The present invention relates to an actuation handle for actuating a surgical, preferably endoscopic and/or minimally invasive, applicator tool, in particular a staple tool, the actuation handle comprising a base body and an actuation lever mounted on the base body in a movable manner, the actuation lever being transferable into at least one preparation and one application position in relation to the base body, a positioning element being accommodated in the base body in a displaceable manner, and the positioning element and the actuation lever being provided with force transmission means in detachable operative connection, in particular mutual engagement. Furthermore, the present invention relates to an applicator tool, in particular a surgical, preferably endoscopic and/or minimally invasive, staple tool, the applicator tool comprising a tube element and an element guided in the tube element in a movable manner.

Actuation handles for surgical applicator tools and corresponding applicator tools are already known from the state of the art. With respect to such applicator tools and the corresponding actuation handles, an optimal, i.e. , precise and exactly dosable, actuation of the tool or activation of the tool must be achieved despite the spatial distance between the tool on the one side, namely inside the body at the location of the medical or surgical intervention or operation area, and the actuation handle on the other side, namely outside the body to be treated or to be operated. In the context of a stapling process in which tissue layers, muscle ends or the like are to be mechanically connected, in particular by means of staples, for example in an endoscopic or minimally invasive manner, inside a body to be treated, this means that a highly precise and exactly dosable application of the staple must be ensured. However, a considerable force must be applied and transmitted to the tool at the same time, because, for example, the surgical, endoscopic and/or minimally invasive staples which are known in conjunction with generic application tools from US 2018/0028181 A1 or WO 2018/127659 A1, for example, require a deformation or forming of the staples. In addition to the simple deformation, said staples must penetrate tissue in order to realize the stapling effect, which also requires a certain amount of force, which is preferably performed or provided by the actuation handle connected to the applicator tool or used together with the applicator tool by an operator, in particular by a surgeon. With respect to generic actuation handles, a sufficient force can normally be built up and provided and allows the deformation of the staples and their penetration into the tissue, for example. However, a disadvantage of the known actuation handles is that a relatively high force must be manually applied by the operator, in particular by the surgeon, said force having a negative influence on the achievable precision and the dosage. For example, the actuation handles from the state of the art require a two-handed operation for the application and transmission of the required forces, in particular of the required tractive forces.

Document DE 69033727 T2 teaches a device for applying surgical clips or clamps during laparoscopic or endoscopic procedures. The device comprises a laparoscopic or endoscopic section and a handle and actuating element connected thereto. The handle and actuating element is used to enable various functions. For example, clamps or clips in the endoscopic or laparoscopic section are to be displaced or pushed forward and further the clamps are also to be deformed or actuated. For this purpose, the handle and actuation element has a mechanism that can perform various movements. Among other things, it is disclosed in Figures 3, 16 and 17, that a spring exerts a preloaded force on a lever arm, which in turn can be actuated by the handle element, so that when the handle element is actuated, the movement of the lever arm and thus the movement of a slide tube is supported.

Prior art document DE 69533960 T2 discloses a surgical cutting forceps in which - as can be seen from Figures 15 and 16 - springs are used at various points to preload individual elements. Wth reference to Figure 26, this document also discloses a gearwheel-rack transmission of movements of a handle to an actuating element movably mounted in the cutting tool.

Against this background, the object of the present invention is to indicate an actuation handle for actuating a surgical, preferably endoscopic and/or minimally invasive, applicator tool which allows a precise and dosed generation and transmission of higher forces, in particular tractive forces, and which simultaneously meets other existing requirements for generic actuation handles, in particular for simple assembly, disassembly and cleaning.

Furthermore, the object of the present invention is to propose an applicator tool by means of which high forces, in particular tractive forces, can be transmitted to a tool on the end side, in particular to a staple tool, in a precise and dosed manner.

