CN204233194U - A kind of endoscope-assistant surgery organ puncture fixture - Google Patents

Abstract

The utility model relates to the technical field of medical instruments, in particular to a fixing device for puncturing and supporting organs during endoscopic surgery, including a tube body, a traction needle, a traction line and a supporting part. A traction needle, a traction line and a supporting part are provided; the supporting part comprises a cover body with an arc-shaped surface and at least one set of flat support bodies, the support bodies are arranged symmetrically on the cover body, and the cover body penetrates through the A central hole is provided; one end of the pulling wire is connected to the support body, and the other end of the pulling wire extends from the cover body through the central hole to the outside of the cover body and connects with the pulling needle. The beneficial effect of the utility model is that it provides a laparoscopic organ puncture with simple structure and convenient operation, which can fully pull the organ under the pneumoperitoneum state, effectively expose the field of view of the operation site, and reduce the trauma caused by the operation to the human body. Fixtures.

Description

Organ puncture and fixation device for laparoscopic surgery

technical field

The utility model relates to the technical field of medical instruments, in particular to a fixing device for puncturing and supporting organs during endoscopic surgery.

Background technique

Laparoscopic surgery has been widely used clinically due to its small overall trauma and quick recovery.

Taking laparoscopic subtotal gastrectomy as an example, the human stomach is located behind the liver, along the cardia, gastric body, and pylorus, and about 50% of the gastric tissue on the side of the lesser curvature of the stomach is covered by the liver. As the liver is one of the most important organs of the human body, it receives dual blood supply from the hepatic artery and the portal vein at the same time, so its blood circulation system has a complex structure, and there are rich connections and interactions between various blood vessels, and the blood supply is rich. During the operation, a certain space is usually left between the liver and the stomach to ensure that the surgical field of view is fully exposed during the operation and to avoid unnecessary trauma to the liver. In traditional laparotomy for gastric surgery, an assistant is required to prepare a lifting tool for lifting the liver to expose the resected stomach before the operation. It has a certain thickness, and then the pulling needle with the pulling thread is passed through the center of the gauze from bottom to top, and the pulling thread at the bottom of the gauze is tied and fixed. During the operation, the traction needle is punctured from the anterior lower border of the liver to the abdominal wall at a suitable position, and the traction needle penetrates the liver and continues to puncture to the outside of the abdominal wall. Although this method uses multiple layers of gauze with a certain thickness, the lifting tool is still point-fixed and pulled on the liver. The greater the lifting degree, the greater the damage to the liver.

Considering the disadvantages of using traditional spot fixation to stretch the liver, the method of puncture and stretching the liver was changed to an assistant using a special retractor to continuously stretch the liver, so that the lesser curvature of the stomach was fully exposed and then the surgery was performed. However, during laparoscopic gastric surgery, the retractor that pulls the liver cannot enter the abdominal cavity, so the exposure of the lesser curvature of the stomach is done by poking forceps or a retractable baffle from the abdominal wall into the abdominal cavity, and the assistant continues to provoke Liver, in order to achieve the purpose of exposing the field of view of gastric surgery. This exposure method has the following obvious defects: 1. When using forceps or a retractable baffle to stir up the liver, it is easy to damage the liver tissue due to the difficulty in controlling the force and instability; 2. The assistant must continue to occupy a poking hole to Provoking the liver, you can’t free your hands, and you can’t effectively cooperate with the surgeon to perform the operation; 3. Due to the size limit of the abdominal wall poking hole, the size and shape of the forceps or the retractable baffle entering the abdominal cavity are not ideal, and cannot reach Satisfactory exposure effect.

