Instrument holding device, assembly set, instrument system and method for assembly and disassembly

Abstract

The invention relates to an instrument holding device (1) for fixing medical instruments (2, 3) along a common longitudinal axis (L), an assembly set for fixing same, an instrument system and a method for the disassembly thereof. The instrument system has a holding device (10), a holding arm (12) and a coupling element (11) connecting the two. The holding arm (12) defines an arm axis (A), and the coupling element (11) has a fastening apparatus for connecting to the holding arm (12) coaxially and rotationally about the arm axis (A). For receiving the instruments (2, 3), the holding device (10) has a distal holding element (101) and a proximal holding element (102) which is pivotably connected to the coupling element (11) about a pivot axis (S) orthogonal to the longitudinal axis (L) and the arm axis (A). The holding elements (101, 102) form a bearing portion (100) which has a cylinder axis which corresponds to the pivot axis (S), and has a projection (10.3) on each of the two sides in the pivot axis (S). The coupling element (11) has two coupling arms (11.1), which have a receiving opening (11.3) for engaging with the projection (10.3), wherein each projection (10.3) has a partially cylindrical guide face (10.5) which is formed on the projection (10.3) at least on one side of the distal holding element (101) and has an insertion chamfer (10.4) on one side of the proximal holding element (102). The coupling arms (11.1) are elastically deformable in the radial direction with respect to the arm axis (A) parallel to the pivot axis (S) and are rigid in each direction orthogonally with respect to the pivot axis (S), and each receiving opening (11.3) is formed with a hollow-cylindrical guide face (11.7) for supporting in each case one of the projections (10.3).

Description

[0001] INSTRUMENT HOLDING DEVICE, MOUNTING SET, INSTRUMENT SYSTEM AND METHOD FOR MOUNTING AND DISMOUNTING

[0002] The invention relates to an instrument holding device for securing medical instruments and to an assembly kit from which the instrument holding device can be assembled. Furthermore, the invention relates to an instrument system comprising the instrument holding device and the medical instruments, and to a method for assembling and disassembling the medical instruments and the instrument holding device.

[0003] It is known from the state of the art to use devices for holding medical instruments during surgical procedures so that fewer medical personnel are needed to hold the instruments on the patient and the risk of unwanted movement of the medical instruments is reduced.

[0004] EP 3 772 345 B1 describes a device for the simultaneous fixation of medical instruments and a system consisting of this device, a trocar, and an endoscope. The device comprises a holding section and a coupling element, which is connected on the one hand to a holding arm and on the other hand pivotably holds the holding section. A sliding element displaceable in the coupling element allows pivoting of the holding section in a first position and fixes the holding section in a second position with respect to rotation about the pivot axis. The holding section is formed by two holding elements which, when joined together, define a passage opening designed to accommodate the medical instruments. For attachment to the holding arm, the coupling element has a flange which is fastened to the holding arm with a coupling element by means of a thread or a bayonet lock.In order to realize the mounting of the holding section on the coupling element, the coupling element has two recesses, each with a winding insertion slot, which face each other, and the holding section has a projection on two opposite sides, which must be threaded through the winding insertion slot to engage with a recess.

[0005] Since the coupling element is coupled to the holding section on the patient while the holding section is already attached to a first medical instrument, threading it into the insertion slot is a complicated assembly process. This mounting of the holding section on the coupling element does not provide good bearing properties in terms of concentricity and can lead to jamming or sticking. Furthermore, unfavorable relative movements of the holding section with respect to the coupling element can lead to unintentional release when the projection passes through the insertion slot.

[0006] Based on this prior art, it is the object of the present invention to provide an improved instrument holding device which allows simple assembly

[0007] - in the sense of fixing medical instruments to the holding device - and disassembly with as few manual steps as possible.

[0008] This object is achieved by an instrument holder device having the features of claim 1.

[0009] A further object is to enable simple assembly and disassembly of different medical instruments to be fixed along a common longitudinal axis. This object is achieved by an assembly set having the features of claim 17.

[0010] The still further object of creating a combination of medical instruments and a corresponding fixing holding device which can be assembled and disassembled more easily is achieved by the instrument system according to claim 18.

[0011] The still further object of providing an improved method for mounting medical instruments along a common longitudinal axis on an instrument holding device is provided by the method according to claim 19.

[0012] Finally, the object of improved disassembly of medical instruments from an instrument holding device is achieved by the method according to claim 22.

[0013] Further developments of the devices and methods are set out in the corresponding subclaims.

[0014] EP 3 772 345 B1 likewise comprises a holding section with an instrument guide element and a coupling element, which is connected on the one hand to a holding arm and on the other hand pivotably holds the holding section. A sliding element displaceable in the coupling element allows pivoting of the holding section in a first position and fixes the holding section in a second position with respect to rotation about the pivot axis. The holding section is formed by two holding elements, each having a base element and an arm element, which, when joined together, delimit a passage opening which is designed in the region of the base elements to receive a second medical instrument or the trocar. In the region of the arm elements, the passage opening is delimited by mutually facing support surfaces at the ends of the arm elements and is designed to receive a first medical instrument or the endoscope.The instrument guide element has an opening that is concentric with the passage opening when the guide element is in contact with the support surfaces and can be easily clipped onto the arm elements in an interchangeable manner.

[0015] This guide element allows the device to be adapted to medical instruments of different diameters by providing different guide elements with openings of different diameters. Thus, each guide element can only fix medical instruments of a specific diameter, to which the opening of the guide element is matched, with a tolerance of less than 0.5 mm. A guide element designed for a diameter of 5.0 mm cannot be used to fix an instrument with a diameter of 4.6 mm.

[0016] Based on this prior art, it is the object of the present invention to provide an improved holding device for an instrument holding device for fixing medical instruments.

[0017] This object is achieved by a holding device having the features of claim 1. A further object is to provide an improved combination of medical instruments and a corresponding, fixing holding device, which is achieved by the instrument holding device according to claim 7.

[0018] The still further object of providing an improved method for guiding and fixing medical instruments along a common longitudinal axis on an instrument holding device is provided by the method according to claim 8.

[0019] A first embodiment of an instrument holding device according to the invention, which is designed to fix medical instruments along a common longitudinal axis, comprises a holding device, a holding arm, and a coupling element. This connects the holding device and the holding arm, which defines an arm axis. The holding arm is coaxially connected to a fastening device of the coupling element so as to be rotatable about the arm axis. The holding device, which has a distal holding element and a proximal holding element for receiving the medical instruments, is pivotally connected to the coupling element about a pivot axis that is orthogonal to the longitudinal axis and the arm axis, and the two holding elements provide a bearing section that is cylindrically shaped at least on its proximal side. The axis of the cylinder (cylinder axis) corresponds to the pivot axis.The bearing section has a projection on each side of the pivot axis or coaxially therewith, and the coupling element has two coupling arms diametrically parallel to the arm axis, each of which has a receiving opening at a coupling end section that serves to engage with the projection. The coupling end sections are spaced apart from one another to receive the cylindrical bearing section. Each of the projections has a partially cylindrical guide surface that is formed on the projection at least on the side of the distal holding element, and has an insertion bevel on the side of the proximal holding element. The two coupling arms are elastically deformable in a direction radial to the arm axis, parallel to the pivot axis, and rigid in any direction orthogonal to the pivot axis, and are not deformable even under the forces normally encountered.Each receiving opening is formed with a hollow cylindrical guide surface for supporting one of the projections corresponding to its partially cylindrical guide surface.

[0020] This design of the instrument holding device according to the invention advantageously results in a good mounting of the holding section on the coupling element. The mounting with the cylindrical guide surfaces advantageously results in good concentricity, preventing tilting or jamming during alignment.

[0021] Another advantage is the lateral mounting of the coupling element to the holding device: By simply sliding the coupling arms onto the holding device and locking them into place, the process is quick, efficient, and easy. It is particularly elegant because it can be performed while the trocar is already in place on the patient. This is where the holding device is attached to the already inserted first instrument, the trocar.

[0022] Disassembly is also very easy and simple by simply pushing the coupling arms further in the same direction - this corresponds to a relative movement of the holding device in the proximal direction. During operation, this is advantageously prevented by a pressure element, because according to a further embodiment of the device according to the invention, a pressure element connected to an actuator arranged in the holding arm extends from the holding arm through the coupling element, which pressure element is displaceable along the arm axis and can be arranged in at least three positions. These include

[0023] - a first distal position as a clamping position, in which the pressure element contacts the cylindrical storage section with a first force, which presses the two holding elements together to clamp the held instruments and fixes the holding device with respect to its rotational position about the pivot axis, and

[0024] - a second central position as an alignment position, in which the pressure element contacts the cylindrical support section with a second force that is smaller than the first force, or which has a first distance from the cylindrical support section that is smaller than the dimension of the insertion bevel in the radial direction of the cylindrical support section, in order to prevent the holding device from being released by displacement in the proximal direction. The pressure element allows the two holding elements to be released from one another to change the held instruments or to rotate them about the longitudinal axis and pivot the holding device about the pivot axis;

[0025] - a third proximal position as a disassembly position, in which the pressure element is spaced from the cylindrical bearing section by a second distance that is greater than the dimension of the insertion bevel in the radial direction of the cylindrical bearing section. The pressure element allows a relative movement of the holding device in the proximal direction and release of the connection between the coupling element and the holding device.

[0026] According to yet another embodiment of the device according to the invention, the coupling element has a coupling base from which the coupling arms extend along the arm axis. The fastening device is arranged on a side of the coupling base facing away from the coupling arms. The fastening device is formed integrally with the coupling base, or alternatively, it can be designed as a fastening adapter that can be connected to the coupling base.

[0027] According to a further embodiment of the device according to the invention, the coupling element has a reinforcement arm or preferably two reinforcement arms for each coupling arm. This arm or these arms extend circumferentially along the arm axis adjacent to each coupling arm and are designed to stabilize the associated coupling arm in the direction radial to the arm axis and to prevent its elastic deformation and thus unwanted bending up to a limit force predetermined for assembly and disassembly.

[0028] According to yet another embodiment of the device according to the invention, each reinforcement arm engages behind the associated coupling arm at least in sections, providing stability, on a side facing away from the arm axis. Additionally or alternatively, each reinforcement arm has a guide tip that extends beyond the coupling end section and is designed to guide the projection relative to the receiving opening during assembly.

[0029] The reinforcing arm may be formed integrally with the coupling base.

[0030] According to yet another embodiment of the device according to the invention, the coupling end section of the coupling arms has a flattened insertion section at the end for guiding the projection during assembly. This insertion section is designed to point in the direction of the arm axis on one side and is delimited by two converging guide shoulders. Additionally or alternatively, a disassembly bevel can be provided on a side of the receiving opening facing away from the end to guide the projection during disassembly. This bevel widens conically from the hollow cylindrical guide surface.

[0031] Furthermore, according to another embodiment of the device according to the invention, each coupling arm can have a so-called thin region, i.e., a region with a narrow cross-section that enables elastic deformability and encompasses the coupling end section with the receiving opening. Furthermore, it can have a solid region for connection to the fastening device.

