RU207999U1 - ADJUSTABLE RETAINER FOR LAPAROSCOPIC TROCARS - Google Patents

Abstract

The utility model relates to medicine, to medical technology, namely to laparoscopic and robot-assisted surgery, urology, gynecology, transplantation, and is designed to provide reliable and long-term fixation of laparoscopic trocars to the patient's body with the possibility of adjustment during the operation. Adjustable retainer for laparoscopic trocars, containing a square base with notches and a central square hole and a trocar fixation mechanism rigidly fixed on the base, made in the form of a conical support, in the cavity of which a movable spherical element with a through hole for the trocar is placed, while the spherical element is equipped with a spring lock, and in the upper part of the conical support, on its inner side, there is a profile recess for a ball element, and on the outer side - a thread for a fixing nut, on the inner surface of which a reciprocal profile recess is made. The proposed device increases the safety of surgical th intervention by reliable and long-term fixation of laparoscopic trocars to the patient's body with the possibility of adjustment during the operation, which reduces the trauma of the patient, facilitates the work of the surgical team, and speeds up the operation. 3 ill.

Description

The utility model relates to medicine, to medical technology, namely to laparoscopic and robotic-assisted surgery, urology, gynecology, transplantology and is designed to ensure reliable and long-term fixation of laparoscopic trocars to the patient's body with the possibility of adjustment during the operation.

The initial success of laparoscopic cholecystectomy prompted surgeons and engineers to invent new instruments and develop new surgical procedures of ever increasing complexity. The laparoscope, which was originally used only to remove the gallbladder, is now used for operations on almost all organs of the abdomen, chest and mediastinum. The development and implementation of new tools is growing exponentially. (Laparoscopic surgery. Atlas. / Theodor N. Pappas, Michael S. Harnish; translated from English under the editorship of Prof. SS Harnas. - M: GEOTAR-Media, 2012. - 338 p.).

Despite the constant improvement of laparoscopic instrumentation and the emergence of new techniques, a number of questions remain unresolved. For a long time, one of these issues has been the possibility of reliable adjustable fixation of trocars on the patient's body. A large number of devices and modifications have been proposed, but the problem has not yet been resolved.

A standard trocar for laparoscopy, for example, a laparoscopic trocar, diameter 11 mm (Art. 1011-04, manufacturer: MNPO Endomedium®, Russia, Kazan) is a laparoscopic trocar, diameter 11 mm, working length 10.5 cm, universal automatic valve with manual control, smooth cannula with a beveled distal end. For use with tools with a diameter of 10 mm.

This trocar and similar products from other manufacturers are the most common. The disadvantage of such trocars is the inability to fix them on the body after insertion, and the instability of the position of the trocar in the tissues during manipulations by the surgeon during the operation leads to their loss, which, as a result, complicates the operation, increases the likelihood of intraoperative complications and leads to a decrease in the efficiency of the surgeon ...

As an attempt to fix the trocar relative to the patient's body, two main solutions, different from each other, have been used.

The first solution is to apply a screw thread to the outer surface of the tube in order to fix the trocar in the thickness of the abdominal wall with it. One example is a trocar for laparoscopic operations (see patent RU 198930 U1, IPC А61В 17/34, publication date 08/03/2020). This trocar for laparoscopic operations contains a sleeve, which is an elongated tubular body with a screw thread, which is single-threaded, while the thread turn height is at least 2 mm, the thread pitch is at least 6 mm, the thread profile is rounded, and the screw thread is made of elastic material. Also, plastic or rubber is used as an elastic material of the screw thread.

Trocars of this type have the main disadvantage in the form of high trauma, since during the installation process these trocars are mechanically screwed along a screw thread through the abdominal wall, due to which they are actually fixed. Obviously, trauma to the tissues that make up the abdominal wall, especially the muscles and aponeurosis, is significantly higher when using threaded trocars than when using standard trocars with a smooth outer surface. In this case, if it is necessary to change the position of the trocar during the operation, it is necessary to screw or unscrew the trocar, which, given the repeated need for trocar correction, leads to significant additional trauma.

The second solution is to use air-inflated balloons to fix the trocar in the thickness of the abdominal wall.

One of the representatives of this group is a device for fixing a trocar in an operative laparoscopic approach (see patent RU 70113 U1, IPC А61В 17/32, publication date 01/20/2008). This device for fixing a trocar in an operative laparoscopic approach contains a retaining element through which a trocar is inserted into the abdominal cavity, a support tube is used as a retaining element, on which two polymer cuffs are fixed at a distance of 5 mm from each other, to each of which in thicker than the carrier tube, there are channels connected to air nipple systems, which alternately inflate the cuffs.

The disadvantages of these devices include: the impossibility of correcting the standing depth after inserting a trocar, which limits the degree of useful operation of the instrument passed through this trocar; excessive compression by swollen cuffs and, as a result, large ischemia of the tissues of the abdominal wall in the case of its significant thickness in patients with a hypersthenic body type; in case of rupture of the outer cuff, migration of the trocar inside the abdominal wall is possible; sterilization and reuse of these devices is extremely difficult.

The closest analogs from the field of technology have not been identified.

The technical result achieved when using the proposed utility model is to increase the safety of the surgical intervention through reliable and long-term fixation of the laparoscopic trocars to the patient's body with the possibility of adjustment during the operation, which reduces the patient's trauma, facilitates the work of the surgical team, and speeds up the operation.

The technical result is achieved by the fact that the device contains a square base with notches and a central square hole and a trocar fixation mechanism rigidly fixed on the base, made in the form of a conical support, in the cavity of which there is a movable ball element with a through hole for the trocar, while the ball element is equipped with a spring lock , and in the upper part of the conical support, on its inner side, a profile recess is made for a ball element, and on the outside there is a thread for a fastening nut, on the inner surface of which a reciprocal profile recess is made.

