RU103464U1 - SURGICAL BINDING MACHINE - Google Patents

Abstract

 1. Surgical stapler, made detachable and containing a pusher, a stop and bracket blocks, each consisting of a working part and a holder, the holder of the stop block serving as a holder of the apparatus, made hollow and includes holders of the bracket block and pusher, which, while moving relative to it, clamp stitched fabric introduced into the gap between the working parts of the thrust and bracket blocks, while the holders of the pusher, bracket and thrust blocks are shifted to the edge of the working parts, from the side of which the gap in a stitched fabric is introduced, characterized in that reinforcing gaskets and two pairs of spring-loaded clamp strips with pins at the ends are inserted into holes on the stop block body and the bracket block case on each side to hold the reinforcing gaskets, while the bracket block store contains three a series of staples arranged in a checkerboard pattern. ! 2. A surgical stapler, made detachable and containing a pusher, a stop and bracket blocks, each consisting of a working part and a holder, the holder of the stop block serving as a holder of the apparatus, made hollow and includes holders of the bracket block and pusher, which clamp relative to it stitched fabric introduced into the gap between the working parts of the thrust and bracket blocks, while the holders of the pusher, bracket and thrust blocks are shifted to the edge of the working parts, from the side of which the gap in a stitched fabric is used, characterized in that reinforcing pads and closed rectangular spring-loaded clamp frames are inserted into it, which are installed�

Description

The invention relates to medical equipment, namely to surgical staplers intended for stitching organ tissues by suturing using metal braces using minimally invasive access technology.

The creation of cross-linking surgical devices is an urgent task of medical technology, since suturing mechanically (using a mechanical stapler) in comparison with the manual method gives better results on the quality of the suture and, accordingly, reduces the number of postoperative complications and reduces the time of postoperative rehabilitation.

The principle of operation of most surgical staplers (CSA) is as follows. Prior to suturing, HSA squeezes two edges of the organ tissue to the necessary gap with the working parts of the stapler, then pierces it with metal brackets, the legs of which are bent and take a B-shape, stitching the fabric.

According to this principle, the well-known in medical technology CSA brand UO-40 [1].

Especially important is the creation of staplers, allowing the use of minimally invasive access technologies, which significantly reduce the time of postoperative rehabilitation. The difficulty of the solution lies in the fact that the stapler should be small-sized, especially for access from a narrow surgical field no more than 4 centimeters in length, while simultaneously performing several operations and functions.

The closest in technical essence to the proposed device is a surgical stapler SU-80 according to the patent for utility model No. 46916 with priority dated July 8, 2003, selected as a prototype [2].

This known HSA device is a schematic, exploded view, shown in FIG. 1, where:

1 - thrust block with a matrix in the plane a to form a bend of brackets;

2 - bracket block;

3 - nut moving bracket unit;

4 - a pusher;

5 - vane screw for moving the pusher;

6 - a fixing plate;

7 - a store with brackets in two rows.

The pusher, thrust and bracket blocks consist of each of the working part and the holder.

The device in assembled form is presented in figure 2, where the bracket unit 2, with the magazine 7 located inside it and the pusher 4, is placed in the housing of the thrust unit 1 and fixed by the plate 6.

When the nut 3 is rotated, the bracket block 2, together with the magazine 7 and the pusher 4, moves relative to the stop block 1. When the screw 5 is rotated, the pusher 4, moving relative to the magazine 7 and bracket 2, squeezes the brackets located in it in two rows from the magazine.

The operation of the apparatus is as follows. The working parts of the assembled apparatus are introduced into the surgical incision in a circular motion, two edges of the organ tissue are inserted into the gap between the thrust block 1 and the bracket block 2 and fixed in the gap by the plate 6. The nut 3 is pulled to the bracket 2, together with the magazine and pusher moves relative to the thrust block 1 so that the plane a of the magazine 7 approaches the plane a of the matrix of the thrust block 1, clamping the two edges of the organ tissue. When the plane a of the magazine 7 charged by the brackets approaches the plane a of the matrix of the thrust block 1 to the required working gap, which is controlled by the marks on the device’s body, by twisting the wing screw 5, the pusher 4 is moved along the bracket block 2 and the plate of the pusher enters the grooves of the magazine 7, as a result, the brackets are pushed out, the stitched fabrics are punctured and, resting against the matrix, take a B-shape, holding the tissues together. The width of the working gap of the SU-80 apparatus is 0.8 × 2.3 mm, the dimensions of the brackets used are 0.3 × 4 × 4.8 mm.

CSA SU-80 allows operations using technologies of minimally invasive access, that is, through a very compact surgical incision of 40-50 mm.

This is achieved by the fact that the holders of the pusher, thrust and bracket blocks are offset to the edge of the working parts, from the side of which a stitching fabric is introduced into the gap between the bracket and thrust blocks.

The disadvantage of this device is the difficulty of obtaining an airtight seam on loose tissue structures, for example, with bullous-emphysema lesions of the lung, lesions of other parenchymal organs, which leads to the cutting of organ tissues with staples with suture failure. This causes postoperative complications - bleeding, leaks, inflammatory and adhesions, etc., and leads to a significant increase in the patient’s recovery time.

The objective of the present invention is to provide a device that ensures the consistency (tightness) of the seam on the loose structures of tissues of organs.

To solve the problem with the aim of increasing the strength of the seam, it is possible to use reinforcing fabric in the form of a gasket, both biological (pleuro-fascial-muscular-periosteal flaps cut from the intercostal space; xeno-peritoneum, etc.) and of synthetic origin (such as polytetrafluoroethylene), which strips are superimposed on the stitched organ on both sides in the seam area. This stitching technique is used with the manual method of suturing, but it is very problematic with mechanical stitching, especially with minimally invasive access technology. This is due to the fact that the strips of the reinforcing strip must be fixed in the desired seam area and at the same time stitching of the organ through the surgical incision 40 ÷ 50 mm. To date, this problem has not been solved.