The Chinese invention patent with the application number "201210035413.4", the authorized announcement number "CN 102579091B", and the title "A Hepatic and Stomach Retraction Device for Single-port Laparoscopic Spleen Surgery" discloses a single-port laparoscopic splenectomy The supporter of removing the liver during surgery, the supporter is a supporting umbrella, a retracting and spreading mechanism of the supporting umbrella and a backstop control mechanism, wherein the supporting umbrella is composed of a tubular umbrella handle and several Umbrella ribs, the umbrella handle passes through the guide hole set in the handle body, and the umbrella ribs are hinged to the head on the side of the front end of the handle on the umbrella handle; The backstop control mechanism is composed of several annular ratchets distributed axially along the surface of the umbrella handle with the tooth tips facing the tail of the umbrella handle, a ratchet hinged on the handle and a return spring. When implementing this invention to remove the supporter part of the liver, turn the rocker arm on the handle to the outside of the handshake, rotate the connecting arm, drive the fixed pulley to rotate, and thereby drive the steel wire rope to rotate, so that the support connected to the steel wire rope The rod can push the umbrella ribs to expand or retract. When the umbrella ribs are stretched to a suitable position, the rocker arm is turned into the handshake side and snapped into the groove, so that the pulley block can be prevented from continuing to rotate. The working principle of its backstop control mechanism is: after the umbrella handle is pushed towards the direction of the umbrella handle tail, it cannot retreat due to the effect of the ratchet and the ratchet, thereby ensuring that when the umbrella bone at the umbrella handle tail supports the organ, it will not It will be loosened backwards; and when the umbrella handle needs to be withdrawn, the ratchet can be loosened by turning the ratchet. The defects of the part of the liver supporter in this invention are: 1. Poor feasibility in actual operation. In single-port laparoscopic surgery, there is only one access hole in the abdominal wall, and the instruments that must be placed in this hole include mirror body, main operation Forceps and auxiliary operating forceps, the retractor device of the present invention is placed in the limited space, and the access holes are continuously occupied during the entire operation process, which will seriously affect the progress of the operation; 2. The assistant needs to adjust and monitor the supporting part in real time, 3. The parts are cumbersome and cumbersome. In laparoscopic spleen surgery or other laparoscopic surgery, the retraction of organs or viscera is a small part of the operation and should not take up too much time. operation process and the energy of the operator, but the retractor device in the present invention has many parts and a large device type. In actual operation, real-time monitoring and position adjustment are required, which wastes time and energy; 4. The structure is complex and flexible, and the more components More, the more serious the mutual interference, it is easy to cause the risk of blocking the operation and forming a blind area of operation, and the cost is higher, causing unnecessary economic burden to the patient.

Utility model content

The purpose of the utility model is to overcome the deficiencies of the prior art and provide a device for puncturing and fixing organs in endoscopic surgery, which includes a tube body, a traction needle, a traction wire and a supporting part. The traction needle and the traction wire are sleeved in the tube body and supporting parts;

The supporting part includes a cover body with an arc-shaped surface and at least one set of flat support bodies, the support bodies are symmetrically arranged on the cover body, and a central hole is formed through the cover body;

One end of the pull wire is connected to the support body, and the other end of the pull wire extends from the cover body through the central hole to the outside of the cover body and connects with the pull needle.

Preferably, the tube body is a double-lumen catheter divided into a main lumen and an auxiliary lumen, wherein the main lumen is sheathed with a supporting part, and the auxiliary lumen is sheathed with a traction needle.

Preferably, a baffle plate is clamped at one end of the pipe body.

Preferably, the cover body is an umbrella structure.

Preferably, one side of the support body is axially provided with a groove, and one end of the pulling wire is connected to the midpoint of the groove in the support body;

One end of the support body is hinged on the edge of the cover body.

Preferably, openings are symmetrically provided on the edge of the cover;

One end of the support body is inserted from the cover body through an opening to the outside of the cover body, and the other end of the support body is connected to the pulling wire.

Preferably, the cover body and the support body are of an integral structure.

Preferably, said fixation device includes a recovery catheter.

Preferably, the area of the unfolded plane of the support body is greater than or equal to the area of a circle formed by taking the length of the support body as a radius.

Preferably, the pipe body has a diameter of 6-10 cm and a length of 11-15 cm;

The length of the traction needle is 10-14cm;

The length of the pulling line is 15-30cm;

The length of the support body is 3-6 cm, and the thickness is 0.2-1.2 mm.

The beneficial effect of the utility model is that it provides a laparoscopic organ puncture with simple structure and convenient operation, which can fully pull the organ under the pneumoperitoneum state, effectively expose the field of view of the operation site, and reduce the trauma caused by the operation to the human body. Fixing device: When the utility model is used to puncture and fix organs, the puncture safety is high, the damage of acupuncture is small, the force on the organ is in the state of surface force, the state of force is stable, and it can always maintain continuous traction during the operation , will not affect the operation due to the repeated falling of the tracted organ, and at the same time release the right auxiliary forceps, which is more conducive to the rapid operation. The utility model can not only be used for continuous stretching of the liver in laparoscopic subtotal gastrectomy, but also can be used in operations such as puncturing and pulling the stomach during pancreatic surgery (the puncture point needs to be sutured), and the scope of application is not limited.

Description of drawings

Fig. 1 is the structural representation of the utility model;

Fig. 2 is the structural representation of pipe body part in the utility model;

Fig. 3 is a schematic diagram of the deployment process of the utility model;

Fig. 4 is the structural representation when the utility model is fully expanded;

Fig. 5 is the front view of Fig. 4;

Fig. 6 is the top view of Fig. 4;

Fig. 7 is another structural representation of the utility model;

in:

1-tube body 2-pull needle 3-pull line

4-supporting part 41-cover body 411-central hole

412-opening 42-support body 421-groove

5- Baffle

Detailed ways

Below in conjunction with accompanying drawing and specific embodiment, the utility model is described further.

