RU158260U1 - GUIDE HOOK - Google Patents

Abstract

Hook-guide for mesh endoprosthesis, consisting of a metal working plate, connecting rod, handle, characterized in that the working plate is 8 mm long, 6 mm wide, 1 mm thick, is bent through an arc with a radius of 3 mm at an angle of 45 °, the distal part of the plate is long 5 mm is divided into two fragments 2.4 mm wide, 2 mm long goes into cylindrical fragments 3 mm long, 1 mm in diameter, the proximal part of the working plate goes into a truncated conical rod with a distal diameter of 2.5 mm, proximal 5 mm, connecting with curly handle with a window for the finger.

Description

The device relates to medicine, namely to surgery.

In surgery, many options for hernioplasty using mesh endoprostheses are used, but with options for plastic surgery of the ventral hernias on lay, in lay and sub lay in the tissues of the abdominal wall, there are practically no tools for placing mesh prostheses. Surgical hooks with which the edges of the wound and tissue are bred are usually used (Ostroverkhov G.E., Bomash Yu.M., Lubotsky D.N. Operative surgery and topographic anatomy, MIA, 2005).

As a prototype, we used a needle-conductor manufactured by Linteks company for conducting tape mesh endoprostheses (Linteks catalog, URL: http://www.lintex.ru/page147.html).

The tool has a working part in the form of a hook-needle, a rod of cylindrical shape and a handle of cylindrical shape.

The peculiarities of using a needle-conductor is that the tool is designed to place a tape graft in the pelvic cavity and is inconvenient with abdominal and thoracic alloplasty of mesh transplants.

The technical result is the ability to quickly and easily fix the edge of the graft and the convenience of its placement deep in the tissues for subsequent hemming with any plastic options, the ease of identifying the location of the instrument with the edge of the mesh in the thickness of the tissues.

The technical result is ensured by the fact that the working part of the guide hook is a plate 8 mm long, 6 mm wide, 1 mm thick, bent through an arc of 3 mm radius, at an angle of 45 °, the distal part of the 5 mm plate is divided into two fragments with a width of 2.4 mm, 2 mm long, goes into cylindrical fragments 3 mm long, 1 mm in diameter, the proximal part of the working plate goes into a truncated cone-shaped rod with a distal diameter of 2.5 mm, proximal - 5 mm, connected to a curly handle with a window for the finger.

USEFUL MODEL EXPLAINED BY FIGURES (Figs. 1-3)

In FIG. 1. View of the device in isometry.

In FIG. 2. General view of the device, top view.

In FIG. 3. General view of the device, side view.

The device consists of a metal plate (1) 8 mm long, 6 mm wide, 1 mm thick, bent through an arc of 3 mm radius, at an angle of 45 °, the distal part of the plate 5 mm long is divided into two fragments 2.4 mm wide, length 2 mm, goes into two cylindrical fragments 3 mm long, 1 mm in diameter, the proximal part of the working plate goes into a truncated cone-shaped rod (2) with a distal diameter of 2.5 mm, proximal - 5 mm, connected to a curly handle (3) having window for the finger (Fig. 3).

THE DEVICE WORKS AS FOLLOWS

The hook-guide device is more convenient to use by pricking the edges of the mesh endoprosthesis on the cylindrical fragments of the working plate when the device handle is located on the side of the mesh. By turning the device 170 ° in length, the mesh is fixed at the level of the extended part of the bases of the cylindrical fragments. In this position of the device, with a grid fixed on it, it is convenient to bring it into the depth of the tissues with any type of endoprosthesis replacement.

In cases of fixation of the endoprosthesis by suturing it through the thickness of the tissues, the localization of the distal end of the guide hook with the mesh is indicated by lifting the distal end of the instrument.

The hook-guide is removed by traction in the direction of the handle or its rotation around the longitudinal axis with subsequent traction. Subsequent hemming of the perimeter of the mesh is carried out by expanding, tensioning and fixing the mesh with the placement of the distal end of the device hook up or down. It depends on the rationality of the arrangement with different methods of plastics.

