DE29717110U1 - Device for inserting a stent, a drainage tube or the like. in hollow organs - Google Patents

Description

Optimed Medical ■ O 2401-Dt/Ru

Instruments GmbH 24 September 1997

DEVICE FOR INSERTING A STENT, A DRAINAGE TUBE OR THE LIKE INTO HOLLOW ORGANS

The present invention relates to a device for introducing a stent, a drainage tube or the like into hollow organs, in particular into blood vessels, ureters, esophagi or bile ducts, with an elongated guide element for receiving the object to be introduced.

Devices of this type, which are also referred to as delivery catheters, include, for example, a tubular inner catheter, onto the proximal end of which the stent to be introduced can be pushed. A tubular sliding element is pushed onto the distal end of the inner catheter until its proximal end rests against the distal end of the stent. The stent is then inserted together with the inner catheter and the sliding element into the desired hollow organ until the stent is in the desired position.

To deploy the stent, the distal ends of the sliding element and the inner catheter protruding from the patient's body are pushed against each other so that the stent is pushed off the inner catheter by the sliding element.

The problem is that this relative displacement can occur by pulling back the inner catheter, by pushing the sliding element forwards, or by a combination of these two movements. However, a forward movement of the sliding element leads to a position

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change in the function of the stent arranged inside the hollow organ, so that it is moved away from its desired position when it is deployed.

Another problem is that both hands are needed to place the stent in order to be able to move the sliding element and the inner catheter relative to one another. This means that the person operating the catheter cannot carry out any other activities, such as injecting medication or operating monitoring devices, while the stent is being placed.

One object of the invention is to design a device of the type mentioned at the beginning in such a way that a secure positioning of the object to be inserted at a desired location within a hollow organ is possible. The device should be as easy to operate as possible so that operating errors during positioning are practically impossible.

Starting from a device of the type mentioned at the outset, this object is achieved in that a handle is provided in a region of the guide element facing away from the proximal end of the guide element, that an actuating element is arranged on the handle and that the guide element can be displaced relative to the handle along its longitudinal axis via the actuating element.

The fact that an actuating element is provided on the handle, via which the guide element can be moved relative to the handle, ensures that the guide element is always pulled back to set down the object to be inserted, and not the support element pushed forward. As a result, the object inserted into the desired location remains in this position even when it is set down, so that a

unwanted displacement within the hollow organ does not occur. By designing the actuating element directly on the handle, the device can be designed in such a way that the actuating element can be operated by the same hand that is used to hold the handle, so that one-handed operation is possible.

According to a preferred embodiment of the invention, the guide element is designed as a guide tube forming a lock into which the object to be inserted can be inserted. By using a guide tube that encloses the object to be inserted during insertion, the part of the device to be inserted into the hollow organ has a self-contained, smooth surface. This largely prevents irritation of the inner walls of the hollow organ when the lock is inserted.

The design of the guide element as a guide tube is particularly advantageous for self-expanding stents, as these expand automatically due to their tendency to expand at body temperature. By inserting these stents into the guide tube, the stents are prevented from expanding during insertion, as the stents rest against the inside of the guide tube and are prevented from expanding by this. The stent is only released when the guide tube is pulled back using the actuating element on the handle, so that it expands into the expanded state due to the ambient temperature.

Preferably, a support element is provided within the lock, by means of which the object to be inserted can be supported in the direction of the handle. The support element prevents the object to be inserted from being pushed through the gap between the inside of the guide tube and the outside of the object to be inserted when the guide tube is pulled back.

The fact that the support element cannot be moved in the direction of the handle ensures that the support element is not also pulled back when the guide tube is pulled back, but is fixed in an unchanged position relative to the handle. If the handle is not moved when the actuating element is operated, the support element and thus also the object supported by the support element are not moved from their position, so that when the guide tube is pulled back, the object to be inserted is placed exactly in its desired position.

