Surgical instrument and method for producing a surgical instrument

Abstract

The invention relates to a surgical instrument (1), in particular an endoscopic surgical shaft instrument, having a joint (150, 450, 550) with at least one joint axis (Y, Z); a proximal portion (100); a distal portion (200); and at least one force transmission element (310, 320, 330, 340, 350). The joint (150, 450, 550) is formed partly on the proximal portion (100) and partly on the distal portion (200), and the joint connects the proximal portion (100) and the distal portion (200). The at least one force transmission element (310, 320, 330, 340, 350) is coupled to the distal portion (200) in order to apply a torque, and the distal portion (200) can be deflected about the at least one joint axis (Y, Z) relative to the proximal portion (100) by means of the torque applied by the at least one force transmission element (310, 320, 330, 340, 350), said proximal portion (100) and / or distal portion (200) and / or at least one force transmission element (310, 320, 330, 340, 350) being monolithically formed. The invention also relates to a method for producing the surgical instrument (1).

Description

[0001] Surgical instrument and method for manufacturing a surgical instrument

[0002] The present invention relates to a surgical instrument, in particular a surgical shaft instrument, comprising a proximal section, a distal section and a joint connecting the proximal section and the distal section, with the features of claim 1. Furthermore, the present invention relates to a method for manufacturing a surgical instrument, in particular a surgical shaft instrument, with the features of claim 28.

[0003] Surgical instruments are known in various forms from the prior art. Surgical shaft instruments of this type are used in the prior art, for example, as hand instruments in minimally invasive (endoscopic) procedures or in robot-assisted surgery.

[0004] Typically, such shaft instruments comprise an elongated proximal section extending along a shaft axis, which may be formed by a shaft with a movable distal section at its distal end. The distal section may include a further shaft and / or a jaw.

[0005] To reach even difficult-to-access areas within a body cavity with the surgical instrument, the distal section, which includes a further shaft, can be angled relative to the proximal section by means of the joint. A jaw-like portion can also be arranged on the distal section, formed by a tool preferably resembling forceps or scissors. This tool can be, in particular, forceps with one or two movable jaws, but also a sampler, a punch, a knife, or the like.

[0006] Such surgical instruments have proven their worth in the past. However, it has become apparent that their manufacture is very complex due to the large number of components and the manufacturing processes involved, resulting in high costs. Therefore, existing surgical instruments are often reused, although cleaning and sterilizing these instruments is associated with considerable effort and expense.

[0007] This is where the present invention comes in.

[0008] The present invention is dedicated to the task of proposing a suitably improved surgical shaft instrument that is suitable for eliminating the disadvantages mentioned in relation to the prior art.

[0009] These problems are solved by a surgical instrument having the features of claim 1 and a method for manufacturing a surgical instrument having the features of claim 28.

[0010] Advantageous embodiments of the invention are specified in the dependent claims. The surgical instrument according to the invention, in particular an endoscopic surgical shaft instrument, with the features of claim 1, comprises at least one joint connecting a proximal section and a distal section.

[0011] The at least one joint has at least one joint axis, wherein the at least one joint axis is preferably arranged perpendicular to the shaft axis.

[0012] The proximal section is preferably formed along a shaft axis and more preferably has a round, in particular a circular or elliptical, cross-section. The shaft axis preferably corresponds to an axis of symmetry of the proximal section.

[0013] Furthermore, the surgical instrument preferably includes at least one force transmission element.

[0014] The at least one joint is preferably formed partially on the proximal and distal sections and connects the proximal and distal sections. The at least one joint allows the distal section to pivot relative to the proximal section about the at least one joint axis.

[0015] The at least one force transmission element is preferably coupled to the distal section to exert a torque on the distal section. The torque applied by the at least one force transmission element allows the distal section to pivot relative to the proximal section about the at least one joint axis. The at least one force transmission element can preferably transmit a tensile and / or compressive force and preferably extends from a proximal end region of the proximal section along the shaft axis and preferably parallel to it to the distal section.

[0016] Preferably, the proximal section and / or the distal section and / or the at least one force transmission element are monolithic.

[0017] The present invention is based on the idea of ​​proposing a surgical instrument, in particular an endoscopic surgical shaft instrument, which has the fewest possible components and can therefore be manufactured, in particular, by primary forming processes such as injection molding, 3D printing, 4D printing or the like. For this purpose, the surgical instrument, in particular the endoscopic surgical shaft instrument, especially the proximal section and / or the distal section and / or the at least one force transmission element, is formed in one piece, or in other words, as a monolithic component, thereby reducing the number of individual components and assembly steps.

[0018] The surgical instrument can have at least two joints, each joint connecting a proximal section and a distal section. The proximal section of each joint can be formed by a shaft or by the at least one force transmission element. The distal section can be formed by a shaft and / or a jaw of a tool, the jaw preferably being a forceps- or scissor-like tool. One and the same component can form the distal section at one joint and the proximal section at another joint.

[0019] The at least two joints can be shaped differently.

[0020] The proximal section is arranged along the shaft axis, although it should be noted at this point that the shaft axis does not necessarily have to be straight. The shaft axis can also be curved and follow a curve. Accordingly, the shaft can be either a straight shaft or a curved shaft.

[0021] A further development of the present invention provides that the at least one joint comprises a solid-body joint. The solid-body joint allows the distal section to pivot relative to the proximal section about at least one joint axis by means of elastic deformation. The solid-body joint preferably has a bending stiffness that is many times lower than the bending stiffness of the proximal and / or distal section.

[0022] The bending stiffness of the solid body joint is preferably achieved by a low modulus of elasticity and / or a low area moment of inertia, wherein the bending stiffness is preferably at least four times smaller than the bending stiffness of the proximal and / or distal section.

[0023] Preferably, the solid body joint is formed monolithically with the proximal and / or distal section, and it is particularly preferred if the at least one joint, the proximal section and the distal section are formed monolithically.

[0024] According to a further development, the solid-body joint has a bending web connecting the proximal and distal sections. The bending web is preferably arranged coaxially to the shaft axis and further preferably exhibits the aforementioned low bending stiffness of the solid-body joint.

[0025] A further development of the present invention provides that at least one rib projects from the bending web. Preferably, a plurality of ribs project from the bending web, with a distance between the ribs that allows unimpeded pivoting of the ribs relative to one another during elastic deformation of the solid joint about the at least one joint axis. The at least one rib preferably has an outer cross-section corresponding to the proximal section.

[0026] A further development of the present invention provides that the joint comprises a bellows connecting the proximal and distal sections. The bellows is preferably designed as an elastic, accordion-like folding tube. Preferably, the bellows forms the solid joint. However, it is also possible for the bellows to surround the at least one joint. The bellows protects the at least one joint from external influences, in particular from contamination.