CLINICAL APPLICATION EXAMPLE

The guide hook was used during hernioplasty in 20 patients with ventral hernias with on-line endoprosthetics, in 15 patients with sub-lay endoprosthetics, and in 5 patients performed in lay plastic surgery.

Patient S., 24 years old. Case history 4945. He was hospitalized on 11/29/13 in the thoracic department of the Kursk Regional Oncology Dispensary. Diagnosis: Ewing's sarcoma XI ribs on the right, stage III, KG II (T3, N0, M0, M0). Operated on 12/05/13. A thoracophrenolumbotomy was performed on the right, combined removal of the chest wall tumor, resection of the X, XI, XII ribs, diaphragm and peritoneum section with endoprosthetics of the diaphragm and chest wall with a mesh transplant, sanitation, abdominal drainage. During the Esfil mesh endoprosthesis replacement, a hook guide and mesh retainer were used. There were no complications associated with the use of surgical instruments. Discharged 12.25.13 in satisfactory condition under the supervision of an oncologist at the place of residence.

Patient P., 54 years old. Case history 1176. Hospitalized on 01.24.14 in the surgical department of the Clinical Clinical Hospital Nursing Home of Kursk. Diagnosis: irreducible umbilical hernia of large sizes. Operation No. 99, 01/24/14. A hernia surgery with endoprosthetics was performed. Under spinal anesthesia, two bordering incisions excised a section of skin with an umbilical ring. A hernial sac measuring 15 × 16 × 10 cm was isolated from subcutaneous tissue, opened, 10 ml of light hernial water was released. The contents of the hernial sac is a large omentum and a loop of the small intestine. The gland is soldered to the wall of the hernial sac. The lock of the omentum is partially resected. There is no effusion in the abdominal cavity. The hernial sac is excised. The hernia gate is sutured with a continuous suture. An abdominoplasty of the anterior abdominal wall was performed with an endoprosthesis of LLC Linteks measuring 15 × 10 cm using a guide hook, a mesh retainer and a needle hook. The postoperative wound is sutured in layers. Aseptic dressing. The postoperative period was uneventful. On the third day, ultrasound of the abdominal cavity and anterior abdominal wall was performed. There is no free fluid in the abdominal cavity, in the projection of the endoprosthesis about 50 ml of exudate, which was evacuated by puncture under the control of ultrasound. The postoperative period was uneventful.

Patient G., 64 years old. Case history 18026. He was hospitalized on 12/27/14 in the surgical department of the Clinical Clinical Hospital Nursing Home of Kursk. Diagnosis: restrained umbilical hernia, necrosis of the small intestine, acute strictive small bowel obstruction. Operation No. 1689, 12/28/14. Hernia surgery was performed with endoprosthetics of the anterior abdominal wall, elimination of small bowel obstruction, resection of the small intestine loop, entero-enteroanastomosis, scientific research institute, drainage of the abdominal cavity. Endoprosthetics with a mesh endoprosthesis of LLC Linteks 10 × 20 cm with subaponeurotic placement using a guide hook and a mesh retainer. The postoperative wound is sutured in layers. Iodine. Aseptic dressing. There were no postoperative complications.

The analysis of the results of the use of the new instrumentation showed that the mesh transplant was easier to fix and fix with all its placement in tissues in patients with ventral, inguinal hernias. The control over the degree of transplant tension improved, the duration of the operation was reduced by 30%.

Thus, the hook-guide tool simplified the technique of endoprosthetics for all options for placement of the graft, it is convenient to use, and the duration of surgery has been reduced. There were no complications associated with the use of the device.

Claims (1)

Hook-guide for mesh endoprosthesis, consisting of a metal working plate, connecting rod, handle, characterized in that the working plate is 8 mm long, 6 mm wide, 1 mm thick, is bent through an arc with a radius of 3 mm at an angle of 45 °, the distal part of the plate is long 5 mm is divided into two fragments 2.4 mm wide, 2 mm long goes into cylindrical fragments 3 mm long, 1 mm in diameter, the proximal part of the working plate goes into a truncated conical rod with a distal diameter of 2.5 mm, proximal 5 mm, connecting with curly handle with a window for the finger.

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