According to a further advantageous embodiment of the invention, the guide element is designed as a guide tube forming an inner catheter, onto which the object to be inserted can be pushed. In this embodiment, the object to be inserted is not located inside a guide tube, but on the surface of a guide tube, via which it can be inserted into the hollow organ. The immovability of the object relative to the guide tube during the insertion process can be ensured by friction or special fixing elements.

Advantageously, a support element is provided on the outside of the inner catheter, in particular pushed onto the inner catheter, by means of which the object to be inserted can be supported in the direction of the handle. In this case too, the immovability of the support element in the direction of the handle ensures that when the object to be inserted is set down, it remains in its desired position as long as the handle is not moved from its position when the inner catheter is withdrawn.

According to a further advantageous embodiment of the invention, a coupling element is provided on or in the handle, which is fixed to the guide element at least in the longitudinal direction and is connected to the actuating element in a force-locking manner, so that the guide element can be moved along its longitudinal axis by means of the actuating element. By providing a coupling element between the actuating element and the guide element, the control of the movement of the guide element via the actuating element can be set in many ways. The coupling element and the guide element can thus advantageously be designed to be separable from one another, so that different guide elements, for example specially adapted to the object to be inserted, can each be used with the same handle that includes the coupling element. Furthermore, the type of actuation of the actuating element, for example pressing, pushing or turning, can be converted into the required linear movement of the guide element via the coupling element.

Preferably, the coupling element is connected to the actuating element via a gear. The gear can have a high gear ratio, so that on the one hand the transmission of large forces to the guide element and on the other hand a very fine displacement of the guide element is possible.

According to a further preferred embodiment, the coupling element is connected to a toothed belt or a rack, which is in engagement with a gear that can be driven by the actuating element, another toothed belt or another rack. By using a gear-controlled connection between the coupling element and the actuating element, a very simple and safe construction of the device according to the invention is possible.

The coupling element is preferably connected to a toothed belt, since the handle containing the toothed belt can thus be designed with particularly small dimensions.

According to a further preferred embodiment of the invention, the actuating element is rotatably mounted on the handle, whereby the guide element can be displaced by turning the actuating element. The actuating element is preferably designed as a rotatable actuating wheel, the axis of rotation of which also forms the axis of rotation for the gear wheel. In this embodiment, the guide element can be displaced by simply turning the actuating wheel, so that the object to be inserted is set down by turning the actuating wheel.

Preferably, the peripheral outer surface of the actuating wheel is designed as an engagement surface with a rough surface, which in particular has a grooved surface structure. This ensures that the actuating wheel can be turned safely even if the fingers of the person operating the wheel are relatively slippery, for example due to sweat or blood.

According to a further advantageous embodiment of the invention, the contact surface of the actuating wheel protrudes at least over one side of the handle. In particular, the actuating element is arranged on the handle in such a way that it is possible to hold the handle and actuate the actuating element with one hand. This makes it possible to operate the device designed according to the invention with one hand, so that the person operating the device can use the other hand to carry out other activities required while setting down the object to be inserted. The actuating element can be arranged on the side of the handle, for example.

so that when you grasp the handle it lies in the area between your thumb and index finger or between your thumb and middle finger.

According to a further preferred embodiment, the actuating element can be fixed using a securing element, in particular a securing pin, in order to prevent inadvertent adjustment of the actuating element. If the actuating element is secured by the securing element during insertion, for example, the guide element is secured against displacement relative to the handle during the insertion process. Only when the object to be inserted has reached the desired position is the securing element released, so that the guide element can be pulled back over the actuating element and the inserted object can be released.

According to a further preferred embodiment of the invention, connection elements for supplying medication, contrast agents or the like are provided on the handle, which are connected to the cavity formed inside the guide element. In this case, a connection element can preferably be formed on the coupling element and/or a connection element in the region of the distal end of the handle.

According to a further advantageous embodiment of the invention, the handle has an elongated opening through which at least a part of the coupling element protrudes and in which the coupling element can be displaced when the guide element is displaced. In this way, on the one hand, the connecting element formed on the coupling element can protrude unhindered from the handle, so that a connecting cable can be attached very easily. On the other hand, the position of the guide element can be determined via the position of the part of the coupling element protruding from the handle.

can be read. This means that the release of the object to be inserted can be easily tracked via the position of the coupling element.

