INSTRUMENT MEDICAL

Abstract

The present invention relates to an actuation unit (16) for a medical device (10) and to a medical device (10) equipped with a rod (12) extending between a proximal end (20) and a distal end (22), the device (10) being made at the distal end (22) to receive an effector terminal organ (14), an actuation unit (16, 216) associated with the proximal end of the rod (12) and comprising a plurality of drives (50, 52, 54, 56) and with at least two control lines (100, 102, 104, 106, 108, 110, 112, 114) extending through the rod (12), the at least two control lines (100, 102, 104, 106, 108, 110, 112, 114) which can be used to control at least one degree of freedom of the instrument, in particular to control the end effector (14). (Figure 1)

Description

Title of the invention: MEDICAL INSTRUMENT

[0001] The present invention relates to a medical instrument equipped with a shaft extending between a proximal end and a distal end, the instrument being made at the distal end to receive an end effector, an actuation unit associated with the proximal end of the shaft and with at least two control lines extending through the shaft, the at least two control lines being usable for controlling at least one degree of freedom of the instrument, in particular for driving the end effector.

[0002] Document US 5,454,827 A discloses in a known manner a surgical instrument which comprises a rigid rod provided with a distal end and a proximal end extending between a handle and a jaw head, a deflectable section being provided at the distal end of the rigid rod, said rod making it possible to deflect the jaw head in any direction relative to the rigid rod, the deviable section comprising a plurality of pivoting joints arranged in line, these joints being able to pivot relative to each other.

[0003] To control the deflection movement, US 5,454,827 A proposes using four actuating wires extending through the rod and the deflectable section and which can be manually controlled via a control lever. The four actuating wires are coupled to each other in such a way by means of a distal link of the deflectable section as well as with a control plate connected to the control lever that in the event of deflection of the control lever, the actuating wires are partly pulled proximally or pulled distally. The jaw head can thus be deflected upwards or downwards and / or to the right or to the left.

[0004] Medical instruments of the most diverse types are known. For example, there are medical instruments with an end effector in the form of a jaw head having two jaw parts movable relative to each other, in order to open or close the jaw head. Such instruments are, for example, designed as cable clamps, scissors, staplers, forceps, tweezers or the like. Corresponding surgical instruments are also known for carrying out electrosurgical treatment and they have one or more electrodes in the region of the jaw head.

[0005] It is understandable that the end effector is not necessarily made in the form of a jaw head. For example, the end effector may comprise optical elements and / or an image sensor. For example, the end effector may be made to emit electromagnetic radiation, for example in the context of phototherapy. dynamic. For example, the end effector can be designed to take samples and / or to deliver a drug or other substance in a realized manner. The end effector can, for example, be designed to provide a rinsing function or a suction function. Mixed forms and combinations are possible.

[0006] Additional degrees of freedom are particularly desired in the case of instruments with a rigid shaft, for example to allow the end effector to be deflected relative to the shaft. The end effector can thus (from a user's point of view) be deflected upwards or downwards and / or to the right or to the left. US 5,454,827 A describes an embodiment in which deflection of a jaw head is possible in several directions using only one control lever.

[0007] The surgical instrument described in US 5,454,827 A is guided by hand, the control of the viable section also being carried out manually. The user can deflect the control lever in different directions in the manner of a joystick, deflecting the jaw head in response.

[0008] Medical instruments with motorized or, where appropriate, robotic control have been known for a very long time. Some or all of the degrees of freedom (movements, functions, etc.) of the instrument can be actuated and, where appropriate, controlled in a motorized manner. This can offer advantages in use. Further developments such as telemedicine (telesurgery), surgical treatments carried out using operating robots and the like require as much motorized / robotic control as possible of all or almost all of the instrument's functions.

[0009] The concept disclosed in US 5,454,827 A is suitable for manual actuation provided that the user has the corresponding experience. An identical implementation would, however, entail a high cost because the control movement comprises various degrees of freedom of movement at the control lever.

[0010] Medical instruments, in particular surgical instruments or even invasive microsurgery instruments, often require taking into account delicate space limitations. This often concerns a shaft diameter. The diameter of a medical instrument shaft can, for example, measure a maximum of 15 mm, a maximum of 12 mm, a maximum of 10 mm, a maximum of 8 mm or even a maximum of 6 mm. This is not to be understood in a limiting manner. Similarly, various functions and degrees of freedom are often desired for the end effector organ. The corresponding movements must regularly be transmitted from the proximal end of the instrument to the distal end. Drives or other actuators cannot regularly be performed directly in the presence of an end effector.

[0011] In this context of the present invention, the aim is to provide a medical instrument having a plurality of degrees of freedom, in particular degrees of freedom of movement, for an end effector, wherein at least some of the degrees of freedom can be motorized in a controllable manner. This applies, for example, to a deflection movement of the end effector. Preferably, the instrument allows the use of a small shaft diameter. Preferably, the instrument allows the end effector to be deflected in different directions. Preferably, the deflection of the end effector can be variably controlled. Preferably, the deflection movement is without play or with little play. The medical instrument is to be suitable, in particular, in telemedical (telesurgical) treatment and / or robotic and / or robot-assisted surgery, at least in the configuration examples.

[0012] The objective of the present invention is further to implement an actuation unit suitable for such an instrument.

[0013] According to a first aspect, the present invention relates to a medical instrument equipped with a shaft extending between a proximal end and a distal end, the instrument being made at the distal end to receive an end effector, an actuation unit associated with the proximal end of the shaft and comprising a plurality of drives, said instrument being with at least two control lines extending through the shaft, the at least two control lines being usable for controlling at least one instrument degree of freedom, in particular for controlling the end effector, the at least two control lines comprising a first control line and a second control line,and the first control line being coupled to a first drive element and the second control line being coupled to a second drive element on which a drive acts to produce a pushing movement or a pulling movement of the drive element.

[0014] This allows the objective to be achieved.

[0015] According to the present invention, an actuation unit is provided in particular which can control movements that are, if necessary, very complex (degrees of freedom of the instrument), but by using simple elements coupled together in a suitable manner. Simple movements (pulling movements or pushing movements) are used in particular to control the desired degrees of freedom of movement of the instrument. The pulling movements or pushing movements are regularly translational movements which can, for example, be produced in a precise and reproducible manner using spindles. threading. Complex movements can thus be subdivided into a plurality of simple partial movements for which established drives, in particular electromotorized drives, are already available.

[0016] In the context of the present invention, a distal end or element is oriented towards a patient and away from a user and / or a base of the instrument. In the context of the present invention, a proximal end or element is oriented towards a user and / or a base of the instrument and away from a patient. In other words, a distal end or element of a unit is regularly arranged closer to a patient than the proximal element of said unit. The concept "distally" can therefore be understood as "oriented towards the patient". The concept "proximal" can therefore also be understood as "away from the patient".

[0017] In the context of the present invention, a pulling movement of a drive element is a movement of the drive element in the proximal direction, for example away from the distal end. In the context of the present invention, a pushing movement of a drive element is a movement of the drive element in the distal direction, for example away from the proximal end.

[0018] For example, the deflection of the instrument is a deflection of the end effector relative to the shaft and / or relative to the proximal end of the instrument. A deflection of the end effector includes, for example, a transition from a lengthwise orientation (e.g., concentrically oriented relative to the longitudinal axis of the shaft) to an angled orientation relative to the longitudinal axis.

