CN109363734B - Device for establishing working space of laparoscope complete extraperitoneal hernia repair operation - Google Patents
Device for establishing working space of laparoscope complete extraperitoneal hernia repair operation Download PDFInfo
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Abstract
The invention discloses a method for establishing a working space of a laparoscopic complete extraperitoneal hernia repair operation, which comprises the following steps: step S1, the handle of the distraction rod is held by hands to enable the distraction rod to enter the preperitoneal space, and a working space is initially established; step S2, after the endoscope is placed, the deep layer of the transverse fascia and the peritoneum are gradually separated by a separation spoon under the direct vision of the endoscope; and step S3, taking out the separation spoon, and lifting the abdominal wall by using an abdominal wall lifting hook to fix the abdominal wall outside the body, thereby establishing a stable laparoscope working space. The method can stably establish the working space of the preperitoneal space, shorten the operation time, improve the operation safety and improve the recovery rate of patients, is simple and easy to implement, is stable to operate and is suitable for clinical application and popularization.
Description
Technical Field
The invention relates to the field of medical treatment, in particular to a method and a device for establishing a working space of a laparoscopic complete extraperitoneal hernia repair operation.
Background
Inguinal hernia refers to hernia formed by the protrusion of visceral organs in the abdominal cavity through the defect of the inguinal region to the body surface, and is commonly called hernia, which is a common and frequently encountered disease in general surgery. With the continuous updating of the concept of rapid rehabilitation and minimally invasive surgery, the laparoscopic inguinal hernia repair is more and more widely applied, the wound of a patient is less, and the patient can be recovered to daily work more quickly. Laparoscopic total extraperitoneal hernia repair (TEP) has become one of the standard procedures for treating inguinal hernia in adults. The success of establishing the preperitoneal space is critical to the success or failure of this procedure.
The creation of the preperitoneal space can be accomplished at a relatively high cost by enlarging the preperitoneal space using a balloon separator. At present, the preperitoneal space is established by common finger separation or mirror pushing in China, but the two methods have higher technical requirements and are easy to cause extraperitoneal hemorrhage and operation failure caused by peritoneum rupture. The separation space of fingers is limited, and the operator often turns to a mirror-pushing method to continue to build the working space, in which the lens is pushed forward along the posterior sheath of the rectus abdominis muscle, and the entering layer is in front of the deep layer of the transverse fascia of the abdomen. However, the continuous separation of the preperitoneal space requires cutting the deep layer of the transverse fascia to reach the real working space of the preperitoneal space, and has certain limitations.
Disclosure of Invention
Based on the above, the invention aims to overcome the defects of the prior art and provides a method and a device for establishing a working space of a laparoscopic complete extraperitoneal hernia repair operation.
The technical scheme is as follows:
a method of establishing a laparoscopic total extraperitoneal hernia repair workspace comprising the steps of:
step S1, the handle of the distraction rod is held by hands to enable the distraction rod to enter the preperitoneal space, and a working space is initially established;
step S2, after the endoscope is placed, the deep layer of the transverse fascia and the peritoneum are gradually separated by a separation spoon under the direct vision of the endoscope;
step S3, taking out the separation spoon, pulling the abdominal wall by using an abdominal wall pulling hook to fix the abdominal wall outside the body, and establishing a stable laparoscope working space;
wherein, the abdominal wall lifting hook comprises: the abdominal wall connecting device comprises a hook used for contacting with the abdominal wall, an arc connecting rod one end of which is connected with the tail end of the hook, and a plurality of bulges arranged at the other end of the arc connecting rod;
the hook comprises a hook section and a transition section, and the transition section is connected with the arc-shaped connecting rod; the tail end of the hook section is connected with the transition section, the starting end of the hook section is bent inwards, and the transition section enables the hook to be in smooth transition connection with the arc-shaped connecting rod;
the arc connecting rod includes first circular arc section and second circular arc section, the tip of first circular arc section and the end connection of second circular arc section, and first circular arc section and second circular arc section acutely set up.
