RU2159088C2 - Device for making laparoscopic puncture of hepatic echinococcus cysts - Google Patents

Device for making laparoscopic puncture of hepatic echinococcus cysts Download PDF

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Publication number
RU2159088C2
RU2159088C2 RU98120775A RU98120775A RU2159088C2 RU 2159088 C2 RU2159088 C2 RU 2159088C2 RU 98120775 A RU98120775 A RU 98120775A RU 98120775 A RU98120775 A RU 98120775A RU 2159088 C2 RU2159088 C2 RU 2159088C2
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trocar
puncture
liver
cyst
cysts
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RU98120775A
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Russian (ru)
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RU98120775A (en
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М.А. Хамидов
Р.Т. Меджидов
М.Н. Исаев
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Дагестанская государственная медицинская академия
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Abstract

FIELD: medical engineering. SUBSTANCE: device has trocar of 10 mm diameter and stiletto of 8 mm diameter. The trocar is manufactured as suction trocar with puncture suction irrigation needle of 5 mm diameter and is provided with electric suction member. EFFECT: enhanced effectiveness of treatment. 6 dwg

Description

 The invention relates to medicine, namely to endoscopic surgery, and can be used for laparoscopic treatment of echinococcal liver cysts.
 The rapid development of laparoscopic technology can significantly expand the list of possible surgical interventions performed in a minimally invasive way. The interest in the use of laparoscopic technologies in liver echinococcectomy is due to the fact that traditional interventions are accompanied by severe surgical trauma and prolonged rehabilitation of patients.
 For the first time, laparoscopic echinococcectomy of the liver was reported by Khoury G., Geagea T., Hajj A.E. et al. (1994). Subsequently, the number of publications on this topic began to increase (Guibert L., Gaural F., 1995; Sever M., Scapin S., 1995; Watson DI, Jamieson GG, 1995; Khoury G., Jabbour-Khoury S., Bikhazi K ., 1996; Bickel A., Daud G., Lefler E. et al, 1997; Ertem M., Yavus N., 1997; Ghamidi A., 1997). However, little attention is paid to them (Ertem M., Yavus N., 1997) or no structural features of tools for puncture of liver cysts are reported at all. Meanwhile, this issue is key for observing the principles of aparasitism and antiparasitism in the treatment of liver echinococcosis.
 Pediatric surgeons (Goremykin I.V. et al., 1996) during laparoscopy, the area of puncture and subsequent opening of the capsule of the echinococcal cyst was previously fenced off with gauze turunda. The cyst contents were punctured and pumped out using a specially made needle and an endosurgical instrument for intraoperative cholangiography, through which a puncture needle was inserted.
 M.A. Aliev et al. (1997) perform a puncture of the liver hydatide cyst, after having suctioned through an additional trocar directly to the puncture zone.
The following two main reasons hinder the widespread adoption of endoscopic surgery in the treatment of parasitic cysts:
1) the probability of seeding of the abdominal cavity;
2) the lack of an effective disinfection method.
 In connection with the foregoing, the search and development of new devices for less traumatic, effective and safe puncture of echinococcal liver cysts is relevant.
 The device described in the work of M.A. was taken as a prototype. Aliyev et al. (1997). They performed laparoscopic echinococcectomy in 9 patients. Indications were small cysts with no obvious signs of daughter blisters. In all patients, the cysts were solitary, the size in diameter ranged from 4 to 6 cm. In 7 patients, the cysts were localized in the right lobe of the liver, in 2 - in the left.
 After applying pneumoperitoneum, a trocar was introduced with a laparoscope and, under the control of the latter, three more trocars were installed so that they were positioned topographically correctly with respect to the echinococcal cyst.
 Then, through one of the trocars, depending on the location of the echinococcal cyst, the latter was punctured with the evacuation of parasitic fluid. Through another trocar, suction was applied directly to the puncture zone of the cyst for insurance.
 Subsequently, antiparasitic treatment of the cyst cavity with flowing steam was performed, the chitinous membrane was removed, and the residual cavity was tamped with an omentum strand. A safety drainage was installed in the subhepatic space.
 In 2 cases out of 9, the authors noted a partial outflow of echinococcal fluid into the free abdominal cavity - they thoroughly aspirated the fluid from the abdominal cavity and in the following, to prevent relapse, these patients received 2 courses of Bayer AG firm Biltricid. During follow-up up to 4 months with ultrasound monitoring of the abdominal cavity, data for the presence of recurrent cysts were not detected.
Thus, laparoscopic puncture of echinococcal liver cysts includes:
1) the imposition of pneumoperitoneum, the introduction of the main trocar, survey laparoscopy;
2) the introduction into the abdominal cavity of the first trocar for puncture of a liver cyst;
3) the introduction into the abdominal cavity of the second trocar for puncture of the liver cyst;
4) conducting suction on one of the trocars to the puncture site;
5) holding a puncture needle on the second trocar;
6) puncture of the liver cyst and evacuation of its contents;
7) The introduction into the cystic cavity of flowing steam at a temperature of 100 o C under a pressure of 33 kPa with an exposure of 3-5 minutes, the maximum aspiration of the contents of the cyst.
