Medical instrument for remote manipulation, and system for robotic surgery

Abstract

The invention relates to a medical instrument (100) for remote manipulation, comprising a shank (200), a distal instrument head (300) having at least two tool parts (370, 380), wherein the instrument head (300) can be pivoted about a first axis of rotation (Z1) with respect to the distal end (230) of the shank (200) and wherein the tool parts (370, 380) can be pivoted about a second axis of rotation (Y1) via first traction means (310) and second traction means (320) which are each guided in the shank (200). In particular, a deflection arrangement which has at least two rollers (361, 362), preferably return pulleys, is provided which is designed to guide each of the first traction means (311) and the second traction means (321) at a spacing from the central axis (201) of the shank (200). The invention also relates to a surgical robot system which comprises a medical instrument (100) having the aforementioned features.

Description

[0001] Medical instrument for remote manipulation and system for robotic surgery

[0002] The invention relates to a medical instrument for femoral manipulation and a system for robotic surgery.

[0003] Technological background

[0004] In minimally invasive surgery or for examining difficult-to-access technical cavities, shaft instruments are used. These have an instrument head at their distal end with a tool or end effector attached for remote manipulation. The shaft extends between a proximal end and a distal end, with an actuating unit provided at the proximal end to actuate the tool located at the distal end. A tool can be used to grip, grasp, or cut objects in patient cavities or in cavities of technical structures such as shafts or pipelines. In minimally invasive, robot-assisted telesurgery, endoscopic manipulation instruments, e.g., grippers, needle holders, etc., are operated on robotic arms.

[0005] The invention is based on instruments with two degrees of freedom, in which not only the tool or the respective tool parts are pivotable, but also the instrument head is angled relative to the shaft. To enable angled positioning relative to the shaft in known instrument heads, components that define a rotation or pivot axis connect the instrument head to the shaft. Similarly, the tool parts of the end effector can be pivotably mounted relative to a tool carrier of the instrument head using suitable components.

[0006] To angle or pivot the instrument head and to control the tool and / or the tool parts at the distal end, it is known to provide control means, e.g., in the form of traction means or cables extending through the shaft. To form a pair of cables for controlling a tool part, it is known to guide each cable in the tool holder around a disc and back into the shaft.

[0007] An example of a robotic surgical system to support the control of endoscopic instruments, e.g. for use in laparoscopy, is the Da Vinci® EndoWrist system from Intuitive Surgical, which features, among other things, forceps instruments with outer diameters of around 8 mm and two degrees of freedom. One such system is known, for example, from US 6,312,435 B 1 and describes a mechanism that imitates a wrist, in which the tool carrier can be angled relative to the shaft about a first axis of rotation, the so-called wrist pivot. To control the second degree of freedom, i.e. the pivoting of two tool parts, pairs of cables are used, with each pair of cables being guided over a disk that is integrally connected to a jaw part or finger of the tool. In this cable arrangement, the pull cables are guided over rollers with a strong offset to control the distal tool parts.This offset must be compensated for when the instrument head is angled relative to the shaft distal to the angled area. This leads to increased mechanical stress, which reduces the service life of the traction devices and thus the instruments.

[0008] For medical instruments, particularly for use in minimally invasive surgery, it is also particularly important that the dimensions of an instrument head or shaft diameter are as small as possible. For example, the diameter of a shaft of a medical instrument can be a maximum of 15 mm, preferably a maximum of 8 mm. Nevertheless, various functions and degrees of freedom for the end effector or the tool should be feasible. Due to lack of space, drives or actuators cannot be arranged directly at the end effector and the movements must be controlled from the proximal shaft end of the instrument. Therefore, complicated arrangements of additional rollers for guiding traction devices that increase the outer diameter of the tool holder and / or the shaft should be avoided. Due to lack of space in the tool holder, space-saving solutions should be found.In a component arrangement such as in the known US 6,312,435 B1, which has rollers on opposite sides at the proximal area of ​​the tool carrier, the outer diameter of the tool carrier is increased, so that a reduction of the outer diameter to preferably approximately 5 mm is difficult to implement in the said structure.

[0009] Therefore, one object is to reduce the load on traction devices compared to known instruments with two-part tools that use cables for control and have an angularly adjustable instrument head. Offsets should be avoided as much as possible. If offsets in the cables need to be compensated for during certain movements, they should no longer be compensated for in the distal region of the tool holder. Furthermore, the invention aims to reduce angular errors when angling the instrument head relative to the shaft. Finally, the object is to provide medical instruments with a small outer diameter of a maximum of 8 mm, preferably 6 mm, and even more preferably 5.5 mm or 5 mm.

[0010] Description of the invention

[0011] Based on the invention, the above-mentioned tasks and problems are to be solved better than with conventional mechanical or electromechanical instruments for femoral manipulation. At least two degrees of freedom of the instrument are to be provided, preferably for use in the field of medicine and particularly preferably for endoscopy. Furthermore, the instrument is to be suitable for adaptation to a robotic surgical system.

[0012] These objects are achieved with a medical instrument according to the invention and a surgical robot system according to the features of the independent claim and the subordinate robot system claim. Preferred embodiments of the invention are set forth in the subclaims following the main claim.

[0013] According to a first aspect of the invention, a medical instrument for human or veterinary medical applications for remote manipulation is provided, comprising the following features: a shaft, a distal instrument head with at least two tool parts, wherein the instrument head is pivotable about a first axis of rotation (ZI) relative to the distal end of the shaft, and wherein the tool parts are pivotable about a second axis of rotation (Y1) via first traction means and second traction means guided in the shaft. In particular, the medical instrument is characterized in that it has a deflection arrangement which comprises at least two rollers and is designed to guide the first traction means and the second traction means at a distance from the central axis of the shaft.

