RU207948U1 - DEVICE FOR CREATING EXTRA-PERYTOMINAL CANAL - Google Patents

Abstract

The useful model relates to medicine, namely to surgery, and can be used in operations aimed at the formation of a retroperitoneal intestinal stoma. The device contains an inflatable cylinder (1) of a cylindrical shape, having a working and outer ends, made of semi-elastic plastic, with a centrally located double-lumen channel (2), including a channel (3) for air injection and an instrumental channel (4) for holding a stylet and an endoscopic loop (5). In the channel for air injection there are holes (6) for conducting air into the cylinder. The maximum diameter of the balloon opening is 5 cm, the length of the balloon is 30 cm, the length of the double-lumen canal is 40 cm, and the diameter of the canals is 0.5 cm. The use of the utility model ensures uniform formation of the retroperitoneal canal corresponding to the diameter of the adducting intestine to be removed, preventing damage to the peritoneum and feeding vessels during excessive mobilization of the peritoneum with rigid surgical instruments. 1 ill., 1 pr.

Description

The useful model relates to medicine, namely to surgery, and can be used in operations aimed at the formation of an extraperitoneal intestinal stoma.

Known surgical instrument for removing the intestinal stoma during operations on the small and large intestines [Patent RU 117795, 2012], which is a device for removing the intestinal stoma, containing a rack and two removable convex working blades. The blades are 7 cm long and 3 cm wide, have a bulge at the working end, are attached to the jaws of the device at an angle of 75 °, and a centimeter scale is made on the rack, corresponding to the diastasis between the blades. With the help of the device, the surgeon expands the operating wound to the required size in accordance with the size of the bowel being removed, and removes the bowel through this wound. The existing instrument, taken as a prototype, has a number of disadvantages: the device is a rigid metal structure and is used only when removing the transperitoneal intestinal stoma, since the instrument has straight working jaws 7 cm long, which is not enough to form an extraperitoneal canal for the stoma. In addition, the extraperitoneal canal must have a long, curved shape and requires a long and simulated instrument to form.

The objective of the utility model is to develop a simple, flexible and versatile design for the formation of canals for the removal of extraperitoneal stomas.

The technical result when using the utility model is the uniform formation of the extraperitoneal canal corresponding to the diameter of the adductor gut brought out to the outside, prevention of damage to the peritoneum and supplying vessels with excessive mobilization of the peritoneum with rigid surgical instruments.

The proposed utility model is illustrated by the figure, which shows the proposed device, general view.

The proposed device contains an oblong inflatable cylinder 1 of a cylindrical shape, having a working and external ends, and made of plastic, with a centrally located double-lumen channel 2, including a channel (lumen) 3 for air injection and an instrumental channel 4 for holding the stylet and endoscopic loop 5 , which are led out in the form of separate tubes at the outer end of the device. The working end of the channel for air injection ends blindly, and there are holes 6 in it for conducting air into the cylinder. The maximum diameter of the balloon opening is 5 cm. The length of the balloon is 30 cm. The length of the double-lumen channel is 40 cm. The diameter of the instrument channel is 0.5 cm, the diameter of the channel for air injection is 0.5 cm.

The device is used in the formation of an extraperitoneal intestinal stoma in the following way: after extirpation of the rectum, the descending colon is mobilized, the place most suitable for removing the intestinal stoma is marked on the skin. At the site of the marking, a rounded skin area is excised with a scalpel, the diameter of which corresponds to the diameter of the intestine, which is brought out in the form of a stoma. The subcutaneous tissue is divided bluntly with the Billroth forceps by sequentially extending the jaws of the instrument. Then the anterior leaflet of the rectus sheath is dissected in the form of a cross according to the diameter of the excreted intestine, then the fibers of the rectus muscle are also pushed apart in a blunt way, and the rectus abdominis itself is peeled off from the posterior leaf of the sheath of the rectus abdominis muscle to the outer edge of the rectus sheath. The posterior leaf of the rectus sheath is vertically dissected along the outer edge of the rectus abdominis muscle according to the diameter of the excreted intestine, while the parietal (parietal) peritoneum layer is not dissected. Then a stylet made of the simulated metal is introduced into the instrument channel of the device, thereby imparting the necessary rigidity to the inflatable balloon. The device is bent according to the shape of the supposed extraperitoneal stomal canal, then, through the previously formed holes in the anterior abdominal wall, it is passed extraperitoneally to the left lateral canal, where the left flank of the colon was previously mobilized laparoscopically. In this place, the internal opening of the extraperitoneal stomal canal is formed. Next, the stylet is removed, and a loop for endoscopic polypectomy is passed through the instrumental canal, with the help of which the end of the excreted intestine is captured. At the same time, in the lumen of the formed extraperitoneal stoma canal, the balloon is inflated to the required diameter by introducing air into the channel for air injection. Thus, an extraperitoneal canal is formed for the removal of the intestinal stoma. Next, the balloon is deflated and pulled out together with the previously fixed intestine.

