RU2135134C1 - Device for intraocular operations - Google Patents

Abstract

FIELD: medical equipment, in particular, ophthalmosurgery, applicable for removal of adhesions, intraocular streaks at a syndrome of perplastic primary vitreous body. SUBSTANCE: device has a handle, cutting members. The device branches are made in form of three tubes tightly enveloping one another for relative concentric movement. The distal ends of two branches, tightly enveloping each other at their concentric movement, have knives whose cutting faces are parallel, and the distal end of the third branch has a clamp whose faces are parallel to the knife faces. The device is furnished with two mechanical drives, one for the external tube and the other for the internal one, using a box, power spring, control push-button. EFFECT: prevented traumatism of neighboring tissues at manipulations in the cavity of fudus of the eye, instant cutting-off and removal of adhesions or strikes by one tool through one microincision, reduced time of surgical intervention. 1 cl, 13 dwg

Description

 The invention relates to medicine, namely to ophthalmic surgery and can be used to eliminate a mooring line, intraocular cords with persistent hyperplastic primary vitreous syndrome.

 Known vitrectomy scissors containing a handle, a cutting element (Hans Geuder "Augeninstrumente", Hejdelberg, 1990, G 19814, 13 P).

Known vitrectomy scissors have the following disadvantages:
- during manipulation in the vitreous body, tissue trauma to the sharp ends of the cutting elements is not excluded, because they open spatially;
- when cutting off tight moorings and cords, their slipping is observed, since the cutting elements of the tool are located at an angle to each other;
- To remove the cut-off moorings or cords, the introduction of other instruments into the cavity of the eye is also required, and this is associated with additional manipulations, time and trauma.

 The prototype of the present invention adopted the well-known microsurgical scissors, consisting of two handles, on the one hand ending with springs, and on the other - cutting elements (blades), movably connected using the axis, and on the working end of one of the blades mounted side (clip), the working surface which is located in a cavity parallel to the plane of the inner surface of the other blade (SU 2012294, A 61 F 9/007, 1994).

 Known scissors, taken as a prototype, have the same disadvantages as the previous counterpart.

 In addition, the side (clamp) mounted on the working end of one of the blades, the cut-off fabric will inevitably be clamped between the side surface of one of the blades at each closing of the blades, and this is not required when removing the mooring or cords from the vitreous cavity.

 We set the task: to exclude trauma to nearby tissues during manipulation in the cavity of the eyeball, to cut off the mooring (strands) and to remove it with one tool through one micro incision.

 This goal is solved by a device containing a handle, jaws with knives, characterized in that the jaws of the device are made in the form of three tubes concentrically arranged in one another, moreover, at the distal ends of the two branches, tightly covering each other during their mutual concentric movement, there are knives cutting the faces of which are parallel, and at the distal end of the third jaw there is a clamp with rounded ribs and a face with notches of the face that are parallel to the cutting edges of the knives. The device is equipped with two mechanical drives, one for the outer, the other for the inner tubes containing the box, power spring, control button.

 The parallelism of the cutting edges of the knives eliminates the sliding of the mooring (strands) when they are cut off.

 The implementation of the jaws (with knives and a clamp) in the form of three tubes concentrically arranged in one another and the concentric movement (working stroke) of the knives, clamp reduces trauma to the vitreous humor, the time of surgery, allows manipulation through one micro section.

 Equipping the device with mechanical drives and a normalized working stroke of the knives facilitates the surgeon's work, reduces the time of operation.

 The presence of a clamp on one of the branches ensures the capture (fixation) of the moorings (strands) before clipping and its removal after clipping.

 Figure 1 presents a General view of the device, a longitudinal section; figure 2 is the same, a top view; figure 3 - node I, left view; figure 4 is the same, a top view; figure 5 is a section AA in figure 1; in Fig.6 is a section of the BB in Fig. 1; in FIG. 7 - fragment of using the device; on Fig depicts a handle with a middle jaw and a knife; figure 9 is the same, a top view; in FIG. 10 is a diagram of the operation of the device, the mooring between the knives; in FIG. 11 - the same, the mooring is fixed (clamped) between the protrusion of the knife and the clamp; Fig.12 is the same, the moment of cutting off the mooring; on Fig - section SS in Fig.9.

