Adaptable work channel devices and surgical instrument systems
The adaptable working channel device and tissue clip application adapter provide a stable and easy-to-use solution for endoscopes, ensuring secure attachment and precise tissue manipulation, addressing connection instability and digestive issues in existing systems.
Patent Information
- Authority / Receiving Office
- JP · JP
- Patent Type
- Patents
- Current Assignee / Owner
- OVESCO ENDOSCOPY AG
- Filing Date
- 2022-01-20
- Publication Date
- 2026-06-25
Smart Images
Figure 0007880150000001 
Figure 0007880150000002 
Figure 0007880150000003
Abstract
Description
Technical Field
[0001] The present disclosure relates to an adaptable working channel device for adaptable attachment to an endoscope, the adaptable working channel device having at least one external working channel connected at its proximal end to a first attachment coupling, and at least one second attachment coupling formed separately from the working channel and provided so as to surround an endoscope shaft or an endoscope handle, and configured to be detachably engaged with the first attachment coupling, and having a sleeve-shaped handle attachment sleeve on its radially outer peripheral side. Further, the present disclosure relates to a surgical instrument system for an endoscope having a distal tissue clip application adapter, an adaptable working channel device, and a tissue clip application adapter.
Background Art
[0002] Medical endoscopes are used for the treatment of many different patients and thus must meet a wide range of requirements. In order to meet the needs of a large number of highly specialized treatment needs, there are highly specialized endoscopes and / or adapter systems for additional working channels, whereby additional instruments and / or functionality can be provided. In particular, such adapter systems are configured to be equipped on standard endoscopes. The adapter system needs to be quickly and easily attached to the endoscope, and the attachment must be performed securely. The adapter system can be manufactured at a low cost as disposable parts, and preferably has a simple configuration.
Prior Art Documents
Patent Documents
[0003]
Patent Document 1
Patent Document 2
Summary of the Invention
[0004] An example of an additional tubular assembly that can be coupled to an endoscope handle via a proximal connector is described in German Published Patent No. 102009014178. This document discloses a clamp bushing fixed to the endoscope handle and having a gap in the bracket with a small projection, and an external working channel having wings for mounting into the gap in the bracket with an engaging recess for engaging with this small projection. However, this connection can be tight, making it difficult and jerky to operate, or smooth but unstable. Furthermore, two hands are required to attach the external working channel to the endoscope handle because increased counterpressure is needed during connection. In addition, the rotating ring can wear down, making it even more unstable. However, for the treatment or surgery of many patients, both high stability of the connection and easy and safe assembly and disassembly are required.
[0005] Furthermore, adapter systems known from prior art often fail to meet the requirements defined by specialized treatments. For example, an adapter system for the distal end of an endoscope is known from German published patent No. 102017112896, which has an attachment carrying a tissue clip that can be pushed down. However, the potential uses of this attachment are severely limited. Moreover, it has been found that problems can arise with this adapter system when performing artificial anastomoses (i.e., when connecting two anatomical cavities, such as between the stomach and the small intestine). In particular, in surgically formed anastomoses, one of the openings of the connection may be too large. In the case of an anastomosis between the stomach and the small intestine, this may result in insufficient digestion because, for example, food is moved too quickly within the digestive tract. On the other hand, the opening may be too small. In this case, the rate at which food is moved may be very slow. In both cases, this can lead to digestive problems. [Means for solving the problem]
[0006] The underlying purpose of this disclosure is to improve upon or resolve the shortcomings of the prior art. In particular, an adaptable working channel system and / or tissue clip application adapter and / or surgical instrument system for endoscopes should be provided that is simple, inexpensive, and safe to assemble and disassemble, and / or can reliably and easily provide additional functionality.
[0007] The underlying objective of this disclosure is to be solved by an adaptable work channel device having the features of claim 1.
[0008] More specifically, the fundamental objective of the present invention is solved by an adaptable work channel device for adaptive attachment to an endoscope. The adaptable work channel device has at least one external work channel connected at its proximal end to a first attachment coupling. Furthermore, the adaptable work channel device has a sleeve-shaped handle attachment sleeve formed separately from the work channel and provided to surround the endoscope shaft or endoscope handle. On the radial outer circumference of the handle attachment sleeve is provided at least one second attachment coupling configured to releasably engage with the first attachment coupling. The first attachment coupling has two clamp branches that are spring-biased, clamp-engaged, and hinged to each other like clothespins to form a clamp branch portion and a manual operating branch portion. The second attachment coupling has an attachment rail extending longitudinally along the handle attachment sleeve and at least one undercut. The undercut is dimensioned so that it can be wrapped around the clamp branch of the first attachment coupling so that its shape adapts. The adaptable working channel device has the advantage of allowing for a simple, smooth, and stable connection of the external working channel to the endoscope handle.
