Medical instrument with adjustable angle control

0001The invention relates to a medical instrument having a shaft whose distal end is angled, with a arranged at the proximal end of the shaft handle on which a Abwinkelsteuerung is arranged to control the bending of the bendable end, the Abwinlzelsteuerung has a pivotable control, the Pivoting causes the angulation, as well as with a detent for locking the Abwinkelsteuerung in certain positions, wherein the pivotable control element passes over a friction element, and further wherein an actuating element is present, via which the friction element from the locking engagement with the control can be brought.

0002A medical instrument, according to the preamble of claim 1, is known from <patcit id="pcit0001" dnum="US2002165484A1"><text>US 2002/165484 A1</text></patcit> known. Inside the handle a disc is arranged, which is connected to control cables, via which the bending of the shaft is controllable. An arranged on the outside of the handle control is connected to the arranged in the interior of the handle disc. A pivoting of this control causes a rotation of the disc in the interior of the handle, whereby then the control cables are moved accordingly. The locking is realized on the peripheral edge of the disc and may be formed as an external toothing. This external toothing can interlock with a corresponding internal toothing in the interior of the housing of the handle. The assembly of disc and control can be shifted in total against a spring, that the teeth of the outer teeth of the disc from the locking engagement with the internal teeth on the housing occur. As a result, the pivotability for controlling the bending of the bendable end is then released. Instead of a lock on a toothing, this can also be done on materials with high coefficients of friction, so that the locking is done by a friction element.

0003From the <patcit id="pcit0002" dnum="WO2007081706A2"><text>WO 2007/081706 A2</text></patcit> a similar medical instrument is known in which by depressing the control element arranged inside the housing locking mechanism, which is also based on the Verzahnungsprinzip can be solved to release the pivoting. Other such medical instruments are from the<patcit id="pcit0003" dnum="DE10650721A1"><text>DE 106 50 721 A1</text></patcit>, of the <patcit id="pcit0004" dnum="US3557780A"><text>US 3 557 780 A.</text></patcit>, of the <patcit id="pcit0005" dnum="EP0306723A"><text>EP 0 306 723 A</text></patcit>, of the <patcit id="pcit0006" dnum="DE3905455A1"><text>DE 39 05 455 A1</text></patcit>, of the <patcit id="pcit0007" dnum="WO2008020964A2"><text>WO 2008/020964 A2</text></patcit> and the <patcit id="pcit0008" dnum="EP1854415A"><text>EP 1 854 415 A</text></patcit> known.

0004The <patcit id="pcit0009" dnum="DE10650721A1"><text>DE 106 50 721 A1</text></patcit> discloses a medical instrument of the type mentioned, wherein the friction element is disposed within the medical instrument and can be moved via a separate lever in a locking and in a non-locking position by this lever is moved along its longitudinal direction. Similar devices show the<patcit id="pcit0010" dnum="US3557780A"><text>US 3 557 780 A.</text></patcit> and the <patcit id="pcit0011" dnum="DE3905455A1"><text>DE 39 05 455 A1</text></patcit>, Here, the locking state can be made by turning a corresponding actuator and also canceled. In the devices of<patcit id="pcit0012" dnum="EP0306723A"><text>EP 0 306 723 A</text></patcit>, of the <patcit id="pcit0013" dnum="WO2008020964A2"><text>WO 2008/020964 A2</text></patcit> and the <patcit id="pcit0014" dnum="EP1854415A"><text>EP 1 854 415 A</text></patcit> In contrast, the activation or deactivation of the lock by an actuating element in the form of a tiltable lever. Medical instruments with an angled end of the shaft allow the operator substantially more handling degrees of freedom in the region of the distal end of the instrument.

0005For instruments with a rigid shaft, which are mainly used for minimally invasive procedures, this opens up the possibility of performing manipulations in a cavity with the instrument, which lie outside the longitudinal axis of the shaft.

0006With flexible stems, it is possible to introduce these into the body via body channels, for example the bronchi, the esophagus, or the intestine, and by additionally bending the distal end of the stem, the mentioned additional degrees of freedom of handling can then be carried out.

0007The manipulations are many, so it may be Fass- or Präpariervorgänge, pure observation walks or combined with the aforementioned operations, Koagulationsvorgänge and the like.

0008To control the angling of the shaft, there is an angle control comprising control cables fixed in the angled region of the shaft at locations apart from the central longitudinal axis of the shaft. By pulling on a control cable and pushing another control cable, the curvature or bending of the shaft can be triggered. Proximalseitig the control cables are applied to a disc or drum-like body and fixed there. Turning this body causes pulling on a control cable and sliding on the other control cable.

0009To rotate the drum, this is connected to a pivotable control, which can be pivoted back and forth, for example, with a finger of a hand that has grasped the medical instrument.

0010It is an object of the present invention to further develop a medical instrument of the type mentioned at the outset such that the deflectable section of the shaft can be locked in any desired position, this being done by a safe and ergonomic control mechanism. This underlying the subject of the application is achieved by the characterizing features specified in claim 1, further particular embodiments are listed in the dependent claims.

