Medical instrument and method of operating the medical instrument

Abstract

A medical instrument for processing structures of a human or animal body and a method for operating the same are proposed. The instrument (1, 31) comprises an elongate instrument shaft (9, 39) having a proximal end on which a manipulation device (6, 36) is arranged and a distal end on which an instrument head (5, 25, 35) is arranged. On or within the instrument shaft (9, 39) an image providing device (11, 41) is arranged having at least one image sensor and at least one objective lens (11b, 41a, 41b). The instrument head (5, 25, 29) and the image providing device (11, 41) are arranged on the instrument shaft (9, 39) in such a way that they are non-slidable in the longitudinal direction of the instrument shaft (9, 39). In this case, the objective lens (11b, 41a, 41b) and the tip of the instrument head (5, 25, 35) opposite the instrument shaft (9, 39) are permanently oriented relative to one another such that the image providing device (11, 41) always generates an image of this tip of the instrument head (5, 25, 35).

Description

[Technical field]

[0001] A medical device for processing human or animal body structures is proposed. [Background technology]

[0002] Medical instruments are introduced into the human or animal body for examination or treatment purposes. The examination or treatment is often carried out in a cavity or recess. This is particularly the case in minimally invasive surgery. In order to be able to see into the area where the medical instruments are inserted, endoscopes are often used. The endoscope has an endoscope shaft, in which an image providing system is arranged. The endoscope shaft is introduced into the human or animal body with its distal end. The endoscope is usually equipped with an illumination system, by means of which the structure to be examined or treated in the corresponding cavity can be illuminated. The light generated by the light source is usually guided to the distal end of the endoscope shaft via a light guide fiber. The image providing system is used to capture the information contained in the light reflected by the structure as an image. As an image sensor, an image converter chip, for example a CMOS or a CCD, is often used. The image sensor (also called image provider or image converter) converts the optical image into an electrical signal, which is then visually made visible on a screen or monitor. The imaging system may comprise one image sensor to generate a two-dimensional image of the structure to be processed. Alternatively, the imaging system may comprise two image sensors to generate a three-dimensional image of the structure to be processed. Endoscopes of this kind are also called 3D endoscopes or stereo endoscopes.

[0003] The endoscope may have a working channel into which a medical instrument is inserted, such as a grasping or cutting tool for obtaining tissue samples or resecting delicate soft tissue or cartilage, a cannula for injection, or a wire electrode for coagulation using electrical current. The working channel has an opening at the distal end of the endoscope shaft, from which the medical instrument is advanced with its instrument head. The medical instrument can be slid longitudinally within the working channel to draw the instrument into the cavity toward the structure to be machined. The imaging system allows the machining of the structure with the medical instrument to be performed under visual control within the body cavity. The instrument is then movable relative to the endoscope, so that the instrument can be oriented relative to the structure to be machined and relative to the field of view presented by the endoscope.

[0004] It has been found to be a disadvantage that the medical tool can be moved into the field of view of the image system of the endoscope in such a way that the view of the structure to be processed for the user is blocked. The user does not directly see in this case the section of the medical tool that comes into contact with the structure to be processed of the human or animal body. This makes processing considerably more difficult and even dangerous for humans or animals, since visual inspection is impossible or at least made difficult. Although the user can in principle orient the endoscope shaft with the imager on the one hand and the medical tool guided in the working channel of the endoscope on the other hand, at least temporarily, relative to one another in such a way that the view of the structure to be processed is open, this is associated with a considerable effort for the user. Moreover, this orientation cannot be maintained for a relatively long period of time during the use of the medical tool, since the medical tool is moved during the processing of the structure, whereby the orientation of the medical tool relative to the endoscope shaft and thus the image system changes. Summary of the Invention [Problem to be solved by the invention]

[0005] The problem underlying the present invention is to provide a medical instrument in which visual confirmation of the area to be processed, where the instrument comes into contact with the human or animal body, is guaranteed, even if the area to be processed is located in a cavity or a recess in the human or animal body that cannot be seen through. [Means for solving the problem]

