RU161539U1 - LAPAROSCOPY DEVICE - Google Patents

Abstract

A device for laparoscopy, characterized in that it is equipped with a device containing holes with valves for moving instruments, releasably fixed to the manual port, while the holes with valves are located according to the rule of an equilateral triangle.

Description

The utility model relates to the field of medical technology, namely to laparoscopic surgery, and is intended to provide the possibility of introducing several additional laparoscopic instruments into the abdominal cavity through a device fixed to the port for manual assist without the need for additional trocars. This makes it possible to quickly transfer the laparoscopic operation, originally performed with manual assistance, to a clean laparoscopic, replacing the surgeon’s hand inserted into the abdominal cavity with one or more laparoscopic instruments conducted through this device, and vice versa, while maintaining the manual port.

Currently, the laparoscopic technique, the universally recognized “gold standard” in performing a number of operations, is an alternative to open surgery and is characterized by minimal postoperative pain and a long recovery period.

To date, laparoscopic surgeries exist in the form of two main techniques: surgeries with manual assistance and pure laparoscopic surgeries.

Manual assistance - implies the initial installation of the manual port, one hand (usually the left one for right-handed people) is inserted through the “hand-port” and constantly works in the abdominal cavity, the surgeon performs the operation with the second hand (right) using laparoscopic instruments performed through 5 mm or 10-12 mm trocars. At the same time, the surgeon mainly performs passive traction of tissues with a hand held in the abdominal cavity, and dissection, intracorporeal suturing, work with electrocoagulation instruments, an aspirator and other active actions are performed by a laparoscopic instrument conducted through special ports.

A clean laparoscopic operation implies active work with two instruments throughout the operation without installing a manual port and introducing the surgeon's hand.

Each of the above methods has a number of advantages and disadvantages.

With manual assistance, it is easier for the surgeon to navigate in the abdominal cavity, since it is possible to tactilely determine tissues and structures. For surgeons who master the laparoscopic method of performing operations and have extensive experience in conducting similar open operations, the manual assist technique is the optimal transition when the surgeon performs an intervention using a hand and a laparoscopic instrument. The presence of the surgeon’s hand in the abdominal cavity provides confident hemostasis by pressing the vessel with the fingers of your hand, using a tissue, quickly removing the organ through the manual port without additional incisions.

The disadvantages of the manual assistant technique include the possibility of active work with only one laparoscopic instrument, the surgeon's hand can impede the visualization of the surgical field, complicating the work of the video assistant. It is advisable to perform some stages of the operation using a combination of two laparoscopic instruments (delicate work on the vessels, the application of an intracorporeal suture, work in hard-to-reach areas of limited space, performing adhesiolysis, etc.). The presence of a surgeon's hand in the abdominal cavity can create difficulties for the operating team.

A purely laparoscopic surgery technique also has several disadvantages, while the disadvantages of one technique are advantages of another and vice versa.

The possibility of the optimal combination of pure laparoscopic surgery with manual assistive technique makes it possible to vary the technique of the operation using the most suitable method for certain stages of the operation. Thus, the risk of complications is reduced and the operation of the operating team becomes more comfortable.

For example, when performing a laparoscopic nephrectomy in a living donor during kidney transplantation - the main stages of the operation, when “soft” traction is required (so as not to damage the integrity of the parenchyma), it is advisable to quickly remove the organ with the help of a surgeon’s hand held in the abdominal cavity through the manual port, and Isolation and clipping of vessels, ureter using a clean laparoscopic technique, which would allow the simultaneous use and optimal combination of two small diameter laparoscopic instruments on elikatnyh stages of operation.

Recently, Lap Disk, which is a sterile device that provides manual access through the anterior abdominal wall while holding pneumoperitoneum, is widely used. This device consists of three superimposed rings, interconnected by a silicone membrane. The lower ring is made of material with shape memory. The membrane connecting the flexible lower and rigid middle ring, simultaneously performs the function of a retractor. Two rigid upper rings are connected by a threaded mechanism, providing a narrowing of the iris membrane when the rings rotate relative to each other. All this allows you to tightly fit the surgeon's hand and hold pneumoperitoneum. This device can be used to introduce trocars through an adjustable iris membrane.

