RU114267U1 - STERNOTOM COAGULATOR - Google Patents

Abstract

Sternotome-coagulator with a saw blade making reciprocating movements set by a motor, which is equipped with a protective guide element, characterized in that the protective guide element of the saw blade includes a dielectric base, a dielectric limiting tip and a metal plate enclosed between them - a coagulator electrode connected to a high frequency power supply with a frequency of 100 kHz and a peak voltage of 70 to 300 V, and the other terminal of this source is connected to the saw blade.

Description

The invention relates to medicine, in particular to electrosurgical instruments and is intended for the simultaneous dissection and coagulation of bone tissue during surgical interventions.

Currently, bone processing is carried out by mechanical or electromechanical methods. In particular, oscillatory or circular saws, osteotomes, sternotomes, the classic Dzhigli saw are used (US Patent No. 5340129, G. Ostroverkhov, D. N. Lubotsky, Yu.M. Bomosh, Operational Surgery and Topographic Anatomy Course, Medgiz, - 1963, - Moscow), universal devices for processing bone tissue (for example, patent SU A1, 1727796, class A61B 17/16, 1992, patent RU C1, 2007135, class A61B 17/16, 1994, patent RU C1, 2082332 A61B 17/16, 1997).

All these devices are convenient to use and widely used, however, they have a significant drawback inherent in most instruments for surgical intervention. During the operation, large blood loss occurs, which can lead to the need for a blood transfusion and, in addition, drastically lengthen the time of the surgical intervention spent on stopping the hemorrhage, which can lead to errors and postoperative complications.

There is a wide range of electrosurgical devices capable of simultaneously dissecting and coagulating the soft tissues of the body. One of them is a bipolar cold-plasma electrosurgical apparatus for precision dissection and ablation, as well as coagulation of soft and cartilage tissues, developed by ArthroCare Corporation (US Patent No. 5697536, 1997), in which the soft tissue is exposed to a 100 kHz plasma discharge initiated in an isotonic saline solution supplied to the area of operation. However, this method is not applicable for dissection of bone tissue.

A common disadvantage of electrosurgical apparatus and methods is the impossibility of simultaneous dissection and coagulation of bone tissue.

The closest device of the same purpose to the claimed invention in terms of features and taken as a prototype is a sternotome (US patent No. 5440129, priority from 09/23/1994) for operations on bone tissue, including on the sternum. The device consists of a handle, a sternotome body, in which the engine is located, providing reciprocating movement of the saw blade, the saw blade itself, one end of which is connected to the shaft, which transfers the saw blade to the reciprocating movement from the engine to ensure cutting, and the other cutting the end of the saw blade is in the groove of the tip of the guide element limiter. The guide element and all its components are made of metal, and it is attached to the metal body of the sternotome. The function of the limiter is to protect the soft tissues and internal organs of the patient during the sternotomy operation from damage by the butt of the saw blade and to prevent bending and breakage of the saw blade during the bone section.

The disadvantage of the device, taken as a prototype of the invention, are large blood loss during the operation, since coagulation of blood vessels is absent.

Thus, the objective of the invention is to provide a device that allows for simultaneous dissection and coagulation of blood vessels of bone tissues.

The technical result of the present invention is:

- in providing a quick and effective coagulating effect on bleeding surfaces immediately at the moment of dissection of bone tissue and a significant reduction due to this blood loss;

- in ensuring the antiseptic and aseptic effect inherent in electrosurgical devices;

- in reducing the total time for surgery on bone tissue, which reduces the risk of postoperative complications;

- in the simplicity of hardware implementation.

The problem is solved in that in the known device sternotome containing a saw blade, performing reciprocating movements defined by the engine, which is equipped with a protective guide element according to the invention, the protective guide element of the saw blade includes a dielectric base, a dielectric limiting tip and enclosed between them a metal plate that acts as a coagulator electrode connected to a high-frequency power source, and the other output that source is connected to the Peel web.

The sawing blade and the coagulator electrode in contact with the cut tissues act as working electrodes of the coagulator. The guide element includes a dielectric base, which ensures its fastening on the sternotome-coagulator body and at the same time the electrical isolation of the coagulator electrode from the body. At the end of the coagulator electrode, a limiter dielectric tip is fixed, in the groove of which the end of the sawing blade enters, and the tip itself provides electrical isolation of the coagulator electrode from the sawing blade. The sawing blade is also electrically isolated from the sternotome body and an alternating voltage is applied between it and the coagulator electrode with parameters sufficient to effect effective coagulation directly during the cutting process.