With respect to the actuation tool, said object is attained by an actuation handle according to the preamble of claim 1 in which, according to the invention, the positioning element is preloaded by an elastically deformable force storage element, in particular a spring, in such a manner that when the actuation lever is transferred from the preparation position into the application position, the forces transmitted to the positioning element by the force transmission means in operative connection are increased by a relaxation of the force storage element, in particular by a relaxation of the spring.

The basic concept of the present invention is thus based on the idea of a force transmission to the positioning element, in particular in the context of a generally known lever force transmission of an actuation lever to a positioning element, and to support the generated forces, in particular tractive forces, via the rectified forces of a force storage element, which have the same effect, to the positioning element, the total forces of the force transmission means of the actuation lever to the positioning element and the total forces of the force storage element to the positioning element thus providing the required total force, the forces applied via the actuation lever and therefore by the operator himself or manually thus being significantly reducible.

A particular advantage is that the preload or the force storage in the force storage element can be applied or realized at times in which a high precision and exact dosing of the applied forces is not possible. It can therefore be intended that the force storage element can be preloaded or loaded at an uncritical moment; in an activation process, i.e. , when the actuation lever is transferred from the preparation position into an application position, the additional forces stored by the force storage element are thus available and can be used in order to reduce the forces to be necessarily applied to the actuation lever for the activation or actuation of the applicator tool.

Another particular advantage of the actuation handle according to the invention is its simple mechanical structure which can be realized using few parts. This has a particularly positive effect on the assembly and disassembly and the required cleaning or sterilization of the actuation handle before and/or after its use.

Another particularly advantageous effect of the actuation handle according to the invention is that the force storage element can realize a fundamental force or a preload in particular via the elastically deformable force storage element the moment when the preparation position of the actuation lever is reached or at an even earlier time , wherein the fundamental force or preload is of particular interest or can be used in a particularly advantageous manner in the generic applicator tools, such as staple tools. In the known applicator tools, a staple is usually pressed onto an abutment before the tool is actuated or activated in order to ensure the attachment of the staple and/or the positioning of the staple before the staple process. For example, the staple is pressed or pulled against the distal end of a tube element by means of an element which is guided in a movable manner in the tube element and which can have, for example, an attachment device, in particular a hook, on the end side, wherein the edge of the tube element or the distal end of the tube element can be used in conjunction with the hook as an abutment for the deformation of the staple when an additional tractive force is applied, in particular via the actuation handle according to the invention.

Accordingly, the force storage element according to the invention allows the preload or force application of the staple by means of the hook against the distal end of the tube element by the force storage element without another external force or a force generated by a user, in particular onto the actuation lever, particularly preferably in its preparation position in relation to the base body. With respect to the exemplary application of the actuation handle according to the invention in conjunction with an applicator tool realized as a staple tool, reference is made to the basic disclosure of US 2018/0028181 A1 , US 2018/0000482 A1 and WO 2018/127659 A1 , whose content is included by reference in the present disclosure.

The preparation position of the actuation lever is to be understood as the position in which the actuation lever has a large, if not the largest, spread in relation to the base body. The application position is to be understood as the position of the actuation lever in relation to the base body in which a minimal spread or a minimal distance between the actuation lever and the base body is realized. Apart from the position of the positioning element, the security position or starting position of the actuation lever is realized in an identical or similar manner as the application position, namely at a small or minimal distance or a small or minimal spread of the actuation lever from the base body.

According to the invention the positioning element is mounted in the base body so as to be rotatable about a longitudinal axis. This rotatability can have different advantages or can be the basis for different advantages which are described in further detail below. Last but not least, the rotatability of the positioning element about a longitudinal axis allows a general transferability of the rotation movement onto a corresponding applicator tool. In the example of a staple tool, a rotation of a staple in relation to a distal end of a tube element and thus an optimal positioning of the staple can therefore be achieved by a specific rotation of the positioning element in the base body.

