Targeting device for guiding a hollow needle to a target in an endoscopic surgical procedure - Patents.com

Abstract

The present disclosure relates to a targeting device 9 for guiding a hollow needle 17 to a target in an endoscopic surgical procedure. The targeting device 9 is fastened or fastenable to an endoscopy unit 1 that extends essentially in an endoscopy longitudinal axis L and defines a field of view 11. The targeting device 9 defines a plurality of hollow needle guides 21, each of which extends toward the field of view 11 along a separate polar angle θ relative to the endoscope longitudinal axis L, and each of the hollow needle guides 21 is open toward two azimuthal sides over its entire length.

Description

[Technical field]

[0001] The present disclosure relates to a targeting device for guiding a hollow needle to a target in an endoscopic surgical procedure, and an endoscopy system including such a targeting device, particularly for minimally invasive spinal surgery. [Background technology]

[0002] Endoscopy systems for minimally invasive spinal endoscopy already exist. For example, US Pat. No. 5,399,433 describes an endoscopy unit for minimally invasive endoscopic spinal endoscopy in the form of an endoscope and shaft system with an access tube and an endoscope insertable in the access tube. This is usually used to perform decompression in the cervical, thoracic or lumbar spine, for example in the case of herniated discs, spinal cysts or spinal stenosis. The endoscopic longitudinal axis can then pass, for example, through the intervertebral foramen, extraforaminal or intervertebral space.

[0003] A problem with known solutions is that the access shaft provides limited space and only provides access between the vertebral bodies from one direction, however, in certain surgical procedures it is advantageous or even necessary to have to provide a second access to the intervertebral space from another direction in addition to the access to the intervertebral space provided by the endoscopy unit.

[0004] In this case, the second access may be to pierce the hollow needle from another angle to place the guidewire inside. After guidewire placement is complete, the hollow needle can be withdrawn proximally from the guidewire and a rigid or flexible working sleeve can be pushed distally over the guidewire. Multiple working sleeves can also be pushed one on top of the other in succession to obtain the required access cross section. Once the required access cross section is achieved, the guidewire and possibly an inner working sleeve can be withdrawn proximally from the outermost working sleeve.

[0005] However, the problem is the correct alignment and placement of the hollow needle to accurately hit the desired target area. So far, this has been done under X-ray and / or ultrasound control by highly skilled surgically trained personnel. However, there is always a risk that the hollow needle puncture will not be optimally determined on the first attempt and may have to be redefined by one or more further attempts. [Prior art documents] [Patent documents]

[0006] [Patent Document 1] European Patent No. 2135542 Summary of the Invention [Problem to be solved by the invention]

[0007] Therefore, the challenge is to simplify the insertion of the hollow needle while reducing the risk of accidental insertion. [Means for solving the problem]

[0008] According to a first aspect of the present disclosure, to solve this problem, there is provided a targeting device for guiding a hollow needle of a certain length to a target in an endoscopic surgical procedure, the targeting device extending essentially in an endoscopy longitudinal axis and fastened or fastenable to an endoscopy unit defining a field of view, the targeting device defining a plurality of hollow needle guides, each of which extends toward the field of view along a separate polar angle relative to the endoscope longitudinal axis, and each of the hollow needle guides is open toward two azimuthal angles over its entire length.

[0009] The field of view can be defined as a focal plane in the object space distally ahead of the endoscopy unit and observable by the endoscope of the endoscopy unit. For the understanding of the present disclosure, it is useful to define a local spherical coordinate system of the endoscopy system consisting of the endoscopy unit and the targeting device attached thereto. Here, the center point of the spherical coordinate system can be defined as the center point of the field of view located distally ahead of the endoscopy unit. Correspondingly, the endoscopic longitudinal axis can be defined as the polar axis z. For example, when performing a translaminar surgical procedure on the spine of a prone patient, the endoscopic longitudinal axis, i.e. the polar axis, preferably extends vertically. The hollow needle guides can be arranged meridianally side by side and extend radially towards the field of view at a polar angle corresponding to each hollow needle guide. The hollow needle guides preferably extend as accurately as possible towards the center point or inner area of ​​the field of view. However, in principle, it is sufficient that the hollow needles guided in the respective hollow needle guides hit the field of view with such accuracy that the distal tip of the hollow needle can be observed by the endoscope of the endoscopy unit.