[0032] The two holding elements, which, when joined to form the holding device, define a passage opening orthogonal to the pivot axis and designed to receive the medical instruments along the common longitudinal axis, each have a base element and an arm element. In turn, the two base elements, when the holding elements are joined to form the holding device, provide the storage section. The passage opening in the area of ​​the base elements is designed to receive a first medical instrument, and in the area of ​​the arm elements, it is designed to receive a second medical instrument; it is defined by the mutually facing contact surfaces at the ends of the arm elements.

[0033] Furthermore, according to another embodiment of the device according to the invention, a guide element arranged at the ends of the arm elements and particularly skillfully abutting the contact surfaces can be provided, which has an opening coaxial with the passage opening for receiving the second medical instrument.

[0034] Finally, according to another embodiment of the device according to the invention, the coupling element can be designed to arrange a sterile disposable cover for covering the holding arm.

[0035] Furthermore, a piston of the pressure element, coaxial with the arm axis, can extend through the fastening device and be displaceable along the arm axis between a mounting position accommodated in the fastening device and a connecting position. In this position, the piston extends into the holding arm to be coupled to an actuator.

[0036] According to a further embodiment of the device according to the invention, the fastening device has a fastening section on the holding arm for fastening the coupling element. This section can be designed as a truncated cone element offset by a neck section, wherein the truncated cone element tapers towards its free end. The neck section is preferably a conical neck section that tapers towards the truncated cone element.

[0037] The holding arm can have at least two or even more gripping arms evenly distributed around the circumference with inwardly projecting gripping lugs at the free ends of the gripping lugs, wherein the gripping arms are elastically bendable in the radial direction or rotatably mounted on the holding arm. The gripping lugs correspond to the neck section in terms of their design for engaging behind the truncated cone element. Furthermore, according to another embodiment of the device according to the invention, the two or more gripping arms can be displaced relative to a housing end section of the holding arm along the arm axis between an assembly position protruding from the housing end section and a fastening position received in the housing end section.A locking sleeve is provided, which is movable relative to the holding arm and the fastening device along the arm axis between an assembly position, in which the locking sleeve is arranged on the fastening device or on the holding arm, and a so-called locking position. In this locking position, the locking sleeve secures the engagement of the gripping arms with the fastening section.

[0038] Furthermore, according to yet another embodiment of the device according to the invention, the fastening device for fastening the coupling element to the holding arm can have a fastening section designed as a mold connecting element. For this purpose, the holding arm can have a counter-mold connecting element designed to correspond to the - quasi-positive - engagement with the mold connecting element. The mold connecting element and the counter-mold connecting element can be joined in a joining direction orthogonal to the arm axis. It is further proposed to provide at least one securing device that secures the - quasi-positive - engagement of the mold connecting element with the counter-mold connecting element with respect to the joining direction.

[0039] Furthermore, according to another embodiment of the device according to the invention, it can be provided that the securing device, or several of them, is / are formed by at least one securing pin which is / are displaceable with respect to the holding arm and the fastening device parallel to the arm axis between an assembly position in which the securing pin or pins is / are received in the fastening device, and in a securing position in which it / they secure the engagement of the mold connecting element with the counter-mold connecting element.

[0040] For this purpose or alternatively, the securing device can be formed by a securing sleeve, which is considered particularly advantageous. This securing sleeve is displaceable with respect to the holding arm and the fastening device along the arm axis between an assembly position, in which the securing sleeve is arranged on the fastening device or on the holding arm, and a fastening position. In this position, the securing sleeve secures the engagement of the mold connecting element with the counter-mold connecting element.

[0041] For this purpose or alternatively, it can be provided that the or a securing device is provided by a housing end section of the holding arm, which is relatively displaceable with respect to the counter-mold connecting element along the arm axis between an assembly position protruding from the housing end section and a securing position accommodated in the housing end section. The housing end section secures the engagement of the mold connecting element with the counter-mold connecting element.

[0042] The mold connecting element can be formed by a profiled recess extending orthogonally to the arm axis through the fastening section, and the counter-mold connecting element can be provided by a profiled rail section extending orthogonally to the arm axis on the holding arm. The mold connecting element and the counter-mold connecting element preferably form a dovetail-like connection.

[0043] Furthermore, according to yet another embodiment of the device according to the invention, the fastening device for fastening the coupling element to the holding arm can have a fastening section designed as a flange collar offset by a cylindrical neck section. This has a circular groove on the front side coaxial with the arm axis. The holding arm has a connecting piece with a radially inwardly offset, U-shaped distal guide section, which delimits a U-shaped guide groove on the inside, which is designed to receive the flange collar. The flange collar and the U-shaped guide section can be joined in a joining direction orthogonal to the arm axis.It is proposed that at least one resilient pressure piece is arranged in the connecting piece parallel to the arm axis and positioned such that a pressure ball of the pressure piece engages in the circular groove when the flange collar is received in the U-shaped guide groove of the guide section.

[0044] A further embodiment of the device according to the invention can then provide that the connecting piece has a radial groove that extends radially from a central passage opening for an actuator-side piston section through an insertion area that the U-shaped guide section leaves free or open. The radial groove is designed to accommodate and guide a piston section of the pressure element that protrudes beyond the end face of the flange collar when the flange collar is inserted into the U-shaped guide section.

[0045] Another device according to the invention is a mounting set for securing medical instruments along a common longitudinal axis, which consists of the following components forming the set. Naturally, the set can always comprise at least one, but also several, of these components, which can be designed to correspond to one another but differently with respect to components of the same type. Thus, the set always comprises at least one holding device, a holding arm, and a coupling element, wherein the holding device can be connected to the holding arm via the coupling element and thus forms an instrument holding device according to the invention as described above.

[0046] Yet another device according to the invention is an instrument system comprising an instrument holding device disclosed herein and furthermore at least two medical instruments, wherein the instrument holding device fixes the medical instruments along a common longitudinal axis.

[0047] Finally, a method according to the invention for fixing medical instruments along a common longitudinal axis using the instrument holding device according to the invention as claimed herein is disclosed. It comprises the steps

[0048] A) Connecting the coupling element and the holding arm,

[0049] B) Arranging and fastening the holding device to a first medical instrument, which is in particular a trocar placed on the patient and defines the longitudinal axis,

[0050] C) Coupling the coupling element attached to the holding arm to the holding device by performing the following: - C1 ) Pushing the coupling arms of the coupling element onto the cylindrical bearing section from the side facing the proximal holding element, wherein the coupling arms are aligned orthogonally to the pivot axis,

[0051] - 02) Aligning the coupling arms and the cylindrical bearing section with respect to the projection so that each coupling end section of the coupling arms points to the insertion bevel of the respective projection,

[0052] - 03) Pushing the coupling end sections along the insertion bevel of the respective projection under elastic deformation of the coupling arms until the receiving opening in the coupling end section reaches the projection,

[0053] - 04) elastic reshaping of the coupling arms while receiving the projections in the receiving openings of the coupling end sections,

[0054] - 05) Providing the rotatable mounting of the cylindrical mounting portion of the holding device with respect to the coupling arms by guiding the partially cylindrical guide surface of the projections in the hollow cylindrical guide surface of the receiving openings, wherein the pressure element is arranged along the arm axis in the second position,

[0055] D) Arranging a second medical instrument along the longitudinal axis relative to the first medical instrument and fixing the device with respect to a rotational position of the holding device about the pivot axis by arranging the pressure element along the arm axis in the first position. The second instrument is preferably an endoscope that is inserted into the trocar.

[0056] According to a further embodiment of the method according to the invention, this provides that the connection of the coupling element and the holding arm in step A) comprises the steps

[0057] A1 ) Bending or pivoting the at least two circumferentially evenly distributed gripping arms on the holding arm in the radial direction and pushing them onto the truncated cone element of the coupling element until the inwardly projecting gripping lugs of the gripping arms engage behind the truncated cone element and engage in the neck section; or

[0058] A2) Joining the mold connecting element on the coupling element and the counter-mold connecting element on the holding arm in the joining direction orthogonal to the arm axis and securing the quasi-positive engagement of the mold connecting element with the counter-mold connecting element with respect to the joining direction by at least one securing device; or

[0059] A3) Inserting the flange collar on the coupling element in the joining direction orthogonal to the arm axis into the U-shaped guide groove of the guide section of the connecting piece on the holding arm and securing the - quasi positive - engagement of the flange collar in the U-shaped guide groove of the guide section with respect to the joining direction by at least one resilient pressure piece by engagement of the ball of the pressure piece in the circular round groove on the front side of the flange collar.

[0060] According to yet another embodiment of the method according to the invention, this provides the step before or after connecting the coupling element and the holding arm in step A):

[0061] A4) Arranging a steep disposable sheath on the coupling element and pulling the sterile disposable sheath over the holding arm; and / or wherein the arranging and fastening of the holding device in step B) comprises the step

[0062] B1) arranging a guide element at the ends of the arm elements of the holding device and providing an opening coaxial with the passage opening for receiving the second medical instrument. Furthermore, a method according to the invention for disassembling an instrument system according to the invention and as described above is disclosed, comprising the steps:

[0063] D') Arranging the pressure element along the arm axis in the second position and releasing the second medical instrument and removing it from the arrangement along the longitudinal axis with respect to the first medical instrument,

[0064] C') Uncoupling the holding device from the coupling element attached to the holding arm by

[0065] - C6) Arranging the pressure element along the arm axis in the third position,

[0066] - C7) Carrying out a relative movement of the holding device in the direction of the coupling element along the arm axis, bending the coupling arms by

[0067] Inserting the respective projection along the insertion bevel until the projections have emerged from the receiving openings in the coupling end sections; it should be noted that when dismantling the trocar placed on the patient, the coupling element or the coupling arms are moved further in the distal direction,

[0068] B') Detaching the holding device from the first medical instrument, and A') Separating the coupling element from the holding arm.

[0069] In a further embodiment of the holding device according to the invention, it is designed to receive medical instruments along a common longitudinal axis and to couple to a coupling element of an instrument holding device fastened to a holding arm. The holding device has a distal holding element with a distal arm section and a proximal holding element with a proximal arm section. The two holding elements, in an arrangement in which they are joined together to form the holding device, delimit a passage opening for receiving the medical instruments along the longitudinal axis. The distal arm element and the proximal arm element are each connected at a free end section by a guide element for receiving a first medical instrument. The free end section of the proximal arm element is angled in the direction of the longitudinal axis and forms a contact surface facing the longitudinal axis.

[0070] According to the invention, the guide element for receiving the first medical instrument is an instrument adapter with a bore coaxial with the through-opening. Arranged therein is a hollow cylindrical sleeve that is elastically deformable in the direction radial to the longitudinal axis and defines an adapter opening aligned with the through-opening.

[0071] Furthermore, the instrument adapter has a proximal receiving portion which delimits a receiving opening which is designed to receive the angled end portion of the proximal holding element, wherein the receiving opening extends through the instrument adapter in a direction radial to the longitudinal axis as far as the bore, wherein the receiving opening is separated from the adapter opening by the hollow cylindrical sleeve.

[0072] Preferably, the receiving opening, which is delimited by the proximal receiving section, is designed for the positive reception of the angled end section of the proximal holding element. "Positive reception" here means "delimited by a cross-sectional profile that is shaped complementarily to a cross-sectional profile of the angled end section of the proximal holding element." The holding device according to the invention advantageously allows the holding of instruments with shaft diameters within a tolerance range of +1.0 mm to -1.5 mm of a nominal diameter. Furthermore, the first medical instrument is advantageously protected from damage by the separate sleeve during the clamping process and offers a secure holding function for a second medical instrument that is inserted into or connected to a second, already fixed instrument.Due to the positive reception of the angled end section of the proximal holding element in the receiving opening of the proximal receiving section, the clamping force can be transferred to the sleeve via this first arm element.