[0009] In other words, the adaptable work channel device is provided with an external work channel that is selectively detachable from the endoscope handle via a simple mounting system. Thus, the (external) work channel and the handle mounting sleeve that can be attached to the endoscope handle have first and second mounting couplings configured to be releasably coupled to each other. The first mounting device of the work channel forms a clamp with two clamp branches that are elastically angle-adjustable to each other (i.e., connected like clothespins) via a rocker joint. Each clamp branch has a first free end that protrudes toward the clamp side beyond the rocker joint to form a clamp branch portion with at least one first engaging member, such as a projection or opening. The second free end of the clamp branch is configured to open the opposing clamp branch portion via a manual push action by the user, forming an operating branch portion opposite the clamp branch portion relative to the rocker joint. The second mounting coupling has a fastener-shaped portion or a bush-shaped portion that can be snap-fitted / attached around the endoscope handle or shaft. The clamping or bushing-shaped portion has a longitudinal bar / mounting rail with at least one second engaging member in the form of an opening or projection provided for engagement with the corresponding first engaging member of the clamp branch. The clamp branch portion and the operating branch portion of each clamp branch are connected to each other particularly firmly.
[0010] The advantageous embodiments are the subject of the dependent claims and are described in further detail below.
[0011] The rocker joint or hinge may be mounted directly on the working channel, on the connecting bush of the working channel, or radially spaced relative to the working channel via spacers. Such spacers ensure that proximal access to the working channel is separated from the endoscope, making it easily accessible. Furthermore, the working branch is preferably positioned so that it can be opened and / or closed with one hand.
[0012] The clamp branch of the first mounting coupling preferably forms engaging members, such as hook-shaped projections or openings, that face each other on the clamp branch portion and are configured to engage with the rear side of at least one undercut of the second mounting coupling. In particular, the contact surface of the undercut and the contact surface of the engaging member can be formed extending perpendicularly to the clamp branch, so that the mounting couplings make stable contact. In particular, a hinge, such as a clothespin, causes the two clamp branches to move in an arc, resulting in each engaging member making a large lateral movement, so that it can have a relatively large extension across the longitudinal direction of the clamp branch, and thus can provide this kind of relatively large contact / mounting surface. In order to provide the longest possible and therefore stable locking edge, it is particularly preferable that projections be formed along the entire width of each clamp branch portion.
[0013] Furthermore, it has been proven practical to chamfer the free ends of the clamp branch sections at their opposing edges to form an insertion wedge between the clamp branch sections.
[0014] Preferably, at least two undercuts are provided on both sides of the mounting rail facing each other in the circumferential direction, with each undercut facing the other. Preferably, one or more undercuts are each configured as through openings extending tangentially to the longitudinal direction of the handle mounting sleeve via the handle mounting sleeve. This makes manufacturing easier and provides a particularly stable coupling structure. Preferably, the handle mounting sleeve may have a substantially cylindrical or conical shape that protrudes radially outward to form the mounting rail. In this way, a simple structure is achieved, and the handle mounting sleeve is easy and inexpensive to manufacture.
[0015] More preferably, each clamp branch extends diagonally away from the hinge or rocker joint. In other words, an acute angle is formed between the clamp branches. This allows the clamp branches to grip the periphery of the mounting rail, especially with a wide and stable grip. Anti-slip structures such as grooves or webs may be formed on the outside of the operating branches (i.e., facing opposite directions) to provide a more stable grip during manual operation of the operating branches.
[0016] It has proven practical that the first mounting coupling forms a connecting bush, to which the working channel is connected at its distal end. Preferably, a Luer adapter or Luer-lock adapter is further connected to the proximal end of the connecting bush. The Luer (lock) adapter may include a biopsy valve. Alternatively, the connecting bush may form an integrated biopsy valve. This allows the external working channel to be sealed, for example, during biopsy or rinsing, extending the promising functionality of the adaptable working channel device of the present invention. In particular, the connecting bush forms a longitudinal passage / channel connecting the working channel to the proximal inlet of the connecting bush.
[0017] Preferably, the clamp branches are elastically connected to each other via a connecting web extending diagonally or perpendicularly to the clamp branch, at a position between the clamp branch portion and the actuating branch portion of the corresponding clamp branch. On the other hand, such a connecting web allows for a simple and integrated configuration without the assembly of hinges or rocker joints connecting the two clamp branches to each other. Furthermore, the connecting web provides space between the two clamp branches, which allows for a greater range of motion when opening and closing the clamp branches via the operation of the actuating branch portion.
[0018] More preferably, the connecting web is connected to the connecting bush via a central beam, for example, a spacer, which is centrally attached to the connecting web. The length of the spacer is preferably sized to space the connecting bush and the connecting web so that the actuation part can actuate freely without being obstructed by the connecting bush. Furthermore, the length of the spacer is sized so that the free end of the actuation branch is close to the connecting bush so that a user can reach the actuation branch by placing one hand around the connecting bush. The spacer can serve as an end stop for the actuation branch to prevent excessive actuation which would result in damage to the first mounting coupling.
