Micro-invasive medical instrument

Abstract

A medical instrument includes an outer shaft, a manipulation device at the proximal end of the outer shaft, a tool at the distal end of the outer shaft, with a first effecting device for a first function and a second effecting device for a second function, a first transmission device in the outer shaft for transmitting at least either a force or a torque for controlling the first effecting device, and a second transmission device in the outer shaft for transmitting at least either a force or a torque for controlling the second effecting device. The outer shaft is at least either curved or able to be curved or has a pivot joint. The first transmission device and the second transmission device are each designed to be flexible at least in sections.

Claims

1. A medical instrument, comprising: an outer shaft having a proximal end, a distal end, a pivot joint between the proximal end and the distal end, and a rotation joint between the pivot joint and the proximal end; a manipulation device at the proximal end of the outer shaft; a tool at the distal end of the outer shaft having a first effecting device and a second effecting device; a first transmission device to transmit an axial force to control the first effecting device and a rotational torque to control the first effecting device and the second effecting device; a second transmission device to transmit an axial force to control the second effecting device; a third transmission device to control the pivot joint and the rotation joint.

2. The medical instrument according to claim 1, wherein the tool and the outer shaft have coupling devices configured to effect a releasable mechanical connection of the tool to the distal end of the outer shaft.

3. The medical instrument according to claim 1, in wherein the outer shaft and the manipulation device have coupling devices configured to effect a releasable mechanical connection of the proximal end of the outer shaft to the manipulation device.

4. The medical instrument according to claim 1, wherein the first transmission device and the second transmission device are arranged coaxially in the outer shaft.

5. The medical instrument according to claim 1, wherein the first transmission device and the second transmission device are arranged alongside each other in the outer shaft.

6. The medical instrument according to claim 1, in which the first effecting device is designed as a bipolar electrosurgical instrument with mutually electrically insulated electrodes, wherein one of the mutually electrically insulated electrodes is connected electrically conductively to the outer shaft and another of the mutually electrically insulated electrodes is connected electrically conductively to the first transmission device.

7. The medical instrument according to claim 1, wherein the rotation joint is arranged proximally of the tool and is configured to rotate the tool relative to the outer shaft.

8. The medical instrument according to claim 1, wherein the first effecting device comprises at least two jaw parts, at least one of the at least two jaw parts being pivotal, configured to grasp or squeeze tissue.

9. The medical instrument according to claim 1, wherein the second effecting device comprises a cutting device configured to cut through tissue.

10. The medical instrument according to claim 9, wherein the first transmission device comprises a transmission rod with a longitudinal groove, wherein the cutting device is disposed at least partially in the groove.

11. The medical instrument according to claim 1, wherein the first effecting device and the second effecting device operate independently of one another.

12. The medical instrument according to claim 1, further comprising a locking device provided on the second transmission device configured to couple the second transmission device to the first transmission device, in such a way that the second transmission device is rotatably fixed relative to the first transmission device.

13. The medical instrument according to claim 12, wherein the second transmission device is mechanically connected to the tool in a releasable manner by a bayonet coupling.

14. The medical instrument of claim 1, wherein the outer shaft, first transmission device, second transmission device, and third transmission device are curvable.

15. The medical instrument of claim 1, wherein the third transmission device is arranged coaxially in the outer shaft.

16. The medical instrument of claim 1, wherein the rotation joint is disposed a maximum distance away from the pivot joint being equal to about 10 times the diameter of the outer shaft.

17. A medical instrument, comprising: a curvable outer shaft having a pivot joint; a manipulation device at a proximal end of the outer shaft; a tool at a distal end of the outer shaft, with a first effecting device for a first function and a second effecting device for a second function; a first transmission device in the outer shaft configured to transmit an axial force to control the first effecting device and a rotational torque to control the first effecting device and the second effecting device; a second transmission device in the outer shaft configured to transmit an axial force to control the second effecting device; a third transmission device, of which the distal end is coupled to the pivot joint, and which controls the pivot joint; a rotation joint arranged proximally of the pivot joint, configured to rotate the pivot joint relative to the proximal end of the outer shaft; wherein the first transmission device and the second transmission device are each designed to be flexible with respect to bending at least in sections; wherein a first portion of the outer shaft is curved independently of a second portion of the outer shaft; wherein the third transmission device is further designed to control the rotation joint.

