RU216429U1 - SURGICAL INSTRUMENT FOR DIVING SURFACE WOUND EDGES AND BLOOD VESSEL RETRACTION - Google Patents

Abstract

The double-sided plate hook belongs to medical equipment and is intended for spreading the edges of a superficial wound and diverting blood vessels during surgical operations. The tool consists of a handle two palm widths long with a 45° bend in the middle and two end blades that are bent in one direction at a right angle. The optimized shape of the hook handle maximizes the operating access, completely frees the operating field for surgical manipulations, reduces the fatigue of the holding hand, and also contributes to more accurate and volumetric movements of the instrument. 11 ill.

Description

A surgical instrument for spreading the edges of a superficial wound and diverting blood vessels has the form of a double-sided plate hook and belongs to medical technology.

Among the requirements for hooks, the main ones are (1):

- compliance with ergonomics, the tool should not tire the doctor's hand during a long operation;

- the shape of the handles of the hooks should not force the surgeon's assistant to take an uncomfortable forced position during the operation;

- hooks should occupy the minimum area of the wound, without obstructing the view of its bottom and the performance of actions by other instruments.

Double-sided lamellar hook according to Farabeuf (1) is widely used in surgery. The tool has a straight handle and two rectangular working parts (blades) bent in one direction at a right angle. The end of the shoulder blades is rounded and bent in the opposite direction (toward the handle), which prevents the edge of the wound from slipping.

The shoulder blades have different heights, the one that is more corresponding to the depth of the wound is selected as the working one, while the non-working shoulder blade plays the role of a stop for the holding hand.

A straight handle with one-sided bending of the shoulder blades determines the working position of the hook (according to Farabeuf) - the inclination to the surface of the surgical field at an angle of 30° (Fig. 7). As a result, the instrument not only expands the edges of the wound, but also lengthens the wound channel (Fig. 10a), which, together with the constant inclination of the working blade to the edge of the wound at the same angle, reduces the surgical access (the angle formed by the lines that connect the incision points with the most deep point).

The length of the lamellar hook handle (according to Farabeuf) is usually 120-150 mm, while the hand of the holding hand with an average palm width of 100 mm occupies almost the entire surgical field (the area of the skin or mucous membrane through which the surgical access is made and the surgical wound is formed), interfering with the surgical manipulations (Fig. 8).

A hook (according to Farabeuf) with a handle 120 mm long rises above the surface of the surgical field to a height of up to 6 cm, and an inclined working blade 20 mm high protrudes 10 mm into the wound lumen (Fig. 7).

The hook (according to Farabeus) with higher blades has a handle extended to 215 mm. This makes it possible to reduce the inclination of the hook to the surface of the surgical field and of the working blade to the wound edge by up to 20°. However, the holding hand moves far away from the surgical field, making it difficult to manipulate the instrument, and the working blade, for example, 40 mm high, protrudes 15 mm into the wound lumen.

The straight handle of the hook (according to Farabeuf) forces the holding hand (depending on the grip - palm up or down) to constantly be in the position of maximum supination (Fig. 7) or maximum pronation of the forearm with a constant maximum tension of the corresponding muscles, which significantly accelerates the onset of fatigue. The problem with ergonomics is reflected in the recommendations for working with the tool (1): "To prevent fatigue of the hand, the hook must be held with the entire hand." Moreover, special attention is drawn to the fact that “the hooks ... are fixed in the hand in the supination position. Transferring the hand to the position of pronation contributes, as practice shows, to its rapid fatigue.

Thus, the double-sided lamellar hook (according to Farabeuf), despite its popularity, does not meet the basic requirements for ergonomics and maximum operational access for such tools.

The constant inclination of the working scapula to the edge of the wound and the position of the holding hand in the position of maximum supination (pronation) interferes with the passage of the hook (according to Farabeuf) along the wound channel (Fig. 9a) and limits its mobility with an additional inclination both to one side and the other.

