RU168637U1 - RETRACTOR SYSTEM FOR ACCESS TO THE THYROID GLAND - Google Patents

Abstract

Operations on the thyroid gland due to anatomical and topographic features are specific and complex. When interventions on the thyroid gland, it is required to provide an adequate overview of the surgical field in order to visualize the anatomical structures to exclude the possibility of damage to them. This problem can be solved through the use of frame retractors, in connection with which the authors developed a retractor with a retractor system to create a full-fledged workspace during surgical interventions on the thyroid gland, including under conditions of mini-access. This retractor differs from the prototype in that the frame is reduced and curved in at least 3 planes in a shape close to a hyperbolic paraboloid corresponding to the anatomical bends of the neck, the upper part of which is arranged to be placed on the chin line. The frame of the retractor has an anatomical design with the possibility of free positioning of the nodes and individual adjustment of the position of the hooks depending on the features of the surgical field, while maintaining the freedom of movement of the surgeon's hands, the structure of the nodal joints allows you to effectively perform traction with the necessary effort, facilitating the effort of the assistant. On the whole, quickly and efficiently, from small cuts, to provide an overview of the organs and structures of the neck during surgery FIR interventions on the thyroid gland.

Description

Technical field

The utility model relates to medical equipment, namely to surgical instruments, and can be used to create optimal surgical access to the thyroid gland.

Operations on the thyroid gland due to anatomical and topographic features are specific and complex. When interventions on the thyroid gland, it is required to provide an adequate overview of the surgical field in order to visualize the anatomical structures to exclude the possibility of damage. This problem can be solved by increasing the incision or the intersection of the pre-throat muscles. However, currently the priority directions in thyroid surgery are improving the cosmetic result of the operation, as well as minimizing the surgical trauma. In this regard, operations on the thyroid gland are increasingly performed from the minimum access without crossing the prethyroid muscles. At the same time, an adequate overview of the surgical field is provided due to the various surgical hooks used by assistants. When interventions on the thyroid gland, the operating surgeon is usually helped by two assistants. One of the options to achieve optimal access to the thyroid gland and reduce the need for the help of a second assistant is to use frame expanders. Currently, various options are proposed for the latter.

For example, the McLoughlin Atraumatic Self-retaining thyroidectomy retractor (MASTR) is known. This retractor is installed on the operating area after creating access to the thyroid gland, hooks are inserted into the wound sequentially, which provide traction of the pre-throat muscles together in the skin, platysma and subcutaneous tissue. Despite its original shape of the frame in this system, there are the following disadvantages: hooks have certain attachment points that provide fixation in one place without the possibility of their rotation on its own and frame axis; hooks are used only of one width and degree of curvature, due to the unchanged design, individual characteristics of the patient are not taken into account.

Also known is the Mahorner thyroid retractor. This retractor provides only traction of the skin-fat platysmal flap in the caudal and cranial directions without taking into account the length of the incision, as a result of which it is impossible to use this system with mini-access.

Thyroid retractor Gray Surgical (GS) is known. This system is designed for operations on the thyroid gland, includes an adjustable frame and a set of hooks that are attached to it. In the cranial and caudal parts there are fixed holders for the skin and subcutaneous fat, as a result of which there is no possibility of their movement, and their width does not allow mini-access.

Also known is the Maxop Retractor System, which has a modular design with the ability to adjust. This device has a "blind spot", as a result of which there is no possibility of installing hooks around the entire perimeter of the wound. Another disadvantage of this system is that the hooks can be installed in the same plane, and the clamping screws are located close to the working part of the hooks, which can complicate manipulations in the depth of the wound.

The Frankfurt Retraction System retractor, which is a system of a frame and hooks fixed on it, is taken as a prototype. In this retractor, hooks can be installed and secured in any part of the frame using special clamps and moved in different directions. A curved frame simplifies access to the thyroid gland. The Frankfurt system allows you to access the operated organs without the help of additional assistants. However, a drawback of the Frankfurt retractor is that part of the frame and the handle of the hooks at the head block the area of the chin, mouth and nose of the patient, which complicates the work of the anesthetist. In addition, the Frankfurt retractor is not easy to use and requires a sufficiently long time to select a position convenient for the surgeon. For stability of the position of the edges of the wound, it is often necessary to fix the frame by additional methods.

