible to use multiple robots, each with one arm or even just two arms, which are controlled together. The camera can also be held endoscopically or exoscopically.

[0058] Through a coupling and / or interface between the end of the robotic arm holding the medical instrument and the medical instrument, the proximal drive of the medical instrument can be activated by the robotic arm's actuator. Any drive component or assembly that converts an electrical signal into a mechanical movement can be used as the actuator.

[0059] Further embodiments, as well as some of the advantages associated with these and other embodiments, will become clear and easier to understand from the following detailed description with reference to the accompanying figures. Objects or parts thereof that are substantially the same or similar may be provided with the same reference numerals. The figures are merely a schematic representation of an embodiment of the invention. An exemplary embodiment of the invention is shown in the drawings. The drawings, the description, and the claims contain numerous features in combination. Those skilled in the art will expediently also consider the features individually and combine them into useful further combinations.

[0060] The invention will be explained in more detail below using exemplary embodiments.

[0061] Figure 1 is a schematic, three-dimensional representation of connected steering wires on a swashplate,

[0062] Figure 2 is a schematic representation of a proximal joint mechanism with the swash plate, the connected steering wires and a main shaft,

[0063] Figure 3 is a schematic, three-dimensional representation of the proximal joint mechanics from Figure 2 in a distal side view,

[0064] Figure 4 is a three-dimensional representation of a video endoscope with a bendable tip of a shaft,

[0065] Figure 5 is a highly schematic representation of a surgical robot with an endoscopic instrument attached to a robot arm, and

[0066] Figure 6 shows a flow diagram of a method for assembling and / or attaching steering wires. A medical instrument 101 comprises a video endoscope 127, wherein the video endoscope 127 has a handle 133 and a flexible shaft 129. Several external control elements 135 for operating the video endoscope 127 by a user are arranged on the handle 133. Furthermore, the handle 133 of the video endoscope 127 is connected to a supply hose 137, at the end of which a plug 141 is arranged. The flexible shaft 129 of the video endoscope 127 has a bendable tip 131, which can be bent by means of an internal joint mechanism in the shaft 129 via the control elements 135 (Figure 4).

[0067] A joint mechanism of the shaft 129 has an internal, proximal-side joint mechanism 103, which has a swash plate 109 made of stainless steel with an external, integrated steering ring 111. The steering ring 111 has ten through-holes 113. Internally, the swash plate 109 has a cavity 110. A main shaft 120 with a proximal-side ball shaft 121 and a distal-side ball shaft 123 extends through the cavity 110 of the swash plate 109 along a longitudinal central axis 143 (see Figures 2 and 3). By means of a drive (not shown), a pivoting movement is imparted to the swash plate 109 via the proximal-side ball shaft 121.Furthermore, the joint mechanism has ten steering wires 105 made of Nitinol, which are fastened internally in the area of ​​the bendable tip 131 on the distal side and are guided in a tensioned manner through the shaft 129 to the opposite proximal end of the shaft 129 to the proximal joint mechanism 103.

[0068] Furthermore, the swash plate 109 has an outer surface 114 on the proximal side of the steering ring 111 and a surrounding, thickened deflection contour 115 at the proximal end. The deflection contour 115 merges into an inner surface 116 on the inside around the cavity 110. A groove 117 with a wall 118 oriented horizontally in Figure 1 and a vertical, proximal-side wall 125 is arranged in the inner surface 116.

[0069] On the proximal side, the steering wires 105 are distributed evenly radially around the circumference, each through a through-bore 113 and further along the outer surface 114 in the proximal direction 145 around the deflection contour 115 and thereby returned in the opposite direction in the distal direction, wherein the proximal steering wire sections 106 guided in this way merge into proximal steering wire ends 107, which rest against the wall 118 of the groove 117 and butt against the proximal wall 125 of the swash plate 109, which is arranged perpendicular to the wall 118. A retaining ring 119 is inserted into the groove 117, wherein the outer surface of the retaining ring clamps the proximal steering wire ends 107 radially around the circumference between its outer surface and the wall 118 of the groove 117.

