RU196328U1 - SOFT FABRIC SEWNER ATTACHMENT PARABOLIC - Google Patents

Abstract

The device relates 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 elastic suture material of different thicknesses, reducing the time of suturing tissue, increasing the ability to flash different volumes of tissue, reducing metal consumption and simplification of the manufacturing technology of the device, reducing the cost of the instrument. The device has been tested in clinical practice in 34 patients. The device with remains of a 60.0 mm long needle-shaped fragment with a parabolic curvature with a small radius in the distal part, an ellipsoidal section at the end with a length of 5.0 mm, with a longitudinal axis of 1.0 mm, a transverse axis of 0.6 mm, and a distance of 2.0 mm from the end of the needle has a slot of a triangular configuration, the tip directed towards the end of the needle, the angle between the faces is 25 °, the angle of the proximal face to the axis of the needle is 35 °, the depth of the slot is 0.4 mm or less, the needle fragment is connected to a truncated conical rod at an angle of 90 °, stock length 70.0 mm, with a distal diameter of 2.0 mm, maximal - 3.0 mm, proximal the rod is connected to the base of the nozzle of a cylindrical configuration, for fixing in a fixing device, diameter 3.0 mm, length 20.0 mm, in the middle part, on the side of the needle fragment there is an opening for the rod of the clamp of working nozzles with a diameter of 2.5 mm, a depth of 2.0 mm. 3 ill.

Description

Suturing of defects in soft tissues, namely skin, subcutaneous fat, muscle, parenchymal organs, is performed using disposable and reusable needles and needle holders. The technique for suturing tissue defects involves flashing each wound wall with a three-fold transfer of the needle holder to the end of the needle, then to the beginning of the needle and again to the end. The second wall of the wound is stitched similarly.

The disadvantage of using conventional disposable and reusable surgical needles and clamp-type needle holders is the multi-stage interception of the needle when flashing each wound wall.

As a prototype of a tool devoid of this drawback, the “Large soft tissue stitcher” was used, RF patent for utility model No. 166942 dated 2016, which was developed for suturing soft tissue wounds, parenchymal organs, abdominal wall wounds, mesh endoprosthetics and eliminates the multi-stage transfer of the needle holder to a conventional surgical needle with fixing ligatures in the tail of the needle.

The ligature is fixed and removed by a large soft tissue stitcher in the area of the needle tip due to the presence of a triangular slot, a cone-shaped rod and a curly handle.

The disadvantage of the prototype is the need to use several options for stitching to suture different types of fabrics, taking into account their mass and a number of other characteristics, and this increases the cost of the toolkit.

EFFECT: creation of a replaceable working nozzle for a parabolic soft tissue stitching device with a simple way of fixing and removing in a fixing device with an increased ability to flash different volumes of tissues, reducing the metal consumption in the manufacture of the device, reducing the cost of the tool.

The technical result is ensured by the fact that the working nozzle of the soft tissue stitcher has a parabolic configuration of a needle fragment with a triangular slot on the distal end for ligatures, a truncated conical rod and the base of the nozzle for fixing in the fixing nozzle device.

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 needle fragment (1) with a length of 60.0 mm in a parabolic configuration with curvature of a small radius in the distal part, an ellipsoidal section at the end with a length of 5.0 mm with a longitudinal axis of 1.0 mm, a transverse axis of 0.6 mm, at a distance of 2 , 0 mm from the end of the needle has a slot of a triangular configuration (2), the tip directed towards the end of the needle, the angle between the faces is 25 °, the angle of the proximal face to the axis of the needle is 35 °, the depth of the slot is up to 0.4 mm or less, the needle fragment is connected with a truncated cone-shaped rod (3), at an angle of 90 °, a rod length of 70.0 mm, with dist diameter 2.0 mm, proximal 3.0 mm, proximally the rod is connected to the base of the nozzle (4) of a cylindrical configuration, for fixing in a fixing device, diameter 3.0 mm, length 20.0 mm, in the middle part, on the side the location of the needle fragment there is a hole for the rod of the clamp of the working nozzles with a diameter of 2.5 mm and a depth of 2.0 mm (5).

THE DEVICE WORKS AS FOLLOWS

The device, the working nozzle of the soft tissue stitcher parabolic, fixed in the clamp of the nozzles of medical instruments, is fed with a needle fragment to the edge of the tissues to be sutured from the outside or from the depth of the wound, taking into account the type of damaged organ and the surgical principles of suturing damaged tissues. By rotating the horizontal stitching movement of the tool along the curvature of the needle fragment, capturing a larger or smaller fragment, pierce one wall of the organ, a ligature is brought to the slot of the needle fragment, it is removed from the tissues along with the ligature by the reverse stroke of the needle fragment of the stitcher. The extracted end of the ligature is fixed by the assistant. The second edge of the wound is stitched with a tool similarly in the opposite direction with the ligature, the ends of the ligature are connected.

