RU2135103C1 - Endolift for gasfree laparoscopy with minilaparotomy - Google Patents

Abstract

FIELD: medicine, applicable in laparoscopic surgery as lifting device. SUBSTANCE: endolift has wound expander with hooks whose width amounts to 0.4-0.5 length of minilaparotomy performed for hook introduction. Length and bending of hook working plane correspond to required configuration of space and place of introduction into abdominal cavity. As a result, structure ensures lift of abdominal wall in gas-free laparoscopy and optimal access for surgical intervention with use of video laparoscopic devices. EFFECT: higher efficiency. 4 dwg

Description

 The invention relates to medicine, in particular to laparoscopic surgery.

 The aim of the invention is to provide a design for lifting the abdominal wall with gas-free laparoscopy and providing optimal access during surgical interventions using video laparoscopic techniques. For this, special hooks are introduced through a small incision in the abdominal wall, with the help of which the abdominal wall is elevated. The method allows to create the optimal surgical field in the intervention area and to avoid the negative effects of gas injection into the abdominal cavity.

 A well-known endolift developed by designers of NPF Endomedium. This device consists of two half rings that are inserted through a small puncture of the skin into the subcutaneous tissue of the abdominal wall and connected at the injection site to a special lift. When using this device in the abdominal cavity creates a working space in the form of a cylinder. The disadvantage of this design is the insufficient amount of working space.

 The method is as follows.

 Under endotracheal anesthesia, minilaparotomy is performed in the area of the intended surgical action with a length of 3-6 cm (depending on the volume of organs removed). 3 hooks of a special design are introduced into the section (Fig. 1, 2). The racks of the DSC apparatus (MZ Sigala and KV Kabanov expander) are attached to the operating table in such a way as to provide traction up and to the sides (2 hooks) and up to the legs or head of the patient (Fig. 3). At an optimal traction angle (Fig. 4), the hook working plane pulls the abdominal wall not only at the point of insertion into the abdominal cavity, but along the entire length of the hook) and using 3 retractors creates opportunities for good visualization. The hooks used, unlike those used in the DGC apparatus for traditional (open) surgery, have a width of 1.5 - 2.5 cm. The length and bend of the working plane of the hooks depend on the desired configuration of the surgical space and the place of their introduction into the abdominal cavity. For example, during operations on the rectum and sigmoid colon, when colostomy is supposed to be formed in the future, endolift hooks are inserted through an incision in the left ileal region. The working plane of the hook, which pulls the abdominal wall to the left and up, has a length of 3 cm, the opposite - 8 - 9 cm, and the third, with a direction to the legs and up - 3 - 4 cm.The incision made to insert the hooks is then used to remove the intestinal stoma. In operations on the stomach, if good access to the proximal organs is necessary, it is more convenient to perform minilaparotomy along the left mid-clavicular line, just below the costal arch. In this case, a hook working towards the patient’s head will raise the patient’s costal arch. Its length is 3.5-4.5 cm. The left hook is of a similar length, and the right one is 8-9 cm. When performing a right-sided hemicolectomy, it is better to place the hooks somewhat to the right of the midline, because this incision can be used for extracorporeal overlay of the anastomosis.

 The proposed method avoids the negative effects of air injection into the abdominal cavity, creating an optimal surgical approach and preserving all the benefits of minimally invasive access. In this case, it becomes possible to use the minilaparotomy performed for insertion of hooks, both for manipulations, including instruments for traditional surgery, and for removing the drug or forming the stoma. The section of the abdominal wall allows you to complement the visual examination with a finger examination of the abdominal cavity.

 Example 1

 Patient F., 64 years old. On March 28, 1997, laparoscopy was performed for gastric cancer using an endolift. Minilaparotomy 3 cm long was performed along the midline at the middle of the distance between the navel and the xiphoid process. A good visualization of the upper and middle floors of the abdominal cavity was noted. The dissemination of the tumor process along the parietal peritoneum, the presence of ascitic fluid were revealed. With a finger revision of the abdominal cavity through an incision made for the introduction of hooks, the spread of tumor infiltration to the roots of the mesentery of the small and transverse colon and the head of the pancreas was found. Case recognized inoperable.

 Example 2

 Patient K., 73 years old. 02/07/97 g for a pancreatic tumor with obstruction of the duodenum laparoscopy was performed using an endolift. On examination, a volumetric formation in the region of the mesentery root of the transverse colon, small disseminates of the parietal peritoneum, and metastases in the greater omentum were revealed. The stomach is very distended. During a biopsy of one of the nodes, metastasis is morphologically confirmed.

 Traced the course of the intestine. Departing from the ligament of Traits, a single-row inter-intestinal anastomosis was applied with a continuous suture. The loop thus insulated is led anteriorly toward the wall of the stomach. It will produce gastroenteroanastomosis in a similar way.

 Patient X., 2.04.97 g for rectal cancer performed laparoscopy with the introduction of an endolift through an incision in the left iliac region. Using video laparoscopy, the rectum was mobilized. Extirpation of the rectum was performed with the removal of the drug through perineal access. Through a cut in the left iliac region, a sigmostoma is removed.

 Sources of information.

 1. I.V. Fedorov, V.M. Belopukhov, V.N. Voronin, F.V. Novikov Gas-free laparoscopic cholecystectomy // Endoscopic surgery.- 1997- N 1 volume 3.

 2. M.Z. Seagal, F.Sh. Akhmetzyanov Gastrectomy and gastrectomy for cancer. - Kazan, 1991.

Claims (1)

 An endolift for gas-free laparoscopy with minilaparotomy, containing a retractor M.Z. Sigala and K.V. the length and bending of the working plane of the hooks are made depending on the desired configuration of the space and the place of introduction into the abdominal cavity.

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