RU2241384C1 - Method for introducing a "blind" (the first) throcar for fulfilling laparoscopic operation - Google Patents

Abstract

FIELD: medicine, laparoscopic surgery.

SUBSTANCE: both skin and subcutaneous fiber should be cut along umbilical edge, separate umbilical skin with scar tissue and surface fascia against umbilical ring, purify aponeurosis around umbilical ring against subcutaneous fatty fiber, dissect surface fascia with scar tissue and skin from umbilical ring, capture umbilical ring with special clamps or cornerplates to introduce a throcar by dissecting or not dissecting the fascia and peritoneum.

EFFECT: higher efficiency.

3 dwg

Description

The invention relates to medicine, namely to surgery, and can be used to introduce a “blind” trocar when performing laparoscopic operations.

The closest analogues of the invention are methods of introducing a “blind” (first) trocar in the midline above and below the navel [1, 2]. This technique of introducing a “blind” (first) trocar is that an incision is made in the skin and subcutaneous fat above or below the navel to the aponeurosis of the white line of the abdomen. Having captured the aponeurosis with a thread, a hoe or a clamp of Mikulich, a Veress needle is inserted into the abdominal cavity through which gas is insufflated. Then, lifting the anterior abdominal wall using one of the above remedies, a “blind” trocar is introduced into the abdominal cavity. After performing the operation or diagnostic examination, the remaining aponeurosis defect is sutured with separate sutures or not sutured at all.

The main disadvantages of these methods of introducing a “blind” trocar are as follows: firstly, the trocar is carried out through a dense layer of the anterior abdominal wall, consisting of aponeurosis, preperitoneal tissue and peritoneum; secondly, the effort exerted to introduce the trocar can lead to damage to internal organs; thirdly, the aponeurosis defect left by the trocar is an additional “weak” place of the abdominal wall through which a hernia can form; fourthly, it allows you to work only on one floor of the abdominal cavity without damage to the tissues surrounding the trocar.

The prototype of the invention is a method of introducing a “blind” (first) trocar when performing gynecological laparoscopic surgery through the navel [2], which is an inverted scar in place of the umbilical ring. The introduction of a trocar according to this technique is as follows: in the transverse or longitudinal axis of the body, a navel skin incision is made. The edges of the incision are captured with a hoe or Mikulich's clamp, the anterior abdominal wall rises and a Veress needle is inserted into the abdominal cavity through which gas is insufflated. Then the needle is removed from the abdominal cavity and through the same incision the “blind” (first) trocar is inserted into the abdominal cavity, passing through the umbilical ring. After the operation or diagnostic examination, the umbilical ring is sutured with a separate suture or not sutured at all.

This method has several disadvantages. Firstly, the skin of the umbilicus is dissected, when stitched, which subsequently causes a cosmetic defect in the form of a deformation of the navel; secondly, the size of the incision of the skin of the navel does not allow you to remove the resected or removed organ through it; thirdly, the insufficient size of the skin incision of the umbilicus and the anatomical structure of the latter do not allow the plasticization of the umbilical ring from this section, which creates the prerequisites for the formation of postoperative umbilical hernias.

The aim of the invention is to develop a safe method of introducing a “blind” (first) trocar, allowing you to enter the latter with minimal risk of damage to internal organs, to exclude the possibility of creating an additional “weak” place of the anterior abdominal wall, favorable for the formation of postoperative hernia, while eliminating the existing “weak” ”A place in the form of an umbilical ring, work on any floor of the abdominal cavity without trauma to the surrounding tissue.

This is achieved by the fact that in the proposed method, the “blind” (first) trocar is inserted through the umbilical ring with subsequent plastic surgery of the latter.

The claimed method of introducing a “blind” (first) trocar is characterized in that, firstly, the umbilical skin with scar tissue and superficial fascia from the umbilical ring is separated. Secondly, the introduction of a “blind” (first) trocar is performed through the umbilical ring, which is the “weak” place of the anterior abdominal wall, that is, bypassing the aponeurosis, through the umbilical fascia and peritoneum (the tissues are less dense than the aponeurosis).