Example 1:

A laparoscopic surgery organ puncture and fixation device as shown in Figures 1 to 6 includes a tubular body 1, a traction needle 2, a traction wire 3 and a supporting part 4, and the traction needle 2, Pull line 3 and supporting part 4.

The tube body 1 is a double-lumen catheter divided into a main lumen and an auxiliary lumen, wherein a supporting part 4 is sleeved in the main lumen, a traction needle 2 is sleeved in the auxiliary lumen, and a baffle plate 5 is clamped at one end of the tube body 1 .

The supporting part 4 includes a cover body 41 with an arc-shaped surface and an umbrella structure, and two sets of support bodies 42 with a flat structure. The cover body 41 is provided with a central hole 411 through it, and four openings 412 are symmetrically provided on the edge of the cover body 41 , and the support body 42 is symmetrically arranged on the cover body 41 after passing through the openings 412 . The other end of the support body 42 is connected to each other and fixedly connected to the pulling wire 3 .

One end of the pulling wire 3 is connected to the support body 42 , and the other end of the pulling wire 3 extends from the inside of the cover 41 through the central hole 411 to the outside of the cover 41 and is connected to the pulling needle 2 .

The fixation device includes a recovery catheter 6 for recovery when the supporting part 4 is removed from the body.

The area of the unfolded plane of the support body 42 ≥ the area of a circle formed by taking the length of the support body as a radius.

When the pulling needle 2 is pulled, the pulling wire 3 is driven, and one end of the support body 42 inside the cover body 41 is pulled to the opening 412 of the cover body 41, and the other end of the support body 42 gradually protrudes from the opening 412. To the outside of the cover 41 until it is fully opened to support the liver.

After the operation is over, the interconnected ends of the supporting body 42 are pulled to make it return to the folded state, which is convenient for the supporting part to be taken out from the body.

Example 2:

The rest are the same as in Embodiment 1, a liver puncture fixation device for laparoscopic surgery as shown in FIG. 7 , the tube body 1 has a diameter of 9 mm and a length of 11 cm, and the length of the traction needle 2 is 10 cm.

The supporting part 4 includes a cover body 41 and a support body 42 of an integral structure, and one end of the support body 42 is hinged on the edge of the cover body 41, wherein:

The cover 41 is a spherical structure with an arc-shaped surface;

Described support body 42 is sheet-like umbrella structure, comprises four blades, and material used is the flexible macromolecule material that concrete memory shape is arranged; The surrounding free ends decrease gradually, wherein the thickness of the blades at the connecting end is 0.8mm, and the thickness of the blades at the free end is 0.4mm; the bottom of each blade is axially provided with grooves.

One end of the pulling wire 3 is connected to the midpoint of the inner groove of the blade.

The length of the pulling wire 3 is 20cm.

Actual clinical use case:

Taking laparoscopic proximal gastrectomy as an example, usually after pneumoperitoneum, a 10mm cannula 1 is poked at the umbilical foramen, a lens is inserted, and a 12mm hole is poked downward from the costal margin of the left anterior axillary line as the main operation port. , Poke holes 5mm above the left umbilicus and 5mm above the umbilicus are auxiliary operation holes, poke holes 5mm below the costal margin on the right anterior axillary line, and poke holes 12mm above the umbilicus on the right midclavian line.

After the operation is confirmed by exploration, the cannula is sent into the upper abdomen through the main operation hole, and the left auxiliary forceps stirs up the liver to expose the liver-gastric space. The main operating forceps grasps the rear end of the pipe body 1, and the left auxiliary forceps pushes the baffle plate 5 forward until the traction needle 2 and the supporting part 4 in the pipe body 1 are ejected. Take out the tube body 1, and leave the traction needle 2, traction wire 3 and supporting part 4 in the space between the liver and stomach. At this time, the ejected supporting part 4 has presented a sheet-like umbrella structure according to the memory function.

Hold the cover body 41 with the main operating forceps and the traction needle 2 with the left auxiliary forceps, select a suitable position from the anterior lower edge of the liver to puncture toward the abdominal wall, and continue to puncture the abdominal wall after penetrating the liver until the needle tip of the traction needle 2 passes through the abdominal wall. The assistant holds and pulls the needle 2 outside the abdominal wall with a needle holder, and the main and auxiliary forceps adjust the positions of the cover body 41 and the support body 42. After the position is adjusted properly, the assistant holds and pulls it with a needle holder outside the abdominal wall. The needle 2 is pulled outward from the abdominal wall until the cover body 41 and the support body 42 support the abdominal wall of the liver and stay away from the stomach wall. Puncture a piece of gauze outside the abdominal wall, tie the traction wire 3 and fix it on the external gauze of the abdominal wall, cut off the distal end of the knot and take away the traction needle 2, so as to provide a wide surgical field of view and operating space for the subsequent gastrectomy, and avoid repeated operation Affected by the falling of the liver and unnecessary damage, the right auxiliary forceps, which are routinely used to stir up the liver during the operation, are released at the same time. The right auxiliary forceps can be added to other surgical steps at will, which speeds up the operation.