[0014] With the help of the two pivot axes, the tool or end effector can not only pivot as far as possible in one plane, but can also achieve a multitude of positions and orientations in space by superimposing the angulation of the instrument head to the shaft. The off-center arrangement of the traction means creates a situation in which the traction means, e.g. in the form of a wire pulley, no longer has to compensate for the misalignment of rollers distal to the angulating area. The change in position of the traction means inevitably resulting from the angulation of the instrument head to the shaft is compensated not in the short distal area of ​​the tool holder (length approx. 10 mm or 1 cm) but across the proximal shaft length (300, 350, 400 or 450 mm).

[0015] According to a preferred embodiment, the instrument head is pivotally mounted in a first plane (XY) by means of a control disk at the distal shaft end, the rotational axis of which defines the first rotational axis (ZI), and a traction mechanism guided above it. Furthermore, the tool parts are pivotable relative to each other in a second plane (XZ), wherein the second plane (XZ) is arranged perpendicular to the first plane (XY).

[0016] With the help of the traction means guided via the control disks, a deflection of the end effector or the tool parts in different directions is achieved and a plurality of degrees of freedom of movement is achieved. By means of the traction means guided via the respective control disks, the deflection and orientation as well as the opening and closing of the tool can be variably controlled. According to a preferred embodiment, the first tool part and the second tool part are each connected to a control disk for pivoting about a common axis of rotation (Yi), wherein the respective traction means can be guided around the respective control disks and can further be deflected by means of a roller designed as a deflection pulley such that a wrap angle (ß) greater than 180 ° is achieved in each case.

[0017] In this way, the deflected traction means section is guided at a distance from the main axis of the tool carrier, wherein the said main axis is aligned with the longitudinal axis or central axis of the shaft at 0° angulation and intersects the axis of rotation (Yi). This ensures off-center traction means guidance in the distal area of ​​the tool carrier. During a control movement of a tool part, the wrap angle of greater than 180° is maintained and only the position of the traction means changes. In other words, in every deflection position of a tool part, the traction means position in the distal tool part area is defined. The control movement of the traction means, which is non-positively connected to the control disk, generates a circular movement of the control disk of the respective tool part and converts this into a rotational movement in order to pivot the tool part.

[0018] According to a preferred embodiment, both traction means each comprise at least three sections in a tool carrier in which both control discs and deflection rollers are arranged, wherein a first section can be guided substantially parallel to the longitudinal extent of the tool carrier and tangentially to the respective control disc, a second section which has a fixing means for the rotationally fixed connection to the respective control disc and can be guided at least partially over the respective control disc, and a third section can be deflected by means of the respective deflection roller towards the first section and at a distance from the central axis of the tool carrier.

[0019] Both traction devices are therefore guided in pairs on opposite sides, i.e. on both sides of the central axis. Each traction device is attached to the respective control disk with a fixing device, which enables reliable control. The first traction device section and the third traction device section are located on the plane spanned by the control disk and is parallel to the XZ plane. This means that the deflection pulley prevents any offset of the traction devices perpendicular to the control plane or the XZ plane. In this way, the first traction device is guided in the plane of the control disk of the first tool part and the second traction device is guided in the plane of the control disk of the second tool part in the tool carrier in such a way that the traction devices, which are each bundled into a pair of cables by the assignable deflection pulleys, are guided on both sides of the control disk of the instrument head, which is arranged at the distal end of the shaft.The control disc of the instrument head or tool holder is positioned so that its rotational axis intersects the central axis of the shaft. This central arrangement of the control disc of the instrument head is optimally complemented by the off-center guidance of the traction mechanism. In other words, a first traction mechanism can be guided to the shaft on one side of the control disc of the instrument head, while the other traction mechanism can be guided on the other side of the control disc.

[0020] According to a preferred embodiment, the axis of rotation of the control discs is arranged parallel to the pivot pins of the deflection rollers.

[0021] This refers to the control discs of the tool parts, whose common rotational axes are arranged parallel to the pivot pins of the deflection pulley. This allows the traction means to be guided in a plane parallel to the central axis while remaining on a plane spanned by the respective control discs. In this way, the traction means guided around the control disc of a tool part can be guided without offset, i.e., it can run in a plane parallel to the plane of the control disc.

[0022] According to a preferred embodiment, the deflection arrangement further comprises rollers for guiding in the proximal region of the tool carrier, wherein the partial sections of the first traction means guided from the instrument head in the direction of the shaft can be guided between a first pair of rollers and a second pair of rollers.

[0023] When the instrument is assembled, the proximal area of ​​the tool carrier is at the level of the distal shaft end. After the sections of the first traction device or the pair of traction cables are guided through both pairs of rollers, the sections can be guided parallel to each other and off-center from the shaft axis within the shaft.

[0024] According to a preferred embodiment, the axes of the first and second roller pairs are arranged perpendicular to the rotational axis of the deflection roller. In this way, the sections guided in a straight line and next to each other in the distal region of the tool carrier after the deflection roller can be further guided one above the other with the aid of the guide rollers or guide rollers in the proximal region of the tool carrier. The distance between the adjacent sections can then also be maintained in the shaft.

[0025] According to a preferred embodiment, the tool carrier comprises a first fork in the distal region for supporting a pivot pin of the control discs and the pivot pins of the deflection rollers. Furthermore, the tool carrier has a second fork in the proximal region, which is arranged perpendicular to the first fork.

[0026] Each fork has two holding arms, which can advantageously accommodate pivot pins or other bearing components between the arms. The perpendicular forks allow the perpendicular axes of the rollers, i.e. the deflection rollers and the guide rollers, to be implemented as roller pairs. The second fork has two recesses in each holding arm to accommodate the pivot pins of a guide roller pair facing the respective holding arm. The spacing of the recesses in the second fork is selected such that the double rollers arranged on the pivot pins can guide the traction device without any play between the roller pair.

