DE102014224268B4 - Endoscopic instrument and method for grasping structures - Google Patents

Abstract

An endoscopic instrument having a proximal drive unit (16) or coupling for a drive unit, a plurality of linkage mechanisms sequentially arranged on the drive unit (16) or coupling for a drive unit, defining sections (26, 32) and one on the drive unit (16) or the end-effector (18, 36) remote from the coupling for a drive unit or a coupling for an end-effector, wherein the sections (26, 32) are independently deterministically bendable and / or kinkable by the hinge mechanisms, characterized at least two bendable sections (26) are provided, wherein the hinge mechanism of each bendable section 26 comprises a plurality of interconnected links (118, 120, 210, 212, 214) interconnected by main hinges (122, 216) and connecting elements (128, 130, 218, 220), each having a member (118, 210) with the over and wherein the main joints (122, 216) each have two pivot axes (124, 126), wherein each provided on a member (118, 120) pivot axes (124, 126) are parallel to each other and the pivot axes (124, 126) of adjacent links (118, 120) are perpendicular thereto.

Description

The invention relates to an endoscopic instrument and to a method which can be used, in particular in minimally invasive surgery (MIC), including robots, for embracing structures.

In the meantime, a procedure has been established in surgery that can do without large body openings, the so-called minimally invasive surgery (MIS). Here, the surgical approach is created by means of small cuts through the body surface. Through these approaches, long, slender instruments called endoscopic instruments are advanced into the patient's interior. These are u.a. thin, rod-shaped endoscope cameras, which are used to gain optical impressions from within the body via video / monitor systems. Advantages of this technique compared to conservative, open surgery are in particular the lower traumatization of the patient, i. lower postoperative pain, less wound healing disorders, less blood loss, lower wound infection rate etc. and the associated faster convalescence.

Known MIC instruments have several disadvantages in handling. On the one hand, working with the usually rigid instruments is difficult because they are not bendable intracorporeally and only one functional degree of freedom, e.g. for cutting or gripping exists. On the other hand, the guidance of the instruments is unintuitive, since the passage point through the body surface is to be regarded as invariant and thus a reversal of movement takes place inside the body. Consequently, learning this technique is tedious and training intensive. Furthermore, complex interventions with high demands on manipulability are hardly feasible with this technique.

To simplify this difficult handling, minimally invasive surgery can be supported by robotic systems. The MIC instruments are carried by robotic arms, which are controlled remotely by the surgeon. Remote control is via a cockpit-like input console remote from the patient, where the MIC instruments are commanded by means of special "joysticks". The main advantages of these robotic systems are the ability to provide additional intracorporeal angulation of the instruments with ease of use and to significantly simplify the handling of the instruments through the interposition of computerized input adjustment systems (restoration of hand-eye coordination or elimination of motion reversal). As a result, even complex MIC interventions with high demands on manipulability are possible after a comparatively short learning phase.

Disadvantage of this technique - due to the spatial or mechanical separation of surgeon and patient - is the complete loss of haptic feedback from the surgical field to the surgeon. The perception of haptic impressions (interaction and manipulation forces and moments) by a technical system is bound to sensors whose position is most sensible, especially at the extremely distal end of the instrument, in order to avoid influences on the measurement that do not originate directly from the surgical field of interest. The most appropriate sensors for the medical environment (e.g., in terms of size for the MIC, biocompatibility, patient risk) are in the broadest sense electro- or optomechanical, i. mostly cable- or fiber-bound sensors. Furthermore, sensor-integrated instruments are expensive and thus costly; So it is not in connection with the MIC outgoing, but from multiple instruments. However, neither cable nor fibers are fatigue resistant to kinking with bendable instruments. So it makes sense from a technical point of view not to bend (bend) these sensor-integrated instruments, but to change their main direction arcuate.

Known kinematic realization of such a bend in the field of robotics is the so-called. Spine kinematics, in which a multi-joint mechanism, consisting of several, one behind the other hinged individual joints, is used.

