EA038346B1 - Universal wound retractor - Google Patents

Abstract

The invention relates to medicine, in particular, to surgical instruments, and may be used during surgical operations on abdominal cavity organs. Wound retractor contains fixtures which are inserted to operating table guides, and two vertical rods are installed into these fixtures. Two horizontal arcs are attached to these vertical rods using a pressure mechanism. The upper arc is directed to the upper part of the operating table which consists of two equal parts connected between each other with a coupling using a thread. The lower arc also consists of two equal parts having similar connection. Holders with a gear rake mechanism featuring mushroom shaped projections at the ends, to which different mirrors are connected, shall be passed through the arcs. After installation of this structure a surgeon gains an opportunity to move surgical wound edges apart in any plane and with any controlled tension. The proposed universal wound retractor allows to create conditions for enhanced and safe work of a surgeon during operations on abdominal cavity organs. The invention enables a better overview of the surgical field and facilitates significantly the surgeon's work.

Description

The invention relates to medicine, in particular to surgical instruments, and can be used in surgical operations on the organs of the abdominal cavity, small pelvis.

The retractor contains fasteners that are inserted into the guides of the operating table and are fixed; two vertical posts are inserted into these fasteners, which are fixed using a clamping mechanism. Four horizontal semi-arched consoles are attached to the vertical posts using a clamping mechanism. The upper arcuate console is directed towards the upper part of the operating table, which is divided into two equal parts, the lower semi-arcuate consoles are directed towards the lower part of the operating table. Both consoles have a fastening sleeve at the end. Holders with a rack and pinion mechanism are held in the console, at the distal end of the slats of the rack and pinion mechanism there is a mushroom-shaped retainer, for which mirrors of various sizes and shapes are attached.

Known retractor (Fig. 1), containing two vertical posts with attachment elements to the operating table. A horizontal arcuate console is attached to the posts by means of a threaded connection. On the upper surface of the console there are cylindrical pins that serve for fastening hooks and a mirror (Mergenov M.M., Ukhanov A.P., Shpenkova A.A., Ignatiev A.I., patent RU 66935 U1, A61B 17/00, Wound expander universal abdominal, published bul. No. 28 of 10.10.2007)

The disadvantage of the analogue is that it does not have a mechanical element for translational, uniform and dosed dilution of the edges of the wound and the removal of adjacent organs of the abdominal cavity using mirrors, and also requires manual tension and retention of the mirrors when working with it, which causes certain difficulties when performing complex and laborious surgical operations.

The objective of the invention is to create a simpler design of the retractor, to reduce the number of parts of the apparatus, to create comfortable conditions for the surgeon's work.

The technical result is the creation of a good view and access to organs as a result of progressive and uniform dilution of the edges of the wound and abduction of organs with rigid fixation to improve the quality of operations.

The problem is solved by the fact that the universal retractor contains an attachment point to the operating table, two vertical posts, four horizontal semi-arched consoles, which are attached to the posts by a clamping system. Semi-arcuate consoles, in turn, can be connected into two arcuate consoles using a coupling; the upper arcuate console is directed towards the upper part of the operating table, which is divided into two equal parts; the two lower consoles are directed towards the lower part of the operating table; the consoles are tapered at the bending points so that the pressure mechanism of the toothed rack bar moves unhindered along its entire length. Clamping mechanisms with a toothed rack and pinion mechanism are held in the semi-arched consoles, the distal ends of the slats of the toothed rack and pinion mechanism contain a mushroom lock, for which, in turn, mirrors of any size and shape are fixed.

List of figures

FIG. 1 shows a universal abdominal retractor;

in fig. 2 - support posts;

in fig. 3 - fastening to the operating table;

in fig. 4 - upper and lower semi-arched consoles;

in fig. 5 - fastening the arc to the posts;

in fig. 6 - rack and pinion mechanism;

in fig. 7 - fastening the rack and pinion mechanism to the console;

in Fig .. 8 is a General view of the invention in assembly;

in fig. 9 - mirrors;

in fig. 10 - a component of a universal retractor;

in fig. 11 - universal retractor assembly;

in fig. 12 - universal retractor - the lower semi-arched console is divided into two equal parts;

in fig. 13 - disassembled universal retractor;

in Fig.14 - universal retractor in the installed form (option A);

in fig. 15 - universal retractor in the installed form (option B);

in fig. 16 - universal retractor in the established form (liver surgery).

