RU2179829C1 - Laparolift wound dilator - Google Patents

Abstract

FIELD: medical engineering. SUBSTANCE: device has hook and lift mechanisms. The lift mechanisms have pivoted fixing member, horizontal cantilever, screw and nut and upright for fixing it to operation table. Flexion-tension and rotation movements are excluded between lift mechanism members both in the hook-to-nut connection area and in the screw-to-upright connection area. Supporting plane of the hook is 30 deg deflected in horizontal plane. This deflection enables one to bring lift mechanisms aside from operation action field. The screw is laterally truncated to prevent rotation. Groove-like arrest member is available in the hook-to-nut connection area. EFFECT: enhanced effectiveness in elevating abdominal wall and making access for performing laparoscopic intervention without gas. 2 cl, 4 dwg

Description

 The invention relates to medicine, in particular to surgery, is intended to lift the abdominal wall and provide optimal access during surgical interventions using video laparoscopic techniques and avoids the negative effects of pneumoperitoneum.

 Known abdominal wall lift - "Endolift for gas-free laparoscopy with minilarotomy." This apparatus contains a retractor M.Z.Sigal and K.V. Kabanov as a lifting device. The endolift is equipped with hooks with a width of 0.4-0.5 of the length produced for their insertion by minilaparotomy, and the length and bend of the working plane of the hooks are made depending on the desired configuration of the space and the place of insertion into the abdominal cavity. The design allows you to create the optimal surgical field for performing various types of laparoscopic interventions in the abdominal cavity without forcing air into the abdominal cavity. At the same time, it becomes possible to use the minilaparotomic access made for introducing hooks, both for manipulations, including instruments for traditional surgery, and for evacuation of a block of organs to be removed or stoma formation, while preserving all the advantages of minimally invasive access. The section of the abdominal wall allows you to complement the visual examination with a finger examination of the abdominal cavity [1].

 The disadvantage of this design is that installed in a high position to ensure traction up the endolift racks, in some cases, impede the movement of the instruments, complicating the work of surgeons.

 It is known "Device for diluting and fixing the edges of the wound during abdominal operations", containing a hook and hoist mechanisms with a rotary-locking device, a horizontal console with a screw with a nut and a stand, attached to the operating table, and bending, extensor and rotational movements are excluded between the elements of the elevator as in the area of connection of the hook with the nut, and in the place of connection of the screw and stand [2].

 A device for diluting and fixing the edges of the wound during single operations is selected as a prototype of the claimed invention.

 Laparolift-retractor allows you to create a similar access for gasless laparoscopy. In this case, the lifting mechanisms of the endolift are maximally removed from the area of the surgeon and assistants and do not interfere with the manipulation of the operating team.

Device description
Laparolift-retractor consists of a hook, a rotary-locking device, a horizontal console, a screw with a nut and a stand attached to the operating table (figure 1). A feature of the connections between the elements of the lift is the absence of flexion-extension movements both in the area of the hook to the nut and in the place where the screw connects to the horizontal console (stand). Due to this, by lifting the rack relative to the operating table, the abdominal wall is elevated and surgical access is created to perform laparoscopic surgery. In contrast to the prototype, the supporting plane of the hooks has a multidirectional displacement in the horizontal plane of 30 ^o , which allows you to take the lift mechanisms away from the operational action (figure 2).

 To prevent the hook from turning along the axis of the screw connection with the horizontal console (stand) and hook, the screws are made non-rotating. For this, the screw has a truncation on the sides (figure 3), and at the junction of the hook and screw there is a limiter in the form of a groove with a rectangular cross-section (figure 4).

Description of the device
Under endotracheal anesthesia, minilaparotomy is performed in the area of the intended surgical action with a length of 3-6 cm (depending on the volume of organs removed). Two or three hooks of the laparolift of the retractor are introduced into the incision. The apparatus racks are attached to the operating table in such a way as to provide traction up and to the sides (two hooks) and up and to the legs or head of the patient. horizontal plane aims to move away the lifting mechanisms of the laparolift-conservator from the operational area.