Thus, it is possible to obtain a high cutting speed with a low level of blood loss. The device can be used both with an electromechanical and with a pneumomechanical engine of the instrument for surgical cutting of bone tissues. Since an alternating high-frequency voltage is used, and the generator leads are isolated, the polarity of the electrodes does not matter, but one of the electrodes must be grounded.

The essence of the invention is illustrated from the following description and the attached drawings and photographs.

Figure 1 presents a diagram of the proposed device that allows for simultaneous dissection and coagulation of bone tissue.

Figure 2 shows a photograph of the saw blade and the guiding element of the sternotome used for experimental verification of the functioning of the invention.

Figure 3 shows sequentially from A) to B) photographs of the operation of the sternum dissection in dogs using this sternotome-coagulator.

The protocol of the operation confirming the successful application of the invention in practice is given later in the text.

The design of the proposed sternotome-coagulator includes the following, essential for the present invention, the elements shown in figure 1:

1 - a sawing blade of a sternotome electrically isolated from the body;

2 - high-frequency power supply with two insulated terminals;

3 - dielectric base of the guide element;

4 - a coagulation electrode, which is a stainless steel plate with a width of 8 mm and a thickness of 1.5 mm, and intended, on the one hand, for fastening a restrictive dielectric restrictive tip 5, which slides when cutting along the back surface of the sternum and protects underlying tissues from damage, and on the other hand, for coagulation of soft and bone tissues located in the incision region when voltage is applied between this electrode 4 and the sawing blade 1 from a power source 2;

5 - dielectric limiting tip of the guide device;

6 - foot pedal for controlling a high-frequency power source.

Proposed in the present invention, the device operates in the following way:

The preparation of the surgical field for the operation to dissect the sternum and dissection of the soft tissues in the usual way (photo A, figure 3). Strenotome-coagulator (photo of figure 2) is introduced into the section (photo B, figure 3). One of the two electrical terminals of the high-frequency generator 2 is connected to the coagulator electrode of the guiding device 4, and the other to the saw blade 1. The polarity of the electrodes does not matter, since an alternating high-frequency voltage is used, and the generator terminals are isolated. The high-frequency generator 2 is turned on, and the necessary electrical coagulation parameters are set based on the requirements of the operating technique. A signal with a frequency of 100 kHz and a peak voltage ranging from 70 to 300 V is applied to electrodes 1 and 4, and the process of cutting the sternum with a sternotome-coagulator begins. The high-frequency power source is controlled at the time of the operation by the foot pedal 6. An electric current is closed between the saw blade 1 and the coagulator electrode 4, and, as a result, all tissues located in the incision area are heated and coagulated. The conductive medium may be blood released at the incision site or isotonic saline, which, in some cases, can be supplied to the area of operation.

The proposed method for performing surgical operations on bone tissues with simultaneous dissection and coagulation was tested experimentally during sternotomy at the Institution of the Russian Academy of Medical Sciences (RAMS) Scientific Research Institute of Cardiology of the Tomsk Scientific Center of the Siberian Branch of the Russian Academy of Medical Sciences (Tomsk city). Surgical interventions were performed on experimental animals (dogs). During the experimental verification, the Stryker brand sternot was used as an electromechanical saw, and the Atlas bipolar high-frequency alternator from ArthroCare Corporation was used as a high-frequency power source. The results of the experimental verification are reflected in the experimental protocol.

Experiment Log

Date: 03/27/2010 Start at 10:00 End at 15:30

Nickname: Fierce

Object: dog. Gender: male. Weight: 26 kg. Length: 90 cm. Height at the withers: 45 cm.

Color: red - black

Operation 1: Median sternotomy through a device that allows simultaneous dissection and coagulation of bone tissue.

Surgical team: Kuznetsov M.S., Panfilov D.S.

Operational sister: D. Scherbakova

Anesthetist: Zhikhareva 3.

Sedation:

Sol. Atropini sulf. 0.1% - 1.0

Sol. Dimedroli 1% - 1,0

Sol. Analgini 50% - 2.0

Sol. Calipsoli 5% - 1.0 v / m at 11 h 10 min

Anesthesia: General intravenous in combination with mechanical ventilation. Sol. Propafoli 5.0 Intravenous Sol. Arduani - 1 mg, tracheal intubation.

