RU183785U1 - Electric knife-coagulator for the outer and middle ear - Google Patents

Abstract

The utility model relates to medicine, namely, otorhinolaryngology, designed to perform microsurgical interventions on the outer and middle ear.

The device consists of a working cutting part; insulating tube; handles; connecting cable; a connector for connecting to a standard connector of the electrocoagulator.

The working cutting part is made of an intradermal injection needle with a diameter of 0.3 mm, has a bend at an angle of up to 45º.

The proposed device is convenient for dissection and micropreparation of the tissues of the outer and middle ear due to the thin working end of the instrument, which does not close the overview of the surgical field, with simultaneous hemostasis by electrocoagulation.

Description

The utility model relates to medicine, namely, otorhinolaryngology, designed to perform microsurgical interventions on the outer and middle ear.

When performing surgical interventions on the outer and middle ear, a microsurgical technique is used. The small size, the particular complexity of syntopy of the topographic and anatomical structures in this area requires not only extremely accurate and accurate dissection of tissues, but also careful hemostasis due to the rich vascularization from the systems of the external and internal carotid arteries, the presence of many intra- and intersystem anastomoses [Chumakov F.I. , Schuster M.A., Kalina V.O. Emergency care in otorhinolaryngology. M., Medicine, 1989].

Traditionally, tissue dissection is performed by standard microsurgical scalpels, the blade dimensions of which do not always meet the requirements of microsurgical technique. In addition, the dimensions of the scalpel blade are quite large and close the overview of the surgical wound. Stopping bleeding in these areas is traditionally carried out by the method of plugging the wound. Thus, the blood in the surgical wound disrupts the review of complex topographic and anatomical relationships, and the tamponade itself is rather traumatic primarily for the structures of the tympanic cavity [Bull TR Atlas of ENT diseases. Transl. From English, Publ. 4-fix Yaroslavl, 2007].

Known for the use of needle electrodes [US Pat. RU for utility model No. 93258] for thermal ablation of biological tissue with the possibility of its resection. The device comprises a control unit with a high-frequency generator, a reservoir with liquid, and pumps, the inputs of which are connected to the reservoir, and the outputs are connected to the inputs of energy transfer devices into the heated biological tissue. To transfer energy to the tissue, there are more than four electrodes, one of which is flat and has a cutting blade connected to one of the generator outputs, and the rest are made in the form of a line of needle electrodes.

The device is quite bulky, for manipulations on a limited-volume surgical field, such as the middle ear cavity, is unsuitable.

Known puncture needle for intracavitary coagulation [US Pat. RU for utility model No. 148055]. The device has two hollow metal tubes, the main and additional, with pointed working ends and cannulas at opposite ends, the main hollow metal tube contains a mandrin, cannulas are made with plugs.

A set of nozzles of FIG. 2 (7) electrocoagulation apparatus STORZ ENDO-COAGULATOR 26027A and others [found on the Internet http://diona-elita.ru/ oborudovanie / gestkie-endoskopi / neyroendoskopiya / page / 209.html], including retractable knives, interchangeable knives-nozzles diameter 3.5 mm, working length 9 cm, insert knives. However, their use is not possible in operations on the ear, since they have a wide handle-holder that completely covers the overview of the surgical field. During operations on the tympanic cavity, manipulations are carried out under a binocular microscope with a twenty-four-fold increase within the ear funnel, having a diameter of 3-5 mm. The short and wide working end of the proposed nozzles for coagulation does not allow the preparation of tissue deep in the external auditory meatus and tympanic cavity; the wide end of the tool does not allow working deep in the wound due to the narrowness of the surgical field; the lack of bending of the working end does not allow visualization of manipulations in the surgical field (Fig. 3).

The technical result is the convenience of dissection and micropreparation of the tissues of the outer and middle ear due to the thin working end of the instrument, which does not close the overview of the surgical field, with simultaneous hemostasis by electrocoagulation

The device consists of a working cutting part (1); insulating tube (2); handle-holder (3); connecting cable (4); connector (5) for connecting to a standard connector of an electrocoagulator.

The working cutting part (1) is made of an intradermal injection needle with a diameter of 0.3 mm. The needles are made of electrically conductive material, the edge of the needle has a beveled pointed edge for puncture of the skin. Accordingly, this edge has sufficient cutting ability and can be used as a scalpel for microsurgical manipulations. To eliminate the possibility of accidental coagulation of nearby tissues, an insulating tube (2) is worn on the intradermal injection needle, so that the length of the working cutting part (1) not covered by the insulating tube (2) is no more than five millimeters.

For the convenience of performing microsurgical manipulations, the working cutting part (1) is made with a bend at an angle of not less than 15 ° and not more than 45 ° with respect to the longitudinal axis of the needle from which this part of the tool is made.

An intradermal injection needle is connected to a pen holder (3). In our case, the handle-holder is made of a handle from an ear hook. As an insulating tube (2) a medical silicone tube with a diameter of up to 3 mm was used (TU 9398-152-00149535-2006, RU No. ФСР 2011/10452). The connecting cable (4) is made of copper wire with a cross section of up to 0.5 mm. The connecting cable (4) is designed to ensure sufficient maneuverability of the tool, its length can vary from 5 to 30 cm. A connector (5) made from the base of the working part of any standard nozzle (11) to the device is soldered to the cable (4) for electrocoagulation.