0011According to the invention, the object is achieved in that the friction element is arranged on an outer side of the handle and between the housing and the control, that the actuating element is arranged on the pivotable control element, that the control element has a Fingerermuldenteil and that the actuating element is arranged in Fingerznuldenteil, and in that the actuating element is designed as a pusher, via which the friction element can be moved away from the locking element from the locking engagement.

0012Characterized in that the pivotable control element runs over a friction element, it can be locked in each of its pivoting positions, provided that it is in frictional engagement with the friction element. The friction element thus acts as a kind of parking brake that leads to the locking frictional engagement in any pivoting state of the control. By providing an additional actuating element, the friction element can be brought out of locking engagement with the control and the control can then be pivoted again to cause a change in Abwinkelungsmaßes the bendable end on the Abwinkelsteuerung or control.

0013This locking is also particularly ergonomic, since the pivotable control element and the friction element, without an actuation of the actuating element, are in frictional engagement. That is, the medical instrument is handled and the actuator is not actuated, the control is locked or a previously caused by this bend of the bendable shaft is held in this angled position. The operator need not pay attention to the locking position being accomplished. Only if a change is desired, the actuating element must be actuated and thereby the lock can be released and the control can then be arbitrarily reciprocated in its Verschwenkungsbereich, be it for rectilinear alignment of the shaft or to bring the bendable end in its pivoting range in a different position. After releasing the actuator then the lock is closed again.

0014This also increases the safety of the handling of the medical instrument to the effect that corresponding manipulations can be carried out in a certain angled position, for example a dissecting process or a coagulation process, without the degree of angulation being changed.

0015In the invention, the friction element is arranged on the handle.

0016This measure has the advantage that the friction element can be attached to a relatively large component of the medical instrument, thus a correspondingly large and massive abutment against the frictional forces is present.

0017In the invention, the actuating element is arranged on the pivotable control element. In ergonomic terms, this has the considerable advantage that both the control of the Abwinkelsteuerung can be accomplished and the suspension or closure of the lock with one and the same element. This is particularly ergonomic because a pivoting of the control first requires a release of the lock, since it can not otherwise be moved, so that it is particularly favorable to combine these two components necessary for this purpose, namely actuating element and control element.

0018In this case, the control has a finger-part, and the Betäitigungselement is arranged in finger finger part.

0019This embodiment shows a particularly high degree of ergonomics in that a finger of a hand holding the medical instrument can be inserted into this finger recess and by this finger, both the actuating element for releasing the locking and the movement of the control for angling the shaft are performed can. Depending on the arrangement of the control on the medical instrument, the example may be the thumb of the hand.

0020In this case, the actuating element is designed as a pusher, via which the friction element from the locking engagement can be moved away from the control.

0021This measure has the advantage that solved by a simple pressing the lock and then the control can be pivoted.

0022In a further embodiment of the invention, the friction element is biased in the direction of the control element.

0023This measure has the advantage that the frictional force for the locking frictional engagement is provided by the bias of the friction element, which is also very favorable in terms of production and control technology. Is the design, a relatively large restoring force in the Abwinkelsteuerung available, then the bias can be chosen to be strong enough to ensure a secure locking. Thus, it is possible to react flexibly to different work inserts in the shank and to different sizes and lengths of the shank.

0024In a further embodiment of the invention, the friction element is designed as a friction plate which can be pressed via spring plates in the direction of the control element.

0025This measure has the advantage that over the friction plate, a relatively large variable Reiburzgsfläche can be provided over which the pivotable control can be moved in the pivoting region. The Bewerkstelligen the bias in the direction of the control via spring plates is production technology very easy to perform, for example, by appropriate stampings that can be easily mounted or replaced.

0026In a further embodiment of the invention, the spring plates are formed as an end arranged on the friction plate bends.

0027These measures have the aforementioned advantage of simple production to a particularly pronounced extent.

0028In a further embodiment of the invention, the friction plate has end-side oblong hole openings, via which it can be mounted on an outer side of the handle.

0029This measure has the advantage that the friction plate can execute the avoidance or displacement movement, in particular if this is curved, via the oblong hole openings. Equally simple, the friction plate is to be mounted on this Langlachöffnung, for example by simple mounting screws.

0030In a further embodiment of the invention, an underside of the control element is in contact with the friction element via a friction contact surface.

0031This measure has the advantage that the frictional contact surface is relatively well protected from the outside and in particular does not occupy other sides of the control, so that the necessary manipulations, ie the movement and the control of the locking can be carried out unhindered on this.

0032By the aforementioned bias of the friction element in the direction of the control element is released after releasing the pusher this again in the opposite direction, so that then simply by releasing the pusher, the lock closes again by itself. This can be done in any position of the pivoting range of the control, of course, in this position, in which the shaft is then aligned straight again.

0033In a further embodiment of the invention, the pusher has at least one pin which stands on the friction element.

0034This measure has the advantage that the force for releasing the locking can be exerted on the friction element via at least one pin.