[0019] In an exemplary configuration, an end effector is disposed at the distal end of the instrument shaft. The end effector is, for example, a jaw head with two jaw portions, of which at least one jaw portion is movable relative to another jaw portion. Such a jaw head is, for example, embodied as a clamp, forceps, scissors, a coagulation instrument, or the like. In the exemplary configurations, the end effector comprises a light source or a radiation source. In the exemplary configurations, the end effector comprises optical module components. In an exemplary configuration, the end effector comprises an image sensor.

[0020] An end effector may also be described as a distal end piece of the instrument disposed at the distal end of the shaft. It is understood that additional components may be provided between the shaft and the end effector, for example a deflectable section. In configurations defined, the deflectable section is an integral part of the rod.

[0021] When a pushing movement or a pulling movement of the drive element occurs, the control line thus coupled can be biased in the direction of a pull (pull in the proximal direction) or in the direction of a push (generally: compensating movement in the distal direction). This can be used on the one hand to carry out a movement at the distal end of the instrument. In addition, the control line(s), in particular both control lines of a pair, can be slightly prestressed, to minimize or even eliminate a movement play when controlling the degree of freedom of the instrument (for example the return play to the initial position). This makes it possible to carry out high-precision movements with high repeat accuracy.

[0022] In the configuration examples, the actuation unit is implemented as a motorized actuation unit with motorized drives. The instrument can thus be used for telemedical applications, telesurgical applications, robot-assisted applications and the like.

[0023] In the context of the present invention, the ordinal numbers (first, second, third element, etc.) are used primarily to distinguish the different elements. Each element is thus not necessarily linked to a weighting or a hierarchy. In other words, configurations can be envisaged for which only a second or a third element are provided, however without the first element of a series.

[0024] In the exemplary configurations, the medical instrument is configured to be introduced into a body of a patient. This may occur via natural or artificial openings in the body. It is understood that the medical instrument may also be configured to treat the body from outside the body.

[0025] The medical instrument is in particular a surgical instrument. For example, the medical instrument is an instrument for invasive microsurgery. For example, the medical instrument is an instrument with a minimized shaft diameter.

[0026] Preferably, the instrument provides several degrees of freedom for the deflection movement. This includes, for example, variable deflection in several directions (e.g., up and down as well as right and left, e.g., relative to a horizon of the observer). In the case of coordinated control, the end effector member can be articulated in any or almost any way in a plane extending perpendicular to the longitudinal axis of the rod, at least in the configuration examples. This can be compared to a watch or clock hand that can assume any positions (correspondingly between 0:00 o'clock and 12:00 o'clock) on a screen with a separation of twelve hours. In addition, a variation of the degree of deflection (and / or the angle of curvature) is also possible. In case of 90° deviation, the end effector organ is perpendicular to the axis of the rod.

[0027] In the configuration examples, a deflection of the end effector member is characterized by an angular position (needle), for example between 0° and 360°, and by a degree of deflection (angle of curvature), for example between 0° (concentric to the longitudinal axis) and 90° (perpendicular to the longitudinal axis) or even more. Other embodiments are conceivable. In an example configuration, the deflection can be controlled incrementally or in steps.

[0028] The degree of freedom is, for example, a degree of freedom of movement of the instrument and / or its end effector member. However, a function can also be understood here in general, in particular a function comprising a movement of at least one element of the instrument. For example, the opening and closing of the jaw part can be understood as a degree of freedom of the instrument.

[0029] According to an exemplary configuration, two or more drives are arranged parallel to each other, preferably two or more drives being arranged parallel to a longitudinal axis of the rod so as to be distributed around the longitudinal axis. In an exemplary configuration, four drives are provided so as to be respectively arranged around the longitudinal axis offset by 90° relative to the longitudinal axis. The drives are arranged in an exemplary configuration at the same axial position along the longitudinal axis.

[0030] According to an exemplary configuration, the control lines are produced in the form of control wires, in particular in the form of control wires that can be stressed in the direction of traction. The control wires are, for example, made of nitinol. It will be understood that the control lines and the control wires can also be stressed at least partly in the direction of thrust, at least in the exemplary configurations. In alternative configurations, the control lines can also be configured as control rods, in particular as flexible control rods and / or control rods with sufficient elasticity.

[0031] According to another exemplary configuration, the end effector is provided relative to the deflectable rod, a deflectable section being provided that includes at least one spherical element having spherical surfaces and disposed between a proximal sphere guide and a distal sphere guide and the at least two control lines being coupled at the distal sphere guide to deflect the end effector. In an exemplary configuration, the deflectable section is disposed at the transition between the rod and the end effector.

[0032] In one exemplary configuration, the deflectable section is constructed similarly to a spine. In other words, two spine-shaped elements sphere or more are arranged in a line, these elements being respectively made between two guides in the form of bowls / bowl discs. This makes it possible to achieve considerable degrees of deviation (angle of curvature).

[0033] According to another exemplary configuration, a first and a second control line form a pair associated with an instrument degree of freedom. According to another exemplary configuration, the control lines of the pair are alternately biased in the direction of a pull by an associated drive. The two control lines of a pair are preferably alternately biased in the direction of a pull by a single drive, i.e. pulled alternately in a distal direction. The respective other control line performs an opposite compensating movement and is at least slightly prestressed in the exemplary configurations to reduce the play.

[0034] When a first control line of the pair is loaded in the direction of a pull and consequently in the direction of its pull in the proximal direction, the other control line - respectively depending on the configuration of the deflectable section - is moved in the opposite direction (compensating movement), i.e. pulled in the distal direction (due to the deflection of the deflectable section) and / or pushed in the distal direction (due to the pushing movement of the drive element). When, on the other hand, a second control line of the pair is loaded in the direction of a pull and consequently in the direction of its pull in the proximal direction, the other control line is respectively moved in the opposite direction depending on the configuration of the deflectable section (compensating movement). This applies at least to the configuration examples.In an exemplary configuration, the drives are implemented as pull and / or push drives. In other words, in an exemplary configuration, a drive can push a drive element in the distal direction and / or pull it in the proximal direction, with the motion being transmitted to the control line coupled to the drive element.

[0035] This ensures in the configuration examples a movement without play or with low play, in particular a deflection with low play or without play. In other words, the end effector can for example be precisely positioned and aligned by means of a deflection movement. The deviable section is provided for this purpose between the rod and the end effector in an example configuration. In the configuration examples, the deviable section is associated with the rod. In the configuration examples, the deviable section is associated with the end effector. This is not to be understood in a limiting manner.

[0036] In an exemplary configuration, an odd number of control lines is provided, two of which respectively form a pair for controlling a degree of instrument freedom. This particularly concerns the control lines used to control the end effector. For example, two, four, six or eight control lines are provided, forming one pair, two pairs, three pairs or four pairs.

[0037] This does not, however, preclude providing an odd number of control lines in total. In an exemplary configuration, a control line is provided for opening or closing the jaw parts of the end effector member. This can, for example, occur against a restoring force, so that a single control line is sufficient because a return position to the initial state is, for example, given by the presence of a spring.

