RU175708U1 - NEEDLE HOLDER SURGICAL - Google Patents

Abstract

Surgical needle holder "VIL" refers to medicine, namely to surgery. The technical result of the utility model is the use of a surgical needle holder with a screw option for attaching straight-line replaceable needles with a hook on the stitching part, thereby increasing the speed of soft tissue stitching, and working safety in depth tissues, in limited spaces and cavities of the body, since a fixed needle has one sharp working end, and the tail of the needle is closed in the needle holder , it is possible to change the position of fixing the needle in the needle holder for ease of use, and it is also possible to replace failed needles. The use of a screw needle holder was evaluated in an experiment on 10 dogs and in clinical practice in 20 patients during laparotomy, duodenotomy, gastrotomy and hernioplasty The device consists of a screw fixing unit for the needles, which is a screw for fixing the needles and the distal part of the tool rod, rod diameter 5.0 mm, length 100.0 mm, in the distal part of the rod 1.5 mm from the end there are two windows for needles with a diameter of 1.0 mm, one is located in the plane of the handle of the tool, the second is in the perpendicular plane, in the distal end along the axis of the shaft there is a hole with a diameter of 2.0 mm with a thread where the screw is screwed to fix the interchangeable needles, proximally the rod is connected to a curly handle with an elongated drop-shaped configuration with a length of 85.0 mm, a screw for fixing needles with a head with a diameter of 6.0 mm, a thickness of 2.6 mm has direct corrugation, a cylindrical rod with a diameter of 2.0 mm, a length of 1.8 mm with an external metric carving. 3 ill.

Description

The device relates to medicine, namely to surgery.

For suturing of soft tissues, skin, adipose tissue, ligaments, fascia, muscles, and hollow organs, soft tissue stitchers are used, in which ligatures are fixed with a stitching needle fragment of a direct configuration stitcher with a hook on a stitching fragment that conducts the ligature through the tissues with the needle fragment returning. through the fabric while removing the stitcher.

The disadvantage of using a soft tissue stitcher is that the needle fragment of the stitch with a hook-shaped element is rigidly fixed to the stitch rod, which leads to failure of the entire tool when the needle fragment or its hook is damaged.

As a prototype of a tool for carrying out ligatures with the aim of suturing soft tissues, a straight soft stitcher was used (Patent for utility model of the Russian Federation “Straight soft stitching stitch” No. 167287), which is designed to hold ligatures through different soft tissues using a straight needle-shaped fragment of an ellipsoid section, 15.0 mm long with a longitudinal axis of 1.0 mm, a transverse axis of 0.6 mm, having a triangular configuration at 2.0 mm from the end of the needle in the distal part, directed toward the end of the needle, the angle between the faces is it 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 of 0.05 mm, the depth of the slot is 0.4 mm, the needle fragment is connected to a truncated conical rod at an angle of 90 °, through an arc of radius 0.5 mm, in a projection perpendicular to the plane of the handle of the instrument, a cone-shaped rod 50.0 mm long with a distal cross-sectional diameter of 1.0 mm, proximal 3.0 mm, the proximal rod connected to a curly handle with an elongated, pear-shaped configuration 85.0 mm long.

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

EFFECT: use of a needle holder with a screw version for attaching replaceable needles of a direct configuration 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 straight-shaped needles, a rod and a curly handle, the screw fixing unit for the needles is made in the form of a screw with a metric thread 2.0 mm, located on a cylindrical rod 1.8 mm long, with a head diameter of 6 , 0 mm, made with direct corrugation and a thickness of 2.6 mm, the screw is located in the hole at the distal end along the axis of the rod, the fixing unit includes two windows for straight needles with a diameter of 1.0 mm, one of which is located in the plane of the handle, perpendicular to the axis second window moreover, the windows are located at a distance of 1.5 mm from the end of the rod having a diameter of 5.0 mm and a length of 100.0 mm, the stem is proximally connected to a figured handle 85.0 mm long having an elongated drop configuration.

The utility model is illustrated 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), a stem and a curly handle, a needle fixing unit made in the form of a screw with a metric thread of 2.0 mm, located on a cylindrical rod 1.8 mm long, with a head diameter of 6.0 mm, made with direct corrugation and a thickness of 2.6 mm, the screw is located in the hole in the distal end along the axis of the rod (4), the fixing unit includes two windows for straight needles (2.3) with a diameter of 1.0 mm, one of which is located in the plane of the handle perpendicular to the axis of the second window, and the windows are located at a distance of 1.5 mm from the end of the rod, I have having a diameter of 5.0 mm and a length of 100.0 mm, the rod is proximally connected to a figured handle (5) with a length of 85.0 mm having the shape of an elongated drop.

The device operates as follows

The screw for fixing the needles is partially unscrewed, windows are opened in the unit for fixing the needles, into one of the windows, taking into account the more convenient location of the needle: in the plane of the handle of the tool or perpendicular to the handle, a straight needle is inserted with the tail part, so that this part of the needle does not protrude from the tool and taking into account the direction of the cutting edge of the needle, the screw is tightened until the needle is fixed and proceed to suturing of various soft tissues. 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 application of the device

In an experiment on 10 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 direct suturing speed, and in some cases, a surgical screw needle holder demonstrates a higher degree of working convenience due to the possibility of changing the needle location plane. Due to the use of the screw mechanism, the surgical screw needle holder demonstrates a higher degree of working convenience due to the possibility of changing the needle location plane. 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 20 patients with laparotomy at the stage of suturing the peritoneum, aponeurosis, suturing of the wall of the stomach and duodenum after excision of the perforated ulcer, in 7 patients with endoprosthetics of the abdominal wall when placing the mesh mesh Sub lay.