0035In a further embodiment of the invention, the at least one pin moves the friction element away from the locking engagement of the control element and slides in the case of a pivoting control element via the friction element.

0036This measure has the advantage that the pin or pins can run with relatively little friction over the friction element during pivoting of the control element and keep it moving away from the control while the pusher is depressed.

0037In a further embodiment of the invention, the pins in sleeves in the control can be performed.

0038This measure has the advantage that when locking with high locking forces, the pins are properly guided by the sleeves, so that they can be made relatively thin to keep the sliding friction forces as low as possible.

0039In a further embodiment of the invention, the pins are formed friction, at least in the area in which they are in contact with the friction element.

0040This measure has the advantage that the at least one pin can slide with a depressed control friction over the friction element.

0041For this purpose, the entire pins may consist of a low-friction plastic material, be coated with such, or on a metallic base body or be attached.

0042In a further embodiment of the invention, the actuator has features that increase its grip.

0043The features are particularly advantageous selected from elevations, depressions, grooves, corrugations, hollows, punched and the like.

0044These features give the operator a particularly good haptic contact between the finger and the control, so that the corresponding control operations can be performed safely and ergonomically. In particular, in the aforementioned construction with the pins running over the friction element when the lock is released, this frictional force can be overcome in a particularly favorable manner via these features, without the risk of the finger slipping off the control element due to high resistance forces.

0045In a further embodiment of the invention, the control element is connected via a connecting arm with a drum, are attached to the control cables, which cause the bending of the bendable end of the shaft.

0046This measure, which is known per se, has the advantage that the control movement of the control element can be transmitted ergonomically and in a harmonic motion to the drum via the invention arm, which in turn moves the control cables in a correspondingly harmonious and smooth manner.

0047In a further embodiment of the invention, one end of a control cable is inserted in a fastening screw and is fixed in this via a fixing screw.

0048This measure has the advantage that the position and length of a control cable can be brought or corrected via the fastening screw in an optimal position, then this position is fixed on the fixing screw in the mounting screw.

0049In a further embodiment of the invention, the fastening screw is secured in place by a locking screw.

0050This measure has the advantage that in addition the seat of the fastening screw is secured to the drum by the locking screw. Furthermore, the assembly is simplified. In principle, this interaction of the screws also makes it easy to readjust or retighten the traction cables or the traction cable tension during inspection operations. You can also secure the screws by gluing after a certain setting. This also helps to transmit the movements of the control of the actuator ergonomically safe and harmonious.

0051In a further embodiment of the invention, the drum has a circumferential groove over which the control cables are guided to the attachment points.

0052This measure also helps to ensure a safe and lasting guidance of the traction cables in the area of ​​the drum, so that the pivoting movements can be transmitted smoothly and safely.

0053In a further embodiment of the invention, the drum is designed as a drum cutout.

0054This measure has the advantage that no complete drum with a 360 ° circumferential surface is necessary, but only a section thereof, which is sufficient to control the reciprocating motion of the control cables attached to the drum for bending the angled end of the shaft.

0055In a further embodiment of the invention, the drum cutout on a side surface which corresponds approximately to a quarter circle.

0056This measure has the advantage that compared to a complete drum much smaller building component can be used to reciprocate the control cables. It has been found that a movement approximately in an angular range of 90 ° is sufficient to carry out the control of the bendable end.

0057In a further embodiment of the invention, at least one deflection roller is arranged adjacent to the drum cutout in order to add a control cable to a peripheral surface of the drum cutout.

0058This measure has the advantage that aligned by the pulley coming from the shaft shafts of the peripheral surface of the drum section can be supplied. This ensures a safe control in a slim or compact design yet.

0059It is understood that the features mentioned above and those yet to be explained below can be used not only in the particular combination given, but also in other combinations or in isolation, without departing from the scope of the present invention.

