RU207584U1 - DEVICE FOR EXPANDING THE STUMP OF THE MAIN PANCREATIC DUCT - Google Patents

Abstract

The utility model relates to medical devices for surgical operations, namely, for the expansion of the main pancreatic duct. The device consists of a body, an axis with a handle and blades, and in the body there are three grooves with leaf springs pressed into them and pushers placed in them, connected to the blades, at the opposite end of the axis with a handle, a driving gear wheel, on the second axis there is a driven gear wheel with a cam. The use of this device in clinical practice makes it possible to clearly visualize all the walls of the stump of the main pancreatic duct and to suture the latter without the threat of critical narrowing, due to the involvement of adjacent walls of the duct into the suture material. 2 ill.

Description

The utility model relates to medical devices for surgical operations, namely, for the expansion of the main pancreatic duct.

In particular, the claimed useful model can be used to form a pancreaticojejunoanastomosis with precision stitching of the stump of the main pancreatic duct into the jejunal mucosa.

State of the art

Known catheter containing a coaxially located on it a working sleeve with a balloon and a channel for its inflation and an additional locking element (A.S. USSR 1662579).

The disadvantage of the known device is the inadequate sealing of the walls of the wound channel, which may be accompanied by leakage of pathological fluid beyond its limits. In addition, a balloon catheter assumes a monofunctional use: external drainage of the cavity in the absence of combinations of the possibility of manipulation in it.

A device for cystostomy of parenchymal organs is known. The device is equipped with a working sleeve with an inflatable balloon through an additional channel in the working sleeve, which is coaxially located on the balloon catheter with the possibility of reciprocating movement, as well as an additional stop sleeve, which is coaxially located on the working sleeve (RU 2093200 C1).

However, this device has its disadvantages associated with the large initial diameter of the sleeve, which makes it impossible to introduce the blades of the device into the ducts, in view of the smaller diameter of the latter.

A device for long-term internal drainage of the bile ducts is known, consisting of a single-channel tube with a diameter of not more than 4 mm and a length of 4 to 13 cm, made of X-ray contrast polyethylene, and the tube has at least two legs, which are located at a distance of 2 cm from the tip at the proximal end and at a distance of 1 cm from the tip at the distal end, with a bioinert carbon coating applied to the inner surface of the tube (RU 84226 U1).

However, this device has its drawbacks in the form of structure, which does not allow the surgeon to fix the diluted duct in the desired diameter for ligation.

Known laparoscopic device for expanding the stump of the main pancreatic duct, consisting of a body having a handle and a stem, inside which is a collet, having at the free end divided by longitudinal slots, three elastic petals, ending in thin spiked jaws, the opening of which is regulated by a screw mounted on the handle of the body, which translationally moves the pusher, which compresses the spring and weakens its deforming effect on the collet petals (RU 193064).

However, this device is intended for laparoscopic interventions, and therefore has an excessive length for open surgery, which does not allow adequate stitching of the pancreatic duct stump to compare pancreatojejunoanastomosis. Also, the disadvantage of the design is that the expansion of the duct with the help of sponges is not performed simultaneously with the same amplitude in opposite directions, but unidirectionally, which reduces the area of contact with the inner surface of the walls of the pancreatic duct and increases the risk of injury.

Closest to the claimed solution is a device for expanding the bile duct, consisting of a sleeve, inside which is placed an axis with a button head, a drum and four blades. Inside the axis there is a Kerner spring mechanism, which sets the blades in motion and fixes them at a certain diameter (RU 187551)

The disadvantage of this device is the possibility of opening the blades only to a certain diameter, thus making it impossible to implement the smooth running of the blades and increasing the risk of trauma to the duct if this expansion turns out to be excessive. In addition, the design feature of the device does not allow the possibility of parallel opening of the blades, which also increases the risk of injury due to the smaller area of contact with the inner surface of the duct. Also, the given number of blades does not provide sufficient visualization of the duct for the operator, impairing exposure during stitching.

