RU2173104C2 - Device for drainage and satureless anastomoses of hollow organs - Google Patents

Abstract

FIELD: medicine, in particular, devices and methods for laparoscopic punctures and drainage of hollow organs, as well as for application of anastomoses between them. SUBSTANCE: the device has two coaxial hollow tubes positioned in a spaced relation, the internal tube is made rigid. The tubes have a permanent joint at the working end. The external tube has two systems of longitudinal cuts spaced at 3 to 5 mm. The systems of slots are shifted relative to each other by a spacing equal to half the interval between them. A catch-stopper is fitted on the internal tube, and an external catch - on the external tube. An elastic cap with slots is fitted on the device working end. Besides, the external and internal tubes may have through holes. EFFECT: provided drainage and accomplishment of sutureless anastomoses of hollow organs in the conditions of laparoscopic equipment. 5 dwg, 2 ex

Description

 The invention relates to medicine, namely to devices and methods for laparoscopic punctures and drainage of hollow organs, as well as for applying anastomoses between them.

 A device for drainage of hollow organs is known, comprising two coaxially located flexible hollow tubes with a gap between them, rigidly connected at the working end, the outer tube having a system of longitudinal slots and equipped with a latch for the relative position of the tubes freely located on the non-working end of the inner tube, as well as the outer a latch freely located on the non-working end of the outer tube [1].

 The disadvantages of the device include obstruction of the gaps of this device (the gap between the outer and inner tubes and the lumen of the inner tube) when they receive the contents of drained hollow organs with peristalsis (for example, the stomach or intestines), as well as the inability to connect two hollow organs in the form of a seamless anastomosis, since the internal retainer at the working end of the device has only one clamping pad, through which you can press the wall of the drained hollow organ to the abdominal wall for sealing a puncture hole, but it is impossible to connect the walls of anastomosed organs.

 Closest to the claimed is a device for drainage of hollow organs, containing two coaxially located flexible hollow tubes with a gap between them [2]. The disadvantage of the prototype device is the same as that of the analogue described above, namely, the inability to perform seamless anastomoses of hollow organs.

 Therefore, the task to be solved by the claimed invention is directed, is to achieve the possibility of drainage and the implementation of seamless anastomoses of hollow organs in laparoscopic technology.

 The problem is solved by the implementation of such a device for drainage and seamless anastomoses of hollow organs, containing two hollow tubes coaxially arranged with a gap, in which the inner tube is rigid, the tubes have a one-piece connection at the working end, and an external clamp is located on the outer tube to move it , on the working end wears an elastic cap with slots having a tight connection with the outer tube, in the outer tube in the area of direct contact with m For the permanent connection of the tubes, the first system of longitudinal slots was made and displaced relative to it by 3-5 mm towards the non-working end, the second system of longitudinal slots was identical in distance between them, in size and in number with the slots of the first system and half offset from the slots of the first system by half the distance between the slots in the systems, with the outer and inner tubes having holes.

 In such a combination of essential features, the device provides drainage and seamless anastomosis of hollow organs, while excluding the contents of anastomosed organs from entering the gaps of the device.

This result is ensured in all cases by the following set of distinctive features:
A) the inner tube is made rigid;
B) the tubes have a one-piece connection at the working end;
C) on the outer tube is located with the ability to move on it an external retainer;
D) on the working end is wearing an elastic cap with slots;
D) the elastic cap has a tight connection with the outer tube;
E) the first system of longitudinal slots is made in the outer tube in the area of direct adjacency to the place of permanent connection of the tubes;
G) in the same section of the outer tube, a second system of longitudinal slots is made;
H) the longitudinal slots of the second system are offset by 3-5 mm relative to the slots of the first system towards the non-working end of the device;
I) both systems of longitudinal slots are the same in distance between them, size and quantity;
K) the system of longitudinal slots are offset in step relative to each other by half the distance between the slots in the systems.

 In a particular case, the outer and inner tubes have holes. This ensures the possibility of outflow of the contents of one of the anastomosed hollow organs, which prevents the flow of bile between their walls and increases the reliability of the anastomosis.

