Applicator for applying a wrap cuff electrode around a nerve fiber bundle

Abstract

The invention relates to an applicator for applying a wrap cuff electrode, cuff electrode for short, around a nerve fiber bundle, in the form of a pincette, comprising two pincette arms, each of which has a longitudinal extent and which each provide a gripper jaw at the end and can be reversibly transferred from a closed state, in which the two gripper jaws touch along a linear or planar contact region that can be associated with the gripper jaws, into an open state, in which the two gripper jaws are spaced apart from one another. The invention is characterized in that a pushing instrument is attached along one of the two pincette arms, said pushing instrument being mounted displaceably in the longitudinal extent of the one pincette arm, and in that the pushing instrument has a pushing instrument end which is closest to the gripper jaws and is at a minimal distance a oriented orthogonally to the contact region, for which the following applies: 0 ≤ a ≤ 5 mm.

Description

[0001] Applicator for applying a wrap-around electrode around a nerve fiber bundle

[0002] Technical field

[0003] The invention relates to an applicator for applying a cuff electrode, or cuff electrode for short, around a bundle of nerve fibers, in the form of tweezers with two tweezer arms, each having a longitudinal extension, each providing a gripper jaw at its end, and which can be reversibly converted from a closed state, in which both gripper jaws touch along a linear or planar contact area attributable to the gripper jaws, to an open state, in which both gripper jaws are spaced apart from each other.

[0004] State of the art

[0005] Cuff electrodes are used for the intracorporeal application of electrical stimulation signals along a nerve fiber bundle. A particularly preferred cuff electrode is disclosed in EP 3204105 B1. Cuff electrodes have a biocompatible, film-like substrate capable of locally encircling a nerve fiber bundle. An electrode arrangement is mounted on the surface of this substrate for the application of electrical signals and is brought into direct surface contact with the epineurium of the nerve fiber bundle. For this purpose, the film-like substrate has an intrinsically imprinted mechanical preload such that the otherwise preferably rectangular, film-like substrate, in an otherwise force-free state, is able to wind itself up or roll up around a winding axis to form a straight hollow cylinder.The film-like substrate is typically rectangular in shape, at least in the area of ​​the material's inherent prestress, with a free edge that is guided at least once, preferably multiple times, around a winding axis. The film-like carrier substrate forms multiple loosely adjacent, hollow cylindrical windings. The electrode array is positioned on the substrate surface directly facing the volume enclosed by the winding sleeve, enabling direct contact with the surface of the nerve fiber bundle's epineurum when implanted and positioned locally around the bundle. To support or improve surface contact, the electrode array is further enhanced by the use of a flexible electrode.The contact pressure between the electrode arrangement and the nerve fiber bundle is achieved by multiple wrappings of the surface substrate around the nerve fiber bundle, thereby improving the mechanical hold on the outer circumference of the nerve fiber bundle with an increasing number of wrappings.

[0006] The radial outermost winding of the surface substrate merges seamlessly into a mechanically unstressed, i.e., otherwise flat, surface substrate section, to which an electrical contact arrangement is usually attached, via which electrical leads connected to the electrode arrangement can be connected to an implantable electrical supply unit via a corresponding conductor structure, in which means for electrical power supply as well as for control and operation of the cuff electrode are housed.

[0007] The current practice for implanting a cuff electrode requires a high degree of skill and steady hands from the surgeon, especially since the cuff electrode, in its normal state (i.e., when unloaded), automatically assumes the hollow cylindrical coiled shape described above. To transfer the cuff electrode into a state that is uncoiled or open for application to the outer circumference of a nerve fiber bundle, it is necessary, firstly, to grasp the cuff electrode at its mechanically unstressed, flat surface area, preferably using forceps, and secondly, to apply force to the cuff-like coiled surface substrate area, stretching it flat against the material's inherent coiling effect, so that the foil-like surface substrate assumes a largely uncoiled, flat shape.

[0008] For this purpose, a wire-like instrument bent into an "L" shape is suitable, the short leg of which is guided completely through the rolled-up cuff electrode on one side along the winding axis. Subsequently, by applying controlled traction along the longer leg of the instrument, and with appropriate counter-pressure using forceps, the winding cuff is transformed into an elongated, i.e., stretched, shape.

[0009] The procedure described above must be performed by the surgeon using both hands and requires the utmost concentration both for the placement of the cuff electrode along the nerve fiber bundle and for the process of unwinding the cuff electrode, especially since even a slightly excessive tension of the coilable surface substrate leads to the instrument slipping or detaching from the stretched surface substrate, causing the surface substrate to spontaneously return to its rolled-up state.

