DE102012206581A1 - Medical wedging and spreading device e.g. tissue clamp for clamping and spreading tissue of patient during surgical intervention, has actuator that is used for actuation of wedging and spreading device casing - Google Patents

Abstract

The wedging and spreading device (10) comprises an actuator (16) that is used for actuation of the wedging and spreading device casing. A force sensor (18) measures the clamping and spreading force affecting tissue (14) of a patient. A controller (20) controls the clamping and spreading force acting on the tissue. A connecting device (26) releasably connects the device casing with a surgical instrument (28). An independent claim is included for method for controlling medical wedging and spreading device.

Description

The invention relates to a medical clamping and / or spreading device and a method for controlling such.

In some surgical procedures, such. As the treatment of aneurysms, a blood vessel must be disconnected for a short time. This is done by means of so-called vascular clamps. A vascular clamp has the purpose of reducing the blood flow in a vessel in a desired manner over a longer period of time or to completely suppress it, thereby causing as little damage to the vessel as possible.

Vascular clamps exist in many mechanical designs designed to prevent or minimize damage to the vessel. The clamping is usually done manually by the surgeon. Monitoring whether the clamp is tight is done directly by the surgeon or an assistant.

Furthermore, hemostasis is known from the prior art, which can be used endoscopically in the body of a patient. Such is for example in the document US 5,569,274 A1 described. Here, the vascular clamp is attached to the tip of a surgical instrument and inserted via a trocar point in the body of a patient.

Operation of the vascular clamp to disconnect the vessel is done mechanically by the surgeon. The disadvantage is that a monitoring of the tightness of the clamping must be performed manually and is associated with a relatively large effort. Also, this monitoring can often not be performed with the required accuracy. An adaptation of the clamping force with a fast response time is also very limited possible.

Vascular clamps known in the art are often too large to be used endoscopically. There must be a connection to the outside to change the clamping action. This requires a considerable effort. Simple loops or clamps allow only a very inaccurate adjustment of the clamping force and usually no subsequent adjustment. Once placed in the body of the patient and then separated from the instruments terminals can not be readjusted. Without continuous monitoring of the clamping function, it is not possible to react directly to malfunctions (for example, an injury to the vessel). A short-term lifting of the clamping is therefore not possible. This can be associated with considerable risks.

The disadvantages mentioned apply not only to a clamping device, such as a vascular clamp, but also to a spreading device which is used during a surgical procedure to spread tissue of a patient, for example an opening.

The object of the invention is to provide a clamping and / or spreading device, which allows easy handling, and the clamping effect or spreading effect can be monitored in particular in a simple manner. The object of the invention is also to provide a method for controlling a actuated by an actuator clamping and / or spreading.

The object is achieved according to the invention by the features of claims 1 and 8.

The medical clamping and / or spreading device according to the invention serves for clamping and / or spreading tissue of a patient during a surgical procedure. It is characterized in that it comprises an actuator for actuating the clamping and / or spreading device, which is formed in and / or on the clamping and / or spreading device.

A clamping and / or spreading device with an integrated actuator offers numerous possibilities to respond very flexibly and quickly to different operating scenarios. First of all, it is no longer necessary to apply the force required by the surgeon or an assistant for the clamping or spreading of the tissue, since this task is performed by the actuator. The actuator can still be controlled very flexible and, for example, respond quickly to change requests that affect the change in the required clamping or spreading force. These can for example be supplied to the actuator via a control or regulating device, which will be explained in more detail below. Such a flexible and above all rapid response to changing requirements is not given in a manual operation of the clamping and / or spreading by a surgeon or assistant. By virtue of this flexibility, the clamping and / or spreading device according to the invention can furthermore make the clamping or spreading of the tissue in a gentler manner, since the clamping force with which the tissue is acted upon can be precisely controlled at any time. This is also not always possible with a manual application of the clamping or spreading force.

The clamping and / or spreading device according to the invention, for example, completely, in particular endoscopically, be inserted into the body of a patient. Alternatively, it is possible to insert the clamping and / or spreading device only partially endoscopically into the body of a patient. For example, in this case, the distal functional element of the clamping and / or spreading device, which has the clamping and / or spreading unit, are introduced into the body of the patient. The clamping and / or spreading unit can be connected via an actuating element, for example a coupling rod, to a drive which is located outside the patient's body. The unit of the distal functional element, namely the clamping and / or spreading unit, the actuator and the drive outside the body of the patient is also understood according to the invention as a clamping and / or spreading, so that in this embodiment, the drive or actuator in and / or is formed on the clamping and / or spreading device.

In a preferred embodiment, the device according to the invention is an endoscopically insertable into the body of a patient vascular clamp.

