MXPA98006964A - Esternal elevator for disease of internal and epigastric inferior arteries - Google Patents

Abstract

The present invention relates to sternal elevator for dissection of internal thoracic and lower epigastric aterias consisting of a rigid vertical support (1), which has a curvature (11) in its upper part, extending said support, with a straight portion and transverse (12), and ending in a portion (13) straight and parallel to the upper end of the support, in said straight and transverse portion (12) is coupled a solid bar (2) with rack (21), through a medium coupling, said solid has upper and lower ends, at the lower end of the solid bar (2) is pivotably coupled a balancing device (3) having horizontal ends, and at the upper end of said solid bar is It projects a traction bending (22), said balancing device (3) has in each of its ends leaflets (31) mounted in a pivoting manner thereto, said elevator characterized in that the coupling means comprises e: a ring (41), movably attached to the straight and transverse portion (12), for transverse and rotational movement with respect to it, said ring is coupled to a ratchet holder (4), which has coupling folds (44) and a mechanism (42), said ratchet fastener (4), in turn slidably engages the solid bar (2) through said folds (44), thereby interacting the mechanism of nail (42) and the zipper (2)

Description

ESTERNAL ELEVATOR FOR DISTRIBUTION OF INTERNAL AND LOWER EPIGÁSTRIC THORACIC ARTERIES Description of the invention TECHNICAL FIELD OF THE INVENTION The present invention relates to instruments such as that used in the field of medicine, particularly in cardiovascular surgery, specifically to surgical instruments whose application is carried out in the dissection of arterial hemodyducts during coronary artery bypass surgery. myocardium BACKGROUND OF THE INVENTION Revascularization surgery of the heart requires the insertion or adaptation of arterial conduits that replace the diseased vessels with other more suitable alternates. So far specialists recognize that the use of arteries obtained from the individual who is subject to surgery, is the best option, because they give better results in the long term. Therefore, the collection of these alternate vessels is a necessary procedure in the practice of surgery that inevitably prolongs the surgical act, with the consequent fatigue of the surgeon and assistants, also causing the demand for more qualified personnel in the ward. of surgery. These circumstances cause the costs to rise, also increasing the risks for the patient that causes a practice of surgery in unfavorable conditions. Since 1946 Vineberg (Vineberg AM: Development of an anastomosis between coronary vessels and internal transplant / mammary artery, Can Med Assoc J 1946; 55: 1 17- 1 19) initiated the clinical application of the internal mammary artery (internal thoracic artery in the new anatomical nomenclature) to implant it in the myocardial tissue; in 1954 Murray and colleagues in their article entitled "Anastomosis of the systemic artery to the coronary /" (Can Med Ass J 1954; 71; 594-598), proposed the direct anastomosis of the same artery to the coronary vessels. In these early stages, the exposure and dissection of the artery was achieved with the use of conventional manual separators of the Volkmann or Farabeuf type, which resulted in the immobilization of a surgeon but, above all, an inconstant and insecure exposure of the patient. operative field caused by the fatigue of the assistant. 10 In later years, revascularization with saphenous vein as a hemoduct reached great popularity and myocardial revascularization was spread as a conventional therapeutic method (Fava / RG gold, Effler DB, Groves LK, et al: Direct myocardial revascularization by saphenous vein graft. Present operative techniqe and indications Ann Thorac Surg 1970; 10: 97-157 7 7). At the same time, the use of the internal thoracic artery began to be profiled as the best option due to the histological characteristics of this arterial duct, so there was a need to design appropriate instruments for its dissection. The first prototype of separator was developed by Rene Favaloro (Favaloro RG Unilateral self retaining retractor for use in mammal artery dissection. J Thoracic Cardiovascular Surgery 1967; 53: 864-865), and consists of a metal frame that on the one hand fits on the edge of the operating table by means of two posts, and on the other, engages adjustable claw spacers on height, by means of a screw mechanism, getting the exposure of the artery when suspending the sternum. From this separator have variants have arisen in the support and traction mechanisms, all of them have greater mechanical complexity, they need special fixings to the operating table as the Favaloro separator, which has to use two bars for its fixation, which takes up more space , the existing modifications of that same separator also need different mechanisms and different from the conventional ones for its fixation, including some others, they use special clothes for the operating room, besides they take time for their installation and frequently hinder the placement of the tubes that are used in extracorporeal circulation, without really achieving a significant improvement in relation to the original separator. In another approach to the problem, some modifications or adaptations are used to the sternal separator of Finochietto, using various mechanisms that elevate one of the branches of the separator to expose the retrosternal space as they lower the other branch (Chaux). This type of exposure, in our experience, limits the field of action of the surgeon, because the bar of the zipper prevents the free action of the right hand; The separator deforms the thorax wall during the transoperative period, which temporarily limits the exposure of the right profile of the heart, as well as dislocation of the chondrosternal joints or fractures of the frail sternum of the elderly by the traction and traction mechanism. In order to obviate the aforementioned drawbacks, it was thought to design a simplified separator that would take advantage of the sternal suspension, without the inconveniences of mounting an apparatus that requires special fasteners or that hinders or delays the placement of the extracorporeal circulation line. This separator comprises devices and elements that, in addition to solving the aforementioned drawbacks, represents a safer and more reliable way to perform the operative practices of patients undergoing myocardial revascularization surgery, which contributes to giving better margins of safety and confidence in the patients. doctors when treating patients. It is therefore an object of the present invention to provide a device that adapts to the conventional mechanisms that the operating tables have for fixing the pectorals, being able to modify the desired height or rotate it, do not obstruct or delay the placement of the extracorporeal circulation tubes. , does not obstruct the vision of the operative field, separates the tissues in a broad and constant way and without the need of an assistant, allows the exposure of the internal thoracic and inferior epigastric artery simultaneously, adapts to the patient's anatomy without causing injury, is Easy placement and allows the mobility of the operating table without having to rearrange the elevator.

