RU2205607C2 - Device for cutting off and grinding uterus in performing laparoscopic amputation - Google Patents

Abstract

FIELD: medical engineering. SUBSTANCE: device has string and two dielectric tubes. The tubes are inserted one into another and movable one relative to the other. The external tube has working end cut at an angle of 45 deg. String movement restrictor is mounted transversely with respect to working end lumen of the external tube. The internal tube has T-shaped handle. Screw for fixing one end of the string to allow adjusting its length. The string exits from the internal tube as a loop. It passes between the internal and external tube. Its other end is rigidly fixed in electric plug with its other end to make connection to the active electrode. EFFECT: wide range of functional applications; accelerated operation; high degree of safety. 2 dwg

Description

 The invention relates to medicine and can be used for morcellation (grinding) of the uterus with its laparoscopic amputation.

 The problem of removing an enlarged uterus with laparoscopy remains relevant, because it is not always possible to remove a large uterus through a section of the vagina, and a section on the anterior abdominal wall nullifies laparoscopy. The currently used models of morcellators (grinders) require a lot of time to extract a cut off organ and have a high cost or do not meet the principles of ablasticity (A. Gordon, P. Taylor Practical Laparoscopy, 1993).

 The problem is the lack of effective, safe and cheap devices for grinding the uterus cut off during laparoscopy, which either drastically lengthens the time of the operation or brings the effect of the laparoscopic aid closer to the results of "open" surgery.

 A known method of crushing the uterus by Zemm's morphicator (Semm K. Morcellation at Endoscopy // J. Europ.Priv.Hosp.l996, 5, p. 69-76), representing a hollow tube with an external cutting edge, inside which moves a metal corkscrew screwed into uterine tissue, and the outer tube cuts the tissue around the corkscrew. To grind the fabric, the corkscrew is screwed into it, and then, holding the corkscrew by hand, the outer tube is lowered along the corkscrew with force. In this case, the outer tube cuts out part of the tissue around the corkscrew. Then the corkscrew with the tissues fixed on it is removed and cleaned, and the procedure is repeated until the volume of the removed tissue (uterus) is significantly reduced. This method of grinding requires a long time, it is dangerous due to the uncontrolled introduction of a corkscrew.

 Closest to the proposed method is the implementation of endoscopic polypectomy with a diathermic loop (P. Cotton, C. Williams Practical Gastrointestinal Endoscopy, 1986), representing a long Teflon tube with an internal metal string, at the end of which a metal loop of a certain shape is fixed (lanceolate, hexagonal, mixed) . When extending, the loop straightens, then pounces on the base of the tumor, drags it into close contact with the tissues, then turns on the current, and in the mode of monopolar coagulation with further tightening of the loop, the tumor is cut off. However, the available instruments for fibroendoscopy have a limited loop diameter, do not have rigidity and do not allow the uterus to be cut off and crushed.

 The objective of the invention is to reduce the time of cutting and grinding of the uterus of any size with its laparoscopic amputation, increasing the safety of the operation.

The task is achieved by the fact that a device is used consisting of two dielectric tubes inserted one into another with the possibility of movement relative to each other. The outer tube has a working end cut at an angle of 45 ^o . Across the lumen of the working part of the outer tube, a limiter for the movement of the string and the inner tube is installed. The inner tube has a T-shaped handle, near which a screw is installed for attaching one end of the string. This screw allows you to adjust the length of the string. The string comes out of the inner tube in the form of a loop and then passes between the inner and outer tubes. The second end of the string is rigidly fixed to the outer tube in the electrical connector.

 The proposed device allows you to cut and grind the uterus, regardless of its size, to reduce the time of the operation by 60-80 minutes, to observe ablasticity through the use of coagulation.

The compliance of the proposed technical solution to the criterion of "novelty" is confirmed by the presence of the following features that are absent in the prototype:
- two dielectric tubes moving relative to each other are used;
- the outer tube has a working end cut at an angle of 45 ^o ;
- across the lumen of the working end of the outer tube, a limiter for the movement of the string and the inner tube is installed;
- the inner tube has a T-shaped handle;
- a string in the shape of a loop can change dimensions;
- the string leaves the inner tube, goes around the limiter and passes between the inner and outer tubes;
- the string is fixed at one end to the inner tube with a screw that adjusts its length, and the other end is rigidly fixed at the outer tube in the electrical connector for connection with the active electrode.

 The device used is illustrated in figures 1 and 2, which presents a General view of the device and its application, respectively.

 The device consists of a dielectric tube 1 with an outer diameter of 10 mm and a wall thickness of 2 mm, in which a metal string 2 from a standard loop for polypectomy is placed so that one end of it is rigidly fixed in a metal connector 3 for connection with the active electrode, and the other end fixed with a screw 4 in the inner dielectric tube 5 with a T-shaped handle 6.