After the operation, under the pneumoperitoneum state, use the auxiliary forceps to lift the liver horizontally to keep the liver in a fixed position, cut the traction line 3 at the proximal end of the outer abdominal wall knot, and remove the gauze punctured outside the abdominal wall and the traction line 3 at the distal end. The main operation hole casing is sent into the recovery conduit, the main operation tongs are used to grasp the traction line 3 near the cover body 41, and the supporting body 4 is gradually sent into the recovery conduit and kept in a folded state. The main operation tongs will recover through the main operation hole The catheter and the supporting body indwelling therein are taken out from the abdominal cavity together.

Comparative example:

In traditional laparoscopic proximal gastrectomy, usually after pneumoperitoneum, a 10mm cannula is poked at the umbilical foramen, and a lens is inserted. The left 5cm above the 5mm hole is the auxiliary operation hole, the right anterior axillary line is 5mm below the costal margin, and the right clavicular midline is 12mm above the umbilicus. All the main and auxiliary operation holes are placed with suitable sleeves. , Routinely use the right auxiliary forceps to stir up the liver, so that the lower edge of the liver is away from the stomach wall, providing a surgical field for the operation. This operation occupies the right auxiliary forceps. At the same time, because the right auxiliary forceps needs to be held by the human hand to lift the liver, long-term lifting of the liver cannot guarantee an ideal surgical space during the operation, and it is necessary to adjust the strength and direction of the right auxiliary forceps in real time. , Seriously affect the assistant's cooperation with the operation, involve energy and waste time, prolong the operation time, and affect the quality of the operation. Moreover, when using the right auxiliary forceps to pick the liver, the liver is in a state of stress, which will inevitably cause considerable damage to the liver.

The preferred embodiments of the utility model creation have been specifically described above, but the utility model creation is not limited to the described embodiments, and those skilled in the art can also make Various equivalent modifications or replacements are included within the scope defined by the claims of the present application.

Claims (10)

1. an endoscope-assistant surgery organ puncture fixture, comprise body (1), pull needle (2), draught line (3) and bearing (4), it is characterized in that: sheathed pull needle (2), draught line (3) and bearing (4) in described body (1);

Described bearing (4) comprises one and has the lid (41) on arc-shaped surface and the supporter (42) of at least one group of flat structure, described supporter (42) symmetry is laid on lid (41), and lid (41) runs through and is provided with centre bore (411);

One end of described draught line (3) connects supporter (42), and the other end of draught line (3) extends the outside of lid (41) through centre bore (411) and connects pull needle (2) in lid (41).

2. a kind of endoscope-assistant surgery organ puncture fixture according to claim 1, it is characterized in that: described body (1) is for being separated into the double channel catheter with main chamber and secondary chamber, the wherein sheathed bearing of main intracavity (4), the sheathed pull needle of secondary intracavity (2).

3. a kind of endoscope-assistant surgery organ puncture fixture according to claim 1 and 2, is characterized in that: plate washer (5) established by one end card of described body (1).

4. a kind of endoscope-assistant surgery organ puncture fixture according to claim 1, is characterized in that: described lid (41) is umbrella cover structure.

5. a kind of endoscope-assistant surgery organ puncture fixture according to claim 4, it is characterized in that: the side of described supporter (42) is axially arranged with groove (421), one end of draught line (3) is connected to the midpoint of supporter (42) inner groovy (421);

One end of described supporter (42) is hinged on the edge of lid (41).

6. a kind of endoscope-assistant surgery organ puncture fixture according to claim 4, is characterized in that: the edge of described lid (41) is arranged with opening (412);

One end of described supporter (42) is interted to lid (41) outside through opening (412) in lid (41), and the other end of supporter (42) is connected on draught line (3).

7. a kind of endoscope-assistant surgery organ puncture fixture according to claim 1, is characterized in that: described lid (41) and supporter (42) are integral type structure.

8. a kind of endoscope-assistant surgery organ puncture fixture according to claim 1, is characterized in that: described fixture comprises recovery conduit.

9. a kind of endoscope-assistant surgery organ puncture fixture according to claim 1, is characterized in that: the area of the expansion plane of described supporter (42) >=with supporter length is for the conglobate area of radius institute structure.

10., very according to a kind of endoscope-assistant surgery organ puncture fixture according to claim 1, it is characterized in that: the caliber of described body (1) is 6 ~ 10cm, and length is 11 ~ 15cm;

The length of described pull needle (2) is 10 ~ 14cm;

The length of described draught line (3) is 15 ~ 30cm;

The length of described supporter (42) is 3 ~ 6cm, and thickness is 0.2 ~ 1.2mm.