[0019] Conveniently, the clamp branch and the connecting bush may be oriented such that, when the first mounting coupling and the second mounting coupling are coupled, the longitudinal axis of the connecting bush and the longitudinal axis of the handle adapter sleeve are oriented diagonally relative to each other. Preferably, an angle of 10° to 50°, more preferably 20° to 25°, is formed between these longitudinal axes. Thus, access to the proximal working channel is oriented away from the endoscope. Therefore, the user can access the proximal working channel even more easily. This is particularly advantageous when combined with the spacer described above, because by arranging the connecting bush at an angle, the working channel can be guided diagonally from the maximum distance toward the endoscope shaft. The working channel is particularly mounted on the outside of the endoscope shaft and guided distally.
[0020] In an advantageous embodiment, the connecting web is wider than the clamp branch so as to project laterally beyond the clamp branch (i.e., proximal and / or distal or longitudinally with respect to the working channel). It is particularly advantageous if the handle mounting sleeve further extends laterally with respect to its longitudinal direction to form at least two support edges spaced apart in its longitudinal direction, the distance between the support edges substantially corresponding to the width of the connecting web. An undercut is preferably formed between these support edges. In this way, forces transmitted through the first and second mounting couplings can be distributed to different coupling members. For example, forces acting longitudinally on the working channel or mounting sleeve can be transmitted through the support edges and the side edges of the connecting web without burdening the clamp branch. In this case, the clamp branch transmits only radially acting forces between the first and second mounting portions.
[0021] Preferably, the mounting rail of the handle mounting sleeve forms multiple undercuts that are offset from each other in the longitudinal direction. This makes it possible to provide working channels of different lengths, and to connect working channels of different lengths to the same handle mounting sleeve. More specifically, for example, relatively shorter working channels can be attached to the handle mounting sleeve via undercuts located further distally, and / or relatively longer working channels can be attached via undercuts located further proximal. This simplifies the connection of adaptable working channel devices with endoscopes of different lengths.
[0022] Advantageously, the handle mounting sleeve forms a plurality of mounting rails that are offset from each other in the circumferential direction of the handle mounting sleeve and preferably facing each other in the diametrical direction. This allows for more flexible positioning of the work channels in the endoscope. Furthermore, the adaptable work channel device may have several work channels with corresponding first mounting couplings.
[0023] In a more preferred embodiment, the handle mounting sleeve has a receiving opening configured to receive the radial projections of the endoscope handle. The radial projections are, for example, the exits of the endoscope-integrated internal working channels of the endoscope handle. In this way, the handle mounting sleeve is fixed to the handle adapter sleeve in at least the longitudinal and / or circumferential directions so as to conform to the shape of the endoscope handle. This enables a particularly simple, stable, and wear-resistant connection between the handle mounting sleeve and the endoscope handle.
[0024] Furthermore, it is advantageous for the handle mounting sleeve to have a continuous longitudinal gap and to be at least partially elastic so that it can be snap-fitted onto the endoscope shaft / handle like a clamp. Thereby, the handle mounting sleeve can apply a clamping force to the endoscope shaft / handle. In particular, one or more holes may be included in the circumferential region of the handle mounting sleeve facing the longitudinal gap in order to at least partially form an elastic region. In other words, the sleeve structure may be locally weakened to have greater elasticity than other regions of the handle mounting sleeve. Particularly preferably, the longitudinal gap is formed on the diametrically opposite side of the receiving port, and the receiving port weakens the sleeve structure.
[0025] According to a further advantageous aspect, the handle mounting sleeve comprises a strap holder to which the first end of the closure strap is attached or can be attached. Furthermore, the handle mounting sleeve may comprise a strap fixing part configured to hold the closure part of the closure strap at a position where the closure strap is wound around the handle mounting sleeve so as to cross the longitudinal gap. In other words, a closure strap is provided on the handle mounting sleeve so as to surround the longitudinal gap and at least a part of the handle mounting sleeve in order to apply tension to the endoscope part arranged within the handle mounting sleeve. Preferably, the strap holder and / or the strap fixing part are mounted radially outwards corresponding to one or two opposing mounting rails. In this way, a lever is provided around the handle mounting sleeve that can apply a greater clamping force to the closure strap. The closure part may be configured as a ratchet strap, for example according to the principle of a perforated belt, or may be made of Velcro®, whereby the strap fixing part is adapted.
[0026] Alternatively or in addition, the object underlying the present disclosure is solved by the tissue clip application adapter according to claim 10.
[0027] More specifically, a tissue clip application adapter, such as a cap attachment for a medical endoscope, i.e., configured separately from the medical endoscope, is provided. The tissue clip application adapter has a bush-shaped base. The base has a proximal endoscope holding portion configured to be attached to the distal head of the medical endoscope. Further, the base has a tissue clip holding portion configured to support the tissue clip on its radially outer peripheral surface such that the tissue clip is removable in the distal direction from the tissue clip holding portion. In particular, the base is open in the distal direction so that an instrument or the like can be advanced through the base to the treatment site / in the patient's cavity, and / or so that the patient's tissue can be retrieved / pulled into the base.