[0010] The targeting device therefore ensures that the distal tip of the hollow needle always reaches within the field of view of the endoscope, regardless of which of the alternatively available hollow needle guides is selected, where it can be finally positioned visually by the endoscope. X-ray and / or ultrasound control for the placement of the hollow needle can therefore be omitted, essentially simplifying the surgical procedure. The hollow needle guides reduce the risk of mis-sticking, since the only degrees of freedom remaining apart from the choice of hollow needle guide are the penetration depth of the hollow needle and the azimuthal rotation position of the targeting device. The azimuthal rotation position of the targeting device extends transversely to the spinal longitudinal axis (which extends horizontally in the case of a prone patient) and is adapted to selectively penetrate between the vertebral bodies from the diagonal left or diagonal right. The targeting device preferably also determines the penetration depth of hollow needles having a defined length by defined stops in each hollow needle guide, such that the selection of the azimuthal rotation position of the targeting device leaves the choice of hollow needle guide as the only degree of freedom remaining. The choice of hollow needle guide determines the polar angle of the puncture relative to the longitudinal axis of the endoscope.

[0011] After final placement of the guidewire within the hollow needle, the hollow needle can be withdrawn proximally from the patient and the target device, where the guidewire remains positioned within the patient, or even the operator holds the portion of the guidewire proximally protruding from the hollow needle by hand. The guidewire is preferably much longer than the hollow needle. Due to each of the hollow needle guides being open in two azimuth directions over its entire length, the guidewire can be easily withdrawn laterally from the target device and / or the target device can be rotated in an azimuth direction so that the guidewire slides out laterally from the hollow needle guide. Thus, the relatively long guidewire does not have to be curved more strongly distally and laboriously withdrawn from the hollow needle guide. Thus, the feature of each of the hollow needle guides being open in two azimuth directions over its entire length should be understood to allow the guidewire within the hollow needle guide to be withdrawn laterally from the hollow needle guide after the hollow needle has been withdrawn proximally from the hollow needle guide. To guide the hollow needles, the hollow needle guides do not open wide enough to allow the hollow needles themselves to be withdrawn laterally. The hollow needles can only be withdrawn from the hollow needle guides in a proximal direction. Each of the hollow needle guides has an inner diameter for axially receiving the hollow needles and at its open azimuthal side has an open slot having an inner slot width, the inner slot width being preferably smaller than the inner diameter of the hollow needle guide. That is, the inner slot width is preferably smaller than the outer diameter of the hollow needle but larger than the outer diameter of the guide wire that is within the hollow needle. The inner slot width is preferably smaller than the outer diameter of the hollow needle but at least as large as the inner diameter of the hollow needle.

[0012] First, after the guidewire placement with the hollow needle is completed, the hollow needle is withdrawn proximally from the selected hollow needle guide, after which the targeting device is no longer needed and can be pivoted azimuthally away and / or removed from the endoscopy unit. A rigid or flexible working sleeve can then be pushed distally over the guidewire into the patient in a known manner. Also, multiple working sleeves can be pushed one on top of the other in succession to obtain the required access cross section. Once the required access cross section is achieved, the guidewire and possibly the inner working sleeve can be withdrawn proximally from the outermost working sleeve.

[0013] Optionally, each hollow needle guide may comprise a proximal guide end and a distal guide end, the proximal guide ends of the hollow needle guides having essentially the same distance from the visual field. This allows hollow needles with a defined length to be used in any hollow needle guide. Alternatively, each hollow needle guide or group of hollow needle guides may be given a corresponding length of hollow needles to be used therein. However, each hollow needle guide is preferably designed to be usable with hollow needles with a defined length, i.e. the proximal guide ends of the hollow needle guides are arranged in an imaginary sphere around the visual field, the imaginary sphere having a radius corresponding to the length of the hollow needle. Therefore, the targeting device is preferably designed to match the hollow needle length.

[0014] Optionally, it may be true that for each of the pairs of hollow needle guides arbitrarily selected, the distal guide end of the first hollow needle guide of the pair extends along a first polar angle and has a first distance from the field of view, and the distal guide end of the second hollow needle guide of the pair extends along a second polar angle and has a second distance from the field of view, the first polar angle being smaller than the second polar angle and the first distance being smaller than the second distance. The hollow needle guide having a larger distance to the endoscope longitudinal axis can be configured shorter than the hollow needle guide having a smaller distance to the endoscope longitudinal axis. This is particularly useful for keeping the tilting moment exerted by the weight of the targeting device and the hollow needle as small as possible, for example when the endoscope longitudinal axis is aligned vertically from above on the spine of a prone patient during a translaminar surgical procedure. The weight of the targeting device should therefore be kept as small as possible, especially in the area far from the endoscope longitudinal axis.