Another advantageous embodiment of the actuation handle can intend that, depending on a rotation position of the positioning element, the operative connection of the force transmission means can be established and undone. This embodiment allows different advantages. Firstly, this allows the movement of the actuation lever, for example from a starting position into a preparation position, without the need for a deformation or change of state of the force storage element. At the same time, the assembly and disassembly of the actuation handle can be facilitated in this way. Finally, the advantageous preload described above onto the positioning element can be created or provided by a, for example temporary, undoing of the operative connection of the force transmission means. An addition or alternative to the situation described above can intend that a change of state, in particular a relaxation of the force storage element, can be accompanied by a basic adjustment or partial adjustment of the positioning element in specific situations or in specific rotation positions of the positioning element in relation to the force storage means of the actuation lever.

A, particularly preferred embodiment of the actuation handle can intend that, depending on a rotation position of the positioning element, an operative connection of the force transmission means of the actuation lever can be established and undone by means of a securing means formed on the positioning element, wherein, in said operative connection, the force storage element has a maximal preload and a force is preferably applied to the actuation lever by the positioning element and/or the force storage element in the direction of the idle position. The securing means allows a particularly advantageous preparation or a particularly practical original form of the actuation handle according to the invention before the activation process is started, i.e., before the actuation lever is transferred from a preparation position into an application position. After a maximal force storage process and an associated maximal elastic deformation of the force storage element, for example an operative connection of the force transmission means with the securing means, can be established by the corresponding rotation of the positioning element and can be undone by a corresponding rotation, if required, the deformation or preload of the force storage element, on the one hand, thus being ensured in an existing operative connection with the securing means; on the other hand, however, a force is applied to the actuation lever in the direction of the idle position, a compact shape of the actuation handle thus being achieved in said starting position or idle position. Once the operative connection with the securing means is undone or undone again, a partial relaxation of the force storage element for providing a preload, for example, and/or the transfer of the actuation lever from the idle position into a preparation position can be intended.

Another overall advantage is realized by the embodiments described above which are related to the rotatability or the rotatable mounting of the positioning element in the base body in the broadest sense. Due to the additional forces which are provided or released by the force storage element in the activation process and the associated, in particular one-handed, actuation or activation of the actuation handle by a user, a plurality of other functionalities of the actuation handle can be achieved or realized by a corresponding rotation of the positioning element about a longitudinal axis, wherein the rotation can particularly preferably be caused via a corresponding action onto the positioning element which is realized by a second hand of the user or operator or, if applicable, by the same hand of the user or operator which causes the actuation or activation. The technical, in particular objective, means for influencing, in particular for rotating the positioning element about a longitudinal axis, will be explained in more detail in the context of the following embodiments.

Another, particularly preferred embodiment of the actuation handle can intend that the positioning element protrudes from one end of the base body in any mounting situation and is connected to a rotation device or comprises a rotation device. This ensures that the rotation device allows a rotation of the positioning element, in particular about an axis of rotation extending along the longitudinal axis of the positioning element. Therefore, the actuation of the actuation handle by one hand and the actuation of the rotation device by another hand can be performed. However, the actuation handle can particularly advantageously be designed in such a manner that the actuation handle is operated by the same hand as the rotation device. The actuation handle can particularly preferably be operated by the index finger, ring finger and/or little finger, whereas the rotation device is operated or actuated by the thumb and index finger.

Accordingly, another, particularly preferred embodiment of the actuation handle can intend that the rotation device has two, preferably opposite, gripping surfaces for placing two fingers, preferably thumb and index finger.

The rotation device which has two, preferably opposite, gripping surfaces allows a manual rotation of the rotation device and thus a corresponding rotation of the positioning element. A manual actuation can particularly advantageously provide that the rotation is realized or possible in a continuous manner. This can particularly advantageously be combined with other embodiments of the actuation handle according to the invention in which a rotatable mounting of the positioning element in the base body is generally intended or to be intended, because normally a corresponding continuous rotation in the base body is possible anyway, the rotation device thus being essentially limited to an actuation device or an actuation element.

