KR20110014548A - A method for forming a knot of stanching loop in a type of needle - Google Patents

Abstract

PURPOSE: A method for forming a knot of a penetration type womb hemostasis loop is provided to forms a rigid structure by comprising a body supporting a loop as a pipe of rigid material. CONSTITUTION: One side of a string which is connected to a needle winds a guiding part(11) of a body. A string penetrates inside the body in state when the needle is removed. As the string which is winded to the body is forced to an external side of the main body, a knot is formed. A string which is temporarily fixed by being winded to the body locates a needle connection part(N) which a needle is connected to the guiding part in a handle side. A fixing part(B) is winded to the guiding part. The needle connecting part and the fixing part is crossed to each other. The fixing part covers the guiding part and the needle connection part.

Description

METHODS FOR FORMING A KNOT OF STANCHING LOOP IN A TYPE OF NEEDLE}

The present invention relates to a method of forming a knot in a laparoscopic uterine hemostasis loop, a laparoscopic through-type uterine hemostasis loop, and a laparoscopic through-uterine hemostasis loop, and more particularly, a through-hole and a guide groove for a line at the tip of the body. By combining the formed resin guide portion, the synthetic resin handle is coupled to the rear end of the body to guide the loop string made of a solid thread such as nylon to the guide of the body tip and then exposed to the outside of the handle through the hole of the handle. During laparoscopic surgery, the handle can be used as a rotary lever and the string can be pulled hard to bind the uterine fibroids firmly with a loop to hemostatically.In addition, the other side of the cord connected with the needle to the guide of the body is temporarily fixed by After removing the needle, pass the end of the needle side line through the guide of the body where the line is temporarily fixed. A line wound relates to a method of forming a knot in a laparoscopic slotted uterine bleeding loops be knotted firmly made pushed out to the outer body.

Uterine fibroids grow like a lump in the uterus mainly due to the effects of estrogen and progesterone and other growth hormones, a very common disease occurring in many women as they age.

When laparotomy is performed to remove uterine fibroids, the patient has a long recovery period and large stitches remain after the surgery.

Laparoscopic uterine leiomyoma removal is performed by inserting 3-4 trocars, inserting a camera and surgical instruments, and making incisions and peelings.

Unlike laparoscopic surgery, laparoscopic surgery has the advantage of fast recovery of the patient because the operation is performed by inserting a trocar with a small incision.

However, surgical removal of uterine fibroids involves a lot of bleeding, so it is necessary to build a lot of electricity to stop the bleeding.

Therefore, in order to prevent bleeding when uterine myoma is removed, penetrate the light ligaments on both sides of the uterus and use the thick nylon thread or the sap line to lignate around the lower uterine isthmus and block the uterine artery. Similarly, there was a way to reduce the bleeding by tying both ovarian arteries by tying them around the top of the uterus.

However, since such a method is manufactured and used by an operator using a conventional surgical nylon thread and an infusion line, such a thing is not produced as a separate product, and furthermore, the above method is possible only when the abdomen is opened, as in the present invention. Laparoscopic instruments for the purpose of uterine hemostasis is currently not available.

 As described above, there is no laparoscopic device for bleeding the uterus to suppress bleeding during uterine myoma surgery, but there is a laparoscopic vascular ligation loop that can be used similarly to this action, for ligation of blood vessels or small tissues. It is widely used.

As illustrated in the cross-sectional view of Figure 1, a conventional laparoscopic vascular ligation loop is formed by knotting the string (3) in the form of a loop (4) to draw off the cut blood vessels or bleeding tissue, the other of the string (3) The side guides the loop 4 to a tissue such as a cut blood vessel, and then the guide 1 is formed of a hollow tube made of a plastic material in which the guide hole 2 is formed to pull the loop 4. The rope 3 on the other side of the loop 4 is assembled to guide to the rear end of the guide 1 after being guided by the guide hole 2 formed at the front end of the guide 1. The loop 4 located at the tip end side of the guide 1 can be tightened by the knot 5 and cannot enter the guide 1 because it is larger than the guide hole 2 of the guide 1.

The conventional laparoscopic vascular ligation loop configured as described above is inserted into a trocar (not shown) to place tissue such as blood vessels to be bleeded so that the loop 4 envelops and then the cord exposed outside the guide 1. Pull the knot part 5 does not enter the guide hole (2), so that the loop (4) is tightened.

Therefore, the bleeding was reduced during the operation of the myoma of the uterus by blocking the circulation of the blood to the uterine myoma of the ovary, which was drawn into the loop 4.

However, the conventional laparoscopic vascular ligation loop cannot be used for the same purpose as the present invention because the strength of the thread is weak enough to compress the entire uterus and cannot be firmly knotted in the knotting method. In addition, there is a drawback that a dangerous situation may occur due to the end of the body sticking the tissue even when the thread is pulled or the thread is broken with a strong force even in the method of use.