 The coaxial arrangement with a gap of hollow tubes having an integral connection at the working end and a system of longitudinal slots on the outer tube allows forming an internal retainer by displacing the inner and outer tubes relative to each other, by means of which the wall of the drained hollow organ is pressed against the abdominal wall to seal the puncture opening and increments of the drained organ to the abdominal wall.

 The latch-plug of the mutual arrangement of the tubes is necessary not only to hold the tubes in the position of the formed internal latch, but also to seal the space between the outer and inner tubes. This space between the tubes can be used both as an additional way of the outflow of the contents of one of the anastomosed hollow organs or the introduction of fluid through this space, and for flow-aspiration washing of the drained hollow organ, which can be performed through both spaces of the device in different directions.

 Put on the outer tube, with the ability to move along it, the external retainer allows you to attach a device for drainage of hollow organs to the skin.

 An elastic cap with slots, worn on the working end of the device, prevents the contents of drained hollow organs with peristalsis (for example, the stomach or intestines) from entering the gaps of the device and, if necessary, allows various fluids to be introduced into the gaps of these drained hollow organs through the inner tube or through clearance between the tubes. In this case, the fluid enters the drained hollow organ through the slots in the cap (for example, with the introduction of bile, as well as various nutrient solutions into the gastrostomy). Thus, the slots in the elastic cap serve as valves for the one-way fluid flow (by type of Bulau drainage).

 The slots in the elastic cap are located so that when the distal (far from the operator) part of the internal retainer is formed, these slots in the elastic cap do not increase in size when the inner fixer is formed (which is accompanied by the outward extrusion of the walls of the outer tube) and the contents of the drained hollow organ are not passed into gaps of the device.

 The elastic cap has a sealed connection to the outer tube. This is done in order to isolate the gaps of the device from the contents of the drained hollow organ.

 The inner tube is rigid to prevent the anastomosis zone from shifting relative to the fixation location of the device for drainage and seamless anastomoses of hollow organs to the abdominal wall and the possible tension of the walls of the anastomosed organs, as well as for the strength of the tube itself with holes made to outflow the contents of one of the anastomosed organs (for example, from the gallbladder with cholecystogastroanastomosis).

 The outer tube has at its non-working end a second system of longitudinal slots located with an interval of 3-5 mm relative to the first system of longitudinal slots. This second system of longitudinal slots is necessary for the subsequent formation of the proximal (closest to the operator) part of the internal retainer and is designed to connect the walls of anastomosed organs, the thickness of which dictates the need for an interval of 3-5 mm between the first and second systems of longitudinal slots.

 The longitudinal slots of the second system are identical in distance between them, in size and in number with the slots of the first system and are offset in step relative to the slots of the first system by half the distance between the slots in the systems. Such a mutual arrangement of the longitudinal slots of the two systems ensures uniform pressure of the walls of the anastomosed hollow organs with the distal and proximal parts of the internal fixator formed.

 The elastic cap has a tight connection with the outer tube to prevent the contents of the second drained hollow organ (for example, the contents of the intestine from gastroejunoanastomosis) from entering the device’s gaps.

 Thus, the distal and proximal parts of the internal retainer formed during operation of the device are covered by an elastic cap as a result of its tight connection with the outer tube in two places. Moreover, in the area of tight connection of the elastic cap with the outer tube, there is an additional pressing of the walls of the anastomosed organs over the entire surface of the place of their connection due to the formation of pressure pads formed by an elastic cap located on top of the branches (protruding walls of the outer tube) of the distal and proximal parts of the internal retainer.

 In the second embodiment, the outer and inner tubes are provided with holes. These additional holes in the outer and inner tubes are necessary for a constant outflow of the contents of one of the hollow organs from the anastomotic zone through the outer tube into the inner tube and further outside the device (for example, for the outflow of bile from the gallbladder with cholecystogastroanastomosis). A constant outflow of bile out after the formation of cholecystogastroanastomosis is necessary to prevent the flow of bile between the walls of anastomosed organs, which can lead to failure of the anastomosis with all the ensuing consequences.

 The inventive device is presented in the drawings (Fig. 1-5).

 In FIG. 1 shows a device according to claim 1 in a starting position in a longitudinal section.

 In FIG. 2 - the device according to claim 2 in the initial position in a longitudinal section.