[0015] Optionally, the proximal guide ends of the hollow needle guides can be funneled proximally to form respective defined stops for the hollow needles, which can be particularly useful for facilitating the surgeon in inserting the hollow needles into the target device and for providing visual confirmation that the hollow needles have been correctly and completely inserted.

[0016] Optionally, adjacent hollow needle guides may have their proximal and distal guide ends connected to one another, although connections between them are not required and may be omitted to reduce the weight of the targeting device.

[0017] Optionally, the hollow needle guides can alternately open towards two different azimuthal sides, i.e. every other hollow needle guide opens towards the right and the intermediate hollow needle guide opens towards the left, or vice versa. This is advantageous in manufacturing as the target device can be more easily manufactured in one piece without the material being stretched and warped to the right or left.

[0018] Optionally, the targeting device may further comprise a fastening member for tool-less releasable fastening to the endoscopy unit, which allows for a secure and rigid connection in which the translational and rotational alignment of the targeting device relative to the endoscopy unit is fully determined and guaranteed.

[0019] Optionally, the fastening member may be configured to at least partially surround and clamp an access tube of the endoscopy unit as required. The endoscope may then be inserted into the access tube independently of the targeting device. The targeting device preferably has a distance relative to the endoscope longitudinal axis proximally from the fastening member to allow the endoscope to be fully inserted into the access tube.

[0020] Optionally, the fastening members can be located at a distal end region of the targeting device, such that the targeting device has a large enough distance relative to the field of view to allow the hollow needle guides to be placed at a sufficient distance from one another, with corresponding polar angles, to provide as many different selectable puncture angles as possible, over as large a range of polar angles as possible.

[0021] Optionally, the fastening member may comprise a quick release lever or a clamp lever. The fastening member may comprise a form-fitting element, which is preferably configured to form-fit with a corresponding form-fitting element provided at a defined position on the endoscopy unit along the endoscope longitudinal axis. The form-fitting of the form-fitting element at a defined position allows a unique determination of the translational and rotational positioning of the target device relative to the endoscopy unit, thereby eliminating errors in mounting the target device on the endoscopy unit. That is, when mounting the target device on the endoscopy unit, there is preferably no freedom to deviate from the correct mounting of the target device on the endoscopy unit.

[0022] Optionally, the hollow needle guide can be formed by a one-piece guide member. This is useful for reducing the number of parts in the targeting device and for avoiding inaccurate assembly of the individual parts. The tight tolerance requirements for the manufacture of the hollow needle guide are easily achieved by a one-piece guide member.

[0023] Optionally, the hollow needle guide can be additively manufactured as an integral unit. The entire hollow needle guide can also form an integrally manufactured guide member. By additive manufacturing, for example by selective laser melting (LPBF, Laser Powder Bed Fusion), the total weight of the target device can be significantly reduced. The integrally manufactured guide member forming the hollow needle guide can be additively manufactured from light metals, light metal alloys and / or light plastics. The material of the guide member can have open and / or closed cavities in order to reduce the weight and at the same time maintain sufficient structural stability. For example, the total weight of the target device can be less than 100 grams, preferably 70 grams to 80 grams. However, the structural stability of the target device is in any case characterized by a high stiffness.

[0024] Optionally, the targeting device may penetrate azimuthally between the hollow needle guides, which among other things saves weight and material.

[0025] Optionally, at least one of the hollow needle guides can comprise a distal guide portion and a proximal guide portion, and the targeting device comprises at least one free portion between the distal and proximal guide portions, where the hollow needle is not guided, which also allows for weight and material savings, since the hollow needle essentially only needs to be guided in two locations as far apart as possible in the longitudinal direction to uniquely determine the spatial alignment of the hollow needle.

[0026] Optionally, it may be true that for each arbitrarily selected pair of hollow needle guides, the first hollow needle guide of the pair extends along a first polar angle, the second hollow needle guide of the pair extends along a second polar angle, the free portion of the first hollow needle guide is longer than the free portion of the second hollow needle guide, and the first polar angle is smaller than the second polar angle. Optionally, it may be true that for each arbitrarily selected pair of hollow needle guides, the first hollow needle guide of the pair extends along a first polar angle, the second hollow needle guide of the pair extends along a second polar angle, the length of the first hollow needle guide is greater than the length of the second hollow needle guide, and the first polar angle is smaller than the second polar angle. Thus, the hollow needle guides can be of different lengths, like the individual tubes of a pan flute, with the length decreasing as the polar angle increases. This reduces the tilting moment exerted on the endoscopy unit by the weight of the targeting device.

