RU118853U1 - INFLATABLE PILLOW FOR TRANSMISSION NEPHROLITOTRIPSY - Google Patents

Abstract

Inflatable pillow for percutaneous nephrolithotripsy, which is a rubber balloon in the form of a hemisphere with an outer diameter of 69.5 cm, an inner diameter of 35.5 cm, the balloon is equipped with a hose with a pump for injecting air into the balloon and a valve for bleeding air from the balloon, the ends of the balloon are connected between a rubber strap.

Description

The utility model relates to the field of medicine, in particular, to urology.

Treatment of patients with urolithiasis is an important part of modern urological practice.

Traditionally, percutaneous nephrolithotripsy (CNLT) is performed when the patient is placed on his stomach. Operations were also possible and were described when the patient was placed on his back with a cushion under the lower back and without it. [De Sio M, Autorino R, Quarto G, et al. Modified Supine versus Prone Position in Percutaneous Nephrolithotomy for Renal Stones Treatable with a Single Percutaneous Access: A Prospective Randomized Trial. EurUrol2008; 54 (1)]

The key to success of percutaneous nephrolithotripsy and nephrolithoextraction is the correctly selected direction of the nephrostomy canal, as well as its least traumatic creation, which allows the most effective removal of stones and their fragments in the absence of bleeding [Alyaev Yu.G., Zhuravlev V.N. Transurethral contact laser pyelolithotripsy with bilateral nephrolithiasis. - M., 2006.].

The choice of direction and puncture point depends on the individual anatomical and clinical features, taking into account syntopy, skeletonotomy, anatomy of the pyelocaliceal system of the kidney, quantity, localization and characteristics of calculi [Marcovich R, Smith AD. Percutaneous renal access: tips and tricks. // BJU Int. 2005 Mar; 95 Suppl 2: 78-84].

But there are general points. The peripheral end of the optimal puncture tract should be located near the posterior axillary line. The position of the patient on the back with CNLT leads to the fact that the maneuverability of the nephroscope during surgery is significantly reduced [Valdivia Uria JG, Valle GJ, Lopez Lopez JA, et al. Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position. J Urol 1998 Dec; 160 (6 Pt 1): 1975-78.]. This is primarily due to the small distance between the peripheral end of the nephrostomy tract and the operating table.

Known anatomical pillow (patent RU No. 9145, class A61F 5/34, publ. 02.16.1999,). The anatomical cushion for supporting the back when sitting is an orthopedic device to maintain proper posture. The anatomical pillow is made of elastic material, its characteristic feature is that there are rollers along its surface adjacent to the back, and in the middle there is a convex surface, the lateral projection of which corresponds to the Akerblom line. In addition, on this convex surface there are transverse embossed protrusions that are spaced from each other at a distance corresponding to the distance between the spinous processes of the spine.

However, the described device cannot be used for CNLT in patients with urolithiasis. First of all, due to its structure, longitudinal ridges located at the edges adjacent to the back will not allow adequate access along the back axillary line in a patient lying on his back.

The anatomical pillow fits snugly on the patient’s back and the table surface, the working distance required to manipulate the surgical instruments will be minimal and insufficient, both for the audit of the pyelocaliceal system of the kidney and for the implementation of CNLT.

The closest in technical essence and taken as a prototype is a device for fixing the spleen in the surgical wound (Patent RU No. 1957, according to class A61B 19/00, publ. 04/16/1996)

The device is represented by an inflatable balloon with a tube glued into it for air injection. In its shape, the balloon is made in the form of a triangular pillow, convex on one side and concave on the other, the dimensions of which are selected from the conditions of its placement in the periollenic subphrenic space.

The device for fixing the spleen is small in size and designed for use directly in the surgical wound. In addition, given its shape when placing it under the patient’s back with CNLT, the device will have only one point of contact with the patient’s back, most often it coincides with the place of surgical intervention (posterior axillary line), often protruding directly into the area of manipulation of surgical instruments with CNLT . The size of the device will not be enough to give the optimal position of the patient on the operating table, thereby reducing the effectiveness of the surgical aid provided for urolithiasis.

The objective of the utility model is to increase the effectiveness of percutaneous nephrolithotripsy when the patient is on the operating table, both on the back and on the stomach.

The problem is solved by an inflatable pillow for percutaneous nephrolithotripsy, which is a rubber balloon in the form of a hemisphere with an outer diameter of 69.5 cm, an internal one of 35.5 cm, the balloon is equipped with a hose with a pump for pumping air into the balloon and a valve for bleeding air from the balloon, ends cylinders are interconnected by a rubber strap.

In figure 1, the air bag is presented in two projections: a rubber balloon (a) with a tube built in it (b) for pumping air through the pump (e), an additional valve is built into the tube for bleeding air from the balloon (c). The ends of the cushion are connected by a rubber strap (g). The cylinder is made in the form of a hemisphere with an outer diameter of 69.5 cm, an internal diameter of 35.5 cm, the cylinder is equipped with a hose with a pump for pumping air into the cylinder and a valve for bleeding air from the cylinder, the ends of the cylinder are connected by a rubber strap, the degree of tension and relaxation will directly depend on the weight and position of the patient on the operating table.