The invention adopts the spreader bar, the separation spoon and the abdominal wall lifting hook as components for establishing a working space of the laparoscope total extraperitoneal hernia repair (TEP), and establishes a stable endoscope working space, wherein the spreader bar is firstly inserted into a preperitoneal gap to establish a preliminary working space, then the separation spoon is used for gradually separating a transverse fascia deep layer from a peritoneum, the working space for working the preperitoneal gap is fully established, and the abdominal wall lifting hook is used for lifting the abdominal wall to be fixed outside the body, so that the working space of the laparoscope is stable. Wherein, the hook contacts with the abdominal wall, and plays a role of clinging to the abdominal wall and supporting the abdominal wall, the arc connecting rod is convenient for an operator to hold the abdominal wall lifting hook for operation on one hand, and on the other hand, the arc connecting rod also plays a role of supporting, can support other tissues or organs, and can provide an operation space, the operation visual field is wider, a plurality of bulges arranged at one end of the arc connecting rod can play a role of anti-skidding on one hand, and are convenient for the operator to stably hold the abdominal wall lifting hook for operation on the other hand, and can be matched with external fixing devices (such as a fixing frame and a fixing clamp) on or beside the operation bed, so that the abdominal wall lifting hook for operation can be fixed through the external fixing devices, namely, the abdominal wall lifting hook can be fixed outside the body through the abdominal wall, the abdominal wall is not completely dependent on pneumoperitoneum, thereby establishing a stable preperitoneal space working space. The arc-shaped connecting rod comprises a first arc section and a second arc section, and the first arc section and the second arc section are arranged at an acute angle so as to avoid overlarge angle for supporting the abdominal wall, tissues or organs of the human body.
In one embodiment, the spreader bar comprises: a shuttle-shaped front end for opening the peritoneum, a connecting rod with one end connected with the shuttle-shaped front end, and a handle connected with the other end of the connecting rod. Further, the edge of the shuttle-shaped front end is a blunt edge.
In one embodiment, the length of the distraction rod is 20-30 cm. Specifically, the length of the handle of the spreading rod is 6-7 cm. More specifically, the handle length of the spreader bar is 6.5 cm.
In one embodiment, the separation scoop comprises: a spoon-shaped front end for separating the deep layer of the transverse fascia ventralis from the peritoneum, a connecting rod with one end connected with the spoon-shaped front end, and a spoon handle connected with the other end of the connecting rod. Furthermore, the spoon-shaped front end is of a thickened blunt spoon-shaped structure. The blunt spoon-shaped structure can avoid the damage of the separating spoon to the deep layer of the transverse fascia of the abdomen and the peritoneum.
In one embodiment, the length of the separation spoon is 40-50 cm. Specifically, the length of the spoon-shaped front end is 9-11cm, and more specifically, the length of the spoon-shaped front end is 10 cm. The length of the spoon handle is 6-7cm, and more specifically, the length of the spoon handle is 6.5 cm.
In one embodiment, the first circular arc segment and the second circular arc segment are arranged at an angle of 15-45 degrees. The arrangement is that the arc-shaped connecting rod has larger bending degree according to the human body structure, and the opening angle of the abdominal wall and the operation space are considered.
In one embodiment, the arc length of the first circular arc segment is 12-18cm, and the arc length of the second circular arc segment is 10-14 cm. The setting is matched with the size of the abdominal wall and the abdominal cavity of the human body.
In one embodiment, the cross sections of the hook section and the arc-shaped connecting rod are both elliptical, and the eccentricity of the elliptical cross section of the hook section is greater than the eccentricity of the elliptical cross section of the arc-shaped connecting rod. According to the invention, the oval flatness of the cross section of the hook section is set to be larger than that of the arc-shaped connecting rod, and the hook section is relatively flat, so that the contact area between the hook section and the abdominal wall is relatively large, the occupied space is relatively small, the visual field is relatively wide, the operation space is relatively large, and the operation is relatively convenient.
In one embodiment, the starting end of the hook segment is blunt. The starting end of the hook section is designed to be a blunt end, so that the hook section can be prevented from scratching human tissues or the abdominal wall.
In one embodiment, the length of the hook is 3cm to 6 cm. The design is also designed according to the human body structure, so that the hook can better support the abdominal wall.
In one embodiment, the protrusion is a hemispherical protrusion, a toothed protrusion, a truncated cone-shaped protrusion, or an inverted bowl-shaped protrusion.
In one embodiment, the material of the surgical abdominal wall lifting hook is a metal material or a plastic material.
In one embodiment, the step S3 is: the separating spoon is taken out, the surgical abdominal wall lifting hook is tightly held, the surgical lifting hook is placed in an abdominal cavity, then the bulge of the abdominal wall lifting hook is connected with the in-vitro fixing device, the abdominal wall lifting hook is used for lifting the abdominal wall to be fixed in vitro, and a stable laparoscopic working space is established.