[0028] The tissue clip application adapter further includes a first adapter integral working channel terminal having a first internal channel. The first internal channel extends through the base such that its proximal first channel end opens outside the base and its distal first channel end opens inside the base. In other words, another working channel is connected or a connectable through-passage extends continuously through the wall of the base diagonally from the proximal direction, from the radially outer side of the base, i.e., distally and radially inwardly. Optionally, an inner flange may be provided in the second internal channel to fix the position of the external working channel that is connected or respectively connected in the distal direction.
[0029] This has the advantage that an additional working channel can be provided, through which an instrument, a cleaning tube, etc. can be advanced into the space directly in front of the actual endoscope. In particular, since the first internal channel has a diagonal course, the inserted instrument or the like is already oriented in the corresponding radial direction, which can be advantageous, for example, for the rinsing process or for pulling the tissue into the base.
[0030] This is particularly advantageous for the precise targeting of tissue clips. For this purpose, the grasping instrument can travel through the base through a corresponding external working channel and a first internal channel, and exit the base distally. The grasping instrument can then selectively grasp patient tissue in an area directly located in the field of view of the endoscope's optical system and retract it into the base. When the tissue clip is then removed / pushed distally from the tissue clip holder, a precisely targeted clamp is performed on a specific site of the patient's tissue. The grasping instrument may be a mechanical, for example, forceps-like instrument, or a suction instrument that can hold / grasp patient tissue via suction pressure.
[0031] The second adapter-integrated working channel terminal of the tissue clip application adapter has a second internal channel extending along the base such that the proximal and distal ends of the second internal channel open outside the base. Furthermore, the distal second channel end is positioned proximal to the tissue clip holder. In other words, an (internal) channel extending substantially linearly along the outer circumferential surface of the bush-like base is provided to connect (independently of the first internal channel) to a further external working channel that is connected to or connectable to the tissue clip application adapter, coming from the proximal direction. Optionally, a flange may be provided within the second internal channel to fix the position of the external working channel in the distal direction. The external working channel is connected to or will be connected to.
[0032] Therefore, the tissue clip application adapter of the present invention allows for the provision of instruments, cleaning tubes, special optical systems, etc., that can observe or manipulate the area around the clamped patient tissue without limiting the functionality of the tissue clip application adapter for clamping patient tissue via a tissue clip, or without significantly limiting the adapted endoscope. This is particularly advantageous when performing anastomosis in which a tissue opening of a predetermined size is kept open in the vicinity of the tissue clamped by the tissue clip.
[0033] In this application in anastomosis configuration, for example, an expansion device such as a balloon catheter can be advanced through a correspondingly connected external working channel and a second internal channel to a provided tissue opening. There, the expansion device can be expanded to a predetermined size / diameter. Then, if the patient's tissue to be stapled is grasped by a grasping device, for example, in close proximity to the expansion device as described above, and drawn into the base, the patient's tissue is expanded around the expansion device. Subsequently, when the staples are set and the expansion device is removed, the tissue opening remains near the stapled tissue site and substantially corresponds to the predetermined size / diameter of the expansion device when expanded.
[0034] Preferably, the sliding bush is mounted longitudinally slidably on a base immediately adjacent to the tissue clip holder, serving as a tissue clip push-off device for sliding the tissue clip distally from the tissue clip holder. In other words, the sliding bush is provided to push the tissue clip between the tissue clip holder and the distal end of the second internal channel. This allows the tissue clip to slide off particularly easily, uniformly, and effectively. Furthermore, since the sliding bush requires only a small radial mounting space, the tissue clip push-off device and the spreader device do not interfere with each other, for example.
[0035] In a favorable embodiment, the distal anterior edge of the base (i.e., the most distal end of the tissue clip application adapter) has two recesses that are opposite each other (preferably in the diametrical direction) and extend or are recessed in the proximal direction. In other words, the anterior edge is jaw-shaped, and the recesses therein form jaw-shaped corners. This is particularly advantageous to allow the patient's tissue to be folded into the recesses by drawing it into the base as specifically defined. This enables clamping of the patient's tissue in a particularly defined longitudinal direction.
[0036] Particularly preferably, each recess is positioned offset from the second adapter-integrated working channel terminal by a corresponding angle in the circumferential direction of the base, preferably 70° to 110°, and more preferably 90°. That is, one recess is offset in the first circumferential direction by a corresponding angle relative to the second working channel terminal, and the other recess is offset in the opposite circumferential direction by a corresponding angle relative to the second working channel terminal. Thus, the two recesses are substantially opposite in the diametrical direction, and the second working channel terminal is positioned circumferentially between the two recesses. In other words, when performing an anastomosis surgery, the second working channel terminal and the recesses are oriented toward each other such that the patient's tissue to be stapled is folded substantially tangentially to the tissue opening provided. Thus, the subsequent stapling of the tissue is particularly precise and targeted.