The technical result is the creation of a device for widening the pancreatic duct and the formation of pancreaticojejunostomy with precision stitching of the stump of the main pancreatic duct into the mucous membrane of the jejunum when performing pancreatoduodenal resections.

The specified technical result is solved in that it consists of a body, an axis with a handle and blades, and the body has three grooves with leaf springs pressed into them and pushers placed in them, connected to the blades, at the opposite end of the axis with a handle, a driving gear wheel, on the second axis accommodates a driven gearwheel with a cam.

The utility model is illustrated by a detailed description and illustrations, which depict:

fig. 1 - Diagram of the device: 1 - case; 2 - pusher; 3 - blade; 4 - cam; 5 - leaf spring; 6 - driven gear wheel; 7 - driving gear wheel; 8 - handle; 9 - axis;

fig. 2 - Layout of the links of the expander mechanism: a) with completely closed blades: 1 - body; 2 - pusher; 3 - blade; 4 - cam; 5 - leaf spring; 9 - axis; b) completely open blades: 1 - body; 2 - pusher; 3 - blade; 4 - cam; 5 - leaf spring; 9 - axis.

The device consists of a housing 1, in the grooves of which three pushers 2 are able to move progressively, into which the blades 3 are pressed. The free ends of the blades 3 protrude from the housing 1 and are inserted into the lumen of the main pancreatic duct during a surgical operation. The pushers 2 are in a movable connection with the cam 4. During rotation, the cam 4 acts on the pushers 2 and translates them in the direction from the axis of the housing 1. The pushers 2 return to their original position under the action of the leaf springs 5. For more precise regulation of the opening of the blades 3, a toothed transmission with a gear ratio equal to 5. The axis of the pusher 2 is fixedly connected to the driven gear 6, which meshes with the driving gear 7. The axis 9 of the driving gear 6 ends with a handle 8 located outside the housing 1.

The device for expanding the main pancreatic duct works as follows.

During surgery, the closed blades 3 of the expander are inserted into the bile duct. When the handle 8 is turned, the driving gear 7 starts to rotate, connected to it motionlessly by means of the axis 9. Together with the driven gear 8, the cam 4 rotates, translationally moving the pushers 2 located in the grooves of the body 1. With further rotation of the handle 8, the direction of movement of the pushers 2 is replaced by the opposite (to the axis of the pusher) and the blades 3 are closed due to the action of the leaf springs 5. The blades 3 are fixed in a certain position due to friction in the engagement of the gear transmission.

Further, under the control of vision, all the walls of the main pancreatic duct are sutured. The injection is carried out from the side of the pancreatic parenchyma between the fixed blades 6 of the device. An injection is made through the mucous membrane of the main pancreatic duct into the lumen of the latter. After the imposition of the required number of sutures, they begin to form a pancreticojejunostomy. The device is removed from the lumen of the main pancreatic duct.

The advantage of the proposed device is that the changes made to the mechanism of the device allow parallel movement of the blades 3 relative to each other, increasing the area of contact with the inner surface of the main pancreatic duct, reducing the risk of trauma to the duct and ensuring the operator's control of the duct during stitching. In addition, due to the reduction in the number of lobes from four to three, improved visualization of the main pancreatic duct is provided compared to the bile duct dilator.

The proposed device allows to achieve optimal tightness of the formed anastomosis and thereby significantly reduce the frequency of early postoperative pancreatic fistulas.

The use of this device in clinical practice makes it possible to clearly visualize all the walls of the stump of the main pancreatic duct and suture the latter without the threat of critical narrowing, due to the involvement of adjacent walls of the duct into the suture material.

The proposed device is industrially applicable, easy to manufacture and does not require large expenditures.

Claims (1)

A device for expanding the stump of the main pancreatic duct, consisting of a body, an axis with a handle and blades, characterized in that the body has three grooves with leaf springs pressed into them and pushers placed in them, connected to the blades, at the opposite end of the axis with a handle leading a gear wheel, on the second axis there is a driven gear wheel with a cam.

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