Abstract: An electrosurgical handpiece is provided that includes a squeezable handle. The squeezable handle has a back grip and a finger grip that can be squeezed to actuate electrosurgical handpiece. The back grip and the finger grip are connected by a lower malleable region that has an elasticity greater than the remainder of the squeezable handle.

Abstract: Systems, methods, and apparatuses for conducting heat from an ultrasound transducer and reducing drop impact forces are disclosed. A thermal management system including a thermally conductive compliant component in an ultrasound probe is disclosed. The thermal management system may include thermally conductive compliant component coupled to a transducer assembly. A printed circuit assembly (PCA) may be coupled to the compliant component. The thermally compliant component may conduct heat from the transducer assembly to the PCA. The PCA may be further coupled to a cable that may conduct heat from the PCA and away from the ultrasound probe.

Abstract: Provided is a technology capable of generating and presenting more kinds of special light images with higher image quality. An endoscope system according to the present disclosure performs image processing using a G1 image data (image data obtained by irradiating light of 524±3 nm to 582±3 nm) and at least one of R1 image (image data obtained by irradiating light of 630±3 nm to 700±3 nm) data other than the G1 image data, B1 image data (452±3 nm to 502±3 nm), R2 image data (image data obtained by irradiating light of 582±3 nm to 630±3 nm), G2 image data (image data obtained by irradiating light of 502±3 nm to 524±3 nm), and B2 image data (image data obtained by irradiating light of 420±3 nm to 452±3 nm) so as to generate a special light image (FIG. 7).

Abstract: Surgical visualization systems and related methods are disclosed herein, e.g., for providing visualization during surgical procedures. Systems and methods herein can be used in a wide range of surgical procedures, including spinal surgeries such as minimally-invasive fusion or discectomy procedures. Systems and methods herein can include various features for enhancing end user experience, improving clinical outcomes, or reducing the invasiveness of a surgery. Exemplary features can include access port integration, hands-free operation, active and/or passive lens cleaning, adjustable camera depth, and many others.

Abstract: Surgical visualization systems and related methods are disclosed herein, e.g., for providing visualization during surgical procedures. Systems and methods herein can be used in a wide range of surgical procedures, including spinal surgeries such as minimally-invasive fusion or discectomy procedures. Systems and methods herein can include various features for enhancing end user experience, improving clinical outcomes, or reducing the invasiveness of a surgery. Exemplary features can include access port integration, hands-free operation, active and/or passive lens cleaning, adjustable camera depth, and many others.

Abstract: A resectoscope operating handle and electrode fitting structure and fitting method are provided. The fitting structure includes a slider of a resectoscope operating handle and a binding post of an electrode. The slider has a front surface and a back surface. The front surface of the slider is provided with a mounting groove for mounting the binding post. An end surface of the binding post is perpendicular to the front surface of the slider. The binding post is mounted in the mounting groove, and an axial direction of the binding post is perpendicular to a plane where the handle is located. The resectoscope operating handle and electrode fitting structure and fitting method of the present invention can ensure that an electrode is accurately and firmly fixed to an operating handle under the condition of convenience in operation.

Abstract: The surgical robotic access system provides access for robotic instruments and/or actuators including the introduction, operation and withdrawal of such robotic manipulators into a body cavity without permitting the escape of pressurized fluid or gas. The surgical robotic access system also provides a multi-faceted range of movement without touching or effecting pressure on the opening in the patient's body cavity.

Abstract: Electrosurgical probes for treating tissue, and surgical procedures that make use of such probes. Such a probe includes a working element having a core member, a sheath secured to the working element, and a conductor disposed in a first internal longitudinal channel of the core member and having an active electrode coupled thereto. The sheath has a passage in which the core member is disposed, and the passage has an opening at a distal end of the sheath. The conductor is reciprocable within the sheath and adapted to carry a radio frequency current to and from the active electrode, which extends from the opening at the distal end of the sheath. An irrigation channel is defined by a second internal longitudinal channel of the core member. The electrosurgical probe is marked as disposable and not for reuse in a medical procedure performed on more than one patient.

Abstract: A controller for a body cavity irrigation system, where the system features a reservoir containing an irrigation liquid and a catheter, includes a housing with a dial attached to the housing and movable between positions corresponding to stages of a body cavity irrigation procedure. The controller is in communication with an electromechanical pump and at least one electromechanical valve that are in fluid communication with the reservoir and the catheter so that the electromechanical pump and at least one electromechanical valve are configured to perform a stage of the body cavity irrigation procedure corresponding to the selected dial position.