BRIEF DESCRIPTION OF THE DRAWINGS Figure 1 represents an isometric and frontal perspective view of the assembly of the device of the present invention with all its details and components that form it. Figure 2 represents a front view of the rack assembly with its balancing device and your ratchet bra. Figure 3 represents a side view of the ratchet holder with all the parts that comprise it.

DETAILED DESCRIPTION OF THE INVENTION The present invention relates to an elevator for the dissection of inferior thoracic and internal epigastric artery, called Sternal Elevator for Dissection of Internal Thoracic Artery and Lower Epigastric Artery, as shown in front isometric perspective in Figure 1 . The lift is mainly composed of a support (1), by a rack assembly (2), attached to the support (1) by means of the ratchet holder (4). The rack assembly (2), in its proximal part to the patient, has a balancing device (3). The support (1) consists of a cylindrical bar, of any metallic or plastic material preferably rigid and sterilizable, whose diameter of said support (1) is such that it allows its adjustment in all conventional mechanisms that the operating tables have to fix the Pierneras The support (1) can be adjusted in variable height on the patient's chest by sliding it through the leg restraint mechanism, a situation that will depend on the need to adapt the patient depending on his corpulence. In accordance with the present invention, the support (1) is shaped in such a way as to allow it to rotate on its vertical axis to accommodate and adapt to the needs of the surgeon and the surgical time, but above all, the design in its form is such that does not interfere with other systems used in this type of surgery, as for example the case of the piping systems of the extracorporeal circulation pump, which can be seen in pictures A and B that are attached for a better understanding of their properties . In accordance with the concept of the present invention, the instrument as a whole by its functionality represents advantages over known instruments and techniques. The height of the support (1) can vary although the best results are obtained around 60 cm in length, also presenting a curvature in the form of a semicircle (1 1) whose angle of curvature is the necessary for the upper end of this device is located above the patient's chest without interfering in the surgical field. This piece of the device is extended at its upper end by a straight and transverse portion (12) ending in a straight and parallel portion (13) to the upper end of the support (1) ending in a rounded tip (14) whose function is to facilitate the coupling of the rack assembly (2) and allowing lateral mobility when sliding along the straight and transverse portion (12) by means of the ring (41) of the ratchet clip (4). The lateral mobility achieved allows to adjust the position of the elevator to the needs of the surgical time for the dissection of the arteries and the corpulence of the patient. This is a function that does not meet any separator used in this type of surgery. The rounded tip (14) allows easy insertion of the ratchet holder (4) and the straight and parallel portion (13) serves as a stop to the lateral movement of the rack assembly (2) as can be seen in figure 1 and in the B. The rack assembly (2) as referred to above is designed to have lateral movement on the straight and transverse portion (12) of the support (1) by means of the ring (41) of the ratchet fastener (4) , and in turn, this bra, allows you to have movement in a vertical direction, raising the sternal edge or the aponeurosis of the anterior rectus muscle by using the balancing device (3) and the claw-shaped valves (31), acting in this way, as a tissue separator. The body of the rack assembly (2) illustrated in FIG. 2 is a solid quadrangular prism bar with a zipper strip (21) on its front face. At the distal end the patient has a fold, (22) which has been designed in this way to allow a safe and comfortable restraint for the surgeon, making it easier to regulate the traction that is desired for each particular case. At its proximal end to the patient, the rack assembly (2) has coupled the balancing device (3), which is constituted by a free piece in the form of a balance, with a length such as to allow it to adapt to sternones of patients of different sizes, the balancing device (3) is a piece that has mobility similar to that of a balance because it is fastened to the rack assembly (2) by means of a free-bolt mechanism (33). Likewise, the balancing device (3) at its respective ends has two claw-shaped crazy valves (31) that make it possible to secure and facilitate the fastening of the tissues of the patients to the device. Due to the mobility of the balancing device (3) and the claw-shaped valves (31), the elevator adapts to the shape of the sternum of each individual, a situation that can be observed well in