An endoscopically insertable into the body of a patient vascular clamp comprises a clamping unit for clamping the vessel. The vessel may be, for example, a blood vessel that needs to be disconnected during surgery. Clamping is understood as meaning complete or partial disconnection, so that a partial flow through the vessel may still be possible. The clamping unit can, for. B. several clamping elements, for example, at least two jaws have, through which the vessel can be clamped.

The device according to the invention is characterized by an actuator for actuating the clamping unit. The actuator is formed in or on the vascular clamp itself, wherein the vascular clamp including the actuator is completely insertable into the body of a patient. By way of example, the at least two clamping jaws of the clamping unit can be actuated by the actuator.

It is preferred that the vascular clamp including the clamping unit and the actuator have dimensions such that they can be completely inserted into the body of the patient and remain there at least for the time of the operation. During this time there need be no mechanical connection between the hemostat and other devices outside the patient's body.

It is preferred that the clamping and / or spreading device comprises a clamping and / or expanding force sensor, wherein the sensor is formed in or on the clamping and / or spreading device and in particular completely inserted into the body of a patient. The clamping and / or expanding force sensor is used to measure the force acting on the vessel clamping or spreading force. This sensor may, for example, be a force sensor known from the prior art. If the clamping unit comprises a plurality of clamping elements, each of them can have a sensor, so that a total of several sensors, at least two sensors, can be used.

The clamping and / or spreading device according to the invention may further comprise a controller for regulating the force acting on the vessel clamping force or spreading force. This takes place taking into account a clamping or spreading force measured by an internal and / or external sensor, which is supplied to the controller. Furthermore, optionally, the control can be carried out in accordance with a predetermined regulation, which is supplied to the controller. Also, the controller is formed in or on the clamping and / or spreading and completely inserted into the body of a patient.

In a preferred embodiment, the clamping and / or spreading device comprises a receiving device, in particular a receiving coil, for receiving inductively transmitted energy from an extracorporeal energy source. It is known in the art to transfer energy via an inductive coupling from an external power source to an implanted device. For this purpose, an extracorporeal transmission coil is provided, which is connected to the energy source and generates a changing magnetic field. The receiving coil, which is arranged in the patient's body in the region of this magnetic field, generates an induced voltage due to the inductive coupling, which is supplied to the implanted device, in this case the clamping and / or spreading device located in the patient's body.

In addition to the external power supply, the clamping and / or spreading device may be an internal power source, e.g. B., a rechargeable battery, with which they can provide themselves at least temporarily energy technically. As a result, in case of failure of the inductive coupling, the power supply can be maintained.

In a further preferred embodiment, the clamping and / or spreading device according to the invention has a connecting device for the releasable and recoverable mechanical connection of the clamping and / or spreading device with a surgical instrument for Inserting the clamping and / or spreading device in the body of a patient. This surgical instrument can be introduced via a trocar in the body of the patient, wherein at its distal end on the said connection device, the clamping and / or spreading device is releasably attached. Once the clamping and / or spreading device is placed at the desired location on the vessel and the clamping unit has disconnected the vessel, the connecting device can be released, so that the clamping and / or spreading device can remain in the body of the patient for the desired duration. During this time, the surgical instrument, through which the clamping and / or spreading device has been inserted, can be removed from the patient's body. After completion of the operation, the surgical instrument can be re-introduced into the body of the patient and mechanically connected via the connection device with the clamping and / or spreading device. The clamping or spreading of the tissue can be released, so that the clamping and / or spreading device can be removed from the body of the patient. The clamping and / or spreading device may be autonomous such that during the time in which there is no mechanical connection to the surgical instrument, a completely autonomous operation including a regulation of the applied clamping or spreading force is possible without any influence of outside is necessary. However, certain aspects of the control or power supply may also be made by external devices.

The actuator used in the clamping and / or spreading device may for example be a piezoelectric actuator. Any used actuator of the clamping and / or spreading device can be used to arbitrarily change or maintain the position of the clamping device. Thus, a very flexible adaptation of the clamping or spreading over time is possible, so that it can be responded to a wide variety of requirements according to the operation just performed. Furthermore, the actuator can be implemented in such a way that only during a change in the position of the clamping or spreading unit energy must be expended. This means that the holding of the clamping or spreading unit is done at a certain position without energy consumption. Only for the change of the position of the clamping or spreading energy must be expended. For this purpose, for example, the drive can be clamped, instead of clamping the clamping or spreading unit itself. The clamping of the drive can be solved for example with resonance. Such an actuator is thus preferably not recoverable and this means that it can not be driven back by an external force, such as the usually occurring clamping force. Furthermore, it makes sense to make the controller accordingly, so that not constantly the actuator is driven, which would lead to increased energy consumption. This means that the controller is preferably designed such that the clamping or spreading force is adjusted as little as possible. By the features mentioned, a particularly energy-saving device can be provided, which is particularly suitable for minimally invasive surgery.