18. The medical instrument according to claim 17, wherein the third transmission device is arranged coaxially in the outer shaft.

19. The medical instrument according to claim 17, wherein the rotation joint is disposed a maximum distance away from the pivot joint being equal to about 10 times the diameter of the outer shaft.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) Embodiments are explained in more detail below with reference to the attached figures, in which:

(2) FIG. 1 shows a schematic view of a medical instrument;

(3) FIG. 2 shows a further schematic view of the medical instrument from FIG. 1;

(4) FIG. 3 shows a further schematic view of the medical instrument from FIGS. 1 and 2;

(5) FIG. 4 shows a further schematic view of the medical instrument from FIGS. 1 to 3;

(6) FIG. 5 shows a schematic axonometric view of a grasping device for a medical instrument;

(7) FIG. 6 shows a schematic axonometric view of a cutting device;

(8) FIG. 7 shows a further schematic axonometric view of the devices from FIGS. 5 and 6;

(9) FIG. 8 shows a schematic sectional view of a transmission device and of an inner shaft;

(10) FIG. 9 shows a schematic sectional view of a further transmission device and of an inner shaft;

(11) FIG. 10 shows a further schematic sectional view of the transmission device and of the inner shaft from FIG. 9.

DETAILED DESCRIPTION OF THE INVENTION

(12) FIG. 1 shows a schematic view of a medical instrument 10 with a proximal end 11 and a distal end 12. The medical instrument 10 has, at the proximal end 11, a manipulation device 18 with a plurality of movable grip parts and other actuating devices. A curved outer shaft 20 extends from the manipulation device 18 at the proximal end 11 to a grasping device 30 and a cutting device 50 at the distal end 12 of the medical instrument 10.

(13) Whereas in FIG. 1 the manipulation device 18 is indicated only by its contours and the grasping device 30 and the cutting device 50 are shown in a side view, a substantially tubular section 23 of the outer shaft 20 is shown in longitudinal section. The tubular section 23 contains, in a coaxial arrangement, a transmission rod 40, an internal inner shaft 60 and an external inner shaft 70. The internal inner shaft 60 and the external inner shaft 70 are each tubular or hose-shaped. The transmission rod 40, the internal inner shaft 60 and the external inner shaft 70 are each flexurally elastic, stiff in respect of longitudinal forces and torsionally rigid. The internal inner shaft 60 is arranged in an annular space between the transmission rod 40 and the external inner shaft 70. The external inner shaft 70 is arranged in an annular space between the internal inner shaft 60 and the tubular section 23 of the outer shaft 20.

(14) Arranged immediately proximally of the grasping device 30, a pivot joint 24 is provided which is connected mechanically to the tubular section 23 of the outer shaft 20, either releasably or non-releasably, and in particular forms a component part of the outer shaft 20. The pivot joint 24 permits a pivoting of the grasping device 30 and of the cutting device 50 about a pivot axis 25 perpendicular to the plane of the drawing of FIG. 1. The pivot joint 24 and the pivot axis 25 are rotatable, relative to the curved, tubular section 23 of the outer shaft 20, about a rotation axis 28 in the plane of the drawing in FIG. 1. The rotation axis 28 is defined by a rotation joint 29, shown schematically in FIG. 1.

(15) The proximal end 31 of the grasping device 30 is mechanically connected to the pivot joint 24 in a releasable manner. A stationary jaw part 32 and a pivotable jaw part 34, which is pivotable about a pivot axis 35 perpendicular to the plane of the drawing of FIG. 1, form the distal end of the grasping device 30. The solid line shows the pivotable jaw part 34 in an open position, spaced apart from the stationary jaw part 32, and the broken line shows it in a closed position, bearing on the stationary jaw part 32. Together with the pivot axis 35 and the cutting device 50, the grasping device 30 is rotatable about the longitudinal axis 38 of the grasping device 30 relative to the pivot joint 24.