The present invention was developed to suppress uterine bleeding during laparoscopic uterine surgery by applying a conventional laparoscopic ligation loop, and an object of the present invention is to secure a safety while using a rotating lever that can pull a string or a string strongly. It is to provide a laparoscopic uterine hemostatic loop in which the body is not bent and the loop knot is firm.

Another object of the present invention is to provide a laparoscopic penetrating uterine hemostasis loop capable of bleeding by hooking a loop even in a portion that cannot be tied by hanging the loop.

Still another object of the present invention is to provide a knot forming method of a laparoscopic penetrating uterine hemostatic loop.

The present invention has a constant length, by combining the synthetic resin guide to the front end of the body, by combining the synthetic resin handle to the rear end, by guiding the line of the loop through the guide and then exposed to the outside of the handle through the handle Is achieved.

In addition, uterine fibroids of a type that cannot be hooked by connecting a needle to a string instead of a loop located on the front end side of the body can be achieved by configuring the bleeding around the uterus to allow hemostasis.

The present invention relates to a method of forming a knot in a laparoscopic uterine hemostasis loop,

Winding the other side of the string connected to the needle 20 to the guide portion 11 of the body 10 to the guide portion temporarily fixed,

This is achieved by passing the end of the needle 20 removed into the temporary fixed body 10, and then pushing the wire wound around the body 10 to the outside of the body 10 to make a knot.

As described above, the laparoscopic uterine hemostasis loop according to the present invention has a rigid body, which is composed of a rigid tube, which supports the loop when the loop is pulled, and uses the handle coupled to the rear end as a rotary lever to hold the string tightly. It can be pulled and tied tightly with a loop to have a hemostatic effect.

In addition, by using a needle connected to the body end side of the hemostasis loop, the part that can not hang the loop is sewn with a needle, and a loop shape is formed, and then hemostasis is performed by dragging.

In addition, the other side of the string connected to the needle to the guide portion of the body is temporarily fixed by winding the guide portion, and the end where the needle is removed is passed into the body where the string is temporarily fixed, and then the cord wound on the body is pushed out of the body to make a knot. By making it has the effect of making a firm fixing.

1 is a cross-sectional view of a conventional laparoscopic uterine hemostatic loop.
Figure 2 is a perspective view of the laparoscopic cervical hemostasis loop of the present invention.
3 is a cross-sectional view of FIG.
Figure 4 is a perspective view of a through hemostatic loop that is another embodiment of the present invention.
Figure 5 is an exemplary state of use of the laparoscopic penetrating cervical hemostasis loop of the present invention.
6 is an exemplary state of use showing the ligation of the uterus using the penetrating hemostatic loop of FIG. 4.
Figure 7 is an exemplary view showing a sequence of using a hemostatic hemostatic loop that is another embodiment of the present invention.
8A to 8I are photographs sequentially showing a method of forming a knot in the hemostatic loop of FIG. 4.

Hereinafter, an embodiment of the present invention will be described in more detail with reference to the accompanying drawings.

As illustrated in Figures 2 to 6, the laparoscopic uterine hemostasis loop of the present invention is provided with a body 10 formed of a desired length, and a synthetic resin handle 14 at the rear end of the body 10, the front end portion The synthetic resin guide portion 11 is coupled to guide the synthetic resin loop line. The body 10 may be made of a rod or tube of rigid material, and may be made of a material having other corresponding characteristics. For example, the guide portion 11, the body 10, the handle 14 may be integrally made of synthetic resin or stainless steel.

The tip portion of the synthetic resin guide 11 is preferably not formed sharply and bluntly edged so as to prevent a dangerous situation even if the tissue is punctured.

The handle 14 serves as a rotating lever when pulling the string (S). In other words, by hanging on the handle 14 to hold the rope with a general surgical forceps can be pulled tightly.

The front end of the body 10 is preferably a synthetic resin guide portion 11 is coupled to prevent friction of a rigid string such as nylon.

The guide portion 11 is formed with a guide hole 13 in the longitudinal direction such that a loop (R) string is guided at the tip end, and the guide hole (13) also has an inclined guide groove (12) formed in the longitudinal direction at the side surface; In communication.

A knot M1 is formed at one end of the string to form a loop R and the knot M1 is larger than the guide hole 13 so that the knot M1 pulls the string to tighten the loop R. 13) The string is pulled without passing through, and the loop R is tightened.

The knot M1 for tightening the loop R is formed of a 4S modification of Roeder knot. The 4S modified Röder knot is published in the article "Sharp HT, Dorsey JH. The 4-S modification of the Roeder knot: how to tie it. Obstet Gynecol. 1997 Dec; 90 (6): 1004-6."