The described mechatronic clamping and / or spreading device can be used endoscopically. An endoscopic insertion is understood according to the invention to mean an intervention that is minimally invasive via one or more incisions in the patient's sheath. Here, the operation can be monitored using an endoscope. Monitoring with other instruments is also possible, so that an endoscope in its actual sense does not necessarily have to be used. It is essential that the clamping and / or spreading device can be introduced as part of a minimally invasive procedure in the body of a patient without, for example, the abdominal wall of the patient would have to be completely opened. During the insertion process, the clamping and / or spreading device is inserted into the patient's body through the incision by means of a surgical instrument. In addition to the embodiment already shown, in which the clamping and / or spreading device is separated from the instrument, while mechanically z. B. is connected to the abzuklemmenden vessel, it may also while still disconnecting the vessel, remain connected to the instrument.

The invention further relates to a method for controlling a actuated by an actuator, in particular completely insertable into the body of a patient clamping and / or spreading device. The method comprises the following steps: It is by the clamping or spreading device on the tissue, such. B. a vessel applied clamping or spreading force detected by an internal and / or external sensor. An internal sensor here is a sensor which is mounted in or on the clamping or spreading device itself. An external sensor is located elsewhere in or outside the patient's body. By a sensor, in particular by the external sensor, the applied clamping or spreading force does not need to be detected directly. For example, it is possible to detect a different size, from which the applied clamping or spreading force, for example by calculations, can be derived. For example, it is possible by means of an external sensor (eg Doppler ultrasound), which is arranged in the flow direction to the vessel clamp in or on the vessel, any remaining Flow in the vessel clamped by the vascular clamp to measure. Based on the measured remaining flow, the clamping force applied to the vessel by the vessel clamp can then be deduced on the basis of previously performed comparative experiments. Alternatively, it is possible to use the measured value of the external sensor, which indicates the remaining flow in the clamped vessel, as a controlled variable for the clamping force or the position of the clamping elements. Depending on the measured flow, the clamping force can thus be set such that the desired flow occurs. In this case it is not necessary to carry out comparative experiments beforehand.

In the further course of the method, the detected clamping or spreading force is supplied to an internal regulator of the clamping and / or spreading device. Alternatively, the detected clamping or spreading force can also be supplied to an internal control of the clamping and / or spreading device, while the actual calculation of the control takes place elsewhere, for example outside the patient's body. In this case, the control variable calculated outside the body would be fed to the internal control of the clamping and / or spreading device.

Subsequently, an autonomous control by the internal controller and / or the internal control of the force applied by the actuator clamping or spreading force.

As a result of the abovementioned method steps, the clamping and / or spreading device is thus able, in particular completely autonomously, to provide the clamping or spreading force which is desired at the respective time and acts on the tissue. Furthermore, it is possible to respond very quickly and flexibly to different requirements, so that the clamping or spreading force can be adjusted accordingly. For example, the clamping or spreading can be stopped immediately, if during an operation a violation of the clamped or spread tissue is diagnosed by the clamping and / or spreading device.

In a preferred embodiment, the regulation of the clamping or spreading force in accordance with a control rule, in particular the controller from the outside, d. H. from a device other than the clamping and / or spreading itself, and in particular wirelessly transmitted. For example, the rule may take into account various scenarios that may occur during an operation. Depending on the scenario just present, the surgeon can select a corresponding rule of law, which then transmits to the clamping and / or spreading device and from this independently, d. H. without further action from external devices. Also, the essential part of the control can be made in an external controller.

When using a flow sensor as an external sensor, the flow of the vessel clamped by the vessel clamp can also be used to determine the tightness of the vessel closure. This can be done, for example, as part of an estimate.

The clamping and / or spreading device according to the invention preferably has such dimensions that it can be introduced through small body openings. It is preferred that the device according to the invention has a diameter of at most 12 mm, preferably at most 10 mm and particularly preferably at most 5 mm. For example, the diameter may correspond to the standard instrument diameter of instruments in minimally invasive surgery. Also, the device according to the invention may have a maximum length of less than 100 mm. The hemostatic clamp according to the invention thus represents an integrated mechatronic system.

In the following, preferred embodiments of the invention will be explained with reference to figures.

Show it:

1a + b show schematic views of an embodiment of the hemostatic clamp according to the invention in the body of a patient,

2 a highly schematic view of an embodiment of the inventive hemostasis, and

3 a schematic view of an embodiment of the hemostat according to the invention together with other external components.

1 shows the clamping device 10 when inserted into the body 100 of the patient. The insertion takes place by means of a surgical instrument 26 passing through a trocar point 40 in the outer shell 38 , namely the skin of the patient, in the body 100 is introduced. The vascular clamp 10 is mechanical with the surgical instrument 26 connected at its distal end.