(16) In the embodiment shown in FIG. 1, the stationary jaw part 32 and the pivotable jaw part 34 are configured as a bipolar electrosurgical instrument with mutually electrically insulated electrodes 80, 81, shown schematically.

(17) FIG. 2 shows a further schematic view of the medical instrument 10 from FIG. 1. The plane of the drawing of FIG. 2 is perpendicular to the plane of the drawing of FIG. 1 and parallel to the pivot axis 25 of the pivot joint 24 and to the rotation axis 28 about which the pivot joint 24 is rotatable relative to the tubular section 23 of the outer shaft 20. In contrast to FIG. 1, the outer shaft 20 in FIG. 2 is shown exclusively in an external and side view.

(18) FIG. 3 shows a further schematic view of the medical instrument from FIGS. 1 and 2. The plane of the drawing of FIG. 3 is perpendicular to the plane of the drawing of FIG. 1, perpendicular to the plane of the drawing of FIG. 2, perpendicular to the longitudinal axis 38 of the grasping device 30 (cf. FIG. 2), perpendicular to the rotation axis 28 about which the pivot joint 24 is rotatable relative to the tubular section 23 of the outer shaft 20, parallel to the pivot axis 25 of the pivot joint 24 and parallel to the pivot axis 35 of the pivotable jaw part 34.

(19) Comparing FIGS. 1 to 3, it will be seen that the outer shaft 20 has a spatial curvature, i.e. not a planar curvature, and in particular has a configuration similar to a screw or a helix.

(20) FIG. 4 shows a further schematic view of the medical instrument from FIGS. 1 to 3. The plane of the drawing of FIG. 4 corresponds to the plane of the drawing of FIG. 1. The view in FIG. 4 differs from the views in FIGS. 1 to 3 in that component parts into which the medical instrument 10 can be dismantled without destruction, i.e. reversibly, by medical personnel without using tools, are shown separately. The flexurally elastic transmission rod 40, the flexurally elastic internal inner shaft 60 and the flexurally elastic external inner shaft 70 are each shown in rectilinear form. Dot-and-dash lines indicate how the component parts of the medical instrument are to be assembled.

(21) The flexurally elastic, torsionally rigid transmission rod 40, which is stiff with respect to longitudinal forces, is mechanically connected to the grasping device 30. As is explained in detail below with reference to FIG. 5, the distal end of the transmission rod 40 is mechanically coupled and electrically conductively connected to the pivotable jaw part 34 and is electrically insulated from the stationary jaw part 32 and from bayonet claws or catches 37 at the proximal end 31 of the grasping device 30. As is likewise explained below with reference to FIGS. 5 to 7, the grasping device 50 can be inserted from the proximal direction into a channel in the transmission device 40 and into the grasping device 30.

(22) The tubular or hose-shaped internal inner shaft 60 has a lumen whose cross section is adapted to the cross section of the transmission rod 40, such that the transmission rod 40 is guided with minimal play and minimal friction in the internal inner shaft 60. At the distal end 62, the internal inner shaft 60 has an L-shaped slit with an axial section 63 and a circumferential section 64. The L-shaped slit 63, 64, a projection 56 on the cutting device 50, and the function thereof, are likewise explained below with reference to FIGS. 5 to 7.

(23) The external inner shaft 70 is mechanically connected to the pivot joint 24. In particular, the distal end of the external inner shaft 70 is coupled to the pivot joint 24 in such a way that an axial translation movement of the external inner shaft 70 is associated with a pivoting movement of the distal part of the pivot joint 24 about the pivot axis 25 relative to the proximal part of the pivot joint 24. At the distal end of the pivot joint 24, L-shaped grooves 27 are formed which correspond to the catches 37 at the proximal end 31 of the grasping device 30, for releasable mechanical connection of the tool 30 to the pivot joint 24. The proximal end of the pivot joint 24 can be mechanically connected in a releasable manner to the distal end of the tubular section 23 of the outer shaft 20 by means of devices not shown in FIG. 4. In particular, bayonet coupling devices are provided at the proximal end of the pivot joint 24 and at the distal end of the tubular section 23 of the outer shaft 20.