the photograph B included for better understanding of the benefits of the invention, in this way, claw-shaped valves (31) suspend the sternum without causing injury, this is a very important feature that is not met with the other separators that exist in the market. The two claw-shaped valves (31) are flat and curved and end in several points (32) that give it the shape of a claw and at the same time provide the necessary firmness to hold and maintain the tissues in a constant and safe way. , but above all, during the desired time avoiding the use of an assistant with the consequent fatigue. Continuing with what is presented in Figures 1, 3 and 4, the lifting device of the present invention shows a ratchet fastener (4). The ratchet fastener (4) allows the movement of the rack assembly (2) since it is fastened to the latter by a fold on both sides (44) that embrace or fasten the rack assembly (2) so firmly but with the time so flexibly that it allows vertical movements on the face that has a scratched or jagged half of the zipper (21); at the end distal to the patient a ring (41) is presented by which it is fastened to the straight and transverse portion (12) of the support (1). The ratchet holder (4) further has a nail mechanism (42) with spring (43) that allows it to exert pressure and adjust the nail (42) on the scratched or serrated (21) of the rack assembly (2) fixing it from This way at the required height and for the time needed for each particular case. The instrument referred to above is efficient to elevate the half of the sternum sectioned longitudinally in cardiovascular surgery presenting the surgical field without the need of an assistant during the entire maneuver and exposing the internal thoracic artery during the routine dissection that must be done of it, in the myocardial revascularization surgery. novel design also allows, and in the same surgical time, the separation of the anterior rectus muscle from the abdomen to proceed with the dissection of the inferior epigastric artery, used in this type of surgery with the same purpose as the internal thoracic artery. The use of the inferior epigastric artery is a new surgical alternative that has been described by Puig et al: (Lower epigastrium artery as a free graft for myocardial revascularization, J Thorac Cardiovasc Surg 1990; 99: 251-256) where, to date The use of an automatic separator has not been described (Barner HB: New Arterial condufor coronary / bypass surgery, Sem Thoracic Cardiovascular Surgery 1994; 6 (2): 76-80). Furthermore, as the support (1) fin the conventional mechanisms that have the operating tables, being integrated to the latter, allowing their mobility together with the elevator to improve the surgeon's vision without performing any additional maneuver to rearrange it.

Installation technique: Next, in order to exemplify the novel features of the present invention, some of the installation modalities of the device as it has been conceived will be shown, without this understanding the limitation of the scope of what is claimed here. 1 . The elevator parts are sterilized in a steam autoclave, with a conventional cycle and wrapped in a double cotton cloth compress. Alternatively, they can be sterilized in an Ethylene Oxide autoclave. 2. Storage according to the standards of the Equipment and Sterilization Center. 3. In the operating room, the elevator is opened in the sterile surgical field, along with all other instruments that will be used in the operative act. 4. The anesthetic induction, the operating room technique and the sterile surgical group dress are conducted in the usual way. 5. When you want to install the elevator, the instrumentalist gives the sterile support (1) to the assistant, the technician of the operating room or non-sterile circulator lifts the split sheet on the desired side and exposes the clamp on that side. 6. The assistant taking the bar by the curvature (1 1) of the support (1), guides the insertion of the vertical bar into the clamp and gives position to the support at the desired height; it is recommended that it be 1 5 cm above the skin, the straight and transverse portion (12) is oriented in the direction of the longitudinal axis of the body by rotating the support (1). 7. The circulator adjusts the clamp in the position desired by the surgeon and without violating the sterile technique returns the sheet to its position. Elapsed time for the installation, 10 to 1 5 seconds which speaks of the quick assembly by a person of the sterile equipment with the support of the circulating one only to fix the support in the standard mechanism of the legs. 8. Surgical intervention is normally conducted and the zipper assembly (2) is placed and adjusted at the desired time (photograph B). 9. Once the dissection of the artery has been completed, the support (1) can be removed by performing the placement maneuver in the opposite direction.