[0073] The holding device enables a holding function of parts of the instrument complex, which consists of the first instrument, which can be fixed by the instrument adapter, and a second medical instrument, in particular a trocar, which is received in the passage opening of the holding device.

[0074] According to a further embodiment of the holding device according to the invention, the adapter opening for receiving the first medical instrument has a variable diameter due to the elastic deformability of the hollow cylindrical sleeve in the radial direction. The diameter is preferably variable within a range of +1.0 mm to -1.5 mm, based on an initial diameter of the adapter opening in an undeformed state. The hollow cylindrical sleeve can be designed as a flexible element and consist of silicone, for example. The clamping force can thus be gently transmitted to the first medical instrument to be held and the sleeve can adapt to the outer surface of the first medical instrument in order to evenly distribute the clamping force. The first medical instrument is thus also protected from damage by the holding device.

[0075] According to yet another embodiment of the holding device according to the invention, the free end section of the distal holding element extends parallel to the longitudinal axis and has a bevel on a side facing the longitudinal axis. In addition, the instrument adapter has a distal clamping section which has a receiving opening parallel to the longitudinal axis and is designed to receive the end section. Furthermore, the distal clamping section delimits a spring chamber which is connected to the receiving opening and extends in the direction radial to the longitudinal axis. A spring is preloaded in the spring chamber, which is fastened at a proximal end in the instrument adapter and is operatively connected at a distal end to the end section of the distal holding element, by means of which the end section strikes the receiving opening on the distal side.The holding device can be assembled quickly and easily by inserting the bevel of the free end section of the distal holding element behind, i.e. on the distal side of the spring permanently installed in the instrument holder. This simplifies use of the holding device on the patient, on whom a trocar (as the second instrument) is generally placed first, to which the holding device is then attached. This design of the holding device with the bevel on the distal holding element and the spring in the instrument adapter allows the holding element to be easily inserted into the instrument adapter so that it remains securely in place. In this way, all distal parts of the holding device can be fastened around the trocar and hold themselves in place until the holding arm is attached to it.The spring then presses the distal retaining element against a stop provided by the clamping section on the distal side of the receiving opening, ensuring a frictional connection. Furthermore, inserting the distal retaining element into the distal receiving section increases the spring preload to the desired level. The preload is defined by the spring constant, or spring hardness or spring characteristic, and by the spring travel when the distal retaining element is inserted. Different preloads can be achieved by using springs with different spring constants or by changing the spring travel.

[0076] By preloading the spring with a defined force, a clamping force is determined for securing the medical instruments in the holder. This causes the instrument adapter to behave like a rigid block until the first medical instrument is clamped with the clamping force defined by the spring. The maximum clamping force applied to the first medical instrument is limited by the separately inserted, flexible sleeve, which protects the first medical instrument.

[0077] According to yet another embodiment of the holding device according to the invention, the bore in the instrument adapter has at least one cylindrical guide section which is aligned with the adapter opening and adjoins the sleeve, the diameter of which section corresponds at least to the initial diameter of the adapter opening. The guide section can adjoin the sleeve at the top (i.e. on a side facing away from the through-opening) and at the bottom (i.e. facing the through-opening); alternatively, it is also possible for it to be present only at the top or only at the bottom. In addition, i.e. adjoining a cylindrical guide section, or alternatively, i.e.Instead of a cylindrical guide section, the bore can have a conical guide section aligned with the adapter opening, located on a side facing away from the through-opening and tapering funnel-like toward the sleeve to a diameter that corresponds at least to the initial diameter of the adapter opening. This allows the inserted instrument part of the medical instrument to be held to be inserted into the sleeve more easily.

[0078] According to yet another embodiment of the holding device according to the invention, the distal holding element has a distal base section connected to the distal arm section, and the proximal holding element has a proximal base section connected to the proximal arm section, wherein the passage opening in the region of the base elements is designed to receive a second medical instrument. The two base elements have a mounting section for pivotably connecting the holding device to the coupling element, which defines an arm axis with the holding arm. Furthermore, the mounting section provides a pivot axis orthogonal to the longitudinal axis and the arm axis, wherein at least the proximal base section is cylindrically shaped for engagement with a pressure element movable along the arm axis, and a cylinder axis corresponds to the pivot axis.

[0079] Further developments of the holding device according to the invention relate to the fact that the second medical instrument is a trocar and / or that the pressure element is connected to a drive unit which is provided by the holding arm.

[0080] Another device according to the invention is an instrument holding device designed to fix medical instruments along a common longitudinal axis and comprising a holding device according to the invention, a holding arm, and a coupling element that connects the holding device according to the invention and the holding arm, which is coaxially connected to a fastening device of the coupling element so as to be rotatable about an arm axis. Advantageously, the instrument holding device allows two medical instruments to be held easily and securely along a common longitudinal axis.

[0081] Yet another device according to the invention is an instrument system comprising an instrument holding device, also according to the invention, and medical instruments arranged with the instrument holding device along a common longitudinal axis. The second medical instrument is preferably a trocar, which is guided in the passage opening of the holding device, and the first medical instrument is an endoscope, which is inserted into the trocar and fixed in the adapter opening of the instrument adapter. Other nestable instruments can also be held in the instrument holding device using the instrument system according to the invention.

[0082] Finally, a method according to the invention for guiding and fixing medical instruments along a common longitudinal axis using the instrument holding device according to the invention as claimed herein is disclosed. It comprises the steps:

[0083] A) Connecting the coupling element and the holding arm,

[0084] B) Arranging and securing the holding device to a second medical instrument defining the longitudinal axis by

[0085] B1 ) Joining the distal holding element and the proximal holding element, wherein the passage opening in the area of ​​the base sections accommodates the second medical instrument,

[0086] B2) Connecting the distal arm section to the proximal arm section by arranging the instrument adapter with the adapter opening aligned with the through-opening, wherein the angled end section of the proximal holding element is received in the positive-locking receiving opening of the proximal receiving section and the free end section of the distal holding element is received in the receiving opening of the distal clamping section parallel to the longitudinal axis, wherein the spring presses the end section in the receiving opening against a distal-side stop,

[0087] C) coupling the coupling element attached to the holding arm to the holding device,

[0088] D) Arranging a first medical instrument along the longitudinal axis with respect to the second medical instrument by inserting it into the adapter opening of the instrument adapter and clamping the first medical instrument by arranging the pressure element along the arm axis in a fixing position in which the pressure element exerts a clamping force on the proximal holding element, wherein the angled end section is moved in the receiving opening in the radial direction until the contact surface of the angled end section clamps the first medical instrument while deforming the sleeve to adapt the diameter of the adapter opening to the first medical instrument.

[0089] Further embodiments of the devices and method, as well as some of the advantages associated with these and other embodiments, will become clear and better understood from the following detailed description with reference to the accompanying figures. Items or parts thereof that are substantially the same or similar may be provided with the same reference numerals. The figures are merely schematic representations of one embodiment of the invention.

[0090] Showing:

[0091] Fig. 1 is a perspective view of an instrument system with an instrument holder device according to the invention for fixing a trocar and endoscope,

[0092] Fig. 2 is a perspective view of an instrument holder device according to the invention, Fig. 3 is a perspective view of a holding device and a separate coupling element of an instrument holder device according to the invention,

[0093] Fig. 4 is a perspective view of the holding device and the coupling element from Fig. 3 in the coupled state,

[0094] Fig. 5 is an enlarged detailed view of the bearing section of the holding device in the coupled state with the coupling element,

[0095] Fig. 6 is a longitudinal sectional view of the support section of the holding device in the coupled state with the coupling element along section line XX in Fig. 5,

[0096] Fig. 7 is an enlarged detailed view of the coupling end portion of a coupling arm of the coupling element,

[0097] Fig. 8 is a perspective view of a coupling element,

[0098] Fig. 9 is a perspective view of a fastening adapter and a holding arm according to an embodiment of the instrument holder device according to the invention,

[0099] Fig. 10 is a side sectional view of the mounting adapter from Fig. 9 attached to the support arm,

[0100] Fig. 11 is a side sectional view of the mounting adapter from Fig. 9 attached and secured to the support arm,

[0101] Fig. 12 is a perspective view of a coupling element and a holding arm according to a further embodiment of the instrument holder device according to the invention,

[0102] Fig. 13 is a perspective view of the coupling element attached to the support arm from Fig. 12,

[0103] Fig. 14 is a side sectional view of the coupling element of Fig. 12 attached and secured to the support arm,

[0104] Fig. 15 is a perspective view of a coupling element with protective cover and a holding arm according to a further embodiment of the instrument holder device according to the invention,

[0105] Fig. 16 is a perspective view of the coupling element attached to the support arm from Fig. 15,

[0106] Fig. 17 is a perspective view of a coupling element attached to a holding arm according to a further embodiment of the instrument holder device according to the invention,

[0107] Fig. 18 is a plan view of the coupling element attached to the support arm from Fig. 17,

[0108] Fig. 19 is a side sectional view of the coupling element attached to the support arm from Fig. 17,

[0109] Fig. 20 is a perspective view of the support arm of Fig. 17.

[0110] Fig. 21 is a perspective view of an instrument system with an instrument holder device according to the invention for guiding a trocar and fixing an endoscope,

[0111] Fig. 22 is a perspective view of an instrument holder device according to the invention,

[0112] Fig. 23 is a perspective view of an instrument adapter, and

[0113] Fig. 24 is a longitudinal sectional view of the instrument adapter from Fig. 23,

[0114] Fig. 25 a longitudinal sectional view of the instrument adapter according to Fig. 24 with the spring relaxed before insertion of the distal holding element.

[0115] The invention relates to an instrument holding device designed to hold medical instruments, and to an instrument system comprising the instrument holding device and the medical instruments secured thereby. Furthermore, the invention relates to an assembly set comprising a holding device, a holding arm, and a coupling element that can be assembled to the instrument holding device, as well as to a method for securing medical instruments using the instrument holding device and to a method for disassembling the instrument system.

[0116] An example of the instrument holding device 1 with the components holding device 10, coupling element 11 and holding arm 12 is shown in Fig. 2; Fig. 1 shows an instrument system 4 in which two medical instruments, here a trocar 2 and an endoscope 3, are fixed by an instrument holding device 1 along a common longitudinal axis L. The holding device 10 has a distal holding element 101 - i.e. remote from the holding arm - and a proximal holding element 102 - i.e. close to the holding arm - which are designed in a joined arrangement to receive the medical instruments 2, 3. For this purpose, the two holding elements 101, 102 in the joined arrangement delimit a passage opening 103 which defines the common longitudinal axis L.

[0117] The two holding elements 101, 102 each have, as shown in Fig. 3 to 6, a partially cylindrical base element 10.1, 10.2 and an arm element 10.6, 10.7, wherein the two partially cylindrical base elements 10.1, 10.2 provide a cylindrical storage section 100 in the arrangement of the holding elements 101, 102 joined together to form the holding device 10. In the area of ​​the base elements 10.1, 10.2, the passage opening 103 is designed to receive a first medical instrument 2 (trocar 2 in Fig. 1), while the arm elements 10.6, 10.7 are designed to receive a second medical instrument 3 (endoscope 3 in Fig. 1). For this purpose, the arm elements 10.6, 10.7 have contact surfaces facing each other at their ends (not labeled in Fig. 3, 4), which delimit the passage opening 103 in the region of the arm elements 10.6, 10.7 for receiving the second medical instrument 3.