[0027] A further development provides that the at least one joint has at least one recess and / or at least one opening through which the at least one force transmission element is movably guided. The at least one recess and / or the at least one opening guides the at least one force transmission element along the at least one joint and prevents, for example, the force transmission element from undergoing undesired deformation, such as buckling. The opening preferably runs along an axis of symmetry of the at least one joint and is coaxial with the shaft axis in the at rest state of the at least one joint.

[0028] The bellows can be monolithic with the proximal section and / or the distal section.

[0029] According to a preferred further development, the at least one joint comprises a first joint section and a second joint section.

[0030] The first and second joint sections can have corresponding guide surfaces formed around at least one joint axis. These corresponding guide surfaces can be in frictional contact. The guide surfaces can have a curvature or radius, such that during rotation around at least one joint axis, one of the two guide surfaces is displaced relative to the other.

[0031] The first joint section and the second joint section can form a ball-and-socket joint or a reciprocating joint and have corresponding guide surfaces that are formed around one joint axis of the reciprocating joint or around both joint axes of the ball-and-socket joint. A further development of the present invention provides that a running and / or separating gap is formed between the corresponding guide surfaces. The at least one joint can be manufactured with the proximal and / or distal section during the initial forming process, wherein the corresponding guide surfaces do not come into contact, but rather a running and / or separating gap is formed between the guide surfaces, which prevents a material or substance bond between the guide surfaces.

[0032] Furthermore, it has proven advantageous if the first and second joint sections are positively connected. The positive connection between the first and second joint sections can preferably be created during the primary forming process. Alternatively, the positive connection can be created after primary forming, for example, by inserting the first and second joint sections into one another, preferably creating a snap-fit ​​connection. Preferably, the first joint section surrounds the second joint section, or vice versa.

[0033] The first joint section and / or the second joint section are / are preferably monolithic with the proximal and / or the distal section. This results in a particularly small number of components.

[0034] Furthermore, it has proven advantageous if the at least one joint includes a spring bar connecting the proximal and distal sections. When the second joint section rotates relative to the first, the spring bar deforms elastically and can generate a restoring force that returns the second joint section to its original position. The spring bar can also provide additional stabilization to the joint.

[0035] In particular, it is advantageous if, in the original designs, a positive fit is already formed between the first joint section and the second joint section, and if the at least one spring bar connects the proximal section and the distal section or the first joint section and the second joint section.

[0036] Due to the manufacturing process, the running and / or separating gap between the first and second joint sections is so large that the joint exhibits play, which can be compensated for by the spring bar. This preferably prevents unwanted relative movement within the joint play between the joint sections.

[0037] According to a further embodiment of the present invention, the at least one spring bar encompasses the at least one joint in an arc-shaped manner. The curved shape of the spring bar preferably corresponds to the guide surfaces of the joint sections, wherein the at least one spring bar is more preferably arranged at a distance from the joint in order to be freely elastically deformable when the joint is rotated about the at least one joint axis. The arc-shaped formation of the spring bar can, for example, be achieved after initial forming when the first joint section and the second joint section are inserted into each other.

[0038] Furthermore, the at least one spring bar can preload the first joint section against the second joint section, thereby closing the running and / or separating gap and eliminating play in the at least one joint. After initial forming, the at least one spring bar can be elastically deformed when the first and second joint sections are inserted, generating a spring force that preloads the first joint section against the second joint section.

[0039] The at least one spring bar can be formed monolithically with the proximal section and / or the distal section, depending on the further development.

[0040] Furthermore, it can be advantageous to provide at least two spring bars. The at least two spring bars can be arranged – preferably circumferentially – around the joint or next to the joint.

[0041] A further development of the present invention provides that the at least one force transmission element is connected to the distal section for applying the torque at a first lever distance to the at least one joint axis.

[0042] A further embodiment of the present invention provides that the at least one force transmission element is guided along the proximal section. Preferably, the at least one force transmission element is guided along, and more preferably parallel to, the shaft axis of the proximal section within the proximal section, thereby protecting the at least one force transmission element from external influences and contamination. In particular, contamination makes the operation of the surgical instrument difficult or impossible. Another embodiment of the present invention provides that the at least one force transmission element is guided in a guide channel in the proximal section. The guide channel is preferably tubular and surrounds the at least one force transmission element along the shaft axis.Preferably, a single force transmission element is arranged in a guide channel.

[0043] According to a further embodiment, the at least one guide channel of the at least one force transmission element can have at least one cleaning opening. The at least one cleaning opening preferably extends from the proximal end region to the distal end region, and the at least one guide channel can have multiple cleaning openings. The at least one cleaning opening connects, for example, at least two guide channels and / or the at least one guide channel to the surrounding environment. To avoid weakening the respective section of the surgical instrument on one side, multiple cleaning openings can be arranged along the shaft axis and / or distributed around the shaft axis.

[0044] The guide channel can be cleaned via the at least one cleaning opening, particularly after the manufacturing process. Specifically, a release agent, which is placed between the guide channel and the power transmission element during manufacturing to prevent material adhesion, can be removed via the at least one cleaning opening.

[0045] Furthermore, it is advantageous that at least two force transmission elements are provided. The force transmission elements are more preferably arranged circumferentially symmetrically around the shaft axis in the proximal section, with two force transmission elements being arranged in pairs on diametrically opposed sides even more preferably. It is even more preferred if two force transmission elements arranged on diametrically opposed sides can cause a rotation of the distal section around the at least one joint axis in opposite directions.

[0046] A further development provides that the at least two force transmission elements are connected to each other in the region of the at least one joint – preferably radially. Preferably, the at least two force transmission elements arranged adjacent in the circumferential direction are connected by an arc-shaped bracket that laterally encompasses the joint. The bracket holds the at least two force transmission elements in position relative to each other, particularly when the joint is deflected.

[0047] In this preferred embodiment, the at least two force transmission elements are coupled or connected to the distal section on opposite sides to the at least one joint axis.

[0048] A further development of the present invention provides that the at least one force transmission element has a cannulation. A medium or at least one electrical conductor can be guided through the cannulation, wherein preferably the at least one force transmission element with the cannulation is guided through the opening by the at least one joint. It is further preferred if the at least one force transmission element with the cannulation actuates the jaw part. The cannulation can preferably open onto the tool. In addition, it has proven advantageous if a steering head is arranged on the proximal section on the side facing away from the distal section. The steering head is preferably rotatable relative to the proximal section, and further preferably the steering head is pivotable about at least one axis relative to the proximal section.Furthermore, it is advantageous if the at least one axis is arranged parallel to the at least one joint axis.

[0049] The steering head can preferably be positioned relative to the proximal section along the shaft axis such that the at least one power transmission element is preloaded by it. Preferably, the at least two power transmission elements are preloaded uniformly by the steering head.

