RU166942U1 - SOFT FABRIC BROWNER LARGE - Google Patents

Abstract

Soft tissue stitcher, consisting of a distal arcuate needle fragment for ligatures, a truncated cone-shaped rod and handle, characterized in that the distal needle fragment has a diameter of 1.0 mm, the radius along the inner generatrix of 15.0 mm, an ellipsoidal section at the end, length 5 , 0 mm, longitudinal axis 1.0 mm, transverse - 0.6 mm; in the distal part, on the inner surface, 2.0 mm from the end of the needle, has a slot of a triangular configuration directed towards the end of the needle, the angle between the edges of the slot is 25 °, the angle of the proximal edge of the slot to the axis of the needle is 35 °, the tip of the slot has a radius of 0.05 mm, slot depth 0.4 mm; the needle fragment is connected to a truncated conical rod 2.0 mm from its distal end at an angle of 60 ° to the horizontal axis, in a projection parallel to the plane of the tool handle; a rod 150.0 mm long, with a distal diameter 3.0 mm and a proximal 4.0 mm, the proximal stem is connected to a curly handle with an elongated drop-shaped configuration, 85.0 mm long.

Description

Reusable and disposable surgical needles and needle holders are used to suture defects of parenchymal and hollow organs, suture the walls of hollow organs when they are resected and sutured deep in the abdominal cavity. The technique of suturing organs and tissues using surgical needles and a needle holder includes stitching with a charged needle one wall of stitched tissues, transferring the needle holder to the beginning of the needle, removing it from the stitched wall, reloading the needle holder on the distal third of the needle, and stitching the second wall of the organ with the same three options for reloading the needle holder , after which the ligature is tied to the defect of the organ wall.

The disadvantage of the method of suturing defects in tissue and organ walls is the multi-stage manipulation of intercepting the needle with the needle holder from the distal third of the needle to the proximal and then again to the distal third when stitching tissues using surgical needles, a needle holder and tweezers. In addition, there is a danger of damage to the sharp and blunt ends of the needle of the surrounding tissue, as these manipulations can be carried out in the depths of the abdominal cavity in a limited space of the surgical field.

As a prototype of a tool for carrying out ligatures, a sharp Deshana ligature needle was used (Catalog of medical instruments: http://www.nworld.spb.ru/medinss_i003v.htm), which is used to conduct ligatures through tissue friable in structure, having an arcuate fragment with a hole for ligatures at the distal end, a truncated cone rod and plate handle.

The disadvantage of the prototype is the inability to use it for stitching dense fabrics, although it has a convenient configuration for use as a stitching tool, at the same time, the method of charging the ligature into the tool is time-consuming.

The technical result is a simplification of the technique of suturing different types of soft tissues, reducing the time of surgery, increasing the safety of manipulations with the help of a stitcher in the depths of the body cavities in comparison with the traditional method of using surgical needles and a needle holder, simplifying charging of the ligature into the instrument.

The technical result is achieved due to the presence in the device of a distal arcuate needle fragment for ligatures, a truncated cone-shaped rod and handle, characterized in that the distal needle fragment has a diameter of 1.0 mm, the radius along the inner generatrix of 15.0 mm, an ellipsoidal section at the end, length 5.0 mm, the longitudinal axis 1.0 mm, the transverse - 0.6 mm; in the distal part, on the inner surface, 2.0 mm from the end of the needle, has a slot of a triangular configuration directed towards the end of the needle, the angle between the edges of the slot is 25 °, the angle of the proximal edge of the slot to the axis of the needle is 35 °, the tip of the slot has a radius of 0.05 mm, slot depth 0.4 mm; the needle fragment is connected to a truncated conical rod 2.0 mm from its distal end at an angle of 60 ° to the horizontal axis, in a projection parallel to the plane of the tool handle; a rod 150.0 mm long, with a distal diameter 3.0 mm and a proximal 4.0 mm, the proximal stem is connected to a curly handle with an elongated drop-shaped configuration, 85.0 mm long.