(24) The external inner shaft 70 is substantially tubular or hose-shaped. The cross section of the lumen of the external inner shaft 70 is adapted to the cross section of the internal inner shaft 60 in such a way that the internal inner shaft 60 is guided and movable in the external inner shaft 70 with minimal play and minimal friction. The cross section of the lumen of the tubular section 23 of the outer shaft 20 is adapted to the cross section of the external inner shaft 70 in such a way that the external inner shaft 70 is guided and movable in the tubular section 23 of the outer shaft 20 with minimal play and minimal friction.

(25) The proximal end 21 of the outer shaft 20, or of the tubular section 23 of the outer shaft 20, can be locked with a form fit in a corresponding recess in the manipulation device 18 by means of a locking device not shown in FIGS. 1 to 4. In the arrangement shown in FIG. 1, the proximal end 41 of the transmission rod 40, the proximal end 61 of the internal inner shaft 60 and the proximal end 71 of the external inner shaft 70 are mechanically coupled to actuating devices on the manipulation device 18 by way of devices not shown in FIGS. 1 to 4.

(26) In particular, the proximal end 41 of the transmission rod 40 is coupled to a pivotable grip part of the manipulation device 18 in such a way that the transmission rod 40 is displaceable in its longitudinal direction, in order to pivot the pivotable jaw part 34 between the open position, shown by solid lines in FIGS. 1, 3 and 4, and the closed position, shown by broken lines in FIGS. 1, 3 and 4. Moreover, the transmission rod 40 is coupled to a further actuating device, for example a rotary wheel, in such a way that the transmission rod 40 is rotatable about its longitudinal axis, in order to rotate the grasping device 30 about its longitudinal axis 38 together with the cutting device 50.

(27) Moreover, the proximal end 61 of the internal inner shaft 60 is coupled to a further actuating device of the manipulation device 18 in such a way that the internal inner shaft 60 can be displaced axially, i.e. in its longitudinal direction, in order to move the cutting device 50 parallel to the longitudinal axis 38 of the grasping device 30. Moreover, the proximal end 71 of the external inner shaft 70 is mechanically coupled to a further actuating device of the manipulation device 18 in such a way that the external inner shaft 70 can be displaced axially, i.e. in the longitudinal direction, in order to pivot the grasping device 30 and the cutting device 50, together with the distal part of the pivot joint 24, about the pivot axis 25. Moreover, the proximal end 71 of the external inner shaft 70 is mechanically coupled to a further actuating device of the manipulation device 18 in such a way that the external inner shaft can be rotated about its longitudinal axis, in order to rotate the pivot joint 24, together with the pivot axis 25, about the rotation axis 28 relative to the distal end of the tubular section 23 of the outer shaft 20.

(28) FIG. 5 shows a schematic axonometric view of the grasping device 30, which is provided and designed to form a medical instrument, as is explained above with reference to FIGS. 1 to 4. The grasping device 30 has a proximal end 31 and two jaw parts 32, 34, which form the distal end of the grasping device 30. Near the proximal end 31, the grasping device 30 has two symmetrically arranged bayonet claws or catches 37, of which one is arranged on a side facing away from the viewer and is therefore largely concealed. The grasping device 30 shown in FIG. 5 differs from what has been explained above with reference to FIGS. 1 to 4 in terms of a slightly different arrangement of the catches 37. Otherwise, the grasping device 30 shown in FIG. 5 corresponds substantially to the grasping device of the medical instrument explained above with reference to FIGS. 1 to 4.