0060Embodiments of the invention are illustrated in the drawings and will be explained in more detail in the following description. Show it:<ul><li>The invention will be described in more detail below with reference to some selected embodiments in conjunction with the accompanying drawings and explained. Show it:<dl id="dl0001"><dt>Fig. 1</dt><dd>a medical instrument with bendable shaft in side view,</dd><dt>Fig. 1a</dt><dd>the medical instrument of <figref idrefs="f0001">Fig. 1</figref> from a proximal view, ie from the perspective of the surgeon,</dd><dt>Fig. 1b</dt><dd>a perspective view of the medical instrument,</dd><dt>Fig. 2</dt><dd>a partial side view of the medical instrument of <figref idrefs="f0001">Fig. 1</figref> from the opposite side,</dd><dt>Fig. 3</dt><dd>a partial side view of the medical instrument of <figref idrefs="f0001">Fig. 1</figref> with an open housing of a handle,</dd></dl><dl id="dl0002" compact="compact"><dt>Fig. 4</dt><dd>a detail of the handle detail to explain the locking of a Abwinkelsteuerung,</dd><dt>Fig. 4a</dt><dd>the detail view of <figref idrefs="f0004">Fig. 4</figref> with a sectional view of a control of the Abwinkelsteuerung in the locked state,</dd><dt>Fig. 5</dt><dd>the detailed view like <figref idrefs="f0004">Fig. 4a</figref>, in unlocked condition,</dd><dt>Fig. 6</dt><dd>the control of the Abwinkelsteuerung in perspective single view,</dd><dt>Fig. 6a</dt><dd>a view of the control from <figref idrefs="f0005">Fig. 6</figref>, along the arrow 93 of <figref idrefs="f0005">Fig. 6</figref>.</dd><dt>Fig. 7</dt><dd>an actuating element of the Abwinkelsteuerung in perspective single view,</dd><dt>Fig. 8</dt><dd>a friction element for locking the Abwinkelsteuerung in a perspective single view,</dd><dt>Fig. 9</dt><dd>a detail view like in <figref idrefs="f0004">Fig. 4</figref> illustrated, with course of control cables around a drum,</dd><dt>Fig. 10</dt><dd>a side view of the drum of <figref idrefs="f0006">Fig. 9</figref>.</dd><dt>Fig. 10a</dt><dd>a section along the line Xa-Xa in <figref idrefs="f0007">Fig. 10</figref>.</dd><dt>Fig. 10b</dt><dd>Another embodiment of a drum in the form of a drum cutout,</dd><dt>Fig. 11</dt><dd>a side view of a tool insert for the medical instrument of <figref idrefs="f0001">Fig. 1</figref>.</dd></dl><dl id="dl0003" compact="compact"><dt>Fig. 12</dt><dd>an enlarged detail view of the distal end of the tool of <figref idrefs="f0008">Fig. 11</figref>.</dd><dt>Fig. 13</dt><dd>Side view of a grip part of in <figref idrefs="f0001">Fig. 1</figref> shown instrument,</dd><dt>Fig. 13a</dt><dd>a view of the handle portion in the direction of arrow 134 of <figref idrefs="f0009">Fig. 13</figref> considered</dd><dt>Fig. 14</dt><dd>an enlarged sectional section along the line XIV-XIV in <figref idrefs="f0009">Fig. 13</figref>, with hinged end of the tool insert of <figref idrefs="f0008">Fig. 11</figref> in the locked state,</dd><dt>Fig. 14a</dt><dd>one of the <figref idrefs="f0009">Fig. 14</figref> corresponding representation with released end of the tool insert,</dd><dt>Fig. 15</dt><dd>an enlarged sectional section along the line XV-XV in <figref idrefs="f0009">Fig. 13a</figref>, with hinged end of the tool insert of <figref idrefs="f0008">Fig. 11</figref>.</dd><dt>Fig. 16</dt><dd>a lock in perspective single view,</dd><dt>Fig. 17</dt><dd>a detailed view of a medical instrument in the region of the grip part to illustrate the locking connection,</dd><dt>Fig. 18</dt><dd>a representation accordingly <figref idrefs="f0010">Fig. 17</figref>, with released detent connection,</dd><dt>Fig. 19</dt><dd>a representation accordingly <figref idrefs="f0010">Fig. 17</figref>, as a section in the viewing plane and with disabled locking connection, and</dd><dt>Fig. 20</dt><dd>a representation accordingly <figref idrefs="f0011">Fig. 19</figref>, with activated locking connection.</dd></dl></li></ul>

0061A medical instrument shown in the figures is designated in its entirety by the reference numeral 10.

0062This in <figref idrefs="f0001">Fig. 1</figref> shown medical instrument 10 has a flexible shaft 12, at the distal end of which an angled portion 14 is located. At the area 14, a tool 126 is arranged on the distal side. The tool 126 provides a distal end of an in<figref idrefs="f0008">Fig. 11</figref> The insert 22 is shown. The proximal end of the shaft 12 is connected to a handle 18.

0063The handle 18 in turn has a movable handle portion 20. This has a circular opening 21 which is bounded by a ring portion 23, through which preferably the indexer finger of the surgeon can be performed to a movement of the handle portion 20, the order in the<figref idrefs="f0003">Fig. 2</figref> shown pivot axis 32 is pivotable to perform. The grip part 20 is connected to the proximal end of the insert 22. By the connection of the handle portion 20 with the insert 22, this is in operative connection with the tool 126 and thus serves to actuate it, such as opening and closing of a jaw part.

0064Furthermore, the grip part 20 can be brought into contact with a catch 24, which can prevent unwanted movement of the grip part 20 in a distal direction. In order to enable a solution of the locking connection, the catch 24, inter alia, an arcuate projection 25 which pivoting of the catch 24 by the surgeon, preferably with the middle finger, as described in connection with the<figref idrefs="f0010">Figures 17ff</figref>, allows.

0065Furthermore, a control element 29 of a Abwinkelsteuerung 30 is arranged on the handle 18, by the movement of which according to the directions of the double arrow 31 about an axis of rotation 38 which is perpendicular to the axis of the shaft 12 shown here, the bending of the bendable end 14 of the shaft 12 is controlled can be. An example of a direction of angling is in<figref idrefs="f0001">Fig. 1</figref> represented by the angled end 14 '.