If such a spine kinematics driven underdetermined, that is for each Abkrümmsebene only one actuator for multiple joints available, the disadvantage in this configuration is that the curvature of the spin kinematics not deterministic, ie the curvature not mandatory over all individual joints evenly distributed, is (for example due to different friction in the individual joints, stick-slip effects, bearing clearance, ripple at the Aktuierung). Also, forces acting on the kinematic structure from the inside or outside (eg interaction forces with the environment, stiffnesses of internal structures, support forces of tension cables for actuation of the functional end effector) can influence their position and orientation. The resulting curvature in this case must therefore not correspond to a polygon with the same internal angles, but may follow an irregular traverse, which in addition (because of non-deterministic) with each attempt to approach the same position, different express. It is therefore never known exactly where the arm end point of the spine Kinematics comes to rest, which is especially in handling technology of great disadvantage.

Even with the integration of a position sensor to determine the Armendpunktposition remains the problem that a known target-actual error can be compensated only by chance, because a change of the actuator does not result in a deterministic Armendpunktpositionsänderung to compensate for the target-actual error - the system has more degrees of freedom than drives and is therefore mechanically underdetermined. This problem could be solved by integrating a separate, in the best case controllable, actuator for each joint. As a result, however, the number of drive cables is greatly increased, such as in WO 2003/001986 A2 described. In orders of magnitude such as the MIC (with regard to the required number of spine joints, instrument diameter and drive shaft diameter for application-assigned cable load), the instrument cross-section for receiving the drive cables is quickly exhausted. This problem exists in particular in the WO 2003/001986 A2 described item, since each degree of freedom of kinematics two drive cables are provided.

An alternative solution to the problem of subregionality is the constraint: In this case, a mechanical coupling of all subsequent joints with each other requires a deterministic curvature. These modular hinge mechanisms are for example in DE 43 03 311 A1 . DE 44 15 057 A1 and WO 94/17965 A1 described. Each individual member of this chain-like linked limbs can thus perform only a defined change in direction relative to the adjacent member. The total curvature of the Gelenkmechanismusses is thus composed of a variety of small buckling. However, these hinge mechanisms are bendable only in a single degree of freedom.

For full dexterity ( 6 Degrees of freedom) in the patient's body, the in DE 44 15 057 A1 and DE 43 03 311 A1 described kinematics have a further degree of freedom, which is realized for example via a rotation of the extremely distal end. Since the sensors should be located in the same place to avoid parasitic effects, there are two disadvantages: 1 ) The construction elements required for the rotation in the case of application-dependent, very limited installation space are disturbing for the sensor integration. 2 ) Cables or fibers, with which the sensors are controlled, can be damaged by the rotation over the term of the instrument, in the worst case turned off, with consecutive sensor failure. In addition to or instead of a sensor, a functional degree of freedom can be integrated at the extremely distal end of the instrument whose force transmission (eg drive cable) could also be damaged.

From the DE 10 2012 220 666 A1 Such a modular multi-link mechanism is known in which two degrees of freedom are available. This is sufficient to achieve full dexterity ( 6 Degrees of freedom) in the interior of the patient's body. Directly accessible structures, such as those found in classical minimally invasive (robotic) surgery, can be manipulated herewith. Even smaller structures such as blood vessels or the bile duct can be encompassed, but larger structures such as the heart or the peritoneal sac are too large to be grasped. A consequence of structures of hollow organs such. As required in the NOTES (Natural Office Translumenal Endoscopic Surgery) surgery is not possible. In principle, bending joints also require a larger working space compared to a kinking joint, for example to perform a 90 ° bend. Even a single port application, in which several instruments and endoscope optics are passed through only a single surgical approach, would be conceivable only with considerable loss of manageability (eg, crossing instruments, no opposing orientation of the functional ends). The integration of a further degree of freedom immediately before the functional end in the form of a rotation of the outermost distal end to improve the dexterity is only conditionally possible, because a cable or fiber connection, eg for sensor integration distal to rotational freedom or for actuation of the functional degree of freedom of continuous load not would resist the cables or fibers would be damaged by the rotational movement sooner or later or completely turned off. In addition, embracing or gripping behind structures would not be possible even with the integration of such a degree of freedom. As a result, by embracing the heart, for example, surgery on the posterior wall of the heart when the thorax is closed is not possible. The treatment of disc disease by an operation from the stomach, which requires embracing the peritoneal sac, not possible.

US 2002/0 091 304 A1 . US 5,916,147 A and WO 2012/027 581 A2 describe endoscopic instruments having at least two curvilinear sections, wherein the sections can be curved independently of one another.