[0037] It is further advantageous if the tissue clip holder forms two diametrically opposed expanding support surfaces configured to hold the tissue clip when it is spread in a predetermined position, one of which is aligned with or circumferentially located on the same base as the second adapter-integrated working channel terminal. In other words, the tissue clip adapted to the tissue clip holder is bear-trap shaped and has two distally directed jaw-like claws. One of the claws is circumferentially located on the same base as the second working channel terminal. This is advantageous because, when performing anastomosis surgery, one of the claws, configured to firmly grasp and scratch the patient's tissue being clamped, thus engages with the patient's tissue in the immediate vicinity of the tissue opening to be provided. In this way, it is possible to minimize the amount of "loose" tissue remaining between the tissue opening and the staple, which can lead to inaccuracies in sizing the tissue opening, and thus avoid discomfort for the patient's digestion.
[0038] Alternatively, or in addition, the underlying object of this disclosure is resolved by the surgical instrument system according to claim 15.
[0039] More specifically, a surgical instrument system for an endoscope is provided, having the adaptable working channel device and the tissue clip application adapter described above. The first adapter-integrated working channel terminal is coupled to the distal end of the external working channel of the adaptable working channel device, which serves as the first external working channel. Furthermore, the instrument system includes a gripping instrument that is inserted distally through the first external working channel or configured to be inserted. Thus, the gripping instrument can advance through the base of the tissue clip application adapter.
[0040] Furthermore, a second external working channel is provided, which is connected at its proximal end to a third mounting coupling for attachment to a handle mounting sleeve of an adaptable working channel device. The distal end of the second working channel is coupled to a second adapter-integrated working channel terminal of a tissue clip application adapter. In addition, the device system includes an expansion device, particularly a balloon catheter, which is inserted into or configured to be inserted into the second external working channel distally. Thus, the expansion device can be provided radially outside the base of the tissue clip application adapter. This device system can advantageously achieve optimal setting of residual tissue opening in anastomosis, as described in detail above. Preferably, the first and second working channels, as well as each of the first mounting couplings, are marked differently, for example, with different colors, to distinguish the working channels.
[0041] In summary, the fundamental objective of the present invention is solved as follows: The gripping handle (handle mounting sleeve) may have several functions. In one embodiment, the gripping handle is preferably configured as a clamp that can be easily slid on or removed from the endoscope (particularly the endoscope handle). This design allows the gripping handle to have a holding force on the endoscope handle by clamping it. Furthermore, this design makes it possible to accommodate endoscope handles of different shapes. In particular, the opening in the center (central region) of the gripping handle allows for direct placement at the entrance of the internal working channel of the endoscope (the opening may be located around the entrance). This positions the gripping handle in an appropriate location in terms of height (or axial extension) (fixed in an appropriate location in the proximal-distal direction). Furthermore, a fixing strap (closure strap) may be used / provided to attach the entire gripping handle to the endoscope / endoscope handle.
[0042] Furthermore, the gripping handle preferably has six latching positions (distributed longitudinally and / or circumferentially) to which a connector (first mounting coupling) can be attached. The different positions are intended to accommodate different endoscope lengths (i.e., different locking positions are selected relative to the axial extension of the gripping handle depending on the length of the endoscope being adapted) and to allow the user to follow their own preference.
[0043] The connector is the entrance (forming) to the external tube (working channel) and is actually composed of a Luer lock (Luer adapter). The (Pentax) biopsy valve is, for example, positioned on this Luer lock. The connector is preferably attached to the gripping handle by a snap hook (engaging member or clamp branch portion of the first mounting coupling). The fastening should be designed to be intuitive and simple. Furthermore, the attachment / connection of the gripping handle and the connector is releaseable via (preferably ridged) wings (working branch portion) so that the connector can be repositioned.
[0044] In summary, the connector may include a Luer lock and optionally, preferably, an attachment for a biopsy valve, a BARS system (i.e., a tissue clip application adapter), and / or an additional working channel (AWC system, "additional working channel"). The attachment may be integrated as part of the BARS / AWC (i.e., forming an integrated system). In addition, the connector may have an operating clamp branch (i.e., a wing or operating branch portion).
[0045] This disclosure will be described below with reference to preferred embodiments. However, these are essentially illustrative and do not limit the scope of protection of the present invention. Furthermore, in the description of various embodiments, the same reference numerals will be used for similar configurations to avoid redundant descriptions. [Brief explanation of the drawing]
[0046] [Figure 1] Figure 1 shows an endoscope with an adaptable working channel device fixed to it, according to a first aspect or a preferred embodiment. [Figure 2] Figure 2 shows a top view of a handle mounting sleeve for an adaptable work channel device according to a preferred embodiment. [Figure 3] Figure 3 shows a perspective view of the connector for the adaptable work channel device. [Figure 4] Figure 4 shows the adjustable structure of an adaptable work channel device according to the first embodiment. [Figure 5] Figure 5 shows an endoscope fitted with a tissue clip application adapter according to a second aspect or further embodiment. [Modes for carrying out the invention]
[0047] Figure 1 shows an adaptable work channel device 1 that can equip or retrofit a medical endoscope 2 with at least one external work channel 3. In this embodiment, two (identical) work channels 3 are provided as an example. Each work channel 3 is formed separately from the endoscope 2. Each external work channel 3 has a proximal end (i.e., facing the user or away from the patient). This proximal end is connected to a connecting bush 4 of a first mounting coupling 5. The first mounting coupling 5 is attached to the endoscope 2 and is configured to releasably hold and engage a second mounting coupling 6, which is described in more detail below.