To solve the problem on a stapler, made detachable and containing a pusher, a thrust and bracket blocks, each consisting of a working part and a holder, the thrust block holder serving as a holder of the apparatus, made hollow and includes holders of the bracket block and pusher, which, moving relative to clamp the stitched fabric inserted into the gap between the working parts of the thrust and bracket blocks, and the holders are shifted to the edge of the working parts, from the side of which into the gap between the bracket and thrust blocks stitched fabric is introduced from two sides: around the matrix of the thrust block 1 and on the bracket block 2 around the magazine 7, strips of a reinforcing strip are fixed. Fixing of reinforcing gaskets is carried out using removable elements, for example, using two pairs of spring-loaded by the method of fixed bending, pressure bars 8 with pins 9 on both sides, which are inserted into the hole 10 made on the housing 1 and the housing of the bracket unit 2; the strips of the reinforcing strip are located between the pins 9 of the strips 8, are pressed against the body of the thrust block 1 and to the body of the bracket block 2 from each side with spring-loaded strips 8 (Fig. 3).

The sequence of steps when using the proposed stapler is as follows. Before introducing the apparatus into the surgical incision, two strips of reinforcing gasket are cut and secured with spring-loaded clamping strips 8 in the form of a semicircle: one around the matrix of the thrust block 1, the second around the magazine 7 of the bracket block 2. The apparatus is ready for introduction into the surgical incision.

After performing the operations of suturing, similar to those indicated for the device of the stapling apparatus prototype SU-80, the straps 8 are removed from the holes 10 of the housing with a tool and removed through the surgical incision.

The reinforcing gasket is then not connected to the stapler and can be removed through the surgical incision without damaging the seam.

In order to increase the tightness by increasing the area of the stitching part of the fabric due to the increase in the width of the seam, the shop 7 of the stapler is used with several (two or more) rows of metal staples arranged in a checkerboard pattern. This allows to reduce the load per unit area of the stitching tissue, thereby reducing its invasiveness and improving the consistency of the seam.

Another option for fixing reinforcing gaskets is the use of two spring-loaded, for example, by the method of fixed bending, rectangular metal frames 11 shown in Fig. 4, which are worn: one on top of the gasket on the side of the body matrix 1, the second on top of the gasket from the magazine 7 of the bracket unit 2 The spring-loaded frames also press the gaskets to the apparatus body, after performing the suturing operations indicated above, they are removed from the apparatus with the tool and removed through the operating room incision.

The advantages of this embodiment of the apparatus can be attributed to a smaller number of fastening elements, which allows to reduce the time of their extraction, as well as more reliable fastening of the reinforcing strip due to the absence of movable fastening elements (pins 9, holes 10).

A possible material for the manufacture of the clamping frame according to the second embodiment may be silicone rubber.

The advantages of this option include lower cost and greater versatility when using reinforcing gaskets of different thicknesses, which is problematic with a metal clamping frame.

A patent search showed the absence of similar solutions and allows us to conclude that the claimed design does not follow explicitly from the studied prior art, that is, it meets the criteria of "novelty" and "inventive step".

The claimed device can be used in medicine during operations using technologies of minimally invasive access on loose structures of organ tissues.

The essence of the claimed technical solution is illustrated by drawings, where in figure 3 and figure 4 shows a modified part of the apparatus.

From the drawing it can be seen that the design allows the use of reinforcing gaskets when suturing mechanically, which leads to its viability.

A prototype of the proposed device was tested at the Central Research Institute of Tuberculosis RAMS Moscow in lung resection and showed good results:

seam tightness is achieved 40% more often than when using the old design CSA.

Thus, the proposed technical solution provides:

- a decrease in the level of postoperative trauma due to inconsistency of the suture, especially with loose tissue structures of organs;

- reducing the time of the operation.

Information sources:

1. Sewers of organs UO-40 and UO-60 of models 227 and 228. Information sheet of TsBNTI No. 1-01-225.

2. Patent for utility model “Surgical stapler” No. 46916 IPC АВВ 17/072 dated July 8, 2003 and application No. 2003/20873 / 22

Claims (3)

1. Surgical stapler, made detachable and containing a pusher, a stop and bracket blocks, each consisting of a working part and a holder, the holder of the stop block serving as a holder of the apparatus, made hollow and includes holders of the bracket block and pusher, which, while moving relative to it, clamp stitched fabric introduced into the gap between the working parts of the thrust and bracket blocks, while the holders of the pusher, bracket and thrust blocks are shifted to the edge of the working parts, from the side of which the gap in a stitched fabric is introduced, characterized in that reinforcing gaskets and two pairs of spring-loaded clamp strips with pins at the ends are inserted into holes on the stop block body and the bracket block case on each side to hold the reinforcing gaskets, while the bracket block store contains three a series of staples arranged in a checkerboard pattern. 2. A surgical stapler, made detachable and containing a pusher, a stop and bracket blocks, each consisting of a working part and a holder, the holder of the stop block serving as a holder of the apparatus, made hollow and includes holders of the bracket block and pusher, which clamp relative to it stitched fabric introduced into the gap between the working parts of the thrust and bracket blocks, while the holders of the pusher, bracket and thrust blocks are shifted to the edge of the working parts, from the side of which the gap in a stitched fabric is introduced, characterized in that reinforcing gaskets and closed rectangular spring-loaded compression frames are inserted into it, which are mounted on the thrust block body and the bracket unit holder on top of the reinforcing gaskets. 3. The surgical stapler according to claim 2, characterized in that the closed rectangular clamping frames are made of silicone rubber.