[0010] Especially under real-world surgical conditions, where space, visibility, and time are limited, the surgeon is required to possess a high level of technical skill and surgical expertise. Furthermore, incorrect attempts or misapplications of the cuff electrode along a nerve fiber bundle represent avoidable burdens for the patient.

[0011] Document WO 2024 / 052274 A1 describes a medical implant in the form of a wrap-around sleeve, designed to facilitate the surgeon's handling during implantation and application of the sleeve around a nerve fiber bundle. The wrap-around sleeve features a simply folded, film-like substrate. This substrate is divided into two sections, one adjoining the other along a common fold edge. Each section has an inherent indentation such that it has a winding direction oriented in opposite directions relative to the fold edge. This allows the sleeve to be grasped at two opposing edges of the substrate, preferably with forceps, and the substrate to be unrolled by applying controlled traction.The goal is to create a stretched, flat shape in which the stretched substrate can be applied to a nerve fiber bundle on one side along the fold. The wrapping cuff conforms to the nerve fiber bundle through self-wrapping as soon as the traction force is reduced by the surgeon.

[0012] All known precautions that support the application of a cuff electrode around a nerve fiber bundle require both hands of the surgeon, who must perform the application procedure with utmost sensitivity, precision and calmness.

[0013] The publication DE 202018 101 753 U1 discloses a surgical electrode application instrument which has two jaw-like movable arms, at least one of which is designed with a semicircular indentation on its end face for receiving an electrode strand.

[0014] Description of the invention

[0015] The invention aims to significantly simplify the application of a cuff electrode around a nerve fiber bundle by using an applicator in the form of forceps with two longitudinally extending forceps, each end of which has a gripping jaw. The applicator can be reversibly moved from a closed state, in which both gripping jaws touch along a linear or planar contact area, to an open state, in which the two gripping jaws are spaced apart. The applicator should enable the surgeon to apply a cuff electrode around a nerve fiber bundle as easily, safely, and quickly as possible. The applicator should be operated with one hand, so that the surgeon generally has their other hand free for any necessary additional steps.

[0016] The solution to the problem underlying the invention is specified in claim 1. Advantageously developing features of the invention are the subject of the dependent claims and the further description, in particular with reference to the figures.

[0017] According to the solution, an applicator for applying a cuff electrode, or cuff electrode for short, around a bundle of nerve fibers, in the form of tweezers, with the features of the preamble of claim 1, is characterized in that a pusher is attached along one of the two tweezer arms, which is slidably mounted in the longitudinal extension of one tweezer arm, and that the pusher has a pusher end closest to the gripper jaws, which has a minimum distance a oriented orthogonally to the contact area, for which: 0 < a < 5 mm.

[0018] The applicator designed according to the solution utilizes a known tweezer, preferably a self-holding tweezer, whose tweezer arms, each having a gripping jaw at its end, are mechanically pre-tensioned such that the gripping jaws contact each other under force without manual actuation. A preferably strand-shaped, e.g., rod- or wire-shaped, pusher is additionally attached to one of the two tweezer arms, which is mounted on the tweezer arm via a linear bearing, allowing it to deflect bidirectionally.

[0019] The linear bearing is preferably designed as a rail guide, allowing for the smoothest possible movement of the propulsion instrument with minimal resistance, so that the instrument can be easily deflected with just one finger, preferably the operator's thumb. The propulsion instrument is preferably mounted along one of the two forceps arms by means of a permanent connection between the instrument and the forceps arm. However, a detachable connection of the propulsion instrument along one of the forceps arms is also conceivable, thus allowing a propulsion instrument mounted in a linear bearing to be retrofitted or attached as an add-on module to a standard and / or already used forceps, for example, by means of a locking, clamping, or clip mechanism.

[0020] The preferably strand-shaped pushing instrument and its attachment to the tweezers are designed in such a way that the tweezer function, i.e., the gripping of an object by means of the gripper jaws, is not impaired.

[0021] The pushing instrument has a pushing instrument end located closest to the gripper jaws, which has the smallest possible orthogonal distance *a* to the contact area between the two gripper jaws. This ensures that, when the pushing instrument is advanced distally towards and beyond the gripper jaws, the pushing instrument end can make contact with a cuff electrode held between the two gripper jaws, allowing the cuff electrode to be unwound by the pushing instrument. In its wound state, the cuff electrode has the form of a hollow cylinder, typically with an outer diameter of a few millimeters. Therefore, the pushing instrument end has an orthogonal distance *a* to the contact area between the two gripper jaws, for which the following applies: 0 < *a* < 5 mm, preferably 0.5 < *a* < 3 mm, and particularly preferably 0.5 < *a* < 1.5 mm.

