RU170829U1 - TROAKAR FOR A SINGLE-BLADED BLADDER PUNCTION OF THE BLADDER - Google Patents

Abstract

A useful model - a trocar for simultaneous suprapubic puncture of the bladder refers to medicine, namely to urology, and is intended for the surgical treatment of patients with acute or chronic urinary retention. The trocar is a tube made in the form of a mono-component, open along the axis with the width of the slit of the double wall diameter designed to remove the trocar from the drainage with the stylet function due to one of the ends chamfered at an angle with a cutting edge to puncture the bladder wall and the opposite stop end, made in the form of a cylinder of increased diameter, having at its end three mutually perpendicular grooves, the depth and width of which correspond to the inner diameter of the trocar, for the initial part of the drainage in the operator’s hand to be located in one of them, and one groove aligned with the slot of the tube and equal in width (Fig. 1-3). This tool provides simultaneous suprapubic puncture of the bladder by locating the drainage tube in the cavity of the tube and getting it into the bladder at the time of puncture of the organ wall, it reduces the number of surgical steps, reduces the risk of possible complications and technically simplifies operator.

Description

The utility model relates to medicine, namely to urology, and is intended for the surgical treatment of patients with acute or chronic urinary retention.

своего диаметра. Один конец тубуса скошен под углом и имеет режущую кромку для обеспечения прокола стенки мочевого пузыря. Противоположный конец тубуса выполнен в виде цилиндра увеличенного диаметра, на торце которого находятся три взаимно перпендикулярных паза, и один паз одинаковой ширины с прорезью тубуса троакара и совмещенный с ним для удобства снятия устройства с катетера Фолея, дренирующего мочевой пузырь. Три паза имеют одинаковую ширину и глубину, равные внутреннему диаметру троакара, и предназначены для укладки проксимальной части дренажной трубки (катетера), дистальная часть которой расположена в полости тубуса троакара, в любом удобном для руки оператора направлении. Торцевая часть троакара за счет своего увеличенного диаметра служит упором для приложения усилия при пункции мочевого пузыря, а также препятствует возможной миграции троакара в полость мочевого пузыря. Глубина и ширина пазов торцевой части троакара такова, что дренаж находится в любом из них "заподлицо" и даже в согнутом положении не передавлен рукой оператора, что позволяет сохранить просвет его постоянным и подтвердить нахождение троакара с дренажом в полости мочевого пузыря после пункции его по жидкости, поступающей из дренажа.The trocar for a simultaneous suprapubic puncture of the bladder is a tube-stylet made in the form of a monodetal. The tube of the trocar is made in the form of a tube, open along the axis with a groove width of up to

its diameter. One end of the tube is beveled at an angle and has a cutting edge to allow for puncture of the bladder wall. The opposite end of the tube is made in the form of a cylinder of increased diameter, at the end of which there are three mutually perpendicular grooves, and one groove of the same width with a slot in the trocar tube and combined with it for the convenience of removing the device from the Foley catheter draining the bladder. Three grooves have the same width and depth equal to the inner diameter of the trocar, and are intended for laying the proximal part of the drainage tube (catheter), the distal part of which is located in the cavity of the trocar tube in any direction convenient for the operator’s hand. The end part of the trocar due to its increased diameter serves as a stop for the application of force during puncture of the bladder, and also prevents the possible migration of the trocar into the cavity of the bladder. The depth and width of the grooves in the end part of the trocar is such that the drainage is “flush” in any of them and even in the bent position is not transmitted by the operator’s hand, which allows it to remain constant and confirm that the trocar with drainage is in the cavity of the bladder after it is punctured with liquid coming from drainage.

The utility model relates to medicine, namely to urology.

Known trocar for puncture epicystostomy (Makarov P.A., Tsukanov A.Yu., Kuritsin A.B., No. 32989, publ. 10.10.2003), consisting in assembled form of a metal tube (tube), open along its axis with a certain width of the groove, and the stylet located in the cavity of the tube. This device is used to install drainage tubes (catheters), including with the possibility of additional fixation in the bladder (for example, a Foley catheter). After the bladder wall is punctured with a stylet located in the tube of the trocar, the former is removed from the tube, and through the channel of the latter, a drainage tube (catheter) is inserted into the bladder, which is fixed to the patient’s skin with ligature sutures after removal of the tube from the wound canal. Some of the disadvantages of this device are:

1. filling the surgical wound with urine through a free tube located in the bladder, after removing the trocar stylet from it and before introducing drainage through the tube into the bladder cavity due to rapid emptying of the bladder due to its puncture under conditions of increased intracavitary pressure in acute or chronic urinary retention;

2. the risk of displacement of the front wall of the bladder from the tube of the trocar before the introduction of drainage (catheter) into the cavity of the bladder through the tube due to the rapid emptying of the urinary bladder that is full of urine and the associated reduction of its wall;

3. the danger of migration of the tube of the trocar into the cavity of the bladder when removing the stylet;

4. the difficulty of assessing the location of the trocar assembled (tube with stylet) in the bladder cavity before removing the stylet from the tube and receiving urine and, as a consequence, the risk of damage to internal organs due to the need for repeated puncture of the bladder when ascertaining the fact of the trocar being outside the cavity Bladder;

5. the need to perform a number of steps that increase the duration of surgery for trocar cystostomy (removing the stylet from the tube of the trocar with the subsequent introduction of a drainage tube through it into the cavity of the bladder).

