RU116036U1 - TOOL FOR PERFORMANCE ANTEGRADOUS PAPILLOSFINCTEROTOMY - Google Patents

Abstract

An instrument for performing antegrade papillotomy, containing a handle and a working part with a rounded end and a slot, which differs from the prototype in that the device is made in the form of a hollow curved tube with an outer diameter of 3 mm and an inner diameter of 2.5 mm, the bend of which divides it into a handle and the working part, the end of the working part is made in the form of a closed rounded spout with a slot in the form of an oval hole measuring 3 × 2.5 mm, the bottom of the slot is made in the form of a groove, smoothly turning into the inner wall of the outer side of the working part of the device, on the inner side of the handle relative to the bend of the tube on the same axis with the above slot there is a mark that orientates the position of the slot in the form of an oval hole at 11 o'clock.

Description

The utility model relates to medicine, namely to surgery of the bile ducts and can be used for endoscopic treatment of choledocholithiasis and stenosis of the large duodenal papilla in cases where endoscopic retrograde papillotomy is impossible.

It is known that for conducting antegrade papillosphippectomy, a modified tension papillotome for endoscopic papillotomy KD-19, Olympus is used, shortened from 1900 mm to 300 mm (patent for invention No. 2253382, publ. 10.06.2005). The disadvantage of this papillotome for antegrade papillotomy is the difficulty of its orientation at the mouth of the large duodenal papilla, since when using it the surgeon is forced to act “blindly” to set the instrument in the correct position, while the erroneous location of the papillotome entails the possibility of damage to the Wirsung duct. The second disadvantage is the need to use a second electrode, which is passed through a duodenoscope.

The closest taken as a prototype is a papillot for operations on a large duodenal papilla according to patent No. 2167621 (publ. May 27, 2001), which contains a handle and a working part made in the form of a hollow tip with a rounded end and a slot on the side surface for extension a knife. The disadvantage of the prototype is the complexity of its orientation at the mouth of the large duodenal papilla.

The task is to create a device for performing antegrade papillosphincterotomy, which provides the necessary orientation of the cutting string of the papillotome at the 11 o’clock position at the mouth of the large duodenal papilla.

Effect: delivery of the papillotome with automatic correct orientation at the 11 o’clock position at the mouth of the large duodenal papilla, which eliminates damage to the Wirsung duct, makes it easier to perform antegrade papillotomy, and also reduces the overall time of manipulation.

To solve this problem, a device is proposed that provides a shortened papillotome at the mouth of a large duodenal papilla, containing a handle and a working part with a rounded end and a slot, different from the prototype in that the device is made in the form of a hollow curved tube with an outer diameter of 3 mm and an inner diameter of 2 , 5 mm, the bend of which divides it into the handle and the working part. The end of the working part is made in the form of a closed rounded nose with a slot in the form of an oval hole of 3 × 2.5 mm in size on the inner side of the tube relative to the bend, the bottom of the slot is made in the form of a gutter that smoothly passes into the inner wall of the outer side of the working part of the device, also on the inside side of the handle relative to the bend of the tube on the same axis with the above slot is a mark, orienting the position of the slot in the form of an oval hole for 11 hours.

Such a technical solution allows for papillotome insertion during antegrade papillosphincterotomy through the proposed device and, thanks to the proposed shape of the bottom of the slot in the form of a groove, to hold it from 3 sides, which prevents spontaneous change in the position of the papillotome and allows you to orient its cutting string according to the mark located on the handle of the device in necessary direction.

The utility model is characterized by the presented drawings:

Figure 1 - General view of the device.

Figure 2 - end of the working part of the device.

The proposed device is a curved metal tube 1 with an outer diameter of 3 mm and an inner diameter of 2.5 mm, the bend of which divides it into a handle 2 and a working part 3. The working part 3 ends with a rounded nose 4 with a slot 5 in the form of an oval hole 3 × 2 in size , 5 mm, which has a common axis 6 with the inner side of the tube 1, and the bottom of the slot 5 is made in the form of a groove 7, smoothly passing into the inner wall of the outer side of the working part 3 of the tube 1, while on the handle 2 from the inner side relative to the bend of the tube 1 on one axis 6 minutes with a slot 5 located label 8, an alignment position of the slit 5 for 11 hours.

Performing antegrade papillotomy with the proposed instrument is carried out in the following way:

1. Through the cystic duct or through the choledochotomy wound into the choledoch in the distal direction, conduct a string conductor with a diameter of 0.3 mm and a length of 300 mm.

2. On the conductor string in the choledoch in the distal direction enter the proposed device 1.

3. The conductor is removed.

3.1 Device 1 is carried out transpapillary into the duodenum under visual control using a duodenoscope. The slot 5 in the form of an oval hole is oriented at “11 o’clock” of the conditional dial of the mouth of the large papilla of the duodenum by setting the mark 8 on the handle 2 in the desired direction.

4 If it is impossible to carry out a papillotome delivery device at the mouth of a large papilla of the duodenum due to stenosis of its mouth or calculus in an ampoule, an atypical endoscopic papillotomy is performed “on the head of the papillotome delivery system” or “on a stone”. The length of the papillotomy wound should be sufficient for further transpapillary device 1 in the duodenum. Then perform paragraph 3.1.

5. Into the tube 1, a tension papillotome of the onion type is introduced, an Olympus KD 19 Q analog, shortened to 300 mm. The distal working part of the papillotome is carried out into the duodenum through the proposed device under visual control using a duodenoscope. Due to the design features of the device, the string of the papillotome is automatically set at 11 o’clock on the conditional dial of the mouth of the large duodenal papilla.

5. Perform a papillotomy with a tension papillotome of the onion type to the transverse fold in the mode of monopolar coagulation under visual control using a duodenoscope.

Application of the proposed utility model allows:

1. Correctly orient the string of the papillotome at the 11 o'clock position at the mouth of the large duodenal papilla, which eliminates damage to the Wirsung duct.

2. Facilitate the implementation of antegrade papillotomy, ie reduce the total time for performing manipulations.

Claims (1)

A tool for performing antegrade papillotomy, comprising a handle and a working part with a rounded end and a slot, which differs from the prototype in that the device is made in the form of a hollow curved tube with an outer diameter of 3 mm and an inner diameter of 2.5 mm, the bend of which divides it into a handle and the working part, the end of the working part is made in the form of a closed rounded nose with a slot in the form of an oval hole 3 × 2.5 mm in size, the bottom of the slot is made in the form of a gutter that smoothly passes into the inner wall of the outer side of the working part trinity, on the inner side of the handle relative to the bend of the tube on the same axis with the aforementioned slot there is a mark orienting the position of the slot in the form of an oval hole for 11 hours