Salient features of the prototype
1. The first trocar with a diameter of 10 mm.
 2. A stylet with a diameter of 8 mm for the first trocar.
 3. The second trocar with a diameter of 10 mm.
 4. A stylet with a diameter of 8 mm for the second trocar.
 5. A suction tube with a diameter of 5 mm, conducted through the lumen of the first trocar.
 6. A puncture needle with a diameter of 5 mm, conducted through the lumen of the second trocar.
The prototype disadvantages
As you know, the first and most important task in echinococcectomy is to prevent scolex scattering during surgery, which creates the prerequisites for the development of secondary echinococcosis. For this purpose, in a traditional operation, the skin of the wound is carefully surrounded by sheets, and then the towels are hemmed to the parietal sheet of the peritoneum. The puncture site and echinococcectomy are additionally surrounded by gauze napkins so that there is no free space left where scolexes and echinococcal fluid could accidentally get. With laparoscopic surgery, the principle of aparasitism is more relevant than with the traditional intervention, which is associated with the technical features of the laparoscopy technique (working with instruments introduced into the abdominal cavity through the lumen of the trocars). In this regard, design features of puncture devices are of decisive importance in laparoscopic puncture of echinococcal cysts.
 The main disadvantage of the prototype is the lack of reliable protection of the area of the puncture opening of the liver cyst from the free abdominal cavity, which led in 2 cases out of 9 to the flow of echinococcal fluid into the abdominal cavity.
 In addition, for puncture of the liver according to the prototype method, the introduction of 2 trocars into the abdominal cavity is necessary.
Thus, the identified disadvantages of the prototype include the following:
1) the lack of reliable protection of the puncture opening of the echinococcal liver cyst from the free abdominal cavity;
2) the need to introduce an additional trocar for puncture of the liver cyst.
 In this regard, the search for more effective devices for laparoscopic puncture of echinococcal liver cysts is relevant, which allows to prevent scolex scattering during surgery and to perform adequate evacuation of cyst contents with minimal trauma for the patient.
 The objective of the invention is to improve the results of surgical treatment of patients with echinococcosis of the liver by developing effective laparosconic structures.
 The essence of the invention lies in the fact that the device for laparoscopic puncture of echinococcal liver cysts contains a trocar with a diameter of 10 mm and a stylet with a diameter of 8 mm. At the same time, unlike the closest analogue, the trocar has an electric suction and is made in the form of a trocar sucker with a puncture aspiration-irrigation needle with a diameter of 5 mm.
 The invention is illustrated in the drawing, where figure 1 shows a trocar sucker; in FIG. 2 - stylet; figure 3 - puncture needle; figure 4 puncture of the abdominal wall; figure 5 - trocar sucker connected to a vacuum electric suction pump; in FIG. 6 - topographically favorable place for puncture in relation to the liver cyst.
 The device contains a trocar suction cup 1 with a diameter of 10 mm, a stylet 2 with a diameter of 8 mm, a puncture aspiration-irrigation needle 3 and an electric suction pump (not shown in the drawing).
 The suction function of the trocar is ensured by tightly applying the tip of the trocar 1 to the protruding surface of the liver cyst and connecting the vacuum suction pump to the trocar 1 through the collector. Puncture needle 3 with a diameter of 5 mm due to the presence of a two-way tap allows not only to aspirate the contents of the liver cyst, but also to carefully evacuate it, which is very important for the subsequent after the initial puncture antiparasitic treatment of the cavity of the echinococcal cyst.
 Laparoscopic puncture of an echinococcal cyst using the proposed device is as follows. After application of pneumoperitoneum and survey laparoscopy, the abdominal wall is punctured with a trocar sucker 1 with stylet 2 in a place topographically favorable with respect to the liver cyst.
 After removing stylet 2, the puncture needle 3 is inserted into the lumen of the trocar sucker 1, the end of which is tightly applied to the protruding part of the liver cyst. After connecting the trocar 1 to the vacuum pump through the connecting tube, the end of the trocar 1 is tightly attached to the cyst wall, which ensures reliable protection of the abdominal cavity from the contents of the echinococcal cyst. Next, the cyst is punctured with a needle 3, evacuation of its contents, antaparasitic treatment of the cyst cavity with a 25% sodium chloride solution with an exposure of 15 minutes. All manipulations on the evacuation of contents and the introduction of fluids into the cyst cavity are carried out by switching a two-way faucet. This allows you to use the modes of aspiration-irrigation through connecting tubes connected to the apparatus-aquapurator, which is included in the standard video laparoscopic stand.
Laparoscopic puncture of an echinococcal liver cyst using the proposed device is carried out by sequentially performing the following main steps:
1) the imposition of pneumoperitoneum, the introduction of the main trocar, survey laparoscopy;
2) puncture of the abdominal wall with a trocar-sucker with a stylet;
3) removing the stylet, introducing a puncture needle into the lumen of the trocar, installing the suction cup trocar on the surface of the liver cyst;