The universal retractor consists of two vertical posts 1 (Fig. 2), which are fixed to the operating table by means of fasteners 2 (Fig. 3). The posts are attached by means of a clamping connection 3 (Fig. 5) horizontal semi-arched consoles 4 (Fig. 4), the ends of which contain a coupling 5 (Fig. 4). The upper arcuate arm 6 (Fig. 4) is directed to the upper part of the operating table and is divided into two equal parts 7 (Fig. 4). The lower semi-arched consoles 8 (Fig. 4) are directed towards the lower part of the operating table. Toothed rack mechanisms 9 (Fig. 6) with a clamping joint 10 (Fig. 7 and Fig. 8) are introduced into the console, at the end of the strips

- 1 038346 gear rack mechanisms there are mushroom clamps 11 (Fig. 6 and Fig. 8), to which mirrors of various sizes 12 are attached (Fig. 9, Fig. 10, Fig. 11).

It is based on the principle of hardware correction of surgical access, which allows performing operations on the abdominal organs and improving the quality of operations.

The proposed universal retractor allows you to evenly and progressively dilute the edges of the wound and remove the adjacent abdominal organs and perform any controlled displacement of the wound in the plane and space with rigid fixation during the operation.

The device works as follows.

During the operation, two vertical posts 1 (Fig. 2) are installed, which are attached to the guides of the operating table by pushing the clamping mechanism 13 (Fig. 3 and Fig. 8) and rotating the screw head 14 (Fig. 3 and Fig. 8).

With the help of fixing elements 3 (Fig. 5, Fig. 8), two horizontal semi-arched consoles 4 (Fig. 4), which are interconnected by means of a coupling 5 (Fig. 4 and 8).

The upper arc of the console 6 (Fig. 4 and Fig. 8), assembled from two separable parts, fixed by the coupling 5 (Fig. 4 and Fig. 8), is directed to the upper part of the operating table, the lower two half-arcs of the consoles 8 (Fig. 4 and Fig. 8), which can also be connected by means of a coupling 5 (Fig. 4 and Fig. 8), are directed to the lower part of the operating table.

Next, a rack and pinion mechanism 9 (Fig. 6) with a clamping connection 10 (Fig. 7) is passed into the arcs. The rack and pinion mechanism is a long rack in the form of slats, at the end of which there are mushroom clamps 11 (Fig. 6 and Fig. 8). To each mushroom-shaped retainer 11 (Fig. 6 and Fig. 8) mirrors of different sizes 12 are attached (Fig. 9, Fig. 10, Fig. 11). In the initial part of the mirrors there is an opening with a locking slot 17 (Fig. 9, Fig. 10, Fig. 11). The lifting of each bar is carried out by rotating the corresponding handle 15 (Fig. 6 and Fig. 8) of the fixing and movable element, fixed on the axis of the rack and pinion, while the slats move relative to the fixed sliders 16 (Fig. 6 and Fig. 8).

After the installation of this design, the surgeon has the ability to perform a uniform and progressive dilution of the edges of the surgical wound and to retrace adjacent organs in any plane and by any adjustable tension, creating conditions for a better view and safer work of the surgeon.

The offered universal retractor is easy to use, reliable, contains fewer parts, and allows the use of mirrors of various sizes and shapes. The device can be autoclaved. This invention allows to achieve a better view of the operating field and greatly facilitates the work of the surgeon.

Thus, the universal retractor makes it possible to create conditions for better and safer work of the surgeon during operations on the abdominal organs by abducting, fixing the abdominal organs and creating a good view of the operating field.

Example. Patient F., 45 years old, was admitted to the surgical department on an emergency basis with a diagnosis of perforated duodenal ulcer. Diffuse serous fibrinous peritonitis. With complaints of pain throughout the abdomen, nausea, vomiting, weakness. For 7 years, he has been suffering from duodenal ulcer, 8 hours ago there were sharp pains in the epigastrium, shortness of breath, cold sweat, pain that spread throughout the abdomen. She was at home due to the deterioration of her condition, an ambulance team was called, and the patient was taken to an urgent clinic.