 In FIG. 3 - the device according to claim 2 in the initial position in cross section.

 In FIG. 4 - the device according to claim 2 in the working position in longitudinal section.

 In FIG. 5 - the device according to claim 2 (type B) in the working position.

 In the General case (Fig. 1), the device consists of a rigid inner tube 1, coaxially located with a gap 2 relative to the outer tube 3, having an integral connection 4 at the working end of the device. In the area of direct adjacency to the junction of 4 tubes 1, 3, there is a first system of longitudinal slots 5, and through a gap 6 of 3-5 mm, a second system of longitudinal slots 7 is made identical in distance between them, in size and in number with slots of the first system and offset in step relative to the slots of the first system by half the distance between the slots in the systems. At the opposite end of the inner tube 1, a latch-plug 8 is mounted with a possibility of movement along it, and an external latch 9 is mounted with a possibility of movement on it of an external tube 3. An elastic cap 10 with slots 11 is put on the working end of the device. The elastic cap has a first tight connection 12 with the outer tube 3, as well as the second tight connection 13 with it.

 The outer tube 3 of the device according to claim 2 (Fig. 2) is provided with holes 14, and the inner tube 1 is provided with holes 15.

 The device operates as follows.

 Example 1

 A trocar consisting of a cholecystostomy, fused with the abdominal wall of the cholecystostomy, is introduced into the hole formed earlier (for example, using a device for drainage of hollow organs according to USSR Autost. N 1533231 dated 12.30.86, M. cl. A 61 B 17/34) from a pointed rod (stylet) placed in a thin-walled tube (sleeve). Under the control of a laparoscope, the gallbladder wall opposite the cholecystostomy is pushed toward the stomach, into which a fibrogastroscope is previously introduced to illuminate the stomach and inflate it with air, as well as to monitor the formation of the distal part of the internal fixative.

 Subsequent puncture of the opposite cholecystostomy of the gallbladder wall and the wall of the stomach at the smallest distance between them. The stylet is removed from the trocar and the inventive device for drainage and seamless anastomoses of hollow organs is inserted through the sleeve into the cavity of the stomach under the control of a fibrogastroscope. The working end of the device is removed from the sleeve of the trocar into the cavity of the gallbladder to the place of the tight connection 12 of the elastic cap with the outer tube 3.

 When the inner tube 1 is pulled towards itself and the outer tube 3 from themselves, they are displaced relative to each other, and the wall of the outer tube 3 protrudes (corrugates) in the region of the first system of longitudinal slots 5. In this way, the distal part 16 of the internal fixer is formed, by means of which the stomach wall 17 tighten to touch the wall of the intestine 18 (Fig. 4).

 The sleeve of the trocar is shifted towards the non-working end of the device to the place of the tight connection 13 of the elastic cap with the outer tube 3. Again, the inner 1 and outer 3 tubes are displaced from each other and the proximal part 19 of the inner retainer is formed. In this case, the elastic cap 10 covers the branches 20 (corrugated walls of the outer tube) of the distal part 16 of the internal retainer and the branches 21 of the proximal part 19 of the internal retainer in the area of the airtight connection 12 and form the pressure pad 22 of the distal part 16 of the internal retainer and the pressure pad 23 of the proximal part 19 of the inner retainer. Thus, the internal fixture 24 of the device is formed by the distal 16 and proximal 19 parts with the corresponding clamping pads 22 and 23. These pads contribute to uniform rapprochement across the entire contact surface of the walls of the anastomosed hollow organs - the stomach 17 and intestines 18.

 The proximal 19 and distal 16 parts of the internal retainer 24 are held in a straightened (working) position by the latch-plug 8 mounted on the inner tube 1, which is moved along the inner tube 1 to the end of the outer tube 3 and partially inserted into the space between these tubes .

 Thus, an anastomosis is formed between two hollow organs - the stomach 17 and the gall bladder 18. Then the sleeve of the trocar is removed. The device is hemmed to the skin by the external clamp 9 moving along the outer tube 3.

 The presence of an elastic cap 10, hermetically connected in place 12 with the outer tube 3 contributes not only to the formation of the distal 22 and proximal 23 pressure pads, but also, which is very important, prevents the contents of peristaltic organs (for example, the stomach and intestines during gastrojejunostomy) from entering the device spaces , which can lead to obturation of these spaces.