Using an electric knife-coagulator, tissue dissection is possible, as well as stopping bleeding at a depth of up to 35 mm, which corresponds to the topography of the tympanic cavity of the middle ear. The figure 3 shows the comparative dimensions of the working part of the proposed device (A) and one of the variants of coagulation probes from the standard set to the device for electrocoagulation (B).

Thus, the proposed electric knife-coagulator for the outer and middle ear is easy to manufacture, convenient to operate and safe in practical work.

Examples of practical use of the proposed device.

Elimination of atresia of the external auditory meatus using traditional surgical instruments.

Patient K.O.V. 10/01/1978 year of birth, was hospitalized in the Audiology Department from 09/21/2016 to 09/09/2016 with a diagnosis of Cicatricial atresia of the left external auditory canal. Left-sided mixed hearing loss

09/23/2016. Plastic surgery of the left external auditory meatus.

Under local anesthesia with a solution of lidocaine 2% - 5 ml and neuroleptanalgesia, a circular incision was made in the skin of the external auditory meatus with a standard ring-shaped knife in front of its stricture. The skin of the external auditory meatus with a standard rasper, microneedles exfoliated from the underlying scar tissue with technical difficulties as a result of: considerable physical effort in the preparation of rigid scar tissue; the complexity of the review and manipulation in a narrow surgical field and intense bleeding. Hemostasis was carried out by tamponade with gauze turundas, which lengthened the time of the operation and made it difficult to review the operative field. On the soft tissues of the restored external auditory meatus, skin flaps and latex strips are laid. The cavity of the external auditory meatus is swabbed with cotton balls with an antibiotic.

Operation time 2 hours 30 minutes.

The postoperative period was uneventful.

Complete healing of the surgical wound occurred after 47 days.

Elimination of atresia of the external auditory canal using our proposed electric knife - coagulator.

Patient Ch.P.M. 10/01/1978 was hospitalized in the deaf department from 06/19/2016 to 07/10/2016. With a diagnosis of Cicatricial atresia of the left external auditory canal. Left-sided exudative otitis media. Right-sided adhesive otitis media. Bilateral mixed hearing loss

06/22/2016. Plastic surgery of the left external auditory canal was performed. Left-sided anthromastoidotomy.

Under local anesthesia with a solution of lidocoin 1% - 9 ml, a circular incision of the skin of the external auditory meatus lateral to the scar membrane was infiltrated by our electric knife-coagulator. Our tool performed the separation of the scar membrane throughout without technical difficulties. Scar tissue 0.2-0.3 cm thick. Carefully prepared from the fibrous layer of the tympanic membrane and removed. The eardrum with pronounced cicatricial changes is available for inspection completely, preserved without defects. The lumen of the external auditory canal is restored. On the wound surface of the external auditory canal, eardrum, strips of free skin rags prepared from the front surface of the thigh are laid, covered with latex sheets and pressed to antibiotic balls.

There was no bleeding because the vessels were coagulated during tissue preparation. Given the changes in the middle ear and the inability to perform shunting of the tympanic cavity, an antromastoidotomy was performed to drain and ventilate the middle ear.

In this case, work without a knife-coagulator would be significantly difficult and traumatic, due to pronounced cicatricial changes, the preparation of which, as a rule, is accompanied by intense bleeding.

The use of a set of nozzles of a standard electrocoagulation apparatus such as "STORZ" autocom 2000 20522520 and others is not possible during ear surgery due to the reasons described below. The wide handle - the holder completely covers the overview of the surgical field - manipulations are carried out under a binocular microscope with an increase of up to 24 times within the ear funnel with a diameter of 3-5 mm. The short and wide working end of the instrument without the necessary bending, the short end of the instrument does not allow the preparation of tissue deep in the external auditory meatus and tympanum; the wide end of the tool does not allow working deep in the wound due to the narrowness of the surgical field; the lack of bending of the working end does not allow to visualize manipulations in the surgical field.

The time for the stage of elimination of atresia of the external auditory meatus is 1 h 30 minutes.

The postoperative period was uneventful.

Complete healing of the surgical wound occurred after 31 days.

Description of the drawings.

Figure 1. General view of the device.

1 - working part - needle for intradermal injection with a diameter of 0.3 mm;

2 - isolation;

3 - handle holder;

4 - connecting cable;

5 - connector for connecting to a standard connector of an electrocoagulator;

FIG. 2. A connector of a standard electrocoagulator and a set of nozzles for it

6 - standard coagulator connector for connecting nozzles

7 - set of probe tips of the apparatus for electrocoagulation

FIG. 3. Comparative sizes of the proposed and standard probe for electrocoagulation

A - the proposed electric knife-coagulator

1 - working part

B - one of the nozzles of the standard set for electrocoagulation

8 - thermal probe

Claims (1)

An electric knife-coagulator for the outer and middle ear, containing a working cutting part in the form of a needle for intradermal injection, bent at the end at an angle of at least 15 ° and not more than 45 ° with respect to its longitudinal axis, a handle-holder, a connecting cable and a connector for connection with the connector of the electrocoagulator, characterized in that the diameter of the needle is 0.3 mm, and the working cutting part is covered with an insulating tube, with the exception of 5 mm at the end.

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