[0038] According to another exemplary configuration, only one drive is associated with both control lines of a pair. When only one drive controls two control lines, this reduces the total number of drives required. This can furthermore make it possible to achieve a backlash-free or low-backlash state when the drive alternately loads the control lines in the direction of a pull and the respective other control line is easily pre-tensioned. In a configuration with four control lines, there are therefore two drives, in a configuration with eight control lines, there are four drives, at least in the exemplary configurations. It will be understood that additional drives can be provided, in particular for opening / closing the jaw part.

[0039] According to another exemplary configuration, the two control lines of a pair are at least arranged offset by 180° from each other at the distal end relative to the longitudinal axis of the rod. In other words, the two control lines are arranged on opposite sides of the rod and / or its longitudinal axis relative to each other. This makes it possible to carry out a deflection movement together with the associated return movement to the initial position, without a return spring or the like.

[0040] In an exemplary configuration, the two control lines are arranged offset by 180° relative to each other relative to the longitudinal axis at the distal end of the rod, for example in the case of a distal coupling position or distal ball guide of the deflectable section. Therefore, an alternating pulling movement can cause in the proximal direction both a deflection movement from a neutral position and an associated return movement to the initial position in the neutral position by pulling one line or the other in the proximal direction. The respectively opposite control line preferably performs a compensating movement.

[0041] In an exemplary configuration, the drive is implemented to include automatic locking. This includes, for example, sufficient friction between the moving parts of the drive coupled to the drive elements of both control lines of the pair. When the static friction is sufficiently high, the end effector remains in its deflected state. The static friction arises, for example, from the coupling elements present, e.g., the components of a thread spindle drive. Alternatively or additionally, it is also possible to use electric motors that provide a correspondingly high static moment. This can also help to reduce the backlash.

[0042] According to another exemplary configuration, the drive can be driven in a first rotational direction and in a second rotational direction, whereby in the first rotational direction the first control line is pulled in the proximal direction and in the second rotational direction the second control line of the pair is pulled in the proximal direction. This makes it possible to use only one motor (e.g. an electric motor) to alternately pull the two control lines in the proximal direction via their drive element. It is only necessary to drive the motor in an alternating rotational direction (clockwise, counterclockwise).

[0043] According to another exemplary configuration, the drive is implemented as a threaded actuation and is provided with a spindle which has two opposing threaded sections, a first threaded section interacting with the drive element of the first control line and a second threaded section interacting with the drive element of the second control line.

[0044] This makes it possible to achieve with only one drive and only one threaded spindle an opposite movement of the two drive elements of the two control lines of the pair. In other words, the two drive elements are moved towards or away from each other depending on the direction of rotation of the threaded spindle and the pitch of two opposing threaded sections, at least in the exemplary configurations. The opposing threaded sections comprise, for example, a right-hand thread and a left-hand thread. In one exemplary configuration, the pitch of the right-hand thread and the left-hand thread is identical. This makes it possible to mechanically synchronize the movement of the two control lines of the pair since the amounts of pushing movement and pulling movement of the drive elements are identical, at least in the exemplary embodiments.

[0045] According to another exemplary configuration, several drives are implemented in the form of threaded actuators with two opposing threaded sections, the drives respectively comprising a spindle and the spindles preferably being arranged in distributed in a circle around the longitudinal axis. This further reduces the total number of drives. For example, only one drive is provided for each of the two control wires in a pair, thus enabling one degree of freedom of the instrument to be controlled.

[0046] According to a configuration variant, a separate assigned drive is respectively associated with the two control lines of a pair, the two drives being able to be driven in a coordinated manner (if necessary synchronously), to alternately pull one of the two control lines in the proximal direction. This makes it possible to cause a deflection movement using the two control lines of a pair. In other words, in this configuration, the two drives of a pair are synchronized, so that the second drive releases the second control line, thus enabling a pushing movement of the drive element in the distal direction when the first drive urges the first control line offset by 180° in the direction of a pull, thus pulling the drive element in the proximal direction.

[0047] According to another exemplary configuration, at least one of the drive elements comprises a pivoting rolling bearing having a first ring and a second ring rotatable relative to each other and the first ring being coupled to the control line and the second ring being coupled to the drive. The first ring is designed, for example, as a coupling of the control line. The second ring is designed, for example, to be coupled to the drive. For example, the first ring is designed as an inner ring and the second ring is designed as an outer ring. For example, the outer ring has a radially outwardly projecting overhang which has a hole with an internal thread coupled to a spindle of the drive. The first ring and the second ring can pivot relative to each other.This enables rotational decoupling between the control lines and the drives of the actuation unit.

[0048] According to another exemplary configuration, the end effector member can pivot about a longitudinal axis of the rod, wherein the rotation of the end effector member preferably occurs relative to the drives. The rotational movement of the end effector member occurs in an exemplary configuration without effect or other feedback coupling on the remaining instrument degree of freedom, in particular on a current pivoting state of the end effector member. In an exemplary configuration, the end effector member can rotate relative to a housing and / or relative to the drives of the actuating unit. In an exemplary configuration, the end effector member can pivot together with the rod relative to a housing of the actuating unit. During rotation of the end effector member effector, in an exemplary configuration, the control lines also rotate for the deflection movement, whereby decoupling of the rotational movement preferably occurs between the control lines and the drives, for example at the drive elements.

[0049] According to another exemplary configuration, a rotational drive is provided for the rotational movement of the end effector, the rotational drive comprising an output drive shaft provided with a pinion, the shaft driving a wheel coupled to the rod. In one exemplary configuration, the rotational drive is disposed within the housing, flush with the drives of the drive elements at the proximal end of the instrument.

[0050] According to another exemplary configuration, an effector control line is provided for the end effector, the effector control line being at least biasable in the direction of a pull or a press to open or close the jaw parts of the end effector. By way of example, the effector control line is embodied as a control rod. By way of example, the effector control line extends concentrically to the longitudinal axis of the rod. Therefore, the control lines provided for the deflection movement are distributed in the radial plane around the effector control line, at least in the exemplary configurations.

[0051] According to another exemplary configuration, several drives are provided which are arranged in a common longitudinal position along the longitudinal axis. This concerns in an exemplary configuration all the drives provided for the deflection movement.

[0052] In an exemplary configuration, the motors of the drives are arranged in the same axial position relative to the longitudinal axis, for example flush with each other, the spindles having at least partly different lengths for coupling the motors to the drive elements arranged offset from each other along the longitudinal axis. In an exemplary configuration, the motors of the drives are each arranged concentrically with respect to the respective spindle.

[0053] According to another exemplary configuration, the drive elements are arranged offset relative to one another along the longitudinal axis, the drive elements preferably comprising cantilevers with a threaded section oriented offset relative to one another about the longitudinal axis. In other words, the drive elements are offset relative to one another about the longitudinal axis, in the longitudinal direction as well as at an angle. This makes it possible to achieve an overall compact construction form with a reduced space requirement, also in the area of ​​the actuation unit. The drives are distributed around the longitudinal axis in an example configuration, similar to a revolver magazine.

[0054] According to another exemplary configuration, at least the relative orientation or the relative position of the cantilevers of the drive elements is constant when the end effector member rotates about the longitudinal axis. This allows, for example, rotational decoupling between the control lines and the spindle-cut cantilever.

