RU2198607C2 - Constrictor-fixative - Google Patents

Abstract

FIELD: medicine, in particular, andrology, applicable for treatment of male sterility as a result of obturation of spermiducts. SUBSTANCE: the constrictor-fixative consists of a forceps-handle that terminates in two branches and has a fixing screw. Depending on the dimensions of the duct and the method for formation of vaso-vasoanastomosis the branches-extension piece may be replaced. The upper branch-extension piece has a plane surface of the branchextension piece with a cross cut-out "aperture" in the center for visual monitoring comparison of the lumen and sutured layers of the wall of the spermiduct and sutured layers of the sperm wall of the efferent duct. The lower branch- extension piece has a plane surface with a cross semicircular recess in the center for placement of anastomosed ends of the duct in it. EFFECT: enhanced reliability of corrected stabilization of testicular and prostatic sections of the spermiduct, technical simplicity and accessibility, hemostasis of hemomicrocirculation channel of the spermiduct, precision of comparison of the lumen, leak-proofness of anastomosa with restoration of tie excretoric function of the duct, reduced technical complexity and time of operation; enhanced efficiency operation by 89%. 2 dwg, 1 ex

Description

 The invention relates to medicine, namely to andrology, and is intended for the treatment of male infertility as a result of obstruction of the vas deferens.

 Known methods for stabilizing the anastomosed ends of the vas deferens during the formation of vasovasoanastomosis / end to end / using microsurgical forceps, stabilizing clamps / D.P. Reignac, N.Kh. Loersen "Principles of microsurgery in the treatment of infertility", 1986 p.235 /, ligature holders / D. P. Chukhrienko, A.V. Lyulko "," Atlas of operations on the organs of the genitourinary system ", 1972, p. 366 /, intraductal catheter-splint / B.V. Petrovsky, BC Krylov" Microsurgery ", 1976 p. 163 / do not satisfy practical surgeons, since they do not provide reliable straightened fixation of the matching duct ends, which technically creates inconvenience, increases the time and trauma of the operation.As a prototype, we selected a modified clamp Bonney / Amelar RD, Dubin L, Walsh PC, Male hifectility Philadelphia, WB Saunders, 1977 /, consisting of tweezers -handles ending in two opposed and branches (Fig. 1). The upper branch has a flat "tabular" surface, which, when the instrument is closed, enters the lumen of the U-shaped lower branch, thereby fixing the vas deferens.

 The practical application of this instrument reveals a number of its shortcomings: for stabilization of the proximal and distal sections of the duct, two clamps of the Bonneu are necessary; there is no reliable fixation of the “slippery” surface of the duct walls, which leads to torsion, displacement and slipping of the duct between the jaws; it is more difficult to produce a precision injection and puncture with an atraumatic needle in the wall of an unstable fixed duct, which reduces the tightness of the anastomosis and prolongs the operation time.

 The aim of the invention is to develop a tool that reliably and atraumatically stabilizes the testicular and prostatic segments of the vas deferens, when applying a vasovasoanastomosis.

TOOL DESCRIPTION
Our proposed semi-rigid pulp clamp of the vas deferens (Fig. 2) consists of two branches-nozzles (the upper with a transverse notch “window” in the center and the lower with a transverse semicircular notch in the center) and an elastic tweezers handle that ensures their interaction by rotation of the fixing a screw located in the center of the tweezers. The upper jaw-nozzle has a flat surface with a transverse notch “window” in the center, through which sutures are laid on the walls of the duct. The lower branch-nozzle in the center has a flat surface with a transverse semicircular recess in the center, corresponding to the profile and size of the vas deferens.

 Given the age-related and individual anatomical fluctuations in the size of the vas deferens (on average in an adult male, the diameter of the duct is 3 mm, the lumen is up to 1 mm), a set of removable jaws with the required dimensions of the working surface of the lower jaw and the width of the “window” of the upper jaw can be made on the tweezers .

 EXAMPLE of the practical use of the instrument: (experimentally) a dog, a male, age 3 g, weight 25 kg. Left oblique incision in the inguinal region made access to the spermatic cord. In a longitudinal section of 1-1.5 cm, the casing of the cord was opened and the vas deferens was isolated. In order to simulate obturation, the duct was bandaged with silk ligature, the wound was sutured in layers. After 3 weeks, the spermatic cord was opened with the same access and an obstructed duct section was isolated. Under a 10-fold increase in an operating microscope, an economical transverse excision of the obstructed duct section was performed.

 The proximal and distal sections of the duct were taken on catgut holders, a temporary endoprosthesis / tantalum wire / with a puncture on the wall of the testicular end of the duct was inserted into the lumen of the duct.

 Taking the anastomosed ends of the duct by the holders, we congruently place them in a transverse semicircular recess on the lower jaw of the instrument, turn the fixing screw clockwise and bring the jaws above the duct to its full stabilization.

 Having fixed the duct, we begin to impose precision sutures through a special “window” on the upper jaw, using an atraumatic needle with a thread 6/0 prolene, with the capture of the adventitio-muscular layer of the duct walls. Having laid 2-3 seams on the front wall of the duct, we move the instrument to the lateral and then the posterior surface of the duct wall, where anastomosed ends are fixed and stitched in the same way.

 Having formed a vasovasoanastomosis, we dilute the branches and remove the duct from the instrument, stitch the layers of the spermatic cord and soft tissues in layers. Temporary endoprosthesis is removed on the 8-9th day.

 With the help of a pulp-fixer, 35 vasovasoanastomoses were applied on 25 sexually mature male dogs. According to the results of vasography on the 30th day, 29 anastomoses are passable. The tool is fed to the rat. proposal and received a positive decision: certificate for the rat. proposal 98955 of 05.20.98, the patent department state honey. academy.

SUMMARY OF THE INVENTION DIFFERENT FROM THE PROTOTYPE:
1. The tweezers of the Vnnеu clamp are merged with jaws, the pulp clamp has removable jaws-nozzles.

 2. The jaws in the Bonney clamp are brought together by pressing the first / big / and second / index / fingers on the middle third of the tweezers, and the jaws are pulled together and fixed in the puller-clamp by rotating the locking screw located in the center of the tweezers.

 3. The upper jaw - the nozzle of the pulp - retainer has a flat surface with a transverse notch "window" in the center. The upper jaw of the Vanneu clamp has a flat, “padded” surface.

 4. The lower branch - the nozzle of the pulp - retainer has a flat surface with a transverse semicircular recess in the center. The lower jaw of the Vonneu clamp is U-shaped.

 A positive effect of using the proposed tool is the ability to reliably stabilize the testicular and prostatic sections of the vas deferens, technical simplicity and accessibility, hemostasis of the hemomicrocircular channel of the deferent duct, precision matching of the lumen, hermetic integrity of the anastomosis with restoration of excretory duct function, reduced conditions for granuloma formation and operation time. Increase in efficiency of operation by 89%. The proposed instrument pulp clamp vas deferens can find practical application in surgical, urological and andrological departments.

Claims (1)

 The pulp of the vas deferens duct, consisting of a forceps handle ending in two branches, characterized in that a fixing screw is installed on the forceps tweezers, nozzles can be replaced depending on the duct size and the method of formation of the vasovasoanastomosis, and the upper nozzle has a flat a surface with a transverse notch “window” in the center for visual inspection of the comparison of the lumen and stitched layers of the wall of the vas deferens, and the lower branch-nozzle has a flat surface with a transverse lukrugloy notch in the center of laying it all anastomoziruemyh duct.

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