[0118] To adapt the device 1 to second instruments 3 with different diameters, a guide element 13 (Figs. 1 and 2) can be arranged, e.g. clipped, at the ends of the arm elements 10.6, 10.7, which has an opening 13.1 coaxial with the passage opening 103 with an adapted diameter for receiving the second medical instrument 3.

[0119] The coupling element 11 connects the holding device 10 and the holding arm 12, which, together with the coupling element 11, defines an arm axis A that is orthogonal to the longitudinal axis L. The holding device 10 is pivotably connected to the coupling element 11 about a pivot axis S that is orthogonal to the longitudinal axis L and the arm axis A. The instrument holding device 1 allows the instruments 2, 3 to be fixed in any position because it provides four degrees of freedom: translation of the instruments 2, 3 along the longitudinal axis L, rotation of the instruments 2, 3 in the holding device 10 about the longitudinal axis L, and rotation with the holding device 10 about the pivot axis S and rotation with the holding device 10 and the coupling element 11 about the arm axis A.

[0120] To fix the rotational position about the pivot axis S, a pressure element 14 (seen in Figs. 5 and 6) extends through the coupling element 11 and is connected to an actuator 16 arranged in the holding arm 12 (cf. Fig. 14). This actuator actuates the pressure element 14, which is displaceable along the arm axis A between a first position (distal clamping position), in which the pressure element 14 fixes the holding device 10 with respect to its rotational position and clamps the instruments 2, 3 by pressing the holding elements 101, 102 together, and a second position (middle alignment position), in which the pressure element 14 allows the holding device 10 to be pivoted about the pivot axis S and the second instrument 3 to be changed or the second instrument 3 to be rotated or moved with respect to the longitudinal axis L.

[0121] For the pivot bearing, which is shown in detail in Fig. 3 to 6, the holding device 10 has the cylindrical bearing section 100, wherein the cylinder axis corresponds to the cylindrical shape of the pivot axis S. On both sides of the cylindrical bearing section 100 (the base surfaces of the cylinder shape), a projection 10.3 is formed which is coaxial with the pivot axis S and provides a partially cylindrical guide surface 10.5. As an assembly aid, each projection 10.3 has an insertion bevel 10.4 on the proximal side, i.e. on the side of the proximal holding element 102, so that the partially cylindrical guide surface 10.5 is formed on the projection 10.3 at least on the distal side, i.e. on the side of the distal holding element 101. When the longitudinal axis L is aligned orthogonally to the arm axis A, the insertion bevel 10.4 is directed towards the coupling element 11 or the holding arm 12.

[0122] The coupling element 11 has two coupling arms 11.1 diametrically parallel to the arm axis A, the coupling end sections 11.2 of which are spaced apart to receive the cylindrical bearing section 100. In each coupling end section 11.2 there is a receiving opening 11.3 which has a hollow cylindrical guide surface 11.7 for supporting one of the projections 10.3, so that the hollow cylindrical guide surface 11.7 of the receiving openings 11.3 is designed to correspond to the partially cylindrical guide surface 10.5 of the projections 10.3.

[0123] The coupling arms 1 1.1 are elastically deformable in a direction radial to the arm axis A and parallel to the pivot axis S and are rigid in any direction orthogonal to the pivot axis S, ie they are not deformable under the forces normally occurring in the application.

[0124] The coupling element 11 can be mounted on the holding device 10 simply by sliding the coupling arms 11.1 laterally onto the insertion slope 10.4 orthogonally to the longitudinal axis L, whereby the coupling arms 11.1 bend open until the receiving opening 11.3 reaches the projection 10.3 and the coupling arms 11.1 snap back into their original shape, so that the holding device 10 is pivotally mounted on the cylindrical bearing section 100 with the projection 10.3 in the receiving opening 11.3 about the pivot axis S.

[0125] To fix the desired rotational position about the pivot axis S, the holding device 10 is contacted by the pressure element 14 on the outer surface of the cylindrical support section 100 in the first position, wherein the pressure element 14 exerts a first force or pressure on the cylindrical support section 100 that is sufficiently large to clamp the instruments 2, 3 in place and prevent rotation of the holding device 10 with the held instruments 2, 3. In the second position, the pressure element 14 is moved in the direction of the holding arm 12, so that the pressure element 14 either contacts the cylindrical support section 100 with a second force that is smaller than the first force and allows the holding device 10 to rotate about the pivot axis S. Or the pressure element 14 is spaced from the cylindrical support section 100 by a distance that is smaller than a dimension of the insertion bevel 10.4 in the radial direction of the cylindrical bearing section 100. In this way, the connection of the holding device 10 to the coupling element 11 cannot be broken. This is because, for disassembly, the pressure element 14 can be arranged along the arm axis A in a third position in which the pressure element 14 is at a distance from the cylindrical bearing section 100 that is greater than the dimension of the insertion bevel 10.4 in the radial direction of the cylindrical bearing section 100. Then, with the longitudinal axis L aligned orthogonally to the arm axis A, the holding device 10 can be moved in the direction of the holding arm 12, so that the coupling arms 11.1 are bent up by the insertion bevel 10.4 and the coupling end sections 11.2 are spaced apart from one another so far that the projections 10.3 emerge from the receiving openings 11.3.

[0126] In order to further secure the mounting of the projections 10.3 in the receiving openings 11.3 against unintentional disassembly, the coupling element 11 has two reinforcing arms 11.8 for each coupling arm 11.1, which extend circumferentially along the arm axis A adjacent to the respective coupling arm 11.1. The reinforcing arms 11.8 are designed to stabilize the associated coupling arm 11.1 in its deformation direction, i.e., in the direction away from the arm axis A, and to prevent unintentional bending. In other words, the reinforcing arms 11.8 are designed to prevent elastic deformation of the coupling arms 11.1 up to a limit force predetermined for assembly and disassembly.

[0127] For this purpose, the reinforcement arms 11.8 can engage behind the coupling arms 11.1 in sections from the outside, i.e., on a side facing away from the arm axis A, in a stabilizing manner. Furthermore, the reinforcement arms 11.8 can be used as guide elements that facilitate the assembly of the coupling arms 11.1 on the projections 10.3 of the cylindrical bearing section 100. For this purpose, the reinforcement arms 11.8 can have a guide tip 11.9 that projects beyond the coupling end section 11.2 and is designed to guide the projection 10.3 in the direction of the receiving opening 11.3.

[0128] To further facilitate assembly, the coupling end section 11 .2 of the coupling arms 11.1 for guiding the projection 10.3 has a flattened insertion section 11 .4 at the end, shown in Fig. 7, which is designed to point on one side in the direction of the arm axis A. This flattened insertion section 11 .4 is delimited laterally by two converging guide shoulders 11 .6, which guide the projection 10.3 into the receiving opening 11 .3. To assist disassembly, the coupling end section 11 .2 of the coupling arms 11.1 for guiding the projection 10.3 has a disassembly bevel 11 .5 on a side of the receiving opening 11 .3 facing away from the free end, which widens conically from the hollow cylindrical guide surface 11 .7.

[0129] As indicated in Fig. 8, the coupling arm 11.1 can have a thin region 111, which enables elastic deformability and comprises the coupling end section 11.2 with the receiving opening 11.3. At the other end - for connection to the fastening device - the coupling arm 11.1 has a solid region 112. The division of the coupling arms 11.1 into the two regions further reduces the forces required for assembly and disassembly. The solid region 112 has a solid and stable cross-section in order to absorb lateral forces and moments. The thin region 111 has a thin and flexible cross-section in order to be able to be bent by manually applied forces without compromising stability. In the example shown, the different stability of the regions 111, 112 is achieved through different geometries, whereby the length of the coupling arm and the length of the regions also influence the stability.A long arm has only minimal stability in the direction in which it is to be bent, but very great stability in the tensile direction. The coupling element 1 1 has a coupling base 1 1.10, from which the coupling arms 1 1.1 extend along the arm axis A. For this purpose, the coupling arms 1 1.1 can be fastened to the coupling base 1 1.10 or manufactured in one piece with the coupling base 1 1.10. The reinforcing arms 1 1.8 are also formed in one piece with the coupling base 1 1.10 or can optionally be fastened thereto. On the side of the coupling base 1 1.10 facing away from the coupling arms 1 1.1, the fastening device for connection to the holding arm 12 is arranged, wherein the fastening device is preferably formed in one piece with the coupling base 1 1.10. Alternatively, the fastening device can be designed as a fastening adapter 113, which can be connected to the coupling base 11.10.Both variants are included in the different fastening devices described below, whereby the respective fastening device is not limited to the described one-piece variant of the coupling element or as a fastening adapter. Rather, the fastening devices connected in one piece with the coupling base can also be implemented as adapters, or the fastening devices described here as fastening adapters can also be formed in one piece with the coupling base 1 1.10.

[0130] A first example of a fastening device for fastening the coupling element 11 to the holding arm 12 is illustrated in Figs. 9 to 11. Here, the fastening device is shown as a fastening adapter 113, which has a base connection section 114 for connection to the coupling base 11.10 of the coupling element 11. A fastening section 11.20 of the fastening adapter 113 has a truncated cone element 11.21 offset by a neck section 11.22, which tapers towards its free end. The neck section 11.22 is also conically shaped and tapers towards the truncated cone element 11.21. The holding arm 12 has four gripping arms 12.1 distributed evenly around the arm axis A, which have radially inwardly projecting gripping lugs 12.2 at their free ends, the profile of which corresponds to the conical shape of the neck section 11.22. The gripping arms 12.1 are elastically mounted on the holding arm 12 so as to be able to bend or pivot open in the radial direction, so that the gripping arms 12.1 are bent open when pushed onto the truncated cone element 11.21 until the gripping lugs 12.2 engage behind the truncated cone element 11.21 and snap into place on the neck section 11.22.

[0131] The gripping arms 12.1, which here extend from a sleeve- or ring-shaped gripping arm base 12.5 and end with a neck collar 12.4 which, in the assembled position, forms a rear grip with the gripping arm 12.1, are connected to a mechanism for displacing the gripping arms 12.1 with respect to a housing end section 12.3 of the holding arm 12 along the arm axis A. The gripping arms 12.1 can thus be moved into an assembled position protruding from the housing end section 12.3 (Fig. 9) and into a fastening position received in the housing end section 12.3 (Fig. 10, Fig. 11). In this way, the engagement of the gripping arms 12.1 with the fastening section 11.20 in the fastening position of the gripping arms 12.1 is secured by the housing end section 12.3.

[0132] As an alternative to this variant, in which the gripping arms 12.1 are displaceable with respect to the housing end section 12.3, a securing sleeve 12.3 displaceable along the arm axis A can be used to secure the engagement instead of the end section 12.3 which is immovable with respect to the holding arm 12, while the gripping arms 12.1 are immovable in the direction of the arm axis A with respect to the holding arm 12. Analogous to Fig. 9 to 10, the securing sleeve 12.3 is retracted in the direction of the holding arm 12 for the assembly position of the gripping arms 12.1 so that the gripping arms 12.1 can bend radially outwards, and in the fastening position comes into contact with the fastening adapter 113 in order to secure the rear grip of the gripping lugs 12.2 with the truncated cone element 11.21.