[0022] The end of the pusher instrument is preferably designed such that it can engage a cuff electrode, grasped by both gripper jaws, over a large area for the purpose of unwinding or unfolding it, i.e., converting it into a flat, extended state. The cuff electrode typically comprises a film-like, biocompatible substrate that can be wound into a hollow cylindrical shape around a spatial axis by means of a winding direction determined by an inherent material imprint. In the wound state, the cuff electrode radially encloses a hollow cylindrical space and has a substrate end that, in the wound state, rests against a surface of the substrate oriented away from the space radially enclosed by the substrate.

[0023] For the purpose of applying such a cuff electrode around a nerve fiber bundle, the grasping jaws of the forceps fix the coiled cuff electrode locally along its substrate end such that a coiling axis attributable to the coiled cuff electrode is oriented orthogonally to the longitudinal extension of the forceps arms. The insertion instrument is in a retracted position, i.e., its insertion end is preferably positioned proximally relative to the cuff electrode grasped by the grasping jaws, so as not to impede the grasping and holding process of the cuff electrode with the forceps.

[0024] The end of the pusher instrument is then advanced along one of the two forceps arms until it comes into contact with the surface of the substrate, which faces radially away from the enclosed space, ideally forming at least a linear contact between the cuff electrode and the end of the pusher instrument. Further advancement of the pusher instrument causes the cuff electrode to be unwound or stretched in the opposite direction of its winding by means of the pusher instrument. In this stretched state, the substrate is clamped against the cuff electrode by the pusher instrument end and the gripper jaws, against the material's inherent shape.

[0025] The shape, size and arrangement of the pusher instrument end and the cuff electrode are designed to be coordinated in such a way that, with further advancement of the pusher instrument, the cuff electrode detaches from the pusher instrument end and can be returned unhindered and independently from the extended state to the wound state.

[0026] A preferred embodiment of an otherwise continuous pusher provides a pusher end that has an end section oriented orthogonally to the longitudinal extent of one of the forceps arms and parallel to the contact area. This end section preferably makes lateral contact with the hollow cylindrically wound cuff electrode along its entire longitudinal extent. For this purpose, the preferably continuous pusher end is U-shaped, so that the straight end section has a free strand end. Alternatively, the cuff electrode can be held by both gripper jaws, with the aforementioned end section projecting through its cylindrical cavity. When the pusher is advanced, the end section reaches the surface of the substrate radially facing the cavity, causing the cuff electrode to unwind around and through the end section.

[0027] As an alternative to the bow-shaped design of the push instrument end, it is also possible to design the push instrument end in a loop shape, whereby the end section, which is also preferably straight, is part of the loop shape.

[0028] The end of the insertion instrument is preferably monolithically connected to the insertion instrument, but can also be designed as a fixed attachment made of a different material, preferably plastic, than the strand-like insertion instrument, which is preferably made of metal. It is also possible to manufacture the insertion instrument entirely from a biocompatible plastic. The solution applicator, consisting of forceps and the insertion instrument described above, is preferably made of an autoclavable material suitable for multiple uses as a medical instrument.

[0029] However, it is possible to offer the applicator together with a cuff electrode as a medical set, in which the cuff electrode is positioned in a precisely defined position between the two gripper jaws, allowing a surgeon to use it directly for implantation. The forceps and the insertion instrument do not necessarily need to be made of a high-quality, autoclavable material. As disposable items, or...

[0030] Consumable tools such as tweezers and push instruments can also be made from a biocompatible and inexpensive plastic.