 If there is no need for further functioning of the device, it is removed by sequentially straightening the distal and proximal parts of the internal retainer, which is achieved by displacing the external and internal tubes of the device in the direction opposite to bringing the device to its working position after preliminary removal of the retainer-plug 8 from the inner tube 1.

 This example extends to the formation of anastomoses between hollow organs with peristalsis (for example, between the stomach and intestines or between different parts of the intestine) when their contents are not allowed in the device’s lumens. To this end, the distal and inner parts of the inner retainer are closed with an elastic cap, and there are no openings on the outer and inner tubes.

 Example 2

 Everything described above applies to other types of anastomoses between the hollow organs, in particular between the gallbladder and stomach and between the gallbladder and various parts of the small intestine.

 However, if it is necessary to constantly divert the contents of one of these organs (for example, from the gallbladder with cholecystogastroanastomosis), it is advisable to use the device according to claim 2. In this case, the constant outflow of bile from the drained gallbladder to the outside is carried out sequentially through holes 14 of the outer tube 3 and then holes 15 inner tube 1.

 If necessary, simultaneously with anastomosis, the introduction of the contents of one hollow organ into another (for example, bile from the gallbladder with cholecystogastroanastomosis) stops the outflow of bile from the inner tube 1 of the device (pinch it with a clamp). In this case, bile moves through the device spaces towards the internal proximal fixator 16 and is poured into the stomach cavity through the holes 11 in the elastic cap 10. Since under these conditions, the passage of fluid is possible in only one direction (by the type of Bulau drainage), then the stomach contents are not thrown into the device spaces.

 The inventive device allows for drainage and seamless anastomoses of hollow organs using laparoscopic techniques. Compared with anastomoses produced through a traditional abdominal wall incision (laparotomy) using various suture materials to form anastomoses, drainage and seamless anastomosis of hollow organs is performed using the inventive device through 2 to 3 punctures in the abdominal wall, performed under local anesthesia for a short time (15-20 minutes), is well tolerated even by seriously ill patients, since it is not accompanied by complications associated with blood loss, anesthesia, tissue trauma, and also allows you to completely eliminate the use of suture material for the formation of anastomoses. As a result of this, the postoperative period proceeds more favorably: due to the minimal traumatic effect of minimally invasive laparoscopic operations on the patient’s body for drainage and seamless anastomosis of hollow organs, the pain syndrome is less pronounced, complications associated with inflammation in the anastomosis zone due to the absence of suture material are significantly reduced ( which is a foreign body for body tissues), as well as with an adhesive process in the abdominal cavity, which helps to reduce postoperative s complications, shortens the hospital stay.

 The design of the device provides the simplicity of its manufacture, does not require scarce materials, can be easily mastered at the enterprises of the medical industry. Performing drainage and seamless anastomoses using the inventive device is possible in any surgical hospital equipped with appropriate equipment for laparoscopic operations.

 Sources of information taken into account when compiling the description.

 1. USSR author's certificate N 1533231 from 12.30.86, M. cl. A 61 B 17/34 is an analogue.

 2. Copyright certificate of the USSR N 1560134, M. cl. A 61 B 17/11, 1990 is a prototype.

Claims (2)

 1. A device for drainage and seamless anastomoses of hollow organs, containing two hollow tubes coaxially located with a gap, characterized in that the inner tube is rigid, the tubes have a one-piece connection at the working end, and the device is equipped with a latch-plug for the relative position of the tubes inserted with the ability to move on the non-working end of the inner tube, on the outer tube is located with the ability to move on it an external retainer, an elastic cap is put on the working end of the device a slotted hole having a tight connection with the outer tube, in the outer tube in the area of direct adjacency to the place of permanent connection of the tubes, the first system of longitudinal slots is made and the second system of longitudinal slots, offset from it by 3-5 mm towards the inactive end, is identical in distance between them, size and quantity with slots of the first system and offset in step relative to the slots of the first system by half the distance between the slots in the systems.  2. The device according to claim 1, characterized in that the outer and inner tubes have openings.

Images