[0006] The above problem is solved by a medical instrument with the features of claim 1. The instrument comprises an instrument head for contacting and processing structures of a human or animal body, an elongate instrument shaft with a proximal end and a distal end, the instrument head being arranged at the distal end, an operating device at the proximal end of the instrument shaft for operating the instrument, and an image-providing device arranged on the instrument shaft and having at least one image sensor and at least one objective lens. In this case, the instrument head and the image-providing device are arranged on the instrument shaft non-slidably in the longitudinal direction of the instrument shaft. The objective lens of the image-providing device and the tip of the instrument head facing away from the instrument shaft are permanently oriented relative to one another such that the image-providing device always generates an image of this tip of the instrument head. The section of the instrument head that interacts with the structure of the human or animal body at the location of the medical instrument and acts on this structure as desired thereby always remains within the field of view of the imaging device as the user moves the instrument to process the structure. The section of the structure on which the instrument acts during processing is also within the field of view of the imaging device. This eliminates the instrument shaft blocking the view to the structure to be processed.

[0007] The image-providing device has an optical axis. In particular, the objective lens has an optical axis. The optical axis extends from the objective lens towards the tool head as a geometric straight line. The image processing device is oriented relative to the tool head in such a way that the optical axis is permanently and invariably directed towards the section of the tool head where processing is performed. This means that the optical axis of the objective lens, which is formed as a geometric straight line, intersects the tool head. The image-providing device is thus permanently positioned and oriented in such a way that it always captures an image of at least the surface of the tool head that comes into contact with the structure of the human or animal body during processing and the periphery of this surface. The image taken by the image-providing device thus always and reliably shows the section of the tool head that comes into contact with the structure to be processed and its periphery. The periphery refers in this case to the structure to be processed, in particular insofar as the tool is brought close enough to the structure at the tool's place of use. The image providing device is in this case oriented such that the tool head does not block the view into the area where the tool head touches the structure, which section is usually located at the tip of the tool head, allowing the user to bring the tool close to the structure to be processed and carry out the processing of the structure under reliable visual confirmation, whereby the user has a permanent and reliable view of the area where the tool touches the human or animal body thanks to the image providing device.

[0008] The image providing device is adjusted only once to image the critical sections of the tool head. This adjustment is already performed during the manufacture of the tool. This adjustment is subsequently maintained and is no longer changed. User adjustments or settings are omitted. The image generated by the image providing device always shows the surfaces of the tool head that are designed to come into contact with the structures of the human or animal body during processing, regardless of the position and orientation of the medical tool and regardless of the place and user of the tool.

[0009] The instrument head is specially designed for processing and has, for example, one or two cutters or blades, staples, gripping tools, cannulas or wire electrodes. Processing includes holding, grasping, clamping, separating or cutting structures or grouping together several structures. If the instrument head is designed, for example, as a gripping tool, this gripping tool must be opened and closed during processing. For this purpose, the gripping tool has, for example, a gripping jaw or a blade. One or two gripping jaws or blades are movably arranged on the instrument head, so that the medical instrument designed as a gripping tool can be opened and closed. Each gripping jaw or each blade is part of a lever. Both levers are movably connected to each other via a hinge. To open and close the instrument, both gripping jaws or blades can be moved. Alternatively, one gripping jaw can be rigidly connected to the instrument head and only the second gripping jaw can be movably attached to the instrument head.

[0010] The instrument shaft and the handling device are used to guide the instrument head to the place of use and to move it there so that the desired processing of the structure is performed, including moving the instrument head closer to or farther from the structure to be processed and, insofar as the specific processing requires, moving the instrument head during processing. If the instrument comprises at least one member movably attached to the instrument head, as is the case for example with forceps, the handling device is further used to move this member relative to the instrument shaft. The handling device may, for example, comprise at least one handle part, which may be moved manually or by a manipulator.

[0011] The image is transmitted from the image providing device to the data processing device by signal lines or wirelessly and is finally provided to the image output device, which may be, for example, a visualization device, in particular a monitor or VR goggles.

[0012] The medical instrument may be combined with an endoscope. For this purpose, the medical instrument may be introduced into the working channel of the endoscope. In this case, images are generated by an image-providing device of the medical instrument and by an image-providing device of the endoscope. This may be meaningful when, by means of the endoscope, the structure to be processed by the medical instrument and its surroundings are first visualized, and then the processing of the structure is carried out by the medical instrument. The image-providing device of the endoscope allows an overview of the entire structure and its surroundings, whereas the image-providing device of the medical instrument aims and generates images only of the sections of the instrument and the parts of the structure that interact with each other during processing.