[0048] A second mounting coupling 6 is formed radially outward of the handle mounting sleeve 7. The handle mounting sleeve 7 is substantially bush-shaped or clamp-shaped and partially surrounds the endoscope 2, particularly the endoscope handle, as shown in Figure 1. The handle mounting sleeve 7 forms a mounting rail 8 that protrudes radially outward from the handle mounting sleeve 7 and extends in its longitudinal direction. In this embodiment, two (identical) mounting rails 8 are provided facing each other. Figure 2 shows a top view of the handle mounting sleeve 7 from the proximal direction, clearly showing that the mounting rails 8 are formed as protrusions on the peripheral wall of the handle mounting rail 8.
[0049] The mounting rail 8 has access openings 9 on its sides or lateral sides, oriented circumferentially to the handle mounting sleeve 7. The access openings 9 are configured / dimensioned for engagement with the first mounting coupling 5. In particular, the access openings 9 extend continuously from corner to corner of the mounting rail 8 and open on both sides of the mounting rail 8. The mounting rail 8 further forms support edges 10 that extend across the longitudinal direction of the handle mounting sleeve 7, particularly perpendicular thereto. The support edges 10 are arranged such that, viewed from the longitudinal direction, there is one support edge 10 on each side of each access opening 9.
[0050] The handle mounting sleeve 7 has a longitudinal gap 11, as shown in Figure 2, which completely divides / separates the handle mounting sleeve 7 along its longitudinal direction at a circumferential position. Thus, the handle mounting sleeve 7 can be widened to receive the endoscope handle through the longitudinal gap 11 and snapped into place therein. The handle mounting sleeve 7 has a receiving opening 12 configured to receive the radial projection 13 of the endoscope, particularly on the opposite side of the longitudinal gap 11.
[0051] Furthermore, preferably in an area between two support edges 10 where no access opening 9 is provided, a strap holder 14 for holding the closure strap 15 is formed radially outward of one of the mounting rails 8. Preferably, the closure strap 15 is fixed translationally to the strap holder 14, but optionally rotatable about an axis that crosses the longitudinal direction of the handle mounting sleeve 7. Strap fixing portions 16 are formed on the opposing mounting rails 8 at the same height with respect to the longitudinal direction. The strap fixing portions 16 are configured such that when the closure strap 15 is stretched across the longitudinal gap 11 and wrapped around the handle mounting sleeve 7, the closure portion 17 of the closure strap 15 can be fixed to the strap fixing portions 16. In Figure 1, the closure strap 15 is shown in such a mounting position stretched across the longitudinal gap, with only the ends of the closure strap 15 visible, held by the strap holder 14 and the strap fixing portions 16 respectively, and protruding behind the endoscope. In Figure 4, the closure strap 15 is not attached to the strap fixing part and is shown in a suspended position. In particular, as can be seen from Figure 2, the strap fixing part 13 and / or strap holder 14 may be provided in the form of buttons.
[0052] The structure of the first mounting coupling 5 is clearly visible, in particular, in Figures 1 and 3. More precisely, the first mounting coupling has a connecting bush 4, to which an external working channel 3 is connected at the distal end of the connecting bush 4. According to the shown configuration, a biopsy valve 19 is provided at the proximal end of the connecting bush 4. Alternatively, a Luer adapter 20 may be formed, as shown in Figure 4.
[0053] When the first and second mounting couplings 5 and 6 are connected to each other, a beam-shaped spacer 21 extends radially outward and preferably distally to the side of the connecting bush 4 so that the working channel 3 and the handle mounting sleeve 7 are positioned at an angle. At the end of the spacer 21 away from the connecting bush 4, a connecting web 22 is positioned extending in both directions across the spacer 21. That is, the spacer 21 and the connecting web 22 form a T. Clamp branches 23 are formed at each outer end of the connecting web 22 and extend at least partially substantially across the connecting web 22 or substantially parallel to the spacer 21. The connecting web 22 provides a rocker joint, around which the clamp branches 23 are elastically and angularly adjustable relative to each other.
[0054] The clamp branch 23 projects outward from the connecting bush 4 (i.e., radially outward relative to the connecting bush 4) beyond the rocker joint or connecting web 22 to form the clamp branch portion 24. The clamp branch portions 24 are bent slightly outward, i.e., away from each other. Furthermore, each clamp branch portion 24 forms a hook-shaped projection 25, which faces the corresponding other clamp branch portion 24 and is configured to engage with the access opening 9 of the second assembly apparatus 6. In the stationary position, the clamp branch 23 is in a closed position, in which the clamp branch portions 24 move toward each other, preferably to their maximum extent. When the first and second assembly apparatuses 5,6 are connected to each other, the contact surfaces 26 of each projection 25 facing the connecting bush 4 contact the corresponding contact surface of one of the access openings 9 of the second assembly apparatus 6. To enable the transmission of the greatest possible force, the contact surfaces 26 of the projections 25 are formed substantially perpendicular to the extending direction of the spacer 21.
