RU108286U1 - DEVICE FOR LAPAROSCOPIC CARRYING OUT THE LIGATURE LOOP IN THE ABDOMINAL CAVITY - Google Patents

Abstract

 1. A device for laparoscopic conducting a ligature loop into the abdominal cavity, consisting of a tube with a conical tip and a thread conductor, characterized in that it further comprises an outer tube with an oblique cut at the working end, while there is a pipe on the opposite end of the tube on which A threaded connection has a stopper made in the form of a nut with a corrugated rounded surface, inside of which there is a sealed gasket with a hole in the center. ! 2. The device according to claim 1, characterized in that the oblique cut at the working end of the outer tube is made at an angle of 45 °.

Description

The utility model relates to the field of medical technology, namely to endoscopic surgery and is intended for surgical treatment of patients with acute and complicated appendicitis using laparoscopic technologies.

Acute appendicitis is the main disease in the structure of emergency conditions of the abdominal organs in pediatric surgery. When performing surgical intervention with laparoscopic access, one of the most important steps is to ensure reliable ligation of the base of the appendix (elimination of communication between the dome of the cecum and the lumen of the appendix).

A device for eliminating the message between the dome of the cecum and the vermiform appendix - an applicator for titanium clips. It consists of 3 elements: a handle with a clamp, an external tube and an insert with clips. (Dronov A.F., Poddubny I.V., Kotlobovsky V.I. Endoscopic surgery in children / Moscow, 2002. - p. 36).

However, despite the apparent convenience, speed and ease of performing this manipulation, in some cases, technical difficulties may arise in performing this technique. So, for example, during surgery for complicated forms of appendicitis, there is often a mismatch between the size of the standard clip and the width of the appendix, which may require the use of more than 1 copy of the clip in order to reliably close the lumen of the appendix. Moreover, a pronounced inflammatory transformation of the base of the appendix and the dome of the cecum can lead to a technical complication such as teething and self-amputation of the appendix, which further requires the use of more invasive techniques to correct this complication. Another, less frequently encountered negative aspect of the use of clips is the loss of the last of the clipper when bringing to the base of the appendix. In addition, standard clippers require the use of 10 ml of accesses, which is the subject of discussion about the cosmetic effect in pediatric surgery.

There is another way to perform ligation of the base of the appendix using a laparoscopic loop, which is carried out in the abdominal cavity using reusable pushers, such as forks for lowering nodes, the loop conductor endo-loop (Dronov A.F., Poddubny I.V., Kotlobovsky V.I. Endoscopic surgery in children / Moscow, 2002. - p. 36). Despite the large selection of reusable loop pusher models, all of the tools presented have a drawback associated with the contact of the loop during the latter with valves of trocars of various designs, as well as the possibility of contact with the media of the abdominal cavity until the loop is connected to the appendix. The above circumstances may adversely affect the effectiveness of such manipulations as looping due to getting wet, which leads to a change in the physical characteristics of the latter. All this leads to impaired mobility of the loop, reduces the possibility of free manipulation by the operating surgeon, in some cases, requires replacement of the latter.

As the closest analogue in technical essence, a device for introducing a ligature loop and performing laparoscopic operations of Axiom firm has been adopted (Axiom product catalog / 2006 - p.14).

It consists of a tube and a thread conductor. The conductor tube is provided at the working end with a conical tip for holding the thread.

The thread conductor is a knitting needle provided with a ring at one end, and its end part is made in the form of a needle eye.

The tip has a diameter corresponding to a thread thickness of 0.5 or 0.8 or 1 mm.

The ligature loop in the abdominal cavity is as follows. The end of the thread, at the opposite end of which a loop is formed in advance, is threaded into the hole in one of the three tips (depending on the thickness of the ligature). The conductor is inserted into the tube and the free end of the thread is threaded into the hole on the flat end of the conductor. For the conductor ring, the thread is passed through the tube and removed from the conductor. The tip with the formed loop is screwed onto the tube by thread. After that, the node is introduced into the surgical field.

A disadvantage of the known device is the insecurity of the loop from external contact, which leads to the inconvenience of its passage through the valves of trocars of various designs and in direct operation in the area of surgical intervention. So, for the free passage of the laparoscopic loop through the valve apparatus of trocars of various designs, in some cases, the opening of the locking valve is required, which can lead to a decrease in intra-abdominal pressure. After passing through the trocar, the laparoscopic loop contacts the environment of the abdominal cavity, changes its physical characteristics. This leads to impaired mobility of the latter, the ability of the operating surgeon to freely manipulate the loop is limited, and the time of surgery is lengthened. In some cases, it may be necessary to replace the loop with a new one, which leads to an increase in the cost of the operation.

The objective of the utility model is to create a simple and reliable device for laparoscopic conducting the ligature loop into the abdominal cavity, which allows protecting it from damage, ensuring quick passage through trocars of various designs and bringing to the surgical intervention zone.

The essence of the utility model consists in the fact that the device for laparoscopically conducting the ligature loop into the abdominal cavity, consisting of a tube with a cone-shaped tip and a filament conductor, additionally contains an outer tube with an oblique cut at the working end, while at the opposite end of the tube there is a pipe on which by means of a threaded connection, a limiter is installed, made in the form of a nut with a corrugated rounded surface, inside of which there is a sealed gasket with a hole in the center.