[0013] Alternatively, the medical instrument may be used without an endoscope, in which case it is sufficient for the imaging device of the instrument to convey a visual impression of the location of use to the user, and the second imaging device may be omitted. The medical instrument may be introduced into a cavity of the human or animal body by a trocar.

[0014] The medical instrument may be directly guided by a doctor or medical personnel, for which purpose the operating device of the medical instrument is manually operated by said person.

[0015] Alternatively, the medical instrument may be used in a robot-assisted surgical system, whereby guidance of the medical instrument is performed by a manipulator, which is connected to a handling device of the medical instrument, the control of which may in this case be performed on the basis of image data acquired by an image providing device arranged on the instrument.

[0016] According to an advantageous configuration of the invention, the instrument head is bent or curved in at least some sections with respect to the longitudinal axis of the instrument shaft, so that it is directed towards the objective lens, which ensures that an image of the instrument shaft is input to the image providing device.

[0017] According to another advantageous configuration of the invention, the objective lens and the image sensor are arranged on an image provider holding device which is attached to the instrument shaft and directs the objective lens towards the tip of the instrument head opposite the instrument shaft.

[0018] According to another advantageous embodiment of the invention, the instrument shaft is fitted with lighting for illuminating the instrument head. For this purpose, for example, a light source can be arranged in the instrument shaft. The light source can be arranged at the distal end of the instrument shaft, or at the proximal end of the instrument shaft, or between the distal and proximal ends of the instrument shaft. If the light source is arranged at a distance from the distal end of the instrument shaft, the light of the light source can be guided via a light guide to the distal end of the instrument shaft. At the distal end of the instrument shaft, the light is emitted towards the instrument head. Light-emitting diodes are particularly suitable as light sources. The energy supply of the light source is preferably carried out via an energy source which also supplies the image providing device.

[0019] According to a further advantageous configuration of the invention, the light source is arranged in the device in a rigid and positionally fixed manner, so that the light source, like the image providing device, does not change its orientation and its position in the device.

[0020] According to another advantageous embodiment of the invention, at least one irrigation channel is arranged in the instrument shaft. Through the irrigation channel, a irrigation medium flows out at the distal end of the instrument shaft. The irrigation medium can then be appropriately discharged again. For this purpose, a second irrigation channel can also be provided. When the structure to be examined is, for example, bleeding, the view to the structure to be processed at the point of use of the medical instrument is improved by irrigation with the irrigation medium.

[0021] According to another advantageous configuration of the invention, the image sensor is designed to convert the optical image into an electrical signal. In this case, the image sensor can be, for example, a semiconductor element, in particular a CCD or CMOS. The image providing device has an electrical signal line, which supplies the electrical signal to a data processing device and / or an image output device. The data processing device processes the electrical signal in this case in such a way that the electrical signal can be displayed by a visualization device and that a user gets an impression of the location of use of the medical instrument on the basis of the image output device formed as a visualization device and the image displayed there. When the image output device is a visualization device, the visualization device can be, for example, a monitor or VR goggles.

[0022] According to a further advantageous configuration of the invention, the signal line is arranged in an instrument shaft of the medical instrument.

[0023] According to another advantageous configuration of the invention, the instrument shaft comprises a longitudinally extending channel, which has a first opening at the proximal end of the instrument shaft and a second opening at the distal end. Through the first opening, the image-providing device is introduced into the channel and advanced to the distal end of the instrument shaft. At the distal end of the instrument shaft, the channel has a second light-transmitting opening. Furthermore, the instrument shaft comprises a locking device, which locks the image-providing device arranged in the channel and immovably connects it to the instrument shaft. By releasing the locking device, the image-providing device can be separated from the instrument and removed therefrom. The image-providing device can thus be inserted, for example, into various instruments. In order to operate several different medical instruments, only one image-providing device is thus needed. Furthermore, the image-providing device can be separated from the medical instrument in order to sterilize the medical instrument and reuse it. Sterilization of the instrument is carried out in this case without the image-providing device. This applies to reusable or multi-use medical instruments. Alternatively, the medical instrument may be configured for single use, while the image-providing device is reusable, again, it may be advantageous if the image-providing device can be removed from the medical instrument.