0066In <figref idrefs="f0001">Fig. 1a</figref> If one looks at the control element 29 of the Abwinkelsteuerung 30 and an actuator located thereon 71 in the form of a pusher 72. This can be actuated by a thumb of the surgeon, whereby a movement of the control element 29 is made possible. For better gripping grooves 73 are mounted on the pusher 72.

0067The instrument 10 also has a power connection 28, which can serve, for example, for the power supply of optional coagulation inserts.

0068Out <figref idrefs="f0003">Fig. 2</figref> can be seen the range of pivotability of the handle portion 20 about the pivot axis 32 in the region of a recess 34. The control element 29 is connected to the axis of rotation 38 via a connecting arm 36.

0069Between a housing 19 of the handle 18 and the control element 29 is a friction element 39 in the form of a friction plate 40, which is fastened by screws 42 and 44 on the outside of the handle 18. This friction plate 40 serves, as will be described in more detail below, to lock the Abwinkelsteuerung 30 in a certain position.

0070An in <figref idrefs="f0003">Fig. 3</figref> recognizable drum 46 is mounted on the axis of rotation 38 and is thus by the connecting arm 36 with the control element 29 of the Abwinkelsteuerung 30 in operative connection. A corresponding actuation of the control element 29 thus also results in a direct transmission of motion to the drum 46. On the drum 46, two extending from the angled end 14 of the shaft 12 through the shaft 12 control cables 48 and 50, each extending away from the axis of rotation 38 and in this embodiment by fastening screws 52 and 54 in combination with locking screws 56 and 58 on the drum 46th are attached. For this purpose, the control cables 48 and 50 are led from the distal side out of casings 62 and 64 to the drum 46 through a guide 60. The control cables 48 and 50 are the actuators for the bendable end 14.<figref idrefs="f0006">Fig. 9</figref>,

0071In connection with the <figref idrefs="f0004 f0005 f0006">FIGS. 4 to 8</figref> will now be discussed in more detail on the lockability of the Abwinkelsteuerung 30 and thus the bendable end 14 of the shaft 12 by means of the friction plate 40.

0072In <figref idrefs="f0004">Fig. 4</figref> it can be seen that a bottom 33 of the control element 29 is in direct contact with the friction plate 40, which is attached via angled spring plates 66 and 68 and by means of screws 42 and 44 to the handle 18. The friction plate 40 thus extends at a distance to the outside of the handle 18 to which it is mounted. A movement of the control element 29 about the axis of rotation 38 corresponding to the directions of the double arrow 70, is hereby prevented by the frictional contact between the control element 29 and the friction plate 40 on a Reibkontaktfläche 82, or braked.

0073In <figref idrefs="f0004">Fig. 4a</figref> It can be seen that the Abwinkelsteuerung 30 includes the pusher 72. This one is, as well as in<figref idrefs="f0002">Fig. 1b</figref> can be seen, the proximal side for the surgeon easily accessible. From the pusher 72 are pins 74, 74 ', 76, 76' (see also<figref idrefs="f0005">Fig. 7</figref>), which are guided and held distally by sleeves 78, 80 in the body of the control element 29. The tips of the pins stand directly on the friction plate 40 and thus provide an operative connection between the pusher 72 and the friction plate 40. By depressing the pusher 72 according to the direction of the arrow 84, the pins through holes 98, 100 in the body of the control 29th moved axially, pressing the friction plate 40 in the direction of the handle 18. The friction plate 40 thereby moves away from the underside 33 of the control element 29. The friction contact surface 82 is thus solved and there is a gap 86, as in<figref idrefs="f0004">Fig. 5</figref> is shown. The flexibility required for this change in position of the friction plate 40 is mainly due to the spring plates 66 and 68, but also through slot openings 102 and 104, as in<figref idrefs="f0006">Fig. 8</figref> shown are possible.

0074The resulting by pressing the pusher 72 position, as shown in <figref idrefs="f0004">Fig. 5</figref> now allows a low-friction movement of the control 29, as shown in FIG <figref idrefs="f0004">Fig. 4</figref> shown by the double arrow 70.

0075Only the tips of the four pins 74, 74 ', 76, 76' are on the friction plate 40 and slide friction over the surface. These can for example consist of a low-friction plastic material. It may also be a metallic body coated with the low-friction material, or exposed to a metallic stump a low-friction tip.

0076Now takes the surgeon his finger, preferably the thumb, again from the pusher 72, so the friction plate 40 is again pressed against the bottom 33 of the control element 29 of the Abwinkelsteuerung 30 due to the tension through the spring plates 66 and 68, so that the gap 86 disappears and again, the friction contact surface 82 is present. Accordingly, the pins 74, 74 ', 76, 76' and thus the pusher 72 also experience a proximally directed movement corresponding to the direction of the arrow 88. As a result, the Abwinkelsteuerung 30 is locked in position again. This is thus carried out steplessly in the pivoting range of the control 29.

