RU203006U1 - Device for safe extraction of organs and tissues during minimally invasive operations - Google Patents

Abstract

The utility model is aimed at ensuring the possibility of safe, quick and ablastic extraction of removed organs and tissues through minimal incisions with laparoscopic or robotic access, which increases the safety of the intervention for the patient, there is no need for additional incisions, eliminates the risk of damage to the abdominal organs during the extraction stage, facilitates the work of the surgical teams, accelerates the operation, reduces the likelihood of conversion to open surgery, accelerates the patient's activation, shortens the postoperative period of hospitalization, allowing the patient to return to work earlier. The specified technical result is achieved by the fact that the device for safe extraction of organs and tissues during minimally invasive operations contains a bag and a loop, while the bag consists of an outer and an inner wall, between which there is a closed space with the possibility of filling and emptying it with a colored liquid through a valve located in the base of the bag on an elastic ring, while on the inner surface of the ring there are holes through which a loop is drawn to tightly tighten the bag. 6 ill.

Description

The utility model relates to medicine, to medical technology, namely to laparoscopic surgery, urology, transplantology, and is intended for fast, safe and ablastic extraction of removed organs and tissues from the abdominal cavity through minimal access with laparoscopic or robotic access.

Currently, interventions performed with the help of endovideo technology are widespread: laparoscopic, robotic and thoracoscopic operations. They are not accompanied by the infliction of large surgical wounds, patients quickly recover after treatment, and rarely postoperative complications, both from the wound and of a general nature. Using a video camera and special instruments, a cholecystectomy, resection of a section of the intestine, removal of an ovarian cyst, suturing of a perforated stomach ulcer and many other operations can be performed laparoscopically. A distinctive feature of endoscopic operations is their low invasiveness. (General surgery / Petrov S.V. - M .: GEOTAR-Media, 2010. - 350 p.).

Despite the fact that the main stage of the operation is carried out using laparoscopic (robotic) instrumentation through minimal skin incisions, the removed organs (parts of organs) and tissues to be removed from the abdominal cavity, in most cases, have incommensurably large dimensions compared to the existing incisions. In a number of operations (usually oncological), for the subsequent precise determination of the stage during histological examination, it is necessary to extract the entire organ from the abdominal cavity without violating the integrity, regardless of its size. For this, an incision is made in the abdominal wall, equal to the diameter of the removed organ, after which the latter is removed in a special bag. However, in most cases, which include operations for the removal of organs and tissues not related to oncology, as well as in a number of oncological operations, it is possible to capture and crush the removed tissues. This is done to reduce patient trauma, reduce pain and accelerate the patient's postoperative recovery, since there is no need to significantly increase the length of the initial incisions to extract a large volume of removed tissue from the abdominal cavity.

For this, various clamps are used, for example, an extractor clamp for removing objects to be removed during laparoscopic operations (see patent RU 109397 U1, IPC А61В 17/22, publication date 20.10.2011). The useful model can be used in laparoscopic operations on the abdominal organs for the purpose of crushing and removing gallstones and fragmentation of the removed organs and tissues. The clamp-extractor for removing objects to be removed during laparoscopic operations contains two intersecting articulated jaws. At the end of the working branch of each branch there is a cup-shaped grip. When separating and approaching the branches, the opening and closing of the grips is ensured, respectively. The grips are oriented and made in such a way that their open cuts face one another and adjoin each other when the grippers are in a closed position. As a result of the closure of the grippers, a working head of the clamp-extractor is formed with a single closed cavity for accommodating the objects and tissues to be removed. Each gripper has an elliptical shape in the form of an extractor clip on the side. On the open sections of the grippers, notches are made to ensure a reliable grip of tissues, removed objects and to facilitate their crushing into fragments and extraction.

However, during fragmentation and extraction of tissues, there is a high risk of grasping with forceps together with the removed tissues and parts of a healthy organ (large and small intestine, mesentery, omentum, etc.), which are also located in the abdominal cavity. Considering that the appearance of healthy and removed organs and tissues in conditions of blood contamination is practically indistinguishable, damage to the integrity of, for example, the intestine can pass unnoticed by the surgeon. Subsequently, this complication will lead to fatal consequences in the form of severe peritonitis in the early postoperative period, which will require an emergency laparotomy followed by transfer to the intensive care unit.