[0055] The clamp branch 23 protrudes beyond the rocker joint or connecting web 22 toward the connecting bush 4 (i.e., radially inward relative to the connecting bush 4), forming the actuation branch 27. The actuation branch 27 and the clamp branch 24 are firmly connected to each other. When the actuation branch 27 is pushed / moved toward each other, preferably by a user with only one hand, the clamp branches 23 each tilt around the connecting web 22 or rocker joint, and the clamp branch 24 moves away from each other so that the clamp engagement with the access opening 9 can be released. The actuation branch 27 has an outward ridge, which allows for safe and slip-free operation of the actuation branch 27.
[0056] The connecting web 22 has side rims 28 that project laterally beyond the clamp branch 23, i.e., in the proximal and distal directions. The width of the connecting web 22 in this direction substantially corresponds to the distance between the support edges 10 of the second mounting coupling 6. Therefore, when the working channel 3 is mounted longitudinally as shown in Figure 1 with the first and second mounting couplings 5, 6 connected, the support edges 10 of the second mounting coupling 6 and the side rims 28 of the connecting web 22 are directly adjacent, and in particular, in contact with each other. The lateral rims of the clamp branch portion 24 oriented in the proximal-distal direction do not contact one side of each access opening 9, thereby the first and second mounting Coupling Force transmission between points 5 and 6 will improve.
[0057] Figures 1 and 4 show different configurations of an adaptive work channel device that has essentially the same structure. In Figure 1, two work channels 3 are connected to a second mounting coupling 6 at the same height as each other. In Figure 4, the work channels 3 are positioned longitudinally offset from the grid defined by the access opening 9.
[0058] Figure 5 shows an endoscope 2, more specifically an endoscope shaft having a tissue clip application adapter 29 retrofitted to its distal endoscope head to add the functionality of cutting patient tissue to the endoscope 2. The tissue clip application adapter 29 is provided in the form of a cap-shaped attachment and has a bush-shaped base 30. The base 30 has a proximal endoscope holding portion 31 configured for attachment to the endoscope head and a tissue clip holding portion 32 on which a tissue clip 33 is carried. A sliding bush 34 is mounted on the base 30 so as to be longitudinally slidable immediately proximal to the tissue clip 33 or the tissue clip holding portion 32. When the sliding bush 34 is moved distally, the sliding bush 34 comes into contact with the tissue clip 33, causing the tissue clip 33 to slide distally and detach from the tissue clip application adapter 29.
[0059] The first adapter-integrated work channel terminal 35 has a first internal channel formed for coupling with the first external work channel 3a. The first internal channel extends radially inward from the outside of the base 30, through the wall of the base 30, from the proximal to the distal direction, and opens into the interior 36 of the base 30. That is, the proximal first channel end opens outside the base 30, and the distal first channel end opens inside the base 30. Preferably, a gripping device 37 is provided that is inserted into or insertable into the first work channel 3a, proceeds through the first internal channel to the interior 36, and optionally proceeds distally to the outside of the base 30.
[0060] The second adapter-integrated work channel terminal 38 has a second internal channel configured to connect with the second external work channel 3b. The second internal channel extends along the outside of the base 30 from proximal to distal. The second internal channel opens to the outside of the base 30 at a position proximal to the tissue clip holding portion 32. That is, both the proximal and distal ends of the second channel open to the outside of the base 30. Preferably, the second work channel terminal 3 is inserted into or insertable into the second work channel 3b and is adjacent laterally to the tissue clip holding portion 32 on the outside of the base 30. 8 An expansion device 39, such as a balloon catheter, is provided through the opening.
[0061] The base 30 further has a distal leading edge that includes two diametrically opposed recesses 40 extending proximal to allow the folding of patient tissue drawn into the interior 36. A projection is provided between the recesses 40, and the outer surfaces of the recesses 40 are formed as expansion support surfaces 41 for holding the opening and spreading out the respective foldable tissue clips 33. The tissue clips 33 have claws, which are adapted to fold toward each other when the tissue clips 33 are pushed away from the tissue clip holder 32. Thus the claws are supported on the expansion support surfaces 41. One of the expansion support surfaces 41 is located circumferentially, in particular, where the distal second channel end opens.