[0055] According to another exemplary configuration, the medical instrument comprises eight control lines forming four pairs, each pair comprising two control lines offset by 180° relative to each other with respect to a longitudinal axis of the shaft at least at the distal end, each of the eight control lines being coupled to the drive elements and the two drive elements of a pair of control lines being coupled to a common drive. The control lines are for example arranged in a circle around the longitudinal axis, offset by 45° relative to each other.

[0056] In another exemplary configuration, a control device is further provided, which device makes it possible to control the four drives in a coordinated and synchronized manner to control the eight control lines so as to achieve the desired deflection of the end effector member. This makes it possible to achieve fine gradations of deflection movement, in particular with regard to the direction and degree of deflection.

[0057] In another exemplary configuration, the medical instrument comprises four control lines forming two pairs, each pair comprising two control lines offset by 180° relative to each other at least at the distal end relative to a longitudinal axis of the shaft, each of the four control lines being coupled to a drive element and the two drive elements of a pair of control lines being coupled to a common drive. This allows a desired deflection to be achieved. The control lines are, for example, arranged respectively offset by 90° relative to each other in a circular manner around the longitudinal axis.

[0058] Synchronized coordinated control of the drives allows for various movements that can be reliably repeated. In other words, it is possible to obtain targeted commands in predefined directions (e.g. left to right-top to bottom from the perspective of a user at the proximal end of the instrument) but also intermediate levels (e.g. top right, bottom left and their equivalent). In other words, superimposed movements of the control lines of the different pairs are possible to precisely achieve the desired direction and degree of deviation.

[0059] According to another aspect, the present invention relates to an actuating unit for a medical instrument, in particular a medical instrument with a deflectable end effector, with a plurality of drives, at least two control lines for controlling at least one instrument degree of freedom and with at least two drive elements, comprising a first drive element and a second drive element, the at least two control lines comprising a first control line and a second control line and the first control line being coupled to the first drive element and the second control line being coupled to the second drive element on which a preferably common drive acts respectively to produce a pushing movement or a pulling movement of the drive element.

[0060] This also helps to achieve the objective.

[0061] In an exemplary configuration, the two control lines act together to control an instrument degree of freedom, for example to drive the end effector in a defined direction (e.g. up and down or left and right). In an exemplary configuration, the common drive is implemented such that a (single) drive movement leads to an opposite movement of the first drive element and the second drive element. This allows the two control lines to be driven together and in opposite directions.

[0062] It will be understood that the actuation unit according to at least one of the configurations described here of the medical instrument can be improved and vice versa.

[0063] It will be understood that the previously cited characteristics as well as the characteristics to be explained later can be used not only according to the proposed combination but also in other combinations or alone without departing from the scope of the present invention.

[0064] Additional features and advantages of the present invention will become apparent from the following description and exemplary embodiments explained with reference to the drawings in which:

[0065] [Fig. 1] illustrates a broken perspective view of a medical instrument after removal from the housing, from the distal end;

[0066] [Fig.2] illustrates another broken perspective view of the instrument according to [Fig.l], from the proximal end;

[0067] [Fig.3] illustrates a detailed view of a distal end of a medical instrument with an end effector organ with the jaw head closed;

[0068] [Fig.4] illustrates another view based on the representation according to [Fig.3], with the head open jaw;

[0069] [Fig.5] illustrates a detailed view of a distal end of a medical instrument with the end effector organ in an undeflected position;

[0070] [Fig.6] illustrates another view based on the representation according to [Fig.5] in a deviated position;

[0071] [Fig.7] illustrates a simplified broken side view of a medical instrument with deflectable section and actuation unit;

[0072] [Fig.8] illustrates a front view of the instrument according to [Fig.7];

[0073] [Fig.9] illustrates an enlarged partial side view of the instrument according to [Fig.7] in view to represent the actuation unit;

[0074] [Fig. 10] illustrates a sectional view of the instrument according to [Fig.9] based on line XX of [Fig.9] to represent the actuation unit;

[0075] [Fig. 11] illustrates another sectional view of the instrument according to [Fig.9] based on line XI-XI of [Fig.9] in order to represent the actuation unit;

[0076] [Fig. 12] illustrates a simplified schematic perspective view of a plurality of control lines distributed in a circle around a longitudinal axis;

[0077] [Fig. 13] illustrates an enlarged partial side sectional view based on the representation according to [Fig.9], various elements being masked for the purpose of good representation;

[0078] [Fig. 14] illustrates another partial side sectional view for representing an alternative configuration of a control unit of a medical instrument; and

[0079] [Fig. 15] illustrates a simplified representation of a manipulator used for manipulating a medical instrument.

[0080] [Fig. 1] and [Fig. 2] show, using perspective representations, an exemplary configuration of a medical instrument generally designated by the number 10. The instrument 10 comprises a rod 12 supporting, in the exemplary embodiment, an end effector 14. An actuating unit 16 for actuating and controlling degrees of freedom of the instrument 10 is further provided. The rod 12 extends between a distal end 18 and a proximal end 20. In the exemplary embodiment, the rod 12 is designed as a hollow rod and is provided with a rigid rod body.

[0081] The end effector member 14 is arranged at the distal end of the instrument 10, thus offset in the distal direction relative to the distal end 18 of the shaft 12. The actuation unit 16 is arranged in the exemplary embodiment at the proximal end of the instrument 10, thus offset relative to the proximal end 20 of the shaft 12 in the proximal direction. The shaft 12 defines a longitudinal axis 22. In the exemplary embodiment, the end effector member 14 is a jaw head 26 with two jaw parts 28, 30 which may comprise a open and closed configuration, see also [Fig.3] and [Fig.4]. The jaw parts 28, 30 are arranged at a support 32.

[0082] In the exemplary embodiment, a deflectable section 34 is formed between the rod 12 and the end effector member 14, this section opening into the support 32. This makes it possible to articulate the end effector member 14 relative to the rod 12 and / or relative to the longitudinal axis 22, see [Fig. 5] and [Fig. 6]. Preferably, the deflectable section 34 can not only be deflected in one direction (e.g. from top to bottom or from left to right) but also from a longitudinal position (concentric to the longitudinal axis 22) in various directions.

[0083] The actuating unit 16 comprises in the exemplary embodiment a rotary drive 36 which supports a pinion 40 arranged on a shaft 38. The pinion 40 is engaged with a wheel 42 connected to the rod 12. The wheel 42 is arranged concentrically with respect to the rod 12 and its longitudinal axis 22. The rotary drive 36 and the shaft 38 are arranged parallel to the longitudinal axis 22 at a distance therefrom. The rotary drive 36 causes the rod 12 and the end effector member 14 to rotate about the longitudinal axis 22 of the rod 12. However, embodiments without a rotary drive are also conceivable.

[0084] The actuating unit 16 further comprises a plurality of drives 50, 52, 54, 56 for controlling the deflectable section 34 for controlling the end effector member 14, see also the rear perspective view according to [Fig. 2] in addition to the front perspective view according to [Fig. 1]. In the exemplary embodiment, four drives 50, 52, 54, 56 are provided in total for the deflecting movement. Each of the drives 50, 52, 54, 56 comprises a spindle 60, 62, 64, 66. In the exemplary embodiment, the drives 50, 52, 54, 56 and the respective associated spindles 60, 62, 64, 66 are arranged distributed in a circular manner around the longitudinal axis 22, for example with a respective transfer angle of 90°.