[0050] The steering head can, for example, be positioned along the shaft axis using an adapter to preload at least one power transmission element.

[0051] The steering head is preferably connected to the at least one force transmission element. The at least one force transmission element transmits a movement of the steering head as a tensile or compressive force to the distal section, causing the distal section to pivot about the at least one joint axis. Preferably, the steering head is connected to the at least one force transmission element, for example by means of an anchor, such that only a tensile force is transmitted to the distal section.

[0052] According to a further development of the present invention, the at least one force transmission element is coupled to the distal section at the second lever distance to the at least one joint axis, and the at least one force transmission element is coupled to the steering head at a first lever distance to the axis, wherein the first lever distance Al is greater than the second lever distance A2. The greater the first lever distance Al is in relation to the second lever distance A2, the less force is required by the user to pivot the distal section relative to the proximal section.

[0053] Another aspect of the present invention relates to a method for manufacturing the previously described surgical instrument comprising the proximal section, the distal section, the at least one joint connecting the proximal and distal sections, the joint having at least one axis, and at least one force transmission element. The method for manufacturing the surgical instrument preferably comprises the following steps:

[0054] - Primary forming of the proximal section, the distal section, the at least one joint and the at least one force transmission element, wherein in primary forming the distal section and the at least one force transmission element and / or the distal section and the proximal section are formed monolithically.

[0055] Furthermore, it is advantageous for the execution of the process if the primary forming is carried out by casting, especially injection molding, or by an additive manufacturing process. In particular, 3D printing and 4D printing enable flexibility in shaping and manufacturing and cost-effective production compared to conventional instruments. Further development suggests that it is advantageous if the proximal section, the distal section, and / or the at least one force transmission element have at least two areas made of a different material or a different material combination. In particular, 4D printing makes it possible to arrange different materials in specific areas in order to selectively influence the properties of the workpiece.In particular, it is conceivable that the at least one force transmission element has different areas that have different stiffnesses, friction properties or strengths.

[0056] In particular, an advantageous embodiment of the invention provides that the tool, and even more preferably the jaw part, has at least two areas which are made of a different material or a different material combination. In particular, 4D printing makes it possible to arrange different materials in specific areas in order to selectively influence the properties of the workpiece.

[0057] In particular, it is conceivable that the tool, especially the jaw section, has different areas with varying electrical properties (conductive / non-conductive), stiffness, friction properties, or strength. For example, the tool may have at least one area that is galvanically isolated and electrically conductive. This area may be connected to the electrical conductor, for instance, to form a coagulation tool. The electrical conductor may be located in the cannulation or in the at least one guide channel, as described above. Alternatively, the electrical conductor may be formed by a galvanically isolated area in the proximal and / or distal section.

[0058] The distal end of the surgical instrument, particularly the tool and, even more preferably, the jaw, can also have a section made of a particularly soft or elastic material. By selecting the appropriate material, the tool can be adapted to a wide range of possible uses.

[0059] An advantageous further development of the method provides that, during primary forming, the guide channel in the proximal section is formed with the at least one force transmission element movably arranged in the guide channel. Furthermore, a separating agent is preferably arranged between the at least one guide channel and the at least one force transmission element.

[0060] In particular, it is advantageous if, during the initial forming process, the at least one force transmission element is already formed monolithically with the distal section, and the guide channel with the at least one force transmission element movably arranged within it is formed in the proximal section. An anchor can be formed at the free end of the at least one force transmission element during initial forming, for example, for connection to the steering head. It is also advantageous if a separation gap and / or running gap is formed between the first joint section and the second joint section during initial forming.

[0061] It is also advantageous if a positive fit is formed between the first joint section and the second joint section during the initial forming process.

[0062] The separation gap can preferably be bridged by the at least one spring bar that connects the proximal section with the distal section.

[0063] Furthermore, it has proven advantageous to create a positive fit between the first joint section and the second joint section during the initial forming process.

[0064] Furthermore, a further development of the process provides that, after the initial forming, the positive locking between the first joint section and the second joint section is achieved by joining the first joint section and the second joint section and closing the separation gap between the first joint section and the second joint section.

[0065] A preferred embodiment of the method provides that, during the formation of the positive locking mechanism, at least one spring bar is elastically deformed and generates a clamping force by which the first joint section and the second joint section, in particular their guide surfaces, are pressed into frictional contact. Two exemplary embodiments and related developments are described below with reference to the accompanying drawings. These are:

[0066] Figure 1 shows a perspective view of a surgical instrument with three joints, each connecting a proximal section to a distal section.

[0067] Figure 2 shows a side view of the surgical instrument according to Figure 1.

[0068] Figure 3 shows a sectional view of the proximal section formed by a first shaft of the first joint of the surgical instrument according to Figure 2 and according to the section line J - J.

[0069] Figure 4 shows a sectional view of a further development of the proximal section formed by the first shaft of the first joint of the surgical instrument according to Figure 2 and according to the section line J - J.

[0070] Figure 5 shows a top view of the surgical instrument according to Figure 1 with the first joint,

[0071] Figure 6 shows a sectional view along the section line C - C in Figure 6 ,

[0072] Figure 7 shows a detailed view according to detail N in Figure 6 of the surgical instrument according to Figure 1.

[0073] Figure 8 shows a detailed view according to detail N in Figure 6 of the surgical instrument according to Figure 1, with one adapter hidden.

[0074] Figure 9 shows a detailed view of the first joint according to detail C in Figure 6.

[0075] Figure 10 shows a schematic and cutaway representation of a first further development of the first joint with a first joint section and a second joint section after the initial forming and before assembly.

[0076] Figure 11 shows a top view of a second further development of the first joint, where the joint sections are not yet joined together.

[0077] Figure 12 shows a sectional view of the second development of the first joint according to Figure 11.

[0078] Figure 13 shows a top view of a distal end of the surgical instrument according to Figures 1 and 2 with the second and third joints, and

[0079] Figure 14 shows a sectional view along the section line in Figure 13.

[0080] Identical or functionally equivalent parts or features are identified by the same reference symbols in the following detailed description of the figures. Likewise, not all identical or functionally equivalent parts or features in the figures are provided with a reference number.

[0081] The surgical instrument 1 can be used, for example, as a hand instrument in minimally invasive (endoscopic) procedures or in robot-assisted surgery and can include a tool 5 with a jaw part 50.

[0082] The surgical instrument 1 has a proximal end and a distal end, wherein an actuating device (not shown) may be arranged at the proximal end and the tool with the jaw part 50 is arranged at the distal end.

[0083] When the surgical instrument 1 is used as intended, the distal end with the tool 5 can be inserted into a body cavity of a patient and the tool 5 can be operated by means of the actuating device.

[0084] The tool 5 can be, for example, pliers, scissors, a sampler, a punch, a spreader or an electrosurgical device, for example for coagulation.