[0133] Preferably, the gripper arms 12.2 are elastically deformable. For the variant with gripper arms 12.2 that are pivotably connected to a gripper arm base 12.5 about a tangential axis, the latter can be provided with a corresponding movement mechanism.

[0134] Furthermore, in Fig. 10 and 1 1 a piston 14.1 of the pressure element 14 is shown which is coaxial with the arm axis A and extends through the fastening adapter 1 13 and is displaceable along the arm axis A between an assembly position (Fig. 10), in which the piston 14.1 is received in the fastening device and does not protrude beyond the truncated cone element 1 1 .21, and a connection position (Fig. 1 1), in which the piston 14.1 extends into the holding arm 12 for coupling with an actuator 16 (cf. Fig. 14).

[0135] Figs. 12 to 14 illustrate a fastening device formed integrally with the coupling base 11.10 and the coupling arms 11.1 for fastening the coupling element 11 to the holding arm 12. The fastening section 11.20 of this fastening device is designed as a shaped connecting element 11.23 for positive engagement with a counter-shaped connecting element 12.6 of the holding arm 12. This means that the shaped connecting element 11.23 and the counter-shaped connecting element 12.6 are shaped complementarily to one another. The shape is selected such that the shaped connecting element 11.23 and the counter-shaped connecting element 12.6 can be joined in a joining direction orthogonal to the arm axis A. A securing device (not shown) secures the engagement of the mold connecting element 11.23 with the counter-mold connecting element 12.6 with respect to the joining direction.

[0136] Preferably, the securing device is provided by a securing sleeve which is displaceable with respect to the holding arm 12 and the coupling element 11 along the arm axis A between an assembly position in which the securing sleeve is arranged on the fastening device or the holding arm 12, and a securing position in which the securing sleeve secures the engagement of the mold connecting element 11.23 with the counter-mold connecting element 12.6.

[0137] In addition, the piston 14.1 of the pressure element 14 acts as a locking pin which is displaceable along the arm axis A between the mounting position accommodated in the fastening device and a connecting position in which the piston 14.1 extends into the holding arm 12 for coupling with an actuator 16 (cf. Fig. 14) and therefore prevents a release of the engagement of the mold connecting element 11.23 and the counter-mold connecting element 12.6.

[0138] As an alternative to the displaceable securing sleeve, the engagement can also be secured as described above by a housing end section 12.3 of the holding arm 12, if the counter-mold connecting element 12.6 is relatively displaceable along the arm axis A between an assembly position protruding from the housing end section 12.3 and a securing position accommodated in the housing end section 12.

[0139] In the example shown, the mold connecting element 11.23 is a profiled recess 11.23 that extends orthogonally to the arm axis A through the fastening section 11.20. The counter-mold connecting element 12.6 is a complementary profile rail section 11.23 that extends orthogonally to the arm axis A on the holding arm 12, wherein the profiled recess 11.23 and the profile rail section 12.6 provide a type of dovetail connection. Fig. 15 and 16 show a coupling element 11, on which a sterile disposable cover 15 (a so-called drape) is arranged in an area between the fastening section 11.20 and the coupling base 11.10, which is slipped over the holding arm 12 after the coupling element 11 has been fastened to the holding arm 12 in order to cover it in a sterile manner.

[0140] Another alternative fastening device for fastening the coupling element 11 to the holding arm 12 is shown in Figs. 17 to 20. The fastening section 11.20 of this fastening device has a flange collar 11.23 offset by a cylindrical neck section 11.24, which has a circular groove 11.25 on its end face that is coaxial with the arm axis A. The holding arm 12 has a connecting piece 12.6 with a radially inwardly offset, U-shaped distal guide section 12.7. This defines a U-shaped guide groove 12.9 on the inside, which is designed to receive the flange collar 11.23. The open side of the U-shaped guide section 12.7 determines an insertion area for the flange collar 11.23 and the joining direction, so that the flange collar 11.23 can be inserted into the U-shaped guide groove 12.9 of the U-shaped guide section 12.7 in a joining direction orthogonal to the arm axis A.

[0141] In addition, three spring-loaded pressure pieces 12.10 are arranged in the connecting piece 12.6, distributed along a circular line parallel to the arm axis A. In Fig. 20, two of the three pressure pieces 12.10 are visible; the third is concealed by the guide section 12.7. The three pressure pieces 12.10 are positioned such that the pressure balls 12.11 of the pressure pieces 12.10 engage in the circular groove 11.25 on the front side of the flange collar 11.23 when the flange collar 11.23 is received in the U-shaped guide groove 12.9 of the guide section 12.7. The spring-loaded pressure pieces 12.10 thus prevent the coupling element 10 from being separated from the holding arm 12 with the actuator unit without considerable force. This prevents unwanted loosening. Ideally, the groove 11.25 is designed to be larger than the ball 12.11 of the spring-loaded thrust piece 12.10. In the normal state, the thrust piece 12 exerts pressure.10 thus exerts no force on the coupling element 10, so no additional friction is created. Therefore, the coupling element 10 can be rotated around the arm axis A with minimal forces, without disturbing the surgeon's force feedback.

[0142] In addition, as can be seen particularly in Fig. 20, the connecting piece 12.6 has a radial groove 12.8, which extends radially from a central passage opening 12.12 for an actuator-side piston section 14.2 through the insertion area, which the U-shaped guide section 12.7 leaves free or open. A piston section 14.3 of the pressure element 14, which protrudes beyond the end face of the flange collar 11.23, can be received and guided in this radial groove 12.8 when the flange collar 11.23 is inserted into the U-shaped guide section 12.7, in order to come into contact with the actuator-side piston section 14.2.

[0143] With regard to the method, five processes or steps can basically be defined, with the attachment of the coupling element 11 to the holding arm 12 being the first process (step A), which can be carried out preparatory away from the patient. In a second process (step B), the holding device 10, optionally with a guide element 13, is placed around the trocar 2 and locked there or acts self-locking. In a third process (step C), the coupling element 11 attached to the holding arm 12 is then connected to the holding device 10 applied to the trocar 2. The second and third processes are carried out with the trocar 2 placed on the patient. The fourth process (step D), in which the ready-to-use instrument system 4 is obtained, relates to arranging the endoscope 3 and fixing the trocar 2 and the endoscope 3 in the desired orientation.The fifth process can be considered to be the disassembly of the instrument system 4, in which, in principle, the first four processes are carried out in reverse order, and which is therefore described below as a separate procedure with the opposite sequence of steps D', C', B', A'.

[0144] The method for fixing the medical instruments 2, 3 along a common longitudinal axis L comprises the steps of using the above-described instrument holding device 1

[0145] A) Connecting the coupling element 11 and the holding arm 12,

[0146] B) Arranging and fastening the holding device 10 to a first medical instrument 2, which can in particular be a trocar 2 placed on the patient and defines the longitudinal axis L, and if necessary B1) Arranging a guide element 13 at the ends of the arm elements 10.6, 10.7 of the holding device 10 and providing an opening 13.1 coaxial with the passage opening 103 for receiving the second medical instrument 3,

[0147] C) Coupling the coupling element 11 attached to the holding arm 12 with the holding device 10 by

[0148] - C1 ) Pushing the coupling arms 11.1 of the coupling element 11 onto the cylindrical bearing section 100 from the side facing the proximal holding element 102, wherein the coupling arms 11.1 are aligned orthogonally to the pivot axis S,

[0149] - C2) Aligning the coupling arms 11.1 and the cylindrical bearing section 100 with respect to the projection 10.3, so that each coupling end section 11.2 of the coupling arms 11.1 points to the insertion bevel 10.4 of the respective projection 10.3,

[0150] - C3) sliding the coupling end sections 11 .2 along the insertion bevel 10.4 of the respective projection 10.3 with elastic deformation of the coupling arms 11 .1 until the receiving opening 11 .3 in the coupling end section 11 .2 reaches the projection 10.3,

[0151] - C4) elastically deforming the coupling arms 11.1 while receiving the projections 10.3 in the receiving openings 11.3 of the coupling end sections 11.2,

[0152] - C5) Providing the rotatable mounting of the cylindrical mounting section 100 of the holding device 10 with respect to the coupling arms 11.1 by guiding the partially cylindrical guide surface 10.5 of the projections 10.3 in the hollow cylindrical guide surface 11.7 of the receiving openings 11.3, wherein the pressure element 14 is arranged along the arm axis A in the second position,

[0153] D) Arranging a second medical instrument 3 along the longitudinal axis L with respect to the first medical instrument 2, so that the instrument system 4 is obtained, wherein the second instrument 3 in the example shown is an endoscope 3 which is inserted into the trocar 2. After aligning the instruments 2, 3 held by the holding device 10, the device 1 is fixed with respect to the rotational position about the pivot axis S by arranging the pressure element 14 along the arm axis A in the first position.

[0154] In step B), holding elements 101, 102 are placed around the trocar 2 and hold thereto independently when the guide element 13 is arranged in step B1, which is selected to adapt the passage opening of the holding device 10 to the diameter of the second medical instrument, in this case endoscope 3. The guide element 13 is clipped, for example, to the ends of the arm elements 10.6, 10.7 of the assembled holding elements 101, 102. In step D), the pressure element 14 is pushed, for example by actuating or releasing a lever or independently by an actuator, from the second position of step C) in the distal direction in order to prevent demolding of the device 1 by preventing the necessary movement of the holding device 10 in the proximal direction. The pressure element 14 exerts a force on the cylindrical bearing section 10 from the two partially cylindrical base sections 10.1, 10.2 and clamps it.Unlike what is shown in Figures 2 to 5, it is possible that, as can be seen in Fig. 1, only the proximal base section 10.2, on which the pressure element 14 acts, is cylindrical. Its cylindrical shape is necessary in order to transmit the clamping force in every rotational position of the holding device 10. This clamping force also moves the two holding elements 101, 102 towards one another or pressed together, so that when the rotational position is fixed, the second medical instrument 3 is simultaneously clamped between the arm sections 10.6, 10.7. If the pressure element 14 is arranged in the second position, the holding device 10 is transferred to an unlocked state in which the base sections 10.1, 10.2 can move away from one another linearly in the direction of the arm axis A or open in a V-shape, for example to enable a realignment of the medical instruments 2, 3.

[0155] Depending on the variants of the fastening devices, the connection of the coupling element 11 and the holding arm 12 in step A) can optionally comprise one of the following steps.

[0156] In the fastening device described in connection with Fig. 9 to 11 with a stepped truncated cone element 11.21 and the gripping arms 12.1 on the holding arm 12, the method comprises step A1): bending or pivoting the four circumferentially evenly spaced gripping arms 12.1 on the holding arm 12 in the radial direction and pushing them onto the truncated cone element 11.21 of the coupling element 11.21 until the inwardly projecting gripping lugs 12.2 of the gripping arms 12.1 engage behind the truncated cone element 11.21 and engage in the neck section 11.22.