An alternative, slightly more complex embodiment of the rotation device can intend that said rotation device comprises a thrust rotation mechanism which has an actuation element which transforms a thrust movement in the direction of the longitudinal axis of the positioning element, preferably once a minimal distance or minimal thrust is reached, via a translation means into a predefined rotation which is transmitted to the positioning element. Such thrust rotation mechanisms are generally known from other technological areas. In the distant technological area of writing implements, for example, comparable thrust rotation mechanisms are often used, the realized embodiments realizing the rotation only as a side effect or as a not primarily desired purpose because the normal object of thrust rotation mechanisms in the field of writing implements is to transfer a writing refill or a comparable ink delivery system into two different positions, namely into a writing position and into a protected position. Although the thrust rotation mechanisms generally have a comparable or similar mode of action as in the present invention, the actual object of the thrust rotation mechanism of the present invention is the rotation of the translation means and the rotation of the positioning element about a predefined rotation angle relating thereto or caused thereby. With respect to the general understanding of a generic thrust rotation mechanism, even if said mechanism effects the longitudinal displacement of a refill and causes the rotation of a translation means only as a side effect, reference is made to disclosure US 3 205 863 A. Similar thrust rotation mechanisms are known from the state of the art and can be advantageously used in the present invention, in particular in the actuation handle according to the invention,. Although the user consequently can no longer rotate the positioning element in a continuous manner, this nevertheless facilitates the handling of the actuation handle and therefore of a possible applicator tool as a whole. When the actuation lever is handled or actuated by the little finger, ring finger and/or middle finger and/or index finger, for example, said thrust rotation mechanism can be actuated by the thumb in a simple manner, in particular by the thumb, and a rotation of the positioning element can thus be effected in a comparatively simple and at the same time precise manner. Another, particularly preferred embodiment of the actuation handle can intend that the rotation device comprises a housing which, except for the application position of the actuation lever and/or of the positioning element, is supported on the base body so as to be protected against rotation . In other words, this means that the rotation device requires an abutment, in particular before the transfer of the actuation lever from the preparation position into the application position and the resulting displacement of the positioning element in the base body, so that the thrust or linear movements performed by means of the actuation element can be transformed into corresponding rotations via the translation means and can be transmitted to the positioning element, if applicable. If there is no abutment, the force or torque could not be transmitted from the translation means to the positioning element. By means of a housing which is designed in a corresponding manner and which allows a contact and/or engagement on the base body which is protected against rotation and, at the same time, preferably allows the removal of said contact or engagement, the advantageous rotation of the positioning element can be performed via the rotation device in preparation for an actuation of the actuation handle and the actuation of the actuation lever and the corresponding displacement of the positioning element along the longitudinal direction of the positioning element can be performed at the same time.

This also means that the housing of the rotation device is preferably realized in such a manner that the support means which ensure the protection against rotation on the base body of the actuation handle in the preparation position of the actuation lever and/or of the positioning element, for example, are detached from the base body when the actuation lever is transferred into the application position and are displaced along the longitudinal direction of the positioning element, preferably together with the positioning element and/or the rotation device.

A particularly advantageous embodiment of the actuation handle can intend that the translation means is designed in such a manner that it effects a predefined rotation of the positioning element between 10° and 40°, preferably between 20° and 30°, particularly preferably of 20°, during any actuation of the rotation device, in particular of the actuation element — provided a minimal distance or minimal lift is reached.

The corresponding design of the translation means can be adapted without any problems in such a manner that up to 36 or even up to 40 individual rotation positions can be taken by means of the translation means. With respect to the sometimes very small rotation angles of up to 10°, this allows for a quasi- continuous rotation of the positioning element. The advantages of a continuous displaceability of the positioning element with respect to the rotation about a longitudinal axis are thus combined with the advantages of a thrust rotation mechanism. Wth respect to a corresponding realization of the translation means to achieve small rotation angles of approximately 10° to 15° or up to 20°, this means that a very precise, though no longer continuous, rotation of the positioning element is still possible, while at the same time using the advantageous operation, in particular the advantageous one-finger operation, of a thrust rotation mechanism.