[0085] As can be seen from Figures 1-8, the surgical instrument 1 comprises several joints 150, 450, 550. Each joint 150, 450, 550 connects a proximal section 100 to a distal section 200.

[0086] In addition, the surgical instrument includes five force transmission elements 310, 320, 330, 340, 350.

[0087] Figures 1 and 2, in particular, show that the surgical instrument 1 comprises three joints 150, 450, and 550. The first joint 150 connects a first shaft 105 to a second shaft 205, the second joint 450 connects the second shaft 205 to the jaw 50 of the tool 5, and the third joint 550 connects the jaw 50 to the force transmission element 350. Accordingly, for the first joint 150, the first shaft 105 forms the proximal section 100 and the second shaft 205 the distal section 200. For the second joint 450, the second shaft 205 forms the proximal section 100 and the tool 5 the distal section 200. For the third joint 550, the force transmission element 350 forms the proximal section 100 and the tool 5 the distal section 200 .

[0088] The first joint 150, which is shown in detail in different configurations in Figures 9-12, connects the proximal section 100 with the distal section 200. The first joint 150 is formed partially by the proximal section 100 and the distal section 200 and connects the proximal section 100 with the distal section 200.

[0089] The proximal section 100 of the first joint 150 is formed along a shaft axis X and the elongated proximal section 100 is formed by the shaft 105 of the surgical instrument 1.

[0090] The shaft axis X can be formed by a straight line, as shown in the accompanying figures. However, the shaft axis X can also be curved and, for example, follow a curve. Accordingly, shaft 105 can be either a straight shaft or a curved shaft.

[0091] The proximal section 100 or the shaft 105 has a round cross-section, as can be seen from the sectional views in Figures 3 and 4, and is preferably made of a metallic material or an electrically conductive material. The first shaft 105 or the proximal section 100 has a proximal end region 101 and a distal end region 102. An adapter 120 can preferably be arranged in the proximal end region 101, which can be attached to an actuating device (not shown).

[0092] In the distal end region 102 the first joint 150 is arranged, via which the proximal section 100 is connected to the distal section 200.

[0093] In the illustrated embodiment, the first joint 150 has a first joint axis Y and a second joint axis Z, wherein the first joint axis Y and the second joint axis Z are arranged in a common plane perpendicular to the shaft axis X and are at right angles to each other.

[0094] The first joint 150 is formed proportionally to the proximal section 100 and the distal section 200 and can comprise a first joint section 151 and a second joint section 251.

[0095] The first joint section 151 is preferably formed at the distal end region 102 of the proximal section 100 and the second joint section 251 is preferably formed at the proximal end region 201 of the distal section 200 .

[0096] The first joint 150 can have corresponding guide surfaces 181, 281, which are formed around the first and / or the second joint axis Y, Z and can come into frictional contact. The distal section 200 has a proximal end region.

[0097] 201 and a distal end region 202. The distal section 200 can be pivoted by the first joint 150 relative to the proximal section 100 about the first and / or the second joint axis Y, Z.

[0098] The distal section 200 can be formed by an elongated second shaft 205 and / or by a movable tool 5.

[0099] As can be seen in particular from the sectional view in Figures 3, 4, 7, 8, the surgical instrument 1 in the illustrated embodiment comprises five force transmission elements 310, 320, 330, 340, 350.

[0100] The force transmission elements 310, 320, 330, 340, 350 are designed as tension or compression rods and transmit a tensile or compressive force along the proximal section 100 or along the first shaft 105.

[0101] The power transmission elements 310, 320, 330, 340, 350 are preferably arranged along the first shaft 105 and further preferably parallel to the shaft axis X.

[0102] In the first shaft 105, a guide channel 110 can be formed for each of the power transmission elements 310, 320, 330, 340, 350.

[0103] The respective guide channel 110 corresponds in shape and size to the respective power transmission element 310, 320, 330, 340, 350, wherein the power transmission element 310, 320, 330, 340, 350 is freely movable in the guide channel 110 through a running gap 185 between the guide channel 110 and the respective power transmission element 310, 320, 330, 340, 350 along the longitudinal axis X.

[0104] The respective force transmission element 310 , 320 , 330 , 340 , 350 is individually held in the respective guide channel 110 transversely to the longitudinal axis X in a form-fitting manner, thereby suppressing undesirable deformations, for example bending or buckling under tensile or compressive load.

[0105] As shown in a further development according to Figure 4, each guide channel 110 can have a cleaning opening 112 extending along the longitudinal axis X. The cleaning opening 112 preferably extends from the proximal end region 101 to the distal end region 102. The cleaning opening 112 serves to clean the guide channel 110 and can either connect the guide channel 110 with at least one further guide channel 110 and / or connect the guide channel 110 with an outer surface of the first shaft 105.

[0106] The force transmission elements 310, 320, 330, 340, which are preferably arranged around the shaft axis X, span the first joint 150 and are, as shown in Figure 11, coupled to the distal section 200 and configured to exert a torque on the distal section 200.

[0107] For this purpose, the force transmission elements 310, 320, 330, 340 are connected to the proximal end region 201 of the distal section 200 at a second lever distance A2, wherein the second lever distance A2 is measured transversely to the at least one joint axis Y, Z. As shown in Figures 9-12, the force transmission elements 310, 320, 330, 340 can be formed in one piece, i.e., monolithically, with the proximal end section 200 or the shaft 205 forming the proximal end section 200.

[0108] The torque applied by the at least one force transmission element 310 , 320 , 330 , 340 allows the distal section 200 - i.e. the second shaft 205 - to be pivoted relative to the proximal section 100 - i.e. the first shaft 105 - about the at least one joint axis Y, Z.

[0109] As can be seen with reference to Figure 3, the force transmission elements 310, 320, 330, 340 are arranged circumferentially symmetrically around the shaft axis X in the proximal section 100 or the first shaft 105.

[0110] Two force transmission elements 310, 330 or 320, 340 can each be arranged in pairs on diametrically opposite sides of the longitudinal axis X.

[0111] It can be advantageous if two force transmission elements 310, 330 or 320, 340 arranged on diametrically opposite sides to the shaft axis X can cause a rotation of the distal section 200 about the at least one joint axis X, Y.

[0112] Furthermore, it can be seen from Figures 4, 5, 7-12 that a force transmission element 350 can be arranged coaxially to the longitudinal axis X.

[0113] The force transmission element 350 extends from the proximal end region 101 of the proximal section 100 to a distal end region 202 of the distal section and can actuate the tool 5, as will be described later with reference to Figures 13 and 14. For this purpose, a guide channel 210 can be formed in the distal section 200 for the at least one force transmission element 350, preferably analogous to the at least one guide channel 110 in the proximal section 110.