0077The control element 29 of the Abwinkelsteuerung 30 is in <figref idrefs="f0005">FIGS. 6, 6a and 7</figref> shown in more detail, which clearly recognizes the pusher 72 and its proximal accessibility. The pusher 72 is fastened to a finger-member part 92, which is mounted on the connecting arm 36 and with an axle 90 on the axis of rotation 38.

0078<figref idrefs="f0005">Fig. 6a</figref> shows the bottom 33, which comes into contact with the friction plate 40. In this embodiment, the pusher 72 is provided with four pins 74, 74 ', 76 and 76' which extend axially in the bores 98, 98 ', 100 and 100' and are movable. Between the two pairs of pins 74, 76 and 74 ', 76' is a Kunststoffinlet 96 is arranged, which is fastened by a retaining plate 94 on the Fingerermuldenteil 92. This Kunststoffinlet 96 serves to increase the friction between the control element 29 and the friction plate 40 and thus to strengthen the lock in the desired position.

0079In <figref idrefs="f0005">Fig. 7</figref> the pusher 72 with the four pins 74, 74 ', 76 and 76' is clearly visible. Due to their distally rounded tips 77, the friction as it slides on the friction plate 40 is reduced to a minimum, which facilitates the operability of the Abwinkelsteuerung 30.

0080This in <figref idrefs="f0006">Fig. 8</figref> shown embodiment of the friction plate 40 is connected at the opposite ends with the angled spring plates 66 and 68, both of which have a slot opening 102 and 104, whereby a mobility of the friction plate 40 on the handle 18, according to the previous descriptions, ie on the handle 18th to or from this way, is made possible. The bends on the spring plates 66 and 68 provide the corresponding pressing force and thus for the correspondingly fixed locking between the control element 29 and handle 18 on which the friction plate 40 is mounted.

0081Based on <figref idrefs="f0006 f0007">Fig. 9 to Fig. 10a</figref> the operation of the Abwinkelsteuerung 30 will be further explained and the attachment of the control cables 48 and 50 are described on the drum 46.

0082In <figref idrefs="f0006">Fig. 9</figref> the course of the control cables 48 and 50 in the drum 46 is shown. The latter comprises a circumferential groove 106 in which the control cables 48 and 50 are guided to then end in bores 108 and 109 of the fastening screws 52 and 54. At these the control cables 48 and 50 are then firmly mounted.

0083Now, if the control element 29 is moved in the direction of the arrow 112, the drum 46 experiences, by the above-described operative connection via the connecting arm 36, a rotational movement about the axis of rotation 38, as indicated by the direction of the arrow 114. For the attached to the drum 46 control cables 48 and 50 this means that they also experience a movement, namely the control cable 48 is pushed in the direction of arrow 116 in the shaft 12 and the control cable 50 accordingly pulled out in the direction of arrow 118 from the shaft , Due to the already mentioned operative connection between the control cables 48 and 50 with the bendable end 14, this is consequently changed in its angular position. This results in angling in accordance with the in<figref idrefs="f0001">Fig. 1</figref> by the bendable end 14 'shown shape.

0084The opposite movement leads again to a stretching of the shaft 12 or angling, from the perspective of <figref idrefs="f0001">Fig. 1</figref>, up. By releasing the pusher 72, the position or bend of the bendable end 14 can be locked in any position.

0085The arrangement of the drum and that of the control rotated by 90 °, instead of the in <figref idrefs="f0001">Fig. 1</figref> shown angled plane "up-down" a rotated about the shaft axis by 90 ° angle plane "left-right" result. You can also attach the control cables reversed, then, for example, a shift of the control leads "forward" instead of an angling to "down" to an angling to "up".

0086In <figref idrefs="f0007">Fig. 10a</figref> Furthermore, the bore 108 of the fastening screw 52 can be seen. Through this, in the example mentioned here, the control cable 48 is inserted into the fastening screw 52 and firmly fixed in this fastening screw by means of a fixing screw 120. The same applies to the fastening screw 54 and the control cable 50 not shown here in cross section. Subsequently, the length of the control cables 48 and 50 can then be adjusted by individual rotation of the screws 52 and 54. In one embodiment, these have differently extending threads, so that fastening screw 52 has a right and fastening screw 54 has a left-hand thread.

0087In <figref idrefs="f0007">Fig. 10b</figref> another embodiment of a drum is shown. The drum 47 differs from the drum 46 in that the drum 47 represents a cutout which corresponds approximately to a quarter drum 46, ie the lateral disk surface corresponds to a circular cutout with an angle of approximately 90 °.

0088The pivot axis 38 and the attachment of the control cables 48 and 50 via the fastening screws 52 and 54 and the locking screws 56 and 58 is the same. For a directed feed of the control cable 50, a feed roller 49 is provided.

0089This design is leaner, so that the instrument 10 can be made less bulky overall in the area of ​​the drum. A pivoting of the drum 47 in the form of the drum cutout is sufficient for the movement of the bendable end 14.