An advantageous embodiment of the actuation handle according to the invention can intend that the force transmission means of the actuation lever are designed as a gearwheel, in particular as a gearwheel section. Such force transmission means can be produced particularly advantageously while having particularly advantageous properties with respect to assembly, disassembly and the possibility of cleaning.

Another particularly advantageous embodiment can intend that the positioning element is designed as a, preferably circular, rack, wherein the teeth of the rack realize the force transmission means of the positioning element. The teeth advantageously extend over the entire circumference in the circumferential direction of the positioning element. In specific areas or sections of the positioning element, the teeth can be flattened or overall recessed in the circumferential direction in specific angle ranges. Said areas can particularly advantageously be used in order to separate the engagement between the force transmission means of the actuation lever on the one hand and the positioning element on the other hand or to undo the engagement of the force transmission means depending on the rotation position of the positioning element.

With respect to an applicator tool, in particular a surgical, preferably endoscopic and/or minimally invasive staple tool, comprising a tube element and an element guided in a movable manner in the tube element, the object mentioned above is attained by using an actuation handle according to any one of the aforementioned embodiments, the movable element being connected to the positioning element of the actuation handle, in particular so as to transmit rotations or at least so as to transmit tractions, in such a manner that movements along the longitudinal axis of the positioning element and/or rotations about the longitudinal axis of the positioning element are transmitted to the movable element.

It is therefore possible to use the applicator tool according to the invention in a particularly effective manner, for example even in one-handed operation, and to control the use. The activation or actuation can be performed using comparatively little force because the force storage element provides a corresponding force in addition to the actuation. At the same time, depending on the embodiment of the actuation handle, a very precise rotation setting of the positioning element and therefore of the element guided in a movable manner in the tube element and therefore in relation to the tube element can be provided. For example, an optimal rotation orientation of a staple can be achieved before the staple is deformed.

It should be stressed here that the use of the applicator tool according to the invention is not limited to only a staple tool. On the contrary, different applicator tools are conceivable in which large or larger forces are required or have to be applied in the course of the actuation of the corresponding tool and the tool or parts of the tool have to be preloaded, if required.

A first advantageous embodiment of the applicator tool can intend that the connection between the movable element and the positioning element is realized on an end of the positioning element opposite the rotation device. Firstly, this allows the establishment of a particularly simple connection between the positioning element and the movable element. At the same time, the connection can be dissolved or undone in a correspondingly simple manner to disassemble the applicator tool for cleaning purposes, for example.

Another, particularly preferred embodiment of the applicator tool can intend that the movable element has a hook, preferably a hook which is elastically deformable when a force is applied, on an end opposite the connection to the positioning element, in particular on a distal end in the area of the distal end of the tube element. The movable element thus allows the transfer of staples into a preparation position, a subsequent deformation of the staples, the realization of an engagement of the staples and tissue or layers of tissue and then a removal of the staples from the hook and therefore from the applicator tool, while still allowing a reuse of the hook for a new staple process.

Another advantageous embodiment of the applicator tool according to the invention can intend that the force storage element is dimensioned and preloaded in the preparation position in such a manner that a force is applied to a staple element, which is disposed on the distal end, in particular on a hook, of the movable element, on a distal element of the tube element, in particular in a corresponding accommodation contour, wherein in particular a protection against rotation of the staple element in relation to the tube element and/or to the movable element is achieved without deforming the staple element.