Compared with the prior art, the invention has the beneficial effects that:
the invention adopts the spreader bar, the separation spoon and the abdominal wall lifting hook as components for establishing a laparoscope complete extraperitoneal hernia repair (TEP) working space, and establishes a stable endoscope working space, wherein the spreader bar firstly enters a preperitoneal gap to establish a preliminary working space, then the separation spoon is used for gradually separating a transverse aponeurosis deep layer from a peritoneum, the working space for the preperitoneal gap to work is fully established, and the abdominal wall lifting hook is used for lifting the abdominal wall to be fixed outside the body, so that the laparoscope working space is stable;
the abdominal wall lifting hook can lift the abdominal wall to be fixed outside the body, does not depend on pneumoperitoneum completely, can stably establish a preperitoneal gap working space, improves safety, reduces the conversion to a transperitoneal extraperitoneal hernia repair (TAPP) operation mode, reduces the change of the environment in the abdominal cavity, shortens operation time, improves operation safety and improves the recovery rate of patients.
The method for establishing the working space of the laparoscopic complete extraperitoneal hernia repair operation is simple and easy to implement, stable in operation and suitable for clinical application and popularization.
Drawings
Fig. 1 is a schematic view of the structure of the surgical abdominal wall lifting hook in example 1.
Fig. 2 is a schematic view of the structure of the spreading bar in example 1.
FIG. 3 is a schematic view of the structure of the separation spoon in example 1
Fig. 4 is a transverse sectional view of the hook and the curved connecting bar of the abdominal wall lifting hook structure for surgery of example 1.
Description of reference numerals: 1. hooking; 11. a hook section; 12. a transition section; 2. an arc-shaped connecting rod; 21. a first arc segment; 22. a second arc segment; 3. a protrusion; 4. a shuttle-type front end; 5. a connecting rod; 6. a handle; 7. a spoon-shaped front end; 8. a connecting rod; 9. a spoon handle.
Detailed Description
In order to make the objects, technical solutions and advantages of the present invention more apparent, the present invention is further described in detail below with reference to the accompanying drawings and the detailed description. It should be understood that the detailed description and specific examples, while indicating the scope of the invention, are intended for purposes of illustration only and are not intended to limit the scope of the invention.
Examples
A method of establishing a laparoscopic total extraperitoneal hernia repair workspace comprising the steps of:
step S1, the handle of the distraction rod is held by hands to enable the distraction rod to enter the preperitoneal space, and a working space is initially established;
step S2, after the endoscope is placed, the deep layer of the transverse fascia and the peritoneum are gradually separated by a separation spoon under the direct vision of the endoscope;
step S3: taking out the separating spoon, then tightly gripping the surgery abdominal wall lifting hook, placing the surgery abdominal wall lifting hook in an abdominal cavity, then connecting the bulge of the abdominal wall lifting hook with an in-vitro fixing device, fixing the abdominal wall lifting hook outside the body, and establishing a stable laparoscope working space;
as shown in fig. 1, the abdominal wall lifting hook for operation comprises: the abdominal wall connecting device comprises a hook 1 used for contacting with the abdominal wall, an arc connecting rod 2 with one end connected with the tail end of the hook 1, and a plurality of bulges 3 arranged at the other end of the arc connecting rod 2; the hook 1 comprises a hook section 11 and a transition section 12, and the transition section 12 is connected with the arc-shaped connecting rod 2; the tail end of the hook section 11 is connected with the transition section 12, the starting end of the hook section 11 is bent inwards, and the transition section 12 enables the hook section 11 to be in smooth transition connection with the arc-shaped connecting rod 2; the arc connecting rod 2 comprises a first arc section 21 and a second arc section 22, the end part of the first arc section 21 is connected with the end part of the second arc section 22, and the first arc section 21 and the second arc section 22 are arranged at an acute angle;
as shown in fig. 2, the spreading bar includes: a shuttle-shaped front end 4 for opening the peritoneum, a connecting rod 5 with one end connected with the shuttle-shaped front end 4, and a handle 6 connected with the other end of the connecting rod (5);
as shown in fig. 3, the separating spoon comprises: a spoon-shaped front end 7 for separating the deep layer of the transverse fascia ventralis from the peritoneum, a connecting rod 8 with one end connected with the spoon-shaped front end 7, and a spoon handle 9 connected with the other end of the connecting rod 8.
In the embodiment, the distraction rod, the separation spoon and the abdominal wall lifting hook are used as components for establishing a working space of the laparoscopic complete extraperitoneal hernia repair (TEP), a stable endoscope working space is established, wherein the distraction rod firstly enters a preperitoneal gap to establish a preliminary working space, then a separation spoon is used for gradually separating a deep layer of an abdominal transverse fascia and a peritoneum, the working space for working the preperitoneal gap is fully established, and then the abdominal wall lifting hook is used for lifting the abdominal wall to be fixed outside the body, so that the laparoscopic working space is stable.