[0114] The force transmission element 350 can, as can be seen from Figures 4, 5, 7-12 and 14, have a cannulation 355. A medium can, for example, be guided through the cannulation 355. This allows the medium to be introduced into or removed from the body cavity. At least one electrical conductor can also be guided through the cannulation 355.

[0115] The force transmission element 350 can, as shown in Figures 9-12, be guided through an opening 165 in the joint 150 preferably centrally through the joint 150.

[0116] In the distal section 200, the force transmission element 350 can also be arranged in a guide channel 210 analogously to the proximal section 100.

[0117] In the proximal end region 101 of the proximal section 100, the force transmission elements 310, 320, 330, 340, 350 can have an anchor 312, 322, 332, 342, 352 for applying the tensile and / or compressive force. The anchor 312, 322, 332, 342, 352 can, for example, be flange-shaped and enables force to be applied to the - preferably comparatively thin - force transmission elements 310, 320, 330, 340, 350. Figure 8, in particular, shows that the

[0118] Power transmission elements 310, 320, 330, 340 can also be connected to each other in the proximal end area 101.

[0119] In the proximal end region 101, as shown in Figures 1, 2, 5, 6, 7, a steering head 130 can be arranged which is connected to the power transmission elements 310, 320, 330, 340.

[0120] The steering head 130 is preferably pivotable relative to the proximal section 100 about at least one axis Yl, ZI and is designed to apply a corresponding tensile and / or compressive force to the corresponding force transmission element 310, 320, 330, 340 when deflected about the at least one axis Yl, ZI .

[0121] The respective anchor 312, 322, 332, 342 is operatively connected to the steering head 130, wherein, as shown in Figure 8, the anchors 312, 322, 332, 342 are connected to each other, for example via a cross, and engage behind the steering head 130 on the side applied by the joint 150.

[0122] The steering head 130 can be spherical and can be mounted proximally on the adapter 120, on the side of the adapter 120 facing away from the shaft 105, in a ball-joint manner, as shown. The axis Y1 is preferably parallel to the joint axis Y, and the axis Z2 is preferably arranged parallel to the joint axis Z.

[0123] The power transmission elements 310, 320, 330, 340 are coupled to the steering head 120 at a first lever distance Al to the axis Y1, Z2. The first lever distance Al is greater than the second lever distance A2, thereby creating a reduction that enables the application of high torques with low effort. The greater the first lever distance Al is in relation to the second lever distance A2, the less force is required from the user to pivot the distal section 200 relative to the proximal section 100.

[0124] Furthermore, it can be seen from Figures 1 and 7 that the adapter 120 has an opening 125 through which an actuating device (not shown) can be connected to the armature 352 in order to actuate, for example, the tool, in particular the jaw part 30.

[0125] The first joint 150 between the proximal section 100 and the distal section 200 can in the simplest case be a solid body joint, which is shown schematically in Figure 9.

[0126] The solid body joint preferably connects in one piece - i.e. monolithically - the distal section 200 with the proximal section 100 or, in other words, the second shaft 205 with the first shaft 105 and allows pivoting about the at least one joint axis Y, Z by means of elastic deformation.

[0127] The solid-body joint has a bending web 160 connecting the proximal section 100 and the distal section 200, which is arranged coaxially to the shaft axis X. The bending stiffness of the bending web 160 is preferably many times smaller than the bending stiffness of the shaft 105 or 205. Ribs 162 project from the bending web 160 – preferably equidistantly – with a distance between adjacent ribs 162 that allows unhindered pivoting of the ribs 162 during elastic deformation of the solid-body joint about the at least one joint axis Y, Z.

[0128] The solid-state joint has a recess 164 for each of the force transmission elements 310, 320, 330, 340, through which the force transmission elements 310, 320, 330, 340 are guided analogously to the guide channels 110. The respective recess 164 can be designed in the form of a radial groove.

[0129] To support and / or stabilize the force transmission elements 310, 320, 330, 340, a recess 164 can also be designed as a through-opening and / or the force transmission elements 310, 320, 330, 340 can be connected to the rib 162, preferably to one, in particular a middle, or several of the ribs 162.

[0130] Furthermore, the solid body joint has an opening 165 through which the force transmission element 350 is preferably movably guided centrally through the joint 150.

[0131] The proximal section 100, the distal section 200 and the force transmission elements 310, 320, 330, 340 are monolithic and can be manufactured in a - preferably single - primary forming process such as casting, 3D printing or 4D printing.

[0132] During primary forming, the first shaft 105 forming the proximal section 100 with the at least one guide channel 110, the second shaft 205 forming the distal section 205 and the at least one force transmission element 310, 320, 330, 340, 350 are formed in the at least one guide channel 110, wherein preferably a separating means is arranged between the at least one guide channel 110 and the at least one force transmission element 310, 320, 330, 340, 350, which prevents a positive locking between the at least one guide channel 110 and the at least one force transmission element 310, 320, 330, 340, 350.

[0133] The first joint 150 according to the developments shown in Figures 10, 11, 12 is designed in the manner of a ball joint and allows a polyaxial pivoting of the distal section 200 relative to the proximal section 100.

[0134] It should be noted at this point that the first joint 150 can also be designed as a pivot joint, in which case only a monoaxial pivoting of the distal section 200 relative to the proximal section 100 about a single joint axis Y or Z is possible. Such a pivot joint 450, 550 will be described later with reference to Figures 13-14. It should also be noted that the features of the described joints 150, 450, 550 can be combined with each other in any way.

[0135] In Figures 10, 11, and 12, the ball joint 150 is not yet assembled. The figures show the proximal section 100 and the distal section 200 with the joint 150 formed therein after initial shaping. A separating gap 186 is arranged between the proximal section 100 and the distal section 200.

[0136] The first joint segment 151 is located at the distal end.

[0137] 102 of the proximal section 100 - i.e. on the first shaft 105 - is formed and the second joint section 251 is preferably formed on the proximal end region 201 of the distal section 200 - i.e. on the second shaft 205 - .

[0138] The first joint section 151 and the second joint section 251 and their further development according to Figures 11 and 12 have corresponding guide surfaces 181, 281 which are formed around the first joint axis Y and the second joint axis Z and can come into frictional contact.

[0139] The guide surface 181 at the distal end region 102 of the proximal section 100 is spherically shaped, and the guide surface 182 at the proximal end region 201 of the distal section 200 can be cup-shaped. Accordingly, the guide surfaces 181 and 281 form a ball and socket joint.

[0140] To form the ball joint, the two joint sections 151, 251 can be plugged together, preferably creating a positive fit between the two joint sections 151, 251.

[0141] To form the joint, the second joint section 251 has an undercut area 252 that can engage behind the first joint section 151. This creates a kind of snap-fit ​​connection.