In principle, it is also possible for the coupling element not to extend out of the handle through the opening, but to be located completely inside the handle and only visible from the outside through the opening. The opening can be covered by a transparent element, such as a transparent plastic plate, so that the inside of the handle is protected against contamination from the outside.

Further advantageous embodiments are specified in the subclaims.

The invention is described in more detail below using an embodiment with reference to the drawings. In these:

Fig. 1 shows a greatly enlarged cross-section through a proximal part of a guide tube with inner catheter and guide wire, as can be used with a device designed according to the invention ,

Fig. 2 shows a cross section through a device designed according to the invention,

Fig. 3 shows a cross section through a second embodiment of a device designed according to the invention,

Fig. 4 is a side view of a device designed according to the invention according to Figs. 2 and 3,

Fig. 5 is a cross-section through another preferred embodiment of the invention,

Fig. 6 is a side view of the embodiment according to Fig. 5,

Fig. 7 is a plan view of the embodiment according to Fig. 5,

Fig. 8 is another side view of the embodiment according to Fig. 5,

Fig. 9 is a partial sectional view of another guide tube for a device designed according to the invention and

Fig. 10 is a detailed view of Fig. 9.

In Fig. 1, a tubular stent 1 is pushed onto the proximal end of an inner catheter 2, which is also tubular. On both sides of the stent 1, a ring 3 made of radiopaque material, such as platinum, is pushed onto it, of which the distal ring 3 rests on the proximal end of a tubular support element 4, which is also pushed onto the inner catheter 2.

At the proximal end of the inner catheter 2, a conically tapered closure element 5 with a rounded tip is provided. Both the closure element 5 and the inner catheter 2 have a cavity 6 in their interior, in which a guide wire 7 is inserted. The proximal end of the guide wire 7 protrudes beyond the proximal end of the closure element 5 through an outlet opening 6' of the cavity 6 provided in the tip of the closure element 5.

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The stent 1, the rings 3 and the support element 4 have essentially the same inner diameter, which essentially corresponds to the outer diameter of the inner catheter 2, so that they are held in the longitudinal direction by the friction occurring between the inner catheter 2 and the stent 1, rings 3 and support element 4 pushed onto it.

The outer diameters of the stent 1, the ring 3 and the support element 4 are also essentially the same size and correspond to the inner diameter of a tubular guide element 8 designed as a lock, which is pushed over the inner catheter 2 in such a way that the support element 4 and the distally located ring 3 are completely enclosed by the guide element 8, as are the stent 1 in some areas.

Both the inner catheter 2 and the guide wire 7 as well as the guide element 8 are made of flexible and in particular biocompatible material. The stent 1 is also made of flexible material and can, for example, be designed to be convertible from the state shown in Fig. 1 into a state with an enlarged diameter. In this way, the stent 1 can be inserted into the corresponding hollow organ in the compressed state shown in Fig. 1, whereupon it is expanded into the expanded state after reaching the desired position in order to take on the desired support function for the hollow organ in this state. The expansion can, for example, take place by balloon insufflation or by self-expansion if the stent is made of a memory metal, such as a nickel-titanium compound.

In Fig. 2, the distal end of the guide element 8 is inserted through a bushing 9 into a handle 10 of a device designed according to the invention.

The handle 10 consists of two half-shells 11, one of which is removed in the illustration shown in Fig. 2, so that only one half-shell 11 can be seen.

The distal end 12 of the guide element 8 is connected to a coupling element 13 arranged within the handle 10, so that the cavity 6 formed in the inner catheter 2 (see Fig. 1) is connected to a cavity 14 passing through the coupling element 13.