[0085] The spindle 60 coupled to the drive 50 is coupled to two drive elements 70, 72 arranged offset from each other in the axial plane. The spindle 62 coupled to the drive 52 is coupled to two drive elements 74, 76 arranged offset from each other in the axial plane. The spindle 64 coupled to the drive 54 is coupled to two drive elements 78, 80 arranged offset from each other in the axial plane. The spindle 66 coupled to the drive 56 is coupled to two drive elements 82, 84 arranged offset from each other in the axial plane. The drive elements 70, 72, 74, 76, 78, 80, 82, 84 are staggered, offset relative to each other in the axial plane and arranged along the longitudinal axis 20 so as to partially rotate relative to each other.

[0086] In the embodiment according to FIGS. 1 and 2, the drives 50, 52, 54, 56 are arranged flush with each other relative to the longitudinal axis 22, i.e. in the same axial position. The length of the pins 60, 62, 64, 66 is respectively adapted to the position and distance of the associated drive elements 70, 72, 74, 76, 78, 80, 82, 84. An overhang of the drive element 84 is indicated in [Fig. 2] by means of the reference 86, see also [Fig. 1 1] in this regard.

[0087] The two drive elements 70, 72, 74, 76, 78, 80, 82, 84 respectively associated with a drive 50, 52, 54, 56 are arranged in a superimposable manner when observed from the front in the exemplary embodiment. In other words, the respective overhang 86 of the two respective drive elements 70, 72, 74, 76, 78, 80, 82, 84 of such a pair are arranged in the same angular rotational position relative to the longitudinal axis 22.

[0088] [Fig. 3] and [Fig. 4] illustrate an exemplary degree of freedom of the instrument 10. The end effector member 14 is embodied in the exemplary embodiment in the form of a jaw head 26 with two jaw parts 28, 30 which can assume a closed position ([Fig. 3]) and an open position ([Fig. 4]). For this functionality, a control line 88 is provided which is embodied for example in the form of a rod 90, see also [Fig. 2] in this regard. In the exemplary embodiment, the control line 88 is arranged concentrically with respect to the longitudinal axis 22 at least partly within the rod 12. The control line 88 penetrates the rod 12 and is coupled at the distal end of the instrument 12 with the jaw head 26 (not shown in more detail in FIGS. 3 and 4).Depending on the type of control selected, the jaw head 26 can be opened or closed by a pulling movement or a pushing movement of the control line 88, see also the double arrow 94 in [Fig. 4]. Such a movement can be controlled manually or motorized. [Fig. 4] illustrates the actuation of the jaw parts 28, 30 using a double arrow 92.

[0089] Figures 3 and 4 further show the presence of said control lines 100, 102, 104, 106, 108, 110, 112, 114, these lines extending in the axial plane through the rod 12 of the instrument 10 towards the end effector member 14 and / or its support 32. See also the schematic top view according to [Fig.12]. In other words, the control lines 100, 102, 104, 106, 108, 110, 112, 114 extend through the deflectable section 34. The control lines 100, 102, 104, 106, 108, 110, 112, 114 serve to introduce and control the deflecting movement of the end effector member 14, including the manipulation of the deflectable section 34, see for this in addition [Fig.5] and [Fig.6].

[0090] [Fig.4] shows with reference 120 a distal coupling provided for the line of control 114. Additional (covered) guides 122, 124 and 126 are provided for the control line 114. Similar guides are provided for the remaining control lines 100, 102, 104, 106, 108, 110, 112. The respective distal coupling 120 ensures that the pulling movements are transmitted to the control lines 100, 102, 104, 106, 108, 110, 112, 114 provided on the support 32 for their deflection. The control lines 100, 102, 104, 106, 108, 110, 112, 114 are at least partly covered by the instrument 10 and pass through the shaft 12 between the distal end 18 and the proximal end 20. The control lines 100, 102, 104, 106, 108, 110, 112, 114 are coupled to the drive elements 70, 72, 74, 76, 78, 80, 82, 84 at their proximal end, respectively a control line with one of the drive elements.This allows the control lines 100, 102, 104, 106, 108, 110, 112, 114 to be pulled in the proximal direction and if necessary pushed and / or loaded in the distal direction via the drives 50, 52, 54, 56 and their pins 60, 62, 64, 66.

[0091] For reasons of visibility, Figures 5 and 6 do not show the control lines 100, 102, 104, 106, 108, 110, 112, 114. [Fig. 5] illustrates a non-deflected state of the end effector member 14. [Fig. 6] illustrates an at least partially deflected state of the end effector member 14 by the corresponding deformation of the deflectable section 34. The exemplary embodiment is produced in such a way that the end effector member 14 can be deflected in other directions relative to the deflectable longitudinal axis 22, for example perpendicular to the plane of the views.

[0092] The deflectable section 34 comprises spherical elements 130, 132, 134 respectively arranged between two sphere guides 136, 138, 140, 142. The sphere guides 136, 138, 140, 142 can also be called spherical bowls. The sphere guides 138, 140 can also be called guide discs. The sphere guide 136 is a distal sphere guide to which the control lines 100, 102, 104, 106, 108, 110, 112, 114 are coupled to act on the support 32 of the end effector 14 via the distal coupling 120 ([Fig. 4]), so as to deflect the end effector 14. An example of a pivoting movement intended for the deflection is represented by a curved double arrow illustrated in [Fig. 5] designated by the reference 144.

[0093] The deflection illustrated in [Fig. 6] is achieved by controlling some of the control lines 100, 102, 104, 106, 108, 110, 112, 114, especially the control lines 108 and 110 opposite each other ([Fig. 8] and [Fig. 12]), to deform the deflectable section 34 in the desired manner. In [Fig. 6] an arrow 150 can be seen illustrating a pulling movement, while an arrow 152 illustrates an opposite compensating movement (movement in the distal direction). As a result of these movements, one side of the deflectable section 34 is pushed back and the other side is extended. This can result in the control line 108 being pulled in the proximal direction and if necessary, the opposite control line 110 is relieved or even pulled / pushed in the distal direction. The compensation movement is also caused in the exemplary embodiment by the tilting of the distal sphere guide 136 (and if necessary of the additional sphere guide 138, 140) at which the control lines 100, 102, 104, 106, 108, 110, 112, 114 are coupled (distal coupling 120). The rocker in response to the pulling movement of one of the control lines 100, 102, 104, 106, 108, 110, 112, 114 in the proximal direction here allows a pulling movement of the opposite control line offset by 180°, in the distal direction 100, 102, 104, 106, 108, 110, 112, 114.

[0094] The deflection illustrated in [Fig. 6] of the end effector 14 requires targeted manipulation of several of the control lines 100, 102, 104, 106, 108, 110, 112, 114. This may result in a reduction of the movement clearance or the return clearance to the initial position. To illustrate this, in the configuration given in [Fig. 6], the control lines 104, 108, 112 may at least partly be biased in the direction of traction above the longitudinal axis 22, pulled in the proximal direction, while the control lines 106, 110, 114 below the longitudinal axis are relieved "mirrored" and / or moved in the distal direction. In these circumstances, the control lines 100, 102 are in the "neutral wire" (zero line), see also [Fig. 12]. This is not to be understood in a limiting way.