In order to facilitate the surgeon's work and reduce the risk of trapping healthy tissues with instruments, various types of bags are used to extract the removed tissues, for example, an organ evacuation bag with a fixing loop and a guide wire prototype (Cat. No: 0602-VP210S, manufacturer: Volkmann, Germany) ... It is a cone-shaped bag made of soft and durable polyurethane, at the end of the bag there is a fixing loop in the form of an elastic nylon thread, with the help of which the bag is held at the guide cannula and the base of the bag is tightly tightened during drug evacuation. This device is intended for single use and is used as a container for collection and extraction of tissue samples, appendix, gallbladder, ovaries, fibroids, other tissues and calculi removed during endoscopic surgical procedures.

However, given that the bag with the drug to be removed is in the abdominal cavity, when using these bags for the extraction of organs and tissues, without increasing the length of the initial incisions in conditions of poor visualization, there is a risk of grasping healthy tissues with forceps through the fold of the bag, which can lead to rupture of the bag. with the ingress of contents into the abdominal cavity and damage to the surrounding healthy tissues with the possible development of bleeding or peritonitis. At the same time, in the case of a large volume of removed tissues, the duration of the procedure for grinding and extracting tissues from the bag increases, which multiplies the risk of seizure with forceps through the fold of healthy tissues and rupture of the bag.

Thus, the technical difficulties associated with the need for safe, fast and ablastic extraction of removed organs and tissues through minimal incisions with laparoscopic or robotic access led to the creation of a device for the safe extraction of organs and tissues during minimally invasive operations.

The technical result achieved when using the proposed utility model is the possibility of safe, quick and ablastic extraction of removed organs and tissues through minimal incisions with laparoscopic or robotic access, which increases the safety of the intervention for the patient, there is no need for additional incisions, eliminates the risk of damage to the abdominal organs at the extraction stage. , facilitates the work of the surgical team, accelerates the operation, reduces the likelihood of conversion to open surgery, accelerates the patient's activation, shortens the postoperative period of hospitalization, allowing the patient to return to work earlier.

The technical result is achieved by the fact that the device for safe extraction of organs and tissues during minimally invasive operations contains a bag and a loop, while the bag consists of an outer and an inner wall, between which there is a closed space with the possibility of filling and emptying it with a colored liquid through a valve located at the base of the bag on the elastic ring, and on the inner surface of the ring there are holes through which a loop is drawn to tightly tighten the bag.

The utility model is illustrated by drawings, where:

in FIG. 1 is a schematic representation of a device for the safe extraction of organs and tissues during minimally invasive operations;

in FIG. 2-6 are a schematic illustration of the stages of removing removed tissues from the abdominal cavity using a device for the safe extraction of organs and tissues during minimally invasive operations;

in FIG. 2 - the stage of introducing a device for safe extraction of organs and tissues during minimally invasive operations through a trocar into the abdominal cavity;

in FIG. 3 - the stage of moving the removed tissues into the device for safe extraction of organs and tissues during minimally invasive operations;

in FIG. 4 - stage of removing the device for safe extraction of organs and tissues during minimally invasive operations with removed tissues from the abdominal cavity (the device is completely in the abdominal cavity);

in FIG. 5 - stage of removing the device for safe extraction of organs and tissues during minimally invasive operations with removed tissues from the abdominal cavity (the device is partially located in the abdominal cavity);

in FIG. 6 - the stage of evacuation of removed tissues from the device for safe extraction of organs and tissues during minimally invasive operations after filling the closed space with a colored liquid.

The device for safe extraction of organs and tissues during minimally invasive operations is made in the form of a bag 1 made of durable polyurethane of a rounded shape, consisting of an outer wall 2 and an inner wall 3, between which there is a closed space 4 with the possibility of filling and emptying it with a colored liquid through valve 5 located at the base of the bag 1 on the elastic ring 6, while on the inner surface of the ring 6 there are holes 7 through which the loop 8 passes to tightly tighten the cavity 9 and hold the bag 1.

The proposed device operates as follows.