A seal 15 and a plug 16 are inserted into the opposite end of the cavity 14, which is provided at the proximal end of a cannula tube 17. The cannula tube 17 extends through the interior of the handle 10 and exits from the latter through an opening 18 provided at the distal end of the handle 10. An injection sleeve 19 is provided at the distal end of the cannula tube 17, which in the arrangement shown in Fig. 2 partially protrudes through the opening 18 into the handle 10.

The coupling element 13 is attached with its underside to an endless toothed belt 20, which can be driven by a gear 21 and is guided over two deflection rollers 22, 23. Furthermore, the section 24 at the bottom in Fig. 2 is guided between the gear 21 and a pressure roller 25, so that the toothed belt 20 is securely driven by the gear 21 through two contact points. The toothed belt 20 is in engagement with the gear 21 via teeth 30 formed on its inside and can be moved along an arrow 31 by rotating the gear 21. The gear 21 can be rotated about a rotation axis 32, which with its two

ends are mounted on the inner sides of the half shells 11 of the housing 10.

Basically, the coupling element 13 can be moved alternately in opposite directions by turning the gear 21 clockwise or counterclockwise along the arrow 31. In the arrangement of the coupling element 13 in its proximal end position shown in Figure 2, the gear 21 can only be turned in the direction of an arrow 3 9.

On the top of the coupling element 13, a connection element 26 is formed in the form of an injection sleeve, which protrudes into the area outside the handle 10 through an elongated opening 27 provided in the housing of the handle 10. Furthermore, a marking 28 is provided on the top of the coupling element 13, which also protrudes through the opening 27. A marking 8' is also provided on the distal end of the guide element 8 located outside the handle 10.

The embodiment shown in Fig. 3 differs from the embodiment according to Fig. 2 only in that a rack 29 is provided instead of the toothed belt 20. The coupling element 13 is attached to the top of the rack, which interacts with the gear 21 via the teeth 30 provided on its underside. The rack 29 is guided by means not shown inside the handle 10 so that it can be moved along the arrow 31.

Fig. 4 shows the device according to Fig. 2, in which the second half-shell 11 has been placed on the first half-shell 11 according to Fig. 2 to complete the handle 10. On the outside of the second half-shell 11 there is an actuating wheel 33

which can be rotated about an axis 34. The axis coincides with the axis of rotation 32 of the gear 21.

On the outer circumference of the actuating wheel 33, V-shaped notches 35 are formed, running parallel to the axis of rotation 34, so that the surface of the outer circumference of the actuating wheel 33 has a grooved structure: The actuating wheel 33 is dimensioned such that its outer circumference with the grooved structure protrudes slightly over the top and bottom of the handle 10.

An elongated recess 36 is formed in the actuating wheel 33, in which a locking pin 37 is arranged so that it can move. The recess 36 is covered by a locking label 38 shown in dashed lines, so that it is not possible to move the locking pin 37 without removing the locking label 38. While the actuating wheel 33 can basically be rotated both clockwise and anti-clockwise, in the setting shown in the figures of the device designed according to the invention, in which the coupling element 13 is in its proximal stop position, the actuating wheel 33 can only be rotated clockwise, as indicated by the arrow 39.

The functionality of a trained device is described in more detail below:

After the guide wire 7 has been introduced into the desired hollow organ in the usual way in a first step, the inner catheter 2 with its closure element 5 is placed on the distal end of the guide wire 7 protruding from the hollow organ together with the rings 3 shown in Fig. 1, pushed onto the inner catheter, the stent 1, the support element

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element 4 and the sheath 8 are threaded onto the guide wire 7, as shown in Fig. 1.

The coupling element 13 is in its proximal stop position, as shown in Fig. 2 to 4. Furthermore, the actuating wheel 33 is fixed against rotation by the locking pin 37, so that the sheath 8 is prevented from being pushed back when it is inserted into the hollow organ.

In the next step, the inner catheter 2 together with the stent 1, the rings 3, the support element 4 and the sheath 8 is inserted into the hollow organ via the guide wire 7 until the stent 1 reaches the desired position. The achievement of this position is observed via an X-ray screen based on the position of the radiopaque platinum rings 3.