US 2004/0236316 A1 describes a power transmission system wherein a plurality of elements are disposed proximally of a rigid shaft and an equal number of elements are disposed distal of the shaft. About train cables are the individual elements arranged proximally with connected to the respective distally arranged elements, so that a movement of the proximal elements is transmitted to the distal elements. Here, the individual elements can be controlled independently of each other.

DE 10 2012 212 510 A1 describes an end effector connected to an endoscopic instrument via a kinking element.

US 2012/0221016 A1 describes an endoscopic instrument having a plurality of interconnected elements, wherein an actuator is provided in each element, so that a subsequent element can be rotated and pivoted by this actuator.
The object of the invention is to provide an endoscopic instrument, with the deterministic embracing of individual organs is made possible at the same time small distal working space and simplified structure.

The object is achieved by the features of claim 1 and by the method of claim 9 and is further determined by the respective dependent claims.

The endoscopic instrument according to the invention has a proximal end and a distal end, the proximal end facing the surgeon and the surgical robot, respectively, and the distal end facing the surgical site. Typically, the distal end is inserted through an opening in the body of the patient. According to the invention, a drive unit or a coupling for a drive unit is arranged proximally. The drive unit controls the endoscopic instrument. Since endoscopic instruments are usually reusable devices which must be sterilized at high temperatures for reuse, it is advantageous to connect the drive unit via a coupling with the endoscopic instrument so that they are separated from the endoscopic instrument prior to sterilization can. At the same time, this also makes it possible to provide a drive unit for a plurality of endoscopic instruments.

According to the invention, the drive unit or the coupling for a drive unit is adjoined by a plurality of, in particular, deterministic link mechanisms arranged one behind the other. The joint mechanisms define sections along the endoscopic instrument. In particular, each section has exactly one hinge mechanism. The sections are arranged directly adjacent to each other and in particular rigidly connected together. The end of a section is linked to the beginning of another immediately following section, and so on. The beginning of the first section points in the proximal direction and is in particular connected to the drive unit or a coupling for the drive unit. In addition to the respective joint mechanism, a section may in particular also have a rigid area. Alternatively, the section has a rigid area both in front of the hinge mechanism and after the hinge mechanism.

According to the invention, an end effector or a coupling for the end effector is arranged on the drive unit, or the coupling for a drive unit, remote from the distal end of the endoscopic instrument. The end effector may be, for example, a gripper, a pair of scissors or the like. Equally conceivable, however, is to provide an optic as the end effector, by means of which the surgical site can be observed. Alternatively, the end effector is a particular diagnostic sensor such as an ultrasonic sensor. If a coupling is provided for an end effector, the end effector is made removable, so that several different end effectors can be used with only one endoscopic instrument.

According to the invention, the sections can be bent and / or bent independently of one another by the hinge mechanisms. In this case, a curvable section has a deterministic curvature, and in particular a radius, wherein the curvature of the curvable section preferably remains substantially constant from the beginning of the curvable section to the end of the curvable section, so that the curvable section substantially follows in particular a circular arc segment. By contrast, in the case of a bendable section, a continuous course from the beginning of the bendable section to the end of the bendable section is not ensured. Rather, in particular an angle of rotation about an individual axis of rotation is generated by the articulated mechanism of the bendable section. The buckling also takes place deterministically. In particular, the individual Abs sections do not have to be the same length. Preferably, however, the bendable joint mechanisms are identically formed and thus the same length and, in addition or alternatively, preferably the bendable portions are formed identically.

Thus, according to the invention, greater variability in guiding an endoscopic instrument is provided by a meaningful cascading of a plurality of curving or buckling sections with corresponding curving or bending joint mechanisms. The cascading allowed new fields of application in the MIC by embracing structures such as the heart or the peritoneal bag, which allows operations by other gentler approaches in comparison to the currently practiced technology. This also allows surgery on the posterior wall of the heart with the thorax closed, an operation previously reserved for open surgery only. This is due, for example, to the fact that it is not possible to reach the heart's posterior wall through the back (even in the minimally invasive case), especially because of the risk of injury to nerve tracts radiating from the spinal cord and the sensitive back muscles. The heart can be reached surgically only by access from the front or the side, for operations on the back of the heart, the organ must be dislocated out of the heart cavity when the thorax is opened. By means of the endoscopic instrument according to the invention, the organ can be encompassed, and thus instruments can be brought from the front or the side behind the organ in order to be able to operate there, whereby dislocation or traumatic open methodology can be dispensed with.