The input end of the tube 1 is cut at an angle of 45 ^o , and across the lumen 2 mm from the edge is a metal rod 7 with a diameter of 3 mm.

 Tubes 1 and 5 are made dielectric and rigid. The stiffness of the tubes 1 and 5 allows you to create sufficient force to quickly grind the uterus and extend the life of the metal string.

The working end of the tube 1 is cut off at an angle of 45 ^o , which facilitates the correct position of the loop when cutting the uterus in the depth of the small pelvis, where contact by the cervix is possible only at an angle to it.

 The limiter of the movement of the string and the inner tube 7 in the form of a rod mounted across the lumen of the working end of the tube 1 limits the stroke of the inner tube 5 and does not allow the string 2 to twist, and also limits the stroke of the string when tightening the loop.

 An electric current from any electrosurgical unit, sufficient for crossing the uterus, is supplied to the loop in cutting mode.

 The device operates as follows. When the uterus is cut off during laparoscopy, two instrumental trocars 9 are inserted for introducing instruments, after mobilization of the uterine ribs through the instrumental trocar, a device is inserted, a metal string 2 is extended until a loop is formed enough for the uterus to pass through, a loop 2 cm from the vagina is thrown on the cervix and tightened tightly. The string 2 is fixed with a screw 4 in the T-handle of the inner tube 5. The handle 6 is pulled by the right hand, and the outer tube 1 of the device is held by the left hand, while current is supplied to the electrical connector on the outer tube 1 in cutting mode. When there is an obstacle to further advancement of the string 2 (limiter of the movement of the string and the inner tube in the device), the traction is stopped. After cutting off the uterus by 12 instruments inserted through two trocars 9 above the bosom, the latter is captured by a laparoscopic clamp 10 without a dielectric sheath, passed through the same metal instrument trocar 9, and rises above the abdominal organs without touching them. A device for crushing the uterus is introduced through another instrumental trocar 9, the metal string 2 extends in the form of a loop to the required size and lashes onto the uterus 12, then is pulled until it is in firm contact with the organ, after which the string 2 is fixed with a screw 4 in the inner tube 5, which is fully inserted into the outer tube 1 to the limiter of the movement of the string and the inner tube 7. Holding the outer tube 1 by hand, traction of the inner tube 5 outward by the T-shaped handle 6 while supplying current to The electrical connector on the outer tube 3 until complete uterine intersection 12. This procedure is repeated until the required size of the uterus fragments. If possible, the uterus is placed in a dielectric container. To ensure the operation of the device, a passive electrode is used on the patient’s body, contact with which of the dissected uterus is made through a metal trocar and a laparoscopic clamp 10. The active electrode 8 is connected to the device through connector 3 on the outer tube 1.

 Example 1. Patient K., 35 years old. Received a planned surgical intervention for bleeding uterine fibroids. With laparoscopy, the uterus is up to 11 weeks pregnant. After mobilization of the uterine ribs, a device was introduced, which is beveled towards the uterus, the loop is straightened and thrown over the cervix, tightly tightened by tightly pressing the bevel of the outer tube to the cervix. The traction of the handle with the string fixed in it has begun while simultaneously supplying a “cutting” current. Clipping time 20 sec. The uterus is captured by a metal clip, it is impossible to place it in the container due to its large size, it is raised above the gland. The loop is re-thrown onto the uterus, tightened, fixed in the handle of the device. During traction of the handle with simultaneous supply of current, the uterus is dissected into 2 fragments up to 10 • 4 cm, accessible for removal through colpotomy. Uterus dissection time 28 sec. The resulting fragments of the uterus are extracted through a colpotomy or instrumental trocar.

 The invention is based on an analysis of the results of laparoscopic uterine amputation in 10 patients and a study of the technique of the proposed method on 3 corpses of adults. Received a reduction in uterine extraction time and operation time, the absence of complications from the use of the device, i.e. set task achieved.

 Thus, the proposed device expands the capabilities of the laparoscopic technique, can be used for cutting and grinding the uterus of any size, it is more convenient to use due to the combination of mechanical and electrical action, the bevel of the outer tube, reduces the time of the operation.

Claims (1)

A device for cutting and grinding the uterus during laparoscopic amputation, including a string that receives electric current drawn from a dielectric tube, characterized in that the device consists of two dielectric tubes inserted one into the other with the possibility of movement relative to each other, the external tube has a working end cut at an angle of 45 ^o, which is installed across the lumen of the string motion limiter and the inner tube, the inner tube has a T-shaped handle which is installed near a nt for attaching one end of the string to be adjustable of its length, the string exits the inner tube in the form of loops extending between the inner and outer tubes and the other end fixedly secured to the outer tube in an electrical connector for connection with the active electrode.

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