Abstract: A hysteroscopy system includes a scope having an internal channel, a sheath removably coupled to the scope, and an outflow channel. The sheath has a distal flange extending internally towards an outer surface of the scope. The outflow channel is formed between an inner surface of the sheath and an outer surface of the scope. The distal flange forms a distal end of the outflow channel and is generally located between the scope and the sheath.

Abstract: An electrosurgical instrument includes a light source, a first conductor, a second conductor, an insulation material positioned between the first conductor and the second conductor, and a light pipe that carries light from the light source to the insulation material.

Abstract: Various embodiments disclosed relate to drug-coated balloon catheters for treating strictures in body lumens and methods of using the same. A drug-coated balloon catheter for delivering a therapeutic agent to a target site of a body lumen stricture includes an elongated balloon having a main diameter. The balloon catheter includes a coating layer overlying an exterior surface of the balloon. The coating layer includes one or more water-soluble additives and an initial drug load of a therapeutic agent.

Abstract: Various embodiments disclosed relate to drug-coated balloon catheters for treating strictures in body lumens and methods of using the same. A drug-coated balloon catheter for delivering a therapeutic agent to a target site of a body lumen stricture includes an elongated balloon having a main diameter. The balloon catheter includes a coating layer overlying an exterior surface of the balloon. The coating layer includes one or more water-soluble additives and an initial drug load of a therapeutic agent.

Abstract: Various embodiments disclosed relate to drug-coated balloon catheters for treating strictures in body lumens and methods of using the same. A drug-coated balloon catheter for delivering a therapeutic agent to a target site of a body lumen stricture includes an elongated balloon having a main diameter. The balloon catheter includes a coating layer overlying an exterior surface of the balloon. The coating layer includes one or more water-soluble additives and an initial drug load of a therapeutic agent.

Abstract: Various embodiments disclosed relate to drug-coated balloon catheters for treating strictures in body lumens and methods of using the same. A drug-coated balloon catheter for delivering a therapeutic agent to a target site of a body lumen stricture includes an elongated balloon having a main diameter. The balloon catheter includes a coating layer overlying an exterior surface of the balloon. The coating layer includes one or more water-soluble additives and an initial drug load of a therapeutic agent.

Abstract: The various inventions relate to robotic surgical devices, consoles for operating such surgical devices, operating theaters in which the various devices can be used, insertion systems for inserting and using the surgical devices, and related methods.

Abstract: Various embodiments disclosed relate to drug-coated balloon catheters for treating strictures in body lumens and methods of using the same. A drug-coated balloon catheter for delivering a therapeutic agent to a target site of a body lumen stricture includes an elongated balloon having a main diameter. The balloon catheter includes a coating layer overlying an exterior surface of the balloon. The coating layer includes one or more water-soluble additives and an initial drug load of a therapeutic agent.

Abstract: A distal end of an introducer sheath into a patient's urethra is advanced into a patient's urethra while flowing an irrigation fluid through a lumen and out a distal end of the introducer sheath into the urethra. The irrigation fluid is simultaneously removed from the urethra through the distal end and lumen of the introducer sheath to establish a circulation of the irrigation fluid in the urethra as the introducer sheath is advanced. The urethra may then be viewed through an endoscope positioned in the lumen of the introducer sheath as the irrigation fluid circulation is continued. A unitary connector is detachably coupled to a proximal end of the elongated sleeve, and a fluid seal is disposed between the unitary connector and the proximal end of the elongated sleeve. The unitary connector is configured to connect the first and second channels to the inflow pump and the outflow pump, respectively.

Abstract: An endoscopic surgical instrument includes at least one endoscopy shaft, with at least one suction and/or rinse unit, with at least one securing element, which is configured to secure the at least one endoscopy shaft on the at least one suction and/or rinse unit in a coupled state, and with at least one fixation unit, which is configured for a captive fixation of the at least one securing element on the at least one suction and/or rinse unit, wherein the at least one fixation unit comprises at least one cover element which, in a mounted state, encompasses the at least one securing element at least partly, wherein the at least one cover element comprises at least one operational recess for an operation of the at least one securing element.