Once the stent 1 has reached the desired position, the security label 38 is removed from the actuating wheel 33 and the security pin 37 is moved downwards from its position shown in Fig. 4. This movement removes the rotation lock of the actuating wheel 33 so that the actuating wheel 33 can be turned in the direction of arrow 39. In order to turn the actuating wheel 33, the handle 10 is grasped with one hand so that the thumb rests on the grooved outer peripheral side of the actuating wheel 33 that protrudes beyond the top of the handle 10 and the middle or index finger rests on the grooved outer peripheral side of the actuating wheel 33 that protrudes beyond the bottom of the handle 10.

In this way, by simultaneously holding the handle 10 and turning the actuating wheel 33 with one hand, the gear 21 can be rotated about its axis of rotation 32 in the direction of the

Arrow 3 9 can be twisted. This twisting is transferred to the toothed belt 20 or the toothed rack 29, so that the coupling element 13 connected to the toothed belt 20 or the toothed rack 29 is displaced in the direction of the distal end of the handle 10. At the same time as the coupling element 13 is displaced, the sheath 8 connected to the coupling element 13 is retracted in the direction of the distal end of the handle 10, whereby the stent 1 is released from the sheath through the proximal end of the sheath 8. Retraction of the stent 1 together with the sheath 8 is prevented by the distal end of the stent 1 resting against the proximal end of the support element 4 via the distally arranged ring 3.

If stent 1 is a stent made of memory metal, after being released by the guide element, it expands to its expanded state due to the ambient temperature in the hollow organ and adheres to the inside of the hollow organ to be supported.

In this expanded state, the diameter of the stent 1 is so large that in a subsequent step the inner catheter 2 together with the rings 3, the support element 4, the sheath 8 and the guide wire 7 can be pulled out of the hollow organ without changing the position of the inserted stent I.

If the stent 1 is not a stent made of memory metal, it can be brought into its expanded state in the usual way, for example by balloon insufflation, after being released through the lock 8.

Through the one-handed operation of the device designed according to the invention, in which the retraction of the lock 8 via the operating wheel 33 and the holding of the handle 10 with a

and the same hand, it is guaranteed that the position of the stent 1 achieved by observation on the X-ray screen is not changed when the sheath 8 is withdrawn. The one-handed operation prevents the support element 4 from being displaced in the proximal direction instead of the sheath 8 being withdrawn in the distal direction, which would change the desired position of the stent I. As long as the handle 10, against which the support element 4 is supported in the distal direction, is not displaced when the actuating wheel 33 is turned, the position of the inserted stent is maintained even when it is released by simply withdrawing the sheath 8 in the distal direction.

Cannulas can be connected to the injection sockets 19 and 26, through which medications or other liquids can be injected into the hollow organ via the cavity 6 formed in the inner catheter 2 during the insertion and release process. Since the maximum displacement path of the guide element 8 in the embodiment according to Fig. 2 depends essentially on the length of the toothed belt 20, the dimensions of the handle 10 can be kept very small. Thus, the length of the handle 10 can be 16 to 20 cm with a maximum displacement path of the guide element of approx. 15 cm.

20 cm.

Furthermore, the half-shells 11 of the handle 10 and the mechanism arranged in the handle 10 can be designed very easily in such a way that the actuating element 33 can be attached to either one or the other half-shell 11. This allows the device to be easily converted from right-handed to left-handed operation. Essentially, all that is required is the rotation axis 32 of the gear wheel

21 must be accessible from both half-shell outer sides to enable the actuating element 33 to be attached.

In the embodiment of a device designed according to the invention shown in Figs. 5 to 8, components that have already been described for Figs. 1 to 4 are designated with the same reference numerals as in Figs. 1 to 4.

In this embodiment, the actuating wheel 33 is arranged at the proximal end of the housing 40 formed by the half-shells 11. The toothed belt 20 is driven directly by the proximal deflection roller 22 designed as a gear, wherein the rotation axis 34 of the actuating wheel 33 coincides with the rotation axis 32 of the deflection roller 22.

