RU175236U1 - SURGICAL SCREW NEEDLE HOLDER - Google Patents

Abstract

A surgical screw needle holder refers to medicine, namely to surgery. The technical result of the utility model is the use of a needle holder with a screw option for attaching interchangeable curved needles with a hook to the stitching part, thereby increasing the speed of soft tissue stitching, and working safety in the depths of tissues in tight spaces and body cavities, since the fixed needle has one sharp working end, and the tail of the needle is closed in the needle holder, it became possible replacement of failed needles. The evaluation of the use of a surgical screw needle holder was carried out in an experiment on 8 dogs and in clinical practice in 15 patients during laparotomy and hernioplasty. The device consists of a needle fixation unit, a rod and a curly handle, the screw fixation unit of the needles is a screw for fixing needles and the distal part of the stem for fixing bent interchangeable needles, rod diameter 5.0 mm, length 80.0 mm, in the distal part of the stem 2.0 mm from the end there is a window for bent needles of a rectangular configuration, located beneath the axis of the stem, passing through its center 3.0 mm long, 1.2 mm wide, the window axis is located at an angle of 60 ° to the plane of the curly handle, at the distal end of the stem axis there is a 2.0 mm diameter hole with a thread where it is screwed screw for fixing removable curved needles, the proximal stem is connected to a curly handle with an elongated drop-shaped configuration with a length of 85.0 mm, screw for fixing removable curved needles with a head with a diameter of 6.0 mm, thickness 2.6 mm and straight groove, cylindrical rod with a diameter of 2.0 , length 2.3 mm, with external metric re boy. 3 ill.

Description

The device relates to medicine, namely to surgery.

For suturing soft tissues, skin, adipose tissue, fascia, ligaments, muscles, and hollow organs, soft tissue stitchers are used in which ligature through the tissue is carried out by a pricking needle fragment of the stitcher with a hook, which removes the ligature through the tissue during the reverse passage of the needle fragment during extraction firmware

The disadvantage of using soft tissue stitchers is the rigid fixation of the needle fragment of the stitcher to the tool rod, which leads to failure of the entire tool when the needle fragment or its hook is damaged.

A small soft tissue stitcher (Patent for utility model “Small soft stitching stitcher” No. 167326), which is designed to conduct ligatures through various soft tissues using an arc-shaped needle fragment with a diameter of 1.0, was used as a prototype of a tool for carrying out ligatures for suturing soft tissues. mm, with a radius along the inner generatrix of 7.0 mm, an ellipsoid section at the working end, length 8.0 mm, with a longitudinal axis of 1.0 mm, a transverse axis of 0.6 mm, in the distal part having 2.0 on the inner surface mm from the end of the needle, a slot of a triangular configuration directed towards the end of the needle, the angle between the faces 25 °, the angle of the proximal edge of the slot to the axis of the needle 35 °, the tip of the slot has a rounding with a radius of 0.05 mm, the depth of the cut 0.4 mm, the needle fragment is connected with a truncated cone-shaped rod in the projection perpendicular to the plane of the handle of the tool, the rod is 100.0 mm long, with a distal diameter of 1.0 mm, proximal - 3.0 mm, is proximally connected to a curly handle with an elongated drop-shaped configuration, 85.0 mm long.

The disadvantage of the prototype is the inability to change the needle fragment when it fails as a result of operation in the form of breakage or dullness.

The technical result - the use of a needle holder with a screw version of the attachment of interchangeable curved needles with a hook on the stitching part.

The technical result is achieved due to the presence in the device of the screw fixing unit for needles, the stem and the curly handle, the screw fixing unit for the needles is a screw and the distal part of the rod, the rod with a diameter of 5.0 mm, length 80.0 mm, in the distal part of the rod 2, 0 mm from the end there is a window for bent needles of a rectangular configuration located along the axis of the rod, passing through its center 3.0 mm long, 1.2 mm wide, the axis of the window is located at an angle of 60 ° to the plane of the curly handle. At the distal end of the stem axis there is a hole with a diameter of 2.0 mm with a thread where a screw is screwed to fix interchangeable curved needles, the stem is proximally connected to a curly handle with an elongated drop-shaped configuration 85.0 mm long, a screw for fixing interchangeable curved needles with a head with a diameter of 6.0 mm, a thickness of 2.6 mm and direct corrugation, a cylindrical rod with a diameter of 2.0, a length of 2.3 mm, with an external metric thread.