In the embodiment, the hook 1 contacts with the abdominal wall to tightly attach to the abdominal wall and support the abdominal wall, the arc-shaped connecting rod 2 is convenient for an operator to hold the abdominal wall lifting hook for operation, the arc-shaped connecting rod 2 also plays a role in supporting to support other tissues or organs and provide an operation space, the operation visual field is wider, the plurality of protrusions 3 arranged at one end of the arc-shaped connecting rod 2 can play a role in skid resistance on one hand to facilitate the operator to stably hold the abdominal wall lifting hook for operation, and the protrusions 2 can be matched with an external fixing device (such as a fixing frame and a fixing clamp) on an operation bed or beside the operation bed on the other hand, so that the abdominal wall lifting hook for operation can be fixed through the external fixing device, namely, the abdominal wall can be lifted by the abdominal wall lifting hook to be fixed outside the body, the abdominal wall is not dependent on pneumoperitoneum completely, and the supporting function, thereby establishing a stable preperitoneal space working space. The arc-shaped connecting rod 2 comprises a first arc section 21 and a second arc section 22, and the first arc section 21 and the second arc section 22 are arranged at an acute angle to avoid the overlarge angle of the abdominal wall, tissues or organs of the human body, which is spread by the abdominal wall lifting hook for the operation.
Specifically, in this embodiment, the edge of the shuttle-shaped front end is a blunt edge.
Further, the length of the distraction rod is 20-30 cm. In particular, the handle 6 of the spreader bar is 6-7cm in length, more particularly, the handle 6 of the spreader bar is 6.5cm in length.
Further, the spoon-shaped front end 7 is of a thickened blunt spoon-shaped structure. The blunt spoon-shaped structure can avoid the damage of the separating spoon to the deep layer of the transverse fascia of the abdomen and the peritoneum.
Further, the length of the separation spoon is 40-50 cm. Specifically, the length of the spoon-shaped front end 7 is 9-11cm, and more specifically, the length of the spoon-shaped front end 7 is 10 cm. The length of the spoon handle 9 is 6-7cm, and more specifically, the length of the spoon handle 9 is 6.5 cm.
Specifically, in this embodiment, the first arc segment and the second arc segment are arranged at an angle of 15 to 45 °, that is, α is 15 to 45 °. The arrangement is that the arc-shaped connecting rod has larger bending degree according to the human body structure, and the opening angle of the abdominal wall and the operation space are considered.
Specifically, in the embodiment, the arc length L2 of the first circular arc segment 21 is 12-18cm, and the arc length L3 of the second circular arc segment 22 is 10-14 cm. The setting is matched with the size of the abdominal wall and the abdominal cavity of the human body.
Specifically, as shown in fig. 4, in this embodiment, the cross sections of the hook section 11 and the arc-shaped connecting rod 2 are both elliptical, and the eccentricity of the elliptical cross section of the hook section 11 is greater than the eccentricity of the elliptical cross section of the arc-shaped connecting rod 2, fig. 4a is a schematic cross-sectional structure diagram of the hook section 11, and fig. 4b is a schematic cross-sectional structure diagram of the arc-shaped connecting rod 2. According to the invention, the oval flatness of the cross section of the hook section 11 is set to be larger than that of the arc-shaped connecting rod 2, and the hook section 11 is relatively flat, so that the contact area between the hook section and the abdominal wall is relatively large, the occupied space is relatively small, the visual field is relatively wide, the operation space is relatively large, and the operation is relatively convenient. In this embodiment, one end of the transition section 12 is connected to the end of the hook section 11, and the other end is connected to the arc-shaped connection rod 2, more specifically, the first arc section 21, so as to perform a smooth transition connection. The transition section 12 is also oval in cross-section, with the eccentricity decreasing from the end connected to the hooking section 11 to the end connected to the curved connecting rod 2.
Specifically, in this embodiment, the starting end of the hook segment 11 is blunt. The starting end of the hook section is designed to be a blunt end, so that the hook section can be prevented from scratching human tissues or the abdominal wall.
Specifically, in the embodiment, the length L1 of the hook is 3cm-6 cm. The design is also designed according to the human body structure, so that the hook can better support the abdominal wall.
Specifically, in this embodiment, the protrusion 3 is a hemispherical protrusion, a tooth-shaped protrusion, a truncated cone-shaped protrusion, or an inverted bowl-shaped protrusion. More specifically, the protrusion 3 is a hemispherical protrusion in this embodiment.
Specifically, in this embodiment, the material of the abdominal wall lifting hook for operation is a metal material or a plastic material.
