RU2144326C1 - Instrument for guiding and forming of sutural material knots in narrow and deep wound and method of its use - Google Patents

Abstract

FIELD: medicine, particularly, neurosurgery. SUBSTANCE: instrument has straight handle with cuts and is made as tapered rod with operating part shaped as fork with symmetrical teeth. Tapered rod is of bayonet form with two bends along axis at angle of 130-140 deg. Total length of operating part is 6-8 mm. Operating part is bent through angle of 90 deg to rod axis. Teeth of operating part are positioned at an angle of 12-15 deg relative to each other. They are 4-6 mm long and 1.5 mm wide. Space between points of teeth makes up 3 mm. Operative wound edges to be sutured are pierced by surgical microneedle, and loops of thread are formed at the top of wound. Knot being formed is brought to sutured edges of wound by means of instrument. One end of thread is held with tension, and knot is lowered along it. In this case, formed knot and both ends of thread are located between teeth of instrument fork. The device provides for direction of loop, dosed tension of thread, formation of sutured material knots, and correct juxtaposition of edges of sutured narrow and deep wound under direct visual control. EFFECT: excluded traumatizing. 3 cl, 3 dwg, 2 ex

Description

 The invention relates to medicine, namely to neurosurgery, and can be used in other fields of surgery.

 Widely known are various tools and methods for using them for suturing and forming surgical sutures. However, standard tools are designed for suturing and the formation of nodes in the surgical field located in a superficial and shallow wound.

 It is known that earlier in neurosurgery with transnasal access (nasal surgery) after removal of a tumor of Sellar-extrasellar localization, the Turkish saddle cavity was sealed in various ways using a hemostatic sponge, muscle or adipose tissue, various adhesive compositions, and the dura mater (TMT) was not it was sutured due to the technical impossibility to impose a surgical suture, form the correct knot and tightly match the edges of the TMT in a very narrow and deep wound, which led to there are postoperative complications in the form of nasal liquors with subsequent meningitis and meningoencephalitis, especially after intraoperative liquorrhea [1].

 Similarly, with transoral (oral surgery) removal of tumors of the base of the skull, subsequent layer-by-layer wound closure was significantly complicated by the depth and narrowness of the wound [2].

 Known suture guide (Suture Pusher Yasargil), taken as a prototype [3], having a straight handle with notches connected to a conical rod containing a forked working part, made in the form of a fork, which is located on the same axis with the rod, and the fork contains two symmetrical teeth located parallel to each other.

 The disadvantage of the prototype is that it limits the overview of the surgical field due to its straightness, it is difficult to visual control the formation of sutures and the correct comparison of the edges of the stitched wound, especially during manipulations in a narrow and deep wound. The fork oriented along the axis of the tool limits the use of the tool when forming the suture material assembly along the vertical axis, as this can lead to trauma to the anatomical formations located at the end of the fork, below the plane of the formed assembly, and the thread and the formed suture assembly can slip off parallel teeth, as it is very difficult to create sufficient thread tension when forming a node on the teeth located in parallel.

 The technical task of the claimed invention is that it provides the ability to guide the loop and the dosed tension of the thread, the formation of nodes of suture material and the correct comparison of the edges of the stitched narrow and deep wounds, under direct visual control, and also eliminates the trauma of anatomical formations located below the plane of the node formation .

The solution of the technical problem is achieved by the fact that the tool is made in the form of a cone-shaped rod containing a straight cylindrical handle with notches, which has a bayonet shape with two bends along the axis at an angle of 130-140 ^o , while the working part is bifurcated, made in the form of a fork, has the total length of 6-8 mm and bent at an angle of 90 ^o (α ₁ ) to the axis of the rod, and the symmetrical teeth of the working part are at an angle of 12-15 ^o (α ₂ ) to each other, have a length of 4-6 mm, width 1, 5 mm, and the distance between the tips of the teeth is 3 mm.

The bayonet shape of the instrument provides the best visual control of manipulations deep in the wound. The location of the working part of the tool at an angle of 90 ^o to the axis of the rod i.e. on the same plane with the formed node, ensures the absence of trauma to anatomical formations located below the plane of the formation of the node. The presence of teeth at an angle of 12-15 ^{o to} each other provides the ability to dose the tension of the thread, correctly form a node of suture material and correctly match the edges of the wound.

 The dimensions of the working part of the tool, as well as the length, width of the teeth and the distance between the teeth are optimal for the formation of nodes in a narrow and deep wound, in particular during transnasal and transoral operations.

 In FIG. 1 shows a tool in lateral projection; in FIG. 2 - oblique projection (general view); in FIG. 3 - the first example of a method of forming a node using the inventive tool; in FIG. 4 - a second example of a method of forming a node using the inventive tool.