Another application is degenerative disc disease, e.g. with pain in the back and legs that require surgical stiffening of spinal segments (spinal fusion). The stiffening can be done from the back (PLIF = posterior lumbar interbody fusion) or from the abdomen (ALIF = anterior lumbar interbody fusion). A stiffening can be done on the one hand by (partial) clearing of the disc and implantation of a spacer (cage) filled with bone material, the bone material filling the intervertebral disc gap over weeks to months and the adjacent vertebral body will bony stiffen. On the other hand, holders can be screwed into the vertebral bodies, which are connected to stiffening along the spine rods (Harrington rods) and thus stiffened (internal fixator). A combination of both methods is possible. The advantage of the ALIF is that the back muscles and the innervation of the back remain uninjured. In addition, the growth behavior of the bone material is better due to the higher compression on the front of the spine. From the front, larger cages can be implanted, which promise a better primary stability. The installation of an internal fixator, however, is not (yet) possible from anterior. The required surgical access from ventral has a length of at least 7-15 cm. Because of the vertical course of the abdominal back muscle, this does not have to be severed in the ALIF, but can be pushed aside. Similarly, the peritoneal sac may remain closed for the anterior approach, but must be pushed aside and partially grasped. Transperitoneal approaches with opening of the peritoneal sac are rarely performed because of frequent additional visceral complications. Endoscopic ALIF approaches have been attempted in the past, but abandoned because of the risk of injury to the large vessels directly adjacent to the spine (aorta or vena cava). ALIF is often performed in cooperation with vascular surgeons who first mobilize the large vessels. After pushing aside the large vessels, the intervertebral disc can be cleared and the cage and the bone material introduced. By means of the endoscopic instrument according to the invention, which has sections which can be bent or bent independently of one another, an operation of the intervertebral discs is possible from the abdomen, the mobilization of large vessels no longer being necessary since they can be grasped. An opening of the peritoneal sac can also be avoided, since this too can be encompassed by the endoscopic instrument according to the invention.

The foldable hinge mechanism has a plurality of links arranged in series via main hinges. In addition, the foldable hinge mechanism has connecting elements, each connecting one link to the next but one link. In this case, the curvable joint mechanism has a plurality of links pivotable in two degrees of freedom. The links are arranged in particular like a chain. The main joints are in particular constructed in such a way that they have two pivot axes which preferably cross each other for the purpose of forming one of the two degrees of freedom. In this case, preferably one axis is guided in one member and the second axis is guided in the adjacent member. In this case, each provided on a member pivot axes are parallel to each other. The pivot axis of the immediately adjacent member is perpendicular to these pivot axes. In particular, the pivot axes of adjacent links of a chain-like joint mechanism are cyclically rotated by 90 ° and cyclically alternately oriented. For example. For example, the pivot axes of each second link are horizontally aligned while the pivot axes of the links therebetween are vertically aligned. Furthermore, in each case two members of the bendable Gelenkmechanismusses are connected to each other via connecting elements. By providing the connecting elements, there is a deterministic forced guidance of all members of the bendable joint mechanism. By such a deterministic bending of the individual limbs, a very precise guiding of a functional end attached to the distal end of the joint mechanism, in particular in the interior of the body when used in minimally invasive surgery, is possible.

In particular, the endoscopic instrument has at least one bendable section. Preferably, all sections are bendable. Since there is no need for bendable sections, a neutral fiber runs along the entire endoscopic instrument from the proximal to the distal end, through which, for example, an optical fiber can be guided so that an optic can be provided at the distal end as the end effector. This makes it possible with the optics also to encompass organs and look behind them or deterministically follow the optics with the optic organs, without supporting themselves on the hollow organs themselves, which would lead to pressure damage to these organs. In particular, the last distal section pointing towards the end effector or the coupling for the end effector can be made bendable. Here, a greater mobility of the end effector is achieved in the smallest possible space. Since kinkable sections have a small space required to carry out their movement, it is particularly advantageous to make the last section kinkable, since on the one hand for the operation a high mobility of the end effector must be ensured and on the other hand, only a small space for movements available.

