RU2294705C1 - Bleeding-stopping laser clamp - Google Patents

Abstract

FIELD: medical equipment; laser surgery.

SUBSTANCE: bleeding-stopping laser clamp has branches connected by hinges. Branches have ring-shaped handles, rack-and-pinion, working jaws with cuts onto inner surfaces and central open slot. Central open slot is placed along length of one working jaw. Slot has length of 0,5 cm, width of 0,1 cm and thickness to be correspondent to thickness of jaw.

EFFECT: reasonable compression of blood vessel; higher reliability of laser welding.

2 cl, 1 dwg, 3 att

Description

The invention relates to medicine, namely to medical equipment: surgical instruments used in laser surgery.

When using a laser scalpel in the experiment and in the clinic, its good hemostatic effect was noted. However, only vessels with a diameter of up to 0.2 cm are coagulated. If the vessel has a diameter of more than 0.2 cm, then the laser radiation is shielded by the blood entering the wound from the crossed vessel, and hemostasis is insufficient. As a consequence, the creation of special laser instruments that would provide the best hemostatic conditions when performing operations is quite relevant.

As a prototype, the authors propose a laser clip of Moiseev and Gerusov.

The clamp contains articulated jaws 8.0 cm long with annular handles with a diameter of 2.5 cm, a rattle and working jaws. There are two sponges: 2.0 cm long, 0.5 cm wide and 0.3 cm thick. There are notches on the inner surface of the sponges, the distance between which is 0.7 mm. Notches are necessary for better fixation of the clamp on the blood vessel. On one of the sponges at a distance of 0.2 cm from the upper edge of the sponge there is a window in the form of a through-closed closed slot 0.3 cm long and 0.1 cm wide.

A clamp is applied to a blood vessel and pinched. After that, the laser beam is directed into the existing slot. The walls of a bloodless vessel under the influence of a laser stick together, bleeding stops. Since the vessel is pre-squeezed, blood from it does not enter the wound and laser radiation is not consumed for the evaporation of blood, but provides welding of the vessel and hemostasis.

The clamp has a certain disadvantage. It does not provide complete laser welding of a blood vessel, since the hole (slot) for the passage of the laser beam is closed and is not at the end of the sponge. Because of this, the part of the wall of the pinched vessel located between the continuous jaws is not exposed to laser radiation and the vessel will not be welded in this section.

To ensure full laser welding when using this clamp, you should advance it deeper into soft tissues, and this will entail additional trauma, which is unacceptable, especially during face operations.

Laser clamp authors Moiseyev and Gerusov. A.S. USSR No. 196242, cl. A 61 B 17/28 from 05/15/1983, SU, 1017314.

The aim of the invention is to increase the reliability of laser welding of a blood vessel and reduce trauma to surrounding tissues when applying a clamp.

This goal is achieved by the fact that in the clamp on one of the jaws an elongated through end open gap is made, 0.5 cm long and 0.1 cm wide (corresponding to the diameter of the laser beam).

The styptic laser clip proposed by the authors (drawing) has articulated jaws of 8.0 cm length 1, with annular arms with a diameter of 2.5 cm 2, cremallera 3 and jaws 4. The sponges have a length of 2.0 cm, a width of 0.5 cm and a thickness 0.3 cm. On the inner surface of the sponge have notches to improve fixation on the vessel. The distance between the notches is 0.7 mm. On one of the jaws along its length an oblong central through open-ended end slot 5 is made, 0.5 cm long, 0.1 cm wide and depth corresponding to the thickness of the sponge.

The technical result of the proposed clamp is to ensure full compression of the blood vessel and reliable laser welding.

Increasing the size of the end slot is not recommended, as this will significantly weaken the sponge and will not provide sufficient compression of the blood vessel.

The clamp is used as follows: during the operation, a clamp is applied to the blood vessel, the vessel is pinched and bled. Then, a focused laser beam is directed into the existing slot, which cuts through the walls of the vessel and brews them. After that, the clamp is removed without applying a ligature.