(29) The grasping device 30 is mechanically connected to the transmission rod 40. The transmission rod 40 is movable, within a predetermined range, relative to the grasping device 30, in particular relative to the proximal end 31 and to the stationary jaw part 32, in the axial direction, i.e. parallel to the longitudinal axis of the transmission rod 40 and to the longitudinal axis 38 of the grasping device 30 (cf. FIGS. 1 and 2). The distal end of the transmission rod 40 is arranged inside the grasping device 30 and is therefore not visible in FIG. 5, and it is coupled to the pivotable jaw part 34 in such a way that an axial movement of the transmission rod 40 is associated with a pivoting movement of the pivotable jaw part 34.

(30) A groove 45, which in particular has a narrow and deep rectangular cross section, is provided in the transmission rod 40. At its distal end, not visible in FIG. 5, the groove 45 in the transmission rod 40 is continued by a channel of corresponding cross section which extends between the jaw parts 32, 34 to almost the distal ends of the latter.

(31) Parts of the grasping device 30, in particular the catches 37 and the transmission rod 40, are made of stainless steel or another metal. The catches 37 and the transmission rod 40 are electrically insulated from each other. The jaw parts 32, 34 have metallic and therefore electrically conductive grasping surfaces, which are electrically insulated from each other when they are not bearing on each other as shown in FIG. 5. The catches 37 and the transmission rod 40 are each electrically conductively connected to the grasping surface of a jaw part 32, 34. In particular, the catches 37 are electrically conductively connected to the grasping surface of the stationary jaw part 32, and the transmission rod 40 is electrically conductively connected to the grasping surface of the pivotable jaw part 34.

(32) FIG. 6 shows a schematic axonometric view of the cutting device 50 with a proximal end 51 and a distal end 52. At the distal end 52, the cutting device 50 has a cutting edge 53. At the proximal end, the cutting device 50 has a projection 56. Between the proximal end 51 and the distal end 52, the cutting device comprises a rod-shaped area 54, which has substantially the configuration of a strip-shaped plate or of a rod with a rectangular cross section.

(33) Between the projection 56 at the proximal end 51 and the cutting edge 53 at the distal end 52, the cross section of the cutting device 50 corresponds substantially to the cross section of the groove 45 in the transmission rod 40 (cf. FIG. 5), such that the cutting device 50 is received completely, except for the projection 56, by the groove 45 in the transmission device 40 and is guided in the latter with minimal play and minimal friction and can be moved in the longitudinal direction of the transmission rod 40 and of the cutting device 50. The projection 56 is provided to protrude from the groove 45 in the transmission rod 40.

(34) FIG. 7 shows a further axonometric view of the grasping device from FIG. 5 and of the cutting device 50 from FIG. 6. In the view in FIG. 7, the cutting device 50 is arranged in the groove 45 in the transmission rod 40 (cf. FIG. 5). The distal end 52 of the cutting device 50 (cf. FIG. 6) is arranged here in the grasping device and in particular between the jaw parts 32, 34. The projection 56 protrudes from the groove 45.

(35) FIG. 7 also shows the internal inner shaft 60, which has substantially a tubular shape or the shape of a jacket of a circular cylinder. At its distal end 62, the internal inner shaft 60 has an L-shaped slit with an axial or axially extending section 63 and a circumferential or circumferentially extending section 64. The width of the axial section 63 of the L-shaped slit, measured in the circumferential direction, and the width of the circumferential section 64 of the L-shaped slit, measured in the axial direction, are adapted to the dimensions of the projection 56 on the cutting device 50.

(36) After the transmission rod 40 has been inserted into the internal inner shaft 60, the projection 56 can be guided by a relative movement in the axial direction through the axial section 63 and into the circumferential section 64. When the projection 56 on the cutting device 50 is located in the circumferential section 64 of the L-shaped slit at the distal end 62 of the internal inner shaft 60, the internal inner shaft 60 can be rotated relative to the grasping device 30, the transmission rod 40 and the cutting device 50, in a first direction 91, as far as the configuration shown in FIG. 7.