 This goal is achieved by installing the lift racks either closer to the head or to the patient’s legs, depending on the type of intervention performed. Despite this, due to the turn around the plane, the abdominal wall is uniformly raised and the access parameters do not deteriorate.

 The length of the hooks used depends on the place of their introduction into the abdominal cavity. For example, during operations on the rectum, when colostomy is supposed to be formed in the future, endolift hooks are inserted through an incision in the left ileal region. The working plane of the hook, which pulls the abdominal wall to the left and up, has a length of 3.5 cm, the opposite - 8 cm.

 In operations on the stomach, if good access to the proximal parts of the organ is necessary, it is more convenient to perform minilaparotomy along the left midclavicular line, just below the costal arch. In this case, the hook working towards the patient’s head will raise the patient’s costal arch. Its length is 3.5 cm. The left hook is the same length, and the right one is 8 cm. When using a laparolift, it is possible to use the minilaparotomy performed for inserting hooks both for manipulations, including instruments for traditional surgery, and for removing the drug or forming a stoma . The section of the abdominal wall allows you to complement the visual examination with a finger examination of the abdominal cavity.

 The absence of elevator elements towering above the surgical field allows surgeons to freely manipulate in the abdominal cavity.

 Example 1

 Patient I., b. 1939 Operated on 11.10.00 for pancreatic cancer complicated by obstructive jaundice.

 The operation began with excision of a cholecystostomy previously placed in the region of the right hypochondrium. As a result of excision, a laparotomic wound is formed in the right hypochondrium, suitable for introducing laparolift hooks. In this way, access was created to perform laparoscopic surgery. Introduced trocars for a laparoscope and manipulators. A bowel loop was selected for anastomosis. Intracorporeal method imposed inter-intestinal anastomosis according to Brown. Thus isolated intestine is brought to the gallbladder. Anastomosis between the gallbladder and the intestine is imposed in an open way through a minilaparotomy incision in the right hypochondrium.

 Example 2

 Patient G., 10.10.00 for rectal cancer, a laparoscopy was performed with the introduction of a laparolift-dilator through an incision in the left iliac region. Using video laparoscopy, the rectum was mobilized. Extirpation of the rectum was performed with the removal of the drug through perineal access. Through a cut in the left iliac region, a sigmostoma is removed.

 Example 3

 Patient X., b. 1928 11.11.00, for cancer of the ascending colon, laparoscopy was performed. Manipulators introduced. Mobilization of the colon started in conditions of pneumoperitoneum. 2 hours after the start of the operation, a transverse minilaparotomy was performed in the right mesogastric region. Installed laparolift. The right half of the colon and the distal ileum are finally mobilized. The removed drug is removed in the wound, cut off. An open way superimposed inter-intestinal small-intestinal anastomosis.

Sources of information
1. Pat. Russia 2135103. Endolift for gasless laparoscopy with minilaparotomy. Sungatullin A.G. and etc.

 2. JP 63-37667 A, 07.26.1988.

Claims (2)

 1. Laparolift-retractor containing a hook and hoist mechanisms with a rotary-locking device, a horizontal console, a screw with a nut and a stand attached to the operating table, and bending, extensor and rotational movements are excluded between the elevator elements, as in the area of the hook and nut connection, and at the junction of the screw and the stand, characterized in that the supporting plane of the hook is made with a shift in the horizontal plane of 30 degrees. , allowing the elevator mechanism to be moved away from the operational action, while to prevent the hook from turning along the axis of the screw to the horizontal console connection, the screw has truncation on the sides, and together with the hook and screw connections there is a limiter in the form of a groove.  2. Laparolift-conservator according to claim 1, characterized in that the limiter is made in the form of a groove with a rectangular cross section.

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