The protective device 13 and the body 10 of the synthetic resin material may be coupled in such a manner that the coupling groove 10-1 and the coupling protrusion 11-1 are fitted. And it can be completely fixed by using an adhesive when fitting.

For example, a coupling groove 10-1 is formed at the distal end of the body 10, and the coupling protrusion 11-1 is formed at an outer circumference of one side of the guide part 11 corresponding to the coupling groove 10-1. Can be formed.

Although the body 10 has been described as a stainless steel rod, the body 10 may be made of a stainless steel tube and other metal materials, which are harmless to the human body and have strength.

In addition, the body 10 of the laparoscopic uterine hemostasis loop should be made of an outer diameter smaller than the inner diameter of the trocar so as to freely enter and exit through a trocar (not shown) inserted into the abdominal wall during laparoscopic surgery.

The inclined guide groove 12 is preferably formed in a curved surface to minimize the friction force to prevent the string (S) is broken due to friction when pulling the string.

The row of loops (R) located at the tip of the body (10) is guided through the guide hole (13) of the synthetic resin guide (11) to the inclined guide groove (12) of the guide part (11) and then to the stainless steel body (10). ) Is guided to the hole 15 of the synthetic resin handle 14 provided on the rear end side (the opposite side of the loop) and is exposed to the outside of the handle.

Then, the uterus is pulled to the uterus to remove the laparoscopic myoma hemostasis loop of the present invention, the uterus is tightened and the blood supply to the uterus is blocked.

When tightening the uterus (S) can be pulled hard by using the handle (14) portion of the rotary lever as a loop (R) can tightly bind the uterus.

In addition, the laparoscopic cervical hemostasis loop of the present invention may be composed of a through loop in which the needle 20 is coupled instead of the loop R formed of the string S. Needle 20 constituting the through-loop is preferably made of plastic, the tip is preferably configured in the form of a peak (cone with a pointed tip) and should be formed bluntly without being too pointed at the tip. In addition, the jaw 22 is formed so as not to fall backward after the peak portion penetrates through the ligament, and a plurality of grooves 21 are formed at the rear of the jam jaw 22 so as to biopsy forceps for laparoscopy () (Not shown). And the rear end of the needle behind the groove 21 is configured in the form of a flat plate to be held by a conventional laparoscopic needle holder (needle holder) (not shown). That is, the needle 20 can be handled by holding the groove 21 portion as a laparoscopic tissue biopsy forceps or by grabbing the flat portion of the needle rear end with a laparoscopic needle forceps.

And, the string (S) is preferably connected integrally during the injection molding of the needle (20).

The needles 20 are formed at intervals so that the needles 20 can be easily gripped with forceps.

When the needle 20 is coupled in this way, the groove 21 of the needle 20 is held by the laparoscopic biopsy forceps (not shown), and the needle is held. You can bleed around your uterus to bleed.

For example, as illustrated in FIG. 5, the uterus may be ligated with a laparoscopic uterine hemostatic loop of the present invention to block blood circulation to uterine myoma.

In addition, as illustrated in FIG. 6, a hole is formed in the thin ligament of the light ligament and then penetrated through the needle 20 of the penetrating loop R to enclose the uterine artery A, and both ovarian arteries B and C. Ligation may block blood circulation to fibroids.

The knot M2 is located in the handle side of the needle connecting portion (N) connected to the needle to the guide portion 11 as shown in the photograph forming sequence of the knot in Figure 8a to 8i, the other side of the needle is not connected After winding the fixing part (B) to the guide part 11 several times, the fixing part (B) is fastened to the needle connecting part (N) by crossing the fixing part (B) with the guide part (11). ) Is positioned on the guide part 11 to be wound.

Then, in the state in which the needle connecting portion (N) is in contact with the end side of the guide portion 11 is wound around the fixing portion (B) several times to surround the guide portion 11 and the needle connecting portion (N) together, The hook (E) is made of a fixed part (B) and the guide part 11 is wound to the fixed part (B) in the opposite direction to the winding direction, and then the fixed part (B) and the needle connecting part (N) are guided by passing the loop (E). It is fixed to the part 11 together. Thereafter, the fixing part B is inserted into the fixing hole 16 of the guide part 11 to temporarily fix the fixing part B of the string to the guide part 11.

Using the needle 20 to wrap the cord around the tissue, cut the needle 20 which is pulled out of the abdominal cavity (cut the needle of the needle and remove the needle), and then insert the fixed portion B into the fixing hole 16. From the fixing hole 16. After inserting the needle connection portion (N) cut out the needle 20 into the guide hole 13 of the guide portion 11 to pass through the inclined guide groove 12 and guides to the hole 14 of the handle 14.

Then, the portion wound on the guide portion 11 is pushed out of the end portion of the guide portion 11 to pull the string around the knot to complete the knot shape.

In this case, the completed knot is formed as a 4S modification of Roeder knot, which is the same as the knot M1.

