RU2268008C2 - Clipping wound dilator - Google Patents

Abstract

FIELD: surgical instruments.

SUBSTANCE: clipping wound dilator can be used in abdominal surgery when forming compression anastomosis among different departments of gastrointestinal tract while using nickelide-titanium devices. Clipping wound dilator made of nickelide-titanium wire has two clipping branches with C-shaped limiters at the ends, which end up with branches of mini-dilator. Branches of mini-dilator are provided with limiters. Clipping branches have mutual parallel semi-oval guides and they are disposed at distance of 1 mm from each other.

EFFECT: simplified procedure of forming of compression anastomosis; higher aseptic quality of operation.

2 cl, 1 ex, 4 dwg

Description

The invention relates to medicine, namely to surgical instruments, and can be used in abdominal surgery to form compression anastomoses between different sections of the gastrointestinal tract using nickel-titanium devices.

Recently, a compression seam has been increasingly developed in abdominal surgery. The main idea of creating a compression anastomosis is a long compression of the connected intestinal loops with latex rings, gaskets or magnetic elements using a special apparatus. The priority of the principle of seamless tissue connection in our country belongs to the school of Professor N.N. Kanshin. The most famous and widespread is the apparatus of compression anastomoses (AKA-2, AKA-4). It is more often used in operations on the rectum and colon. Despite the significant advantages noted by many surgeons when using this method, it was not widely used in clinical practice. The main reasons are structural complexity, cumbersomeness, high cost, the risk of purulent-septic complications due to the need for a complete opening of the intestinal lumen.

An alternative to the compression joint was proposed by the school of prof. R.V. Ziganshina. The method is based on the use of nickelide-titanium implants having a “shape memory” effect as compressive mechanisms. Designs for creating compression anastomoses in surgery have been used for more than 15 years (R.V. Ziganshin et al., 1990; Kecherukov A.I., 1998; Plotnikov V.V. et al., 1998 and others). Due to not only the property of thermomechanical “memory”, but also biomechanical compatibility with body tissues, they are increasingly preferred by surgeons (V.E. Gunter, 2001). The most widely used in clinical practice are wire implants of the TN-10 brand with a cross-sectional diameter of 2-3 mm in the form of a paper clip, consisting of 2 and 3 spiral-wound coils in contact with the generatrix. (A.S. No. 1186199).

Compression anastomoses with these devices can be formed both side to side (2-wire) and end-to-end (3-wire). Technically, the operation is much aseptic and simpler; a mechanically strong and biologically tight seam is created, healing mainly by primary intention, not prone to scarring (Makarov A.I., 1986; Ziganshin R.V., 2000 and others).

The main stages of the formation of compression anastomoses of the gastrointestinal tract are:

• fixation of anastomosed organs with interrupted sutures;

• dissection of the walls of hollow organs with the imposition of ligatures-holders on the edges of the wound;

• dilution of intestinal openings in the transverse direction with mini retractors 2 mm wide in the form of hooks;

• implantation of a deformed titanium nickelide device;

• dissection of tissues in the device window;

• suturing of the intestinal wound.

Despite all the technical simplicity, the process of applying compression anastomoses with titanium nickelide devices has significant drawbacks, which, in our opinion, are as follows:

1. Preliminarily, fixing sutures are applied between anastomosed organs, and suture-holders on intestinal wounds (the injection device injection site), which increases the septicity of the operation;

2. When introducing the device, special mini-expanders in the form of hooks are used (prototype);

3. The direction of implantation and the location of nickel-titanium devices is mainly subjective, poorly controlled, which is important if you need to choose a transverse or longitudinal type of anastomosis;

4. Necessarily requires a second assistant during the operation or the help of the operating sister to hold the conservatives.

The aim of the present invention is the development of surgical instruments to avoid the imposition of fixing sutures and ligatures-holders between anastomosed hollow organs, as well as the use of mini-expanders, thereby increasing the asepticity of the operation and reducing the risk of purulent-septic complications.

The objective of the invention is to simplify the process of forming a compression anastomosis with nickel-titanium devices, to increase the asepticity of the operation.

The essence of the invention consists in the proposal of a special device made of wire titanium nickelide grade TV-10 with a cross section diameter of 1.2 mm, which has the property of "shape memory". The device consists of 2 parts: clipping and retractors (figure 1). The clipping branches are represented by 2 mutually parallel semi-oval generators (1) with dimensions of 22-32 × 16-22 mm, from the free ends of which there are 2 C-shaped bends (3), which end with branches of the mini-expander (2) with limiters. In order to prevent tissue crushing and subsequent extraction, the distance between the clipping branches is 1 mm. The size of the clipping part depends on the size of the “paper clip” for applying anastomoses and exceeds its size by 3 mm. The branches of the retractor provide in working condition a trapezoidal shape of the intestinal wound, which greatly facilitates implantation.

The device works as follows: After cooling in a cold antiseptic (t from -5 ° C to -7 ° C) it is deformed: the clipping branches are V-shaped, and the expanders are reduced to the center so that they are in the same plane with the clips (Fig. .2). Previously, 2 holes are made in anastomosed loops. The adjacent intestinal walls of the wounds are brought together by Alice clamps, which are removed after the device branches into the openings of the hollow organs. Under the influence of body temperature, the structure begins to restore its original form, exhibiting the effect of “shape memory". At the same time, the walls of the anastomosed loops come together and are fixed with clipping branches, and the intestinal wounds themselves are expanded by the branches of the mini-expander (Fig. 3).