Description of Operation 1

The surgical field is twice treated with a solution of kutasept. Median sternotomy: skin, subcutaneous fatty tissue, fascia dissected in layers. Stitched, bandaged, intercostal arteries. A longitudinal sternotomy was performed using a device allowing simultaneous dissection and coagulation of bone tissue (Fig. 3). Additional hemostasis using foreign materials (medical wax) was not performed. The sternum sections were compared using the “Z-shaped” metal osteosynthesis by wire ligature No. 7 at the site of its dissection. Layer closure of the surgical wound. The operation ended at 12.35. Extubation at 15.20.

At the end of the operation, intramuscularly administered: Bicyllini-5 - 600000 ED, Sol. Analgini 50% - 2 ml, Sol. Dimedroli 1% - 1 ml; intravenously Sol. Cordiamini 2 ml.

Appointments: do not feed 1 day.

Early postoperative period: without features.

Date: 04/28/2010

General condition: The condition is closer to satisfactory. Appetite saved.

Destination: Sol. Dimedroli 1% - 1 ml. Sol. Analgini 50% - 2 ml Bicyllini-5 - 600,000 ED intramuscularly

Date: 04/03/2010

General condition: Satisfactory condition. Appetite saved.

There were no complications from the postoperative wound.

Destination: Sol. Dimedroli 1% - 1 ml. Sol. Analgini 50% - 2 ml Bicyllini-5 - 600,000 ED intramuscularly.

Operation 2: Sampling sternum fragments at the site of sternotomy.

Surgical team: Kuznetsov M.S., Panfilov D.S.

Operational sister: D. Scherbakova

Anesthetist: Zhikhareva 3.

Sedation:

Sol.Atropini suli. 0.1% - 1.0.

Sol. Dimedroli 1% - 1.0.

Sol. Analgini 50% - 2.0.

Sol. Calipsoli 5% -1.0 v / m at 11 h.

Anesthesia: General intravenous in combination with mechanical ventilation. Sol. Propafoli 5.0.

Intravenous Sol. Arduani - 1 mg, tracheal intubation.

Description of Operation 2

The surgical field is twice treated with a solution of kutasept. The postoperative scar is excised. Completed access to the sternum. The sternum is stable, complete consolidation of bone tissue at the site of stenotomy is noted. Wire ligatures removed. The sternum fragments were taken together with sternotomy. In places of sampling fragments of the sternum, hemostasis was performed. Layer closure of the surgical wound. The operation is completed at 12.30. Extubation at 13.30.

At the end of the operation, intramuscularly administered: Bicyllini-5 - 600000 ED, Sol. Analgini 50% - 2 ml, Sol. Dimedroli 1% - 1 ml; intravenously Sol. Cordiamini 2 ml.

Appointments: do not feed 1 day.

Early postoperative period: without features.

Date: May 16, 2010

General condition: The condition is closer to satisfactory. Appetite saved.

Destination: Sol. Dimedroli 1% - 1 ml. Sol. Analgini 50% - 2 ml Bicyllini-5 - 600,000 ED intramuscularly

Sutures from the skin were removed on the 5th day. No complications from the postoperative wound were identified. The condition is satisfactory. Appetite saved. Physiological administration is normal.

The analysis of the results using the sternotome coagulator presented in the present invention showed a number of advantages over traditional methods of surgical intervention. So, with simultaneous dissection of tissues and coagulation, bleeding stops almost immediately at the moment of incision, which provides good hemostasis and a minimum amount of perioperative blood loss, about 10-15 times less than when using only a standard mechanical saw, and also provides good antiseptic and aseptic Effect. In addition, there is no need to use foreign materials, such as medical wax, to stop bleeding from the spongy bone of the bone tissue and the overall operation time is reduced. All this, taken together, helps to reduce the risk of postoperative complications and has a positive effect on the long-term results of the operation.

Claims (1)

Sternotom-coagulator with a saw blade reciprocating, set by an engine, which is equipped with a protective guide element, characterized in that the protective guide element of the saw blade includes a dielectric base, a dielectric limiting tip and a metal plate enclosed between them - a coagulator electrode connected to a high-frequency power source with a frequency of 100 kHz and a peak voltage of 70 to 300 V, and the other output of this source is connected to the saw him a canvas.