[0024] According to another advantageous embodiment of the invention, the image providing device has an interface, via which the image data is output wirelessly to the data processing device, whereby wired signal lines can be omitted, which facilitates handling of the medical instrument. The data processing device processes the data generated by the image providing device and displays it for the user on the visualization device.

[0025] According to another advantageous embodiment of the invention, the medical device comprises an energy accumulator, which can be configured as a primary or secondary battery. A cable for the current supply of the image providing device can then be omitted. This facilitates handling of the medical device at the place of use.

[0026] According to another advantageous configuration of the invention, the image providing device is configured as a stereo image providing device (also called 3D image providing device). A suitable visualization device can provide the user with a three-dimensional image of the tool head and its surroundings. The user can then more easily determine the position of the tool at the point of use and determine the distance between the tool head and the structure to be processed. This applies both qualitatively with respect to the reference point and quantitatively, insofar as the image providing device is appropriately calibrated. In this case, a special visualization device is required, which displays the image data for the left eye and the image data for the right eye separately from each other.

[0027] According to another advantageous configuration of the invention, the device for providing 3D images comprises a left image sensor and a right image sensor, whereby two images are generated, which are combined in the visualization device into one three-dimensional image. Alternatively, one image sensor may be used with a first number of pixels for the left image and a second number of pixels for the right image.

[0028] According to another advantageous embodiment of the invention, the focal point of the image-providing device is set in such a way that the tip of the instrument head facing away from the instrument shaft is in the focal point of the image-providing device. The focal point is set by an objective lens and possibly an additional lens of the image-providing device. The focal point of the objective lens is selected so as to be adapted to the distance between the objective lens and the tip of the instrument head.

[0029] According to another advantageous embodiment of the invention, the instrument is configured as a cutting tool. The instrument may in particular be configured as a scalpel. Furthermore, the instrument may be configured as scissors. Alternatively, the instrument may be configured as a shaver. Shavers are used to cut delicate soft tissue or cartilage and are primarily used in arthroscopy.

[0030] According to a further advantageous embodiment of the invention, the instrument is configured as a gripping tool, and can thus be, for example, a forceps or, moreover, a tweezers.

[0031] According to a further advantageous embodiment of the invention, the instrument is configured as a holding tool and can thus comprise, for example, a staple.

[0032] According to another advantageous embodiment of the invention, the instrument is configured as a trocar, by means of which access is made, either sharply or bluntly, to a body cavity, for example the abdominal or thoracic cavity, which is kept open by a tube. An image providing device provided on the trocar facilitates positioning at the point of use.

[0033] According to a further advantageous embodiment of the invention, the device is configured as a cannula.

[0034] According to a further advantageous configuration of the invention, the instrument comprises at least one wire electrode for coagulation by means of an electric current.

[0035] According to another advantageous embodiment of the invention, the instrument is designed for single use, so that after use it can be discarded and does not have to be sterilized for further use.

[0036] According to a further advantageous embodiment of the invention, the instrument is reusable. The instrument is designed so that it can be sterilized. In particular, the instrument is suitable for treating the instrument in an autoclave.

[0037] According to another advantageous configuration of the invention, the medical instrument comprises a shade, which hides the instrument shaft and / or the section of the instrument head facing the instrument shaft from the image taken by the image providing device, so that the visual impression of the user from the shown image is not marred by the instrument shaft or the section of the instrument head facing the instrument shaft.

[0038] According to the method for operating a medical instrument according to the invention, the image generated by the image providing device is processed so as to be visible on the image output device, in such a way that the section of the instrument shaft and / or the instrument head facing the instrument shaft is erased in the image displayed on the image output device. The section of the instrument shaft or the instrument head facing the instrument shaft is thereby not visible in the image displayed by the image output device. The attention of the user is therefore not directed to the section of the instrument shaft or the instrument head directly connected to the instrument shaft, but only to the distal tip of the instrument head facing away from the instrument shaft, which interacts with the structure to be processed and processes the structure accordingly.

[0039] Further advantages and advantageous configurations can be seen from the claims.