[0027] According to a preferred embodiment, the deflection arrangement further comprises rollers for guiding the second traction means, wherein the sections of the second traction means guided from the instrument head in the direction of the shaft can be guided between a third pair of rollers and a fourth pair of rollers such that the section of the second traction means near the central axis can be guided at a distance of at least 0.4 mm from the central axis of the shaft.

[0028] In the non-angled state, the traction element section of the second traction element runs parallel to the guide rollers, offset by at least 0.4 mm from the center axis of the tool holder and the shaft. If the tool holder is angled, the section distal to the guide rollers is arranged off-center, i.e., spaced from the main axis of the tool holder, while the section guided into the shaft is guided off-center from the longitudinal axis of the shaft. Despite the angled position, no offset is necessary for the section distal to the rollers.

[0029] According to a preferred embodiment, the first pair of rollers is / are arranged above the second pair of rollers and / or the third pair of rollers and the fourth pair of rollers are arranged one above the other in such a way that two rollers lying one above the other form common axes (Z281, Z282, Z273, Z274) and are optionally designed as a double roller, wherein the axes (Z281, Z282, Z273, Z274) are arranged parallel to each other and parallel to the axis of rotation of the control disc at the distal shaft end.

[0030] This allows the rollers to be arranged in a space-saving manner. Two rollers stacked on top of each other can share a pivot pin.

[0031] According to a preferred embodiment, one pivot pin for each two superimposed rollers or for each double roller is guided through the control disc at the distal shaft end.

[0032] In addition to controlling the angulation of the instrument head, the control disc can advantageously be used to space the traction mechanism from the shaft's centerline. The pivot pins are housed in the control disc and extend away from the control disc to accommodate a double pair of rollers on each side.

[0033] According to a preferred embodiment, depending on the angulation of the instrument head with respect to the longitudinal axis of the shaft, a traction means forms a wrap angle (5) around the rollers of the respective pair of rollers facing the direction of angulation for guidance, wherein the wrap angle (5) is preferably up to 90".

[0034] When the tool holder or instrument head is angled relative to the shaft, the guide rollers can also be used as deflection rollers. In the extreme angle, a wrap angle 5 of approximately 90° can be achieved.0 around a leadership role. If the tool carrier only 45 0 Angled relative to the shaft, this results in a wrap angle 5 of approximately 45°. Regardless of the angle, the sections guided over one another by the rollers are guided further into the shaft. The change in position of the traction device caused by the angle is compensated not in the short distal tool carrier area, but rather over the proximal shaft length. In this way, the load on the traction device can be reduced.

[0035] According to a preferred embodiment, an actuating unit arranged proximally on the shaft is designed to pivot the first tool part by means of the first pulling means and / or the second tool part by means of the second pulling means from a closed to an open position and vice versa, wherein the guidance of both pulling means in the region of the tool carrier is effected by means of the deflection arrangement without offset between the rollers and in any position of the pulling means, wherein the position depends on the respective degree of pivoting.

[0036] With the help of the deflection arrangement, any desired open position can be achieved without offsetting the traction means.

[0037] According to a preferred embodiment, the first traction means and the second traction means are guided on both sides of the longitudinal extension or central axis in the shaft casing.

[0038] In this way, contact between both the traction devices and the sections of a pair of cable pulleys can be avoided. The double pair of rollers ensures that the sections are kept at a safe distance from each other.

[0039] According to a preferred embodiment, the tool parts comprise a tool with at least two straight or at least partially curved jaws, cutting edges or other jaw parts and furthermore the tool is selected from the group comprising: a gripping forceps, dissecting forceps or other forceps, scissors or a needle holder.

[0040] In minimally invasive endoscopy, which can be used in robot-assisted telesurgery, among other applications, these tool components can be used advantageously. For manipulation with automatic actuation units, the grippers, needle holders, or forceps can be operated on robotic arms.

[0041] According to a preferred embodiment, the first traction means and the second traction means are each a tension-absorbing rope, which forms a pair of traction ropes in the shaft and is made of one of the following materials: wire, steel, aramid, nylon, preferably as monofilament, multifilament or in combination with tension rods guided in the shaft or other suitable materials.

[0042] Cable pulleys are preferred as traction devices. Both traction devices can be metallic cables, such as steel cables or those made of tungsten. Tensile-resistant synthetic fiber cables, such as aramid or high-strength nylon fibers, can also be used. As an alternative to completely flexible traction devices, tension rods can be used that are flexible at least distal to the distal end of the shaft, i.e., from the area where the bend between the shaft and instrument head occurs transversely to the longitudinal extent of the shaft. The traction device should also be flexible at the level of the rollers and control discs and in every control position.

[0043] According to a preferred embodiment, both pairs of traction cables are arranged at least partially parallel to each other within the shaft; wherein the shaft has at least a length of 300, 350, 400, preferably 450 mm and an outer diameter of less than 8 mm, preferably less than or equal to 5.5 mm.

[0044] The parallel arrangement of the traction cable pairs prevents contact and thus unwanted friction. The two traction cable pairs are also arranged symmetrically on either side of the central axis, ensuring sufficient separation between the traction cable pairs.

[0045] According to a preferred embodiment, the medical instrument comprises at least one actuating unit for controlling the first traction means and / or the second traction means, wherein the actuating unit can be actuated manually or automatically.

[0046] To control the pivoting of the tool parts by the respective traction means or pairs of cables, an actuating unit is preferably provided, which is located at the proximal end of the shaft. The two pairs of traction cables are operatively connected to the actuating unit for control and are then guided through the shaft to the distal end of the medical instrument. The actuating unit can be a manually operated handle or an automated unit.

