Invasive instrument for treating vessels

Abstract

It is provided an invasive instrument for the treatment of a vessel, which possibly includes secondary vessels, with a tip formed for the dissection of tissue at the distal end of a shaft to be introduced into the body. The tip includes at least one recess, in particular a vessel receptacle, which is arranged and formed such that in the operating condition of the instrument always at least one functional unit of the shaft is kept clear, so that working on the vessel, a secondary vessel and/or on the surrounding tissue is possible using or by means of the functional unit.

1 . An invasive instrument for treating a vessel, which possibly includes secondary vessels, comprising:
 an elongated shaft extending along a longitudinal axis and having a proximal end and a distal end to be introduced into a body of a subject, the distal end having a working opening of a working channel that is located in the elongated shaft;   a dissection tip coupled to a guide element that is operably coupled to the shaft so that the dissection tip has a retracted tip position proximal to the distal end of the shaft and a shifted tip position spaced apart from the distal end of the shaft that is shifted relative to the retracted position, wherein the dissection tip is formed for the dissection of tissue, wherein the dissection tip includes at least one vessel receptacle in the form of an anatomically shaped recess extending substantially along the longitudinal axis of the elongated shaft;   at least one functional unit operably coupled with the shaft so as to have a retracted functional position within the working channel of the shaft when the dissection tip is in the retracted tip position and have a dissection functional position when the at least one functional unit is extended from the distal end of the shaft when the dissection tip is in the shifted tip position such that the at least one vessel receptacle is spaced apart from the at least one functional unit.   
     
     
         2 . The invasive instrument according to  claim 1 , wherein the dissection tip at least partly includes a conical region, a prismatic region, a region in the form of a dolphin nose, a region with a frustoconical shape and/or a region with the shape of a triangle. 
     
     
         3 . The invasive instrument according to  claim 1 , wherein the dissection tip is shiftable in axial direction and/or pivotable about the longitudinal axis by up to 180°, so that during the procedure a vessel arranged in the at least one vessel receptacle can be spaced selectively in particular from a cutting device of the functional unit. 
     
     
         4 . The invasive instrument according to  claim 1 , further comprising a handle at the proximal end of the shaft, and a manipulator, in particular arranged at the handle, for axially shifting and/or rotating the dissection tip relative to the distal end of the shaft between the retracted tip position and the shifted tip position. 
     
     
         5 . The invasive instrument according to  claim 1 , wherein the guide element is formed substantially rod-shaped and is attached at a point of the dissection tip which is located opposite the vessel receptacle. 
     
     
         6 . The invasive instrument according to  claim 1 , wherein a guide channel having the guide element and the working channel having the at least one functional unit are arranged on opposite sides of the shaft. 
     
     
         7 . The invasive instrument according to  claim 1 , wherein in the shaft and/or in the handle of the instrument at least one endoscope channel, at least one working channel for receiving a cutting device, at least one guide channel for receiving a guide element, at least one irrigation channel and/or at least one insufflation channel are arranged. 
     
     
         8 . The invasive instrument according to  claim 1 , wherein the dissection tip with the recess is designed such that the cutting device and/or an endoscope can be moved past the dissection tip in an axially retracted position and/or also in an axially extended position. 
     
     
         9 . The invasive instrument according to  claim 1 , wherein the distance between extended dissection tip and instrument tip is adjustable steplessly or in discrete steps. 
     
     
         10 . The invasive instrument according to  claim 1 , wherein the handle and/or the shaft are designed as reusable instrument. 
     
     
         11 . The invasive instrument according to  claim 1 , wherein the dissection tip, the guide element and/or the manipulator are designed as disposable components. 
     
     
         12 . The invasive instrument according to  claim 1 , further comprising at least one channel integrated into the shaft for conducting rinsing liquid and/or for sucking off undesired liquids. 
     
     
         13 . The invasive instrument according to  claim 1 , wherein an endoscope tip operably coupled with the shaft protrudes out of the instrument tip and into the retracted transparent tip. 
     
     
         14 . The invasive instrument according to  claim 1 , further comprising an insufflation channel such that a gas, in particular CO 2  gas, for the insufflation can be passed to the instrument tip in the insufflation channel. 
     
     
         15 . The invasive instrument according to  claim 1 , wherein the insufflation channel is arranged relative to the endoscope tip such that the endoscope tip can be cleaned with the gas, in particular in that the gas stream is diverted on the back of the dissection tip and directed to the endoscope tip. 
     
     
         16 . The invasive instrument according to  claim 1 , wherein at the instrument tip a video camera is arranged, wherein the video camera includes a video sensor, e.g. a CCD or CMOS sensor, along with associated electronics and suitable optics, and glass fibers, a flexible optical waveguide and/or a solid polymer rod are guided in a separate illumination channel from the handle via the shaft to the instrument tip. 
     
     
         17 . The invasive instrument according to  claim 1 , wherein at the instrument tip at least one LED is arranged for illumination. 
     
     
         18 . The invasive instrument according to  claim 1 , wherein the dissection tip includes at least one diverter for an irrigation jet. 
     
     
         19 . The invasive instrument according to  claim 1 , wherein the shaft has an at least partly circular or elliptical cross-section. 
     
     
         20 . The invasive instrument according to  claim 1 , wherein when in the retracted tip position the at least one vessel receptacle of the dissection tip is aligned with the working channel so that the at least one functional unit is movable relative to the dissection tip when the at least one functional unit is moved between an axially retracted position and an axially extended position. 
     
     
         21 . The invasive instrument according to  claim 1 , wherein when in the retracted tip position the endoscope is aligned with the working channel so that the endoscope is movable relative to the dissection tip when the endoscope is moved between an axially retracted position and an axially extended position. 
     
     
         22 . A surgical method performed with an invasive instrument, wherein
 a) forming a cut into the skin of a body,   b) introducing a dissection tip of the invasive instrument into the cut along a vessel, in order to separate surrounding tissue from the vessel,   c) during introduction and/or in the end position of the dissection tip treating the surrounding tissue, a secondary vessel and/or a vessel with a functional unit through a recess at the dissection tip, without separating the connection of the dissection tip from the instrument.   
     
     
         23 . The surgical method according to  claim 22 , wherein after being introduced through the cut, at least one functional unit is at least partly cleaned by a gas and/or a rinsing liquid.