EXAMPLES OF CLINICAL USE OF THE DEVICE.

The device is a parabolic soft tissue stitching attachment, used in 34 patients in clinical practice.

Patient P., 56 years old. He was hospitalized at the Kuznetsk Regional Clinical Hospital KMPB in Kursk from 11/20/18 to 11/28/18. Diagnosis: restrained umbilical hernia. Necrosis of the site of the greater omentum. 11/20/18 a hernia repair operation was performed with sub lay endoprosthetics.

After spinal anesthesia after 3-fold treatment of the surgical field with iodopyron, 10 cm long marginal hernial protrusion was made. A hernial sac 40.0 × 30.0 × 30.0 mm was extracted from subcutaneous fat, opened, serous-hemorrhagic hernia water was released into volume of 15 ml. The contents of the hernial sac is a necrotic strand of a large omentum. The gland section is resected. The hernial sac is isolated and excised. There is no exudate in the abdominal cavity. Subaponeurotic endoprosthesis replacement of the anterior abdominal wall was performed with Lintex 60.0 × 80.0 mm endoprosthesis. Fixation was carried out with polypropylene No. 2/0 using a device for fixing nozzles of medical instruments and a working nozzle of a soft tissue stitch parabolic. With flashing of the aponeurosis with caprone, subcutaneous fatty tissue and skin with PHA floss. Skin treatment with iodopyron. Aseptic sticker. The suturing of aponeurosis, subcutaneous fat and skin was halved. The postoperative period was uneventful.

Patient M., 60 years old. He was hospitalized at the Kuznetsk Regional Clinical Hospital KMPB in Kursk from 11/17/18 to 11/26/18. Diagnosis: acute commissural small bowel obstruction. 11/18/18 the operation was performed laparotomy, intestinolysis, nasointestinal intubation of the small intestine, debridement, drainage of the abdominal cavity.

Under intubation anesthesia, after 3-fold treatment of the surgical field with a solution of iodopyrone, a median laparotomy was performed. There is a pronounced adhesion process in all parts of the abdominal cavity, with obtuse and sharp adhesions separated. In the abdominal cavity, about 150 ml of transparent serous effusion is drained. The loops of the small intestine from the ligament of Traits are swollen, expanded to 50.0 mm in diameter, contain liquid and gas. The cause of obstruction is the adhesion process between the lateral peritoneum and the ileum, which causes an excess of the small intestine and impaired food passage through it. Dull and sharp way the adhesions are separated. With technical difficulties, nasointestial intubation to the cecum was performed. The abdominal cavity is sanitized with a solution of furatsilin, drained in the right iliac region. Control of hemostasis during the operation is dry. The wound is sutured in layers. The laparotomic wound was sutured using a device for fixing the nozzles of medical instruments and the working nozzle of the soft tissue stitching parabolic with the stitching of the aponeurosis capron, subcutaneous fat and skin - PHA. The skin is treated with iodopyron. Aseptic sticker. Suturing of aponeurosis, subcutaneous adipose tissue and skin was halved. The postoperative period was uneventful.

Patient K., 61 years old. He was hospitalized at the Kuznetsk Regional Clinical Hospital KMPB in Kursk from 11/17/18 to 11/26/18. Diagnosis: impaired postoperative ventral hernia. 11.17.18 hernia repair with endoprosthetics was performed.

Under spinal anesthesia, after 3-fold treatment with iodopyron of the surgical field, a skin incision was made along the midline up to 180.0 mm long. A hernial sac 50.0 × 40.0 × 50.0 mm in size, the contents of which is a lock of the greater omentum, is viable; multiple hernial defects with diameters from 5.0 to 10.0 mm are viable along the postoperative scar. After excision of the hernial sacs with scar tissue and ligatures, an abdominal wall defect with a maximum diastasis of up to 40.0 mm was formed. The mobilization of the posterior sheets of the aponeurosis of the rectus muscles was performed, after which the posterior leaf was sutured edge to edge with polypropylene No. 2/0. Endoprosthetics of the anterior abdominal wall with Lintex endoprosthesis of 250.0 × 150.0 mm were performed, fixation was performed using a device for fixing nozzles of medical instruments and a working parabolic soft tissue stitching nozzle with stitching of the anterior leaf of the aponeurosis capron, subcutaneous fat and skin - PHA Paraprothetic the space is drained by tubular drains. Skin treatment with iodopyron. Aseptic sticker. Suturing of aponeurosis, subcutaneous adipose tissue and skin was halved. The postoperative period was uneventful.

Patient S., 71 years old. He was hospitalized at the University of Kursk Children's Clinical Hospital KMPB from 11/11/18 to 11/20/18. Diagnosis: restrained umbilical hernia. Acute small bowel obstruction. Common serous peritonitis. 11.11.18 surgery was performed on laparotomy, nasointestinal intubation of the small intestine, debridement, drainage of the abdominal cavity, hernia repair with endoprosthetics.

