RU193272U1 - SOFT FABRIC SEWER ATTACHMENT - Google Patents

Abstract

The working nozzle of the soft tissue stitcher end-face refers to medicine, namely to surgery. The technical result of using the utility model is to reduce the number of manipulations when charging the ligature into the instrument and the time of suturing soft tissues with suture material of different thicknesses, reducing the amount of tools used when suture material is passed through the tissues, reduction of tissue stitching time. The device consists of a distal arcuate needle-shaped fragment for ligatures of different dia meter, truncated cone-shaped rod and handle. The distal needle fragment has a parabolic configuration, with a radius along the inner generatrix of 7.0 mm, an ellipsoidal section at the end, with a length of 8.0 mm, with a longitudinal axis of 1.0 mm, a transverse axis of 0.6 mm, in the distal part it has an inner surface on 2.0 mm from the end of the needle, a slot of a triangular configuration directed by the apex angle towards the end of the needle, the angle between the edges of the slot 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 - 0.4 mm, the needle fragment of the compound n with a truncated cone-shaped rod at the end, a rod 50.0 mm long, with a distal diameter of 2.0 mm and a proximal diameter of 3.0 mm, the proximal stem is connected to the base of a cylindrical working nozzle with a diameter of 3.0 mm, length 20.0 mm , in the middle part, on the side of the location of the needle fragment, there is an opening for the rod of the clamp of the working nozzles from the fixation unit of the working nozzles, with a diameter of 2.5 mm and a depth of 1.0 mm. 3 ill.

Description

The device relates to medicine, namely to surgery.

To suture skin defects, subcutaneous fat, muscle, abdominal wall aponeurosis, gastric wall defects, disposable and reusable surgical needles and needle holders are used. The technique for suturing wound defects of organs and tissues includes flashing a wall of stitched tissues with a charged needle, transferring the needle holder to the beginning of the needle, removing it from the stitched wall, applying the needle holder to the distal third of the needle, and stitching the second organ wall with similar options for applying the needle holder, after which the knot is knotted on the wound.

The disadvantage of the method of suturing defects in tissues and walls of hollow organs is the multistep manipulation of intercepting the needle with the needle holder from the distal third of the needle to the proximal, and then again to the distal when stitching tissue using classical surgical needles and needle holders of clamp type action.

A small soft tissue stitcher is used as a prototype of the tool for ligatures (RF Patent for Utility Model No. 167326 dated December 16, 2016), which is designed to hold ligatures through soft tissues, having an arcuate fragment with a triangular slot at the distal end to extract ligatures, the rod in the form of a truncated cone connecting an arcuate fragment of a tool with a plate handle.

The disadvantage of the prototype is the impossibility of its use for stitching different tissues, taking into account the thickness of these tissues, the difficulty of using a needle and a stitcher in a limited surgical field.

EFFECT: creation of a working nozzle for soft tissue stitching with end fixation of ligatures at the distal end of the instrument, reduction of the number of manipulations and time of flashing soft tissues, the possibility of using suture material of different diameters, reduction in the number of tools used, ease of charging the ligature into the instrument, the working nozzle is easily attached and it is removed in a clamp for replaceable working nozzles in comparison with the traditional method of using surgical needles and a needle holder.

The technical result is ensured by the fact that the working nozzle of the soft tissue stitcher end-face has a parabolic needle fragment with a diameter of 1.0 mm connected to a truncated conical rod 50.0 mm long, with a distal diameter of 2.0 mm and a proximal 3.0 mm, proximal connected to the base of the nozzle in a cylindrical shape, with a diameter of 3.0 mm, a length of 20.0 mm, in the middle of the base of the nozzle on the side of the needle-shaped fragment there is a hole with a diameter of 2.5 mm, a depth of 1.0 mm, with the help of the base the device is fixed in clamp working nozzles.

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 distal needle fragment (1) of a parabolic configuration with a radius along the inner generatrix of 7.0 mm, an ellipsoidal section at the end, 8.0 mm long, with a longitudinal axis of 1.0 mm, a transverse axis of 0.6 mm, in the distal part on the inner surface 2.0 mm from the end of the needle, a slot of a triangular configuration (2), the apex of the angle directed towards the end of the needle, the angle between the edges of the slot 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 radius of 0, 05 mm, slot depth 0.4 mm, needle this fragment is connected with a truncated conical rod (3) to the end, a rod 50.0 mm long with a distal diameter of 2.0 mm and a proximal diameter of 3.0 mm, the proximal rod is connected to the base of the working nozzle (4) of a cylindrical shape with a diameter of 3.0 mm, 20.0 mm long, in the middle part, on the side of the needle fragment location, there is an opening (5) for the working nozzle retainer rod from the working nozzle fixation unit, 2.5 mm in diameter, 1.0 mm deep (Fig. 3).

