RU2185113C1 - Device for performing echinococcectomy - Google Patents

Abstract

FIELD: medical engineering. SUBSTANCE: device has trocar having side tube shaped as truncated cone with sharpened end and screw thread over the conic surface. Worm having tubular casing with side tube connected to suction unit is placed inside of the trocar. Two openings for tightening cyst with its contents are arranged on the distal end of the casing. The openings have sharp edges. The worm is connected to electric motor. EFFECT: enhanced effectiveness of treatment; reduced risk for cyst contents to get into the abdominal cavity. 3 cl, 3 dwg

Description

 The present invention relates to medicine, namely to surgical trocars. These tools are used in laparoscopic surgery or research methods, and in particular for the surgical treatment of parasitic, in this case, echinococcal, liver cysts.

 The only method for treating echinococcal liver cysts is the surgical method. The success of the surgical intervention depends on the observance of the conditions of parasitism, which are provided by delimiting the surgical field from the contents of the cyst, the full treatment with germicidal solutions and the complete removal of the germinal elements.

 A device is known - cystotome - for drainage of echinococcal liver cysts [Milonov O.B., Babur A.A. Echinococcosis of the liver. Tashkent, 1982, 107c.], Including a circular vacuum chamber for fixing the device on the surface of the fibrous cyst capsule and a steel perfusion tube with a diameter of up to 20 mm with sharp edges, inserted into the cyst cavity, through which its contents are evacuated by vacuum suction. In this case, small and medium daughter bubbles are completely absorbed into the tube, and larger ones are previously destroyed on the sharp edge of the tube. Together with the contents of the cyst, its shells are removed.

 A disadvantage of the known device is the difficulty of placing the camera in the surgical wound and the inability to use it with cysts of the diaphragmatic surface of the liver and complicated echinococcal cysts.

A device for echinococcectomy is also known, including a trocar with a direct distal section, equipped at the distal end with a transparent silicone casing protruding 10 mm beyond the section, and a vacuum suction; inside the trocar there is an endoscopic needle with a cutoff angle of the working part of 45 ^o and external centimeter marking to control the depth of penetration of the needle into the cyst cavity [Goremykin I.V. Video laparoscopy in the treatment of liver echinococcosis. Abstract. dis .... dr. honey. sciences. - Saratov, 1999. - 42p.]. When an endoscopic needle is inserted into the cavity of the trocar, negative pressure is created in it, which ensures a dense attraction of the slice to the surface of the fibrous capsule. The transparent casing allows you to remove echinococcal fluid from the lumen, which entered the trocar by leaking in addition to the needle. Extraction of the contents of the cyst, including the chitin membrane, is carried out through an endoscopic needle using a vacuum suction.

 However, after a puncture of the cyst, the contents of the cyst are likely to enter the abdominal cavity during manipulations or respiratory movements of the patient. In addition, this device cannot be used for complicated and dead cysts due to the fact that the needle is clogged with solid elements of the cyst.

 The closest set of essential features to the claimed device is a device for echinococcectomy, comprising a trocar with a side pipe connected to a suction, and a screw located inside the trocar connected to an electric motor [Alper A., Emre A., Hazar H. et. al. Laparoscopic surgery of hepatic hydatid disease: initial results and early follow-up of 16 patients // World-J-Surg. - 1995. - Vol.19, N5. - P.725-728.]. The working part of the device is a spear-shaped sharpened screw driven by an electric motor, perforates the cyst wall, then, as it moves into the cyst cavity, it is recessed into the trocar tube to prevent damage to the liver tissue. The contents of the cyst are crushed when sucked into the end opening of the trocar.

 However, at the time of perforation of the cyst wall, there is a high probability of cyst fluid entering the abdominal cavity. The low efficiency of crushing the shells by suction and grinding inside the trocar makes it impossible to remove cysts with massive chitinous shells and denser contents of dead cysts.