The length of the housing 40 is only slightly greater than the longitudinal extent of the toothed belt 20, so that a particularly compact design is achieved. The coupling element 13 is connected to the housing 40 via a locking pin 41, so that a longitudinal displacement of the coupling element relative to the housing 40 is prevented as long as the locking pin 41 is not removed, the locking pin 41 extending beyond the top of the housing 40 for easy removal.

The coupling element 13 is shown both in its forwardmost position and in dashed lines in its fully retracted position 13'.

The part of the sheath 8 emerging from the proximal end of the housing 40 is surrounded by a sheath 43 having markings 42, which can be glued to the sheath 8, for example. The total length of the markings 42 preferably corresponds to the length of the stent 1 to be inserted, so that when the stent 1 is removed, the visible markings can be used to determine how far the stent has already emerged from the proximal end of the sheath 8.

is. In principle, the markings 42 can also be attached directly to the lock 8. The separate cover 43, however, has the advantage that, depending on the stent 1 used, the total length of the markings 42 can be individually adapted to the stent length. In particular, the critical moment at which the stent 1 half emerges from the lock 8 can be determined precisely using the markings 42. While from this point onwards it is no longer possible to pull the stent 1 back into the lock 8, the stent 1 can be pulled back into the lock 8 at any time beforehand using a device designed according to the invention.

The slim and compact design of this preferred embodiment can be seen particularly well from Figs. 6 to 8.

From Fig. 9 and in particular from the detailed view A of Fig. 9 shown in Fig. 10, it can be seen that the cannula tube 17 and the lock 8 are telescoped into one another. The proximal end 44 of the cannula tube 17 extends through the cavity 14 formed in the coupling element 13 into the distal end 12 of the lock 8 and rests against the distal end face of the support element 4.

Between the outside of the support element 4 and the inside of the lock 8, an annular cavity 46 is formed, which is connected to the interior of the support element 4 via lateral openings 45 provided in the distal end area of the support element 4. To vent the lock 8, before the lock is introduced into the patient's body, liquid is injected into the interior of the cannula tube 17 via the injection sleeve 19, which flows out of the proximal end of the cannula tube 17 and into the interior of the support element 4 until it exits from the outlet opening 6 ¹ (Fig. 1). At the same time, part of the injected liquid enters the cavity 46 through the openings 45, so that

this area located within the lock 8 is also completely vented. In addition, the liquid arranged in the cavity 46 creates a type of lubricating film between the lock 8 and the support element 4, which makes it easier to retract the lock 8.

Of course, the lock 8 and the cannula tube 17 shown in Figs. 9 and 10 can be used not only in the device shown in Figs. 5 to 8, but in any device designed according to the invention, for example according to Figs. 2 and 3.

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O 2401 - Dt/Ve

LIST OF REFERENCE SYMBOLS

1 Stents 2 Inner catheter 3 ring 4 Support element 5 Conclusion 6 cavity 6' Outlet opening 7 Guide wire 8th Guide element (lock) 9 Rifle 10 Handle 11 Half shell 12 distal end of the guide element 13 Coupling element 14 cavity 15 poetry IS Plug 17 Cannula tube 18 opening 19 Injection bushing 20 Timing belt 21 gear 22 Deflection pulley 23 Deflection pulley 24 lower section of the timing belt 25 Pressure roller 26 Connection element 27 opening 28 mark 28' mark

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29 Rack

3 O teeth

31 Arrow

32 Axis of rotation of the gear

33 Operating wheel

34 Rotation axis of the operating wheel 3 3 5 V-shaped notches

3 6 Recess

3 7 Locking pin

3 8 Security label

39 Arrow

4" O Housing

41 Locking pin

42 markings

43 Cover

44 proximal end of the cannula tube

45 openings

46 Cavity

Claims (22)