[0095] Likewise, a control of the drives 50, 52, 54, 56 is advantageous for manipulating the control lines 100, 102, 104, 106, 108, 110, 112, 114 and the deflectable section as a whole in a desired manner. A control unit is shown for this purpose with the reference 154 in [Fig. 6]. Two control lines 100, 102, 104, 106, 108, 110, 112, 114 offset by 180° form a pair coupled in the exemplary embodiment to a single drive 50, 52, 54, 56.

[0096] With further reference to Figures 7 and 8 and Figures 9 to 11 derived therefrom, the control of individual control lines (and / or pairs of control lines 100, 102, 104, 106, 108, 110, 112, 114) with a single drive 50, 52, 54, 56 will now be explained in more detail.

[0097] [Fig. 7] illustrates a broken side view of the instrument 10, a housing 160 is shown using a dotted line for the actuation unit 16. [Fig. 8] illustrates a corresponding front view. [Fig. 9] illustrates an enlarged side partial view based on [Fig. 7] after removal of various elements. Figures 10 and 11 illustrate sectional views along lines XX and XLXI in [Fig. 9]. The optional rotary drive 36 and the housing 160 are not shown in Figures 9 to 11. In addition to Figures 7 to 11, [Fig. 12] illustrates an enlarged schematic representation of the control lines 100, 102, 104, 106, 108, 110, 112, 114. [Fig. 13] further illustrates an enlarged side sectional view of selected components in the representation according to [Fig. 9].

[0098] The actuating unit 16 corresponding to the rod 12 is shown compactly, the drives 50, 52, 54, 56 being distributed in a circular manner around the longitudinal axis 22. The drives 50, 52, 54, 56 and their spindles 60, 62, 64, 66 are each arranged offset by 90° relative to each other around the longitudinal axis 22, parallel thereto, see [Fig. 11]. [Fig. 8] illustrates that in the exemplary embodiment, a space is used between two drives 50, 52 for the location of the rotary drive 36 as well as the shaft 38. This is not to be understood in a limiting manner. The drives 50, 52, 54, 56 are, for example, regulated electromotor drives with an output drive shaft forming the respective spindle 60, 62, 64, 66 in the exemplary embodiment.

[0099] The drive elements 70, 72, 74, 76, 78, 80, 82, 84 are arranged, in the exemplary embodiment, between the drives 50, 52, 54, 56 and the rod 12, at a constant axial distance along the longitudinal axis 22. Insofar as the exemplary embodiment provides a rotary drive 36 for the rod 12 and the end effector 14, a corresponding wheel 42 is coupled to it at the proximal end 20 of the rod 12. The wheel 42 is driven via a pinion 40 resting on the shaft 38 of the rotary drive 36, see also [Fig. 8] with the double arrow 44 for representing the rotary movement.

[0100] The components of the rotary drive 36 and the housing 160 are not shown in FIGS. 9 to 11. The drive elements 70, 72, 74, 76, 78, 80, 82, 84 form four pairs respectively coupled to one of the spindles 60, 62, 64, 66 of the drives 50, 52, 54, 56. In the exemplary embodiment, the drive elements 70, 72, 74, 76, 78, 80, 82, 84 of a pair are respectively placed at a certain constant distance from each other in the axial plane. Figures 10 and 11 show that each of the drive elements 70, 72, 74, 76, 78, 80, 82, 84 has an outwardly projecting cantilever in the radial plane 86 traversed by the associated spindle 60, 62, 64, 66.

[0101] In addition, [Fig. 11] illustrates that the drive elements (shown here: the drive element 84) each comprise a pivoting bearing 166 for rotational decoupling between the spindle (shown here: the spindle 66) and the associated control line (here: the control line 110). Such functionality is at least conceivable in the configuration examples to enable relative rotation of the end effector 14 relative to the actuation unit 16 without effect on the current deflection status (direction and / or degree of deflection) of the end effector 14. The pivoting bearing 166 is illustrated in a side section also shown in the schematic representation according to [Fig. 13].

[0102] The pivoting bearing 166 comprises a first ring 168 formed as an inner ring and a second ring 170 formed as an outer ring. The first ring 168 and the second ring 170 can rotate relative to each other. An extension 172 at which the control line 110 is coupled is formed at the first ring 168, see again [Fig. 13]. The overhang 86 is formed at the second ring 170, said overhang providing a guide for the spindle 66. [Fig. 13] illustrates in this regard that the overhang 86 provides an internal thread 174 for the spindle 66. The embodiment of the drive element 84 illustrated with the aid of figures 11 and 13 is representative of the set of drive elements 70, 72, 74, 76, 78, 80, 82, 84.

[0103] [Fig. 12] illustrates with the aid of a schematic perspective view the circular arrangement of the control lines 100, 102, 104, 106, 108, 110, 112, 114 around a common center defined by the longitudinal axis 22 in the exemplary embodiment. The transfer angle here is 45° respectively. The control line 88, implemented as an example in the form of a rod, is arranged concentrically with respect to the longitudinal axis 22 for opening and closing the jaw head 26. [Fig. 2] illustrates with the aid of hatching the control lines 100, 102, 104, 106, 108, 110, 112, 114, the respective association of which forms a pair. Control lines 100, 102 form a first pair. Control lines 104, 106 form a second pair. Control lines 108, 110 form a third pair. Control lines 112, 114 form a fourth pair.Deflections of the end effector 14 can be achieved in various, if any, directions relative to the longitudinal axis 22 by means of the targeted coordinated and synchronized control of the control lines 100, 102, 104, 106, 108, 110, 112, 114. The control unit 154, which is only symbolically represented, is provided for this purpose and, in particular, controls the drives 50, 52, 54, 56 in an appropriate manner.

[0104] It will be understood that in contrast to the configuration shown in [Fig. 12] with a total of four pairs, embodiments with two pairs, three pairs or, if appropriate, a single pair of control lines 100, 102, 104, 106, 108, 110, 112, 114 are conceivable. In principle, more than four pairs are also conceivable. The previously mentioned document US 5,454,827 A illustrates a configuration of a deflection mechanism with two pairs of control wires and it is to this that reference is made here.

[0105] [Fig. 13] illustrates instead of the plurality of drives 50, 52, 54, 56 the func motorized drive element 56. The drive 56 is coupled to the drive element 82 and to the drive element 84 via its spindle. The drive element 82 is coupled to the control line 108. The drive element 84 is coupled to the control line 110. As already described above, the drive element 84 is provided with a pivoting roller bearing 166. The spindle 66 passes through the drive element 84 in the area of ​​its overhang 86 in which an opening is made with an internal thread 174. The control line 110 is coupled to an extension 172 of the drive element 84.

[0106] Similarly, the drive element 82 comprises a pivoting rolling bearing 176 formed between a first ring 178 and a second ring 180. The first ring 178 serves as an inner ring and has an extension 182 at which the control line 108 is coupled. The second ring 180 serves as an outer ring and is provided with an opening with an internal thread 184 in the area of ​​its overhang, said overhang being traversed by the pin 66. The pin 66 is a threaded pin.