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 screw fixing unit for needles (1), which is a screw for fixing bent needles and the distal part of the stem, a rod (3) with a diameter of 5.0 mm, a length of 80.0 mm, 2.0 mm from the end of which there is a window (2) a rectangular configuration located along the axis of the stem, passing through its center, 3.0 mm long, 1.2 mm wide, the axis of the window is located at an angle of 60 ° to the plane of the curly handle (4), to which the stem is proximally connected, in at the distal end of the rod axis there is a hole with a diameter of 2.0 mm with a thread where a screw is screwed to fix the interchangeable bent needles, curly handle, 85.0 mm long tear-shaped configuration, screw for fixing interchangeable curved needles with a head with a diameter of 6.0 mm, a thickness of 2.6 mm and direct corrugation, a cylindrical rod with a diameter of 2.0, 2.3 mm long, with external metric thread.

THE DEVICE WORKS AS FOLLOWS

The screw for fixing the bent needles is partially unscrewed, a window is opened in the distal part of the needle holder, the tail part of the bent needle is inserted into it, the screw is tightened until the needle is fixed and the various soft tissues are sutured. The tissue is pierced, the ligature is brought to the end of the needle, the ligature captured by the hook of the needle is removed in reverse when the needle is removed from the tissue. Similarly, the second edge of the wound is stitched and the ligature ends are tied.

EXAMPLES OF EXPERIMENTAL AND CLINICAL USE OF THE DEVICE

In an experiment on 8 dogs that underwent laparotomy and gastrotomy, the technique of applying different suture options to the peritoneum, aponeurosis, and stomach wall was tested using a screw needle holder device. Elastic threads (PHA, fluoride, catgut) of different diameters were used as suture material. With the use of a new type of needle holder, the technique of stitching all types of tissues has been simplified. The results obtained are comparable with the use of a soft tissue stitcher with a low suturing rate, and in some cases a screw needle holder demonstrates a higher degree of ease of use. Through the use of a screw mechanism, a good degree of fixation of the needle is ensured. There were no complications associated with the use of the new tool.

The clinical part of evaluating the effectiveness of the use of the instrument included its use in 15 patients with laparotomy at the stage of suturing the peritoneum, aponeurosis, suturing of the stomach wall and duodenum after excision of the perforated ulcer, in 10 patients with endoprosthetics of the abdominal wall when placing the mesh endoprosthesis on lay and sub lay.

Patient A., 63 years old. She was hospitalized in the surgical department of the City Clinical Hospital for Emergency Medicine in Kursk according to emergency indications 10.12.16, with a diagnosis of strangulated postoperative ventral hernia, obesity of the II degree. 12/10/16, hernia surgery was performed with endoprosthetics of the abdominal wall.

Under spinal anesthesia, a skin incision was made along the midline of the abdomen in the projection of the postoperative scar. Hernial sacs of 15.0 × 10.0 cm and 10.0 × 10.0 cm in size were isolated from the subcutaneous tissue, the contents of the first sac were a fixed lock of the greater omentum and a section of the transverse colon with signs of pinching, a small volume of hernial water, the intestine was viable, the second hernial sac section of the greater omentum. The hernial sacs are excised, the internal organs are inserted into the abdominal cavity, the hernial gates are 10.0 × 4.0 cm and 2.0 × 3.0 cm. The hernial gates are sutured edge to edge, an anterior neuropathic prosthesis of the anterior abdominal wall was performed with a Lintex 25.0 × 20.0 cm. The abdominal wall was sutured in layers, the endoprosthesis was fixed using a surgical screw needle and a curved hooked needle. The subcutaneous tissue is drained by tubular drainage. Iodine, aseptic dressing. The postoperative period was uneventful. Sutures were removed on 12/19/16. Healing per prima. 12.20.16, was discharged under the supervision of a surgeon.

Patient N. 38 years old. He was hospitalized in the surgical department of the Clinical Clinical Hospital, Kursk, 11.24.16, with a diagnosis of peptic ulcer, duodenal ulcer complicated by perforation, common serous-fibrinous peritonitis. 11.24.16, the operation was performed lapartomy, excision of a duodenal ulcer, rehabilitation, drainage of the abdominal cavity.

Under endotracheal anesthesia, a median laparotomy was performed. In the subhepatic space, in the right lateral canal and in the pelvic cavity, up to 100 ml of serous-fibrinous effusion with fibrin flakes and an admixture of bile. The abdominal cavity is drained. An audit of the abdominal organs revealed: the stomach is of normal size, the pyloric bulbar zone is moderately deformed by the scar-ulcer process. On the front wall of the duodenal bulb after the pyloric sphincter, a ulcerative infiltrate is determined with a diameter of up to 1.0 cm with a perforation in the center of up to 4.0 mm. An ulcer excision was performed followed by an expanding duodenoplasty. The abdominal cavity is sanitized and drained by tubular drainage in the right hypochondrium and right iliac region. To suture the wall of the duodenum, a double-row interrupted suture of the PHA, a surgical screw needle holder and a curved hooked needle were used. The abdominal wall is sutured in layers fluorine using the above tools. Iodine, aseptic dressing. Drainages are removed on the third or fourth day. Sutures were removed on 12/03/16, healing per prima. The postoperative period without complications. The patient was discharged 04.12.16 g.