Preferably, the endoscopic instrument has at least two curved sections and one bendable section exclusively in this sequence, starting exclusively from the drive unit or the coupling for a drive unit. Each further curved section extends the intracorporeal mobility of the endoscopic instrument. As described above, a distally located kinking section extends the range of motion at the surgical site.

Preferably, a sensor is provided which is arranged distally. The distal arrangement of the sensor avoids influences on the measurement that are not directly derived from the surgical field of interest. Preferably, however, the sensor is arranged starting from the drive unit or the coupling for a drive unit in front of the first bendable section, since it is not possible to produce a durable optical or electrical connection by means of a bendable section. In particular, the kinkable sections have no neutral fiber, through which cables or optical fibers can be guided as a connection for the sensor and are protected from kinking. Thus, especially in the formation of the endoscopic instrument in which the last, distal portion is formed as a kinking portion, the sensor is arranged at a maximum distally, in particular, the sensor is a position sensor for detecting the position of the end effector. Preferably, however, the sensor is a force / torque sensor, wherein a permanent connection of the position sensor and / or force / torque sensor to the drive unit is ensured by the distal arrangement, in particular in front of the first bendable portion. Alternatively, it may be the sensor to a diagnostic sensor such. B. act an ultrasonic sensor.

In particular, the drive unit has at least one output per joint mechanism or curvature or buckling plane. As a result, a deterministic behavior of the individual joint mechanisms is ensured, so that a precise control of the end effector to the operation area is guaranteed. At the same time, the control of the endoscopic instrument can be robot-controlled, in particular because the kinematics have deterministic behavior. For an optional, additional improvement of the positioning quality, an internal curvature sensor system, in particular, can be integrated as a position sensor on the joint plane. In addition, it is possible to integrate diagnostic sensors at the distal end of the instrument so that their cable or fiber connection is permanently bent (not kinked), in particular designed as a force / moment sensor for interaction forces between robot and tissue or as an ultrasonic sensor for tissue examinations.

In particular, the drive unit has a plurality of drives, wherein each drive is connected to a maximum of one hinge mechanism in order to drive it. This ensures targeted activation of the individual joint mechanisms, which leads to a deterministic behavior of the endoscopic instrument and the movement of the endoscopic instrument.

In particular, the foldable hinge mechanism, which defines the bendable sections, exactly one joint. This can be designed as a universal joint, as a swivel joint, as a ball joint, as a saddle joint or as a hinge joint or the like. In this case, the bendable joint mechanism has a joint which is designed to be movable about an axis or, alternatively, to a joint which is designed to be movable about more than one axis.

Preferably, the connecting elements are arranged such that in each case one member is connected to the next but one member, so that a member arranged therebetween is bridged. It is further preferred that two connecting elements form a pair of connecting elements. The connecting element pair, which in particular has at least two connecting elements, is preferably designed such that preferably two identical links are formed by the connecting elements be connected to each other. First ends of the two connecting elements are thus connected to one and the same member and second ends connected to one and the same other member, so that the two connecting elements extend between two members.

Alternatively, the foldable hinge mechanism has a plurality of links pivotable in two degrees of freedom. The links are arranged in particular like a chain, wherein joint elements are provided between adjacent links. Furthermore, the hinge mechanism on first and second connecting elements. The first connecting elements and the second connecting elements serve to connect adjacent members with each other. An aspect which is essential to the invention here is that the first connecting elements to the second connecting elements are arranged in different planes. Since the first and second connecting elements are arranged in two planes, a positive guidance of the angling is realized in two planes over all joints. In this case, it is preferable that the two planes are perpendicular to each other. In particular, the first connection element and the second connection element each form a connection element pair. The two connecting elements, each defining a plane, are arranged such that the planes form an angle to each other, in particular perpendicular to each other.

The pair of connecting elements, which in particular has two connecting elements, is preferably designed such that two identical links are connected to one another by the connecting elements. First ends of the two connecting elements are thus connected to one and the same member and second ends connected to one and the same other member, so that the two connecting elements extend between two members.

The connecting elements are preferably hingedly connected to the links. In particular, this is a ball joint.

In particular, the connecting element pairs are arranged such that they each connect a member to the next-but-one member. Between two via a pair of connecting elements interconnected links thus another member is arranged. Also, this intermediate member is preferably connected via another pair of fasteners turn to the next-but-one member. This creates an overlap of pairs of connecting elements, each of which connects the next but one links.