[0142] The second joint section 251 can have several slots 253 around its circumference, which facilitates the bending of the second joint section 251 when the joint sections 151, 251 are joined together. The joint 150 also has a recess 164. The recess 164 can be conical, as shown in Figures 10 to 12, and is intended, in particular, to widen the opening on the side facing the distal section 200 in order to prevent undesired deformation of the force transmission element when the joint 150 is deflected.

[0143] In the manufacture of the surgical instrument with the joint 150 according to Figure 10, the first shaft 105 forming the proximal section 100 with the at least one guide channel 110, the second shaft 205 forming the distal section 205 and the at least one force transmission element 310, 320, 330, 340, 350 are formed in the at least one guide channel 110, wherein preferably a separating means is arranged between the at least one guide channel 110 and the at least one force transmission element 310, 320, 330, 340, 350, which prevents a positive locking between the at least one guide channel 110 and the at least one force transmission element 310, 320, 330, 340, 350.The second shaft 205 forming the distal section 205 and the at least one force transmission element 310, 320, 330, 340, 350 are monolithic and the first shaft 105 forming the proximal section 100 is mounted on the at least one force transmission element 310, 320, 330, 340, 350.

[0144] The proximal sections 100, the distal section 200 and the force transmission elements 310, 320, 330, 340 are monolithic and can be manufactured in a - preferably single - primary forming process such as casting, 3D printing or 4D printing. During primary forming, the first shaft 105 forming the proximal section 100 with the at least one guide channel 110, the second shaft 205 forming the distal section 205 and the at least one force transmission element 310, 320, 330, 340, 350 are formed in the at least one guide channel 110, wherein preferably a separating means is arranged between the at least one guide channel 110 and the at least one force transmission element 310, 320, 330, 340, 350, which prevents a positive locking between the at least one guide channel 110 and the at least one force transmission element 310, 320, 330, 340, 350.

[0145] A further development of the first joint 150 according to figure 10 is shown in figures 11 and 12, wherein this first joint 150 is intended to allow a particularly large deflection of the distal section 200 relative to the proximal section 100 about the at least one joint axis Y, Z.

[0146] To avoid repetition, only the difference between joint 150 according to figure 10 and joint 150 according to figures 11 and 12 will be discussed.

[0147] Since high stresses occur in the transition area between the force transmission element 310, 320, 330, 340 and the distal section 200 when the distal section 200 is deflected significantly relative to the proximal section 100, the force transmission elements 310, 320, 330, 340 are coupled to the distal section 200 by means of ball joints 314, 324, 334, 344. The respective ball joint 314, 324, 334, 344 engages in a corresponding bearing shell 260 in the proximal end region 201 of the distal section 200. The respective ball head 314, 324, 334, 344 is connected to the distal section 200 by means of a retaining web 316, 326, 336, 346, wherein the retaining web 316, 326, 336, 346 has a bending stiffness and / or tensile strength that is many times lower than that of the force transmission element 310, 320, 330, 340.

[0148] The retaining rib 316, 326, 336, 346 serves in particular to position the respective ball head 314, 324, 334, 344 during manufacturing, especially during primary forming. The retaining rib 316, 326, 336, 346 can be destroyed after manufacturing, for example, by high tensile or bending forces.

[0149] Figures 13 to 14 show the second joint 450 and the third joint 550 of the surgical instrument 1, with the second joint 450 being described first and the third joint 550 subsequently.

[0150] The second joint 450 connects a proximal section 100 and a distal section 200, the proximal section 100 being formed by the second shaft 205. The distal section 200 is formed by a jaw part 50 of the tool 5.

[0151] The jaw part 50 can be pivoted about a joint axis Y relative to the proximal section 200 formed by the second shaft 205, for example to open and / or close the tool 5 formed with the jaw part 50.

[0152] The tool 5 can be, for example, pliers with one or two movable jaw parts, but also a sampler, a punch, a knife or the like. The second joint 450 is formed proportionally to the proximal section 100 and the distal section 200 and can comprise a first joint section 151 and a second joint section 251.

[0153] As can be seen in particular from Figure 14, the joint 450 is designed as a reversible joint with a joint bolt 155 which creates a positive fit between the distal section 200 and the proximal section 100.

[0154] The joint bolt 155 can be formed on the distal section 200 and / or the proximal section 100, i.e., on the first and / or the second joint sections 151, 251, and engages positively in at least one corresponding recess. The joint bolt 155 can be formed on the first joint section 151 and / or the second joint section 251 and can form guide surfaces 181, 281 corresponding to the recess, which can come into frictional contact.

[0155] The proximal section 100 and the distal section 200, or in other words the second shaft 205 and the jaw part 50, are monolithic, i.e., formed in one piece, in the illustrated exemplary embodiment.

[0156] The jaw part 50 can be connected directly to the shaft 205 forming the proximal section 100 via a spring bar 190, as indicated in Figure 13, wherein the spring bar 190 is S-shaped or meander-shaped to allow low-force pivoting of the distal section 200 relative to the proximal section 100.

[0157] Figure 14 shows in particular the third joint 550. The third joint 550 connects the jaw part 50 with the force transmission element 350, wherein the force transmission element 350 forms the proximal section 100 and the jaw part 50 the distal section 200.

[0158] Apart from the differences explained below, the third joint 550 can be designed as a reciprocating joint analogously to the second joint 450 described above and has a joint axis Y' which is preferably parallel to the joint axis Y of the second joint 450. For the sake of simplicity, the reference numerals of the features of the third joint 550 are marked with a “ .

[0159] As shown in the sectional view according to Figure 14, the third joint 550 comprises a joint bolt 155 ' which creates a positive fit between the distal section 200 or the jaw part 50 and the force transmission element.

[0160] The distal section 200 and the force transmission element 350 are monolithic in the illustrated example, i.e., made from a single piece.

[0161] The distal section 200 or the jaw part 50 can be connected directly to the force transmission element 350 forming the proximal section 100 ' via a spring bar 190 - as indicated in Figure 13.

[0162] The spring bar 190' spans the third joint 550 in an arc at a distance. Due to the distance between the spring bar 190' and the joint 550, the spring bar is elastically deformable when the joint 550 is deflected. In the illustrated embodiment, the spring bar 190 is arranged radially spaced from the third joint 550. Other arrangements of the spring bar 190 are possible. For example, the spring bar 190 can be arranged on one or both sides of the joint 550.

[0163] When the third joint 550 is rotated about the joint axis Y, the spring bar 190 ' should be freely elastically deformable to allow low-force pivoting of the distal section 200 or of the jaw part 50 relative to the force transmission element 350 .

[0164] The surgical instrument 1 described above can be manufactured from a metal or a metal alloy in a particularly cost-effective and simple manner by a primary forming process, in particular by a casting process and even more preferably by an injection molding process.