[0157] For the fastening device with the mold connecting element 11.23 and the counter-mold connecting element 12.6 on the holding arm 12 from Fig. 12 to 14, the connection in step A2) comprises joining the mold connecting element 11.23 on the coupling element 11 and the counter-mold connecting element 12.6 on the holding arm 12 in the joining direction orthogonal to the arm axis A and securing the positive engagement of the mold connecting element 11.23 with the counter-mold connecting element 12.6 with respect to the joining direction by means of a securing device.

[0158] The variant with flange collar 11.23 as fastening device and connecting piece 12.6 on the holding arm 12 according to Fig. 17 to 20 provides for the connection step A3) insertion of the flange collar 11.23 on the coupling element 11 in the joining direction orthogonal to the arm axis A into the U-shaped guide groove 12.9 of the guide section 12.7 of the connecting piece 12.6 on the holding arm 12 and securing the positive engagement of the flange collar 11.23 in the U-shaped guide groove 12.9 of the guide section 12.7 with respect to the joining direction by means of resilient pressure pieces 12.10, the balls 12.11 of which engage in the circular round groove 11.25 on the front side of the flange collar 11.23.

[0159] Before or after connecting the coupling element 11 and the holding arm 12 in step A), the method can, as can be seen from Fig. 15, 16, comprise step A4): arranging a sterile disposable sheath 15 on the coupling element 11 and pulling the sterile disposable sheath 15 over the holding arm 12. For example, such a sterile drape can be placed over the sterile coupling unit and then partially placed over the unsterile holding arm 12 with the actuator unit in order to enable contact during the coupling process without contamination. The arrangement of the drape prevents contact of a sterile person with an unsterile surface of the holding arm 12. In the next step, the person can, if necessary, operate buttons or levers on the holding arm 12 to complete the coupling process, ie to retract the gripping arms 12.1 engaging behind the truncated cone element 11.21 into the fastening position in the housing end section 12.3 according to A1), and in A2), e.g.B. to move the locking sleeve to secure the engagement of the mold connecting element 1 1.23 with the counter-mold connecting element 12.6 into the locking position.

[0160] The procedure for disassembling the instrument system 4 then comprises the steps

[0161] D') Detaching the second medical instrument 3 and removing it from the arrangement along the longitudinal axis L with respect to the first medical instrument 2,

[0162] C') Uncoupling the holding device 10 from the coupling element 11 attached to the holding arm 12 by

[0163] - C6) Arranging the pressure element 14 along the arm axis A in the third position,

[0164] - C7) Moving the holding device 10 in the direction of the coupling element 1 1 along the arm axis A, thereby bending the coupling arms 1 1.1 by

[0165] Inserting the respective projection 10.3 along the insertion bevel 10.4 until the projections 10.3 have emerged from the receiving openings 1 1 .3 in the coupling end sections 1 1 .2;

[0166] B') Detaching the holding device 10 from the first medical instrument 2, A') Separating the coupling element 11 from the holding arm 12.

[0167] The simple assembly and disassembly according to the invention is ensured not only by the fastening device for connecting the coupling element 11 to the holding arm 12, but in particular by the coupling of the holding device 10 to the coupling element 11 by the coupling arms 11.1, which grip the cylindrical bearing section 100 and are flexible in the direction away from the arm axis A, while being rigid in the other spatial directions. During assembly, the coupling arms 11.1 are pushed onto the cylindrical bearing section 100 and there bent open by the insertion bevel 10.4 until they snap shut again when the projections 10.3 enter the receiving openings 11.3. Due to the arrangement of the insertion bevel 10.4 and the disassembly bevel 11.5, the holding device 10 cannot be released in the distal direction, ie not in the direction of force of the actuator 16, but only if the holding device 10 is moved further in the proximal direction, ieis pushed in the direction of the holding arm 12, which is prevented during operation by the pressure element 14 located in the first or second position. Release is therefore only possible if the pressure element 14 has been retracted sufficiently far into the third position, so that unintentional release is reliably prevented during operation. One advantage of the fact that the holding device 10 must be moved in the direction of the holding arm 12 in order to be disassembled, while the direction of force of the pressure element 14 for fixing the instruments 2, 3 is opposite, is that the device 1 can be clamped with significantly greater forces than it can be disassembled.

[0168] In the alternative embodiment, the invention relates to a holding device with an instrument adapter and an instrument holding device designed to hold medical instruments. Furthermore, the alternative invention relates to an instrument system comprising the instrument holding device and the medical instruments guided and fixed thereby, and to a method for guiding or positioning and fixing medical instruments using the instrument holding device. An example of the instrument holding device 1 with its components holding device 10 with instrument adapter 13, coupling element 11 and holding arm 12 is shown in Fig. 22; Fig. 21 shows an instrument system 4 in which two medical instruments, here a trocar 2 and an endoscope 3, are arranged along a common longitudinal axis L by an instrument holding device 1.The holding device 10 has a distal holding element 101—i.e., remote from the holding arm—and a proximal holding element 102—i.e., close to the holding arm—which, in a joined arrangement, are configured to receive the medical instruments 2, 3. For this purpose, the two holding elements 101, 102, in the joined arrangement, define a passage opening 103 that defines the common longitudinal axis L.

[0169] The two holding elements 101, 102 each have, as shown in Fig. 22, a partially cylindrical base element 10.1, 10.2 and an arm element 10.6, 10.7, wherein the two partially cylindrical base elements 10.1, 10.2 provide a cylindrical storage section 100 in the arrangement of the holding elements 101, 102 joined together to form the holding device 10. In the area of ​​the base elements 10.1, 10.2, the passage opening 103 is designed to receive a second medical instrument 2 (trocar 2 in Fig. 21), while the arm elements 10.6, 10.7 are designed to receive a first medical instrument 3 (endoscope 3 in Fig. 21). For this purpose, the arm elements 10.6, 10.7 have contact surfaces 10.8, 10.9 (in Fig. 24) facing each other at their ends, which delimit the passage opening 103 in the region of the arm elements 10.6, 10.7 for receiving the first medical instrument 3.

[0170] To adapt the device 1 to first instruments 3 with different diameters, an instrument adapter 13 (Figs. 23 and 24) can be arranged, e.g. clipped, at the ends of the arm elements 10.6, 10.7, which has an opening 13.1 coaxial with the passage opening 103 with an adapted diameter for receiving the first medical instrument 3.

[0171] A sleeve 16 is arranged in the opening 13.1, which is a bore. The sleeve 16 is hollow-cylindrical and can be elastically deformed in a direction radial to the longitudinal axis L. It defines an adapter opening 16.1 aligned with the through-opening 103 of the storage section 100, in which the first instrument 3 can be received.

[0172] The instrument adapter 13 has a proximal receiving section 13.4, which in turn is delimited by an elongated receiving opening 13.5, into which the angled end section 10.4 of the proximal arm section of the proximal holding element 102 can be received. The receiving opening 13.5 extends through the longitudinal extent of the instrument adapter 13 in a direction radial to the longitudinal axis L up to the bore 13.1 and opens into the latter. The hollow cylindrical sleeve 16 is inserted into the receiving opening 13.5 and thus separates the receiving opening 13.5 from the adapter opening 16.1. If the angled end section 10.4 is received in the receiving opening 13.5, as can be seen in Figs. 23 and 24, the contact surface 10.9 is spaced from the sleeve 16. Depending on the design, it is also possible that the angled end section 10.4 touches the sleeve 16 from the outside with the contact surface 10.9.

[0173] The instrument adapter 13 has a distal clamping section 13.2, which faces away from the proximal receiving section 13.4. A receiving opening 13.3 parallel to the longitudinal axis L is provided in the distal clamping section 13.2, in which opening the free end section 10.3 of the distal holding element 101 is received. The free end section 10.3 of the distal holding element 101 extends parallel to the longitudinal axis L and has a bevel 10.8 on a side facing the longitudinal axis L, which tapers the cross-section of the distal holding element 101 toward the free end. When inserting the distal holding element 101, the bevel 10.8 on the free end section acts as an insertion bevel, along which the spring 15 slides and is simultaneously increasingly compressed and thus increasingly tensioned until the spring 15 rests against the adjoining non-beveled section of the distal holding element 101 with the stronger preload.

[0174] Formed in the distal clamping section 13.2 is a spring chamber 13.6 which is connected to the receiving opening 13.3 and extends in a direction radial to the longitudinal axis L along the longitudinal extent of the adapter 13. A spring 15 is arranged in the spring chamber 13.6 and is pretensioned by inserting the end section 10.3. The spring 15 is fastened with its proximal end 15.1 or a fastening end turn 15.1 in the body of the instrument adapter 13 and, with its distal end 15.2 or an active end turn 15.2, is operatively connected during insertion first to the bevel 10.8 and then to the end section 10.3 of the distal holding element 101. Due to the force of the spring 15, the end section 10.3 strikes the receiving opening 13.3 on the distal side. Because of the slope 10.8, the spring 15 is in the position shown in Fig.In the example shown in Figure 24, in which the spring 15 is compressed by the distal retaining element 101 in a defined preload, only a lower part of the effective end coil 15.2 is in contact with the end section 10.3. Figure 25 shows the spring 15 in a non-preloaded or less preloaded state before the distal retaining element 101 is inserted into the receiving opening 13.3.

[0175] In terms of the procedure, four steps can basically be defined, whereby

[0176] A) Connecting the coupling element 11 and the holding arm 12;

[0177] B) Arranging and fastening the holding device 10 to a second medical instrument 2, which can in particular be a trocar 2 placed on the patient and defines the longitudinal axis L;

[0178] B1) Joining together the distal holding element 101 and the proximal holding element 102, wherein the passage opening 103 in the region of the base sections 10.1, 10.2 receives the second medical instrument 2;

[0179] B2) Connecting the distal arm section 10.6 to the proximal arm section 10.7 by arranging the instrument adapter 13 with the adapter opening 16.1 aligned with the through-opening 103. The angled end section 10.4 of the proximal holding element 102 is received in the positive-locking receiving opening 13.5 of the proximal receiving section 13.4, and the free end section 10.3 of the distal holding element 101 is received in the receiving opening 13.3 of the distal clamping section 13.2, parallel to the longitudinal axis L. The spring 15 presses the end section 10.3 in the receiving opening 13.3 against a distal-side stop.

[0180] Then, in step C), the coupling element 11 attached to the holding arm 12 is coupled to the holding device 10, and

[0181] D) Arranging a first medical instrument 3 along the longitudinal axis L with respect to the second medical instrument 2 by inserting it into the adapter opening 16.1 of the instrument adapter 13 and clamping the first medical instrument 3 by arranging the pressure element 14 along the arm axis A in a fixing position in which the pressure element 14 exerts a clamping force on the proximal holding element 102. In this case, the angled end section 10.4 is moved in the radial direction in the receiving opening 13.5 until the contact surface 12.9 of the angled end section 10.4 clamps the first medical instrument s while deforming the sleeve 16 to adapt the diameter of the adapter opening 16.1 to the first medical instrument s.