This can have different advantageous effects. Firstly, this allows the performance of manipulation actions on a tissue, for example, by means of the staple element before the handle and/or applicator tool is activated or actuated because the force application and/or protection against rotation allows a corresponding force transmission to the staple element. At the same time, the staple element is thus secured on the applicator tool so not to be lost. Additionally, the abutment of the staple element at the distal end of the tube element can effect or cause an equilibrium of the force storage element in which a further relaxation of the force storage element is excluded by the deformation resistance of the staple element. Said embodiment can therefore also be used in order to secure the preparation position of the handle or to keep it stable without the need of providing additional restraint means on the part of the handle which counteract a further relaxation of the force storage element.

The present invention is explained below on the basis of purely schematic drawings of exemplary embodiments.

In the drawings,

Figs. 1a, b show a schematic perspective view and a sectional view of an actuation handle according to the invention in a first position of the positioning element/actuation lever;

Figs. 2a, b show a schematic perspective view and a sectional view of an actuation handle according to the invention in a second position of the positioning element/actuation lever;

Figs. 3a, b show a schematic perspective view and a sectional view of an actuation handle according to the invention in a third position of the positioning element/actuation lever;

Figs. 4a, b show a schematic perspective view and a sectional view of an actuation handle according to the invention in a fourth position of the positioning element/actuation lever; Figs. 5a, b show a schematic perspective view and a sectional view of an actuation handle according to the invention in a fifth position of the positioning element/actuation lever;

Figs. 6a, b show a schematic perspective view and a sectional view of an actuation handle according to the invention in a sixth position of the positioning element/actuation lever; Figs. 7a-c show a schematic view of an actuation handle according to the invention according to a second embodiment including an enlarged view/sectional view of the rotation device; Fig. 8 shows a schematic view of an actuation handle according to the second embodiment (Fig. 6) in a second position of the actuation handle/positioning element;

Fig. 9 shows a schematic view of a distal end of an applicator tool according to the invention.

Fig. 1 shows an actuation handle 01 according to the invention which has a base body 02 and an actuation lever 03. A positioning element 04 is mounted in base body 02 so as to be displaceable in longitudinal direction L of positioning element 04. Positioning element 04 has force transmission means 05 which are realized as radial projections or teeth and rings, if applicable, on the otherwise essentially cylindrical surface of positioning element 04.

Actuation lever 03 also has force transmission means 05 which can be realized as a gearwheel section 06, for example. On an end which protrudes from base body 02, positioning element 04 merges into a rotation device 07 which has two opposite gripping surfaces 08 by means of which rotation device 07 can be actuated, preferably by means of a thumb and an index finger, and a rotation of positioning element 04 about a longitudinal axis L or longitudinal center axis can be caused by the frictional connection with positioning element 04.

Furthermore, actuation handle 01 comprises an elastically deformable force storage element 09 which is provided according to the invention and which is disposed on an end of positioning element 04 opposite rotation device 07. With respect to elastically deformable force storage element 09 which can be realized as a spring, for example, Fig. 1a and Fig. 1b already show that when actuation lever 03 is actuated in a corresponding manner and force transmission means 05 interact, force storage element 09 is designed in such a manner that the forces transmitted to the positioning element by the operative connection between force transmission means 05 are increased by a relaxation of force storage element 09 and therefore support a corresponding longitudinal displacement or movement of positioning element 04 in longitudinal direction L or reduce the corresponding force applied on the actuation lever.

The representation of Fig. 1b shows that force transmission means 05 of actuation lever 03 establish an operative connection with a securing means 11 formed on positioning element 04, the force storage element thus having a maximum preload and a force being applied to actuation lever 03 by positioning element 04 and/or force storage element 09 in the direction of idle position shown in Fig. 1a and Fig. 1b. The operative connection between force transmission means 05 of actuation lever 03 and securing means 11 of positioning element 04 can be established or undone by a rotation of positioning element 04, preferably caused by rotation device 07.