[0165] The third joint 550 can apply a tensile and / or compressive force from the force transmission element 350 to the jaw part. A compressive force can open the jaw part 50 shown in Figure 14, and a tensile force can close it. The tensile and / or compressive force is preferably transmitted via the interlocking joint sections 151', 251' and their guide surfaces 181', 281'.

[0166] Together, the first shaft 105 forming the proximal section 100 with the at least one guide channel 110, the jaw part 50 forming the distal section 205 and the force transmission element 350 forming the proximal section 100' of the third joint 550 can be formed in the guide channel 210 during the initial forming process, creating a positive fit between the joint sections 151, 251 and 151', 251' of the second and third joints 450, 550.

[0167] A separating element is arranged between the guide channel 210 and the force transmission element 350, and between the joint sections 151, 251 and 151', 251'. This separating element prevents a positive fit between the at least one guide channel 110 and the at least one force transmission element 310, 320, 330, 340, 350, and forms the running gap 185 between the joint sections 151, 251 and 151', 251' or their guide surfaces 181, 281 and 181' and 182'. The spring bar 190' compensates for the joint play caused by the running gap 185 and stabilizes the third joint.

[0168] According to further developments not shown, the joints 150 can also have a spring bar analogous to the third joint 550, according to the further developments in Figures 10-12.

[0169] The first joint 150, for example according to Figure 10, can comprise several spring bars 190, which are preferably arranged rotationally symmetrically around the shaft axis X and even more preferably between the force transmission elements 310, 320, 330, 340.

[0170] The respective spring bar 190 connects the proximal section 100 and the distal section 200, wherein preferably the spring bar 190 is formed in one piece / monolithically with the proximal section 100 and the distal section 200.

[0171] The respective spring bar 190 bridges the first joint 150 designed as a ball joint and preferably connects the first joint section 151 with the second joint section 251 .

[0172] When the second joint section 251 is rotated relative to the first joint section 151, the spring bar 190 is elastically deformed and can generate a restoring force by which the second joint section 251 can be moved back to an initial position.

[0173] The spring bar 190 can preferably clamp the first joint section 151 to the second joint section 251, thereby stabilizing the joint 150.

[0174] The respective spring bar 190 is preferably arc-shaped, wherein the curved shape of the spring bar 190 is curved around the joint axis and preferably corresponds to the guide surfaces 181, 281 of the joint sections 151, 251.

[0175] The respective spring bar 190 is preferably arranged at a distance from the guide surfaces 181, 281 of the joint 150 in order to be freely elastically deformable when the first joint 150 is rotated about the at least one joint axis Y, Z.

[0176] In this further development, a ball joint is formed between the first shaft 105 and the second shaft 205, whereby the positive locking between the joint sections 151, 251 is already formed during the primary forming.

[0177] The method for manufacturing the surgical instrument 1 provides that, during the primary forming process, the surgical instrument 1 is manufactured in a monolithic manner with the proximal section 100, the distal section 200, the joint 150, 450, 550 connecting the proximal section 100 and the distal section 200, and with at least one force transmission element 310, 320, 330, 340, 350.

[0178] In primary forming, at least one guide channel 110 with at least one force transmission element 310, 320, 330, 340, 350 movably arranged in the guide channel 110 is preferably formed in the respective proximal section 100, wherein a running gap 185 is formed between the guide channel 110 and the force transmission element 310, 320, 330, 340, 350 arranged individually in the guide channel 110.

[0179] In order to later enable relative movement between the proximal sections 100, 350 and the distal sections 200, a running gap 185 is also formed between the first joint section 151 and the second joint section 251 during the initial forming, wherein a positive locking is preferably produced between the first joint section 251 and the second joint section 251 during the initial forming.

[0180] During primary forming, the spring bar 190 is also produced in a bridged manner, whereby the respective separation gap 186 is bridged by the at least one spring bar 190. The respective spring bar 190 connects the respective proximal section 100 with the distal section 200.

[0181] After primary forming, the positive locking between the first joint section 151 and the second joint section 251, which did not occur during primary forming, can be achieved by joining the first and second joint sections 151 and closing or reducing the gap 186 between them. After primary forming, the at least one spring bar 190 can be elastically deformed and generate a clamping force that clamps the joint 150, 450, 550. This clamping force forces the joint sections 151 and 251 into frictional contact.

[0182] Furthermore, after initial forming, the surgical instrument 1 can be cleaned, whereby any impurities in the guide channel 110 are removed through the cleaning opening 112 of the respective guide channel 110.

[0183] Reference character list

[0184] 1 instrument

[0185] 5 tools

[0186] 30 mouth part

[0187] 100 proximal section

[0188] 101 proximal end area

[0189] 102 distal end

[0190] 105 first shaft

[0191] 110 guide channel

[0192] 112 Cleaning opening

[0193] 120 adapters

[0194] 125 Opening

[0195] 130 steering head

[0196] 150 first joint

[0197] 151 first joint section

[0198] 155 hinge bolts

[0199] 160 bending bridge

[0200] 162nd rib

[0201] 164 Exclusion

[0202] 165 Breakthrough

[0203] 181 guide surface

[0204] 185 barrel gap

[0205] 186 Separation gap

[0206] 190 spring bar

[0207] 200 distal section

[0208] 201 proximal end area

[0209] 202 distal end

[0210] 205 second shaft

[0211] 210 guide channel

[0212] 251 second joint section

[0213] 252 Hint er schneidungsber eich 253 Schlitz

[0214] 260 bearing shell

[0215] 281 guide surfaces

[0216] 310 Power transmission element

[0217] 312 anchors

[0218] 314 Ball head

[0219] 316 Footbridge

[0220] 320 Power transmission element

[0221] 322 anchors

[0222] 324 Ball head

[0223] 316 Footbridge

[0224] 330 Power transmission element

[0225] 332 anchors

[0226] 334 Ball head

[0227] 336 Footbridge

[0228] 340 Power transmission element

[0229] 342 anchors

[0230] 344 Ball head

[0231] 346 Footbridge

[0232] 350 power transmission element

[0233] 352 anchors

[0234] 355 Cannulation

[0235] 450 second joint

[0236] 550 third joint

[0237] Al first lever distance

[0238] A2 second lever spacing

[0239] X shaft axis

[0240] Y joint axis

[0241] Z-axis joint

[0242] Y1 axis

[0243] Z 1 axis

Claims

Patent claims 1. Surgical instrument (1), in particular an endoscopic surgical shaft instrument, comprising - a joint (150, 450, 550) with at least one joint axis (Y, Z) , - a proximal section (100) and a distal section (200) , - at least one power transmission element (310, 320, 330, 340, 350) , - wherein the joint (150, 450, 550) is formed proportionally on the proximal section (100) and the distal section (200) and connects the proximal section (100) and the distal section (200), - wherein the at least one force transmission element (310, 320, 330, 340, 350) is coupled to the distal section (200) to apply a torque, - wherein the distal section (200) can be deflected about the at least one joint axis (Y, Z) relative to the proximal section (100) by the applied torque of the at least one force transmission element (310, 320, 330, 340, 350), characterized in that the proximal section (100) and / or the distal section (200) and / or the at least one force transmission element (310, 320, 330, 340, 350) are monolithic.