Patient P., 58 years old. He was hospitalized in the surgical department of the Clinical Clinical Hospital, Kursk, 03.01.17, with a diagnosis of acute catarrhal appendicitis. 01/03/17, an appendectomy was performed.

Under intravenous anesthesia, a section of the Volkovich-Dyakov abdominal cavity was opened in the right iliac region. A dome of the cecum with a vermiform appendix was withdrawn into the wound; the latter was 6.0 cm long. It was somewhat thickened, tense, the vessels were injected, and the apex was phlegmonous. In the right iliac region 10 ml of serous effusion. A typical appendectomy was made, the stump of the process was immersed in a purse string and Z-shaped sutures, the mesentery of the process was stitched and tied in portions by fluorescence. Control of hemostasis. Microirrigator in the right iliac region. Appendectomy and layer-by-layer suturing of the abdominal wall wound was performed using a needle holder of a screw, curved hook-shaped needle. Iodine, aseptic dressing. The microirrigator was removed on 05.01.17. The sutures were removed on 01.10.17. Healing per prima. The postoperative period was uneventful. The patient was discharged on January 11, 17 under the supervision of a surgeon.

Patient I., 54 years old. Received January 3, 1717 in the surgical department of the City Clinical Hospital NSR in Kursk. Diagnosis: cholelithiasis, acute phlegmonous calculous cholecystitis. Performed laparoscopic cholecystectomy, drainage of the abdominal cavity.

Under ETN, after the creation of carboxyperitoneum, a typical entry into the abdominal cavity was made from four standard points. When examining the abdominal cavity: the liver is not enlarged, the gallbladder with signs of phlegmonous inflammation, 12.0 × 4.0 × 4.0 cm in size, the wall is thickened to 4.0 mm, the gall bladder is punctured, cloudy bile is evacuated. The cystic duct and artery were isolated, clipped and crossed. The gall bladder is isolated from the bed and removed from the abdominal cavity through paraumbilical access in the cotainer. Control of bile and hemostasis. Sanitation of the subhepatic space, drainage by tubular drainage. Sutures on the wounds of the abdominal wall using a surgical screw and curved hook-shaped needle holder. Iodine, aseptic dressings. Macro drug in the neck of the gallbladder, calculus up to 7.0 mm in diameter. The drainage was removed on 01/05/17 g. The postoperative period was uneventful. Discharged 09.01.17, under the outpatient supervision of a surgeon.

Thus, an analysis of the use of the device in patients showed that the technique of flashing tissue was simplified, the duration of surgical intervention was reduced in comparison with the use of conventional needle holders, the safety of working in the depths of tissues, in limited spaces of the surgical field and in the abdominal cavity was increased, since the tool has only one the sharp end of the needle fragment, at the same time there is a double control of its location due to the visual, and in difficult situations tactile component, due to kryvaniya finger of the surgeon at the stage of summing up to the sewn fabrics. There were no complications associated with the use of the instrument in patients. The need to use conventional surgical needles and a needle holder in a number of patients has disappeared. The results obtained in terms of quality correspond to the results of using soft tissue stitchers, and in some situations a surgical screw needle holder is more convenient to use due to a new tissue stitching mechanism.

Claims (1)

A surgical screw needle holder, consisting of a needle fixing unit, a rod and a curly handle, characterized in that the screw needle fixing unit is a screw for fixing needles and a distal part of the rod for fixing curved interchangeable needles, rod diameter 5.0 mm, length 80.0 mm, in the distal part of the stem 2.0 mm from the end there is a window for bent needles of a rectangular configuration located along the axis of the stem, passing through its center 3.0 mm long, 1.2 mm wide, the axis of the window is at an angle of 60 ° to the plane of the curly handle at the distal end of the and the stem there is a hole with a diameter of 2.0 mm with a thread where a screw is screwed to fix interchangeable curved needles, the rod is proximally connected to a curly handle with an elongated, pear-shaped configuration with a length of 85.0 mm, a screw for fixing interchangeable curved needles with a head with a diameter of 6.0 mm, thickness 2.6 mm and straight groove, cylindrical rod with a diameter of 2.0, length 2.3 mm, with external metric thread.

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