Medical instrument
A medical tubular shaft instrument for gripping and cutting tissue which provides a safe mode of operation. The instrument includes electrodes by which a mechanical contact between a blade and an associated cutting surface can be electrically determined. This determination allows the operating physician to be provided with sufficient information to determine whether the tissue that is to be severed has been successfully severed.
1. A medical instrument comprising:
a first mouth part and a second mouth part, each mouth part having at least one clamping surface for fixing and/or positioning tissue in a fixing plane;
a cutting device having a blade, which is disposed opposite one of the mouth parts for cutting tissue and is displaceable along a predetermined cutting path that is substantially parallel to the fixing plane;
a first electrode and a second electrode, disposed on the cutting device and/or the clamping surface, such that a mechanical contact between blade and clamping surface may be ascertained by a processing unit connected to the electrodes;
a tubular shaft joined to the first and second mouth parts;
an actuating device whereby the blade is displaceably guided substantially parallel to the fixing plane; and
a preloading device whereby the blade is preloaded by a flexible element against a fixing plane during cutting.
2. The medical instrument according to claim 1 , wherein the blade comprises the first electrode, the clamping surface comprises the second electrode and the processing unit comprises a device for determining an electrical resistance between the first and second electrodes.
3. The medical instrument according to claim 2 , wherein the processing unit allows a curve of the resistance to be ascertainable along the cutting path.
4. The medical instrument according to claim 2 , further comprising a means for emitting a signal when the resistance over the entire cutting path falls below a predetermined minimum value.
5. The medical instrument according to claim 1 , wherein the processing unit comprises a travel sensor for detecting the displacement of the blade parallel to the clamping surface.
6. The medical instrument according to claim 1 , wherein each of the first and second mouth parts comprises a coagulation electrode for coagulating the fixed tissue.
7. The medical instrument according to claim 1 , wherein at least one of the first and second mouth parts comprises a blade guide.
8. The medical instrument according to claim 1 , wherein the preloading device comprises a resilient guide wire—having a curvature, and wherein the guide wire is substantially rigidly joined to the blade and is guided in the tubular shaft such that the blade is preloaded in relation to the tubular shaft in the direction of the fixing plane.
9. The medical instrument according to claim 1 , wherein the preloading device includes a crimped section, which is disposed in the guide wire such that it is close to the distal end of the tubular shaft when the blade is pushed forward.
10. The medical instrument according to claim 1 , further comprising a ramp-shaped blade guide, wherein the blade guide is configured such that, by moving in the direction of cutting the blade is brought out of a starting position at a distance from the fixing plane onto the fixing plane.
11. The medical instrument according to claim 1 , wherein the first and second mouth parts are disposed rotatably to one another and the blade guide is configured such that the blade may be brought into a starting position close to a fulcrum of the first and second mouth parts.
12. A medical instrument according to claim 1 ,
wherein the tubular shaft accommodates the first and second mouth parts, and further comprising
at least one articulation for rotatably supporting the first and second mouth parts such that the first and second mouth parts may be brought from an open position into a closed position in order to fix the tissue using the clamping surfaces,
wherein the articulation is configured such that a fulcrum of the articulation is located outside the first and second mouth parts and the distal end of at least one of the first and second mouth parts is displaceable away from the distal end of the tubular shaft when the first and second mouth parts are brought into the open position.
13. The medical instrument according to claim 12 , wherein the articulation comprises a slotted guide system.
14. The medical instrument according to claim 12 , wherein the articulation comprises an articulation guide on one of the first and second mouth parts and at least one rail or groove on the other of the two mouth parts.
15. The medical instrument according to claim 12 , wherein at least two partial articulations are provided, which are spaced apart from one another to form a passage disposed centrally between said partial articulations.
16. The medical instrument according to claim 12 , further comprising a strip that can be displaced substantially linearly for opening and closing of a mouth part to be displaced, said strip being attached by a resilient end section on the mouth part to be displaced.
17. The medical instrument according to claim 1 , wherein the medical instrument is an electrosurgical tubular shaft instrument.
18. The medical instrument according to claim 1 , wherein the processing unit comprises an electric switch for detecting the displacement of the blade parallel to the clamping surface.