Patient S. 29 years. He was hospitalized in the surgical department of the Clinical Clinical Hospital, Kursk, 10/27/16, according to emergency indications. Diagnosis: peptic ulcer, exacerbation, ulcer of the anterior wall of the duodenal bulb, complicated by perforation. Local serous-fibrinous peritonitis. 10.27.16 performed laparotomy, excision of an ulcer of the anterior wall of the duodenal bulb, debridement, drainage of the abdominal cavity.

Under ETN, a median laparotomy was performed, in the subhepatic space and in the right lateral canal a turbid effusion with fibrin, hyperemia of the peritoneum. The stomach is of normal size, its walls are not thickened, on the front wall of the duodenal bulb is an ulcerative infiltrate up to 1.5 cm in diameter. In the center is a perforation hole 4.0 mm in diameter. No ulcerative history. An ulcer excision was performed by a closed method with expanding duodenoplasty, a surgical screw needle holder, a straight hook-shaped needle, and a ligature conductor were used. The stitching series of sutures was superimposed with PHA material, serous-muscular sutures with lavsan. Sanitation of the abdominal cavity with furatsilin, tubular drainage in the right hypochondrium, layer-by-layer suturing of the wound of the abdominal wall, iodine, aseptic dressing. The skin is sutured with a cutting needle with lavsan.

Drainage from the abdominal cavity was removed on the third day, the sutures were removed on 11/04/16, healing by primary intention, there were no complications in the postoperative period. Discharged 05.11.16 under the supervision of a gastroenterologist.

Patient E. 64 years. Hospitalized in the surgical department GKB SMP Kursk 12/18/16, the Diagnosis: strangulated hernia of the white line of the abdomen. According to emergency indications operated. Performed hernia repair with sub lay endoprosthetics. Under spinal anesthesia, an incision was made up to 15 cm above the hernial protrusion from the subcutaneous tissue; a hernial sac measuring 8.0 × 7.5 × 5.5 cm was selected, the contents of which are a lock of the greater omentum and hernial water, the hernial sac is isolated and excised, the size of the anterior defect abdominal wall 3.0 × 4.5 cm. Subaponeurotic endoprosthesis replacement of the anterior abdominal wall was performed with a Lintex 15.0 × 10.0 cm endoprosthesis using a surgical screw needle, straight needle and ligature conductor. Fixation of the endoprosthesis was carried out by the material fluorine. The edges of the aponeurosis are also sutured with a continuous suture by fluorescence, the subcutaneous tissue is drained by two rubber plate drains. Nodal sutures on the skin, iodine, aseptic dressing.

Drainages removed on the second day. The postoperative period without complications. Nodal sutures were removed on the seventh day. Primary healing.

Patient C. 84 years. She was hospitalized in the surgical department of the City Clinical Hospital for Emergency Medicine in Kursk on 01.07.17. Diagnosis: strangulated direct right-sided femoral hernia, necrosis of the ileum. Emergency surgery 07.01.17. Bassini hernia repair, laparotomy, resection of the small intestine, abdominal drainage were performed.

Under spinal anesthesia, an incision was made parallel to and below the inguinal ligament to the right above the hernial protrusion, a hernia sac measuring 6.0 × 5.0 × 5.0 cm was isolated and opened. About 10 ml of dark hernia water with hemorrhagic exudate stood out, the contents of the bag are the iliac loop intestines 3.0 cm long with a pronounced strangulation groove, the wall of the intestine is black-crimson. An inferior mid laparotomy was performed, there was no effusion in the abdominal cavity, loops of the small intestine without significant expansion, at a distance of 50.0 cm from the ileocecal junction, the ileum 4.0 cm long was necrotic, resection of the ileum in the proximal direction by 30.0 cm, in the distal - 20.0 cm with the application of an anastomosis “side to side” An entero-enteroanastomosis was applied with a double-row interrupted suture with PHA thread using a surgical screw needle, straight hook-shaped needle and a ligature conductor. The abdominal cavity is sanitized with a solution of furatsilin and is drained in the right iliac region by tubular drainage. The median wound was sutured in layers, a plastic hernia defect was made according to Bassini. Rubber graduate in a subcutaneous fat cell, iodine, aseptic bandage.

The drainage was removed on the fourth day, the sutures were removed on 1/16/17, healing per prima. The postoperative period was uneventful. Discharged 01/17/17.

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 accuracy of the injection and puncture of the straight needle was increased, the safety of work deep in the tissues, in limited spaces of the surgical field and in the abdominal cavity, since the tool has only one sharp end of the needle, the second is hidden in the needle holder, at the same time there is a double control of its location due to the visual wow, and in difficult situations, the tactile component, due to the finger covering the surgeon at the stage of bringing to the stitched tissues. There were no complications associated with the use of the instrument in patients. There was no longer any need for a number of patients to use conventional surgical needles and a clamp holder needle holder. The quality results obtained correspond to the results of using a direct soft tissue stitcher, and in some situations a surgical screw needle holder is more convenient due to the possibility of changing the needle plane.

Claims (1)

A surgical needle holder containing a needle fixation unit, a stem and a curly handle, characterized in that the needle fixation unit is made in the form of a screw with a metric thread of 2.0 mm, located on a cylindrical rod 1.8 mm long, with a head diameter of 6.0 mm, made with direct corrugation and a thickness of 2.6 mm, the screw is located in the hole at the distal end along the axis of the rod, the fixing unit includes two windows for straight needles with a diameter of 1.0 mm, one of which is located in the plane of the handle, perpendicular to the axis of the second window, and windows are located at a distance of 1.5 mm from the end of a rod having a diameter of 5.0 mm and a length of 100.0 mm, the rod is proximally connected to a figured handle 85.0 mm long having an elongated drop configuration.

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