[0107] The spindle 66 has a first threaded section 190 and a second threaded section 192. The threaded section 190 is associated with the drive element 82. The threaded section 192 is associated with the drive element 84. The two threaded sections 190, 192 have an opposite pitch, the internal thread 174, 184 of the drive element 82, 84 adapting thereto. This has the consequence that in the event of a rotational movement induced by the drive 56, the spindle 66 of one of the two drive elements 82, 84 is moved in the proximal direction and the other in the distal direction. A rotational movement in the opposite direction of the spindle 66 leads to an opposite movement of the two drive elements 82, 84.In other words, the two drive elements 82, 84 are respectively moved towards each other or away from each other towards the drive direction depending on the respective spindle 66, see for this the respective arrows 150, 152 in [Fig. 13].

[0108] In other words, one of the two control lines 108, 110 is respectively pulled in the proximal direction while the other of the two control lines 108, 110 is discharged or even pushed in the distal direction. This makes it possible to achieve the deflection of the end effector member 14 generally illustrated in FIGS. 5 and 6.

[0109] This ensures, based on the opposing threaded sections 190, 192 of the exemplary embodiment, that the two control lines 100, 102, 104, 106, 108, 110, 112, 114 of a pair are moved by an equal amount in different movement directions. This can also contribute to reducing the backlash. This further reduces the number of drives required.

[0110] The control unit 154 ([Fig. 12]) synchronizes the drives 50, 52, 54, 56, some of the control lines 100, 102, 104, 106, 108, 110, 112, 114 having to be moved more than the others depending on the direction of the deviation from the longitudinal axis 22.

[0111] In an exemplary configuration, the drive 56 (each representing the drives 50, 52, 54, 56) is designed to comprise an automatic locking. This can be achieved, for example, by providing the threaded sections 190, 192. The concept of automatic locking in the context of the present invention is understood to mean an embodiment in which a respective deflection state of the end effector 14 is securely maintained once the desired position has been reached. This also occurs in the exemplary embodiments when the drives 50, 52, 54, 56 are not energized. An automatic locking allows, for example, that manipulation is made more difficult or is hindered directly at the distal end of the instrument 12, thus, for example, a manual "movement" of the end effector 14 or "flexions" of the deflectable section 34.

[0112] [Fig. 14] illustrates an alternative configuration of an actuation unit generally designated by the reference numeral 216. Aspects of the embodiment deviating primarily from the embodiments according to FIGS. 1 to 13 are described below. A difference from the configuration illustrated with the aid of [Fig. 13] can be seen in which the two control lines 108, 110 of a pair arranged offset by approximately 180° relative to each other with respect to the longitudinal axis are controlled by two motors 220, 222. A first drive 220 is coupled to the control line 108 via the spindle 224 and the drive element 82. A second drive 222 is coupled to the control line 110 via a spindle 226 and the drive element 84. The drive element 82 is offset in the distal direction relative to the drive element 84.

[0113] Each of the two control lines 108, 110 is controlled by a separately assigned drive 220, 222, in particular in the form of an electric motor with a drive spindle at the output. The spindle 224 has a threaded section 230. The spindle 226 has a threaded section 232. The drive elements 82, 84 are correspondingly provided with a corresponding internal thread. The drives 220, 222 can pull the drive elements 82, 84 in the proximal direction (see arrows 150) or push them in the distal direction (see arrows 152) respectively depending on the selected direction of rotation. The two control lines 108, 110 form a common pair and can thus alternately be biased in the direction of traction to deflect the end effector 14, see Figures 5 and 6.

[0114] [Fig. 13] illustrates an embodiment in which a synchronization mechanical is achieved due to the opposing threaded sections 190, 192. A control unit is shown by reference 42 in [Fig. 14], said unit controlling the two drives 220, 222 in a targeted and synchronous manner, thus achieving the desired opposing movements of the drive elements 82, 84. It is also possible to achieve in this way a play-free or low-play deflection of the end effector 14. It will be understood that in addition to the two control lines 108, 110, the remaining control lines 100, 102, 104, 106, 108, 110, 112, 114 are respectively controlled with a separate drive. Eight drives are therefore provided with eight threaded spindles in the embodiment example in which there are a total of eight control lines 100, 102, 104, 106, 108, 110, 112, 114.The two drives associated with a respective 180° offset pair of the control lines 100, 102, 104, 106, 108, 110, 112, 114 are controlled in synchronization to pull the opposite control lines 100, 102, 104, 106, 108, 110, 112, 114 in the opposite direction in the proximal direction or to release or push them in the distal direction.

[0115] [Fig. 15] illustrates by means of a schematic representation an exemplary configuration of a medical system 300 for manipulating and guiding an instrument 10 according to the invention. The system 300 comprises a manipulation device 302 for stopping and guiding the instrument 10. The manipulation device 302 can also be referred to as a manipulator. The manipulation device 302 can, for example, be a surgical robot. The system 300 further comprises a control device 304 controlling the degrees of freedom of the manipulation device 302. The control device 304 can furthermore also be implemented, for example, to control the degrees of freedom of the instrument 10 in the sense of the present invention.

[0116] The present invention relates to an actuation unit 16 for a medical instrument 10 and to a medical instrument 10 equipped with a shaft 12 which extends between a proximal end 20 and a distal end 18, the instrument 10 being designed at the distal end 18 to receive an end effector 14, an actuation unit 16, 216 associated with the proximal end of the shaft 12 and having a plurality of drives 50, 52, 54, 56 and with at least two control lines 100, 102, 104, 106, 108, 110, 112, 114 extending through the shaft 12, the at least two control lines 100, 102, 104, 106, 108, 110, 112, 114 which can be used to control at least one degree of freedom of instrument, in particular to control the end effector organ 14, the at least two control lines 100, 102, 104, 106, 108, 110, 112, 114 comprising a first control line 100, 104, 108, 112 and a second control line 102, 106, 110,114 and the first control line 100, 104, 108, 112 being coupled to a first element, drive 70, 74, 78, 82 and the second control line 102, 106, 110, 114 being coupled to a second drive element 72, 76, 80, 84 on which a drive 50, 52, 54, 56 acts to produce a pushing movement or a pulling movement of the drive element 70, 72, 74, 76, 78, 80, 82, 84. It will be understood that the actuation unit according to at least one of the configurations described herein of the medical instrument can be improved and vice versa. It will be understood that the previously cited features as well as the features still to be explained hereinafter can be used not only according to the proposed combination but also in any other possible way without departing from the scope of the present invention.

Claims

Claims

1. A medical instrument having a shaft (12) extending between a proximal end (20) and a distal end (22), the instrument (10) being designed at the distal end (22) to receive an end effector (14), an actuating unit (16, 216) associated with the proximal end of the shaft (12) and having a plurality of drives (50, 52, 54, 56) and with at least two control lines (100, 102, 104, 106, 108, 110, 112, 114) extending through the shaft (12), the at least two control lines (100, 102, 104, 106, 108, 110, 112, 114) being usable for controlling at least one degree of freedom of instrument, in particular for controlling the end effector organ (14), the at least two control lines (100, 102, 104, 106, 108, 110, 112, 114) comprising a first control line (100, 104, 108, 112) and a second control line (102, 106, 110, 114) and the first control line (100, 104, 108,112) being coupled to a first drive element (70, 74, 78, 82) and the second control line (102, 106, 110, 114) being coupled to a second drive element (72, 76, 80, 84) on which a drive (50, 52, 54, 56) of the plurality of drives (50, 52, 54, 56) acts to produce a pushing movement or a pulling movement of the drive element (70, 72, 74, 76, 78, 80, 82, 84), the first and second control lines (100, 102; 104, 106; 108, 110; 112, 114) forming a pair associated with a degree of freedom of the instrument (10) ;, a single drive (50, 52, 54, 56) of the plurality of drives (50, 52, 54, 56) being associated with both control lines (100, 102; 104, 106; 108, 110; 112, 114) of a pair; each drive (50, 52, 54, 56) of the plurality of drives (50, 52, 54, 56) being embodied as a threaded actuation and comprising a spindle (60, 62, 64, 66), said spindle (60, 62, 64, 66) comprising two opposing threaded sections (190, 192), a first threaded section (190) interacting with the drive element (70, 74, 78, 82) of the first drive line (100, 104, 108, 112) and a second threaded section (192) interacting with the drive element (72, 76, 80, 84) of the second drive line (102, 106, 110, 114).