In the representation of Fig. 1, a movable element of an applicator tool guided into base body 02 through an opening 12, for example, can be dimensioned or designed in such a manner in relation to a tube element enclosing the movable element that a staple is partially or entirely led out of the tube element; however, a rotation of the staple has not taken place yet and a clamping contact of the staple with the tube element has not been provided yet either. The movable element which is inserted into base body 02 through opening 12 can preferably be fixed or connected to a recess or opening 13 of the positioning element, tractions, in particular in longitudinal direction L of positioning element 04, and rotations about longitudinal direction L of positioning element 04 thus being transmitted to the movable element (not shown).

Figs. 2a and 2b show a situation in which a preload effect of positioning element 04 is caused or has been caused, in particular without significant change of position of actuation lever 03. To this end, a temporary undoing or dissolution of the engagement or the operative connection between securing means 11 and force transmission means 05 of actuation lever 03 by a rotation of rotation device 07 can be provided, in particular in the transition between the representations of Fig. 1 and the representations of Fig. 2, a specific, slight movement of positioning element 04 thus being created by a relaxation of preloaded force storage element 09. For example, said movement can in turn be limited by force transmission means 05 of actuation lever 03 which, as shown in Fig. 2b, stop or prevent an additional movement or displacement of positioning element 04 by a partial engagement with force transmission means 05 of positioning element 04 in the position of positioning element 04 of Fig. 2b.

In the representations of Figs. 3a and 3b, actuation lever 03 of actuation handle 01 has been transferred into a preparation position spread apart from base body 02 without an additional displacement of the positioning element or a relaxation of force storage element 09. To this end, a rotation of rotation device 07 can undo the engagement between force transmission means 05 of positioning element 04 and force transmission means 05 of actuation lever 03 or can undo the corresponding operative connection; at the same time, however, other mechanical impeding means are provided which prevent a further relaxation of force storage element 09 and therefore a further displacement of positioning element 04. This can be realized by corresponding projections in base body 02, for example, in combination with the corresponding design of force transmission means 05 of positioning element 04.

Overall, the representations of Figs. 3a and 3b show that there is no further relaxation of elastically deformable force storage element 09 in relation to the representation of Figs. 2a and 2b and that positioning element 04 including rotation device 08 has the same longitudinal position as in Figs. 2a and 2b.

As an alternative to means and device elements of the handle itself, external means of the handle, such as an applicator tool, can secure the state of the force storage means in the state of Figs. 3a, 3b. For example, an equilibrium of the force storage means can be achieved in that a force is applied to a staple element, which is disposed on a distal end, in particular on a hook, of a movable element, on a distal end of a tube element, in particular in a corresponding accommodation contour, of an applicator tool, wherein, in particular, a protection against rotation of the staple in relation to the tube element and/or to the movable element is achieved without deforming the staple. The securing or the stabilization of the force storage means in the preparation position can thus be achieved without the need to provide means of the handle. Details of this design are also apparent from Fig. 9 and the corresponding description.

Figs. 4a, 4b show the first transfer of actuation lever 03 into the application position and the corresponding displacement and transfer of positioning element 04 including rotation device 07 while force storage means 09 is relaxed. The thus released forces can be transmitted to a tool via a movable element. Said representations essentially show that a linear displacement or shift of positioning element 04 is caused in conjunction with the actuation of actuation lever 03 and an existing operative connection between force transmission means 05, wherein said linear displacement or shift is correspondingly transferred to a displacement of the movable element of the applicator tool, wherein the movement or the forces to be applied therefor to actuation lever 03 are supported by further relaxation of elastically deformable force storage element 09.

This means that, starting from Fig. 3 up to Fig. 4, a further relaxation of force storage means 09 takes place which ensures that correspondingly large forces act or can act onto positioning element 04, even if comparatively low forces are applied to actuation lever 03 by a one-handed operation of the actuation handle according to the invention, for example.