[0070] To attach the steering wires 105 made of Nitinol to the swashplate 109 comprising stainless steel, the following work steps are carried out in a method 201 for mounting and / or attaching steering wires 105 (Figure 6):

[0071] The respective proximal steering wire sections 106 of the steering wires 105 are each passed through a through-hole 113 of the integrated steering ring 111 of the swash plate 109, so that the respectively passed through proximal steering wire sections 106 are arranged on the proximal side of the swash plate 109 (step 203, Figure 6). Subsequently, the guided steering wire sections 106 are guided along the outer surface 114 of the swash plate 109 (step 205) and then the steering wire sections are deflected around the terminal, thickened deflection contour 115 (step 207) so that the steering wire sections 106 guided in the proximal direction 145, after being deflected by means of the deflection contour 115, are guided inside around the cavity 110 in the opposite direction along the inner surface 114 and the wall 118 and the proximal steering wire ends 107 impinge bluntly on the proximal-side wall 125 transversely to the longitudinal central axis 143.Subsequently, by inserting the retaining ring 119 into the groove 117, the proximal steering wire ends 107 are clamped radially between the outer side of the retaining ring 119 and the wall 119 (step 209), whereby the steering wires 105 are fastened to the swash plate 109 on the proximal side in a force-fitting and secure manner.

[0072] In an alternative of the swash plate 109 not shown in Figure 2, an external locking ring has additionally been placed on the proximal side of the integrated steering ring 111 on the proximal side of the steering wire sections 106, thus repeating 211 step 209 (Figure 6).

[0073] In a further alternative, steps 203 to 209 have been carried out first, whereby an external retaining ring (not shown) has been set, and then, after the deflection contour 115 with a complete deflection 207 in the distal direction, a repetition 211 takes place with a further guiding of the steering wire sections 106 along the inner surface 114 and the wall 118 in the groove 117 (step 207) and the clamping of the steering wire ends 107 in the groove by means of the retaining ring 119 (step 209).In the case of a further alternative with a multi-part clamping element, steps 203 to 209 can also be repeated one after the other (step 211), so that the respective steering wire 105 or two or more steering wires 105, but not all ten steering wires 105, are guided through the respective through-bore 113 (203), guided along the corresponding surface 116, 114 of the swash plate 109 (205), deflected around the deflection contour 115 (207), and then secured by clamping the steering wire sections 106 (step 209). Subsequently, all steps 203 to 209 are repeated one after the other for one steering wire 105 or several steering wires 105 of the steering wires 105 not yet passed through (211, Figure 6).

[0074] In an alternative embodiment of the medical instrument, an endoscopic instrument 301 is configured as the end effector of a surgical robot 341. The surgical robot 341 has a base 347 with four robot arms, wherein only the robot arm 343, which holds the endoscopic instrument 301, is shown in Figure 5. The proximal-side joint mechanism 103 shown in Figure 2 is arranged in a shaft 329 of the endoscopic instrument 301, wherein the endoscopic instrument 301 has, at its distal end, a bendable tip 331 with a terminal jaw tool 335 (the jaw tool 335 is not shown to scale in Figure 5). At the proximal end of the shaft 329, the endoscopic instrument 301 has a holding unit 333, which is held at the end of the robot arm 343 of the surgical robot 341.An interface 345 is arranged between the holding unit 333 of the endoscopic instrument 301 and the end of the robot arm 343 for coupling, at which interface 345 a likewise internal proximal drive of the endoscopic instrument 301 is actuated via an internal actuator of the surgical robot 341 (not shown in Figure 5). As a result, a pivoting movement of the swash plate 109 is imposed via the proximal-side ball shaft 121, wherein, due to the force-locking connection of the steering wires 105 to the swash plate 109 and the tension state of the steering wires 105, the induced pivoting movement is transferred to the bendable tip 331 in a corresponding bending movement.