[0027] Optionally, the targeting device may include open and / or closed hollow chambers in addition to the hollow needle guide to reduce weight and material.

[0028] Optionally, the hollow needle guides can be arranged side-by-side meridianally, so that the azimuthal extent of the targeting device is as narrow as possible, with the meridian distance of the hollow needle guides relative to each other being as small as possible to reduce material and weight, and as large as necessary to provide a sufficient selection of puncture angles over the largest possible range of polar angles.

[0029] According to a further aspect of the present disclosure, there is provided an endoscopy system for an endoscopic surgical procedure, comprising: an endoscopy unit extending essentially in an endoscopy longitudinal axis and defining a field of view; at least one hollow needle; a targeting device as described above for guiding at least one hollow needle toward a target along a selectable polar angle relative to an endoscope longitudinal axis toward a field of view, the targeting device being fastened or fastenable to an endoscopy unit; An endoscopy system is provided, comprising:

[0030] Optionally, the endoscopy unit may comprise an access tube extending essentially in the endoscopic longitudinal axis, and an endoscope proximally insertable into the access tube.

[0031] Optionally, the targeting device may be releasably fastenable to the proximal end of the access tube without tools.

[0032] Optionally, the hollow needle can be equipped with a guidewire that passes inside the hollow needle, the guidewire protruding proximally from the hollow needle and having an outer diameter smaller than the inner slot width of the azimuthal opening of each hollow needle guide of the targeting device.

[0033] The system disclosed in this specification will now be described in more detail with reference to the accompanying drawings. [Brief description of the drawings]

[0034] [Figure 1a] FIG. 1 is a schematic diagram of one of three different surgical access possibilities to the intervertebral space. [Figure 1b] FIG. 1 is a schematic diagram of one of three different surgical access possibilities to the intervertebral space. [Figure 1c] FIG. 1 is a schematic diagram of one of three different surgical access possibilities to the intervertebral space. [Diagram 2] FIG. 1 is a side view of an example embodiment of an endoscopy system disclosed herein. [Diagram 3] FIG. 3 is a side view of the endoscopy system shown in FIG. 2 without the endoscope. [Figure 4] FIG. 3 is a side view of a targeting device of the endoscopy system shown in FIG. [Figure 5a] FIG. 5 is a top view of the targeting device shown in FIG. 4. [Figure 5b] FIG. [Figure 6]FIG. 4 is a top view, without an endoscope, of the endoscopy system shown in FIG. 3, with the hollow needle being withdrawn proximally from the seventh hollow needle guide. [Figure 7] FIG. 5 is a detailed perspective view illustrating the attachment of the targeting device shown in FIG. 4 to the distal end of the access tube of an endoscopy system. [Figure 8a] FIG. 8 is a detailed top view of the targeting device shown in FIG. 7 prior to attachment to the distal end of the access tube of the endoscopy system. [Figure 8b] FIG. 8 is a detailed top view of the targeting device shown in FIG. 7 after attachment to the distal end of the access tube of the endoscopy system. [Figure 9] FIG. 2 is a side view of a further example embodiment of an endoscopy system disclosed herein without an endoscope. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0035] In Figures 1a-c three different surgical access possibilities to the intervertebral space are shown. On the left are longitudinal or oblique sections, and on the right are sections through the vertebrae of the spine of a prone patient. To simplify the orientation, a right-handed Cartesian coordinate system is shown in all figures, where the z-axis is vertical, the x-axis is horizontal along the spine, and the y-axis extends horizontally laterally. Furthermore, it is useful to present the relative spatial positions and alignments by spherical coordinates, where the polar angle θ is defined as the angle with respect to the z-axis, the azimuthal angle φ is the rotation angle in the horizontal xy-plane, and r is the distance with respect to the coordinate origin.

[0036] In FIG. 1a, a translaminar access is shown, where a surgical procedure is performed in the intervertebral space by means of an endoscopy unit 1. In FIGS. 1a-1c, only the distal end of the endoscopy unit 1 is shown. The endoscopy unit 1 defines an endoscopic longitudinal axis L, which in the case of the translaminar access shown in FIG. 1a extends relatively vertically. FIG. 1b shows a posterolateral transforaminal or extraforaminal access, and FIG. 1c shows a lateral transforaminal or extraforaminal access. It should be noted here that the patient can be lying down so that the endoscopy unit 1 extends essentially vertically along the z-axis. If the patient remains in a prone position, it is useful in the following figures to define an arbitrarily defined coordinate system in which the z-axis extends along the endoscopic longitudinal axis L.