In figures 5a, 5b, a subsequent intermediate position of actuation handle 01 and actuation lever 03 is shown. In this position, actuation lever 03 is slightly spread apart from base body 02 again; this can be achieved by another detachment and engagement of force transmission means 05. Meanwhile, the position of positioning element 04 and the state of force storage means 09 can be secured by other restraint means which, depending on the rotation position of positioning element 04, temporarily interact with force transmission means 05 of positioning element 04, for example. Starting from said position of actuation lever 03, another displacement of the positioning element can be caused, for example until force storage means 09 is completely relaxed and even a spatial separation between force storage means 09 and positioning element 04 is achieved, as shown in Figs. 6a and 6b. Of course, the force for further displacement of positioning element 04 must be provided exclusively by the actuation lever after the complete relaxation of force storage element 09. This suggests, however, that the idea according to the invention comprises an at least temporary, preferably initial, support of the displacement of positioning element 04 by using the additional force application of force storage element 09.

Fig. 7a shows an actuation handle 01 according to the invention in a second embodiment. In the second embodiment, rotation device 07 comprises a thrust rotation device or thrust rotation mechanism 18 which is shown in the view of Fig. 7b and in the sectional view of Fig. 7c and in which a thrust or longitudinal movement of an actuation element is transferred into a predefined rotation of positioning element 04 via a translation means 15, preferably once a minimal distance or minimal lift is achieved. Rotation device 07 comprises a housing 16.

Housing 16 comprises anti-rotation means 17 which are shown in Fig. 8 and which allow or establish a protection against rotation of housing 16 on base body 02 before and/or during the actuation of actuation lever 03 and, at the same time, allow a sliding out of rotation device 07 from base element 02 in conjunction with positioning element 04 in the course of the actuation whilst abandoning the protection against rotation, if required. As shown in Fig. 8, for example, anti-rotation means 17 can be designed as engagement means having a profile on the outside and/or on the inside, the profiling extending perpendicular to longitudinal direction L or in the circumferential direction in such a manner that a protection against rotation of housing 16 is ensured as long as anti-rotation means 17 are in operative connection with surfaces of base body 02 which have a corresponding complementary profiling and the protection against rotation is then abandoned when positioning element 04 moves out of base body 02, if an operative connection of anti-rotation means 17 with surfaces of base body 02 which have a corresponding complementary profiling is no longer guaranteed.

According to Figs. 7 and 8, rotation device 07 can be realized via the design of translation means 15 in such an manner, for example, that a rotation of positioning element 04 by 10° to 40°, preferably by 20° to 30°, particularly preferably by 20°, is caused per actuation of actuation element 14. Fig. 9 shows a section of an applicator tool 23, namely distal end 20 of a tube element 19 and therefore the end of tool 23 facing away from the handle. Fig. 9 also shows a staple element 21 which is held centrally by a hook 22 of a movable element (not shown in detail). The movable element and therefore hook 22 are preloaded by the force storage element of the handle, a force thus being applied to staple element 21 against distal end 20 of the tube element. The abutment of staple element 21 on distal end 20 of tube element 19 and the deformation resistance of staple element 21 ensure that the force storage element is held in equilibrium via the movable element, for example in the preparation position of the handle or of the actuation lever. At the same time, a protection against rotation of staple element 21 in relation to tube element 19 and/or to the movable element is guaranteed by the pressing or the force application of staple element 21 against end 20 of tube element 19, and staple element 21 can thus be used at this point in order to realize tissue manipulations, for example.

Reference signs

01 actuation handle

02 base body 03 actuation lever

04 positioning element 05 force transmission means 06 gearwheel section 07 rotation device 08 gripping surfaces 09 force storage element 11 securing means 12 opening 13 recess/opening of the positioning element 14 actuation element

15 translation means

16 housing

17 anti-rotation means

18 thrust rotation device 19 tube element

20 distal end of the tube element 21 staple element 22 hook 23 applicator tool

L longitudinal direction