Abstract: Methods and devices are described for performing a combined hysteroscopy and endometrial sampling. Techniques for improving visual images include forward facing fluid ports for clearing tissue debris and LED positioning and design. Manufacturability is improved through separately formed tip and shaft pieces. User interface features are described including user-friendly handle-mounted buttons as well the use of an interactive integrated touch screen display. The handle and display can be mated to a docking station for storage and recharging batteries.

Abstract: An endoscopic instrument according to the invention includes an elongate tube, which has an axially continuous and substantially cylindrical main lumen for receiving a shaft of an endoscope lens system, and a tool, which is arranged at a distal end of the tube and can be controlled via an elongate transmission element from a proximal end of the tube, wherein the tube has an axially continuous secondary lumen which adjoins the main lumen in a transverse direction, is connected to the main lumen via a narrowed transition area and receives the transmission element. The invention also relates to an endoscopic instrument system.

Abstract: A transporter for controlling the longitudinal movement of an electrode of a urological resectoscope, with a guide tube which is secured lengthwise on the resectoscope and on which a carriage is mounted so as to be longitudinally movable, with a spring mounted at one end on the carriage and at the other end on one of the ends of the guide tube, and with finger supports secured on the carriage and on one of the ends of the guide tube, is characterized in that the spring is formed in one piece with at least one of the finger supports, and wherein the spring is designed as a leaf spring and has portions curved in opposite directions.

Abstract: A surgical access apparatus is presented including a cannula having a housing and a cannula shaft, the cannula shaft defining an internal lumen and a slot in communication with the internal lumen and an obturator insertable through the internal lumen of the cannula. The obturator includes an obturator shaft having a proximal end and a distal end and a tip member disposed at the distal end of the obturator shaft, the tip member configured to form an incision through tissue. An outer surface of the obturator shaft and the tip member defines a channel for receiving and directing insufflation fluid into a body cavity, a portion of the same channel also configured to guide a surgical instrument, such as a suture passer/grasper for closing an incision, towards and through the slot. In this way, the cannula and obturator can be employed both for forming an incision at the beginning of a surgical procedure and for closing the same incision at the conclusion of the surgical procedure.

Abstract: A tissue visualization and modification device may include a rigid access body having a longitudinal axis, an internal passageway extending from the proximal end to the distal end, and an access body imaging sensor positioned on the distal end of the body and protruding inward beyond an inner wall into the internal passageway. An elongated member may be slidably positioned within the rigid access body. The elongated member may include, when viewed substantially along the longitudinal axis, a dissection electrode in the shape of a semicircle, an irrigation channel positioned within the semicircle, an aspiration channel positioned partially within the semicircle and adjacent the irrigation channel, first and second illumination elements positioned adjacent the respective tips of the semicircle and an elongated member imaging sensor positioned adjacent the aspiration channel.

Abstract: A surgical system includes a first instrument defining a first channel and a second instrument receivable by the first channel. The second instrument defines a second channel. A valve coupled to the first instrument controls fluid flow through the first channel, such that impedance of fluid flow through the first channel is substantially the same without the second instrument received in the first channel and with the first channel partially blocked by the second instrument. In another aspect, a surgical apparatus includes an outer member and an inner member received within the outer member to define a first channel therebetween. The inner member houses an optical lens and defines a second channel for receiving a surgical instrument. The first and second channels are configured such that a pump having an inflow rate of up to about 0.7 L/min connected to the second channel can maintain fluid pressure inside an organ.

Abstract: A concentric tube catheter for positioning a polymeric urethral stent implementing resistance heating to make the stent malleable for insertion into a urinary tract. An inflatable bladder is mounted to one end of the concentric tube catheter with the stent positioned around the inflatable bladder. The concentric tube catheter charged with a quantity of fluid. A static pressure control assembly and a variable pressure control assembly are in fluid connection with the concentric tube catheter. The quantity of fluid is pressurized within the concentric tube catheter with the static pressure control assembly in order to expand the inflatable bladder. A heating control system is used to increase the temperature of the stent allowing to become more malleable. The variable pressure control assembly oscillates the quantity of fluid to distribute heat evenly to the inflatable bladder and therefore to the stent. As the inflatable bladder expands, the malleable stent also expands.