[0047] According to a preferred embodiment, the medical instrument has an interface for connection to a robot.

[0048] With the help of an interface for connection to a robot or a robotic operating system, the actuation unit can be operated automatically.

[0049] Finally, according to a further aspect of the invention, a surgical robot system can be provided which comprises a medical instrument according to one of the preceding features. Brief description of the figures

[0050] The invention as well as further advantageous embodiments and developments thereof are described and explained in more detail below with reference to the examples shown in the drawings. The drawings are for illustrative purposes and are not necessarily to scale, since the focus is generally on illustrating the principles of the invention. Terms such as 'top', 'bottom', 'above' and 'below' and the specified planes such as XY, XZ are not to be understood as limiting, but as reference planes for a better understanding of the invention. The features shown in the following description and the drawings can be used according to the invention individually or in groups in any combination. In the drawings, like reference symbols generally refer to the same parts throughout the different views. Not all parts are necessarily provided with reference symbols in all drawings.

[0051] Further embodiments as well as some of the advantages associated with these and further 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. Further advantages will become apparent from the following description of the drawings. An embodiment of the invention is shown in the drawings. The drawings, the description and the claims contain numerous features in combination. It is understood that the features mentioned above and those to be explained below can be used not only in the respective combination specified, but also in other combinations or on their own, without departing from the scope of the present invention.

[0052] Figure 1 shows a view of a distal end of an endoscope shaft with an instrument head, with the tool part shown in the XY plane;

[0053] Figure 2 also shows a distal end of an endoscope with an instrument head, showing the XZ plane and details of the tool holder and the shaft end with a partially transparent representation; Figure 3 shows another embodiment of a medical instrument with a tool designed as scissors, as well as details in the tool holder regarding the roller arrangement and the cable guide;

[0054] Figure 4 shows three views and in the middle a side view in the plane XY with marking of the shown sectional views along the sections AA and BB;

[0055] Figure 5 shows a perspective view of a distal end of an endoscope shaft with a tool, wherein the external components of the tool carrier are drawn transparent in order to be able to show the roller arrangement both in the tool carrier and at the end of the shaft;

[0056] Figure 6 shows a perspective exploded view of the components of an embodiment of a medical instrument according to the invention;

[0057] Figure 7 shows a view with the instrument head angled and the tool open, as well as details of the traction mechanism guide around the control discs or rollers.

[0058] Detailed character description

[0059] Figure 1 shows a view of the XY plane of a distal shaft end of a medical instrument according to the invention. The shaft 200 and the instrument head 300 are shown in curly brackets. The shaft 200 consists of a shaft sleeve 220 and has a central axis or longitudinal axis 201. The traction mechanism 210 serves to bend the instrument head in a plane (here the XY plane or drawing plane). The traction mechanism 210 is guided around a control disc 215 of the instrument head and is fastened to the control disc 215 with a fixation means 216. The movement of the traction mechanism 210 (indicated by the curved double arrow) rotates the control disc 215, and the instrument head 300 can be bent relative to the shaft 200 at the distal shaft end.

[0060] At the end of the shaft, a partially transparent tool carrier holder 260 with a retaining pin 250 is arranged. The retaining pin 250 connects the tool carrier 330 to the tool carrier holder 260. At the distal end of the tool carrier 330, a pivot pin 350 is arranged, around which both tool parts 370 and 380 can rotate. For this purpose, each tool part 370 and 380 has a control disk 315 and 325, respectively. Tension means 310 and 320, respectively, are looped around these control disks 315 and 325 and are guided toward the shaft 200 for control. The tension means 310 is guided over a deflection pulley 361. The deflection pulley 361 has a pivot pin 360. As Figure 1 shows, both the traction means 310 and the traction means 320 are guided without offset to the deflection rollers 361 and 362, respectively. The traction means 310, guided toward the shaft 200 in the X direction, is guided between two rollers 281 and 282 in a straight line and parallel to the center axis of the tool carrier 330.The guide roller 282 can be rotated by means of the pivot pin 285. The rollers 281 and 282 thus form a roller pair 280 for guiding the section of the first traction means 310 shown in Figure 1 (see dark coloring compared to the lighter color of the second traction means 320).

[0061] Figure 2 shows the medical instrument 100 of Figure 1 rotated by 90° so that the XZ plane is shown here. The instrument head 300 and the tool 301 are shown here in curly brackets. The tool 301 has a first tool part or jaw part 370 and a second jaw part or tool part 380. The tool carrier 330 is shown transparently so that the upper control disc 315 of the tool part 370 can be seen. A traction means 310 is guided around this control disc 315, wherein the traction means 310 is deflected via the deflection roller 361 from the outside over the center in the direction of the other traction means section, which is guided on the outside of the tool carrier. In this way, the traction means pair of the traction means 310 is guided off-center.

[0062] The deflection pulley 361 has a pivot pin extending in the y direction. The adjacent sections of the traction means 310 are guided at the distal end 230 of the tool carrier holder 260 via two adjacent pulleys 281 and 282. These two pulleys are arranged one above the other so that they can rotate via a common pivot pin 285.

[0063] For the other traction mechanism 320, a roller arrangement consisting of rollers 271 and 273 arranged one above the other is also provided, also with a common pivot pin 385. This roller arrangement allows the traction mechanisms 310 and 320 to be guided parallel to each other within the shaft. Furthermore, the spacing created by the rollers allows each pair of cable pulleys to be guided contact-free within the shaft 200.

[0064] Figure 3 shows a further embodiment of the medical instrument 100 according to the invention with a different tool, wherein the tool parts are designed as cutting edges (371, 381). The circle 390 schematically shows the open position of the tool parts. The tool parts 370, 380 can each be opened or closed in the XZ plane, as indicated by the double arrow in the circular area and between the tool parts 371 and 381. Figure 3 also shows a shaft 200 and the tool carrier 330 with further details. In particular, the traction means 310 is divided into various traction means sections.