THE DEVICE WORKS AS FOLLOWS

The device, the working nozzle of the soft tissue stitcher, is inserted using a needle fragment to the edge of the tissues to be stitched from above or from the depth of the wound, taking into account the principles of surgery, the appropriate technique for stitching tissues (skin, subcutaneous fat, aponeurosis, muscle, stomach wall) is determined. The fabrics are punctured with a needle fragment of the stitcher when it is moved vertically, a thread is inserted into the slot at the end of the needle fragment of the tool with a ligature conductor, a clamp or tweezers, the tool is removed from the tissues along with the end of the thread in the opposite direction, the latter is fixed with a clamp or held by the assistant's hand. The second edge of the wound is pierced by the stitcher in the opposite direction, the end of the thread, which is already drawn through the edge of the wound, is inserted into the slot of the needle fragment of the stitcher, its second end is fixed in the clamp. The working nozzle of the stitcher with the thread is removed by reverse movement from the tissues. Then the ends of the thread drawn through both edges of the wound are connected. By changing the localization of the injection and puncture of the instrument and the distance from the edge of the wound, different adaptation options for the edges of the wound can be provided.

EXAMPLES OF EXPERIMENTAL AND CLINICAL USE OF THE DEVICE

In an experiment on 10 dogs that underwent laparotomy and gastrotomy, various techniques for suturing the skin, subcutaneous fat, muscle, aponeurosis, and stomach wall were tested using the tool for working soft tissue stitching butt ends. As a suture material, PHA threads, fluoride, lavsan, kapron, catgut were used. There were no complications associated with tissue stitching with a new tool. The duration of tissue stitching in comparison with stitching with surgical needles and a needle holder was reduced by more than half. The design of the tool simplified the technique of stitching tissues, increased the safety of working deep in the tissues, in confined spaces and in the abdominal cavity, since the only sharp end of the needle at the stage of bringing the tool to the sutured tissues is visually controlled and, if necessary, is covered with the finger of the surgeon.

The clinical part of evaluating the effectiveness of the use of the instrument included its use in 50 patients with laparotomy at the stages of suturing of the peritoneum, aponeurosis, subcutaneous tissue, muscle, and skin. Gastrotomy openings were sutured in 7 patients, chronic gastric ulcers complicated by bleeding were sutured in 4 patients with a high degree of operational risk, hernia repair with endoprosthetics was performed in 8 patients.

Patient K., 49 years old. He was hospitalized at the Kuznetsk Regional Clinical Hospital KMPB in Kursk from 12/01/18 to 7/12/18. Diagnosis: cholelithiasis. Acute phlegmonous cholecystitis, perivesical infiltrate. 12/02/18 operation LCE, drainage of the abdominal cavity.

Under endotracheal anesthesia, after 3-fold treatment of the surgical field with iodopyrone and the creation of carboxyperitoneum, an entrance to the abdominal cavity was made from four standard points. On examination of the abdominal cavity: liver of normal size, gall bladder with signs of phlegmonous inflammation, in infiltrate. The wall of the gallbladder is 3.0 mm thick, the size of the bladder is 120.0 × 40.0 × 30.0 mm, in the neck a blocking calculus up to 15.0 mm, pronounced edema of the hepatoduodenal ligament. With puncture of the gallbladder, mucopurulent bile up to 50.0 ml was obtained. 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 umbilical access. Control of bile and hemostasis, sanitation of the abdominal cavity, drainage of the subhepatic space. Sutures for wounds, umbilical access aponeurosis were sutured with polypropylene No. 2/0, three other incisions were sutured using a device for fixing medical instrument tips and a soft tissue stitch stitching nozzle with a capone aponeurosis, subcutaneous fatty tissue and skin thread PHA. Skin treatment with iodopyron. Aseptic sticker. Suturing of aponeurosis, subcutaneous adipose tissue and skin was halved. The postoperative period was uneventful.

Patient P., 61 years old. He was hospitalized at the Kuznetsk Regional Clinical Hospital KMPB in the city of Kursk from 11/16/18 to 11/25/18. Diagnosis: peptic ulcer, exacerbation. An ulcer of the anterior wall of the stomach complicated by perforation. Local serous-fibrinous peritonitis. 11.16.18 surgery was performed laparotomy, excision of perforated ulcers, debridement, drainage of the abdominal cavity.

Under intubation anesthesia, after 3-fold treatment of the surgical field with an aqueous solution of iodopyron, a median laparotomy was performed. In the subhepatic space and along the right lateral canal, up to 200.0 ml of serous effusion with fibrin. Revision: the stomach is not enlarged. On the front wall of the body of the stomach there is a peptic ulcer with dimensions of 20.0 × 20.0 mm with a perforation up to 3.0 mm in diameter. There is no cicatricial deformity of the stomach. An excision of a peptic ulcer was performed. Suturing with nodal sutures of the PHA and sero-muscular sutures with nylon. No other pathology in the abdominal cavity was found. The abdominal cavity is sanitized with a solution of furatsilin to clean wash water, drained by tubular drainage in the right hypochondrium. Control of hemostasis during the operation is dry. The wound was sutured in layers using a device for fixing the nozzles of medical instruments and the working nozzle of the soft tissue stitcher with the piercing of the aponeurosis with caprone, subcutaneous fat and skin with the help of a PHA thread. Skin treatment with iodopyron. Aseptic sticker. Suturing of aponeurosis, subcutaneous adipose tissue and skin was halved. The postoperative period was uneventful.