Abstract: This disclosure is directed to a resilient interpositional arthroplasty implant for application into a knee joint to pad cartilage defects, cushion a joint, and replace or restore the articular surface, which may preserve joint integrity, reduce pain and improve function. The implant may endure variable joint compressive and shear forces and cyclic loads. The implant may repair, reconstruct, and regenerate joint anatomy, and thereby improve upon joint replacement alternatives. Rather than using periosteal harvesting for cell containment in joint resurfacing, the walls of this invention may capture, distribute and hold living cells until aggregation and hyaline cartilage regrowth occurs. The implant may be deployed into debrided joint spaces, molding and conforming to surrounding structures with sufficient stability to avoid extrusion or dislocation.

Abstract: A surgical device (2) having a distal end and a proximal end, and comprising a delivery portion (12) extending from the proximal end and comprising first and second instrument delivery channels, an active portion (4,8) at a distal portion of the device and a plug (10) having a proximal end and a distal end, and engageable with the delivery portion at its proximal end, and with the active portion at its distal end, the plug comprising first and second plug channels (82) each defining a curved path, such that the plug channels diverge from one another towards the distal end of the plug wherein when the plug is engaged with the delivery portion the first plug channel and the first instrument delivery channel form a first instrument channel and the second plug channel and the second instrument delivery channel form a second instrument channel.

Abstract: The invention relates to a surgical instrument system encompassing a morcellator with a hollow shaft on whose distal end a cutting blade is configured, as well as a gripping instrument with a shaft on whose distal end a tool consisting of at least two jaw members and on whose proximal end a handle consisting of at least two gripping members is configured to activate the tool, in such a way that the gripping instrument can be inserted into the hollow shaft of the morcellator so that it can slide in the longitudinal direction of the morcellator shaft. To ensure versatile application along with simple structure, it is proposed with the invention that the morcellator with the insertable gripping instrument can be inserted into a hollow shaft of an additional medical instrument, in particular a resectoscope, and that an additional irrigation and/or suction canal is configured between the shaft of the morcellator and the inside of the hollow shaft of the additional medical instrument.

Abstract: The inventive endoscopy system includes a cannula for arranging an endoscope and forming, between said cannula and endoscope, an irrigation or aspiration channel for transporting an irrigation or aspiration fluid, respectively, a connection ring mounted around the cannula and provided with a connection channel connectable to the irrigation or aspiration channel, respectively and a connector which is mounted on the connection ring and includes a transport channel with the connection channel and a first pressure sensor for detecting pressure in the transport channel. The connection ring is provided with a bypass circuit connectable to the irrigation or aspiration channel, respectively and the connector including a dead channel connectable to the bypass circuit and a second pressure sensor for detecting pressure in the dead channel.

Abstract: The present disclosure relates to systems and methods for controlling pressure during percutaneous and endoscopic surgeries, including percutaneous renal procedures, endoscopic uterine procedures, transurethral endoscopic procedures for the bladder or prostate, or any percutaneous or endoscopic procedure. The system can include a sheath and/or endoscope each having an inflow port providing access to an inflow channel extending from the inflow port to a distal portion of the sheath, and an outflow port providing access to an outflow channel extending from the outflow port to the distal portion of the sheath. The sheath can also include a pressure sensor configured to generate a pressure measurement, and an electronic processor configured to control fluid through at least one of the inflow port and the outflow port based on the pressure measurement.

Abstract: A continuous flow irrigation endoscope and a continuous flow irrigation fluid management system, both designed to be compatible to each other and to function as a single system. The endoscope and the fluid management system are synergistic to each other such that both enhance the efficiency of each other. The invented system allows a body tissue cavity to be distended by continuous flow irrigation so that detached tissue pieces and waste fluid present inside a body tissue cavity are continuously automatically evacuated from the tissue cavity without causing the cavity to collapse at any stage and without the need of withdrawing the endoscope of a part of the endoscope from the tissue cavity. No type of feedback mechanism, such as mechanical or electrical, or valve or valve like systems, are incorporated in the endoscope to influence or facilitate the removal of detached tissue pieces or waste fluid in any manner.

Abstract: The teachings provided herein are directed to a methods and devices for treating a hemorrhoid in a subject in a manner that produces substantially less post-procedural pain in the subject, the method minimizing or avoiding a removing or a necrosis of a rectal tissue fold.