[0037] Here, in certain surgical procedures, it may be advantageous or even necessary to have to make a second access to the intervertebral space from another direction in addition to the access to the intervertebral space made by the endoscopy unit 1.

[0038] 2 to 4 show an embodiment of an endoscopy system 3 according to the invention, which greatly simplifies the creation of a second access to the intervertebral space. The endoscopy system 3 comprises a conventional endoscopy unit 1 consisting of an endoscope 5 and an access tube 7, a targeting device 9 and a hollow needle 17. The endoscopy unit 1 defines an endoscopy longitudinal axis L, which here extends along the z-axis, by the longitudinal axis L of the access tube 7. The endoscope 5 is insertable in the access tube 7 from proximal to distal direction. The access tube 7 comprises an irrigation liquid inlet and / or outlet 10 at its proximal end. When the endoscope 5 assumes its maximum distal position in the access tube 7, the distal tip of the endoscope 5 is located at the distal end of the access tube 7 and a field of view 11 is observed, which is distally ahead of the distal tip of the endoscope 5. The endoscope 5 preferably comprises an optical system for illuminating and observing the field of view 11. The surgeon can use eyepiece 13 to view field of view 11 directly with his eyes, or an adapter (not shown) can be used to connect a camera to eyepiece 13 for imaging on a screen. Endoscope 5 preferably further comprises a working channel having a proximal working channel opening 15 through which an endoscopic instrument such as a resecting forceps or scissors can be pushed into field of view 11. The intervertebral space can then be surgically operated under visual control.

[0039] The field of view 11, shown here as an ellipse, can be defined as a focal plane extending transversely to the endoscope longitudinal axis L in an object space distally in front of the endoscopy unit 1, observable by the endoscope 5. The local spherical coordinate system of the endoscopy system 3 can thus be defined here as one in which the centre point of the spherical coordinate system is the centre point of the field of view 11, located distally in front of the endoscopy unit 1. The endoscopy longitudinal axis L is accordingly defined as the polar axis z. For example, when performing a translaminar surgical procedure on the spine of a prone patient, the endoscopy longitudinal axis L, i.e. the polar axis z, preferably extends vertically.

[0040] The targeting device 9 according to the invention serves to simplify the creation of a second access to the field of view 11 by means of a hollow needle 17. The targeting device 9 here comprises a fastening member 19 having a quick release lever 33 for tool-free releasable fastening to the proximal end of the access tube 7. Thereby, the targeting device 9 is rigidly fixed to the access tube 7 during use. As soon as the targeting device is no longer required after successful placement of the hollow needle 17, it can be quickly removed without tools and therefore does not interfere with further surgical procedures.

[0041] The targeting device 9 defines a plurality (here ten) of hollow needle guides 21 arranged side by side in a sector shape, each extending towards the field of view 11 along a different polar angle θ relative to the endoscope longitudinal axis L. The hollow needle guides 21 are arranged meridianally side by side and extend radially towards the field of view 11 at a polar angle θ corresponding to each hollow needle guide 21. In Figures 2 and 3, the hollow needle 17 is inserted into the fifth hollow needle guide 21, which extends towards the field of view 11 at a polar angle θ5 relative to the endoscope longitudinal axis L.

[0042] Each hollow needle guide 21 comprises a proximal guide end 23 and a distal guide end 25, respectively, and the proximal guide ends 23 of the hollow needle guides 21 have essentially the same distance from the field of view 11. Thus, the proximal guide ends 23 of the hollow needle guides 21 are arranged in a circle around the field of view 11 in the yz plane shown in Figures 2 to 4. The radius of the circle is determined by the length of the hollow needle 17. Thus, each hollow needle guide 21 is available for hollow needles 17 having a defined length, i.e. the targeting device 9 is designed to fit a certain length of hollow needle 17.

[0043] The hollow needle guides 21 that are at a greater distance to the endoscope longitudinal axis L are designed to be shorter than the hollow needle guides that are at a smaller distance to the endoscope longitudinal axis L. The distance of the distal guide end 25 from the field of view 11 is therefore greater for the hollow needle guides 21 that are at a greater distance to the endoscope longitudinal axis L than for the hollow needle guides 21 that are at a smaller distance to the endoscope longitudinal axis L. This is particularly useful for keeping the tilting moment exerted by the weight of the targeting device 9 as small as possible, for example when the endoscope longitudinal axis L is aligned vertically from above on the spine of a prone patient during a translaminar surgical procedure. The weight of the targeting device 9 is therefore as small as possible, particularly in the area far from the endoscope longitudinal axis L. The targeting device 9 is preferably aligned diametrically opposite to the alignment of the eyepiece 13 of the endoscope 5 in the circumferential direction around the endoscope longitudinal axis L, as shown in FIG. 2, i.e. there is an azimuth angle φ of about 180° between the targeting device 9 and the eyepiece 13. Thereby, the tilt moments caused by the eyepiece 13 and the target device 9 are at least partially cancelled out.