The proposed clamp provides sufficient compression and bleeding of a blood vessel, and the presence of an open slot allows a full laser welding of the vessel wall along its entire length, while ensuring reliable hemostasis.

Clinical example 1: Patient B-s D.I. 20 years old, medical history No. 3459, turned to the dental clinic of the TSMA on 09/17/2005.

Diagnosis: Festering atheroma of the right cheek.

Operation: Laser excision of suppurating atheroma.

Operation progress: local infiltration anesthesia was performed, a spindle-shaped skin incision was made above the scalpel atheroma, with mandatory excision of the area fused to the skin. Atheroma is taken on a holder and is gradually allocated together with a shell by means of a laser beam.

During laser excision, bleeding occurred from a blood vessel located in the subcutaneous tissue. It was impossible to coagulate a blood vessel with a laser beam, since it had a diameter of more than 0.5 mm and the laser energy was spent on the evaporation of blood flowing from the damaged vessel. In this regard, a hemostatic laser clip was applied to the blood vessel. A focused laser beam was directed into the central end-to-end open-ended slot on the clamping lip and laser-welded the walls of the bloodless vessel.

Since the damaged vessel is washed with blood, it is quite difficult to hold it with a clamp. Therefore, notches on the inner surface of the working jaws are essential for better fixation of the clamp on a blood vessel.

After removing the clamp, there was no bleeding from the vessel, hemostasis is complete, additional vessel ligation was not required.

After complete removal of atheroma, the wound was washed with antiseptics, catgut sutures were applied, sutures were made on the skin with lavsan, and rubber drainage was left in the wound.

Hemostatic laser clip is used for all types of laser operations, but for clarification we offer two more clinical examples.

Clinical example 2: Patient E-va M.I., 32 years old, medical history No. 5621, turned to the dental clinic of the TSMA on 05/10/2005.

Diagnosis: Pigmented-warty nevus of the forehead.

Operation: Removing the nevus.

Operation progress: under the infiltration anesthesia with a scalpel, two bordering skin incisions were made around the nevus. Then, the nevus within the skin is excised with a laser scalpel. During the excision, bleeding from several blood vessels of subcutaneous fat occurred. A hemostatic laser clip was applied to each damaged vessel, the diameter of which exceeded 0.5 mm, and laser welding of the bloodless vessel was carried out. After removing the clamp, there was no bleeding. After removal of the skin flap along with the nevus, catgut sutures and sutures on the skin were applied to the wound with lavsan.

Clinical example No. 3: Patient S. s. E.P. 57 years old, medical history No. 19001, went to the dental clinic 02/12/2006.

Diagnosis: Basal cell carcinoma of the left cheek.

Operation: Removal of basal cell carcinoma.

Operation progress: under the infiltration anesthesia with a scalpel, two bordering skin incisions were made around the basal cell, departing 1.0 cm from the borders of the tumor, then laser excision of the basal cell carcinoma was performed along with the underlying subcutaneous tissue. During dissection, blood vessels were damaged, the diameter of which exceeded 0.5 mm, and the laser beam energy was not enough for complete hemostasis, therefore, a hemostatic laser clamp was applied to the damaged vessels, the vessels were clamped and the walls of the bloodless vessels were laser-welded. After removing the clamp, there was no bleeding. After removal of basal cell carcinoma in a skin-fat flap, the wound surface was additionally treated with a laser beam in order to ensure complete ablasticity. Catgut sutures and lavsan sutures were placed on the wound.

Claims (2)

1. The hemostatic laser clip contains articulated jaws with ring-shaped handles, a cremallera, working jaws and a central slot placed along the length of one of the working jaws, characterized in that the working jaws are made with notches on the inner surfaces, and the slot is made open, has a length of 0 , 5 cm, a width of 0.1 cm and a thickness that corresponds to the thickness of the sponge. 2. The clamp according to claim 1, characterized in that the distance between the notches is 0.7 mm