The aim of the invention is the creation of a device - a retractor with a system of retractors to create a full-fledged working space during surgical interventions on the thyroid gland, including under conditions of mini-access.

The proposed utility model is presented in different positions in the photographs (Fig. 1, Fig 2.) and its use during thyroid surgery is demonstrated (Fig 3.)

The inventive device is a structure consisting of a frame curved at least in 3 planes in accordance with the anatomical bends of the neck, in a shape close to a hyperbolic paraboloid, the upper part of which can be placed on the chin line without going on the area of the face, on which hooks can be fixed in any position and plane with the help of special units, the number of which is limited only by the size of the frame. The units are equipped with clamping screws for fixing them on the frame in the desired position, while turning the clamping screw, both the assembly on the frame and the hook are simultaneously locked in the desired position, depending on the stage of the operation, the hook necessary at the moment can be used. Curved in 3 planes, close to the hyperbolic paraboloid, the shape of the frame makes it possible to better maneuver the hooks and set them in the optimal fixation position with the best access to the thyroid gland or to other organs of the neck. The shape of the frame also eliminates the location of the hooks in a plane that creates discomfort to the operating surgeon, which does not complicate the necessary manipulations. All parts of the cervical retractor and hooks are made of anti-corrosion medical steel, which ensures sterilization in any way.

The proposed retractor with a retractor system is used as follows. After a collar-like skin incision, dissection of the subcutaneous tissue, platysma, and dilution of the pretracheal muscles along the midline, a frame is placed on the surgical area. Further, the working parts of the corresponding hooks are introduced into the surgical wound, including a reduced one, migrating depending on the anatomical features. Further, the nodes are installed on the frame in the required positions. Using the clamping screws, the knots are securely fixed together with the hooks on the frame. Access is shifted and locked in position.

Examples of specific use of the proposed device. Patient D., 35 years old, was hospitalized in the endocrine surgery department of the City Clinical Hospital named after S.P. Botkin with a diagnosis of Multinodular goiter of the 2nd degree (according to WHO), compression syndrome. When TAB data for atypia is not detected. Thyroid status is euthyroidism. Indications for thyroidectomy are displayed. Under endotracheal anesthesia, a reduced collar incision was made up to 4 cm long. The skin, subcutaneous tissue and m were dissected in layers. platisma. After mobilization of the pre-throat muscles, the retractor is mounted on the neck. Then, corresponding hooks are introduced into the wound, which are fixedly fixed to the frame of the expander. Next, mobilization of the upper thyroid pole was performed, then the hooks were moved to mobilize the lower pole of the thyroid gland, then to the area of the posterolateral surface. The left lobe with the isthmus was removed by a similar technique. After careful hemostasis, the hook retractor was removed. After which the wound is sutured in layers. The postoperative period was uneventful. The patient was discharged on the 3rd day after surgery.

Features of utility model other than prototype

1. In contrast to the device of the prototype, the frame of the retractor of the proposed system has smaller dimensions and "tight" shape, more consistent with the anatomy of the neck, and the upper part of which is made with the possibility of placement on the chin line, without going to the face area.

2. The frame, curved at least in 3 planes, in a shape close to a hyperbolic paraboloid, makes it possible to better maneuver the hooks to find the optimal fixation location with the best access to the operation area and providing the surgeon with sufficient working space (including including with mini-access) for complete manipulations under the control of vision.

3. A retractor with a retractor system allows you to displace and fix the surgical wound in different necessary directions when using migratory accesses.

4. The frame of the retractor has an anatomical design with the ability to freely position the nodes and individually adjust the position of the hooks depending on the features of the surgical field, while maintaining the freedom of movement of the surgeon's hands.

5. The structure of nodal connections allows you to effectively perform traction with the necessary effort, facilitating the effort of an assistant.

Using the proposed retractor makes it possible, on the whole, to quickly and efficiently provide an overview of neck organs and structures during surgical interventions on the thyroid gland from small incisions along the length of the incisions.

Claims (1)

A retractor for access to the thyroid gland, which is a structure including a frame, nodes with clamping screws and hooks, characterized in that the frame is curved in at least 3 planes in a shape close to a hyperbolic paraboloid corresponding to the anatomical bends of the neck, the upper part of which is arranged to be placed on the chin line.

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