Next, a compression device is introduced, which is implanted into the tissue in the projection of the clipping branch window (Fig. 4). After restoration of the primary patency of the intestinal tube, the instrument is removed and intestinal wounds are sutured.

Thus, the use of the proposed device in the formation of compression anastomoses using nickel-titanium implants allows to achieve a technical result, to avoid the imposition of fixing sutures and ligature-holders, the use of additional retractors, the help of a second assistant, to control the implantation of compression implants by choosing the direction of the clipping branch necessary for the surgeon parts of the structure, increase the asepticism of manipulations and thereby prevent the development of purulent complications. The technical result is achieved by the shape of the structure.

The description of the invention is illustrated by the following illustrations:

Figure 1. General view of the clipping retractor: 1) clipping part; 2) retractors; 3) C-shaped bends.

Figure 2 The device is in a deformed state.

Fig 3. General view of the clipping retractor in anastomosed loops of the intestine.

Figure 4. The moment of implantation of the compression device into the anastomosed loops of the intestine using a clipping retractor.

The device was tested on experimental animals at the Central Scientific Research Laboratory of TGMA and in clinical practice.

Here is a clinical example: Patient A., 46 years old, was admitted to the surgical department of the 1st Clinical Hospital G. Tyumen on 22.06.01 with a clinic of acute intestinal obstruction. The diagnosis was established: "Dolichosigma complicated by inversion". After resection of the sigmoid colon, a compression end-terminal anastomosis was formed using a nickel-titanium device in the form of a “clip” consisting of 3 turns. When forming the anastomosis, a clipping retractor is used. After removal of the pathological focus, the oral and aboral ends of the intestine are tied with silk. The stumps were centered by tying ligatures together. Holes are prepared on the mesenteric sides of the intestines. In a cooled cold antiseptic, the clipping retractor is deformed: the clipping branches are V-shaped, and the retractors at the point of their bend are brought together so as to be in the same plane with the branches. The prepared tool with its branches is inserted separately into the formed holes. As they warmed up, the form was reconstructed, the anastomosed ends of the colon were fixed with clipping branches, and intestinal wounds were diluted with retractors. Thus, the ends of the intestine are prepared for implantation of a compression device. Then a cooled 3-wire device (32 × 25 mm) is implanted and 1.5 turns are inserted into the lumen of each of the anastomosed sections of the intestine. After dissection of the clamped tissues in the window of the compression device, the tool was removed. The wounds of the intestinal wall are sutured. On day 8, the compression device was rejected, and a descendorectal end-terminal anastomosis was formed. There are no complications after the operation.

The proposed invention greatly simplifies and improves the technique of forming compression anastomoses using nickel-titanium devices and helps to prevent the risk of severe purulent-septic complications in the postoperative period.

Information sources

1. A.S. No. 1186199. The method of creating anastomoses. / Makarov A.I., Borodin N.A., Ziganshin R.V. et al. // Publ. B.I., 1985, No. 39. - S.22-23.

2. Gunter V.E. The law of delay is the basic law of biocompatibility. // In the book: Biocompatible materials and implants with "shape memory". / Ed. V.E. Gunther. Northampton: STT, Tomsk: STT, 2001 .-- P.5-8.

3. Ziganshin R.V., Gunter V.E., Gibert B.K., Mashkin A.M., Ruchkin V.I., Sinyakov A.G., Zaitsev E.Yu., Robak A.N. New technology for creating a compression anastomosis in gastrointestinal surgery with superelastic implants with a “shape memory". Tomsk: STT, 2000 .-- 176 p.

4. Ziganshin R.V., Gunter V.E., Ginovker A.G., Gibert B.K. et al. Compression anastomoses in gastrointestinal surgery performed using an alloy device with a shape “memory”. // Surgery, 1990, No. 8. - S.115-120.

5. Kecherukov A.I. Development and application of devices with a “shape memory" in surgery of the colon and rectum. // Dis .... doct. Medical Sciences, Tomsk, 1998 .-- 576 p.

6. Makarov A.I. A method of forming a compression anastomosis in gastrointestinal surgery using an alloy device with a "shape memory": experimental study. Diss .... cand. honey. sciences. Tyumen, 1986.- 138 p.

7. Plotnikov VV, Chinarev Yu.B., Myslivtsev S.V. Implants with the effect of "memory" of the form in surgery of the colon and rectum. // Abstract. doc. International Symposium "Medicine and Health Protection-98", Tyumen, 1998. - S.95-96.

Claims (2)

1. Clipping nickel-titanium wire retractor, characterized in that it contains two clipping jaws with C-shaped stops at the ends, which end with mini-expander jaws, and the mini-expander jaws are equipped with limiters, and the clipping jaws have mutually parallel semi-oval generators and are placed at a distance of 1 mm from each other. 2. The clipping retractor according to claim 1, characterized in that the nickel-titanium wire has a cross-sectional diameter of 1.2 mm, and the sizes of the clipping branches are 22-32 × 16-22 mm.

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