[0065] The first section of the first traction means 311 runs along the outer edge of the tool carrier 330. The first section 311 is therefore guided tangentially to the control disk 315. The second section of the traction means 312 is then guided around the control disk 315, wherein the second section 312 can have a fixing means 316 for a rotationally fixed connection to the control disk 315. The fixing means 316 is not shown here and can be seen, for example, in Figure 2 or Figure 6. If no fixing means is provided, a force-locking connection with the control disk 315 is established by sufficient tensioning of the traction means 310. For precise control, play of the traction means in relation to the control disk should be avoided so that every change in the position of the traction means also causes a pivoting of the respective controlled tool part.

[0066] The next section of the first traction means 313 shows the deflection from the control disc 315 to the deflection pulley 361. After the deflection pulley 361, the fourth section 314 of the traction means runs in a straight line between a pair of guide pulleys (here only one pulley 283 of the pair is visible).

[0067] The third section 313 is guided to the first section 311 by the respective deflection pulley 361 such that the distance between the first section 311 and the third section 313 is less than the diameter of the traction mechanism. Furthermore, the third section 313 is deflected by the deflection pulley 361 such that it is spaced from the center axis of the tool carrier. The deflection pulley 361 guides the traction mechanism 310 around the control disk such that the wrap angle ß is greater than 180°.

[0068] The same deflection arrangement with a deflection pulley (362 largely hidden here) and guide rollers in the distal region of the tool carrier 330 is also provided for the second traction means 320. However, in this illustration, only the sections 321 and 324 can be seen.

[0069] Figure 4 shows three views of the distal end of an endoscope with an instrument head 300 and a shaft 200. In the middle image, the medical instrument 100 is shown from the side of the tool part 380. The shaft 200 has a shaft sleeve 220 and a tool carrier holder 260, which has opposing holding pins 250, 251 for the tool carrier 330. Also shown are the control disks 315 and 325 of the tool parts 370 and 380. Sections are made through the planes of the control disks 315, 325: once section BB seen from above and once section AA seen from below.

[0070] Section AA shows a section through the control disc 325 from below, with the control disc 325 located at the distal end of the tool carrier 330. The traction device 320 is placed around the control disc 325 and secured thereto with a fixing device 326. Also visible in section AA are the first traction device 310 and a section through the pivot pin 285 for two guide rollers for the first traction device 310. The pivot pin 285 is passed through the control disc 215 and extends toward the tool carrier 330 and through it to the height of the tool carrier holder 260.

[0071] Section BB, which depicts the instrument 100 from above, shows the control disc 315 of the other tool part 370 and the traction element 310, which is also wrapped around the control disc 315 and secured with a fixing element 316. The wrap angle of the traction element 310, 320 around the respective control disc 315, 325 is greater than 180° in both arrangements. After the traction elements 310, 320 are guided off-center by a respective deflection roller 361 or 362, the traction elements are then guided by the respective double roller pairs, which are only partially visible in the sections.

[0072] The representation of the shaft 200 in section AA shows that the traction element sections 320S1 and 320S2 of the traction element 320 are guided parallel to each other, thus eliminating contact. This contact-free parallel guidance in the shaft 200 is also present in the partial sections 317 and 318 of the first traction element 310 (see reference symbols in BB). This prevents friction. Section BB shows a section through a pivot pin 385 and the associated rollers for guiding the second traction element 320.

[0073] Figure 5 shows a perspective view of the medical instrument 100 with a tool consisting of two tool parts 370 and 380. These can be moved along the rotation axis Yi and the associated pivot pin 350 in a first degree of freedom. Furthermore, the entire instrument head 300 can be rotated with the aid of the control disk 215 about a further axis Zi, which is arranged perpendicular to the axis Yi. This creates two degrees of freedom for the instrument. Figure 5 also shows the axes of the deflection pulleys, namely the axes Y361 and Y362, which each shift the returned traction means outwards and off-center and bring them so close together that they can be guided by the pairs of rollers at the proximal end of the tool carrier 330. One pair of rollers is shown here, and the axis Z281 is shown as an example.This illustration shows that the deflection rollers 361, 362 on the control discs of the tool parts 370, 380 are perpendicular to the axes of the double rollers (Z281).

[0074] Figure 6 shows an exploded perspective view of the medical instrument 100. The tool part 370 has an associated control disc 315, around which the traction means 310 is guided (not shown). In this case, the section 312 can be fixed to the control disc 315 with the fixing means 316. The exploded view shows the course of the traction means 310, as if the section 312 is guided around the control disc 315 in a loop and with the deflection roller 361, which has a pivot pin

[0075] 360, to which the traction means 310 is deflected or returned.

[0076] Furthermore, the loop-shaped traction mechanism configuration shows that both traction mechanism sections 317 and 318 run essentially parallel after being deflected by roller 361. This parallel guidance is realized in the assembled state of the medical instrument by the illustrated roller pairs 283, 284 and 281, 282. This means that section 317 is guided by the roller pair 283 and 284, and section 318 is guided by the roller pair 281 and 282.

[0077] The rollers 281 and 283 are arranged one above the other and have a common axis of rotation Z281. The rollers 282 and 284 are also arranged one above the other and have a common axis Z282. The axes Z282 and Z281 are perpendicular to the axis of rotation of the deflection roller.

[0078] 361. Pivoting pins 285 are provided for rotating the rollers 281, 283, 282, 284.