In 1b became the surgical instrument 26 mechanically from the vascular clamp 10 decoupled after this the abzuklemmende vessel 14 has disconnected. To remove the hemostat 10 after the desired intervention, the coupling with the surgical instrument 26 be restored.

In 2 is an enlarged view of an embodiment of the vascular clamp 10 shown. At its distal end, this includes two jaws or clamp arms 12a . 12b , between the vessel 14 is clamped. The vascular clamp further comprises a clamping force sensor 18 , an actor 16 for actuating the clamping device 12a . 12b , a regulator 20 and an internal energy source 30 that with a receiver coil 22 is connectable. Through this receiver coil, the hemostat 10 be supplied inductively with energy. Furthermore, the vascular clamp comprises 10 a connection device 26 for connection to the surgical instrument 28 ,

In 3 the same components are provided with identical reference numerals. The direction of fluid flow in the vessel 14 is with the arrow 36 characterized. In the direction of flow 36 after the hemostat 10 is on the vessel 14 an external sensor mounted by the z. B. a remaining flow in the through the vascular clamp 10 clamped vessel 14 can be measured. This external sensor 19 Depending on the application, also a greater distance to the hemostat 10 exhibit.

In 3 is also an external source of energy 24 shown, which is a transmitting coil 25 has or can be connected to such. Through the transmitter coil 25 , which is arranged extracorporeally, can energy inductively to the receiving coil 22 in the body the patient will be transferred.

In 3 are also external control devices 32 . 34 shown, which may be located outside the body of the patient and can be performed by the calculations relating to the control and in particular the regulation of the clamping force. These can be connected to the vascular clamp via a wireless data link 10 be transmitted. For this purpose, the vascular clamp 10 a corresponding receiver.

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• US 5569274 A1 [0004]

Claims (10)

Medical clamping and / or spreading device ( 10 ) for clamping and / or spreading tissue ( 14 ) of a patient during a surgical procedure, wherein the clamping and / or spreading device ( 10 ) an actor ( 16 ) for actuating the clamping and / or spreading device ( 10 ), which in and / or on the clamping and / or spreading device ( 10 ) is trained. Clamping and / or spreading device according to claim 1, characterized in that the clamping and / or spreading device ( 10 ) including the actor ( 16 ) completely, in particular endoscopically, into the body ( 100 ) of a patient is insertable. Clamping and / or spreading device according to claim 1 or 2, characterized by a clamping or expanding force sensor ( 18 ) for measuring the on the vessel ( 14 ) acting clamping force or spreading force, wherein the sensor ( 18 ) in or on the clamping and / or spreading device ( 10 ) is formed and completely in the body ( 100 ) of a patient is insertable. Clamping and / or spreading device according to one of claims 1-3, characterized by a regulator ( 20 ) for regulating the tissue ( 14 ) clamping force or spreading force under consideration of an internal sensor ( 18 ) and / or external sensor measured or otherwise determined clamping or spreading force, in particular according to a predetermined regulation rule, wherein the controller ( 20 ) in or on the clamping and / or spreading device ( 10 ) and in particular completely in the body ( 100 ) of a patient is insertable. Clamping and / or spreading device according to one of claims 1-4, characterized by a receiving device ( 22 ), in particular a receiving coil, for receiving inductively transmitted energy from an extracorporeal energy source ( 24 ). Clamping and / or spreading device according to one of claims 1-5, characterized by a connecting device ( 26 ) for the releasable and recoverable mechanical connection of the clamping and / or spreading device ( 10 ) with a surgical instrument ( 28 ) for introducing the clamping and / or spreading device ( 10 ) in the body ( 100 ) of a patient. Clamping and / or spreading device according to one of claims 1-6, characterized by an internal energy source ( 30 ) for at least temporary self-supply of the clamping and / or spreading device ( 10 ) with energy. Clamping and / or spreading device according to one of claims 1-7, characterized in that the actuator ( 16 ) is a piezoelectric actuator or is not recoverable, ie that it is not recoverable by the usually occurring clamping force. Method for controlling an actuated by an actuator, in particular completely in the body ( 100 ) of a patient insertable clamping and / or spreading device ( 10 ), characterized by the following method steps: - Detecting by the clamping and / or spreading device ( 10 ) on the tissue ( 14 ) of a patient applied clamping force or spreading force by an internal sensor ( 18 ) and / or an external sensor - supplying the detected clamping or spreading force to an internal controller ( 20 ) of the clamping and / or spreading device ( 10 ) - Autonomous control by the internal controller ( 20 ) by the actuator ( 16 ) applied clamping or spreading force A method according to claim 9, characterized in that the regulation of the clamping or spreading force is carried out according to a control rule, in particular the controller ( 20 ) externally, ie from another device ( 32 . 34 ) as the clamping and / or spreading device ( 10 ) itself, in particular wireless, is transmitted.

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