Close to the claimed device is a trocar-cystofix used for trocar cystostomy (Vahlensieck W. J. etal. Z. Urol. Nephrolog. 1990 Jun; 83 (6): 309-12). This is a disposable hollow trocar with a pointed end, through the cavity of which, after a bladder puncture, a Foley catheter is carried out. After the Foley catheter is inserted, the balloon of the latter is inflated, the trocar is carefully removed from the bladder and the wound channel (prebubble fatty tissue, muscle-aponeurotic layer of the anterior abdominal wall, subcutaneous fatty tissue, skin), after which the trocar-cystofix is broken along the axis in half to extract from it cavity of the Foley catheter.

Some of the disadvantages of this device are

1. the danger of the intersection of the drainage tube (catheter) with the tip of the trocar when breaking the cystofix trocar along its axis, the end of the drainage tube (catheter) remains in the wound, which will require revision of the wound canal and re-drainage of the bladder with new drainage (DograP.N., GoelRInt. Urol. Nephrol. 2004; 36 (3): 343-4));

2. single use of the trocar-cystofix;

3. the high cost of a set of trocar-cystofix.

The objective of the utility model is to create a trocar for simultaneous suprapubic puncture of the bladder, which provides an accurate, less traumatic, less time-consuming and more convenient surgical technique in the treatment of patients with acute or chronic urinary retention.

According to a utility model, the solution of this problem is achieved by the fact that the proposed trocar for simultaneous suprapubic puncture of the bladder is a tool that combines the functions of the tube and stylet at the same time due to the presence of a cutting edge at the piercing end of the tube, while the drainage tube at the time of puncture of the bladder is the cavity of the tube and appears in the bladder simultaneously with a puncture of its wall. As a drainage, a Foley catheter or any other drainage tube suitable in its characteristics for drainage of the bladder cavity can be used.

The proposed trocar is shown schematically in FIG. 1-3, where 1 is the tube-stylet, 2 is the stop end of the tube, 3 is the piercing end of the tube, 4 is the slot of the tube wall for removing the instrument from the drainage after the bladder is punctured, 5 is the groove of the persistent end of the trocar connected by the slot of the tube wall, 6 - grooves of the persistent part of the trocar for location in one of them "flush" of the initial part of the drainage in the operator's hand.

A trocar for simultaneous suprapubic puncture of the bladder is used as follows. A Foley catheter (or other drainage tube) is placed in the cavity of the stylet tube so that the cystic end of the drainage does not protrude beyond the distal (piercing) end of the trocar and is at the same level with it, and the proximal part of the catheter located outside the trocar is placed in the operator’s hand so that it forms a right angle to the axis of the trocar and its initial section is "flush" in one of the grooves on the end (thrust) part of the trocar. After piercing the front wall of the bladder and receiving urine via a Foley catheter, which is already in the bladder, the catheter is straightened and advanced along the lumen of the trocar further deeper into the bladder, then fixed by filling its balloon, and the trocar is removed from the bladder and removed from the catheter through a longitudinal slot located on the tube.

This trocar can reduce the risk of trauma of puncture cystostomy due to its simultaneity (getting drainage into the cavity of the bladder along with a puncture of its wall), achieved by the design of the device, which allows to reduce the number of stages of surgical intervention (removing the stylet from the tube and the very introduction of a catheter into the cavity of the bladder through tube) and thereby facilitating its carrying out for the operator.

A trocar for simultaneous suprapubic puncture of the bladder was used in the surgical treatment of 24 patients with acute and chronic urinary retention hospitalized in an emergency. The average age of the operated patients was 65.3 years, the average duration of inpatient treatment was 5.1 hospital days. All operations are performed under local anesthesia. There were no complications when using a trocar for simultaneous suprapubic puncture of the bladder during surgery and in the postoperative period, there was no mortality.

The proposed device (a trocar for simultaneous suprapubic puncture of the bladder) is effective, safe and convenient when performing a trocar cystostomy with drainage of the bladder cavity as a Foley catheter or any other drainage suitable in its characteristics for this surgical intervention. The device is designed for reusable use, economical and affordable for use in hospitals and outpatient clinics.

Claims (1)

A trocar for simultaneous suprapubic puncture of the bladder, providing simultaneous catheter drainage with its wall puncture, characterized in that it is made in the form of a mono-component, representing a tube, open along the axis with a wall slot width of up to

its diameter, designed to remove the trocar from the drainage with the stylet function due to one of the ends chamfered at an angle with a cutting edge to puncture the bladder wall and the opposite stop end, made in the form of a cylinder of increased diameter with three mutually perpendicular grooves on its end, the depth and width corresponding to the inner diameter of the trocar, for the location in one of them of the initial part of the drainage in the operator’s hand, and one groove combined with the slot of the tube and equal in width to it.

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