Example of use: This new model of elevator has been tested in myocardial revascularization procedures where it has shown better performance than existing conventional separators and which are currently in common use in this type of surgery. Its main advantages have been that it occupies little space in the operative field, allows the visibility of the complete path of the vessels to be dissected, does not produce fractures or sternal dislocations, its mechanism is simple and its management accessible to the technician of non-specialized operating room. It has been shown that it does not hinder or complicate the installation of the extracorporeal circulation line as can be seen in photograph A. It also allows the dissection of the internal thoracic artery and at the same time the second surgeon can dissect the lower epigastric without interference from the thoracic artery. space and without the need of a third surgeon. Using two devices, one on each side of the operating table, allows simultaneous dissection of the contralateral inferior internal and epigastric thoracic artery, without interference between surgeons.

Claims (10)

CLAIMS:

1 . Sternal elevator for dissection of internal thoracic and lower epigastric arteries characterized in that it comprises: a support; a rack assembly that allows the lifting of tissues; a fixing means or ratchet fastener, which preferably working with the rack assembly allows raising the half of the sectioned sternum and the anterior rectus muscle; and a balancing device at the ends of which there are claw-shaped valves that are attached to the patient's body separating the tissues.

2. The sternal elevator for dissection of internal thoracic and lower epigastric arteries according to claim 1, characterized in that it also includes a support that has a design that does not obstruct the surgical field, which is inserted into conventional mechanisms or devices for securing the legs of any operating table.

3. Sternal elevator for dissection of internal thoracic and lower epigastric arteries according to claim 2, characterized in that the support has a curvature in its upper portion at an angle such that its upper end is above the chest of the patient without interfering with the surgical field.

4. Sternal elevator for dissection of internal thoracic and lower epigastric arteries according to claim 2, characterized in that the support at its upper end has a portion straight and transverse to this end in which it holds the ratchet holder.

5. Sternal elevator for dissection of internal thoracic and lower epigastric arteries according to claim 4, characterized in that the length of the straight and transverse portion is such as to allow lateral mobility of the rack assembly to adjust to the needs of the surgeon, weather surgical p and corpulence of the patient.

6. Sternal elevator for dissection of internal thoracic and inferior epigastric arteries according to claim 4, characterized in that it has a straight and parallel portion to the upper end of the support ending in a rounded tip that facilitates the insertion of the ratchet holder.

7. Sternal elevator for dissection of internal thoracic and lower epigastric arteries according to claim 1 characterized in that the rack assembly has a design that allows to easily regulate tissue traction without injuring them, separating them and exposing a wide and constant surgical field .

8. Sternal elevator for dissection of internal thoracic and lower epigastric arteries according to claim 7, characterized in that the rack assembly has on its front face a scratched or toothed rack.

9. Sternal elevator for dissection of internal thoracic and lower epigastric arteries according to claim 7, characterized in that at its distal end the patient presents a fold that facilitates regulating tissue traction.

10. Sternal elevator for dissection of internal thoracic and lower epigastric arteries according to claim 7 characterized in that at its proximal end to the patient presents a balancing device with two claw-like crazy valves. The balancing device of claim 10, characterized in that it presents a balance movement due to a free-bolt mechanism that also allows it to be adapted to the patient's tissues. 12. The balancing device of claim 10, characterized in that at its ends it has two claw-like leaflets which, due to their mobility, adapt to the morphology of the tissues. 13. The balancing device of claim 10, characterized in that the claw-like leaflets have a curved shape ending in several tips that allow the fastening of the tissues 14. The elevator of claim 1, characterized in that the ratchet holder has a ring by which it is clamped from the transverse portion to the upper end of the holder allowing lateral movement of the rack assembly. 1 5. The elevator of claim 14, characterized in that said ratchet fastener has a fold on both sides of the face that engages the scratched or serrated for zipper while firmly but flexibly hugging the rack assembly allowing it to move in a vertical direction. 16. The elevator of claim 14, characterized in that said ratchet fastener has a nail mechanism that allows to fix the traction when the nail is inserted in the zipper. 17. The elevator of claim 1, characterized in that by working together the elevator parts separate the tissues and expose the entire inferior thoracic and internal epigastric arteries facilitating their dissection during myocardial revascularization surgery.