Although lamellar hooks (according to Farabeuf) are used in surgery as a universal tool for layer-by-layer expansion of superficial wounds, they often turn out to be ineffective for this. For example, unidirectional linear wounds of the skin, subcutaneous fat and aponeurosis of the external oblique muscle of the abdomen during appendectomy (access according to Volkovich-Dyakonov) have to be moved apart with the same pair of lamellar hooks (according to Farabeuf). At the same time, for the complete expansion of the wound of the skin and subcutaneous fat, the hooks are clearly narrow, and for pushing the edges of the wound of the aponeurosis of the external oblique muscle of the abdomen, on the contrary, they are too wide. The edges of the wound of the skin and subcutaneous tissue can and should be moved apart much wider than the edges of the wound of the aponeurosis, but the simultaneous spreading of the edges of these wounds with only hooks forces us to limit the operational access to a small width of the aponeurotic wound. At the same time, the rounded edge of the lamellar hook does not reliably cling to the edge of the aponeurosis, easily slipping off it.

Dissection of the internal oblique and transverse muscles of the anterior abdominal wall during appendectomy (Volkovich-Dyakonov access) is performed by each surgeon in his own way using a variety of instruments (sometimes even fingers), which are completely unsuitable for this. As a result, muscle passage can be time consuming and traumatic. The dissection of the muscles is completed by not always accurate passing through the narrow gap created between the muscle fibers of the inclined blades of the hooks (according to Farabeuf), which is inconvenient and fraught with the creation of a new wound channel.

A small wound in the transverse fascia, preperitoneal tissue and parietal peritoneum (Volkovich-Dyakonov access) is also stretched with lamellar hooks (Farabeuf). However, it is difficult to insert rectangular blades of relatively wide hooks into a small aperture.

At the same time, it is impossible to push the edges of the laparotomic wound and remove the abdominal organs with lamellar hooks (according to Farabeuf). Therefore, an additional hook of the “surgical mirror” type, also with a very uncomfortable straight handle, has to be inserted into the wound.

The purpose of the proposed technical solution is to give the handle of the plate-shaped double-sided hook of the optimal shape, which allows to maximize the operational access and free the surgical field, reduce the fatigue of the holding hand, increase the volume and accuracy of manipulations, and expand the capabilities of the instrument.

The essence of the technical solution was expressed in the totality of new essential features sufficient to achieve technical results corresponding to the goal: the handle of the double-sided plate hook is bent in the middle at an angle of 45°; the bend divides the handle into two equal parts, each of which has a length equal to the average width of the palm, i.e. 100 mm.

The 45° bend of the handle prevents tilting of the blade and lifting of the non-retained part of the handle above the skin (mucous) surface, as well as extreme supination of the holding hand (Fig. 8), placing the forearm in an ergonomically advantageous middle position between supination and pronation when the rotator muscles relaxed.

The length of the held part of the handle, equal to the width of the palm, allows you to place the hand between the non-working (stubborn) shoulder blade and the non-held part of the handle, while the holding hand is sufficiently distant from the surgical wound, which completely frees the operating field for surgical manipulations (Fig. 8).

The vertically positioned working blade does not occupy the wound lumen and does not lengthen the wound channel, maximizing the operational access (Figs. 8 and 10b).

With an increase in the height of the blades of the hook, the handle of the optimized shape does not require lengthening.

The vertical position of the working blade contributes to the accurate holding of the hook along the wound channel (Fig. 9b), and the middle position of the holding hand between supination and pronation makes it possible to additionally tilt the instrument in one direction or another.

Thus, a hook with an optimized handle shape fully meets the basic requirements for such a tool.

The precision and increased amount of movement of the hook with an optimized handle shape greatly expands the possibilities of the tool. It is enough to change the width and shape of the blades, and the effectiveness of the hooks specialized in this way (Fig. 3, Fig. 4, Fig. 5, Fig. 6) increases, for example, at the stages of appendectomy (Volkovich-Dyakonov access).