Patient I., 30 years old. He was hospitalized at the Kuznetsk Regional Clinical Hospital KMPB in Kursk from 11/11/18 to 12/12/18. Diagnosis: necrosis of the fat suspension of the sigmoid colon. 6.11.18 performed laparoscopic removal of the suspension of the sigmoid colon.

After 3-fold treatment of the surgical field with iodopyrone under combined anesthesia and after the creation of carboxyperitoneum, an entrance to the abdominal cavity was made from 3 standard points. On examination of the abdominal cavity: infiltrate in the left iliac region. After separation, a necrotic altered fat suspension of 5.0 mm × 2.0 mm was isolated. Mobilized after diathermocoagulation of the legs, removed in a container. Tubular drainage in the pelvis. Layered seams on the postoperative wound, catgut and nylon using a device for fixing the nozzles of medical instruments and the working nozzle of the stitcher of soft tissue butt. Iodine on the skin, aseptic dressings on the wound. Suturing of aponeurosis, subcutaneous adipose tissue and skin was halved in time. The postoperative period was uneventful.

Patient B., 59 years old, was hospitalized at the Kuznetsk Regional Clinical Hospital KMPB in Kursk from 11/26/18 to 12/12/18. Diagnosis: cholelithiasis, chronic cholecystitis, exacerbation. 11/26/18 produced laparoscopic cholecystectomy, drainage of the abdominal cavity.

Under intratracheal anesthesia, after triple skin treatment with iodopirone solution and the creation of carboxyperitoneum, a typical entrance to the abdominal cavity was made from four standard points. During revision of the abdominal cavity: the liver is not enlarged, dark cherry in color, the gall bladder with signs of chronic inflammation measuring 90.4 × 40.0 × 30.0, the wall is thickened to 4.0 mm. The cystic duct and artery were isolated, clipped and crossed. The gall bladder is isolated from the bed, removed from the abdominal cavity through paraumbilical access. Control of bile and hemostasis, sanitation and drainage of the subhepatic space by tubular drainage. The abdominal cavity is sutured using a device for fixing the nozzles of medical instruments and the working nozzle of the stitcher of soft tissues of the butt. Iodine on the skin, aseptic dressings on the wound.

Patient K., 46 years old, was hospitalized at the Kuznetsk Regional Clinical Hospital KMPB in the city of Kursk from 11.11.18 to 11.19.18. Diagnosis: cholelithiasis, acute phlegmonous, calculous cholecystitis. 11.11.18 laparoscopic cholecystectomy, debridement, drainage of the abdominal cavity.

Under endotracheal anesthesia, after triple treatment of the surgical field with iodopyrone, the creation of carboxyperitoneum, a typical entry into the abdominal cavity was made from four standard points. When examining the organs of the abdominal cavity: the liver is of normal size, the gall bladder is 140.0 × 40.0 mm in size, the walls are thickened to 4.0 mm, the phlegmonous changes in the lumen are multiple calculi. The cystic duct and artery were isolated, clipped and crossed. The gall bladder is isolated from the bed, removed from the abdominal cavity through paraumbilical access in the container. Control of bile and hemostasis. Remediation of the subhepatic space, drainage by tubular drainage. Layered seams on the postoperative wound with catgut and nylon using a device for fixing the nozzles of medical instruments and the working nozzle of the stitcher of soft tissue butt. Iodine on the skin, aseptic dressings on wounds. Suturing of aponeurosis, subcutaneous adipose tissue and skin was halved in time. The postoperative period was uneventful.

Thus, the analysis of the use of the working nozzle of the soft tissue suture stitcher in patients showed that the technique of suturing tissue was simplified, the time of suturing was reduced, the possibilities of suturing tissue in limited spaces and inaccessible parts of the abdominal cavity were expanded, while the risk of complications during manipulations was reduced in comparison with the use of surgical needles and a needle holder, the need for their use in a number of cases has disappeared, the method of charging ligatures of different diameters has been simplified tool.

Claims (1)

The working nozzle of the soft tissue stitcher is mechanical, consisting of a distal arc-shaped needle fragment for ligature, a truncated cone-shaped rod and the base of the nozzle, characterized in that the distal needle fragment has a parabolic configuration with a radius along the inner generatrix of 7.0 mm, an ellipsoidal section at the end, length 8 , 0 mm, with a longitudinal axis of 1.0 mm, a transverse axis of 0.6 mm, in the distal part has a triangular configuration slot on the inner surface 2.0 mm from the end of the needle, with an apex of the angle directed toward the end of the needle, the angle between the faces of the slot is 25 °, the angle of the proximal edge of the slot to the axis of the needle is 35 °, the top of the slot has a rounding of 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 the end, a rod with a length of 50.0 mm, with a distal diameter of 2.0 mm and a proximal diameter of 3.0 mm, is proximally connected to the base of the working nozzle of a cylindrical shape with a diameter of 3.0 mm, a length of 20.0 mm, in the middle part, on side of the location of the needle fragment, there is an opening for the rod of the clamp of the working nozzles ok from the unit for fixing the working nozzles, with a diameter of 2.5 mm, a depth of 1.0 mm.

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