(37) In the relative positioning of cutting device 50 and internal inner shaft 60 shown in FIG. 7, the cutting device 50 and the internal inner shaft 60 are rigidly coupled to each other in terms of axial movements (except for play). An axial movement of the internal inner shaft 60 is therefore associated with a corresponding axial movement of the cutting device 50. Thus, by means of the internal inner shaft 60, a movement of the cutting edge 53 at the distal end 52 of the cutting device 50 (cf. FIG. 6) can be effected in said channel (not shown in the figures) between the jaw parts 32, 34, such that, for example, tissue that is grasped by the jaw parts 32, 34 can be separated after electro-cauterization.

(38) The internal inner shaft 60 has an insulating jacket 69, which has a distal edge lying near the L-shaped slit 63, 64, and which can extend to near the proximal end of the internal inner shaft 60.

(39) FIG. 8 shows a schematic sectional view of an example of how the mechanical coupling, explained above with reference to FIG. 7, between the projection 56 at the proximal end of the cutting device 50 and the L-shaped slit 63, 64 at the distal end 62 of the internal inner shaft 60 is locked. The sectional plane in FIG. 8 is perpendicular to the plane of the drawing of FIG. 1, perpendicular to the plane of the drawing of FIG. 2, parallel to the plane of the drawing of FIG. 3, and perpendicular to the plane of the drawing of FIG. 4. The sectional plane in FIG. 8 lies immediately proximally of the distal end 62 of the internal inner shaft 60 in the area of the axial section 63 of the L-shaped slit (cf. FIGS. 4 and 7).

(40) The internal inner shaft 60 has an axial, or axially extending, locking slit 67 which lies substantially opposite the L-shaped slit 63, 64. Thus, in relation to the views shown in FIGS. 5 and 7, the axial locking slit 67 lies on a side facing away from the viewer. The transmission rod 40 has a projection 47, which corresponds to the axial locking slit 67 on the internal inner shaft 60 and which, for example, is in the form of a lug, an axially extending web or a pin.

(41) The angle position of the projection 47 relative to the groove 45 (cf. FIGS. 4 and 7) in the transmission rod 40 and the angle position of the axial locking slit 67 relative to the L-shaped slit 63, 64 in the internal inner shaft 60 are chosen such that the projection 56 on the cutting device 50, arranged in the groove 45 in the transmission rod 40, is held in the circumferential section 64 of the L-shaped slit at the distal end 62 of the internal inner shaft 60 when the projection 47 on the transmission rod 40 engages in the axial locking slit 67 on the internal inner shaft 60, as is shown in FIG. 8. The projection 47 is arranged so far distally of the proximal end of the groove 45 in the transmission rod 40 (cf. FIGS. 5 and 7) that, first of all, the cutting device 50 can be inserted into the groove 45 in the transmission rod 40 and can be coupled to the distal end 62 of the internal inner shaft 60 in the manner described above with reference to FIG. 7. Thereafter, the internal inner shaft 60 is moved distally together with the cutting device 50. It is only with this movement of the internal inner shaft 60 in the distal direction that the projection 47 on the transmission rod 40 engages in the axial locking slit 67 on the internal inner shaft 60, as is shown in FIG. 8, in order to lock the mechanical connection between the cutting device 50 and the internal inner shaft 60.

(42) FIG. 9 shows a schematic sectional view of another example of how the internal inner shaft 60 is locked relative to the transmission rod 40. The sectional plane in FIG. 9 is perpendicular to the plane of the drawing of FIG. 1, perpendicular to the plane of the drawing of FIG. 2, parallel to the plane of the drawing of FIG. 3, perpendicular to the plane of the drawing of FIG. 4, and parallel to the sectional plane in FIG. 8.

(43) The transmission rod 40 has two flat surfaces 46 lying opposite each other. The internal inner shaft 60 has two openings lying opposite each other, in which a bolt 66 is in each case mounted so as to be radially movable. The bolts 66 are in particular movable between radially inward locking positions and the radially outward unlocking positions shown in FIG. 9. The bolts 66 can be held in the recesses in the internal inner shaft 60 by an O-ring made of an elastic material or by other devices not shown in FIG. 9 and/or can be pressed radially inward into the locking positions.

