RU161309U1 - DEVICE FOR EXPOSURE OF LAPAROSCOPIC ACCESS IN OBESITY PATIENTS - Google Patents

Abstract

A device for exposing laparoscopic access in obese patients, consisting of three interconnected cone-shaped parts: large, medium and smaller, which allow you to place smaller parts in larger parts, the inner surface of the large and medium parts is made with sawtooth protrusions and a side for engaging each part with the subsequent, the smaller part has a bottom fixed with tongues.

Description

The utility model relates to medicine and medical equipment, in particular, to surgery, and in particular, to devices for forming a "well" of soft tissues, which allows for better online access.

One of the most common chronic diseases in the world is obesity. Many researchers call obesity an epidemic of the 21st century [Alekseeva O.P. Metabolic syndrome: a modern concept, risk factors and some associated diseases / O.P. Alekseeva, A.A. Vostokova, M.A. Kurysheva / study guide - Nizhny Novgorod: Publishing House of Nizhny Novgorod State Medical Academy, 2009. - P. 17-25., Ginzburg M.M. Obesity and metabolic syndrome. Influence on the state of health, prevention and treatment / M.M. Ginzburg, G.S. Kozupitsa, N.N. Kryukov // Samara: Publishing House "Sail". - 2000. - 159 p.]. One of the characteristic features of patients with postoperative ventral hernias is the presence of obesity. Patients with obesity of various degrees make up from 50 to 70% of all patients with postoperative ventral hernias. Women in this category are 2-4 times more than men [Belokonev V.I. Comprehensive treatment of patients with postoperative ventral hernia / V.I. Belokonev, Z.V. Kovaleva, A.V. Vavilov, S.Yu. Pushkin, Yu.V. Ponomareva, O.N. Melentyev // Journal of them. N.I. Pirogov. - 2008. - No. 2. - S. 42-47., Bobrova N.V. A method for the treatment of postoperative hernias in individuals with a high degree of operational risk / N.V. Bobrova // Reconstructive and reconstructive surgery: Sat. scientific works. Voronezh, 1992. - S. 143-145.]. Obesity is one of the most important factors contributing to the formation or relapse of postoperative ventral hernia [Plechev B.V Surgical treatment of patients with postoperative ventral hernia / V.V. Plechev, P.G. Kornilayev, P.P. Shavaleev - Ufa: Ufa - 2000. - 152 p., Surgeman H.J. Greater rise of incisional hernia with morbidly obese then steroid-dependent patients and low recurrence with prefascial polypropylene mesh / H.J. Surgeman, J.M. Kellum, H. D. Reines et al. // Am. J. Surg - 1996 - No. 171. - P. 80-84.]. Obesity, on the one hand, predisposes to the formation of a hernia, on the other hand, progresses with its appearance [Timoshin A.D. Surgical treatment of inguinal and postoperative ventral hernias / A.D. Timoshin, A.V. Yurasov, A.L. Shestakov. - M .: Triad-X, 2003. - 144 p.].

With obesity, the course of surgical intervention is significantly complicated, therefore, the development of devices that allow for effective online access is relevant.

The patent literature describes a device for conducting open laparoscopy [Patent RU No. 59956 U1 of 01/10/2007]. The disadvantage of this device: in the presence of morbid obesity, significant difficulties arise during the operation.

In the process of laparoscopy, hollow cylinders with a flange and plugs are used [Patent RU No. 73185 U1 of 05/20/2008] or expanders having an external and internal tube [Patent RU No. 58803 U1 of 12/10/2006]. With morbid obesity, the proposed devices do not allow for wide online access.

A device for fixation of a trocar in operative laparoscopic access [Patent RU No. 70113 U1 of 01.20.2008] having two cuffs that can be inflated is selected as a prototype. The device has a different purpose and is not acceptable for performing wide operational access for morbid obesity.

The objective of the present invention is to provide a simple, easy-to-use device that allows for wide operational access due to the maximum separation of fatty tissue and soft tissues.

The technical result is achieved in that the device consists of three interconnected cone-shaped parts of different sizes. Lowering the cone-shaped smaller part to the surgical field causes the adipose tissue and soft tissues to expand, which provides wide operational access.

The utility model according to the technical solution consists of three interconnected cone-shaped parts: large, medium and smaller, which allow you to place smaller parts in larger parts, the inner surface of the large and medium parts is made with sawtooth protrusions and a side for engaging each part with the next, the smaller part sizes has a bottom fixed with tongues.

The proposed utility model is illustrated by graphic material.

The figure 1 presents a General view of the device, where the cone-shaped part of smaller sizes - 3 and the cone-shaped part of medium size - 2 are placed in a large cone-shaped part - 1.

The figure 2 presents the device, lowered to the surgical field, where 1 is the cone-shaped part of the largest sizes, 2 - the cone-shaped part of medium sizes, 3 - the cone-shaped part of smaller sizes, 4 - the sawtooth protrusions, 5 - the sides on the 1st, 2nd and 3rd cone-shaped parts, 6 - removable bottom mounted in the 3rd part, 7 - tongues for fastening the removable bottom (6) in the 3rd part.

The utility model is used as follows:

After an incision of the skin and subcutaneous fat, the device in the assembled state (Fig. 1) is installed on the surgical wound. Then, by pressure on the removable bottom 6, the part 3 is moved down, which entrains the cone-shaped part 2. This causes the sides 5 to engage with the sawtooth protrusions 4. When lowering the part 3 to the surgical field, the removable bottom of the 3rd cone-shaped part is removed using a tongue ( 7) and carry out the planned operation.

An example of the practical use of the device.

Medical record of inpatient №100881. Date of receipt: 01/23/2014. Date of discharge: 01/26/2014.

Patient K., 33 years old, was hospitalized with a diagnosis of Obesity 1 tbsp (BMI 32.1 kg / m2). Surgeon consultation: surgical treatment is indicated - bandaging of the stomach.

The patient was hospitalized in the surgical department No. 3 of the Design Bureau of Tyumen for surgical treatment.

Using the proposed device, an operation was performed - laparoscopic banding of the stomach.

System - Cousion biotech BCBRL23POU No. 2015-10_111719

The postoperative period was uneventful. Dressings were performed daily, drainage from the abdominal cavity was removed after 2 days, postoperative wounds were clean, and sutures were well-to-do. Discharged in satisfactory condition. There are no complaints.

During dynamic observation during the year, there are no postoperative hernias.

The utility model is implemented on the basis of the Design Bureau of Tyumen. 23 operations were performed using a device for exposing laparoscopic access in obese patients.

The device is convenient to use and allows for wide operational access due to the maximum separation of fatty tissue and soft tissues.

Claims (1)

A device for exposing laparoscopic access in obese patients, consisting of three interconnected cone-shaped parts: large, medium and smaller, which allow you to place smaller parts in larger parts, the inner surface of the large and medium parts is made with sawtooth protrusions and a side for engaging each part with the subsequent, the smaller part has a bottom fixed with tongues.

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