[0075] Thus, a medical instrument 101 with a video endoscope 127 and a surgical robot 341 with an endoscopic instrument 301 are provided, in which a continuous, homogeneous, and fluid movement of the respective bendable tips 131, 331 is effected by the force-locking connection of the proximal steering wire ends 107 and steering wire sections 106 of the steering wires 105 to the swash plate 109. An exemplary embodiment of the invention is illustrated in the drawings. The drawings, the description, and the claims contain numerous features in combination. Those skilled in the art will expediently consider the features individually and combine them into useful further combinations.The invention relates to a method for mounting and / or fastening steering elements to a spatially adjustable disc, wherein the spatially adjustable disc at least partially has an internal cavity, an outer surface, an inner surface and a deflection contour for deflecting the steering elements, with the following steps:.

[0076] - passing the steering elements with a respective steering element end through a respective hole of the spatially adjustable disc, so that a respective passed-through section of the steering elements with the respective steering element end is arranged on a proximal side of the spatially adjustable disc,

[0077] - guiding the guided sections of the steering elements at least partially along the outer surface, the deflection contour and / or the inner surface of the spatially adjustable disc, and

[0078] - Clamping the guided sections (106) of the steering elements by means of at least one clamping element on the outer surface, the deflection contour, and / or the inner surface of the spatially adjustable disc, so that the steering elements are non-positively attached to the spatially adjustable disc. Furthermore, the invention relates to steering elements, a medical instrument, and a robot.

[0079] List of reference symbols

[0080] 101 Medical Instrument

[0081] 103 proximal joint mechanics

[0082] 105 steering wire

[0083] 106 proximal guide wire section

[0084] 107 proximal guide wire end

[0085] 109 Swashplate

[0086] 110 cavity

[0087] 111 Steering ring

[0088] 113 Through hole

[0089] 114 Outer surface deflection contour

[0090] inner surface

[0091] Nut

[0092] Wall

[0093] Retaining ring

[0094] Main shaft

[0095] Proximal side ball shaft

[0096] Distal ball shaft

[0097] Proximal wall

[0098] Video endoscope

[0099] Shaft angled tip

[0100] handle

[0101] Controls

[0102] supply hose

[0103] Plug

[0104] Longitudinal central axis proximal direction

[0105] Method for mounting and / or fastening steering wires

[0106] Carrying out steering wire sections

[0107] Guiding sections of steering wire along a surface

[0108] Deflecting steering wire sections around the deflection contour

[0109] Clamping the steering wire sections

[0110] Repeat

[0111] Endoscopic instrument

[0112] Shaft angled tip

[0113] Holding unit

[0114] jaw tool

[0115] Surgical robot

[0116] robot arm

[0117] interface

[0118] Stand

Claims

Patent claims:

1. A method (201) for mounting and / or fastening steering elements (105) to a spatially adjustable disc (109), wherein a distal-side joint mechanism for bending a distal end section (131, 331) of a medical instrument (101, 301) is movable by means of the steering elements (105), and the spatially adjustable disc (109) has, for each steering element (105), a hole (113) with a cross-section through a thickness of the spatially adjustable disc (109), at least partially an internal cavity (110), an outer surface (114), an inner surface (116), and a deflection contour (115) for deflecting the steering elements (105), comprising the following steps: - passing (203) the steering elements (105) with a respective steering element end (107) through the respective hole (113) of the spatially adjustable disc (109), so that a respective passed-through section (106) of the steering elements (105) with the respective steering element end (107) is arranged on a proximal side of the spatially adjustable disc (109), - guiding (205) the guided sections (106) of the steering elements (105) at least partially along the outer surface (114), the deflection contour (115) and / or the inner surface (116) of the spatially adjustable disc (109), and - clamping (209) the passed-through sections (106) of the steering elements (105) by means of at least one clamping element (119) on the outer surface (114), the deflection contour (115) and / or the inner surface (116) of the spatially adjustable disc (109), so that the steering elements (105) are non-positively fastened to the spatially adjustable disc (109).