0090In the following <figref idrefs="f0008 f0009">FIGS. 11 to 16</figref> the design and the assembly of the insert 22 will be described.

0091The in <figref idrefs="f0008">Fig. 11</figref> Insert 22 shown distally has a tool 126, here two expandable jaw members 127, 127 ', which is connected via a rod-shaped flexible actuator 128 with a connector 130 in operative connection. Proximally mounted behind the tool 126 is a hood 124 and a screw cap 122, both for securing the insert 22 to a flexible shaft, such as the flexible shaft 12<figref idrefs="f0001">Fig. 1</figref>, serve. As already mentioned above, the proximal end of the insert 22 has the connecting piece 130, which serves, for example, for attachment to the grip part 20 of the medical instrument 10. For this purpose, in this embodiment, the end is spherical and arranged proximally behind a smaller diameter portion 131 on the insert 22.

0092<figref idrefs="f0008">Fig. 12</figref> shows the attachment of the distal end of the insert 22 at the distal end of the shaft 12. The proximal behind the tool 126 located hood 124 is firmly connected to the insert 22. This prevents the screw cap 122 from slipping in a distal direction. This screw cap 122 is in turn then screwed onto an external thread 123 at the distal end of the shank 12. The force transmission element 128 is previously introduced from the distal into the shaft 12. By this attachment, the distal end of the insert 22 is fixed in position. Angling the angled end 14 then no longer causes the insert 22 to be pushed out of the distal end of the shaft 12.

0093The <figref idrefs="f0009">Fig. 13 to 16</figref> show the handle portion 20, its pivot axis 32 and a latch 132 for releasable connection to the proximal end of the insert 22 <figref idrefs="f0009">Fig. 13a</figref> can be seen opening in the direction of the pivot axis 32 opening 136 through which the spherical end of the connecting piece 130 is inserted. The distal following small diameter portion 131 on the insert 22 can be laterally led out of the interior of the handle portion 20 via a groove 138 (see<figref idrefs="f0009">Fig. 15</figref>). To insert the end of the insert 22, a lock 132 must be pressed so that the connector 130 can pass through it. This can be done to the<figref idrefs="f0009">Figures 14 and 14a</figref> recognize.

0094In the <figref idrefs="f0009">Fig. 16</figref> apparent lock 132 is held by a holder 146 on the handle portion 20. By a spring 148, this is further pressed against the edge of this holder 146. In the<figref idrefs="f0009">Fig. 14</figref> The position shown thus represents the basic position of the lock 132. It can be seen here how the connecting piece 130 is blocked by the lock 132 due to its spherical end here and thus can not pass upwards through the opening 136 with reference to the illustration. If one then actuates the lock 132 against the direction in which it is pressed by the spring 148, ie in the direction of the arrow 147, then a recess 144 moves on the lock 132, which in the illustration of<figref idrefs="f0009">Fig. 14</figref> located to the right of the connector 130, in a central position of the opening 136, as for example. In <figref idrefs="f0009">Fig. 14a</figref> is shown. This indentation can be performed via a button 145 which extends laterally beyond the holder 146 to the outside. This recess 144 just gives the spherical connector 130 enough space to pass this barrier 132. Thereby, the connector 130 can be removed through the opening 136 from the holder in the grill part 20. If the lock 132 is released again, it moves in the direction of the arrow 149<figref idrefs="f0009">Fig. 14a</figref> out again. The reason for this in turn is the spring 148. At the same time, the recess 144 also shifts.

0095If you want to insert the connector 130 back into the holder of the handle portion 20, so it is again required a depression of the lock 132 in the direction of the arrow 147 <figref idrefs="f0009">Fig. 14</figref>so that the recess 144 returns to the central position, as in <figref idrefs="f0009">Fig. 14a</figref> is shown, comes to rest. In this way, you can now pass the spherical end again on the lock 132 and fasten the connector 130 through the opening 136 on the handle portion 20.

0096In <figref idrefs="f0009">Fig. 15</figref> it can be seen with a connector 130 illustrates how this is below the lock 132. Moving upwards is not possible. The small diameter portion 131 at the proximal end of the insert 22 passes through the groove 138, and thus, movability corresponding to the double arrow 151 is enabled. This freedom of movement is required in the movement of the grip part 20.

0097In order to prevent rotation of the lock 132 rotatable about the longitudinal axis and thus also a rotation of the recess 144, an axial groove 142 is incorporated at the distal end of the lock 132. This also serves as a stop for the sliding movement. This is in the<figref idrefs="f0009">Figures 14 and 14a</figref>, as well as in the perspective view of <figref idrefs="f0009">Fig. 16</figref> shown. In this groove 142 ends now in the attachment in the handle part 20, a pin 140, which prevents undesired rotation about the longitudinal axis of the lock 132, however, allows axial movement of the lock 132 in the direction of the arrows 147 and 149.

0098In the <figref idrefs="f0010 f0011">FIGS. 17 to 20</figref> is the locking connection, which results from the catch 24 on the handle portion 20, explained in more detail.