[0031] Brief description of the invention

[0032] The invention is described below by way of example, without limiting the general concept of the invention, with reference to the drawings. The drawings show:

[0033] Fig. 1a Applicator designed according to the solution with a pusher in the starting position,

[0034] Fig. 1b Detail view as a longitudinal section through the front area of ​​the forceps arrangement with pusher instrument end,

[0035] Fig. 1c Applicator with extended pusher,

[0036] Fig. 2 a, b, c Sequence images of the applicator with cuff electrode for application along a nerve fiber bundle as well as

[0037] Fig. 3, a, b Applicator designed according to the solution with loop-shaped pusher end. Ways of carrying out the invention, industrial applicability

[0038] Figure 1a shows an applicator 1 in the form of self-retaining tweezers 2 with two tweezer arms 3, 4, each having a gripping jaw 5, 6 at its end. A pusher 7 is mounted longitudinally on the upper side of one of the two tweezer arms 3, allowing it to move along the length of the tweezer arm 3. The rod-shaped pusher 7 is mounted bidirectionally in a linear bearing 8, which is fixed (i.e., permanently) to the tweezer arm 3. Alternatively, instead of being fixed (e.g., monolithic), the linear bearing 8 can be connected to the tweezer arm 3 in a detachable, fixed manner. This makes it possible to retrofit or combine tweezers 2 with a pusher 7 guided in a linear bearing 8.For this purpose, the linear bearing 8 can be attached to a tweezer arm 3 by means of a clip, clamp, screw or locking mechanism.

[0039] The linearly shaped pusher 7 has a manual actuation structure 9 on its proximal side, which allows an operator, for example, to push the pusher 7 along the linear bearing 8 using their thumb. In the embodiment shown in Figure 1a, the manual actuation structure 9 is designed as a projection above the linear bearing 8 in order to establish direct contact with the operator's thumb via a frictional connection.

[0040] Opposite the manual actuation structure 9, the pusher 7 has a bow-shaped pusher end 10, which is integrally, i.e. monolithically, connected to the strand-shaped pusher 7 and has a straight end section 11, the spatial orientation of which is orthogonal to the longitudinal extension of the pusher 7 or of both forceps arms 3, 4. The end section 11 has a free strand end 12. The arrangement and design of the pusher instrument 10 and in particular its end section 11 are chosen such that a distance a between the instrument end 11 and the linear or planar contact area 13 formed between the two gripper jaws 5, 6 in the closed state moves in the range between 0 and 5 mm, i.e. 0 < a < 5 mm, see detailed illustration according to Figure 1b, which shows a longitudinal section through the front area of ​​the tweezer arrangement with pusher instrument end 10.The distance dimension a is chosen in relation to a typical cuff electrode diameter in the wound state, so that it is ensured that the end section of the pusher instrument end 10 comes into contact with a cuff electrode in the wound state during a distal advance of the pusher instrument 7, which is fixed between the two gripper jaws 5, 6, as can be seen further with reference to Figures 2 a - c.

[0041] Figure 1c shows the applicator 1 with a distally advanced thrusting instrument 7, the proximal portion of which remains guided along the linear bearing 8 and the end 10 of which projects distally beyond the gripper jaws 5, 6. The thrusting instrument 7 can be returned to its retracted position as shown in Figure 1a by moving it proximally along the linear bearing 8.

[0042] Figures 2a-c illustrate the function of the solution-based applicator for grasping and applying a cuff electrode 14 around a nerve tract 15. The cuff electrode 14 has a film-like, biocompatible surface substrate 16, which can be transformed into a hollow cylindrical shape by self-winding around a winding axis 17 in a direction determined by a shape imprint inherent in the material. A cuff electrode of this type is disclosed, for example, in EP 3204 105 B1. In the wound state, the cuff electrode 14 typically has a protruding surface substrate end 18 that rests against a surface of the surface substrate 16 oriented away from the inner, hollow cylindrical space 19 radially enclosed by the surface substrate 16.In the wound state of the cuff electrode 14, as shown in Figure 2 a, the cuff electrode 14 is fixed centrally along its surface substrate section end 18 by the gripper jaws 5, 6 in such a way that the winding axis 17 of the cuff electrode 14 is oriented orthogonally or transversely to the longitudinal extension of the tweezer arms 3, 4.

[0043] Typically, the hollow cylinder diameter b associated with the cuff electrode 14 measures 1–5 mm, preferably 2–4 mm. The orthogonal distance a of the pusher end 10, in particular the end section 11, from the contact area 13, in which the surface substrate section end 18, fixed by both gripper jaws 5, 6, is located, should be equal to, preferably smaller than, the diameter b of the wound cuff electrode 14. This ensures that when the pusher 7 is advanced in the direction of the cuff electrode 14 gripped by both gripper jaws 5, 6, the end section 11 comes into contact with the cuff electrode 14. For this purpose, the end section 11 is aligned straight and parallel to the winding axis 17 of the cuff electrode 14. Furthermore, the length 11 of the end section 11 is greater than or equal to the width f1 of the cuff electrode 14.In this way, it is ensured that the cuff electrode 14 experiences a uniformly distributed contact pressure from the end section 11 due to the feed movement of the pusher instrument 7 and is thus completely unrolled in the feed direction, as illustrated in Figure 2b.