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 distal arcuate needle fragment (1) for ligatures, a truncated cone-shaped rod and handle, characterized in that the distal needle fragment has a diameter of 1.0 mm, a radius along the inner generatrix of 15.0 mm, an ellipsoidal section at the end, length 5 , 0 mm, longitudinal axis 1.0 mm, transverse - 0.6 mm; in the distal part, on the inner surface, 2.0 mm from the end of the needle, has a slot of a triangular configuration (2) directed towards the end of the needle, the angle between the edges of the slot is 25 °, the angle of the proximal edge of the slot to the axis of the needle is 35 °, the tip of the slot has a rounding with a radius 0.05 mm, slot depth 0.4 mm; the needle fragment is connected to a truncated conical rod (3) 2.0 mm from its distal end at an angle of 60 ° to the horizontal axis, in a projection parallel to the plane of the handle of the tool; a rod 150.0 mm long, with a distal diameter 3.0 mm and a proximal 4.0 mm, the proximal stem is connected to a curly handle (4) of an elongated drop-shaped configuration, 85.0 mm long (Fig. 3).

THE DEVICE WORKS AS FOLLOWS

A large soft tissue stitching device is supplied with a needle fragment to the edge of tissues to be sutured from the outside or from the depth of the wound, taking into account the type of organ and surgical principles of suturing. By rotating the horizontal stitching movement of the tool along the curvature of the needle fragment, one organ wall is pierced, a ligature is brought to the slot of the needle fragment, the needle fragment of the stitcher is removed from the tissues along with the ligature in reverse. The extracted end of the ligature is fixed by the assistant. The second edge of the wound is stitched with the tool in the same way in the opposite direction with the ligature. Then the ends of the ligature drawn through both edges of the wound are connected.

CLINICAL APPLICATION EXAMPLES

Patient B., 67 years old. Hospitalized in the Municipal Clinical Hospital Municipal Clinical Hospital SMP in Kursk 11/01/15. Diagnosis: Penetrating wound of the abdominal cavity with damage to the right lobe of the liver, intraperitoneal bleeding of 1 degree. 11/01/15, Operation - PHC wounds of the abdominal wall, laparotomy. Diathermocoagulation of a liver wound, tamponade with an omentum, suturing of a liver wound, debridement and drainage of the abdominal cavity.

During laparotomy, after revision of the abdominal cavity, up to 150 ml of blood with convolutions was found in the right lateral canal and pelvic cavity. Drained. A torn wound 2.5 × 1.5 × 1 cm in size with a slight leakage of blood was found on the diaphragmatic surface of the right lobe of the liver. Excreted areas of the edges of the wound of the liver are excised. Hemostasis was performed by electrocoagulation. The edges of the liver wound are stitched with a large soft tissue stitcher with 2 catgut nodal sutures, which are tied over a strand of a large omentum inserted into the wound. Sanitation of the abdominal cavity. Tubular drainage into the subhepatic space. Rubber strip to the wound of the liver. Layered seams on the wound of the abdominal wall using a large soft tissue stitcher. The peritoneum is sutured with a continuous suture with catgut, the aponeurosis with nodular sutures of nylon, the subcutaneous tissue with nodular sutures with catgut. The skin is sutured with a traditional-cutting needle, nodal seams nylon. Iodine. Aseptic dressing. 11/05/15, the drainage tube is removed. The postoperative period was uneventful, the sutures were removed 11/11/15, healing by primary intention.

Patient K., 36 years old. He was hospitalized at the Municipal Clinical Hospital Municipal Clinical Hospital SMP of Kursk on 12/13/15. Diagnosis: peptic ulcer. LDPC ulcer complicated by perforation. Local serous-fibrinous peritonitis. Operation 12/13/15 - laparotomy, excision of an ulcer of LDPC, duadenoplasty, debridement and drainage of the abdominal cavity.