[0044] The proximal guide end 23 of the hollow needle guide 17 funnels out in the proximal direction, forming a defined stop for each hollow needle 17. This is particularly useful for facilitating the surgeon's insertion of the hollow needle 17 into the targeting device 9, and for visually confirming that the hollow needle 17 has been inserted correctly and completely. This ensures that the hollow needle 17 cannot be inadvertently inserted too deeply, and that the distal tip of the hollow needle 17 always reaches the field of view 11, where final placement can be performed under visual control.

[0045] In the targeting device 9, adjacent hollow needle guides 21 connect to each other at the proximal guide end 23 and the distal guide end 25. The connections between them are not required and eliminating the material there reduces the weight of the targeting device 9. Thus, the targeting device 9 includes azimuthal penetrations 27 between the hollow needle guides 21.

[0046] According to the invention, each of the hollow needle guides 21 opens along its entire length towards one of two azimuthal sides. In the embodiment shown in Figs. 2-4, the hollow needle guides 21 open alternately towards two different azimuthal sides. That is, every other hollow needle guide opens towards the right and the intermediate hollow needle guide opens towards the left, or vice versa. In Figs. 2 and 3, the first, third, fifth, seventh and ninth hollow needle guides 21 open towards the observer from the endoscope longitudinal axis L (negative x-direction), while the second, fourth, sixth, eighth and tenth hollow needle guides 21 open away from the observer from the endoscope longitudinal axis L (negative x-direction). In Fig. 4, the target device 9 is shown from the other azimuthal side. The alternate left and right opening configuration is advantageous in manufacturing, since the target device 9 can be more easily manufactured integrally without warping to the right or left.

[0047] Thus, the feature of each of the hollow needle guides 21 being open along its entire length towards two azimuthal sides means that a guidewire (not shown) located within the hollow needle guide 21 can be withdrawn laterally from the hollow needle guide 21 after the hollow needle 17 has been withdrawn proximally from the hollow needle guide 21. In order to guide the hollow needle 17, the hollow needle guide 21 does not open wide enough to allow the hollow needle 17 itself to be withdrawn laterally. The hollow needle 17 can only be withdrawn proximally from the hollow needle guide 21.

[0048] As shown in more detail in Figures 5a, 5b, each of the hollow needle guides 21 has an inner diameter D for axially accommodating a hollow needle 17. The inner diameter D is the same in all hollow needle guides 21, so that each can snugly accommodate a hollow needle 17 having a corresponding outer diameter. Each hollow needle guide 21 has an open slot 29 on its open azimuthal side, the slot inner width S being smaller than the inner diameter D of the hollow needle guide. That is, the slot inner width S is smaller than the outer diameter of the hollow needle 17, but larger than the outer diameter of a guidewire (not shown) that is located within the hollow needle 17. Preferably, the slot inner width S is smaller than the outer diameter of the hollow needle 17, but at least as large as the inner diameter of the hollow needle 17.

[0049] In order to reduce the variety, costs and weight of the parts of the target device 9, the hollow needle guide 21 is formed by an integral guide member. Furthermore, the tight tolerance requirements for the manufacture of the hollow needle guide 21 are more easily achieved by the integral guide member. The integral guide member is additively manufactured here. In this case, the whole of the hollow needle guide 21 forms an integrally manufactured guide member. By additive manufacturing, for example selective laser melting (LPBF, Laser Powder Bed Fusion), the total weight of the target device 9 is significantly reduced. For example, the total weight of the target device 9 can be less than 100 grams, preferably 70 grams to 80 grams. However, the structural stability of the target device 9 is in any case characterized by a high rigidity. Besides the hollow needle guide 21, the target device 9 can comprise an open and / or closed hollow chamber 30 in order to reduce weight and material.