[0040] The drawings show an embodiment of the subject matter of the invention. [Brief description of the drawings]

[0041] [Figure 1]FIG. 1 is a perspective view of a first embodiment of a medical instrument. [Diagram 2] 2 shows the proximal end of the instrument shaft and operating device of the instrument shown in FIG. 1. [Diagram 3] 2 shows the distal end of the instrument shaft and instrument head of the instrument shown in FIG. 1. [Figure 4] FIG. 2 shows an image of the instrument head of the instrument shown in FIG. 1 produced by an image providing device and shown on a visualization device. [Diagram 5] FIG. 5 is a view of the image shown in FIG. 4 with the instrument head partially obscured. [Figure 6] FIG. 2 shows an image of an instrument head of a second embodiment of a medical instrument, generated by an image providing device and shown on a visualization device. [Figure 7] FIG. 7 is a view of the image shown in FIG. 6 with the instrument head partially obscured. [Figure 8] FIG. 13 is a perspective view of a third embodiment of a medical instrument. [Figure 9] 9 is a diagram showing the proximal end of the instrument shaft and the operating device of the instrument shown in FIG. 8 when the image-providing device is received and locked within the instrument shaft. FIG. [Figure 10] FIG. 10 illustrates the proximal end of the instrument shaft shown in FIG. 9 with the image-providing device unlocked and partially separated from the instrument shaft. [Figure 11] 9 is a top view of the instrument head and distal end of the instrument shaft of the medical instrument shown in FIG. 8. [Figure 12] 9 is a perspective view of the instrument head and distal end of the instrument shaft of the medical instrument shown in FIG. 8. [Figure 13] 9 is a front view of the instrument head and distal end of the instrument shaft of the medical instrument shown in FIG. 8. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0042] 1 to 5 show a first embodiment of a medical instrument 1. The instrument is a forceps, which is formed as a bifurcated tool and has two gripping jaws 2, 3. The gripping jaws 2, 3 are formed as levers. They have serrated surfaces on opposite sides. The gripping jaws are connected to one another via a hinge 4 and arranged on an instrument head 5. The instrument 1 comprises an elongated instrument shaft 9. At a first end, called the distal end, the instrument head 5 is arranged on the instrument shaft 9. At a second end, called the proximal end, of the instrument shaft two ring-shaped handle parts 7, 8 are arranged. These handle parts 6, 7 are components of an operating device 6, by means of which the medical instrument 1 can be manually controlled. In this case the first handle part 7 is movably connected to the instrument shaft 9 via a hinge. The second handle part 8 is rigidly connected to the instrument shaft 9. Through the movement of the two handle parts 7, 8, the two gripping jaws 2, 3 are moved. The gripping jaws 2, 3 and the handle parts 7, 8 each have an open position and a closed position. The movement of the handle parts 7, 8 is transmitted to the gripping jaws 2, 3 via a mechanism, which is partly present in the instrument shaft 9. The gripping jaws 2, 3, the hinge 4 and the members of the mechanism 10 are attached to the instrument head 5. An image-providing device 11 and a light 12 are furthermore arranged in a fixed position on the instrument shaft 9. The image-providing device 11 comprises an image sensor and an objective lens 11b, which are arranged in the image-providing housing 11a. The image sensor is in this case completely surrounded by the image-providing housing 11a, so that the image sensor is not visible from the outside and is therefore not shown in the drawings. The objective lens 11b is present in an opening window of the image-providing housing 11a. In the illustration shown in Fig. 3, the observer looks towards this aperture window with the objective lens 11b. The image providing device 11 and the illumination 12 are in this case arranged and adjusted on the instrument shaft 9 such that the objective lens 11b and the illumination are permanently directed towards the opposite ends of the gripping jaws 2, 3 of the instrument head 5 from the instrument shaft 5.The image providing device thereby captures images of both gripping jaws 2, 3 in the open position of the gripping jaws 2, 3, in the closed position of the gripping jaws 2, 3, and in all positions between the open and closed positions of the gripping jaws 2, 3. When a structure, e.g. tissue, is sampled by both gripping jaws 2, 3 of the instrument head 5, this structure is also visible in the images taken by the image providing device.

