RU160780U1 - Spiral gallbladder fixator for laparoscopic cholecystectomy - Google Patents

Abstract

A spiral gallbladder fixator for laparoroscopic cholecystectomy, represented by a metal tube, characterized in that the tube is hollow with a diameter of 0.1 cm, consisting of three parts: the first is 1.5-2 cm long with a pointed tip, the second is spirally curved, having 7, 8 turns with a pitch of 0.5 cm, the third is a straight distal part with an external thread and a flywheel with the possibility of fixing the device on the skin with a length of 3.5-4 cm with a tip for a puncture syringe.

Description

The utility model relates to surgery, namely to abdominal surgery and can be used to perform laparoscopic cholecystectomy.

Closest to the proposed device is Galimova O.V. for fixing the gallbladder (RF Patent No. 110967, A61B 17/94, Bull No. 34, 12/10/2011), including a handle with a button and a tube connected to it, in which a groove is made with a needle placed in it, connected to the lever mechanism of the button . After creating pneumoperitoneum, introducing the required number of trocars and opening the parietal peritoneum using the device, an abdominal wall is punctured in the area of the right hypochondrium with the passage of all the underlying layers. Further, the device enters the abdominal cavity, they pierce through the wall of the gallbladder and release a metal thread from it. Then the device is removed back from the resulting puncture in the wall of the gallbladder, and, capturing the end of the thread with it, the device with the thread is taken out of the abdominal cavity through the existing puncture in the abdominal wall. Then the gallbladder is tightened until it contacts the inside of the abdominal wall. The device allows you to quickly, reliably fix and hem the gallbladder to the abdominal wall to safely highlight it in conditions of better visualization of the elements of the neck of the bladder. The main disadvantages of access are a 5 mm incision on the anterior abdominal wall, which in turn does not reduce the morbidity and pain in the postoperative period, the impossibility of puncture of the gallbladder.

The objective of the proposed device: to ensure reliable fixation and effective traction of the gallbladder with laparoscopic cholecystectomy, as well as puncture of the gallbladder for the prevention of intraoperative bile flow.

The problem is solved due to the fact that the tube is hollow, 0.1 cm in diameter, consisting of three parts: the first is 1.5-2 cm long with a pointed tip, the second is curved in a spiral shape, having 7-8 turns in increments of 0.5 cm, the third is a straight, distal part with an external thread and a flywheel with the possibility of fixing the device on the skin, 3.5-4 cm long with a tip for a puncture syringe (Fig. 1). The proposed device works: after penetrating into the abdominal cavity, the gallbladder is pulled with a soft clip to the device, continuing to “screw” it into the lumen of the gallbladder. After this, the gallbladder is punctured, the volume of the gallbladder decreases. Thus, the gallbladder is pulled to the parietal peritoneum of the anterior abdominal wall, its reliable fixation, traction of the gallbladder for free visualization of the neck of the gallbladder.

Clinical example

Patient R, 45 years old, admitted diagnosis: gallstone disease; chronic calculous cholecystitis.

Operation. In sterile conditions, over the navel, an abdominal puncture is performed with a Veress needle. Carbon dioxide insufflation. A 10 mm trocar is introduced, optics are installed, and diagnostic laparoscopy is performed. Then, under the control of optics, a 10 mm trocar is installed in the epigastric region. A device for fixing the gallbladder is introduced by spiraling movements through the front abdominal wall in the projection of the bottom of the gallbladder. After penetrating into the abdominal cavity, the gall bladder behind the bottom is pulled with a soft clip to the device, continuing to “screw” it into the lumen of the gallbladder. After this, the gallbladder is punctured, the volume of the gallbladder decreases. With a locking device, the bottom of the gallbladder is pulled to the parietal peritoneum of the anterior abdominal wall, an additional 5 mm trocar is inserted in the right hypochondrium, and the elements of the neck of the gallbladder are selected and clichés. The locking device is removed. Perform neck cholecystectomy. The hemostasis of the gallbladder bed is achieved. Conduct a desfusion. Stitches to the skin. Aseptic dressings.

When performing the operation, there were no technical difficulties, the duration of the operation was 35 minutes.

1st day of the postoperative period: complaints of moderate soreness in the area of postoperative wounds.

3rd day of the postoperative period: the patient does not complain, postoperative sutures without signs of inflammation, healing per prima. Aseptic dressing.

6 months after surgery: she feels well, she does not complain of a cosmetic defect after surgery.

Use in clinical practice of the claimed device allows to achieve several technical results:

- instead of a cut on the anterior abdominal wall, a puncture is performed by a device for fixing the gallbladder, with a diameter of up to 1 mm;

- the ability to manipulate the proposed device provides adequate traction of the gallbladder during processing and selection of elements of the neck of the gallbladder;

- the device for fixing the gallbladder is represented by a spiral-shaped hollow tube that allows you to puncture the gallbladder, avoiding intraoperative bile leakage

Claims (1)

A spiral gallbladder fixator for laparoroscopic cholecystectomy, represented by a metal tube, characterized in that the tube is hollow with a diameter of 0.1 cm, consisting of three parts: the first is 1.5-2 cm long with a pointed tip, the second is spirally curved, having 7, 8 turns with a pitch of 0.5 cm, the third is a straight distal part with an external thread and a flywheel with the possibility of fixing the device on the skin with a length of 3.5-4 cm with a tip for a puncture syringe.

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