An oblique cut at the working end of the outer tube is made at an angle of 45 °.

Using the utility model allows to obtain the following technical result.

A device for conducting laparoscopic looping into the abdominal cavity is simple to assemble and convenient to operate.

Provides speed, reliability of the laparoscopic loop through trocars of various designs.

It eliminates contact with the environment of the abdominal cavity and creates a loop protection from getting wet, allows you to bring the latter directly to the area of surgical intervention.

The risk of unsuccessful attempts to impose a loop on the base of the appendix is reduced, the need to repeat the indicated step is prevented, and the time of the operation is reduced.

Simplicity and reliability provide convenience for sterilization and reusable use.

The technical result is provided by the new device design, which provides for the protection of the ligature loop from contact with the environment of the abdominal cavity due to the outer tube, while all the elements - the conductor for the thread, the inner and outer tubes are mounted coaxially with the possibility of reciprocating movement relative to each other.

The outer tube allows you to protect the ligature loop from contact with the internal environment of the abdominal cavity and bring it without damage to the area of surgical intervention. Moreover, the oblique cut at its working end ensures its passage through the valves of trocars of various designs without the risk of reducing intra-abdominal pressure.

The limiter on the outer tube eliminates the entry of a conductor with a loop into the abdominal cavity since it rests on the working part of the trocar.

The rubber gasket eliminates the loss of pneumoperitoneum when the device is inserted into the abdominal cavity, the danger of which arises when the installed tubes are moved relative to each other.

Performing a rounded surface with corrugation creates convenience for fixing by hands when assembling the device under operational conditions: the presence of rubber gloves, slippery environments.

Figure 1 shows the device is a General view, figure 2 is the outer tube, figure 3 is the inner tube, figure 4 is the conductor of the thread.

A device for laparoscopic looping into the abdominal cavity contains coaxially mounted outer tube 1, inner tube 2 and thread conductor 3.

At the working end of the outer tube 1, an oblique cut 4 is made at an angle of 45 °. At the opposite end of the tube there is a pipe 5 on which, through a threaded connection, a stop 6 is installed, made in the form of a nut with a rounded corrugated surface. Inside the limiter there is a sealed gasket 7 (not shown) in the shape of a nut with a hole in the center. The length of the outer tube is 200 mm, the inner diameter is 5 mm.

The inner tube 2 for the conductor 3 is provided at the working end with a conical tip 8 for holding the thread.

The length of the inner tube is 300 mm, the diameter is 4.4 mm.

The conductor of the thread 3 is a spoke, it is equipped with a ring 9, and its end part is made in the form of a needle eye 10. The length of the conductor is 310 mm

The tip 8 has a diameter corresponding to the thickness of the thread is 0.5 or 0.8 or 1 mm.

The device is made of stainless steel 12x18 N 10T.

The device operates as follows.

The patient is placed on the operating table, anesthesia is performed, the surgical field is treated, and covered with sterile sheets. The operating surgeon imposes pneumoperitoneum, working trocars are introduced into the abdominal cavity. With a further revision of the abdominal cavity, the surgeon assesses the severity of the inflammatory process, determines the indications for appendectomy. Using a monopolar coagulator, the appendix is mobilized. Next, the operating surgeon performs the following step: the outer tube 1 is put on the inner tube 2. Through the tip 8 with the corresponding hole diameter, the thread is inserted and the end of the latter is inserted into the eyelet 10 of the conductor 3, previously drawn through the inner tube 2. The thread is carried out by the traction on the ring 9 of the conductor 3 through the inner tube 2, remove the end of the thread from the eyelet 10 of the conductor 3. This end of the thread is fixed with a clamp. The tip 8 is fixed to the inner tube 2 by means of a threaded connection. The end of the thread is tied in the form of a loop (extracorporeal node), the clip is removed, after which the thread is pulled up to the stop of the formed loop by the knot in the tip 8.

The outer tube 1 is shifted forward by 2/3 of the length, while the laparoscopic loop is immersed in it.

In this position, the device is passed through the trocar to the manipulation zone and then, by pressing the inner tube 2, a laparoscopic loop is removed from the outer tube 1. The loop is released, imposed on the base of the vermiform appendix and pulled into a knot, the ligature is cut off. The device is being removed. A second ligature loop is formed and similarly brought to the appendix. The second loop is applied 1.5 cm above the superimposed knot, the thread is pulled into the knot and cut off. The appendix between the ligatures is intersected, the device is removed from the abdominal cavity.

Claims (2)

1. A device for laparoscopic conducting a ligature loop into the abdominal cavity, consisting of a tube with a conical tip and a thread conductor, characterized in that it further comprises an outer tube with an oblique cut at the working end, while there is a pipe on the opposite end of the tube on which A threaded connection has a stopper made in the form of a nut with a corrugated rounded surface, inside of which there is a sealed gasket with a hole in the center. 2. The device according to claim 1, characterized in that the oblique cut at the working end of the outer tube is made at an angle of 45 °.