In practical application, before the operation abdominal wall lifting hook, the opening bar and the separating spoon are used for establishing the working space of the laparoscopic complete extraperitoneal hernia repair operation, the patient is usually firstly subjected to anesthesia and sterilization drape, and trocar is drawn out.
The technical features of the embodiments described above may be arbitrarily combined, and for the sake of brevity, all possible combinations of the technical features in the embodiments described above are not described, but should be considered as being within the scope of the present specification as long as there is no contradiction between the combinations of the technical features.
The above-mentioned embodiments only express several embodiments of the present invention, and the description thereof is more specific and detailed, but not construed as limiting the scope of the invention. It should be noted that, for a person skilled in the art, several variations and modifications can be made without departing from the inventive concept, which falls within the scope of the present invention. Therefore, the protection scope of the present patent shall be subject to the appended claims.
Claims (5)
1. The device for establishing the working space of the laparoscopic complete extraperitoneal hernia repair is characterized by comprising a distraction rod, a separation spoon and an abdominal wall lifting hook;
the distraction rod includes: a shuttle-shaped front end (4) for opening the peritoneum, a connecting rod (5) with one end connected with the shuttle-shaped front end (4), and a handle (6) connected with the other end of the connecting rod (5);
the abdominal wall lifting hook comprises: the abdominal wall connecting device comprises a hook (1) used for being in contact with the abdominal wall, an arc-shaped connecting rod (2) with one end connected with the tail end of the hook (1), and a plurality of bulges (3) arranged at the other end of the arc-shaped connecting rod (2);
the hook (1) comprises a hook section (11) and a transition section (12), and the transition section (12) is connected with the arc-shaped connecting rod (2); the tail end of the hook section (11) is connected with the transition section (12), the starting end of the hook section (11) is bent inwards, and the transition section (12) enables the hook (1) to be in smooth transition connection with the arc-shaped connecting rod (2);
the arc connecting rod (2) comprises a first arc section (21) and a second arc section (22), the end part of the first arc section (21) is connected with the end part of the second arc section (22), and the first arc section (21) and the second arc section (22) are arranged in an acute angle;
the cross sections of the hook sections (11) and the arc-shaped connecting rods (2) are both oval, and the eccentricity of the cross section oval of the hook sections (11) is greater than the eccentricity of the cross section oval of the arc-shaped connecting rods (2).
2. The apparatus for establishing a laparoscopic total extraperitoneal hernia repair workspace according to claim 1, wherein the separation scoop comprises: a spoon-shaped front end (7) for separating the deep layer of the transverse fascia ventralis from the peritoneum, a connecting rod (8) with one end connected with the spoon-shaped front end (7), and a spoon handle (9) connected with the other end of the connecting rod (8).
3. The device for establishing a laparoscopic total extraperitoneal hernia repair workspace according to claim 1, wherein the first circular arc segment (21) and the second circular arc segment (22) are arranged at 15-45 °.
4. Device for establishing a laparoscopic total extraperitoneal hernia repair working space according to claim 1, wherein the starting end of the hook segment (11) is blunt.
5. Device for establishing a laparoscopic total extraperitoneal hernia repair working space according to claim 1, wherein the protrusions (3) are hemispherical protrusions, toothed protrusions, truncated cone-shaped protrusions or inverted bowl-shaped protrusions.
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| CN201811435261.0A CN109363734B (en) | 2018-11-28 | 2018-11-28 | Device for establishing working space of laparoscope complete extraperitoneal hernia repair operation |
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| CN201811435261.0A CN109363734B (en) | 2018-11-28 | 2018-11-28 | Device for establishing working space of laparoscope complete extraperitoneal hernia repair operation |
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| CN109363734B true CN109363734B (en) | 2021-01-15 |
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| US8726909B2 (en) * | 2006-01-27 | 2014-05-20 | Usgi Medical, Inc. | Methods and apparatus for revision of obesity procedures |
| US9955957B2 (en) * | 2011-09-09 | 2018-05-01 | Endogastric Solutions, Inc. | Methods and devices for manipulating and fastening tissue |
| USD754855S1 (en) * | 2014-11-24 | 2016-04-26 | Ethicon, Inc. | Curved tissue fastening device |
| DE102016201022A1 (en) * | 2016-01-25 | 2017-07-27 | Igor IGOV | HERNIA REPAIR DEVICE, SYSTEM AND METHOD |
| CN106264667B (en) * | 2016-08-29 | 2018-10-30 | 陈少骥 | A kind of preperitoneal space separator |
| CN107951518B (en) * | 2017-12-26 | 2024-03-15 | 暨南大学 | Drag hook for laparoscopic weight-reduction surgery |
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