[0079] The pivot pins 285 for the aforementioned double rollers 283, 284 and 281, 282 are designed to be passed through or received by the control disk 215. For this purpose, the control disk 215 has corresponding through holes 218 or receptacles. In addition, a fork 352 of the tool carrier 330 has two recesses 354 in the holding arm facing the traction means 310 to accommodate the pivot pins 285. The control disk 215 has a fixing means 216 with which the traction means 210 can be fastened. The traction means 210 is designed to angle the instrument head 300 relative to the shaft about the rotation axis Zi. This rotation axis Zi is indicated by a dashed line at the level of the retaining pin 250 of the tool carrier holder 260.

[0080] The shaft 200 with the shaft sleeve 220 and the central axis 201 has the aforementioned tool holder 260. The tool holder 260 is fork-shaped, or rather, has a first fork 351 and a second fork 352, which are perpendicular to each other. In the transition area to the first fork 351, four recesses 354 are arranged in the holding arms of the second fork 352, parallel to the Yi axis. Of these, only three recesses 354 for the pivot pins 285 and 385 are visible. The recesses 354 are arranged in the opposite sides of the holding arms of the second fork 352 in such a way that a pair of rollers and associated pivot pins 285 and 385 can always be accommodated.

[0081] At the distal end of the shaft 200, the tool carrier holder 260 is configured to provide a cover 265 for the shaft end. This cover 265 has through holes for the traction means. On the one hand, the through hole 221 for the traction means 210, and on the other hand, the through holes 261 for the traction means pairs 310, 320, which lead to the respective tool parts 370 and 380, respectively.

[0082] Furthermore, the tool carrier 330 is shown with the pivot pin 350. The tool carrier 330 has a first fork 351 in the distal region for supporting the pivot pin 350 of the control disks 315, 325 and for supporting the pivot pins 360, 363 of the deflection rollers 361, 362. In the proximal region of the tool carrier 330, the second fork 352 is arranged, which is arranged perpendicular to the first fork 351. The main extension axes of the holding arms of the second fork 352 are parallel to the fork-shaped arms of the tool carrier holder 260. The second fork 352 has receptacles 353 for the respective holding pins 251 and 250. In this way, the second fork 352 can be used to connect the tool carrier 330 to the tool carrier holder 260 via the retaining pins, wherein the components are mounted so as to be movable relative to one another in order to enable the angling of the tool carrier 330 about the Zi axis.

[0083] Furthermore, Figure 6 shows the second tool part 380 with a control disk 325, which can be connected to the second traction means 320 with the shown fixing means 326. The section 322 of the traction means 320 shows a loop (more than 180°) along a control disk, not shown here, wherein the deflection roller 362 with the pivot pin 363 is designed to guide the traction means section 323 to the first section 321. Finally, the respective traction means sections are guided between a pair of rollers, i.e. between axes Z273 and Z274, in the direction of the shaft. The roller pairs, like the other rollers, are rotated via pivot pins 385. The pivot pins 385 are shown in Figure 6 close to the control disk 215, since the pivot pins 385 are received by the control disk 215 with corresponding receptacles 218.

[0084] Figure 7 shows the distal end of a shaft 200 with an instrument head angled relative to the shaft 200 and an open tool 301. The tool 301 has the tool parts 370 and 380, and, as the circular area 390 schematically indicates, the tool parts 370 and 380 enclose an opening angle e. Other opening angles e are, of course, possible. The tool part 370 is controlled by the traction device 310 via the control disc 315. The other tool part 380 is controlled by the second traction device 320, also with a control disc 325, which is not visible here.

[0085] The tool carrier 330 is indicated by a dash-dot line and is shown transparently so that the deflection arrangement is visible. The second traction means 320 is deflected off-center by means of the deflection pulley 362 and the associated pivot pin 363. On the opposite side, a deflection pulley 361 with a pivot pin 360 is also provided to deflect the first traction means 310 off-center and guide it to the assigned roller pairs.

[0086] To better illustrate the deflection, the course of the second traction means 320 is shown schematically to the right of the opened tool part. Here, the first section 321 (see black dotted pattern) is guided tangentially to the control disc 325 and the second section 322 (white dotted pattern) of the traction means 320 is wound around the control disc with a wrap angle ß of greater than 180 0The third section 323 of the second traction means is guided to the deflection pulley 362 and thus off-center, and then guided toward the first section 321 and almost parallel to it. The first section 321 and the fourth section 234 are then guided to the rollers 372 and 374, with the rear rollers concealed.

[0087] A double roller pair is shown in a further schematic detailed view in the dashed circle. Here you can see the opposing rollers 371 and 372 as well as the second traction means 320. The traction means 320 coming from the shaft is deflected by the roller 371 for guidance due to the angulation by an angle θ. This is indicated by the differently patterned section 327 (white dots on a dark background). The angle θ is 90° in the angulation shown. The analogous deflection or guidance also takes place via the other roller pair, which is offset to the rear with the section 324. Alternatively (not shown), the wrap angle θ can also be less if the angulation is chosen to be less extreme. After deflection by the respective guide rollers 371 and 373 (not shown), the sections of the second traction means 320 are guided parallel in the shaft.

[0088] The angulation of the instrument head relative to the shaft 200 is achieved, as in the other embodiments, by the control disk 215 and the corresponding traction mechanism 210. The angulation merely changes the wrap angle (here angle 5) around the superimposed rollers 371 and 373. This guidance of the traction mechanism and an off-center arrangement outside the longitudinal axis 201 achieves a situation in which the traction mechanism 320 distal to the angling region no longer has to compensate for any offset of the rollers. The position change inevitably resulting from the angulation of the traction mechanism 310, 320, preferably designed as a wire, is compensated not in the short distal tool carrier region but over the proximal shaft length of approximately 450 mm. This minimizes the angular error of the wire rope, and the load on the traction mechanism 320 can be significantly reduced. The same advantage also applies to the other traction mechanism 310.Finally, the configuration according to the invention allows for the shaft and instrument head to be constructed with smaller outer diameters, e.g., 8 mm. Preferably, outer diameters of 5.5 mm and 5 mm, respectively, are provided.