(44) FIG. 10 shows a further schematic sectional view of the example from FIG. 9. The sectional plane in FIG. 10 corresponds to the sectional plane in FIG. 9. The view in FIG. 10 differs from the view in FIG. 9 in that the internal inner shaft 60 is rotated relative to the transmission rod 40 to the extent that the bolts 66 can assume their radially inward locking positions and in so doing can bear on the flat surfaces 46 on the transmission rod 40.

(45) In the view in FIG. 10, the transmission rod 40 and the internal inner shaft 60 are arranged in the external inner shaft 70. Here, radially outer surfaces of the bolts 66 bear on the inner surface of the external inner shaft 70. In this way, the bolts 66 are held with a form fit in their locking position shown in FIG. 10. Thus, when the transmission rod 40 and the internal inner shaft 60 are arranged in the external inner shaft 70 as shown in FIG. 10, the transmission rod 40 is locked in terms of rotation about its longitudinal axis relative to the internal inner shaft 60.

(46) The angle positions of the flat surfaces 46 relative to the groove 45 in the transmission rod 40 (cf. FIGS. 5 and 7) and the angle positions of the openings in the internal inner shaft 60, receiving the bolts 66, relative to the L-shaped slit 63, 64 at the distal end 62 of the internal inner shaft 60 are chosen such that, in the locked configuration shown in FIG. 10, the projection 56 of the cutting device 50 is held in the groove 45 in the form-fit connection shown in FIG. 7 with the circumferential section 64 of the L-shaped slit at the distal end 62 of the internal inner shaft 60. Thus, in the configuration shown in FIG. 10, the mechanical connection between cutting device 50 and inner shaft 60 is locked.

(47) The locking between transmission rod 40 and internal inner shaft 60, as has been explained with reference to FIGS. 9 and 10, can be arranged near the distal end of the internal inner shaft 60 or, if the transmission rod 40 and the internal inner shaft 60 have a sufficiently torsionally rigid design, can be arranged at any other desired location as far as the proximal ends of the transmission rod 40 and of the internal inner shaft 60.

(48) TABLE-US-00001 Reference signs 10 medical instrument 11 proximal end of the medical instrument 10 12 distal end of the medical instrument 10 18 manipulation device at the proximal end 11 of the medical instrument 10 20 outer shaft of the medical instrument 10 21 proximal end of the outer shaft 20 22 distal end of the outer shaft 20 23 tubular section of the outer shaft 20 24 pivot joint at the distal end 22 of the outer shaft 20 25 pivot axis of the pivot joint 24 27 L-shaped groove at the distal end 22 of the outer shaft 20 28 rotation axis of the pivot joint 24 30 grasping device at the distal end 12 of the medical instrument 10 31 proximal end of the grasping device 30 32 stationary jaw part of the grasping device 30 34 pivotable jaw part of the grasping device 30 35 pivot axis of the pivotable jaw part 34 37 catch at the proximal end 31 of the grasping device 30 38 longitudinal axis of the grasping device 30 40 transmission rod of the medical instrument 10 41 proximal end of the transmission rod 40 45 groove in the transmission rod 40 46 flattened surface on the transmission rod 40 47 projection on the transmission rod 40 50 cutting device at the distal end 12 of the medical instrument 10 51 proximal end of the cutting device 50 52 distal end of the cutting device 50 53 cutting edge on the cutting device 50 54 rod-shaped area of the cutting device 50 56 projection at the proximal end 51 of the cutting device 50 60 internal inner shaft of the medical instrument 10 61 proximal end of the internal inner shaft 60 62 distal end of the internal inner shaft 60 63 axial section of an L-shaped slit at the distal end 62 64 circumferential section of an L-shaped slit at the distal end 62 66 bolt on the internal inner shaft 60 67 axial locking slit on the internal inner shaft 60 69 insulating jacket on the internal inner shaft 60 70 external inner shaft of the medical instrument 10 71 proximal end of the external inner shaft 70