Alternatively, the foldable hinge mechanism has a plurality of preferably miniaturized elements of identical design dimensions, these elements consisting of only two components, a coupling and a rocker. The elements are coupled to each other so that when pivoting all these elements perform a similar movement. With a curvature of two successive elements, the first element is deflected by an angle φ with respect to its zero position or the position in undeflected state. Due to the positive movement generated by the coupling, the second element is also deflected relative to the first element by an angle φ, so that a total deflection ip results by the two curved elements, which corresponds to substantially equal to twice the angle φ. In a hinge mechanism with more than two elements, the substantially identical angles φ add up, thereby producing the curvature of the bendable hinge mechanism. However, the angles may be different, but are determined.

Preferably, the hinge mechanisms of the bending portions are formed as in FIG DE 10 2011 107 510 A1 , the DE 10 2012 220 666 A1 and / or the DE 43 03 311 A1 educated.

The invention will be explained in more detail below with reference to preferred embodiments.

• 1 drei mögliche Ausführungsformen des erfindungsgemäßen endoskopischen Instruments in einer schematisch dargestellten Operationssituation,
• 2 eine schematische Darstellung eines krümmenden Gelenkmechanismusses
• 3 eine alternative Ausgestaltung eines Gelenks mit drei Freiheitsgraden zwischen einem Verbindungselement und einem Glied, bei dem krümmenden Gelenkmechanismus der 2 und
• 4 eine alternative Ausführungsform eines krümmenden Gelenkmechanismusses.

Show it:

• 1 three possible embodiments of the endoscopic instrument according to the invention in a schematically illustrated surgical situation,
• 2 a schematic representation of a curving Gelenkmechanismusses
• 3 an alternative embodiment of a joint with three degrees of freedom between a connecting element and a member, in the curving hinge mechanism of the 2 and
• 4 an alternative embodiment of a curving Gelenkmechanismusses.

1 shows three endoscopic instruments according to the invention 10 . 12 . 14 , showing the endoscopic instruments 10 . 12 one drive unit each 16 and an end effector 18 on. The endoscopic instruments 10 . 12 . 14 have an extracorporeal proximal part, as well as an intracorporeal distal part which passes through openings 20 . 22 . 24 be introduced into the body of the patient. It is also possible that all three endoscopic instruments in the Single Port Surgery be introduced through only one opening in the body surface in the body.

The endoscopic instruments 10 . 12 . 14 have several curvilinear sections 26 on, which are arranged one behind the other and adjacent to each other. The boundaries of each section are in 1 schematically as a dashed line 25 shown. The end of the first curvable portion is connected directly to the beginning of the second curvable portion. Through the bendable sections 26 , which have not shown curvable joint mechanisms, can be an organ 28 or a similar structure that is to remain intact, such as the heart or the peritoneal sac, are completely encompassed so that on the side of the organ 28 or the structure can be operated, which the openings 20 . 22 . 24 is opposite. At the same time it is possible through the curving sections 26 a hollow organ 30 , such as the esophagus, the intestine or a vessel to follow, to the organ 28 to get. Here, the burden is kept low by a required in the prior art supporting the hollow organ for the hollow organ by the deterministic curvature of the endoscopic instrument.

The endoscopic instrument 12 has a distally disposed kinking section 32 which is located immediately adjacent to the last distal curving section 26 followed. Through the kinking section 32 which is located distally, becomes a greater mobility of the end effector 18 guaranteed.

The endoscopic instruments 10 . 12 have distally located sensors 34 on. With the sensors 34 For example, these are force / moment sensors or diagnostic sensors. These sensors 34 are arranged distally as far as possible in order to ensure as precise a detection as possible at the surgical site and to prevent indirect influences on the measurement. While in the endoscopic instrument 10 a neutral fiber exists from the drive unit to the end effector, through which the optical or electrical terminals of the sensor 34 can be guided, has the endoscopic instrument 12 a kinking section 32 which is located distally on. Here is the sensor 34 in the endoscopic instrument 12 starting from the drive unit 16 arranged immediately before the buckling section or immediately before the buckling hinge mechanism, so that despite providing a buckling section a permanent connection of the sensor 34 can be done by a cable or an optical fiber.