The device is used as follows: depending on the position of the patient on the operating table, the inflatable pillow will be located either across or longitudinally relative to the table. When the patient is on his stomach in order to reduce the mobility of the kidney, as well as to give it a more comfortable position for subsequent access to the pyelocaliceal system using ultrasound and radiography, the pillow is located across the operating table and placed under the patient’s stomach, a belt connecting the ends of the balloon to in this case unzipped. Thus, additional pressure is applied to the anterior abdominal wall, more favorable conditions are created for the puncture of the pyelocaliceal system and the creation of a nephrostomy canal.

When the patient is on his back, an inflatable cushion for CNLT is placed longitudinally relative to the operating table under the lumbar region, its ends are connected by a belt supporting its curved (hemispherical) shape. Due to its hemispherical shape, the pillow has two points of contact with the patient’s back, which creates an additional supply of space between the patient’s back and the operating table, which is an important condition, given the fact that the peripheral end of the optimal puncture tract should be located near the rear axillary line.

Thus, when using an inflatable pillow for CNLT, the operator can significantly increase the maneuverability zone of surgical instruments during surgical endourological intervention due to the shape of the inflatable pillow, and give the kidney a more convenient position for access during CNLT. When air is injected into the balloon of an inflatable pillow, the surgeon, both before the start of the surgical aid and intraoperatively, can adjust the level of elevation of the patient relative to the operating table. This, in turn, will allow the operator, starting from the data obtained during the examination regarding the structural features of the pyelocaliceal system, the size and location of calculi, to determine the most advantageous position of the patient on the operating table for the subsequent implementation of the most effective surgical manual.

1. Clinical example 1

Patient S., 54 years old, was admitted to the urology department on 01.20.2012. With multispiral computed tomography: in the pelvis of the left kidney, a calculus is determined with a size of 24 × 16 × 29 mm. In the lower group of cups, two calculi are determined with dimensions of 9 × 5 mm, 11 × 8 mm. 01/26/2012 percutaneous nephrolithotripsy was performed on the left, all fragments of calculus were removed.

Puncture was hindered by the crest of the ilium, and it was also not possible to visualize the pelvis stone. This situation is regarded as a constitutional feature of the location of the left kidney. An inflatable pillow was used for CNLT, the latter was located across the operating table, and the patient’s lumbar region was lifted upward by the pump, approximately 10-15 cm above the table surface. Upon repeated ultrasound examination, it was possible to visualize the pelvis stone and to puncture the middle cup for HFL.

A string was drilled along the string to 12 Ch, then a flexible bougie was made, along the lumen of which a second string was drawn into the ureter. An amplatz tube No. 30 Ch, along which a nephroscope was drawn, was installed in the middle cup along the bougie. In the lumen of the pelvis, a white calculus was found, 2 cm in size. The string was removed. Using an ultrasonic lithotripter, the stone is disintegrated, the fragments are completely removed. An audit of the lower calyx revealed 2 stones of the same color measuring 1 cm and 0.5 cm, which were also completely removed. When the pelvis was revised, no other calculi were detected. Amplatz tube removed. Nephrostoma No. 24 Ch. Was installed along the safety string.

Ds: urolithiasis, left kidney stone. Chronic pyelonephritis. Cysts of the right kidney.

The postoperative period without complications. Within 5 days, antibacterial and anti-inflammatory therapy. Nephrostomy drainage was removed on January 30, 2012. It was discharged 12 days after surgery in a satisfactory condition.

Clinical example 2

Patient F., 71 years old, was admitted to the urology department on November 28, 2011. When examining a survey picture, a projection of a shadow suspicious of an calculus of 2 × 1 cm is visualized in the projection of the right pelvis-ureter segment at the level of L-3. When multispiral computed tomography is determined calculus in the pelvis of the right kidney with dimensions of 8.3 × 18.2 × 13.3 mm. 12/06/2011, performed percutaneous nephrolithotripsy surgery on the right.

Operation progress: In the supine position with the balloon of the CNLT inflatable pillow under the right lumbar region located longitudinally relative to the operating table, the patient’s lumbar region was raised upward by about 15 cm above the table surface using a pump. A puncture of the pyelocaliceal system was performed on the right through the lower anterior calyx.

A string was drilled along the string, a flexible bougie was made, along the lumen of which a safety string was drawn into the ureter. An amplatz tube No. 30 Ch, along which a nephroscope was conducted, was installed along the bougie in the lower front cup. Nephroscopy In the pelvis, the calculus is visualized with uneven surface, black. With the help of forceps, the calculus is destroyed, its fragments are evacuated by forceps. When x-ray and endoscopic control of calculus fragments in the pyelocaliceal system is not determined. A catheter-stent Cook Ch7 is installed along the safety string through the nephrostomy passage into the right ureter. The thread attached to the proximal curl of the stent catheter is removed through the nephrostomy passage and is fixed with a patch to the skin. The postoperative wound in the area of the nephrostomy course is sutured with two interrupted sutures.

Ds: urolithiasis, stone of the right kidney. Chronic pyelonephritis. Kidney cysts.

The postoperative period was uneventful. The ureteric catheter stent was removed on the 6th day, the sutures were removed on the 10th day after the operation. Antibacterial and anti-inflammatory therapy was carried out. The patient was discharged on the 14th day after the operation in satisfactory condition.

Claims (1)

An inflatable pillow for percutaneous nephrolithotripsy, which is a rubber balloon in the form of a hemisphere with an external diameter of 69.5 cm, an internal one of 35.5 cm, the balloon is equipped with a hose with a pump for pumping air into the balloon and a valve for bleeding air from the balloon, the ends of the balloon are connected between a rubber strap.