A device for safe extraction of organs and tissues during minimally invasive operations is placed into the abdominal cavity through a trocar 10, passed through the abdominal wall 11. In this case, the device easily passes through a trocar 10 of small diameter due to the elasticity of bag 1 and ring 6. Trocar 10 is placed near fragments of removed tissues 12 (Fig. 2). Further, the device is placed in a convenient place for the surgeon and remains in the open state due to the elasticity of the ring 6. Then, using a clamp 13 passed through the trocar 10, fragments of the removed tissue 12 are placed in the cavity 9 of the bag 1 (Fig. 3). After all the fragments of tissue 12 are placed in the cavity 9 of the bag 1, the clamp 13 grabs and tightens the loop 8 through the holes 7, as a result of which the ring 6 is pulled together and the cavity 9 is closed. Further, the clamp 13 and the trocar 10 are synchronously removed from the abdominal wall 11, pulling the clamp 13 by the ends of the loop 8 of the bag 1 (Fig. 4). Complete removal from the abdominal cavity of the device for safe extraction of organs and tissues in minimally invasive operations is prevented by a significant number of fragments of removed tissues 12 located in cavity 9 of bag 1, which is incomparable with the diameter of the opening of the abdominal wall 11 after trocar 10 is removed. Ring 6 due to its elasticity and absence tension of the loop 8 is straightened and the bag 1 is opened. There is no interlayer between the outer wall 2 and the inner wall 3, as a result of which folds in the bag may appear and the intestinal loops 14 in the abdominal cavity may enter them, with the subsequent risk of damage to them when the clamp 13 grabs tissue fragments 12, while this damage will be imperceptibly for the surgeon, and subsequently can lead to peritonitis and reoperation (Fig. 5). To exclude the possibility of getting into the fold and damaging the abdominal organs through the valve 5, the closed cavity 4 is filled with a colored liquid. As a result, the bag 1 takes on a constant shape and between the outer wall 2 and the inner wall 3 there is a layer of liquid, which is additionally an indicator of the integrity of the bag 1, since if one or two walls of the bag 1 are damaged, the tissues of the wall pouring out through the defect from the closed cavity 4 will become stained Then, using the clamp 13, tissue fragments 12 are removed until the bag 1 is completely empty. After that, the colored liquid is evacuated from the closed cavity 4 through the valve 5 and the bag 1 is completely removed from the abdominal wall 11. The stage of removing the removed tissues from the abdominal cavity is safely completed.

Thus, the proposed device provides the possibility of safe, quick and ablastic extraction of removed organs and tissues through minimal incisions with laparoscopic or robotic access, which increases the safety of the intervention for the patient, there is no need for additional incisions, eliminates the risk of damage to the abdominal organs at the extraction stage, and facilitates work. surgical team, accelerates the operation, reduces the likelihood of conversion to open surgery, accelerates the patient's activation, shortens the postoperative period of hospitalization, allowing the patient to return to work earlier. The device has wide functionality. It can be used for operations in surgery, urology, transplantology and can be used both with open surgical techniques and with the use of laparoscopic and robotic techniques.

An experimental sample of the proposed device for the safe extraction of organs and tissues during minimally invasive operations has been made. This device has been used in 7 laparoscopic operations. There were no inconveniences during operation when working with it, good results were achieved in all operations, additional incisions were not required at the stage of tissue extraction, and no damage to the abdominal organs was noted.

Clinical example. Patient Y., 42 years old, was admitted routinely to the urology department with a diagnosis of Terminal hydronephrosis on the right for surgical treatment. According to MSCT of the abdominal cavity with contrast, performed at the stage of preoperative examination, complete depletion of the parenchyma of the right kidney, stricture of the LMS on the right is noted. The patient underwent laparoscopic nephrectomy on the right using a device for safe extraction of organs and tissues during minimally invasive operations. The operation time was 70 minutes, blood loss was 50 ml, no conversion to open surgery was required, the stage of extracting the removed organ took 5 minutes, and was performed without complications. According to control analyzes and instrumental methods of examination in the postoperative period without deviations. The course of the postoperative period is favorable, the patient was discharged on the 3rd day after the operation.

Claims (1)

A device for safe extraction of organs and tissues during minimally invasive operations, containing a bag and a loop, characterized in that the bag consists of an outer and an inner wall, between which there is a closed space with the possibility of filling and emptying it with a colored liquid through a valve located at the base of the bag on an elastic ring, while on the inner surface of the ring there are holes through which a loop is drawn to tightly tighten the bag.

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