4) puncture of the cyst, evacuation of its contents;
5) the introduction into the cyst cavity of a hypertonic solution of sodium chloride with exposure for 15 minutes, the evacuation of the solution.
Thus, the essential features of the invention are:
1) trocar sucker with a diameter of 10 mm;
2) stylet for a trocar sucker with a diameter of 8 mm;
3) puncture aspiration-irrigation needle with a diameter of 5 mm;
4) an electric suction pump that creates negative pressure in the trocar suction cup.
 An example of a specific implementation.
 Patient S., 22 years old, medical history 5/939, was admitted to the General Surgery Clinic of Dagmedakademiya 06/29/98 with complaints of aching dull pain in the right hypochondrium, not associated with eating. Ultrasound in the projection of the 6th segment of the liver visualizes a liquid formation with a diameter of 7.5 x 6.7 cm with a dense capsule and homogeneous contents. The reactions of latex agglutination and indirect hemagglutination are positive. The clinical diagnosis is uncomplicated solitary echinococcosis of the liver.
 Under endotracheal anesthesia, an operation was performed - laparoscopic echinococcectomy of the liver. After applying pneumoperitoneum 12 mm RT. Art. laparoscopy was performed: there was no effusion in the abdominal cavity, on the diaphragmatic surface of the liver at the border of 5-6 segments of the liver, closer to the gall bladder a cystic mass with a diameter of about 7 cm, other organs without visible pathology. The abdominal wall was punctured (Fig. 2, a) with a suction trocar (Fig. 2, b) with a stylet (Fig. 2, c) in the direction of the liver cyst (Fig. 2, d). After removing the stylet, the puncture needle (Fig. 2, f) is drawn into the lumen of the trocar sucker (Fig. 2, b), the end of which is tightly attached to the protruding part of the liver cyst. After connecting the trocar to the vacuum pump through the connecting tube (Fig. 2, e), the end of the trocar is tightly attached to the wall of the cyst, which ensures reliable protection of the abdominal cavity from the contents of the echinococcal cyst. Next, puncture of the cyst with a needle was performed (Fig. 2, f), evacuation of its contents, antiparasitic treatment of the cyst cavity with a 25% sodium chloride solution with an exposure of 15 minutes. All manipulations on the evacuation of contents and the introduction of fluids into the cyst cavity were carried out by switching a two-way faucet (Fig. 2, g). This made it possible to use the modes of aspiration - irrigation through connecting tubes (Fig. 2, h, and) connected to the apparatus-aquapurator. A lock of the omentum is brought into the residual cavity of the cyst and is fixed with clips. A drainage tube has been brought to the area of operation. Air is released. Trocars removed, sutures on the wounds. The postoperative course is smooth. The patient got up and began to walk on the day of the operation. The drainage tube was removed on the 3rd day after surgery. On the 5th day after surgery, the patient was discharged. Examined 3 months after surgery: no complaints, satisfactory condition, with ultrasound-fluid formations in the liver and abdominal cavity were not detected.
 The developed device for laparoscopic puncture of echinococcal liver cysts was used in the clinic in the treatment of 18 patients with liver echinococcosis aged 18 to 82 years. Indications for endoscopic treatment of echinococcal cysts were the location of cysts on the lower surface of the liver (segments 3 to 6); diameter of cysts no more than 10 cm; the absence of complications and daughter bubbles in the cavity of the cysts (1st phase of the parasite's life according to OB Milonov).
 There were no complications during cyst puncture and during laparoscopic surgery itself. There were no cases of leakage of the contents of the cyst into the abdominal cavity. Regardless of the method of eliminating the residual cavity (closed echinococcectomy-6, abdominization of the residual cavity-8, omentoplasty of the residual cavity-4), no complications were noted in the postoperative period and it was characterized by early activation of patients. Patients were discharged on the 5-6th day after surgery. With dynamic ultrasound monitoring, within one to two years, areas of residual cavities of no more than 3 x 2 cm were detected. No disease recurrence was observed during the observation.
Literature
1. Khoury G., Geagea T., Hajj AE et aL Laparoscopic treatment of gidarid cysts of the liver. Surg.Endosc. 1994; 8 (9): 1103-4.
 2. GuibertL. , Gaural F. Laparoscopic perycystcctomy hepatic hydatid cyst. Suig.Endosc. 1995; 9 (14): 442-3.
 3. Sever M., Scapin S. Laparoscopic peryeystectomy hydatid cysts of the liver. Suig.Endosc.l995; 9 (10): 1125-6.
 4. Watson D.I., Jamieson G.G. Laparoscopic fenestration gigant posterolateral hepatic cyst. J. Laparoendosc.Swg. 1995; 5 (4): 255-7.
 5. Khoury G., Jabbow-Khouly S., Bikhazi K. Results of laparoscopic treatment of hydatid cysts of the liver. Surg.Endosc. 1996; 10 (1): 57-9.
 6. Bickel A., Daud G., Lefler E. et al. Laparoscopic approach to hydatid liver cysts: is it logic. Surg.Endosc. 1997.
 7. Ertem M., Yavus N. A new instrument to used in laparoscopic surgery for hidatid disease of the liver. Surg.Endosc. 1997.
 8. Ghamidi A. Laparoscopic excision of hidatid cysts of the liver. Surg. Endosc. 1997.
 9. Goremykin I.V., Romanov A.Yu., Phillipov Yu.V. Echinococcectomy of the liver in children using laparoscopic access. Endoscope chir. 1996; 3: 20-21.
 10. Aliev M. A., Seisembaev M.A., Doskaliev M.A. et al. Echinococcectomy using a laparoscopic technique. Endoscope chir. 1997; 1:40. (prototype).