In FIG. 1 shows a double-sided lamellar hook with a handle having a 45° bend in the middle.

Figure 2 shows double-sided lamellar hooks with an optimized handle shape and conventional rectangular blades.

In FIG. 3 shows a variant of double-sided plate hooks with an optimized handle shape and wide blades, equipped with additional single-toothed hooks, for diluting the edges of the surgical wound of the skin with subcutaneous tissue and for simultaneously expanding the wound of the aponeurosis of the external oblique muscle of the abdomen (with appendectomy using the Volkovich-Dyakonov access).

In FIG. 4 shows a variant of double-sided lamellar hooks with an optimized handle shape and a rounded bend of the trapezoidal blades with a sharpened end without a reverse bend for dissection of the internal oblique and transverse muscles (with appendectomy using the Volkovich-Dyakonov approach).

In FIG. Figure 5 shows a variant of double-sided plate hooks with an optimized handle shape and narrow trapezoidal blades, convenient for expanding small wounds, for example, in the peritoneum (with appendectomy using the Volkovich-Dyakonov access).

In FIG. Figure 6 shows a variant of double-sided plate hooks with an optimized handle shape and wide, high and straight trapezoidal blades (such as a surgical "mirror") for expanding the laparotomic wound and simultaneously retracting the abdominal organs.

In FIG. 7 shows the working position of the holding hand and the double-sided lamellar hook with a straight handle (Farabeuf).

In FIG. 8 shows the working position of the holding hand and the double-sided lamellar hook with an optimized handle.

In FIG. 9a shows the introduction into the wound of a lamellar hook with a straight handle (according to Farabeuf); the inclination of the working blade does not correspond to the course of the wound channel.

In FIG. 9b shows the introduction of a lamellar hook with an optimized handle shape into the wound; the inclination of the working blade corresponds to the course of the wound channel.

In FIG. 10a shows the expansion of the wound with lamellar hooks with a straight handle (according to Farabeuf); the edges of the wound rise, and the wound channel lengthens.

In FIG. 10b shows the expansion of the wound with plate hooks with an optimized handle shape; the unretained part of the handle is tightly pressed against the surface of the skin (mucosa), and the working blade is located vertically, so the wound channel does not lengthen.

In FIG. 11a, 11b show manipulations of plate hooks with an optimized handle shape according to FIG. 4 for dissection of the internal oblique and transverse muscles of the anterior abdominal wall (with appendectomy using the Volkovich-Dyakonov access).

The surgical instrument (Fig. 1) consists of a handle 1 with a bend 2 in the middle at an angle of 45° and two end blades 3, which are bent in one direction at a right angle to the handle.

Hooks are used, as a rule, in pairs, and they work as follows. The capture of each hook is carried out with the fingers of the entire hand within half of the handle 1 to the bend 2 with the non-working blade 3 resting against the second metacarpal bone and the muscles of the first intermetacarpal space.

Working blades of 3 opposite hooks are matched and inserted into the wound channel along the edges of the wound.

After maximum immersion in the wound channel of the working blades 3 of both hooks, the edges of the wound are bred in opposite directions.

The utility model and its variants are implemented in the form of real instruments (Fig. 2, Fig. 3, Fig. 4, Fig. 5, Fig. 6), which have been successfully used for their intended purpose during surgical operations in a military hospital for 25 years.

Literature

1. Semenov G.M. Modern surgical instruments. Practical guide, 2nd edition. 2013. Chapter 13 "Tools for breeding the edges of the wound." pp. 255-258.

Claims (1)

Surgical instrument for spreading the edges of a superficial wound and diverting blood vessels in the form of a double-sided plate hook, consisting of a handle and two end blades bent in one direction at a right angle, characterized in that the handle has a 45° bend in the middle with a vertex oriented towards the bend of the annular blades, and the bend divides the handle into two parts, each of which has a length equal to the average width of the palm, corresponding to 100 mm.

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