[0062] The first and second external working channels 3a and 3b are preferably the external working channel 3 of the adaptable working channel device 1 shown in Figure 1. Thus, the adaptable working channel device 1 and the tissue clip application adapter 29 shown in Figure 4 form a surgical instrument system further comprising a gripping instrument 37 and an expansion instrument 39. [Explanation of symbols]
[0063] 1. Adaptable work channel device 2 Endoscope 3 Working Channels 3a First external working channel of the surgical instrument system 3b Second external working channel of the surgical instrument system 4 Linked Bushings 5. First mounting coupling 6. Second mounting coupling 7. Handle mounting sleeve 8 Mounting rails 9. Access opening / engaging member of the second mounting coupling 10 Support edge 11. Gap in the longitudinal direction 12 Undercut / Receptacle 13 Radial projections 14 Strap holder 15 closure straps 16. Strap fixing part 17 Closure section 19. Biopsy valve 20 Lure Adapters 21 Spacer / Center Bar 22 Linked Web 23 Clamp Branch 24 Clamp branch section 25 Hook-shaped projection / engaging member of the first mounting coupling 26 Contact surface 27 Operating branch section 28 Convex rim of the connecting web 29. Tissue clip application adapter 30 Bush-like substrate 31 Proximal endoscope holding section 32. Tissue clip holding section 33 tissue clips 34 Sliding bush 35. First adapter-integrated work channel terminal 36 Internal 37 Grasping instruments 38 Second adapter-integrated work channel terminal 39. Dilatation devices / balloon catheters 40. Concave of the distal anterior margin 41 Expanded support surface
Claims
1. An adaptable working channel device for adaptive attachment to an endoscope, The first mounting coupling has at least one external working channel connected to its proximal end, An adaptable work channel device comprising: a sleeve-shaped handle mounting sleeve formed separately from the work channel and provided to surround the endoscope shaft or endoscope handle, the handle mounting sleeve having at least one second mounting coupling on its radial outer circumference configured to releasably engage with the first mounting coupling; The first mounting coupling is, It has two clamp branches, which are spring-biased, clamp-engaged, and hinge-connected to each other like clothespins, to form the respective clamp branch section and the manually operated branch section. The second mounting coupling is, The handle mounting sleeve has a mounting rail that extends in the longitudinal direction, An adaptable work channel device having or having formed at least one undercut, which is sized to be wrapped around the clamp branch of the first mounting coupling in a shape that adapts to it.
2. The adaptable work channel device according to claim 1, wherein the clamp branches are elastically connected to each other via connecting webs extending diagonally or perpendicularly to the clamp branches, at a position between the clamp branch portion and the working branch portion of the corresponding clamp branch.
3. The connecting web is wider than the clamp branch so as to protrude laterally beyond the clamp branch. The handle mounting sleeve extends laterally with respect to its longitudinal direction and forms at least two support edges spaced apart in the longitudinal direction. The adaptable work channel device according to claim 2, wherein the distance between the support edges substantially corresponds to the width of the connecting web.
4. The first mounting coupling forms a connecting bush, The working channel is connected to the distal end of the connecting bush. The adaptable work channel device according to any one of claims 1 to 3, wherein a Luer adapter or an integrated biopsy valve is formed at the proximal end of the connecting bush.
5. The adaptable work channel device according to any one of claims 1 to 4, wherein the mounting rail of the handle mounting sleeve forms a plurality of undercuts that are offset from each other in the longitudinal direction.
6. The adaptable work channel device according to any one of claims 1 to 5, wherein the handle mounting sleeves are offset from each other in the circumferential direction of the handle mounting sleeves.
7. The adaptable work channel device according to any one of claims 1 to 6, wherein the sleeve for mounting the handle has a receiving port configured to receive the radial projection of the endoscope shaft or the endoscope handle.
8. The adaptable work channel device according to any one of claims 1 to 7, wherein the handle mounting sleeve has a continuous longitudinal gap and is at least partially elastic so that the handle mounting sleeve can be snap-fitted onto the endoscope handle or the endoscope shaft like a fastener.
9. The aforementioned handle mounting sleeve is The first end of the closure strap is attached to or can be attached to a strap holder, The adaptable work channel device according to claim 8, further comprising a strap fixing portion configured to hold the closing portion of the closure strap at a position where the closure strap is wrapped around the handle mounting sleeve so as to traverse the longitudinal gap.
10. A surgical instrument system for endoscopes, The adaptable work channel device according to claim 1, A tissue clip application adapter configured as a cap attachment for a medical endoscope, comprising a bush-shaped base having a proximal endoscope holding portion configured to be attached to the distal head of the medical endoscope, and the tissue clip holding portion further having the tissue clip holding portion configured to support the tissue clip on its radial outer surface so that the tissue clip can be removed distally from the tissue clip holding portion, and a first internal channel extending through the base such that the proximal first channel end opens outside the base and the distal first channel end opens inside the base A tissue clip application adapter comprising a first adapter-integrated work channel terminal, wherein the second adapter-integrated work channel terminal has a second internal channel extending along the base such that a proximal second channel end and a distal second channel end open outside the base, and the distal second channel end is positioned proximal to the tissue clip holding portion, wherein the first adapter-integrated work channel terminal of the tissue clip application adapter is the adaptable work channel device as a first external work channel. A tissue clip application adapter is coupled to the distal end of the external work channel, A gripping device inserted distally through the first external working channel so as to be able to move forward through the interior of the base of the tissue clip application adapter, or configured to be inserted therein A second external work channel having a third mounting coupling at its proximal end for mounting to the handle mounting sleeve of the adaptable work channel device, and having its distal end coupled to the second adapter-integrated work channel terminal of the tissue clip application adapter, A surgical instrument system comprising: an expansion device inserted distally into or configured to be inserted into the second external working channel so as to be provided radially outward from the base of the tissue clip application adapter.