2. A medical instrument according to claim 1, two or more drives (50, 52, 54, 56) of the plurality of drives (50, 52, 54, 56) being oriented parallel to each other and two or more drives (50, 52, 54, 56) of the plurality of drives (50, 52, 54, 56) preferably being arranged distributed around the longitudinal axis (22), parallel to a longitudinal axis (22) of the rod (12).

3. A medical instrument according to claim 1 or 2, wherein the end effector (14) is deflectable relative to the shaft (12), a deflectable section (34) is provided, which section comprises at least one spherical element (130, 132, 134) with spherical surfaces and is disposed between a proximal sphere guide (142) and a distal sphere guide (136), and the at least two control lines (100, 102, 104, 106, 108, 110, 112, 114) are coupled at the distal sphere guide (136) for deflecting the end effector (14).

4. A medical instrument according to any one of claims 1 to 3, wherein the control lines (100, 102; 104, 106; 108, 110; 112, 114) of the pair are preferably alternately biased in the direction of traction by an associated drive (50, 52, 54, 56).

5. Medical instrument according to claim 4, the two control lines (100, 102; 104, 106; 108, 110; 112, 114) being preferably arranged offset by 180° from each other with respect to the rod (12) at least at the distal end (18).

6. A medical instrument according to claim 1, wherein the drive (50, 52, 54, 56) of the plurality of drives (50, 52, 54, 56) is drivable in a first rotational direction and in a second rotational direction and wherein the first control line (100, 104, 108, 112) is pulled in the proximal direction in the first rotational direction and the second control line (102, 106, 110, 114) of the pair is pulled in the proximal direction in the second rotational direction.

7. Medical instrument according to claim 1, several of the drives (50, 52, 54, 56) being designed as threaded actuators with two opposing threaded sections (190, 192), the drives (50, 52, 54, 56) of the plurality of drives (50, 52, 54, 56) each having a spindle (60, 62, 64, 66) and the spindles (60, 62, 64, 66) being preferably arranged distributed in a circular manner around the longitudinal axis (22).

8. A medical instrument according to claim 4, wherein an assigned drive (50, 52, 54, 56) of the plurality of drives (50, 52, 54, 56) is respectively associated with the two control lines of a pair and the two drives (50, 52, 54, 56) of the plurality of drives (50, 52, 54, 56) being able to be driven in a coordinated manner to alternately bias one of the two control lines in the direction of traction.

9. A medical instrument according to any one of claims 1 to 8 wherein at least one of the drive elements (70, 72, 74, 76, 78, 80, 82, 84) comprises a pivotable rolling bearing (166, 176) comprising a first ring (168, 178) and a second ring (170, 180) rotatable relative to each other and wherein the first ring (168, 178) is coupled to the control line (100, 102, 104, 106, 108, 110, 112, 114) and wherein the second ring (170, 180) is coupled to the drive (50, 52, 54, 56) of the plurality of drives (50, 52, 54, 56).

10. A medical instrument according to any one of claims 1 to 9, wherein the end effector member (14) is pivotable about a longitudinal axis (22) of the shaft (12) and wherein rotation of the end effector member (14) is preferably relative to the drives (50, 52, 54, 56) of the plurality of drives (50, 52, 54, 56).

11. A medical instrument according to claim 10, wherein a rotary drive (36) is provided for the rotary movement of the end effector member (14) and the rotary drive (36) comprises an output drive shaft (38) provided with a pinion (40) driving a wheel (42) coupled to the rod (12).

12. A medical instrument according to any one of claims 1 to 11, wherein an effector control line (88) is further provided for the end effector (14) and the effector control line (88) is biasable at least in the direction of pulling or pressing to open or close jaw portions (28, 30) of the end effector (14).

13. A medical instrument according to any one of claims 1 to 12, wherein a plurality of drives (50, 52, 54, 56) of the plurality of drives (50, 52, 54, 56) arranged along the longitudinal axis (22) at a common axial position are provided.

14. A medical instrument according to any one of claims 1 to 13, wherein the drive elements (70, 72, 74, 76, 78, 80, 82, 84) are arranged offset from each other along the longitudinal axis (22) and the drive elements (70, 72, 74, 76, 78, 80, 82, 84) have overhangs (86) with a threaded section (174,

15.

16.

17. 184) preferably oriented offset from each other around the longitudinal axis (22). A medical instrument according to claim 14, at least the relative orientation or relative position of the cantilevers (86) of the drive elements being constant as the end effector member (14) rotates (70, 72, 74, 76, 78, 80, 82, 84) about the longitudinal axis (22).A medical instrument according to any one of claims 1 to 15, comprising eight control lines (100, 102, 104, 106, 108, 110, 112, 114) forming four pairs, each pair comprising two control lines (100, 102; 104, 106; 108, 110; 112, 114) offset by 180° relative to each other with respect to a longitudinal axis (22) of the shaft (12) at least at the distal end (22), each of the eight control lines (100, 102, 104, 106, 108, 110, 112, 114) being coupled to a drive element (70, 72, 74, 76, 78, 80, 82, 84) and the two drive elements (70, 72; 74, 76; 78, 80; 82, 84) of a pair of control lines (100, 102; 104, 106; 108, 110; 112, 114) being coupled to a common drive (50; 52; 54; 56) of the plurality of drives (50, 52, 54, 56). Actuating unit for a medical instrument according to one of the preceding claims, in particular a medical instrument with a deflectable end effector, with a plurality of drives (50, 52, 54, 56), at least two control lines (100, 102, 104, 106, 108, 110, 112, 114) for controlling at least one instrument degree of freedom and with at least two drive elements (70, 72, 74, 76, 78, 80, 82, 84), comprising a first drive element (70, 74, 78, 82) and a second drive element (72, 76, 80, 84), the at least two control lines (100, 102, 104, 106, 108, 110, 112, 114) comprising a first control line (100, 104, 108, 112) and a second control line (102, 106, 110, 114) and the first control line (100, 104, 108, 112) being coupled to the first drive element (70, 74, 78, 82) and the second control line (102, 106, 110, 114) being coupled to the second drive element (72, 76, 80,84) on which a drive (50, 52, 54, 56) of the plurality of drives (50, 52, 54, 56) acts respectively, preferably in common, to produce a pushing movement or a pulling movement of the drive element (70, 72, 74, 76, 78, 80, 82, 84).,

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