O 2401-Dt/Ru PROTECTION CLAIMS; 1. Device for introducing a stent (I), a drainage tube or the like into hollow organs, in particular into blood vessels, ureters, esophagi or bile ducts, with an elongated guide element (8) for receiving the object (1) to be introduced, characterized in that a handle (10) is provided in a region of the guide element (8) facing away from the proximal end of the guide element (8), that an actuating element (33) is arranged on the handle (10) and that the guide element (8) is displaceable along its longitudinal axis relative to the handle (10) via the actuating element (33). 2. Device according to claim 1,
characterized in that the guide element (8) is designed as a guide tube forming a lock into which the object (1) to be introduced can be inserted. 3. Device according to claim 2,
characterized in that a support element (4) is provided within the lock (8), by means of which the object to be inserted can be supported in the direction of the handle (10). 4. Device according to one of the preceding claims, characterized in that the guide element is designed as a guide tube forming an inner catheter, onto which the object to be introduced can be pushed. 5. Device according to claim 4,
characterized in that a support element is provided on the outside of the inner catheter, in particular a support element is pushed onto the inner catheter, by means of which the object to be inserted can be supported in the direction of the handle. 6. Device according to one of the preceding claims, characterized in that the guide element (8) is hollow over its entire length and a guide wire (7) can be inserted into the guide element (8). 7. Device according to one of the preceding claims, characterized in that a coupling element (13) is provided on or in the handle (10), which is fixed to the guide element (8) at least in the longitudinal direction and is non-displaceably connected to the actuating element (33) so that the guide element (8) can be displaced along its longitudinal axis by means of the actuating element (33). 8. Device according to claim 7,
characterized in that the coupling element (13) is connected to the actuating element (33) by a gear (20, 21, 29). 9. Device according to claim 7 or 8, characterized in that the coupling element (13) is connected to a toothed belt (20) or a rack (29) which is in engagement with a gear wheel (21) drivable by the actuating element (33), a further toothed belt or a further rack. 10. Device according to one of the preceding claims, characterized in that the actuating element (33) is rotatably mounted on the handle (10) and the guide element (8) is displaceable by rotating the actuating element (33). 11. Device according to one of the preceding claims, characterized in that the actuating element (33) is designed as a rotatable actuating wheel, the axis of rotation (34) of which in particular simultaneously forms the axis of rotation (32) for the gear wheel (21). 12. Device according to claim 11, characterized in that the peripheral outer surface of the actuating wheel (33) is designed as an engagement surface having a rough surface, which in particular has a grooved surface structure. 13. Device according to claim 11 or 11, characterized in that the engagement surface of the actuating wheel (33) projects beyond at least one side of the handle (10). 14. Device according to one of the preceding claims, characterized in that that the actuating element (33) is arranged on the handle (10) in such a way that it is possible to hold the handle (10) and actuate the actuating element (33) with one hand. 15. Device according to one of the preceding claims, characterized in that that the actuating element (33) is arranged laterally on the handle (10) and when the handle (10) is gripped, it comes to rest in the area between the thumb and the index finger or between the thumb and the middle finger. 16. Device according to one of the preceding claims, characterized in that an actuation of the actuating element (33) is possible via two fingers, in particular via thumb and index finger or via thumb and middle finger. 17. Device according to one of the preceding claims, characterized in that the actuating element (33) can be fixed via a securing element, in particular a securing pin (37), in order in particular to prevent unintentional adjustment of the actuating element (33). 18. Device according to one of claims 11 to 17, characterized in that the actuating wheel (33) can be secured against rotation by the securing element (37). 19. Device according to one of claims 6 to 18, characterized in that connection elements (19, 26) for supplying medication, contrast media or the like are provided on the handle, which are connected to the cavity (6) formed in the interior of the guide element (8). 20. Device according to claim 19,
characterized in that a connecting element (26) is formed on the coupling element (13). 21. Device according to claim 19 or 20, characterized in that a connecting element (19) is formed in the region of the distal end of the handle (10). 22. Device according to one of claims 7 to 21, characterized in that the handle (10) has an elongated opening through which at least a part of the coupling element (13) projects and in which the coupling element (13) is displaceable when the guide element (8) is displaced. 3i\trSR\ED\V2469X.DOC