On examination, the general condition was severe, conscious. The skin and visible mucous membranes are pale pink. The lymph nodes are not enlarged. Subcutaneous fat is poorly developed. Osteoarticular and muscular system without visible pathology. Free breathing through the nose. The rib cage is conical. Percussion over the lungs is determined by a clear pulmonary sound in all departments. Auscultation over the lungs in the lower parts of the weakened vesicular breathing, no wheezing. NPV 22 per min. There is no visible pulsation in the area of the heart and large vessels. Auscultatory heart sounds are muffled. Murmurs are not heard, the heart rhythm is sinus. Heart rate 100 beats per minute. BP 110/70 mm Hg The pulse in the peripheral arteries is satisfactory. The kidneys are not palpable. Free, painless urination. Dark yellowish urine. The tapping symptom is negative on both sides. Tongue dryish, coated with white bloom. Swallowing is free. The abdomen is inflated, lags behind the act of breathing, on palpation it is sharply painful in all parts. From the xiphoid process to the navel, there is a postoperative scar up to 1 cm long; in the right iliac region, a scar up to 7 cm long is of regular shape, symmetrical, and participates in the act of breathing evenly. Symptom Shchetkin - Blumberg positive in all departments. On a digital examination of the rectum, the sphincter tone is preserved, and on the glove, feces are of a normal color.

Laboratory and instrumental research:

Blood group from 10/16/2018: AB (IV) second. Rh + (positive);

OAK from 10/16/2018: hemoglobin - 129 g / l; erythrocytes - 3.9x10 ¹² / l; CPU-0.98; leukocytes 10.6x10 ⁹ / l; hematocrit - 41%; stab - 2; segmented -84%; monocytes - 1%; lymphocytes - 2 038346

13%; ESR - 52 mm / h; OAM from 10/16/2018: color - yellow, transparency - slightly turbid, relative density - 1021; reaction - acidic, protein - 0.165; leukocytes - 3-4-3 in the field of view; er. unchanged - 1-1-2; epit.

transitional - 2-1-2; mucus ++; BHAK from 16.10.2018: urea - 10.9 mmol / l; glucose - 4.7 mmol / l; total bilirubin - 18.8 mmol / l; direct bilirubin - 3.79 mmol / l; indirect bilirubin - 15.01 mmol / l;

total amylase -24.2 g starch / h;

Analysis of feces for worm eggs from 10/15/2018: not found;

ELISA blood test for Anti-HIV from 15.10.2018: negative;

ELISA for HbsAg and HCV from 10/15/2018: negative;

PCR from 19.10. 2018: HCV positive

Blood micro-reaction from 03/17/2018: negative;

On the plain x-ray of the chest and abdominal cavity from 16.10. 2018: Chronic bronchitis. Pneumoperitoneum.

Ultrasound examination of the abdominal cavity from 10/16/2018: Expressed flatulence! There is a moderate amount of fluid in the abdominal cavity. Diffuse liver changes.

Fibrogastroduodenoscopy from 10/16/2018: on the anterior wall of the duodenal bulb, a large ulcer up to 2.0 cm with dense edges, without a bottom.

Electrocardiography from 10/16/2018: Sinus tachycardia with a heart rate of 100 beats per minute. The normal position of the EOS. Changes in the myocardium.

The patient was operated on after preoperative preparation. Performed verkhnesadinaya laparotomy, in the abdominal cavity up to 800 ml of serous turbid effusion with an admixture of bile. The imposition of fibrin filaments in the subhepatic space, lateral canals, small pelvis, on the loops of the small intestine, subphrenic spaces. On the front wall of the duodenal bulb ulcerative infiltrate with a diameter of up to 3.5 cm below the pyloric pulp by 0.7 cm, with a perforation of up to 0.5 cm. The abdominal cavity was sanitized, the perforated ulcer was excised. In the postbulbar section, there is ulcerative-cicatricial subcompensated extended stenosis with pronounced infiltration; duodenoplasty is not possible. A loop of a skinny loop was cut out below the Treitz ligament at a distance of 20 cm, 60 cm long, a duodenojejunoanastomosis was formed laterally to the end in front of the transverse colon. Formed a two-row jejuno-jejunoanastomosis end to the side. The abdominal cavity is flushed and drained with drainage tubes. Layered sutures on the wound, alcohol bandage.

The postoperative period was uneventful, the sutures were removed on the 8th day. Recovery.

Bibliographic data of the source of information:

1. Mergenov MM, Ukhanov AP, Shpenkova AA, Ignatiev AI, patent RU 66935 U1 - Universal abdominal retractor Official Bulletin of the Federal Service for Intellectual Property No. 28, 2007.

Claims (1)

CLAIM Universal retractor containing two vertical struts (1), mount (2), arcuate console (4), mirrors (12), characterized in that it contains a pressure mechanism (3), upper and lower arcuate consoles (6, 8), each of which it consists of two identical parts, interconnected by a coupling (5) by means of a thread; holders (10) with gear rack mechanisms (9), fixed to the consoles (6, 8), mushroom-shaped protrusions (11) are made at the ends of the strips of gear rack mechanisms (9) for fixing mirrors (12).