[0044] Figure 2b shows the complete stretching of the flat substrate 16 of the cuff electrode 1, achieved by means of the pushing instrument 7. In this state, the unrolled flat substrate 16 is held taut on one side by the end section 11 of the pushing instrument 7 and on the other side by the gripping jaws 5, 6 of the forceps 2. The surgeon positions the cuff electrode 14, thus stretched, below a nerve fiber bundle 15, around which the cuff electrode 14 is to be applied. After appropriate positioning, the pushing instrument 7 is advanced further distally, causing the cuff electrode 14 to automatically assume its wound state and wrap itself at least once, preferably several times, around the nerve fiber bundle, as shown in Figure 2c. The shape of the pushing instrument end 10 must be selected such that it does not impede the winding process carried out automatically by the cuff electrode 14.For this purpose, the stirrup-shaped geometry of the pusher instrument end 10 must be adapted to the shape and size of the surface substrate of the cuff electrode 14. Thus, for the lengths 11 of the end section 11 shown in Figure 2b and the stirrup length I2, the following should apply depending on the length f1 and width f2 of the surface substrate 16 of the cuff electrode 14: 11 > f1 and I2 > f2.

[0045] In Figures 2a to 2c, the yoke length I2 is defined by a straight side section 11'. In a preferred embodiment, a modified side section 11" has a concave contour or is concave along its entire yoke length I2, as illustrated in Figures 2a to 2c by a dashed side section 11". This prevents the otherwise possible contact of the nerve bundle 15 by the insertion instrument 7 during the positioning of the extended cuff electrode 14 below the nerve fiber bundle 15, see Figure 2b. When using the implantation forceps, the concave contour along the modified side section 11" is oriented towards the nerve fiber bundle 15.

[0046] As an alternative to the arrangement of the cuff electrode 14 relative to the propulsion instrument end 10 of the propulsion instrument 7 shown in Figures 2a-c, it is also conceivable to arrange the propulsion instrument 7 relative to the cuff electrode 14 grasped by the forceps 2 such that the end section 11 is arranged coaxially to the winding axis 17, so that the end section 11 extends through the cuff electrode 14 along its hollow cylindrical space 17. In this configuration, the cuff electrode 14 can be unrolled and brought into the position shown in Figure 2b in the same way as described for Figures 2a to c. Such an arrangement is particularly suitable for a set designed as a consumable product, which provides the cuff electrode together with the forceps-propulsion instrument arrangement for direct use by a surgeon.Figures 3a and 3b show an alternative embodiment of the pusher 7 in a schematic top view. The pusher 7, which is bidirectionally deflectable on the forceps arm 3 by means of a linear bearing 8, has a pusher end 10' shaped like a loop 20, with a loop length I2' and a loop width 11. The loop length I2' is greater than the surface substrate length f2, and the loop width 11' is greater than the width f1 of the cuff electrode 14. Figure 3a shows the initial state with a cuff electrode 14 in its wound state, gripped centrally by both gripper jaws 5 and 6 of the forceps along its surface substrate section end 18. Figure 3b shows the tensioned state of the cuff electrode 14, comparable to the situation shown in Figure 2b.

[0047] Similar to the set arrangement described above, it is conceivable to arrange the cuff electrode 14 in its wound state around the distal end section 11 of the pusher instrument 7, while its surface substrate section end 18 is gripped centrally by the gripper jaws 5, 6 of the forceps. Reference numeral list

[0048] 1 applicator

[0049] 2 self-holding tweezers

[0050] 3, 4 tweezer arms

[0051] 5, 6 Gripper jaw

[0052] 7 Push instrument

[0053] 8 linear bearings

[0054] 9 manual actuation structure

[0055] 10, 10'end of thrust instrument

[0056] 11 Final Section

[0057] 11' Page section

[0058] 11 “ modified page section

[0059] 12 free ending

[0060] 13 Contact area

[0061] 14 Cuff electrode

[0062] 15 nerve fiber bundles

[0063] 16 Surface substrate

[0064] 17 winding axis

[0065] 18 Surface substrate section end

[0066] 19 hollow cylindrical space

[0067] 20 loops

[0068] f1 Width of the surface substrate

[0069] f2 Length of the surface substrate 11, 11' Width of the thrust instrument end