2. Surgical instrument (1) according to one of the preceding claims, characterized in that the joint (150, 450, 550) comprises a solid body joint.

3. Surgical instrument (1) according to one of the preceding claims, characterized in that the solid body joint comprises a bending web (160) connecting the proximal section (100) and the distal section (200).

4. Surgical instrument (1) according to one of the preceding claims, characterized in that the bending bridge (160) is arranged centrally.

5. Surgical instrument (1) according to one of the preceding claims, characterized in that at least one rib (162) projects from the bending web (160).

6. Surgical instrument (1) according to one of the preceding claims, characterized in that the joint (150, 450, 550), preferably the rib (162), comprises at least one recess (164) or opening (165) through which the at least one force transmission element (310, 320, 330, 340, 350) passes.

7. Surgical instrument (1) according to one of the preceding claims, characterized in that the proximal section (100) and / or the distal section (200) and / or the rib (162) have the same cross-section.

8. Surgical instrument (1) according to one of the preceding claims, characterized in that the joint (150, 450, 550) comprises a bellows connecting the proximal section (100) and the distal section (200).

9. Surgical instrument (1) according to one of the preceding claims, characterized in that the joint (150, 450, 550) has a first joint section (151) and a second joint section (251).

10. Surgical instrument (1) according to one of the preceding claims, characterized in that the joint (150, 450, 550) has corresponding guide surfaces (181, 281) which are formed around the at least one joint axis (Y, Z) and can come into frictional contact.

11. Surgical instrument (1) according to one of the preceding claims, characterized in that a running- and / or a separation gap (185, 186) is formed.

12. Surgical instrument (1) according to one of the preceding claims, characterized in that the first joint section (151) and the second joint section (251) are positively connected.

13. Surgical instrument (1) according to one of the preceding claims, characterized in that the first joint section (151) and the second joint section (251) form a ball and socket joint or a swivel joint.

14. Surgical instrument (1) according to one of the preceding claims, characterized in that the proximal section (100) and the distal section (200) are connected by at least one spring bar (190).

15. Surgical instrument (1) according to one of the preceding claims, characterized in that the at least one spring bar (190) surrounds the joint (150, 450, 550) in an arc-shaped manner.

16. Surgical instrument (1) according to one of the preceding claims, characterized in that the at least one spring bar (190) bridges the joint (150, 450, 550) at a distance in order to prevent rotation of the joint (150, 450, 550) about the at least to be able to deform a joint axis (Y, Z) freely and elastically.

17. Surgical instrument (1) according to one of the preceding claims, characterized in that the at least one spring bar (190) clamps the first joint section (151) and the second joint section (251) against each other.

18. Surgical instrument (1) according to one of the preceding claims, characterized in that the at least one spring bar (190) is formed monolithically with the proximal section (100) and / or the distal section (200).

19. Surgical instrument (1) according to one of the preceding claims, characterized in that the at least one force transmission element (310, 320, 330, 340, 350) is guided along the proximal section (100).

20. Surgical instrument (1) according to one of the preceding claims, characterized in that the at least one force transmission element (310, 320, 330, 340, 350) is guided in a guide channel (110).

21. Surgical instrument (1) according to any one of the preceding claims, characterized by the fact that the guide channel (110) has a cleaning opening (112).

22. Surgical instrument (1) according to one of the preceding claims, characterized in that the at least one force transmission element (310, 320, 330, 340, 350) has a cannulation (355).

23. Surgical instrument (1) according to one of the preceding claims, characterized in that at least two force transmission elements (310, 320, 330, 340, 350) are provided which are coupled to the distal section (200) on opposite sides to the at least one joint axis (Y, Z).

24. Surgical instrument (1) according to one of the preceding claims, characterized in that a steering head (120) is provided on the side of the proximal section (100) facing away from the distal section (200) and that the steering head (120) is connected to the at least two force transmission elements (310, 320, 330, 340, 350).

25. Surgical instrument (1) according to one of the preceding claims, characterized in that the steering head (120) is pivotable about at least one axis (Yl, ZI), wherein the at least one axis (Yl, ZI) preferably parallel to the at least one joint axis (Y, Z).

26. Surgical instrument (1) according to one of the preceding claims, characterized in that the at least one force transmission element (310, 320, 330, 340, 350) is coupled to the distal section (200) at a second lever distance (A2), and that the at least one force transmission element (310, 320, 330, 340, 350) is coupled to the steering head (120) at a first lever distance (Al), wherein the first lever distance (Al) is greater than the second lever distance (A2).

27. Surgical instrument (1) according to one of the preceding claims, characterized in that the proximal section (100) is formed by a shaft (105, 205) or by a force transmission element (310, 320) and / or that the distal section (200) is formed by a shaft (205) or a jaw part (50).

28. Method for manufacturing a surgical instrument (1), in particular a surgical endoscopic shaft instrument (1) according to one of the preceding claims, comprising a proximal section (100), a distal section (200), and a joint (150, 450, 550) connecting the proximal section (100) and the distal section (200) with at least one joint. steering axis (Y, Z) and with at least one power transmission element (310, 320, 330, 340, 350) , characterized by the process steps: - Primary forming of the proximal section (100), the distal section (200) and the at least one force transmission element (310, 320, 330, 340, 350), wherein during primary forming the distal section (200) and the at least one force transmission element (310, 320, 330, 340, 350) and / or the distal section (200) and the proximal section (200) are formed monolithically.

29. Method according to one of the preceding claims, characterized in that the primary forming is carried out by injection molding or an additive process.

30. Method according to one of the preceding claims, characterized in that during primary forming a guide channel (110) with at least one force transmission element (310, 320, 330, 340, 350) movably arranged in the guide channel (110) is formed in the proximal section (100).

31. Method according to one of the preceding claims, characterized in that the joint (150, 450, 550) has a first joint section (151) and a second joint section (251) having corresponding guide surfaces (181, 281) between which a running and / or separating gap (185, 186) is trained.

32. Method according to one of the preceding claims, characterized in that the formation of a positive locking connection between the first joint section (151) and a second joint section (251) is achieved by joining and closing the running and / or separating gap (185, 186).

33. Method according to one of the preceding claims, characterized in that at least one spring bar (190) is formed during the primary forming process, which connects the proximal section (100) and the distal section (200).

34. Method according to one of the preceding claims, characterized in that, when forming a positive locking connection, the at least one spring bar (190) is elastically deformed and generates a clamping force by which the guide surfaces (181, 281) are pressed into a frictional contact.

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