Claims (1)

  1.  A device for laparoscopic puncture of echinococcal liver cysts containing a trocar with a diameter of 10 mm and a stylet with a diameter of 8 mm, characterized in that the trocar has an electric suction and is made in the form of a trocar sucker with a puncture-irrigation needle with a diameter of 5 mm.
RU98120775A 1998-11-23 1998-11-23 Device for making laparoscopic puncture of hepatic echinococcus cysts RU2159088C2 (en)

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
RU2621121C1 (en) * 2016-04-20 2017-05-31 Государственное бюджетное образовательное учреждение высшего профессионального образования "Дагестанская государственная медицинская академия" Министерства здравоохранения РФ Device for transcutaneous centesis execution and intraoperative cito lavage of gall bladder cavity

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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
MD2489G2 (en) * 2003-12-17 2005-01-31 Тудор БАЛАБАН Device for puncture and aspiration of the hydatid cyst content

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
Алиев М.А. и др. Эхинококкэктомия с использованием лапароскопической техники. В: Эндоскопическая хирургия, 1997, N 1, с.40. *

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
RU2621121C1 (en) * 2016-04-20 2017-05-31 Государственное бюджетное образовательное учреждение высшего профессионального образования "Дагестанская государственная медицинская академия" Министерства здравоохранения РФ Device for transcutaneous centesis execution and intraoperative cito lavage of gall bladder cavity

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