A comparative analysis of the distinguishing features of the claimed invention indicates the absence of these features in already known inventions. Thus, the claimed invention meets the criterion of "novelty."

In the claimed method of introducing a “blind” (first) trocar, the navel skin is detached with scar tissue and superficial fascia from the umbilical ring. This solution allows, firstly, to save the skin or the outer part of the navel and to obtain a good cosmetic effect in the future when suturing a wound; secondly, to determine the presence of an umbilical hernia or a predisposition to its formation - the weakness of the umbilical ring; thirdly, to provide access to the trocar along the path of least resistance.

The introduction of the “blind” (first) trocar is done through the umbilical ring. This solution allows, firstly, to exclude the possibility of creating an additional “weak” place of the anterior abdominal wall; secondly, to introduce the trocar without much effort along the path of least resistance, bypassing the aponeurosis, only through the umbilical fascia and peritoneum; thirdly, to exclude accidental damage to internal organs; fourthly, the absence of a dense aponeurosis in the path of the trocar allows the latter to be introduced without prior insufflation of gas into the abdominal cavity; fifthly, work on any floor of the abdominal cavity without damaging the surrounding tissues of the trocar.

Thus, the analysis of the features of the invention gives the right to recognize the claimed invention meets the criterion of "inventive step".

Figure 1 presents the stage of separation of the aponeurosis from the skin of the navel with scar tissue and superficial fascia.

2, a detached umbilical ring captured by Mikulich's clamps.

Figure 3 reflects the introduction of a “blind” trocar.

The introduction of a “blind” (first) trocar according to the claimed technique is as follows. A bordering cut along the edge of the navel 1 cut through the skin and subcutaneous fat until aponeurosis 2. Aponeurosis 2 around the umbilical ring 3 is cleaned from subcutaneous fat for subsequent plasty (figure 1). Then, from the umbilical ring 3, which is an opening limited by compacted tendon fibers of the white line, the surface fascia with scar tissue and skin is cut off. The umbilical ring 3 thus highlighted is gripped by a clamp or Mikulich's clamps 4 (or hoes) (FIG. 2). Next, introducing or not introducing a Veress needle for insufflation of gas into the abdominal cavity, a “blind” (first) trocar 5 (Fig. 3) is inserted into the abdominal cavity without effort.

Using the introduction of a “blind” (first) trocar into the abdominal cavity according to the claimed method allows you to save the skin, or external, part of the navel and to obtain a good cosmetic effect in the future; determine the presence of umbilical hernia or a predisposition to its formation; to provide access for the introduction of the trocar along the path of least resistance, bypassing the aponeurosis, through the thin umbilical fascia and peritoneum; exclude accidental damage to the abdominal organs; to exclude the possibility of creating an additional “weak” place of the anterior abdominal wall, favorable for the formation of postoperative hernia; work on any floor of the abdominal cavity without damaging the surrounding tissue.

The method was applied in 60 patients who were treated in the 2nd surgical department of the General Surgery Clinic of the Medical Faculty of Belgorod State University. The results were tracked throughout the year - the formation of postoperative hernia was not observed in any patient.

BIBLIOGRAPHIC DATA:

1. V.S. Saveliev, V.M. Buyanov, A.S. Balalykin. Endoscopy of abdominal organs. - M .: Medicine, 1977, p.168-170.

2. I.V. Fedorov, E.I. Seagal, V.V. Odintsov. Endoscopic surgery. - M .: GEOTAR Medicine, 1998, p. 52-59.

Claims (1)

The method of introducing the first trocar to perform laparoscopic surgery, including introducing the trocar through the umbilical ring to perform subsequent plastic surgery of the latter, characterized in that the skin and subcutaneous tissue are cut along the edge of the umbilicus, the skin of the umbilical cord with scar tissue and superficial fascia from the umbilical ring is separated, aponeurosis around the umbilical cord the rings are cleaned of subcutaneous fatty tissue, the surface fascia with scar tissue and skin is cut off from the umbilical ring, the umbilical ring is gripped with Mikulich's clamps or hoe and enter the trocar, dissecting or not dissecting the fascia and peritoneum.

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