The tool contains a handle 1, made in the form of a straight cylindrical rod, 110-120 mm long, for the convenience of working with the tool, the handle contains notches 2. The tool also contains a cone-shaped rod 3 120-140 mm long, which is twice bent along the axis at an angle of 130-140 ^o , i.e. the rod has a bayonet shape, and the working part 4 is bent at an angle of 90 ^o (α ₁ ) to the axis of the rod and is made in the form of a fork with a total length of 6-8 mm, containing two symmetrical teeth 5, 6, at an angle of 12-15 ^o (α ₂ ) to each other and having a length of 4-6 mm, a width of 1.5 mm, and the distance between the tips of the teeth is 3 mm.

 The tool is used in the following way. The first example of a method of forming a knot: after piercing the stitched edges with a surgical microneedle, a loop is formed at the top of the wound, and then, using the inventive tool, a loop is looped to the matching edges of the surgical wound and a knot is formed, one of the ends of the thread being tensioned (it is guiding) and lowered along it the loop, while the loop, both ends of the thread and the formed node are located between the teeth of the fork of the tool (see Fig. 3). A second example of a method of forming a knot: a loop is formed at the top of the wound, and then, using the inventive tool, a loop is brought to the corresponding edges of the operational wound, one end of the thread being kept energized (it is guiding) and the other end of the thread is placed between the teeth of the tool fork and the force of the tool is directed perpendicular to the axis of the guide thread (see Fig. 4).

 Thus, the medical and technical effectiveness of the claimed tool and method of its use is that it eliminates the trauma of anatomical formations located below the plane of the formed node, allows you to direct the loop, dose the thread tension, form the node and correctly match the edges of the stitched narrow and deep wounds , under visual control, preventing such formidable postoperative complications, in particular in neurosurgery such as cerebrospinal fluid, meningitis and meningoencephalitis.

 The inventive tool and method of its use can be applied in various fields of medicine: in neurosurgery (during operations performed by transnasal, transoral, transmaxillary, subfrontal approaches, with intralaminar methods for removing herniated discs, etc.), otorhinolaryngology, traumatology, cardiac surgery, and he was introduced into the clinical practice of the Research Institute of Neurosurgery. Acad. NN Burdenko, in particular during transnasal and transoral operations.

Sources of information
1. Shkarubo A. N. Dysembryogenetic tumors of sellar-sphenoidal localization (clinic, diagnostics, transnasal-transsphenoidal microsurgery). PhD thesis. - M., 1994, 228 p.

 2. Trunin Yu.K., Shkarubo A.N., Krasnoperov I.V., Turkin A.M., Belova T.V. Transoral removal of the chordoma of the slope of the skull. Questions of neurosurgery. - 1994, N 1, p. 34-36.

 3. Yasargil Suture Pusher // Martin Surgery catalog. Martin Medizin - Technik. Gebruder Martin GmbH @ Co. KG, 1995, 5, s. 534, N 24-957-01.

Claims (3)

1. A tool for guiding and forming nodes of suture material in a narrow and deep wound, having a straight handle with notches made in the form of a cone-shaped rod with a working part in the form of a fork with symmetrical teeth, characterized in that the cone-shaped rod has a bayonet-shaped with two bends in axis at an angle of 130 - 140 ^o , while the working part has a total length of 6 - 8 mm and is bent at an angle of 90 ^o to the axis of the rod, and the teeth of the working part are at an angle of 12 - 15 ^{o to} each other and have a length of 4 - 6 mm and a width of 1.5 mm, and the distance between vert splint teeth is 3 mm. 2. The method of using the tool for guiding and forming nodes of suture material in a narrow and deep wound, having a straight handle with notches and made in the form of a cone-shaped rod with a working part in the form of a fork with symmetrical teeth, while the cone-shaped rod has a bayonet shape with two bends in axis at an angle of 130 - 140 ^o , the working part has a total length of 6 - 8 mm and is bent at an angle of 90 ^o to the axis of the rod, and the teeth of the working part are at an angle of 12 - 15 ^{o to} each other and have a length of 4 - 6 mm and a width 1.5 mm, and the distance between the tops of the teeth is 3 mm, which consists in piercing the stitched edges of the surgical wound with a surgical microneedle and forming a loop of thread from the top of the wound, while the knot being formed is lowered to the stitched edges of the wound using a tool, one end of the thread is tensioned and the knot is lowered along it, moreover the knot being formed and both ends of the thread are between the teeth of the tool fork.  3. The method according to claim 2, characterized in that the guide end of the thread is located between the teeth of the fork, and the force of the tool is directed perpendicular to the axis of the guide thread.

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