[0050] In the top view shown in FIG. 6 , the hollow needle 17 is shown immediately prior to insertion into the seventh hollow needle guide 21 from the endoscopy longitudinal axis L. The fastening member 19 is configured to at least partially surround and clamp the access tube 7 of the endoscopy unit 1 as specified. The endoscope 5 can then be inserted into the access tube 7 independent of the fixed targeting device 9. The targeting device 7 has a distance A relative to the endoscope longitudinal axis L proximally from the fastening member 19 such that the endoscope 5 can be fully inserted into the access tube 7.

[0051] The fastening member 19, shown in more detail in Figures 7 and 8a, 8b, here comprises a quick release lever 33 azimuthally opposite to a gripping hook 31 which surrounds the proximal end of the access tube 7 of the targeting device 9. The gripping hook 31 comprises a form-fitting element 35, here in the form of a web extending on the inner circumferential surface, which fits into the proximal end of the access tube 7 and is adapted to form-fit into a correspondingly shaped form-fitting element 37 in the form of a groove extending on the outer circumferential surface of the access tube 7. The form-fitting elements 35, 37 form-fit into each other in defined positions uniquely determines the translational and rotational positioning of the targeting device relative to the endoscopy unit, so that any incorrect mounting of the targeting device 9 on the endoscopy unit 1 can be excluded. That is to say, when mounting the targeting device 9 on the endoscopy unit 1, there is no freedom to deviate from the correct mounting of the targeting device 9 on the endoscopy unit 1.

[0052] FIG. 9 shows another example embodiment of a targeting device 9 fastened to an access tube 7. The reduced complexity of the targeting device 9 may possibly be produced more easily by other than additive manufacturing methods, for example by casting and / or milling. Here, a total of nine hollow needle guides 21 each comprise a distal guide portion 39 and a proximal guide portion 41, and the targeting device 9 comprises at least one free portion 43 between the distal guide portion 39 and the proximal guide portion 41, in which the hollow needle 17 is not guided. This also allows weight and material to be saved, since in order to uniquely determine the spatial alignment of the hollow needle 17, it is basically necessary to guide the hollow needle 17 in two positions as far apart as possible in the longitudinal direction. The length of the free portion 43 is longer for the hollow needle guides 21 closer to the longitudinal endoscopy axis L than for the hollow needle guides 21 further away from the longitudinal endoscopy axis L. The features of the example embodiment according to FIGS. 2 to 8a, 8b can be combined in any way with the features of the example embodiment according to FIG. 9. 9, the hollow needle 17 extends along a polar angle θ4 relative to the longitudinal endoscopy axis L and is inserted into a fourth hollow needle guide 21 that opens towards the non-visible azimuth side, as do the second, sixth and eighth hollow needle guides 21. The first, third, fifth, seventh and ninth hollow needle guides 21 each open towards the visible azimuth side. [Explanation of symbols]

[0053] 1 Endoscopy unit 3 Endoscopy system 5 Endoscopy 7 Access Tube 9 Targeting device 10 Cleaning fluid inlet and / or outlet 11 Field of view 13 Eyepiece 15 Proximal Working Channel Opening 17 Hollow needle 19 Fastening members 21 Hollow needle guide 23 Proximal Guide End 25 Distal Guide Tip 27 Penetration 29 Open Slots 30 Hollow Chamber 31 Grip Hook 33 Quick release lever 35 Form fitting elements 37 Form fitting elements 39 Distal guide portion 41 Proximal guide part 43 Free part A Distance D Inner diameter S slot inner width θ polar angle φ Azimuth

Claims

1. A targeting device (9) for guiding a hollow needle (17) to a target in an endoscopic surgical procedure, the targeting device (9) being fastened or fastenable to an endoscopy unit (1) extending essentially in an endoscopy longitudinal axis (L) and defining a field of view (11), the targeting device (9) defining a plurality of hollow needle guides (21), each of which extends toward the field of view (11) along a different polar angle (θ) relative to the endoscope longitudinal axis (L), and each of the hollow needle guides (21) being open toward two azimuthal angles over its entire length.

2. 2. A targeting device (9) as described in claim 1, wherein each hollow needle guide (21) has a proximal guide end (23) and a distal guide end (25), and the proximal guide ends (23) of the hollow needle guides (21) have essentially the same distance from the field of view (11).

3. 3. A targeting device (9) as claimed in claim 2, wherein for each arbitrarily selected pair of hollow needle guides (21), the distal guide end (25) of a first hollow needle guide (21) of the pair extends along a first polar angle (θ) and has a first distance from the field of view (11), and the distal guide end (25) of a second hollow needle guide (21) of the pair extends along a second polar angle (θ) and has a second distance from the field of view (11), the first polar angle (θ) being smaller than the second polar angle (θ) and the first distance being smaller than the second distance.