[0089] Figure 7 shows the double pair of rollers 371 and 372 for guiding the second traction means 320. The guidance is carried out, for example, at a distance of 0.4 mm from the main axis, whereby the second traction means no longer needs to be offset in the area distal to the rollers, as is the case, for example, with the medical instrument mentioned in the introductory section according to the Da Vinci® Endrowrist system from Intuitive Surgical.

[0090] The present invention provides a medical instrument with two instrument degrees of freedom and a deflection arrangement of the traction means for remote manipulation of a tool at the distal end of the instrument. The deflection arrangement is designed to reduce the mechanical stress on the traction means. The instrument is further suitable for minimally invasive surgery and for robot-assisted manipulation of the medical instrument. An exemplary embodiment of the invention is illustrated in the drawings. The drawings, the description, and the claims contain numerous features in combination. It is understood that the features mentioned above and those to be explained below can be used not only in the respective combination specified, but also in other combinations or on their own, without departing from the scope of the present invention.The disclosure relates to a medical instrument 100 for femoral manipulation comprising a shaft 200, a distal instrument head 300 with at least two tool parts 370, 380, wherein the instrument head 300 is pivotable about a first axis of rotation ZI relative to the distal end 230 of the shaft 200, and wherein the tool parts 370, 380 are pivotable about a second axis of rotation Y1 via first traction means 310 and second traction means 320, each guided in the shaft 200. In particular, a deflection arrangement with at least two rollers 361, 362, preferably deflection rollers, is provided, which is designed to guide the first traction means 311 and the second traction means 321 at a distance from the central axis 201 of the shaft 200.Furthermore, the deflection arrangement comprises rollers for guidance in the proximal region of a tool carrier 330, wherein the partial sections of the first traction means 310 guided from the instrument head 300 toward the shaft 200 can be guided between a first pair of rollers 281, 282 and a second pair of rollers 283, 284, wherein the axes Z281, Z282 of the first and second pairs of rollers are preferably arranged perpendicular to the rotational axis of the deflection roller 361 of the first traction means. Furthermore, a surgical robot system is disclosed, which comprises a medical instrument 100 with the aforementioned features.

[0091] List of reference symbols

[0092] Medical instrument

[0093] shaft

[0094] Central axis and longitudinal axis of the shaft first traction mechanism for angling the instrument head in a first plane (XY plane) control disc arranged at the distal end of the shaft for angling the instrument head in the first plane (XY plane)

[0095] Fixing devices for traction devices

[0096] Through holes or receptacles

[0097] Stock cover

[0098] Passage or recess for second traction device distal shaft end

[0099] Retaining pin for tool carrier additional retaining pin for tool carrier

[0100] Tool carrier holder at the distal end of the shaft

[0101] Performs holes

[0102] cover

[0103] Pair of rollers (281, 282) for guiding a section of the first traction means first roller for guiding the traction means second roller for guiding the traction means

[0104] Turning pin for two superimposed rollers

[0105] instrument head

[0106] Tool first traction means first section of the first traction means second section of the first traction means third section of the first traction means first control disc for pivoting the first tool part in a plane (XZ)

[0107] Fixing means for control disc 315 and first traction means

[0108] Partial section of the first traction device in the shaft

[0109] Partial section of the first traction means in the shaft 320 second traction means

[0110] 320 Sl, 320 S2 parallel sections of the second traction element in the shaft

[0111] 321 first section of the second traction device

[0112] 322 second section of the second traction device

[0113] 322 third section of the second traction means between deflection pulley 362 and control disc 325

[0114] 324 fourth section of the second traction device

[0115] 325 second control disc in second level

[0116] 326 Fixing means for fixing the second traction means to the control disc

[0117] 330 tool carriers

[0118] 331 Central and longitudinal axis of the shaft

[0119] 350 turning pin

[0120] 351 first fork (distal) of the tool carrier

[0121] 352 second fork (proximal) of the tool carrier

[0122] 353 Holder for retaining pin

[0123] 354 Recess for pivot pins for rollers for guidance

[0124] 360° Y-direction pivot pin for first pulley

[0125] 361 first pulley for the first traction device

[0126] 362 second pulley for the second traction device

[0127] 363 Y-direction pivot pin for second pulley

[0128] 370 first tool part (jaw part)

[0129] 371 first tool part designed as a cutting edge

[0130] 380 second tool part (jaw part)

[0131] 381 second tool part designed as a cutting edge

[0132] 385 towing pins for guide rollers

[0133] Y i axis of rotation of the first and second jaw parts for rotation in XZ plane

[0134] Y361 and Y362 rotation axis of the first and second pulley

[0135] Zi rotation axis for swiveling the instrument head relative to the shaft axis, for example for angulation in the XY plane