Abstract: A continuous flow irrigation endoscope and a continuous flow irrigation fluid management system, both designed to be compatible to each other and meant to function as a single system. The endoscope and the fluid management system are synergistic to each other such that both enhance the efficiency of each other. The system allows a body tissue cavity to be distended by continuous flow irrigation so that the detached tissue pieces and waste fluid present inside a body tissue cavity are continuously automatically evacuated from the tissue cavity without causing the cavity to collapse at any stage and without the need of withdrawing the endoscope or a part of the endoscope from the tissue cavity.

Abstract: A surgical system includes a first instrument defining a first channel and a second instrument receivable by the first channel. The second instrument defines a second channel. A valve coupled to the first instrument controls fluid flow through the first channel, such that impedance of fluid flow through the first channel is substantially the same without the second instrument received in the first channel and with the first channel partially blocked by the second instrument. In another aspect, a surgical apparatus includes an outer member and an inner member received within the outer member to define a first channel therebetween. The inner member houses an optical lens and defines a second channel for receiving a surgical instrument. The first and second channels are configured such that a pump having an inflow rate of up to about 0.7 L/min connected to the second channel can maintain fluid pressure inside an organ.

Abstract: The teachings provided herein are directed to a methods and devices for treating a hemorrhoid in a subject in a manner that produces substantially less post-procedural pain in the subject, the method minimizing or avoiding a removing or a necrosis of a rectal tissue fold.

Abstract: A treatment device for an endoscope includes an operating wire having a treatment section at a distal end thereof, a first sheath through which the operating wire is inserted, a second sheath into which the first sheath is inserted, a locking portion provided in the treatment section to advance or retreat, a first stopper that regulates advance movement of the locking portion, a second stopper that regulates retreat movement of the locking portion, and a sheath operating portion that advances or retreats the second sheath between a first positional relationship and a second positional relationship. The first stopper is provided in the first sheath via a connecting portion that extends toward the front side from a distal end of the first sheath, and the second stopper is provided in the second sheath on the rear side of the first stopper in the direction of the axis.

Abstract: Provided is a surgical apparatus for transanal endoscopic microsurgery (TEM) in which a thin and long endoscope and surgical instruments are inserted through a natural orifice of a human body and the endoscope and surgical instruments are conveyed to the operation area in the body to perform the operation area in the body. According to the surgical apparatus for TEM, a rotation function is added to a barrel of the surgical apparatus for TEM to enable manual rotation of the barrel to a required extent and adjustment of an operation area, without separation of the surgical apparatus for TEM from a fixing frame during an operation. In addition, since the endoscope is disposed outside the barrel, it is possible to reduce the outer diameter of the barrel and uniformly maintain a visual direction of the endoscope even when the barrel is rotated. Further, since the rotation function is added to both the barrel and the surgical instrument insertion hole, more convenient operation is possible.

Abstract: A surgical system includes a first instrument defining a first channel and a second instrument receivable by the first channel. The second instrument defines a second channel. A valve coupled to the first instrument controls fluid flow through the first channel, such that impedance of fluid flow through the first channel is substantially the same without the second instrument received in the first channel and with the first channel partially blocked by the second instrument. In another aspect, a surgical apparatus includes an outer member and an inner member received within the outer member to define a first channel therebetween. The inner member houses an optical lens and defines a second channel for receiving a surgical instrument. The first and second channels are configured such that a pump having an inflow rate of up to about 0.7 L/min connected to the second channel can maintain fluid pressure inside an organ.

Abstract: Apparatus for accessing a bodily passageway, the apparatus comprising: a flexible tube having a distal end and a proximal end, a longitudinal axis extending between the distal end and the proximal end, and a lumen extending from the distal end to the proximal end, the lumen being sized to receive matter to be transported through the bodily passageway; and an external thread disposed over the distal end of the tube, the external thread having a sufficient structural integrity, and a sufficient surface profile, such that when the tube is disposed in a bodily passageway, rotation of the tube about the longitudinal axis will result in longitudinal motion of the tube along said bodily passageway.

Abstract: A system for endoscopic suturing is provided having an endoscope, such as a gastroscope, with a distal end locatable in the body of a patient and a flexible shaft extending to the distal end, a flexible accessory tube coupled to the endoscope to flex relative to the endoscope's shaft, and a tip coupled to the shaft of the endoscope having an opening through which one end of the accessory tube is received. Tissue suturing and suture securing instruments are provided each having a sufficiently flexible shaft locatable through the accessory tube.