2. Method (201) according to claim 1, characterized in that the clamping of the passed-through sections (106) of the steering elements (105) is carried out by means of a second clamping element, a third clamping element and / or further clamping elements (119). Method (201) according to claim 1 or 2, characterized in that a retaining ring (119) or two or more retaining rings is or are used as the at least one clamping element, the second clamping element, the third clamping element and / or as further clamping elements. Method (201) according to one of the preceding claims, characterized in that the deflection contour (115) is arranged at a proximal end of the spatially adjustable disc (109), and a deflection (207) of the guided sections (106) of the steering elements (105) is carried out along and / or around the deflection contour (115) of the spatially adjustable disc (109).Method (201) according to one of the preceding claims, characterized in that at least one groove (117) is introduced into the outer surface (114), the deflection contour (115) and / or the inner surface (116), and the clamping (209) of the passed-through sections (106) of the steering elements (105) takes place by means of the clamping element and / or the respective clamping element (119) between a wall (118) of the groove (117) and the clamping element and / or the respective clamping element (119). Method (201) according to one of the preceding claims, characterized in that the inner surface (116) and / or the groove (117) has or have at least one receiving element or one receiving element each for receiving the steering element ends or a respective steering element end (107). Method (201) according to one of the preceding claims, characterized in that a swash plate (109) is used as the spatially adjustable plate.Method (201) according to one of the preceding claims, characterized in that before clamping (207) the spatially adjustable disc (109) with a distal-side ball shaft (123) is pushed into a main shaft (120) of the proximal-side joint mechanism (103) and after forming the force-fitting fastening for pretensioning the force-fittingly fastened steering elements (105), the spatially adjustable disc (109) with the distal-side ball shaft (123) is partially pulled out of the main shaft (120) in the proximal direction (145). Steering elements (105) for moving a distal-side joint mechanism for bending a distal end section (131, 331) of a medical instrument (101, 301), characterized in that the steering elements (105) are fastened to a spatially adjustable disc (109) by means of a method (201) according to one of claims 1 to 8. A medical instrument (101, 301) having an elongated shaft (129, 329), wherein an actuating unit for actuating a proximal drive is arranged at a proximal end of the shaft (129, 329) and an end section (131, 331) is arranged at a distal end, and the end section (131, 331) is bendable relative to a longitudinal axis of the shaft by means of a distal-side joint mechanism, a plurality of steering elements (105) are guided through the elongated shaft (129, 329) and connect the proximal-side drive to the distal-side joint mechanism,wherein the proximal-side drive can act on a spatially adjustable disc (109), and the steering elements (105) are guided with a respective proximal steering element end (107) through a respective hole (113) through a thickness of the spatially adjustable disc (109), characterized in that sections (106) of the steering elements (105) arranged proximal to the spatially adjustable disc (109) are arranged along an outer surface (114), a deflection contour (115), and / or an inner surface (116) of the spatially adjustable disc (109) and are non-positively connected to the spatially adjustable disc (109) by means of at least one clamping element (119). Medical instrument (101, 301) according to claim 10, characterized in thatthat the steering elements (105) comprise a nickel-titanium alloy, and the spatially adjustable disc (109) and / or the at least one clamping element (119) comprise a material with a higher material hardness than the nickel-titanium alloy. Medical instrument (101, 301) according to one of claims 10 or 11, characterized in that the medical instrument (101, 301) comprises a second clamping element, a third clamping element, and / or further clamping elements (119) for force-fittingly fastening the steering elements (105) to the spatially adjustable disc (109) and / or a second deflection contour, a third deflection contour, and / or further deflection contours (115) for deflecting the steering elements (105). Medical instrument (101, 301) according to one of claims 10 to 12, characterized in that the clamping element, the respective clamping element or the clamping elements is or are designed as an external locking ring and / or as an internal locking ring (119). Medical instrument (101, 301) according to one of claims 10 to 13, characterized in that the at least one deflection contour, the respective deflection contour or the deflection contours (115) is or are a curved contour, a contour raised above a surface of the spatially adjustable disc, and / or a curved and / or thickened edge at a proximal end of the spatially adjustable disc (109).Robot (341) with at least one robot arm (343) for holding and / or positioning a medical instrument and / or with an actuator for controlling a distal-side joint mechanism of the medical instrument (101, 301), characterized in that the medical instrument (101, 301) is a medical instrument according to one of claims 10 to 14, so that the medical instrument (101, 301) can be positioned by means of the at least one robot arm (343) and / or the distal-side joint mechanism can be actuated by the action of the actuator of the robot (341) on the proximal drive of the medical instrument (101, 301).

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