[0043] The objective lens 11b has an optical axis 11c, which extends towards the gripping jaws 2,3 as a geometric straight line. The instrument head 5 has a curvature towards this optical axis 11c. For this purpose, the gripping jaws 2,3 are curved. The optical axis 11c intersects both gripping jaws 2,3 at their ends facing away from the instrument shaft 9, which are also called the distal ends of both gripping jaws 2,3. This allows in particular an optical capture of the distal ends of both gripping jaws 2,3.

[0044] The image-providing device 11 has an image sensor, which converts the optical signal into an electrical signal. The instrument shaft 9 comprises a channel 13, in which run the electrical signal lines of the image-providing device 11 and the supply lines for the illumination 12. The signal lines and the supply lines are grouped in a cable 14, which has a cable housing 14a at its proximal end. This cable 14 can be connected to a visualization device, on which the image generated by the image-providing device 11 is shown. The visualization device is not shown in the drawings.

[0045] 4 shows an image 15 produced by the image-providing device 11 of both gripping jaws 2, 3 in the open position. This image produced by the image-providing device 11 is displayed on a visualization device, not shown in the drawings. In the image 15, the section of the instrument head 5 on which the gripping jaws 2, 3 are movably mounted is also visible.

[0046] When the user approaches the tool 1 to a structure at the place of use of the tool 1, first opens both gripping jaws 2, 3 this time, takes at least a partial section of the structure and closes the gripping jaws 2, 3 again afterwards, the gripping jaws 2, 3 and the structure arranged in the gripping jaws are always visible to the user by the image providing device 11. Since the positions of the hinges 4 of the gripping jaws 2, 3 and the image providing device 11 are fixedly predetermined and do not change during the operation of the tool, the processing area of ​​both gripping jaws can always and permanently be viewed by the image providing device. The view shown in the image 15 is not blocked by parts of the tool or by the image providing device.

[0047] 5 shows another image 16 generated by the image providing device of the grasping jaws 2, 3 of the medical instrument. In this image 16, the section of the instrument head 5 facing the instrument shaft has been erased. To this end, an area 23 has been cut out from the image 16. This is done by image processing. The erasure of the instrument head makes the user's work easier, since the user is less distracted by the section of the instrument head 5 facing the instrument shaft.

[0048] In figures 6 and 7, images 17, 18 of a second embodiment of a medical tool are shown. These images 17, 18 were generated by an image providing device arranged on the second embodiment of the medical tool according to the images 15, 16. The medical tool is a shaver for cutting delicate soft tissue or cartilage. The shaver has a housing 19 with an opening 20 in an instrument head 25. A blade 21 is arranged rotatably in the housing 19. The medical tool with the shaver can be designed corresponding to the first embodiment of the medical tool in figures 1 to 5, except for the housing 19 with the opening 20 and the blade 21. The housing 19 and the blade 21 are arranged on the instrument head 25, which is partially visible in the image 17 shown in figure 6. In the image 18 shown in figure 7, a section of the instrument head 25 facing the instrument shaft has been erased. For this purpose, the section 24 has been cut out of the image 18 by image processing.

[0049] 8 to 13 show a third embodiment of a medical instrument 31. The medical instrument 31 is a spoon forceps. The medical instrument 31 comprises two gripping jaws 32, 33 which are formed as levers and are arranged on an instrument head 35 so as to be pivotable about a hinge 34. Both gripping jaws 32, 33 are part of the instrument head 35. Both gripping jaws 32, 33 are curved towards the optical axis 41c of the image providing device 41. In this case, the optical axis 41c is a geometric straight line.