0099The catch 24 is mounted on a pivot axis 150 pivotally mounted on the handle 18 in a recess 163. By contact with the grip part 20, this catch 24 in this embodiment can prevent the movement of the grip part 20 in the distal direction. For this purpose, the catch 24 is pressed by the bias voltage due to a spring plate 166 in the direction of the handle portion 20.

0100For this purpose, the catch 24 has latching teeth 174 on the side facing the grip part 20, which engage with a latching pin 160 on the grip part 20. The inclination of the flanks of the locking teeth 174 in the direction of the handle 18, allow movement of the handle portion 20 in the direction of the handle 18, but lock it in the opposite direction.

0101If you want to release the locking connection for a short time, so you pivots the catch 24 corresponding to the direction of the arrow 170, preferably by pressing the arcuate projection 25, resulting in an end position, as in <figref idrefs="f0010">Fig. 18</figref> shown leads. Due to the bias, the latch 24 is brought back to the handle portion 20 when released according to the direction of the arrow 172.

0102In order to deactivate the latching connection for a certain period of time, a latching lock 152 is attached to the handle part 20.

0103The detent 152 is formed as a bent element, in the illustrated embodiment as a curved strip 153 (see also <figref idrefs="f0009">Fig. 13a</figref>) whose curvature of the curvature of the outside of the annular portion 23 of the handle portion 20 is adjusted.

0104Recesses 155 in the strip 153 increase the grip.

0105This latch 152 may, as out <figref idrefs="f0010">Fig. 17</figref> can be seen between handle 20 and latch 24 are brought. In this case, the locking connection is deactivated and the handle member 20 is freely movable in both directions. For this purpose, the detent 152 has a rounded jaw 157, which can run over the teeth 174 in both directions. This corresponds to a second position of the detent lock 152. In order to activate the detent connection again, the detent lock 152 can be pushed in the direction of a detent pin 162. This corresponds to a first position of the detent 152. On both sides of the strip 153, a cover 158 is present. This covers a transversely extending in the locking lock guide pin 156 which runs in both sides guide grooves 154 in the ring section 23. The covers 158 themselves can be attached to the locking catch 152 via pins not shown here. Accordingly, the detent 152 passes through a circular motion, as determined by the shape of the annular portion 23 of the handle portion 20 and thus ends in a position as shown in FIG<figref idrefs="f0010">Fig. 18</figref> is shown. As a result, a detent pin 160 previously blocked by the detent lock 152 is then released and can engage with the teeth 174 of the detent 24.

0106As in the <figref idrefs="f0011">FIGS. 19 and 20</figref> is shown circumferentially in the handle portion 20, an outer groove 178 is cut. In this, a projecting in the radial direction of the ring portion 23 stage 176 of the catch 152 is movable, which is arranged centrally on the latch 152. At each end of this stage 176 there are spring clips 180 and 182. These can engage in accordance with the position of the locking catch 152 in the locking pin 160 and 162 and thus prevent a simple back and forth sliding the locking catch 152. This is thus held in the respective positions.

0107<figref idrefs="f0011">Fig. 19</figref> shows in this context, the second position of the detent 152, in which the locking connection is disabled. The spring clip 182 of the step 176 on the detent 152 is engaged in the detent pin 160, thus blocking the contact between the detent teeth 174 and the detent pin 160. Movement of the detent 152 in the direction of the arrow 184 would eventually end in the first position, such as it in<figref idrefs="f0011">Fig. 20</figref> is shown. In this case, the spring clip 180, which is located on the step 176, engaged in the locking pin 162, and thus the locking catch 152 is fixed in this position. The locking pin 160 is thus free and can hook into the teeth 174 of the catch 24.

0108In contrast, a proximal movement of the grip part 20, which would lead, for example, to closing of the jaw parts 127, 127 ', is still possible via the catch 24.

0109A deactivation of the latching connection can now again by movement of the lock 152 analogous to the previously said according to the direction of the arrow 186, preferably after previously lowering the latch 24, as described in the <figref idrefs="f0010">FIGS. 17 and 18</figref>, respectively.

0110The operator may manipulate the instrument 10 as shown in FIG <figref idrefs="f0001">Fig. 1a</figref> can be seen, take over the handle 18. With the thumb, the pusher 72 can be pressed and then the control 29 can be moved. This causes a corresponding bending of the bendable end 14 of the shaft. Release of the pusher 72 locks the angled end 14 in the appropriate position.

0111A movement of the handle part 20, for example with the inserted pointer finger, allows the opening and closing of the jaws 127, 127 'on the insert 22 in any Abwinkelstellung the bendable end 14 of the shaft 12th

0112When the locking function is disabled, the movement of the handle member 20 in both directions of pivoting is possible.

0113When the locking function is activated, this can be accomplished briefly by pivoting the catch 24 with the middle finger on the arcuate projection 25.

0114The operator can thus easily and safely operate the medical instrument 10 in a very ergonomic manner.