Abstract: A handheld device for performing an optical medical examination of a patient. The device comprises a handle; an image sensor positioned at an end of the handle; a trigger provided in the handle; an image memory for storing the image data upon activation of the trigger; a roll of print media mounted in the handle; an ink supply within a core of the roll of print media; a media transportation mechanism; a pagewidth print head extending longitudinally within the handle; a guillotine mechanism for severing a printed image from the transported print media; and a print engine controller.

Abstract: A continuous flow irrigation endoscope and a continuous flow irrigation fluid management system, both designed to be compatible to each other and meant to function as a single system. The endoscope and the fluid management system are synergistic to each other such that both enhance the efficiency of each other. The system allows a body tissue cavity to be distended by continuous flow irrigation so that the detached tissue pieces and waste fluid present inside a body tissue cavity are continuously automatically evacuated from the tissue cavity without causing the cavity to collapse at any stage and without the need of withdrawing the endoscope or a part of the endoscope from the tissue cavity.

Abstract: A surgical instrument comprising a sleeve, a electro-mechanical transducer containing a hollow passage for producing mechanical vibrations in response to a magnetic field, an ultrasonic horn mechanically connected to the transducer, containing a hollow passage communicating with that in the transducer, for amplifying the produced vibration such that dissection of biological tissue is produced and a tip having a hollow passage, mechanically connected to the horn and whose passage communicates with that in the horn, for contacting such tissue, connection of the passage to a source of vacuum and a sheath connected to the instrument and surrounding the tip and horn, with a connection to a source of irrigating fluid and a structure for mounting the transducer and horn within the sleeve permitting retracting and extension of the transducer and horn within and with respect to the sheath. The transducer, horn and tip are immersed in the irrigating solution.

Abstract: An in-vivo imaging device including a camera may include a frame storage device. Systems and methods which vary the frame capture rate of the camera and/or frame display rate of the display unit of in-vivo camera systems are discussed. The capture rate is varied based on physical measurements related to the motion of the camera. Alternatively, the frame capture rate is varied based on comparative image processing of a plurality of frames. The frame display rate of the system is varied based on comparative image processing of a multiplicity of frames. Both the frame capture and the frame display rates of such systems can be varied concurrently.

Abstract: An oval or ovoid electrode is used in a resectoscope. A longer dimension of the electrode preferably extends in a direction that is perpendicular to the direction in which the electrode is moved during tissue resection.

Abstract: An endoscopic instrument with a hollow shank which on the proximal side is provided with a connection part with at least one suction connection and/or rinsing connection, with a coupling part for fixing a working insert. The coupling part is mounted rotatably with respect to the connection part and the coupling part is detachably connected to the connection part. The endoscopic instrument further includes an annular axial seal which is arranged between the connection part and the coupling part.

Abstract: An anoscope for inspection and/or surgery is provided. The anoscope includes a tubular body having a distal end, a proximal end, and a longitudinal axis defined therebetween, where the tubular body includes at least one elongated slot. The anoscope also includes an insert removably attached to the at least one elongated slot in the tubular body. The insert including an elongated slot having a smaller width than the at least one elongated slot in the tubular body.

Abstract: A method and device for endoscopic harvesting of blood vessels from a patient for use in subsequent procedures. The device having a two piece headpiece. A vessel to be removed is inserted into the headpiece and the top and bottom portions of the headpiece are alternatively extended in reciprocating fashion to dissect above and below the vessel. The headpiece having electrodes for ligation of any side branch vessels which are uncovered in the dissection process.

Abstract: A urological resectoscope (1) includes a tubular, metallic external stem (2) fitted with holes (3) in its distal end zone, a tubular insulating element (7, 27, 37, 47) being affixed distally to the external stem, further comprising a tubular internal stem (8) configured within the external stem and resting against it in sealing manner and an electrode support (13) longitudinally displaceable inside the internal stem and supporting a cutting loop (15) in the region of the insulating element (7, 27, 37, 47), the inside space of the internal stem (8) and the gap (12) between the stems (2, 8) being proximally connected to liquid hookups (10, 11), the insulating element (7, 27, 37, 47) being configured in longitudinally mutually overlapping manner within an affixation zone (6) and the insulating element (7, 27, 37, 47) exhibiting a wall thickness distally from the affixation zone (6) larger than the wall thickness of the external stem (2), wherein the inside diameter of the insulating element (27, 47) is the same