[0050] In contrast to the first embodiment shown in Figures 1 to 5, the two gripping jaws of the medical instrument 31 shown in Figures 8 to 13 each have a recess on opposite sides. The medical instrument 31 according to the third embodiment, which corresponds to the first embodiment, comprises an elongated instrument shaft 39, at the distal end of which an instrument head 35 is arranged and at the proximal end of which an operating device 36 with two handle parts 37, 38 is arranged. In this case, the gripping jaws 32, 33 are moved by the handle parts 37, 38. In contrast to the medical instrument 1 shown in Figures 1 to 5, in the case of the medical instrument 31 shown in Figures 8 to 13, the image-providing device 41 is removably accommodated in the instrument shaft 39. For this purpose, the instrument shaft 39 has a channel 43, which has an opening at the distal end of the channel 43 and at the proximal end of the channel 43. A locking device 45 with a locking pin 46 is arranged in the opening at the proximal end. The image-providing device 41 has a signal line, which is accommodated in a cable 44 with a cable housing 44a. The image-providing device 41 is inserted with this cable 44 into the channel of the instrument shaft 39 and advanced towards the distal end of the instrument shaft 39 until the objectives 41a, 41b are in a predetermined end position of the objectives 41a, 41b at the distal end of the instrument shaft 39. As soon as this end position is reached, the image-providing device 41 is locked to the instrument shaft 39. For this purpose, the locking pin 46 is moved into its locking position in the locking device 45. In this locking position, the locking pin 46 engages in an engagement part on the cable housing 44a. This prevents the image-providing device 41 from moving in the longitudinal direction of the instrument shaft 39. Figures 8 and 9 show the image-providing device 41 in its locked end position within the instrument shaft 39. Figure 10 shows the image-providing device 41 in an unlocked position and partially withdrawn from the instrument shaft 39.

[0051] A further difference between the first and third embodiment is that the medical instrument 31 shown in Figures 8 to 13 comprises irrigation channels 47, 48. The irrigation channels 47, 48 have tubes 49, 50, 51 at the proximal end of the instrument shaft 39 and openings 52, 53 at the distal end of the instrument shaft 39. Lines can be connected to the tubes 49, 50, 51, which are not shown in the drawings. They are used for the supply and discharge of an irrigation medium, which flows out through one opening 52 and is aspirated through the other opening 53.

[0052] A further difference between the first and third embodiment is that the image providing device 41 of the medical instrument 31 shown in Figs. 8 to 13 is a 3D image providing device. The image providing device 41 has a left image channel and a right image channel. Each image channel is assigned to one objective lens 41a, 41b and one image sensor. The image sensors are arranged in the instrument shaft 39 and therefore not visible in the drawings. The image providing device further comprises an illumination 42. Each objective lens 41a, 41b is assigned to one optical axis 41c, which corresponds to a geometric straight line. The optical axes 41c of both objective lenses 41a, 41b may be parallel to each other or may be oriented with an angle different from 0° to each other. In the case of the medical instrument 31, the optical axes are parallel to each other. In the representation shown in Fig. 12, only one of the two optical axes 41c is visible. The other optical axis is hidden from view in this illustration, since it exists behind optical axis 41c.

[0053] The images generated by the image providing device 41 must be rendered by a visualization device that allows three-dimensional rendering. For this purpose, the image of the left image channel must be rendered for the user's left eye and the image of the right image channel must be rendered for the right eye.

[0054] All features of the invention may be essential to the invention either alone or in any combination with one another. [Explanation of symbols]

[0055] 1. Medical equipment 2 Grasping Jaws 3 Grasping Jaw 4 Hinge 5. Instrument Head 6 Operating device 7 Handle part 8 Handle part 9 Instrument Shaft 10 Mechanism 11 Image providing device 11a Image provided by Housing 11b Objective lens 11c Optical axis of image providing device 12. Lighting 13 Channels 14 Cable 14a Cable housing 15 images 16 images 17 images 18 images 19 Housing 20 aperture 21 blades 23 Areas cropped from an image 24 Areas cropped from an image 25 Instrument Head 31 Medical equipment 32 Grasping Jaw 33 Grasping Jaw 34 Hinge 35 Instrument Head 36 Operating device 37 Handle part 38 Handle part 39 Instrument shaft 41 Image providing device 41a Objective lens 41b Objective lens 41c Geometric Axis 42 Lighting 43 Channels 44 Cable 44a Cable housing 45 Locking device 46 Lock pin 47 Washing Channel 48 Washing Channel 49 Body 50 Body 51 Body 52 Aperture 53 Aperture