The proposed device contains:
- a cylindrical handle 1 (it is the middle tube), to the top of which a branch 2 with a knife 3 at the distal end is planted; branch 2 is made in the form of a tube; the lower part of the handle 1 is provided with a box 4 for the drive;
- an inner tube 5, to the upper part of which a branch 6 with a knife 7 is inserted at the distal end; branch 6 is covered by branch 2, has the possibility of concentric movement in it. The cutting edges of the knives 3 and 7 are parallel, have the same length L. With mutual concentric movement of branches 2 and 6, the knives 3 and 7 cut off the mooring (strands);
- the outer tube 8, to the upper end of which a branch 9 is inserted with a clamp 10 at the distal end; the outer jaw 9 covers the jaw 2 and has the possibility of concentric movement; during concentric movement of the jaw 9 around the jaw 2, the clip 10 presses the mooring to the protrusion of the knife 3; the lower end of the tube 8 is provided with a box 11 have covers 12 and 13; the handle 1 and the inner tube 5 have longitudinal through holes (slots) 14 and 15 for the movement of the pins 16 and 17;
- drive 18 of the outer tube 8, consisting of a power spring 19, a support disk 20, a cup-leaf spring 21, a control button 22 with a finger-lock 23;
- drive 24 of the inner tube 5, consisting of a power spring 25, a support disk 26, a cup-leaf spring 27, a control button 28 with a finger-latch 29; holes 30 and 31 are made on the covers 12 and 13 for the locking pins 23 and 29.

 The length L of knives 3 and 7, clamp 10 are equal.

 The handle 1 (it is also the middle tube) of the device is the basic element, i.e. concentric movement of the inner jaw 6 with the knife 7 and the outer jaw 9 with the clamp 10 occurs relative to the handle 1 held by the surgeon.

 To exclude the possibility of axial movement of the outer 8, inner 5 tubes relative to the handle 1, a finger 37 and radial holes-slots 38 are provided in the walls of the outer 8 and inner 5 tubes.

 To ensure reliable fixation of the mooring (strands) 35 between the knife 3 and the clamp 10, the knife 3 has a protrusion 39, the front surface of which has a notch. The front surface 40 of the clamp 10 also has a notch.

 Preparing the device for work.

 Holding the handle 1, for example, in the left hand, press the control button 22 with a thumb (while the retainer finger 23 comes out of the hole 31 of the cover 13). With his right hand, grasping the box 11 of the actuator 18, the outer tube 8 is rotated counterclockwise (while the power spring 19 is charging) until the locking pin 23 is drowned in the hole 31 (under the action of the leaf spring 21). The jaw 9 with the clamp 10 takes its initial position, as shown in FIG. 2, 4, 10.

 Charging the drive 24 of the inner tube 5 is as follows.

 Holding the device by the handle 1, for example, in the left hand, with the right hand press the control button 28 and rotate it clockwise until the locking pin 29 is buried in the hole 30. In this case, the power spring 25 is charged, as shown in FIG. 2, 4, 10.

 The operation of the device. When you press the control button 22, under the action of the power spring 19, the outer tube 8 together with the jaw 9 and the clamp 10 moves (rotates) counterclockwise, capturing (fixing) the mooring (or strands) by pinching between the clamp 10 and the front surface of the protrusion 39 knives 3.

 When you press the control button 28, under the action of the power spring 25, the inner tube 5 with a jaw 6 and a knife 7 moves (rotates) counterclockwise until the locking pin 29 is drowned in the hole 30, cutting off the mooring (or cords) held by the clamp 10.

 The proposed device is used as follows.

 In case of persistent hyperplastic primary vitreous syndrome, the sclera 32 is microcuts, and the branches of the device prepared for operation are transciliary introduced into the cavity of the eyeball 33.

 Knives 3 and 7 cut off the distal end 34 mooring 35.

 Then, the proximal end 36 of the mooring 35 is gripped by the clamp 10 and cut off with knives 3 and 7. After that, the device with the cut-off mooring 35 is brought out through a micro section.

 In the clinic of the Ufa Research Institute of Eye Diseases, a prototype of the proposed device performed 4 operations to remove the moorings and cords from the vitreous body of the eyeball.

Using the proposed device in practice showed:
- since the distal ends of the cutting elements do not have pointed ends, trauma to nearby tissues is excluded;
- since the cutting edges of the knives are parallel, when cutting off, the mooring (strands) does not slip, there is no need for an additional micro incision and the holding of a fixing tool, such as tweezers, into the eyeball cavity;
- because the cutting elements of the device work by mutual concentric movement, without going beyond the diameter of the outer jaw, eliminating trauma to the tissues in the eyeball and sclera in the area of microcuts;
- the presence of mechanical drives to move the jaws with knives and a clamp reduces the number of manipulations in the cavity of the eyeball, which ultimately improves the quality and reduces the time of surgery.

Claims (2)

 1. Device for intraocular surgery, containing a handle, jaws with knives, characterized in that the jaws of the device are made in the form of three concentrically arranged tubes in one another, moreover, there are knives at the distal ends of the two branches, tightly covering each other during their mutual concentric movement , the cutting edges of which are parallel, and at the distal end of the third jaw there is a clamp with rounded ribs and a notched face, the edges of which are parallel to the cutting edges of the knives.  2. The device according to claim 1, characterized in that it is equipped with two mechanical drives: one for the outer, the other for the inner tubes containing the box, power spring, control button.

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