However, the fixation of the instrument by the membrane leads to the appearance of free uncontrolled movements due to the softness of the membrane material itself, which leads to a decrease in the accuracy of movements at the working end of the instrument. Moreover, using this device, it is possible to introduce only one instrument into the abdominal cavity of the abdomen. A quick change of tools is not possible, since when replacing tools you have to loosen and then tighten the membrane. When the membrane is weakened, carbon dioxide is etched and pressure in the abdominal cavity is lost.

Also known is the technology of using monoports. For example, SILS is a technique (Single Incision-Less Surgery) the basis of which is the use of a special latex monoport. This port is installed in the abdominal cavity through a two-centimeter skin incision in the navel. Moreover, it already has four holes with a diameter of up to 5 mm, which are used as follows: the first is for supplying gas, which is necessary for visualizing internal organs, as in the standard laparoscopic technique, and the second for a video camera. Special manipulators are introduced through the remaining two holes, whose main feature is the ability to form unique bends, which makes it possible to perform an operation with a pronounced deficit of free space.

However, in this case, it is possible to use only 5 mm tools, with a special shape and bend. The use of 10 mm tools is excluded. The small diameter of the monoport, the proximity of the location of the input holes of the tools can create certain difficulties during the operation. In addition, in this case, it is not possible to hold a surgeon's hand and remove a large, remote organ through a small-diameter port.

Thus, at present, there is an urgent need to create a device that allows you to perform, if necessary, a quick transition from manual assistive techniques to clean laparoscopic surgery and vice versa, using the original location of the ports and without making additional incisions, and, as a result, without causing additional injury to the patient .

The essence of the utility model is that this device is a device fixed to the manual port with three holes equipped with valves located according to the rule of an equilateral triangle, which allows the use of up to three laparoscopic instruments.

Application of the utility model allows to obtain the following technical result:

1. The location of the working valves according to the rule of an equilateral triangle makes it possible to use up to three laparoscopic instruments simultaneously, reducing the possibility of their intersection during the operation, improving ergonomics

2. The use of up to three additional laparoscopic instruments, the possibility of their combination depending on the position taken.

3. The ability to use both 10 mm and 5 mm tools, and their combinations.

4. If it is necessary to insert the surgeon's hand into the abdominal cavity, it is possible to quickly replace this device with a standard device with a sealing membrane and vice versa.

This utility model is a complete device completely ready for use.

The design of the proposed device can minimize the invasiveness of surgical intervention, reduce tissue trauma, provide the optimal combination of manual assisting techniques and a purely laparoscopic technique at different stages of the operation, which will reduce the likelihood of intra- and postoperative complications. The combination of different techniques will make the work of the operating surgeon and team more comfortable.

The device has wide functionality. It can be used in various laparoscopic operations in surgery, urology, gynecology.

In FIG. 1 is a schematic illustration of a device for laparoscopy.

A device for laparoscopy, which is a disk 1, having three holes 2, located according to the plan of an equilateral terugolok, equipped with valves 3.

In FIG. 2 is a schematic illustration of a laparoscopy device fixed to a manual port, ready for use.

The device for laparoscopy 4, is fixed on the manual port 6, using the fastening 5.

The technical result is achieved due to the design of the device.

1. The presence of three holes with valves, located according to the rule of an equilateral triangle, makes it possible to optimize the combination of tools in quantity (up to three), location (depending on the position)

2. This device is comparable in shape and size to a standard device with a sealing membrane for introducing a hand.

3. The same form of attachment to the manual port allows quick replacement of one device with another.

4. The holes with valves have a diameter of 12 mm, which allows the use of different diameter tools (10 mm, 5 mm).

This device was used for laparoscopic surgery in 20 patients. All patients achieved a positive result. No intra- or postoperative complications were observed. It should be noted that the time of the operation is reduced, the patient's injuries are reduced, and the cosmetic effect is improved, due to the lack of the need for additional trocars.

Claims (1)

A device for laparoscopy, characterized in that it is equipped with a device containing holes with valves for moving instruments, releasably fixed to the manual port, while the holes with valves are located according to the rule of an equilateral triangle.

Images