Claims

1. A medical instrument for manipulating a structure of a human or animal body, said manipulating comprising holding, grasping, clamping, separating or cutting said structure, or bringing together a plurality of structures; an instrument head (5, 25, 35) configured for contacting and processing the structure of the human or animal body; an elongate instrument shaft (9, 39) having a proximal end and a distal end, said instrument head (5, 25, 35) being disposed at said distal end; at least one operating device (6, 36) disposed at the proximal end of the instrument shaft (9, 39) and configured to operate the instrument (1, 31); an image providing device (11, 41) arranged on or within the instrument shaft (9, 39), the image providing device (11, 41) comprising at least one image sensor and at least one objective lens (11b, 41a, 41b); Equipped with The instrument head (5, 25, 29) and the image providing device (11, 41) are arranged on the instrument shaft (9, 39) so as not to be slidable in the longitudinal direction of the instrument shaft (9, 39); and the objective lens (11b, 41a, 41b) and the tip of the instrument head (5, 25, 35) opposite the instrument shaft (9, 39) are permanently oriented relative to one another such that the image providing device (11, 41) always generates an image of this tip of the instrument head (5, 25, 35), Medical equipment.

2. 2. The medical instrument according to claim 1, wherein the instrument head (5, 25, 35) is curved or bent in at least some sections with respect to the longitudinal axis of the instrument shaft (9, 39) and is then directed towards the objective lens (11b, 41a, 41b).

3. 3. The medical instrument according to claim 1, wherein the objective lens (11b, 41a, 41b) and the image sensor are arranged on an image provider holding device, the image provider holding device being attached to the instrument shaft (9, 39), and wherein the objective lens (11b, 41a, 41b) is oriented towards the tip of the instrument head (5, 25, 35) on the side opposite the instrument shaft (9, 39).

4. 3. Medical instrument according to claim 1 or 2, characterized in that the instrument shaft (9, 39) is fitted with a light (12, 42) for illuminating the instrument head (5, 25, 35).

5. 3. Medical instrument according to claim 1 or 2, characterized in that at least one irrigation channel (47, 48) is arranged in the instrument shaft (9, 39).

6. 3. The medical instrument according to claim 1 or 2, characterized in that the image sensor is configured to convert an optical image into an electrical signal, and the image providing device (11, 41) comprises an electrical signal line, which supplies the electrical signal to a data processing device and / or an image output device.

7. 7. Medical instrument according to claim 6, characterized in that the signal line is housed within the instrument shaft (9, 39).

8. the instrument shaft (9, 39) comprises a longitudinally extending channel (13, 43) having a first opening at the proximal end of the instrument shaft (9, 39) through which the imaging device (11, 41) is introduced into the channel (13, 43) and advanced to the distal end of the instrument shaft (9, 39), the channel (13, 43) having a light-transmitting second opening (52, 53) at the distal end of the instrument shaft (9, 39); the instrument shaft (9, 39) is provided with a locking device (45), which locks the image-providing device (11, 41) disposed in the channel (13, 43) and immovably couples it to the instrument shaft (9, 39); 3. The medical device according to claim 1 or 2.

9. 3. Medical instrument according to claim 1 or 2, characterized in that the imaging device (41) is formed as a 3D imaging device.

10. 3. A medical instrument according to claim 1 or 2, characterized in that it comprises a shade, which hides the instrument shaft (9, 39) and / or a section of the instrument head (5, 25, 35) facing the instrument shaft (9, 39) from the image taken by the image providing device (11, 41).

11. 3. A medical instrument according to claim 1 or 2, characterized in that it is formed as a scalpel.

12. 3. Medical device according to claim 1 or 2, characterized in that it is designed as a shaver (19, 20, 21).

13. 3. Medical instrument according to claim 1 or 2, characterized in that it is designed as forceps (1, 31).

14. 3. Medical instrument according to claim 1 or 2, characterized in that it is formed as scissors.

15. 3. The medical device according to claim 1 or 2, characterized in that it is formed as a staple.

16. 3. Medical instrument according to claim 1 or 2, characterized in that it is formed as tweezers.

17. 3. The medical device according to claim 1, wherein the medical device is configured as a trocar.

18. 3. A medical device according to claim 1 or 2, characterized in that it comprises at least one wire electrode.

19. 3. A method for operating a medical instrument according to claim 1 or 2, characterized in that the image (16, 18) generated by the image providing device (11, 41) is processed so as to be visible on an image output device and the image (16, 18) is processed in such a way that sections of the instrument shaft (9, 39) and / or the instrument head (5, 25, 35) on the side of the instrument shaft (9, 39) are obscured in the image (16, 18) displayed on the image output device.

Images