[0070] 12, I2' Length of the thrust instrument end

[0071] a) Distance between the end of the thrust instrument and the contact area b) Diameter of the cuff electrode

Claims

Patent claims 1. Applicator for applying a cuff electrode (14) around a nerve fiber bundle (15), in the form of tweezers (2) with two tweezer arms (3, 4) each having a longitudinal extension, each arm having a gripper jaw (5, 6) at its end, and which can be reversibly converted from a closed state, in which both gripper jaws (5, 6) touch along a linear or planar contact area (13) attributable to the gripper jaws (5, 6), to an open state, in which both gripper jaws (5, 6) are spaced apart from each other. characterized in that a pushing instrument (7) is attached along one of the two tweezer arms (3), which is slidably mounted in the longitudinal extension of one of the tweezer arms (3), and that the pusher (7) has a pusher end (10) closest to the gripper jaws (5, 6) which has a minimum distance a oriented orthogonally to the contact area (13) for which: 0 < a < 5 mm.

2. Applicator according to claim 1 , characterized in that the distance a is: 0.5 < a < 3 mm, preferably 0.5 < a < 1.5 mm.

3. Applicator according to claim 1 , characterized in that the pushing instrument (7) is detachably fixed to one of the tweezer arms (3).

4. Applicator according to one of claims 1 to 3, characterized in that the pusher instrument (7) is connected to a tweezer arm (3) via a linear bearing (8).

5. Applicator according to claim 4, characterized in that the linear bearing (8) is designed in the form of a rail guide in which the thrust instrument (7) is longitudinally movable.

6. Applicator according to one of claims 1 to 4, characterized in that the thrust instrument (7) is formed in a strand-like form.

7. Applicator according to any one of claims 1 to 6, characterized in that the push instrument end (10) has an end section (11) oriented orthogonally to the longitudinal extension of one tweezer arm (3) and parallel to the contact area (13).

8. Applicator according to claim 7, characterized in that the pusher instrument end (10) is formed in a strand-like and bow-shaped manner and the end section (11) has a free strand end (12).

9. Applicator according to claim 7, characterized in that the thrust instrument end (10) is formed in a strand-like manner and in the form of a loop (20) and the end section (11) is part of the loop (10).

10. Applicator according to any one of claims 1 to 9, characterized in that the thrust instrument end (10) is monolithically connected to the thrust instrument (7).19 11. Applicator according to one of claims 7 to 10, characterized in that the push instrument end (10) has a side section (11") oriented parallel to the longitudinal extension of one forceps arm (3), which has a concave contour or is concave over its entire extension.

12. Applicator according to one of claims 1 to 11 , characterized in that the tweezers (2) are self-holding tweezers.

13. Applicator according to any one of claims 1 to 12, characterized in that the thrust instrument (7) has an end opposite the thrust instrument end (10) to which a manual actuation structure (9) is attached.

14. Applicator according to one of claims 1 to 13, comprising a cuff electrode (14) which provides a film-like, biocompatible surface substrate (16) which can be transformed into a hollow cylindrical shape by self-winding with a winding direction predetermined by a material-inherent shape imprint around a winding axis (17), radially enclosing a hollow cylindrical space (19) in the wound state and having a surface substrate section end (18) which, in the wound state, rests against a surface of the surface substrate (16) which is oriented away from the hollow cylindrical space (19) radially enclosed by the surface substrate (16), characterized in that the gripper jaws (5, 6) locally fix the cuff electrode (14) in the wound state along the end of the surface substrate section (18) such that the winding axis (17) of the cuff electrode (14) is oriented orthogonally to the longitudinal extension of the tweezer arms (3, 4), and that the pusher end (10) of the pusher (7) is brought to the surface of the surface substrate (16) facing away from the hollow cylinder space (19) radially enclosed by the surface substrate (16) by pushing along one of the two 20 The tweezer arms (3, 4) can be brought into position and, by further advancement, the cuff electrode (14) can be brought into a stretched state by unwinding against the given winding direction, in which the surface substrate (16) is clamped by the pusher instrument end (10) on the one hand and by the gripper jaws (5, 6) on the other hand against its material-inherent shape impression.

15. Applicator according to claim 14, characterized in that the pusher instrument end (10) and the cuff electrode (14) are designed in such a way as to be matched in shape and size that, with further advancement of the pusher instrument (7), the cuff electrode (14) detaches from the pusher instrument end (10) and can be returned unhindered and independently from the extended state to the wound state.

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