4. 4. A targeting device (9) according to claim 2 or 3, wherein the proximal guide end (23) of the hollow needle guide (21) is funnel-shaped in the proximal direction and forms a defined stop for the hollow needle (17), respectively.

5. A targeting device (9) according to any one of claims 2 to 4, wherein adjacent hollow needle guides (21) are connected to each other at the proximal guide end (23) and the distal guide end (25), respectively.

6. The targeting device (9) according to any one of claims 1 to 5, wherein the hollow needle guide (21) alternately opens towards two different azimuthal sides.

7. The targeting device (9) according to any one of the preceding claims, further comprising a fastening member (19) for tool-free releasable fastening to the endoscopy unit (1).

8. 8. The targeting device (9) of claim 7, wherein the fastening member (19) is configured to at least partially surround and clamp an access tube (7) of the endoscopy unit (1) as specified.

9. 9. The targeting device (9) according to claim 7 or 8, wherein the fastening member (19) is arranged in a distal end region of the targeting device (9).

10. A targeting device (9) according to any one of claims 7 to 9, wherein the fastening member (19) comprises a quick release lever (33) or a clamp lever.

11. A targeting device (9) according to any one of claims 7 to 10, wherein the fastening member (19) comprises a form-fitting element (35) configured to form-fit with a corresponding form-fitting element (37) provided at a predetermined position of the endoscopy unit (1) along the endoscope longitudinal axis (L).

12. The targeting device (9) according to any one of the preceding claims, wherein the hollow needle guide (21) is formed by a unitary guide member.

13. The targeting device (9) according to any one of the preceding claims, wherein the hollow needle guide (21) is additively manufactured as an integral unit.

14. The targeting device (9) according to any one of the preceding claims, wherein the targeting device (9) penetrates azimuthally between said hollow needle guides (21).

15. A targeting device (9) according to any one of claims 1 to 14, wherein at least one of the hollow needle guides (21) comprises a distal guide portion (39) and a proximal guide portion (41), and the targeting device (9) comprises at least one free portion (43) between the distal guide portion (39) and the proximal guide portion (41) in which the hollow needle (17) is not guided.

16. 16. A targeting device (9) as described in claim 15, wherein for each arbitrarily selected pair of hollow needle guides (21), the first hollow needle guide (21) of the pair extends along a first polar angle (θ), the second hollow needle guide (21) of the pair extends along a second polar angle (θ), the free portion (43) of the first hollow needle guide (21) is longer than the free portion (43) of the second hollow needle guide (21), and the first polar angle (θ) is smaller than the second polar angle (θ).

17. A targeting device (9) as described in any one of claims 1 to 16, wherein for each arbitrarily selected pair of hollow needle guides (21), a first hollow needle guide (21) of the pair extends along a first polar angle (θ) and a second hollow needle guide (21) of the pair (θ) extends along a second polar angle (θ), the length of the first hollow needle guide (21) is greater than the length of the second hollow needle guide (21), and the first polar angle (θ) is smaller than the second polar angle (θ).

18. 18. A targeting device (9) according to any one of claims 1 to 17, wherein each of the hollow needle guides (21) has an inner diameter (D) for axially accommodating the hollow needle (17) and is provided with an open slot (29) on its open azimuthal side having an inner slot width (S), the inner slot width (S) being smaller than the inner diameter (D).

19. A targeting device (9) according to any one of the preceding claims, which besides said hollow needle guide (21) comprises an open and / or closed hollow chamber (30).

20. The targeting device (9) according to any one of the preceding claims, wherein the hollow needle guides (21) are arranged in a meridian-like alignment.

21. An endoscopy system (3) for endoscopic surgical procedures, the endoscopy system (3) comprising: an endoscopy unit (1) extending essentially in an endoscopy longitudinal axis (L) and defining a field of view (11); At least one hollow needle (17); An endoscopy system, comprising: a targeting device (9) according to any one of claims 1 to 20, for guiding the at least one hollow needle (17) to a target toward the field of view (11) along a selected polar angle (θ) relative to the endoscope longitudinal axis (L), the targeting device (9) being fastened or fastenable to the endoscopy unit (1).

22. An endoscopy system (3) as described in claim 21, wherein the endoscopy unit (1) comprises an access tube (7) extending essentially in the endoscopy longitudinal axis (L) and an endoscope (5) insertable proximally into the access tube (7).

23. 23. An endoscopy system (3) according to claim 22, wherein the targeting device (9) is releasably fastenable to the proximal end of the access tube (7) without tools.

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