[0182] In principle, the first medical instrument 3 is clamped when the distal arm section 10.6 and the proximal arm section 10.7 are pressed together, and the angled end section 10.4 presses against the sleeve 16, effectively clamping it with friction. If the required clamping force is exceeded, the spring 14 compresses and the instrument adapter 13 moves a short distance toward the beveled free end of the free end section 10.3. The effect is that the instrument adapter 13 is rigid until the necessary clamping force is built up and then behaves flexibly. As a result, the maximum force acting on the first medical instrument 3 is limited by the spring constant R of the spring: Fmax = Fmin + Imax x R, where Imax is the diameter difference between the thickest and thinnest first medical instrument 3.By adapting the sleeve 16 to the outer surface of the first medical instrument 3, the latter can be positioned almost self-retaining on the trocar 2 and cannot fall off. When the spring 14 is compressed, the first medical instrument 3 does not press against a rigid stop, but always only against the flexible sleeve 16, thus protecting the first medical instrument 3 from damage.

Claims

PATENT CLAIMS 1 . An instrument holding device (1) designed to fix medical instruments along a common longitudinal axis (L) and comprising a holding device (10) connected via a coupling element (11) to a holding arm (12) defining an arm axis (A), wherein the coupling element (11) has a fastening device for coaxial connection to the holding arm (12) such that it can rotate about the arm axis (A), and wherein the holding device (10) for receiving the medical instruments (2, 3) has a distal holding element (101) and a proximal holding element (102), and is pivotably connected to the coupling element (11) about a pivot axis (S) orthogonal to the longitudinal axis (L) and the arm axis (A), wherein the two holding elements (101, 102) provide a bearing section (100) which is cylindrically shaped at least on the proximal side, wherein a cylinder axis corresponds to the pivot axis (S),wherein the bearing section (100) has a projection (10.3) on each side of the pivot axis (S), and the coupling element (11) has two coupling arms (11.1) parallel to the arm axis (A), which have a receiving opening (11.3) for engagement with the projection (10.3) at a coupling end section (11.2), characterized in that each projection (10.3) has a partially cylindrical guide surface (10.5) formed on the projection (10.3) at least on one side of the distal holding element (101) and an insertion bevel (10.4) on one side of the proximal holding element (102), and the two coupling arms (11.1) are elastically deformable in a direction radial to the arm axis (A) parallel to the pivot axis (S) and are rigid in every direction orthogonal to the pivot axis (S),and each receiving opening (11.3) is formed with a hollow cylindrical guide surface (11.7) for supporting one of the projections (10.3) corresponding to its guide surface (10.5).

2. Device (1) according to claim 1, characterized in that a pressure element (14) extends from the holding arm (12) through the coupling element (11), which pressure element (14) is displaceable along the arm axis (A) and can be arranged in at least three positions, which include - a first position in which the pressure element (14) contacts the cylindrical bearing section (100) with a first force which presses the two holding elements (101, 102) together and fixes the holding device (10) with respect to its rotational position about the pivot axis (S), and - a second position in which the pressure element (14) contacts the cylindrical bearing section (100) with a second force which is smaller than the first force, or has a first distance from the cylindrical bearing section (100) which is smaller than a dimension of the insertion bevel (10.4) in the radial direction of the cylindrical bearing section (100), wherein the pressure element (14) allows a release of the two holding elements (101, 102) from one another and a pivoting of the holding device (10) about the pivot axis (S), - a third position in which the pressure element (14) has a second distance from the cylindrical bearing section (100) which is greater than the dimension of the insertion bevel (10.4) in the radial direction of the cylindrical bearing section (100), wherein the pressure element (14) has a relative movement movement of the holding device (10) in the proximal direction and release of the connection of the coupling element (11) to the holding device (10).

3. Device (1) according to claim 1 or 2, characterized in that the coupling element (11) has a coupling base (11.10) from which the coupling arms (11.1) extend along the arm axis (A), wherein the fastening device is arranged on a side of the coupling base (11.10) facing away from the coupling arms (11.1), wherein the fastening device is formed integrally with the coupling base (11.10) or as a fastening adapter (113) connectable to the coupling base (11.10).

4. Device (1) according to at least one of claims 1 to 3, characterized in that the coupling element (11) has a reinforcing arm (11.8) or preferably two reinforcing arms (11.8) for each coupling arm (11.1), which extends / extends circumferentially adjacent to each coupling arm (11.1) along the arm axis (A) and is / are designed to stabilize the associated coupling arm (11.1) in the direction radial to the arm axis (A) and to prevent its elastic deformation up to a limit force predetermined for assembly and disassembly.

5. Device (1) according to claim 4, characterized in that each reinforcing arm (1 1 .8) - at least partially engages behind the associated coupling arm (11.1) on a side facing away from the arm axis (A) in a stabilizing manner, and / or - has a guide tip (11.9) which projects beyond the coupling end section (11.2) and is designed to guide the projection (10.3) during assembly with respect to the receiving opening (11.3), and / or - is formed integrally with the coupling base (1 1.10).

6. Device (1) according to at least one of claims 1 to 5, characterized in that the coupling end section (11.2) of the coupling arms (11.1) - to guide the projection (10.3) during assembly, a flattened insertion section at the end (1 1 .4) which is designed to point on one side in the direction of the arm axis (A) and is limited by two converging guide shoulders (1 1.6), and / or - for guiding the projection (10.3) during disassembly, on a side of the receiving opening (11.3) facing away from the end, there is a disassembly bevel (11.5) which widens conically from the hollow cylindrical guide surface (11.7).

7. Device (1) according to at least one of claims 1 to 6, characterized in that each coupling arm (1 1.1) has a thin region (1 1 1) which provides the elastic deformability and comprises the coupling end section (11.2) with the receiving opening (11.3), and has a solid area (112) for connection to the fastening device.

8. Device (1) according to at least one of claims 1 to 7, characterized in that the coupling element (11) is designed for arranging a sterile disposable cover (15) for covering the holding arm (12).

9. Device (1) according to at least one of claims 1 to 8, characterized in that a piston (14.1) of the pressure element (14) which is coaxial with the arm axis (A) extends through the fastening device and is displaceable along the arm axis (A) between an assembly position accommodated in the fastening device and a connection position in which the piston (14.1) extends into the holding arm (12) for coupling to an actuator (16).

10. Device (1) according to at least one of claims 1 to 9, characterized in that the fastening device for fastening the coupling element (11) to the holding arm (12) has a fastening section (11.20) which is designed as a truncated cone element (11.21) offset by a neck section (11.22), wherein the truncated cone element (11.21) tapers towards its free end, wherein preferably the neck section (11.22) is a conical neck section (11.22) which tapers towards the truncated cone element (11.21), and the holding arm (12) has at least two circumferentially evenly distributed gripping arms (12.1) with inwardly projecting gripping lugs (12.2) at their free ends, wherein the gripping arms (12.1) are elastically in the radial direction are mounted on the holding arm (12) in a bendable or rotatable manner, and the gripping lugs (12.2) for engaging behind the truncated cone element (11.21) are designed to correspond to the neck section (11.22).

11. Device (1) according to claim 10, characterized in that the at least two gripping arms (12.1) are relatively displaceable with respect to a housing end section (12.3) of the holding arm (12) along the arm axis (A) between a mounting position projecting from the housing end section (12.3) and a fastening position received in the housing end section (12); or - a securing sleeve (12.3) is displaceable with respect to the holding arm (12) and the fastening device along the arm axis (A) between an assembly position in which the securing sleeve (12.3) is arranged on the fastening device or on the holding arm, and a securing position in which the securing sleeve (12.3) secures the engagement of the gripping arms (12.2) with the fastening section (11.20).

12. Device (1) according to at least one of claims 1 to 9, characterized in that the fastening device for fastening the coupling element (11) to the holding arm (12) comprises a fastening section (1 1 .20) which is designed as a mold connecting element (1 1 .23), and the holding arm (12) has a counter-mold connecting element (12.6) designed to engage with the mold connecting element (1 1 .23), wherein the mold connecting element (1 1.23) and the counter-mold connecting element (12.6) can be joined in a joining direction orthogonal to the arm axis (A), and at least one securing device is provided which secures the engagement of the mold connecting element (1 1 .23) with the counter-mold connecting element (12.6) with respect to the joining direction.

13. Device (1) according to claim 12, characterized in that the at least one safety device - is provided by at least one locking pin (14.1) which is displaceable with respect to the holding arm (12) and the fastening device parallel to the arm axis (A) between an assembly position in which the locking pin (14.1) is received in the fastening device and a locking position in which the locking pin (14.1) prevents the engagement of the mold connecting element (1 1 .23) with the counter-mold connecting element (12.6); and / or - is provided by a securing sleeve (12.3) which is displaceable with respect to the holding arm (12) and the fastening device along the arm axis (A) between an assembly position in which the securing sleeve (12.3) is arranged on the fastening device or on the holding arm (12), and a fastening position in which the securing sleeve (12.3) secures the engagement of the mold connecting element (11.23) with the counter-mold connecting element (12.6); and / or - is formed by a housing end section (12.3) of the holding arm (12), with respect to which the counter-mold connecting element (12.6) is relatively displaceable along the arm axis (A) between an assembly position projecting from the housing end section (12.3) and a securing position received in the housing end section (12); in which the housing end section (12.3) secures the engagement of the mold connecting element (11.23) with the counter-mold connecting element (12.6).

14. Device (1) according to claim 13, characterized in that the mold connecting element (11.23) is provided by a profiled recess (11.23) which extends orthogonally to the arm axis (A) through the fastening section (11.20), and the counter-mold connecting element (12.6) is provided by a profiled rail section (12.6) which extends orthogonally to the arm axis (A) on the holding arm (12), wherein the mold connecting element (11.23) and the counter-mold connecting element (12.6) preferably provide a dovetail-like connection.

15. Device (1) according to at least one of claims 1 to 9, characterized in that the fastening device for fastening the coupling element (11) to the holding arm (12) has a fastening section (11.20) which is designed as a flange collar (11.23) offset by a cylindrical neck section (11.24) and which has a circular end face coaxial to the arm axis (A). shaped circular groove (11.25), and the holding arm (12) has a connecting piece (12.6) with a radially inwardly offset, U-shaped guide section (12.7), which delimits on the inside a U-shaped guide groove (12.9) which is designed to receive the flange collar (11.23), wherein the flange collar (11.23) and the U-shaped guide section (12.7) can be joined in a joining direction orthogonal to the arm axis (A), and wherein in the connecting piece (12.6) at least one resilient pressure piece (12.10) is arranged parallel to the arm axis (A) and positioned such that a pressure ball (12.11) of the pressure piece (12.10) engages in the circular round groove (11.25) when the flange collar (11.23) is in the U-shaped guide groove (12.9) of the guide section (12.7).

16. Device (1) according to claim 15, characterized in that the connecting piece (12.6) has a radial groove (12.8) which extends from a central passage opening (12.12) for an actuator-side piston section (14.2) in the radial direction through an insertion area which the U-shaped guide section (12.7) leaves free and / or open, wherein the radial groove (12.8) is designed to receive and guide a piston section (14.3) of the pressure element (14) projecting beyond the end face of the flange collar (11.23) when the flange collar (11.23) is inserted into the U-shaped guide section (12.7).

17. Mounting set for fixing medical instruments (2, 3) along a common longitudinal axis (L), characterized in that the mounting set comprises a holding device (10), a holding arm (12) and a coupling element (11), and the holding device (10) can be connected to the holding arm (12) via the coupling element (11) and forms an instrument holding device (1) according to at least one of claims 1 to 16.

18. Instrument system (4), comprising an instrument holding device (1) and medical instruments (2, 3), characterized in that the instrument holding device (1) is an instrument holding device (1) according to at least one of claims 1 to 16 and fixes the medical instruments (2, 3) along a common longitudinal axis (L).