The described device makes it possible to form an extraperitoneal canal, exactly corresponding to the diameter and shape of the excreted intestine, thereby preventing excessive exfoliation of the peritoneum and damage to the supply vessels during the formation of this canal with rigid surgical instruments.

The proposed device was used in 3 patients with rectal cancer.

Clinical example

Patient V., 70 years old, was admitted to the oncology department in a planned manner with a diagnosis of Cancer of the lower ampullar rectum, st.3. At the outpatient stage of preoperative examination, no data were obtained for distant metastases. Previously, the patient underwent large-fraction neoadjuvant radiation therapy at a dose of 25 Gy, after which the patient was prepared for surgical treatment. Before the operation, the patient was made a preoperative marking on the skin of the abdomen for the optimal place for removing the stoma in the following way: using a marker, the place of intersection of the middle of the thickness of the rectus abdominis muscle with the line connecting the umbilicus with the anterior superior iliac spine was marked. Laparoscopic abdominal-perineal rectal extirpation with D3 lymph node dissection was performed under endotracheal anesthesia. The proximal sigmoid colon was transected using a linear stapler with the removal of the removed colon through the perineal wound. Further, the pelvic peritoneum and perineal wound are sutured. The descending colon is mobilized. Outside, in the place of the previously applied marking with a scalpel, a rounded area of skin was excised with a diameter corresponding to the diameter of the excreted intestine. The subcutaneous adipose tissue is divided in a blunt way using the Billroth forceps, by successive spreading of the jaws of the instrument. Then the anterior leaflet of the rectus sheath is dissected crosswise according to the diameter of the excreted intestine, then the fibers of the rectus muscle are separated using the Billroth clamp, and the rectus itself is separated from the posterior leaf of the rectus sheath to the outer edge of the sheath of the rectus abdominis muscle. The posterior leaflet is dissected vertically along the outer edge of the rectus abdominis muscle according to the diameter of the excreted intestine. Then a stylet made of the simulated metal is inserted into the instrument channel of the device. The device is curved in the shape necessary for the formation of the extraperitoneal canal, then through the previously formed holes in the anterior abdominal wall it is passed extraperitoneally to the left lateral canal of the abdominal cavity, where the descending colon was previously mobilized laparoscopically. In this place, the internal opening of the extraperitoneal stomal canal is formed. The stylet was removed, a loop for endoscopic polypectomy was inserted through the instrumental canal, the loop was opened. A laparoscopic clamp in the open loop is placed the end of the withdrawn descending colon, prepared for removal in the form of a colostomy, the loop is tightened, thereby the colon is fixed in the device. The balloon was inflated to 5 cm by introducing air with a Janet syringe through the air injection channel. Thus, the extraperitoneal stoma canal is formed. Then the air from the balloon is evacuated, and the device itself is removed from the abdominal cavity together with the intestine fixed in the loop. Thus, the intestine is held in the extraperitoneal canal. The end of the intestine was fixed to the skin with interrupted sutures, and a single-barreled end colostomy was formed. A colostomy bag was glued to the colostomy, the stoma was opened. In the postoperative period, analgesic therapy and dressings were carried out. The intake of liquid food was started on the first day after the operation. The stoma began to function on the 2nd day after the operation, the patient did not notice dyspeptic symptoms, the wound healed by primary intention, the sutures were removed on the 10th day after the operation.

Claims (1)

A device for the formation of an extraperitoneal canal, characterized in that it contains an inflatable cylindrical balloon 30 cm long, made of plastic, with a centrally located double-lumen canal 40 cm long, including a channel for injecting air into the balloon and an instrumental channel for holding a stylet and an endoscopic loop, while the channels are brought out in the form of separate tubes at the outer end of the device, the working end of the channel for air injection ends blindly, and there are holes in it, and the diameter of each channel is 0.5 cm.

Images