Under endotracheal anesthesia, after 3-fold treatment of the surgical field with iodopyron, a longitudinal incision was made over the hernial protrusion. A hernial sac that exits through the aponeurosis defect above the umbilical ring along the midline, with dimensions of 120.0 × 80.0 × 50.0 mm, was isolated. The bag is opened with a dissection of the aponeurosis to expand the infringing ring. Hernia gates up to 70.0 mm in diameter. The contents of the hernial sac is the section of the transverse colon and the lock of the greater omentum, recognized as viable. The serous cover is pink, shiny with single subserous hemorrhages, active peristalsis, pulsation of the vessels of the mesentery is distinct, the strangulation groove is not expressed, the organs are immersed in the abdominal cavity. The leading and discharging loops of the intestine are expanded. Nasointestinal intestinal intubation is indicated, which is done. Endoprosthetics of the anterior abdominal wall were performed with Esfil mesh prosthesis, Lintex LLC 200.0 × 100.0 mm. Control of hemostasis during the operation is dry. Tubular drainage for active aspiration to the endoprosthesis. Suture of subcutaneous fat with the use of a device for fixing nozzles of medical instruments and a working tip of a parabolic soft tissue stitcher with stitching of a capone aponeurosis, subcutaneous fat and skin with a PHA thread. Skin treatment with iodopyron. Aseptic sticker. The duration of suturing of aponeurosis, subcutaneous fat and skin was reduced by half. The postoperative period was uneventful.

Patient D., 29 years old. He was hospitalized at the Kuznetsk Regional Clinical Hospital KMPB in the city of Kursk from 11/11/18 to 11/18/18. Diagnosis: acute gangrenous-perforated appendicitis. Common purulent peritonitis. 11.11.18 the operation was performed laparotomy, appendectomy, rehabilitation with drainage of the abdominal cavity.

Under endotracheal anesthesia, after a three-fold treatment of the surgical field with a solution of iodopyron, a median laparotomy was performed. In the small pelvis, in the left and right lateral canals, about 200.0 ml of odorless purulent effusion is determined - drained. The vermiform appendix up to 7.0 mm long is sharply thickened, strained, gangrenous, changed with a perforated hole in the apex. A typical appendectomy was performed. The mesentery of the appendix is stitched and tied in portions. The stump of the process is immersed in the Z-shaped and purse string sutures. Sanitation of the abdominal cavity with a solution of furatsilina. Drainage of the pelvis and right lateral canal by tubular drainage. Hemostasis during the operation. Layered sutures 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 curved taperkat. 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 P., 39 years old, was hospitalized at the Kuznetsk Regional Clinical Hospital KMPB in Kursk from 11/29/18 to 6/12/18. Diagnosis: strangulated hernia of the white line of the abdomen. 11.29.18 hernia repair with plastic by local tissues was performed.

After processing the surgical field three times with iodopyron solution under the spinal anesthesia, an incision was made along the midline of the abdomen. A hernial sac with dimensions of 40.0 × 30.0 × 30.0 mm containing a lock of an omentum, with signs of chronic infringement, of doubtful viability, was isolated, the latter was resected. The aponeurosis defect is sutured with nodal nylon sutures using a device for fixing the nozzles of medical instruments and the nozzle of the soft tissue stitching parabolic. Hemostasis during the operation. Stitches on the wound, iodine, aseptic dressing. Suturing of aponeurosis, subcutaneous fat and skin was halved in time. The postoperative period was uneventful.

Thus, the working nozzle of the soft tissue stitching parabolic is simple in structure, less metal-intensive, simple to fix and remove working nozzles in the retainer, easy to pre-sterilization processing, sterilization, to halve tissue suturing time by half, no complications associated with the use of the device were noted.

Claims (1)

The soft parabolic stitcher’s working nozzle consists of a curved needle fragment, a rod, a handle, characterized in that the needle fragment is 60.0 mm long in a parabolic configuration with a small radius of curvature in the distal part, an ellipsoid section at the end 5.0 mm long, with a longitudinal axis 1.0 mm, with a transverse axis of 0.6 mm, at a distance of 2.0 mm from the end of the needle has a slot of a triangular configuration, with the apex directed towards the end of the needle, the angle between the faces is 25 °, the angle of the proximal face to the axis of the needle is 35 °, depth slot 0.4 mm and ME her, the needle fragment is connected to a truncated conical rod at an angle of 90 °, the rod is 70.0 mm long, with a distal diameter of 2.0 mm, proximal - 3.0 mm, the proximal rod is connected to the base of the nozzle of a cylindrical configuration 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 for the rod of the working nozzle retainer with a diameter of 2.5 mm and a depth of 2.0 mm.

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