The utility model is illustrated by drawings, where: FIG. 1 is a schematic representation of an adjustable retainer for laparoscopic trocars (A - side view, B - top view).

FIG. 2 is a schematic illustration of an example of the use of an adjustable retainer for laparoscopic trocars (side sectional view).

FIG. 3 schematically shows an example of the use of an adjustable retainer for laparoscopic trocars (top view).

An adjustable retainer for laparoscopic trocars is made in the form of a square base 1, which has a square central hole 2, while the base 1 on its upper surface has notches 3 and a conical support 4, in which a profile recess 5 is made on the inner side, and on the outer side - thread 6 for fastening nut 7, also having a profile recess 8 on the inner surface, while in the profile recesses 5 and 8 there is a movable ball element 9 with a through hole 10 for a trocar and a spring lock 11 to hold the trocar in a given position.

The proposed device functions as follows:

Let's consider the mechanism of action of an adjustable retainer for laparoscopic trocars (Fig. 2-3). Before installing the trocar 12, first, an incision is made in the skin of the abdominal wall 13, then the spring lock 11 is unclasped and the trocar 12 is passed into the hole 10 located in the ball element 9, after which the spring lock 11 is brought into a closed state. Trocar 12 with the help of a stylet is passed through the abdominal wall 13 into the abdominal cavity and exposed to the required standing depth. Then, using an adjustable fixator for laparoscopic trocars, the laparoscopic trocar is attached to the patient's body. To do this, the spring lock 11 is opened, the ball element 9 is shifted through the hole 10 along the trocar 12 to the level of full contact of the base 1 with the skin surface of the abdominal wall 13. After that, the spring lock 11 is closed and the trocar 12 is securely fixed at a predetermined level to the ball element 9. Base 1 is additionally fixed to the surface of the skin of the abdominal wall with a plaster 14.

Thus, an adjustable fixator for laparoscopic trocars allows you to create optimal conditions for fixing laparoscopic trocars to the patient's body due to its design:

1. The spring lock 11, placed on the ball element 9, allows you to reliably fix the trocar 12 in a given position relative to the ball element 9 and, if necessary, to quickly close / open to change the position of the trocar, while changing the position of the trocar 12 is carried out by its longitudinal movement through the hole 10 relative to the ball element 9 with the open spring lock 11.

2. The hole 10 for the trocar 12 passes inside the ball element 9, which is fixed with the possibility of rotation thanks to the profile recesses 5 and 8, the conical support 4 and the fastening nut 7, which allows the trocar 12 fixed in the ball element 9 to perform free movements relative to the fixed on abdominal wall 13 base 1.

3. The shape of the conical support 4 increases the angles of rotation of the ball element 9 and, accordingly, the amplitude of movement of the trocar 12.

4. The presence of the fastening nut 7 makes it possible to carry out a complete disassembly of the device into several component parts, which facilitates its postoperative processing and increases maintainability.

5. The presence of notches 3 on the outer surface of the base 1 ensures reliable fixation of the base 1 with a plaster 14 to the abdominal wall 13, which allows the trocar 12 to be reliably fixed relative to the abdominal wall 13 (unintentional migration of the trocar 12 deep into the abdominal wall 13 is impossible due to the fixation of the trocar 12 with a spring the lock 11 in the hole 10 of the ball element 9 and the support of the base 1 directly on the wall of the abdomen 13, and the migration of the trocar 12 outside the wall of the abdomen 13 is impossible due to the fixation of the base 1 with a plaster 14.

6. All parts of the adjustable fixator for laparoscopic trocars are made of medical steel with the possibility of disassembling the device and sterilizing, which allows the device to be used repeatedly and leads to savings in money for the surgical operation.

The proposed device increases the safety of the surgical intervention by reliable and long-term fixation of laparoscopic trocars to the patient's body with the possibility of adjustment during the operation, which reduces trauma to the patient, facilitates the work of the surgical team, accelerates the operation, and increases the safety of the intervention for the patient. The device has wide functionality. It can be used in operations in surgery, urology, transplantology, gynecology and used in laparoscopic and robotic operations.

Made 5 experimental samples of the proposed adjustable fixator for laparoscopic trocars. These devices were used in 11 laparoscopic operations. There were no inconveniences during operation when working with them, good results were achieved in all operations, there was no trocar migration, and no additional assistant was required.

The proposed fixator for laparoscopic trocars with the ability to ensure reliable and long-term fixation of laparoscopic trocars to the patient's body with adjustment during the operation makes it easier to carry out the operation, reduce the likelihood of intraoperative complications and increase the efficiency of the surgeon in laparoscopic and robotic access.

The utility model is illustrated by an example.

Clinical example. Patient M., 32 years old, was admitted routinely to the urology department with a diagnosis of stricture of the pelvic-ureteric segment on the right for surgical treatment. The patient underwent laparoscopic LMS plasty according to Anderson-Hines on the right using adjustable fixators for laparoscopic trocars. The operation time was 72 minutes, the blood loss was minimal, there was no trocar migration, no additional assistant was required, and no conversion to open surgery was required. The postoperative period is favorable.

Claims (1)

An adjustable retainer for laparoscopic trocars, containing a square base with notches and a central square hole and a trocar fixation mechanism rigidly fixed to the base, made in the form of a conical support, in the cavity of which there is a movable ball element with a through hole for the trocar, while the ball element is equipped with a spring lock , and in the upper part of the conical support, on its inner side, a profile recess is made for a ball element, and on the outside there is a thread for a fastening nut, on the inner surface of which a reciprocal profile recess is made.

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