The endoscopic instrument 14 is designed as an optical endoscopic instrument, which in turn has a plurality of foldable sections 26 having. The end effector, however, is as an optic 36 educated. By providing the plurality of bendable sections 26 It is possible through the optical endoscopic instrument 14 behind the organ 28 to get there and to observe the operation site.

In the illustrated schematic first embodiment in 2 a bendable Gelenkmechanismusses is a first member 110 shown as stationary. At a distal limb 112 Not shown end effectors and / or sensors may be arranged. As by the arrows 114 . 116 is the hinge mechanism and thus the distal limb 112 swiveling in two levels. A panning can around the y -Axis according to arrow 114 or around the z -Axis according to arrow 116 respectively. If it is simultaneously pivoted about both axes, the result is a curvature in space. Between the two limbs 110 . 112 can be arranged a plurality of individual links. These are alternately arranged members in their orientation 118 . 120 In particular, a larger number than the illustrated number of three members may be provided. The limbs 118 . 120 are each about main joints 122 connected with each other. Each of the main joints 122 has two pivot axes 124 . 126 on. The pivot axes 124 . 126 are each perpendicular to each other, wherein in the illustrated embodiment, the pivot axes 124 each in z Direction and the pivot axes 126 in y Direction. The pivot axes 124 or 126 of a limb 118 or 120 are each aligned parallel to each other.

The gift axes of the individual members 118 . 120 are thus rotated cyclically alternately by +/- 90 °. This also applies to the first member 110 or the last term 120 the chain, which are each half members. The main joints 122 thus have two through the two pivot axes 124 . 126 defined degrees of freedom.

Two links each have first connecting elements 128 and second connecting elements 130 connected with each other. The two connecting elements form a pair of connecting elements.

In the illustrated embodiment, all fasteners 128 . 130 arranged such that they each connect a member to a next but one member, in such a way that the first connecting element 128 with the limb 110 or. 120 guided axis 126 the main joints 122 is connected and the second connecting element 130 directly with the limbs 110 or. 120 connected is. So connects the first in 2 left connector pair 128 . 130 the stationary link 110 with the limb 120 , The second or middle fastener pair 128 . 130 connects the two with 118 designated links or their associated axes 124 the main joints 122 , For a longer chain thus connect the fastener pairs 128 . 130 two identical links each 118 or 120 or their associated axes 124 or. 126 the main joints 122 because the limbs 118 and 120 are arranged alternately in the chain.

The first fasteners 128 are, for example, with the two limbs 118 associated axes 124 the main joints 122 at their ends in each case via a pivot joint 132 associated with one degree of freedom. The swivel joints 132 are each at a point of articulation 134 with the corresponding axes 124 the main joints 122 connected. The pivot points 134 the first connecting elements 128 are related to the associated main joint 122 at a distance to the pivot axis 126 arranged. In particular, the articulation points 134 at the height of the pivot axes 124 arranged so that the pivot axes in a neutral state in a plane with the main joints 122 lie.

The second connecting elements 130 are about two joints at their ends or on the corresponding members, for example. The two members 118 or 110 and 120 connected, wherein an axial-rotational degree of freedom must be provided. At a first in 2 left end of the second pivot joint 130 is a joint device 136 provided with three degrees of freedom. This is at the in 2 illustrated embodiment by a hinge 138 with two degrees of freedom, such as a universal joint in conjunction with a swivel joint rotatable about a longitudinal axis 140 realized. The swivel joint 140 allows in this case a rotation of the example. Rod-shaped connecting element 130 around its longitudinal axis. The joint is at a distance to the main joint 122 arranged. The axes are perpendicular to each other or parallel.

The joint device 136 with three degrees of freedom can also be like in 3 represented, be formed. Here is a swivel joint 142 with one degree of freedom, with two hinges 144 . 146 combined, with the two hinges 144 . 146 are arranged at an angle of 90 ° to each other.

The joint device 136 is also at a distance to the corresponding main joint 122 at a point of articulation 148 with the corresponding limb, for example the limb 118 , connected. The articulation point 148 is at a distance to the main joint 122 arranged.

The second end of the second connecting element 130 is about a joint 150 with two degrees of freedom, like a universal joint, with the next limb, for example the limb 120 connected.

Also the joint 150 is at a distance to the main joint 122 at a point of articulation 152 arranged.