Under intubation anesthesia, the upper median laparotomy was performed. In the subhepatic space up to 200 ml of serous-fibrinous effusion. Drained. The stomach is of normal size. The pylorobulbar zone is moderately deformed by the scar-ulcerative process. On the front wall of the LDPC, an ulcerative infiltrate with a diameter of up to 1.5 cm with perforation in the center with a diameter of 0.5 cm. The front wall of the LDPC is mobilized from scars, a sealing and purse string suture around the infiltrate was applied. In the transverse direction to the axis of the intestine, a clamp is applied to excise the anterior wall of the intestine. With the help of a large soft tissue stitcher, a continuous trapezoidal suture with a catgut was sutured, a fragment of the anterior intestinal wall was dissected, and the edge of the excised intestine was sutured in an opposite seam. The ends of a continuous seam are connected. Peretonization of the stitching seam with serous-muscular nodal sutures with an atraumatic needle with a PHA thread. Sanitation and drainage of the abdominal cavity by tubular drainage in the right hypochondrium. Layered suturing of the peritoneum, aponeurosis and subcutaneous fat with the help of a large soft tissue stitcher. The skin is sutured traditionally with a cutting needle using nylon. Iodine. Aseptic dressing. 12/17/15, the drainage is removed. 12.24.15, an X-ray examination of the gastrointestinal tract was carried out. Marked deformity of LDPK 1 degree. Motor evacuation function is not impaired. Sutures were removed on 12/25/15. Healing by primary intention. In satisfactory condition, was discharged for aftercare by a gastroenterologist.

Patient N., 52 years old. He was hospitalized at the Municipal Clinical Hospital Municipal Clinical Hospital SMP in Kursk on 10/03/15. Diagnosis: Mellori-Weiss syndrome, complicated by recurrent bleeding of 2-3 degrees. Operation 05.10.15, - laparotomy, gastrotomy, flashing of a subcardia crack, drainage of the abdominal cavity.

Under intubation anesthesia, the upper median laparotomy was performed. The stomach is plugged with blood; in the loops of the small and large intestine there is fragmentary dark blood. An anterior-upper gastrotomy was performed. Blood clots removed. During the audit, a crack of the mucous membrane of the posterior wall 1.5 × 0.5 cm under the fibrin was found in the subcardial zone, with a bleeding venous vessel in the center. Hemostasis by piercing a crack with 2 interrupted sutures by fluoride using a tool. The soft tissue stitcher is large. There are no other sources of bleeding. The gastrotomy opening is sutured with a continuous stitching catgut suture superimposed with a soft tissue stitch. Peretonization of the stitching suture is performed by nodular serous-muscular sutures, atraumatic needles with PHA threads. Remediation, drainage of the abdominal cavity by tubular drainage in the right hypochondrium. With the help of a large soft tissue stitcher, layered stitches were applied to the wound of the abdominal wall. The peritoneum is sutured with a continuous catgut suture. Aponeurosis is sutured with nodular sutures with nylon, nodal sutures on the subcutaneous tissue with catgut. The skin is sutured with nodular sutures with nylon cutting needles. Iodine. Aseptic dressings. Drainage from the abdominal cavity was removed on 10/08/15. The sutures were removed on 10/15/15. Healing by primary intention. In satisfactory condition, was discharged on October 16, 2015 for aftercare by a gastroenterologist.

Thus, an analysis of the use of the soft tissue stitcher tool large in patients with injuries of the parenchymal and hollow organs, as well as during emergency surgical interventions on the stomach, showed that the technique of suturing injuries of various types of soft tissues was simplified, the time of surgical intervention was reduced compared to suturing with surgical needles and needle holder, the number of tools used has decreased, the technique of charging ligatures into a tool has been simplified, the safety of manips has been improved lyatsy via proshivatelya deep body cavities, and the reduced amount of manipulation time suturing parenchymal organs and hollow suture different thickness decreased amount of the toolkit.

Claims (1)

Soft tissue stitcher, consisting of a distal arcuate needle fragment for ligatures, a truncated cone-shaped rod and handle, characterized in that the distal needle fragment has a diameter of 1.0 mm, the radius along the inner generatrix of 15.0 mm, an ellipsoidal section at the end, length 5 , 0 mm, longitudinal axis 1.0 mm, transverse - 0.6 mm; in the distal part, on the inner surface, 2.0 mm from the end of the needle, has a slot of a triangular configuration directed toward the end of the needle, the angle between the edges of the slot is 25 °, the angle of the proximal edge of the slot to the axis of the needle is 35 °, the tip of the slot has a radius of 0.05 mm, slot depth 0.4 mm; the needle fragment is connected to a truncated conical rod 2.0 mm from its distal end at an angle of 60 ° to the horizontal axis, in a projection parallel to the plane of the tool handle; a rod 150.0 mm long, with a distal diameter 3.0 mm and a proximal 4.0 mm, the proximal stem is connected to a curly handle with an elongated drop-shaped configuration, 85.0 mm long.

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