That is, the knot M2 formed by winding a line on a photograph is a temporary knot, and the needle 20 is cut out as described above, and the fixing part B fixed to the fixing hole 16 is removed, and then the connecting part N ) Is inserted into the guide hole 13 to guide the inclined guide groove 12 and the hole 15, and then the knot M2 temporarily formed on the rod must be pushed out of the rod end to form a knot. 4S modification of Roeder knot same as knot M1.

However, here, for convenience, a method of forming a knot M2 on the rod is illustrated, but in reality, the knot M2 is formed on the guide part 11 as shown in the photograph, and the fixing part B is a fixing hole of the guide part 11. The needle 20 is fixed to and fitted to the needle connecting portion N on the other side.

As described above, the fixing part B of the other side to which the needle 20 is connected is wound in the fixing hole 16 of the guide part 11 after winding the needle connecting part N, and the knot M2 is not completely made. It is a state. Therefore, when the needle connecting portion N is not later inserted into the guide hole 13 of the guide portion 11, the line wound on the guide portion 11 is released.

The knot M2 cuts out the needle 20 and then inserts it into the fixing hole 16. The fixing portion B is removed from the fixing hole 16, and then the end of the needle connecting portion N is inserted into the guide hole 13. After inserting the needle connecting portion (N) through the inclined guide groove (12), the knot (M1) wound on the guide portion (11) is pushed out of the end of the guide portion (11) and pulls the string around the knot. Knot M1 is made.

Laparoscopic penetrating cervical hemostasis loop of the present invention configured as described above may be used in the order of (a) to (e) in FIG.

That is, after guiding the through-loop to the tissue, such as the uterus to hemostasis, using a needle 20 to surround the line around the tissue, cut the needle 20 taken out of the abdominal cavity and cut the line (S) of the fixing hole 16 Subtract

After the needle 20 is cut line (S) is pushed into the guide hole 13 of the guide portion 11 coupled to the front end of the body 10 to come out to the guide groove 12 and then the handle of the rear end of the body 10 (14) Exposed to the outside of the handle 14 through the hole (15).

Then push the knot (M2) portion fixed to the guide portion 11 of the front end of the body 10 to make a knot shape by pushing out of the front end of the body 10, the operation force (S) exposed to the handle 14 side (S) Pull) while pulling and rotating while pulling the body 10 is made in the knot M1 itself.

At this time, the handle 14 is preferably formed to be concave to be suitable for rotating the surgical forceps.

Handle 14 when rotating by holding the forceps serves as a rotating lever.

In this way, since the string S is guided to the guide portion 11 coupled to the front end of the body 10 and the handle 14 coupled to the rear end, the handle 14 can be pulled hard with a lever. A string (S) surrounding tissues such as the uterus tightly tightens tissues such as the uterus to block blood with uterine fibroids, thereby preventing excessive bleeding of the uterus.

As described above, an embodiment of the present invention forms a knot of the hemostatic loop through the hemostatic loop as shown in FIGS.

Although the preferred embodiments of the present invention have been described in detail above, the present invention is not limited to the above embodiments, and various modifications and variations can be made within the scope of the utility model registration claims, the detailed description of the invention, and the accompanying drawings. Such changes, deformations, and the like are, of course, within the scope of the present invention.

<Explanation of symbols for the main parts of the drawings>
10: body 11: guide
12: Inclined guide groove 13: Guide hole
14: Handle 15: Hole (of handle)
16: fixing hole 20: needle
S: line R: loop

Claims (3)

In the method of forming a knot of a laparoscopic hemostatic loop,
Winding the other side of the string connected to the needle 20 to the guide portion 11 of the body 10 to the guide portion temporarily fixed,
Laparoscopic through type, characterized in that the knot is made by passing the end of the needle 20 is removed through the line 10 is temporarily fixed to the body (10) and then the line wound on the body (10) outside the body (10) How to form a knot in the uterine hemostatic loop. The method according to claim 1,
The rope fixed to the body (10) temporarily fixed
Position the needle connecting portion (N) connected to the needle to the guide portion 11 to the handle side, and then wound the fixing portion (B), which is the other side where the needle is not connected, to the guide portion (11) and then fixed with the needle connecting portion (N). The fixing portion B surrounds the guide portion 11 and the needle connecting portion N together while the needle connecting portion N is brought into contact with the end side of the guide portion 11 while crossing the portion B. Winding so many times, and the fixed portion (B) is fixed to the guide portion 11, characterized in that the knot forming method of laparoscopic penetrating uterine hemostasis loop. The method according to claim 1,
Guide portion 11 is made of a synthetic resin material, the guide hole 13 is formed in the longitudinal direction to guide the string (S), the guide hole 13 is characterized in that the communication with the guide groove 12 of the side Knot formation method of a laparoscopic penetrating uterine hemostasis loop.

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