In an alternative embodiment shown in the 4 are three schematic frame-shaped limbs 210 . 212 . 214 shown. The limbs 210 . 212 . 214 each have a gimbaled main joint 216 connected with each other. One link 210 is each with the next but one member 214 via first connecting elements 218 and second connecting elements 220 connected, wherein the connecting elements 218 . 220 formed rod-shaped in the illustrated embodiment. The two connecting elements 218 . 220 are about trained in the embodiment as ball joints joints 222 with the respective member 210 . 214 connected. The joints 222 correspond respectively to the corresponding member 210 . 214 connected articulation points. The pivot points 222 point to the associated main joint 216 a distance up.

The first connection element 218 penetrates this between the two limbs 210 . 214 provided member 212 , so that through the first connecting element 218 two articulation points 222 the limbs 210 . 214 connected on different sides, based on the intermediate member 212 , are arranged. The same applies to the second connecting element 220 , wherein the connecting element 220 additionally arranged such that it passes through in the member 212 provided recesses 224 passed through. This is the location of the intermediate member 212 based on the second connecting element 220 Are defined.

Like from the 4 can be seen, are the first connection element 218 and the second connecting element 220 arranged in a different plane, wherein the two planes are perpendicular to each other.

The illustrated pair of fasteners 218 . 220 connects the two limbs 210 . 214 such that there is a link between them 212 is arranged. The in the 4 left side of the limb 212 would be about a corresponding pair of fasteners with another, not shown, in the 4 to the left of the limb 210 connected member connected. Accordingly, the right side of the limb can 212 via another appropriately arranged pair of connecting elements with another, in the figures right next to the member 214 arranged member or a drive unit or a coupling to be connected to a drive unit. Due to the design of the curving Gelenkmechanismusses it is particularly possible to run fiber cables, cables, hoses, drive elements for end effectors, etc. inside. As a result, the risk of damage is significantly reduced or excluded.

Claims (10)

Endoscopic instrument having a proximal drive unit (16) or a coupling for a drive unit, a plurality of successively arranged hinge mechanisms, which are defined by the sections (26, 32) and are connected to the drive unit (16) or the coupling for a drive unit the drive unit (16) or the coupling for a drive unit distal end side arranged end effector (18, 36) or a coupling for an end effector, wherein the sections (26, 32) by the hinge mechanisms independently deterministically curvable and / or bendable, characterized characterized in that at least two bendable sections (26) are provided, wherein the hinge mechanism of each bendable section 26 comprises a plurality of interconnected links (118, 120, 210, 212, 214) connected via main joints (122, 216) and connecting elements (128, 130, 218, 220), each having a member (118, 210) with the connect next but one link (118, 214) and wherein the main joints (122, 216) each have two pivot axes (124, 126), wherein each of a member (118, 120) provided pivot axes (124, 126) are parallel to each other and the Pivot axes (124, 126) of adjacent links (118, 120) are perpendicular thereto. Endoscopic instrument after Claim 1 , characterized in that all sections (26) are bendable. Endoscopic instrument after Claim 1 , characterized in that the last distal portion (32) pointing towards the end effector (18, 36) or the coupling for the end effector is bendable. Endoscopic instrument after Claim 3 characterized by exclusively starting from the drive unit (16) or the coupling for a drive unit two curved sections (26) and a buckling section (32). Endoscopic instrument after one of Claims 3 or 4 , characterized by a distal sensor (34), which is arranged in particular from the drive unit (16) or the coupling for a drive unit (16) in front of the first bendable portion (32) and is preferably designed as a force / moment sensor. Endoscopic instrument after one of Claims 1 to 5 , characterized in that the drive unit (16) has at least one drive per hinge mechanism. Endoscopic instrument after one of Claims 1 to 6 , characterized in that the drive unit (16) comprises a plurality of drives, wherein each drive is connected to a maximum of one hinge mechanism in order to drive this. Endoscopic instrument after one of Claims 1 to 7 , characterized in that the hinge mechanism of the at least one bendable portion (32) has exactly one joint, in particular a universal joint, a swivel joint, a ball joint, a saddle joint or a hinge joint. Method for encompassing structures with an endoscopic instrument according to one of Claims 1 to 8th in which a first section is deterministically curved or kinked and at least one further section is deterministically curved or kinked independently of the first section. Use of an endoscopic instrument according to one of Claims 1 to 8th in robotic surgery.

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