19. A method for fixing medical instruments (2, 3) along a common longitudinal axis (L) using the instrument holding device (1) according to at least one of claims 1 to 16, comprising the steps A) Connecting the coupling element (11) and the holding arm (12) B) arranging and securing the holding device (10) to a first medical instrument (2) defining the longitudinal axis (L), C) coupling the coupling element (11) attached to the holding arm (12) with the holding device (10) by - C1 ) sliding the coupling arms (11.1) of the coupling element (11) onto the cylindrical bearing section (100) from the side facing the proximal holding element (102), wherein the coupling arms (11.1) are aligned orthogonally to the pivot axis (S), - 02) Aligning the coupling arms (11.1) and the cylindrical bearing section (100) with respect to the projection (10.3) so that each coupling end section (11.2) of the coupling arms (11.1) points to the insertion bevel (10.4) of the respective projection (10.3), - C3) Pushing the coupling end sections (11.2) along the insertion bevel (10.4) of the respective projection (10.3) with elastic deformation of the coupling arms (11.1) until the receiving opening (11.3) in the coupling end section (11.2) reaches the projection (10.3), - C4) elastically reshaping the coupling arms (11.1) while receiving the projections (10.3) in the receiving openings (11.3) of the coupling end sections (11.2), - C5) Providing the rotatable mounting of the cylindrical mounting section (100) of the holding device (10) with respect to the coupling arms (11.1) by guiding the partially cylindrical guide surface (10.5) of the projections (10.3) in the hollow cylindrical guide surface (11.7) of the receiving openings (11.3), wherein the pressure element (14) is arranged along the arm axis (A) in the second position, D) Arranging a second medical instrument (3) along the longitudinal axis (L) with respect to the first medical instrument (2) and fixing the device (1) with respect to a rotational position of the holding device (10) about the pivot axis (S) by arranging the pressure element (14) along the arm axis (A) in the first position.

20. The method according to claim 19, wherein the connecting of the coupling element (11) and the holding arm (12) in step A) comprises the steps A1 ) Bending or pivoting the at least two circumferentially evenly distributed gripping arms (12.1) on the holding arm (12) in the radial direction and pushing them onto the truncated cone element (11.21) of the coupling element (11) until the inwardly projecting gripping lugs (12.2) of the gripping arms (12.1) engage behind the truncated cone element (11.21) and engage in the neck section (11.22); or A2) joining the mold connecting element (11.23) on the coupling element (11) and the counter-mold connecting element (12.6) on the holding arm (12) in the joining direction orthogonal to the arm axis (A) and securing the engagement of the mold connecting element (11.23) with the counter-mold connecting element (12.6) with respect to the joining direction by at least one securing device; or A3) Inserting the flange collar (11.23) on the coupling element (11) in the joining direction orthogonal to the arm axis (A) into the U-shaped guide groove (12.9) of the guide section (12.7) of the connecting piece (12.6) on the holding arm (12) and securing the engagement of the flange collar (11.23) in the U-shaped guide groove (12.9) of the guide section (12.7) with respect to the joining direction by at least one resilient pressure piece (12.10) by engagement of the ball (12.11) of the pressure piece (12.10) in the circular round groove (11.25) on the end face of the flange collar (11.23).

21. Method according to claim 19 or 20, wherein the method comprises the step before or after connecting the coupling element (11) and the holding arm (12) in step A). A4) Arranging a steep disposable sheath (15) on the coupling element (11) and pulling the sterile disposable sheath (15) over the holding arm (12); and / or wherein the arranging and fastening of the holding device (10) in step B) comprises the step B1) Arranging a guide element (13) at the ends of the arm elements (10.6, 10.7) of the holding device (10) and providing an opening (13.1) coaxial with the passage opening (103) for receiving the second medical instrument (3).

22. A method for disassembling an instrument system (4) according to claim 18, comprising the steps D') arranging the pressure element (14) along the arm axis (A) in the second position and releasing the second medical instrument (3) and removing it from the arrangement along the longitudinal axis (L) with respect to the first medical instrument (2), C') Uncoupling the holding device (10) from the coupling element (11) attached to the holding arm (12) by - C6) Arranging the pressure element (14) along the arm axis (A) in the third position, - C7) relatively moving the holding device (10) in the direction of the coupling element (11) along the arm axis (A), thereby bending the coupling arms (11.1) by Inserting the respective projection (10.3) along the insertion bevel (10.4) until the projections (10.3) have emerged from the receiving openings (11.3) in the coupling end sections (11.2); B') Detaching the holding device (10) from the first medical instrument (2), A') Separating the coupling element (11) from the holding arm (12).

23. Holding device (10) which is designed to receive medical instruments (2, 3) along a common longitudinal axis (L) and to be coupled to a coupling element (11) of an instrument holding device (1) fastened to a holding arm (12), wherein the holding device (10) has a distal holding element (101) with a distal arm section (10.6) and a proximal holding element (102) with a proximal arm section (10.7), and the two holding elements (101, 102) in an arrangement joined together to form the holding device (10) delimit a passage opening (103) for receiving the medical instruments (2, 3) along the longitudinal axis (L), wherein the distal arm element (10.6) is fastened at a free end section (10.3) and the proximal arm element (10.7) is fastened at a free end section (10.4) by a guide element for receiving a first medical instrument (3), wherein the free end portion (10.4) of the proximal arm element (10.7) is angled in the direction of the longitudinal axis (L) and provides a contact surface (10.9) pointing towards the longitudinal axis (L), characterized in that the guide element for receiving the first medical instrument (3) is an instrument adapter (13) with a bore (13.1) coaxial with the passage opening (103), in which a hollow cylindrical sleeve (16) is arranged, which is elastically deformable in a direction radial to the longitudinal axis (L) and delimits an adapter opening (16.1) aligned with the passage opening (103), wherein the instrument adapter (13) has a proximal receiving section (13.4) which delimits a receiving opening (13.5) which is designed to receive the angled end section (10.4) of the proximal holding element (102), wherein the receiving opening (13.5) extends through the instrument adapter (13) in a direction to the longitudinal axis (L) extends radially up to the bore (13.1), wherein the receiving opening (13.5) through the hollow cylindrical sleeve (16) from the adapter opening. tion (16.1 ) is separated.

24. Holding device (10) according to claim 23, characterized in that the adapter opening (16.1) for receiving the first medical instrument (3) has a variable diameter due to the elastic deformability of the hollow cylindrical sleeve (16) in the radial direction, wherein the diameter is preferably variable within a range of +1.0 mm to -1.5 mm based on an initial diameter of the adapter opening (16.1) in an undeformed state.

25. Holding device (10) according to claim 23 or 24, characterized in that the free end section (10.3) of the distal holding element (101) extends parallel to the longitudinal axis (L) and has a bevel (10.8) on a side facing the longitudinal axis (L), and the instrument adapter (13) has a distal clamping section (13.2) which - a receiving opening (13.3) parallel to the longitudinal axis (L) which is designed to receive the end section (10.3), and - delimits a spring chamber (13.6) connected to the receiving opening (13.3), which extends in the radial direction to the longitudinal axis (L) and in which a spring (15) is arranged in a prestressed manner, which spring is fastened at a proximal end (15.1) in the instrument adapter (13) and is operatively connected at a distal end (15.2) to the end section (10.3) of the distal holding element (101), by means of which the end section (10.3) strikes the receiving opening (13.3) on the distal side.

26. Holding device (10) according to at least one of claims 23 to 25, characterized in that the bore (13.1) - has at least one cylindrical guide section (13.8) aligned with the adapter opening (16.1) and adjoining the sleeve (16), the diameter of which corresponds at least to the initial diameter of the adapter opening (16.1), and / or - a conical guide section (13.9) aligned with the adapter opening (16.1) and facing away from the passage opening (103), which tapers in the direction of the sleeve (16) to a diameter which corresponds at least to the initial diameter of the adapter opening (16.1).

27. Holding device (10) according to at least one of claims 1 to 4, characterized in that the distal holding element (101) has a distal base section (10.1) connected to the distal arm section (10.6) and the proximal holding element (102) has a proximal base section (10.2) connected to the proximal arm section (10.7), wherein the passage opening (103) in the region of the base elements (10.1, 10.2) is designed to receive a second medical instrument (2), and wherein the two base elements (10.1, 10.2) have a bearing section (100) for pivotably connecting the holding device (10) to the coupling element (11), which defines an arm axis (A) with the holding arm (12), wherein the bearing section (100) provides a pivot axis (S) orthogonal to the longitudinal axis (L) and the arm axis (A), and at least the proximal base section (10.2) is cylindrically shaped for engagement with a pressure element (14) movable along the arm axis (A), and a cylinder axis corresponds to the pivot axis (S).

28. Holding device (10) according to claim 27, characterized in that the second medical instrument (2) is a trocar (2), and / or the pressure element (14) is connected to a drive unit (12) which is provided by the holding arm (12).

29. Instrument holding device (1) which is designed to guide and fix medical instruments (2, 3) along a common longitudinal axis (L) and has a holding device (10), a holding arm (12) and a coupling element (11) which connects the holding device (10) and the holding arm (12), which is coaxially connected to a fastening device of the coupling element (11) so as to be rotatable about an arm axis (A), characterized in that the holding device (10) is a holding device (10) according to at least one of claims 23 to 28.

30. Instrument system (4) comprising an instrument holding device (1) according to claim 29 and medical instruments (2, 3) arranged with the instrument holding device (1) along a common longitudinal axis (L).

31. Method for guiding and fixing medical instruments (2, 3) along a common longitudinal axis (L) using the instrument holding device (1) according to claim 7, comprising the steps A) Connecting the coupling element (11) and the holding arm (12), B) Arranging and securing the holding device (10) to a second medical instrument (2) defining the longitudinal axis (L), by B1) Joining together the distal holding element (101) and the proximal holding element (102), wherein the passage opening (103) in the region of the base sections (10.1, 10.2) receives the second medical instrument (2), B2) Connecting the distal arm section (10.6) to the proximal arm section (10.7) by arranging the instrument adapter (13) with the adapter opening (16.1) aligned with the through-opening (103), wherein the angled end section (10.4) of the proximal holding element (102) is received in the positive-locking receiving opening (13.5) of the proximal receiving section (13.4) and the free end section (10.3) of the distal holding element (101) is received in the receiving opening (13.3) of the distal clamping section (13.2) parallel to the longitudinal axis (L), wherein the spring (15) presses the end section (10.3) in the receiving opening (13.3) against a distal-side stop, C) coupling the coupling element (11) attached to the holding arm (12) to the holding device (10), D) Arranging a first medical instrument (3) along the longitudinal axis (L) with respect to the second medical instrument (2) by insertion into the adapter opening (16.1) of the instrument adapter (13) and clamping the first medical instrument (3) by arranging the pressure element (14) along the arm axis (A) in a fixing position in which the pressure element (14) exerts a clamping force on the proximal holding element (102), wherein the angled end section (10.4) is moved in the receiving opening (13.5) in the radial direction until the contact surface (10.9) of the angled end section (10.4) clamps the first medical instrument (3) to the first medical instrument (3) by deforming the sleeve (16) to adapt the diameter of the adapter opening (16.1).

Images