 The technical problem to be solved by the claimed invention is directed, is to reduce the likelihood of the contents of the cyst getting into the abdominal cavity and, therefore, to prevent contamination of the abdominal cavity with germinal elements of echinococcus, as well as the possibility of endovascular surgery for dead and complicated echinococcal cysts.

 The stated technical problem is solved in that in the device for echinococcectomy, which includes a trocar with a lateral nozzle and a screw located inside the trocar, connected to an electric motor, the distal part of the trocar is made in the form of a truncated cone with a sharpened end face and a screw thread, for fixing in tissues, and the thread is applied on the conical surface, and the screw is equipped with an outer tubular case with a side pipe connected to the suction, while the tubular case has two holes for tightening the contents of the cyst, which Some are located in the distal part of the case and are made with sharpened edges.

 The holes are made parallel and are located on both sides of the distal part of the case. The auger is made of a strip of steel with a rectangular cross section.

 The inventive device is presented in figures 1-3. In Fig.1 presents a General view of the device, in Fig.2 - a trocar, and in Fig.3 - auger and its cover.

 Trocar 1 (see FIGS. 1 and 2) has a nozzle 2, which can be connected with both a suction to extract the contents of the cyst and an irrigator to fill the cavity with germicidal solutions (not shown). The distal part 3 of the trocar 1 is made in the form of a truncated cone; thread 4 is applied to it, end 5 is sharpened sharply. Inside the trocar 1, a screw 6 is placed, made of a sheet of steel with a rectangular cross section (Figs. 1 and 3); the distal end of the screw is not pointed. The screw 6 is connected to an electric motor 7, which drives it. The screw 6 is covered by a tubular case 8 having a side pipe 9 connected to a suction (not shown). In the distal part of the case 9, two parallel holes 10 are made with sharpened edges 11. The holes are placed symmetrically on both sides of the distal part of the case 8.

 The device operates as follows.

 Light rotational movements around the case 8 trocar 1 sharpened end 5 cuts a hole in the cyst wall and 2-3 threads of thread 4, is fixed in the tissues. All actions are carried out with aspiration (suction). After aspiration of a part of the fluid through the pipe 9, the screw 6, covered by a case 8, moves into the cavity of the cyst. The electric motor 7 is turned on, and when the screw is rotated inside the case, the contents of the cyst are pulled through the side holes 10 into the case 8. The contents of the cyst are crushed (crushed) on the cutting edges 11 of the side holes. At the same time, through the pipe 2, an 80% glycerol solution is fed into the cyst cavity for simultaneous antiparasitic treatment. After removal of the cyst, a residual cavity is formed, prepared for further processing.

 The helical conical distal end of the trocar firmly holds the instrument in the wall of the cyst and does not allow the trocar to spontaneously exit from its cavity during the manipulation of the surgeon and the patient’s breathing. The probability of contamination of the abdominal cavity during surgery is reduced. The sharp end of the trocar eliminates the increase in pressure inside the cyst during wall perforation and thereby eliminates the likelihood of rupture of the cyst during surgery. Side cutting holes of the case in combination with the screw provide a large area of the working surface of the tool, which allows you to effectively remove any number of dense masses.

Claims (3)

 1. Device for echinococcectomy, comprising a trocar with a lateral nozzle and a screw located inside the trocar connected to an electric motor, characterized in that the distal part of the trocar is made in the form of a truncated cone with a sharpened end and a screw thread for fixation in tissues, the thread being applied to a conical surface and the screw is equipped with an outer tubular case with a side pipe connected to the suction, while the tubular case has two holes for tightening the contents of the cyst, which are located in the distal parts of the case and made with sharpened edges.  2. The device according to p. 1, characterized in that the screw is made of a strip of steel of rectangular cross section.  3. The device according to claim 1, characterized in that the holes for tightening the contents of the cyst are parallel and are located symmetrically on both sides of the distal part of the case.

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