[0136] Z273, Z 274, Z 282, Z 28i Rotary axes of the double rollers for guiding

Claims

Medical instrument (100) for femoral manipulation, comprising a shaft (200), a distal instrument head (300) with at least two tool parts (370, 380), wherein the instrument head (300) is pivotable about a first axis of rotation (ZI) relative to the distal end (230) of the shaft (200), and wherein the tool parts (370, 380) are pivotable about a second axis of rotation (Y1) via first traction means (310) and second traction means (320) each guided in the shaft (200), wherein a deflection arrangement comprising at least two rollers (361, 362) is designed to guide the first traction means (311) and the second traction means (321) at a distance from the central axis (201) of the shaft (200).Medical instrument (100) according to claim 1, wherein the instrument head (300) is pivotally mounted in a first plane (XY) by means of a control disk (215) on the distal shaft end (230), the rotational axis of which defines the first rotational axis (ZI), and a traction means (210) guided thereabove; and wherein the tool parts (310, 320) are pivotable relative to one another in a second plane (XZ), the second plane (XZ) being arranged perpendicular to the first plane (XY). Medical instrument (100) according to claim 1 or 2, wherein the first tool part (370, 371) and the second tool part (380, 381) are each connected to a control disk (315, 325) for pivoting about a common axis of rotation (Yi), and wherein the respective traction means (310, 320) can be guided around the respective control disks (315, 325) and can further be deflected by means of a roller (361, 362) designed as a deflection roller (361, 362) such that a wrap angle (ß) greater than 180 ° is achieved in each case. Medical instrument (100) according to claim 3, wherein both traction means (310, 320) each comprise at least three sections (311, 312, 313; 321, 322, 323) in a tool carrier (330) in which both control discs (313, 325) and deflection rollers (361, 362) are arranged, wherein - a first section (311, 321) can be guided essentially parallel to the longitudinal extension of the tool carrier and tangential to the respective control disc (315, 325), - a second section (312, 322) which has a fixing means (316, 326) for the rotationally fixed connection to the respective control disc (315, 325) and which can be guided at least partially over the respective control disc (315, 325), and - a third section (313, 323) can be deflected by means of the respective deflection roller (361, 362) toward the first section (311, 321) and at a distance from the central axis (201) of the tool carrier (330). Medical instrument (100) according to one of claims 3 or 4, wherein the rotational axis (Y1) of the control discs (315, 325) is arranged parallel to the pivot pins (360, 363) of the deflection rollers (361, 362). Medical instrument (100) according to one of claims 4 or 5, wherein the tool carrier (330) comprises a first fork (351) in the distal region for supporting a pivot pin (350) of the control discs (315, 325) and the pivot pins (360, 363) of the deflection rollers (361, 362); and wherein the tool carrier (330) comprises a second fork (352) in the proximal region and which is arranged perpendicular to the first fork (351).Medical instrument (100) according to one of the preceding claims, wherein the deflection arrangement further comprises rollers for guiding in the proximal region of the tool carrier (330), wherein the partial sections of the first traction means (310) guided from the instrument head (300) in the direction of the shaft (200) can be guided between a first pair of rollers (281, 282) and a second pair of rollers (283, 284), wherein the axes (Z281, Z282) of the first and second pairs of rollers are preferably arranged perpendicular to the axis of rotation of the deflection roller (361). Medical instrument (100) according to one of the preceding claims, wherein the deflection arrangement further comprises rollers for guiding the second traction means, wherein the sections of the second traction means (310) guided from the instrument head (300) in the direction of the shaft (200) are guided between a third pair of rollers (273, 274) and a fourth pair of rollers (271, 272) such that the section of the second traction means near the central axis can be guided at a distance of at least 0.4 mm from the central axis of the shaft. Medical instrument (100) according to one of claims 7 or 8, wherein the first pair of rollers (281, 282) is arranged above the second pair of rollers (283; 285) and / or the third pair of rollers (273, 274) and the fourth pair of rollers (271, 272) are arranged one above the other such that in each case two superimposed rollers have common axes. (Z281, Z282, Z273, Z274) and are optionally designed as a double roller, whereby the axes (Z281, Z282.Z273, Z274) are arranged parallel to one another and parallel to the axis of rotation of the control disk (215) at the distal shaft end. Medical instrument (100) according to claim 9, wherein a pivot pin (385) for each two superimposed rollers or for each double roller is guided through the control disk (215) at the distal shaft end. Medical instrument (100) according to one of claims 7 to 10, wherein, depending on the angulation of the instrument head with respect to the longitudinal axis (201) of the shaft, a traction means forms a wrap angle (θ) around the rollers of the respective roller pair (280) facing the angulation direction for guidance, wherein the wrap angle (θ) is preferably up to 90. 0 amounts. Medical instrument (100) according to one of the preceding claims, wherein an actuating unit arranged proximally on the shaft (200) is designed to pivot the first tool part (380) by means of the first pulling means (310) and / or the second tool part (390) by means of the second pulling means (320) from a closed to an open position and vice versa, wherein the guidance of both pulling means in the region of the tool carrier (330) is effected by means of the deflection arrangement without offset between the rollers and in any position of the pulling means, wherein the position depends on the respective degree of pivoting. Medical instrument (100) according to one of the preceding claims, wherein the first pulling means (310) and the second pulling means (320) are guided in the shaft sleeve (220) on both sides of the longitudinal extension or central axis (201).A medical instrument (100) according to any one of the preceding claims, wherein the tool parts (370, 380) comprise a tool (301) with at least two straight or at least partially curved jaws, cutting edges, or other jaw parts, and the tool is selected from the group comprising: grasping forceps, dissecting forceps, or other forceps, scissors (371, 381), or a needle holder. A medical instrument (100) according to any one of the preceding claims, wherein the first traction means (370) and the second traction means (380) each comprise a tension-absorbing cable, which forms a pair of traction cables in the shaft, and is made of one of the following materials: Wire, steel, aramid fiber, nylon, preferably as a monofilament or in combination with tension rods or other suitable materials guided in the shaft (200). The medical instrument (100) according to claim 15, wherein both pairs of tension cables are arranged parallel to one another at least in sections within the shaft; wherein the shaft has a length of at least 450 mm and preferably an outer diameter of less than 8 mm, preferably less than or equal to 5.5 mm. The medical instrument (100) according to one of the preceding claims, further comprising at least one actuating unit for controlling the first traction means (310) and / or the second traction means (320), wherein the actuating unit is manually or automatically operable. The medical instrument (100) according to one of the preceding claims, further comprising an interface for connection to a robot. A surgical robot system comprising a medical instrument (100) according to one of the preceding claims 1 to 18.

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