RU2307605C1 - Device for stitching tissues in narrow and deep wounds - Google Patents

Abstract

FIELD: surgical instruments.

SUBSTANCE: device for stitching tissues in narrow and deep wounds has elongated branches with movable and motionless handles and with movable and motionless working jaws. Handles are provided with rings for fingers. Working jaws are provided with removable curved needle. Needle is fastened to movable jaw and it is mounted for shift in guiding channel onto motionless jaws. Working jaws are made straight and they are disposed along longitudinal axis of elongated branches. Handles are oriented at angle to elongated branches and they are disposed at plane of movement of working jaws. Movable working jaw is connected with elongated branch at side of handles. Removable curved needle is made atraumatic; it is disposed in guiding channel and it is provided with sharpened working end. Sharpened end of needle is disposed in guiding channel at distance of 0,3 mm and move from output of channel or it protrudes above surface of motionless working jaw for 0,6 mm max when working jaws are put apart.

EFFECT: atraumatic stitching of tissues by backstroke in narrow spaces.

3 cl, 2 ex, 4 dwg

Description

The invention relates to surgical instruments, in particular to devices for suturing wounds, and can be used in all fields of medicine.

The most common manipulation performed by the surgeon during surgical interventions is tissue flashing. For this purpose, various types of staplers and needle holders are most often used, fixing the needle with the thread between the jaws of the working part of the tool. As a rule, tissue stitching is carried out by rotating the needle holder around its longitudinal axis. In this case, the needle moves along an arc in a plane perpendicular to the tool length. The rigid dependence of the planes of rotation of the needle and the needle holder is one of the negative sides of such tools. If it is necessary to stitch the tissues in another plane parallel to the axis of the needle holder, as well as in the direction from the “depth of the wound” to the outside, the surgeon faces significant technical difficulties, and in some situations it becomes impossible to carry out such manipulations. A similar situation can occur, in particular, in thoracic surgery, with plastic surgery of bronchopleural fistula. In this situation, it is necessary to manipulate in the deep narrow "window" of the mediastinum, the "walls" of which are the stumps of large pulmonary vessels. Damage to the latter can lead to fatal bleeding.

A device for stitching tissues is known, which contains elongated jaws with movable and fixed handles and with movable and fixed working jaws having removable curved needles mounted for movement in guide channels made in one of the jaws (RU 2076639, 04/10/1997).

The known device has an advantage over a conventional needle holder, but its complex design is not suitable for working in narrow and deep wounds.

Closer to the invention is a device for stitching tissues, containing elongated jaws with movable and fixed handles having finger rings, and with movable and fixed working jaws having a removable curved needle mounted on a movable sponge mounted to move in the guide channel on fixed sponge (US 3090386, 05.21.1963).

The device according to US 3090386 allows you to effectively stitch tissues, including those located deep in the wound, but the location of its working jaws on both sides of the stitched area indicates that the cavity in which the working jaws equipped with a needle are located should exceed the dimensions these sponges are diluted.

However, the location of direct branches, working parts and handles in one line makes it difficult to bring the device to the desired location in the depth of the wound channel, while the location of the finger rings at an angle to the handles and branches cannot facilitate the work with the device.

The present invention is aimed at solving the problem of creating a device for stitching tissues, which is not difficult to manufacture, does not require large financial expenses, is processed and sterilized like any other surgical instrument, and provides stitching of tissues in narrow and deep wounds, where it is impossible to perform large-amplitude movements, for example, a standard needle holder.

The technical result of the invention is the possibility of atraumatic stitching of tissues with a reverse stroke of the needle (from the depth of the surgical field to the outside) in narrow spaces.

The invention is expressed in the aggregate of essential features, in which a device for suturing tissues in narrow and deep wounds, containing elongated jaws with movable and fixed handles having finger rings, and with movable and fixed working jaws having a removable curved needle fixed to the movable sponge and installed with the possibility of movement in the guide channel on a fixed sponge. The proposed device differs from the closest analogue in that the working jaws are straight and located along the longitudinal axis of the elongated jaws, and the handles are oriented at an angle to the elongated jaws and are located in the plane of movement of the working jaws, while the movable working jaw is connected to the elongated jaw from the side of the handles, and the removable curved needle is made atraumatic, placed in the guide channel and has a pointed working end, which is located in the guide channel at a distance of not more than 0.3 mm from the exit from the anal or with diluted working jaws protrudes above the surface of the stationary working jaw by no more than 0.6 mm.

The above set of essential features is sufficient to achieve the technical result of the invention in all cases to which the requested amount of legal protection applies.

In particular cases of its implementation or use, the device may have means for fixing a removable curved needle located on a fixed working jaw near the guide channel, and a removable curved atraumatic needle can be fixed in the installation recess.

The connection of these features with the technical result of the invention is manifested in the fact that the execution of the working jaws straight and located along the longitudinal axis of the elongated branches, to which the handles are oriented at an angle, located in the plane of movement of the working jaws, provides a convenient supply of the device to the stitched area in narrow and deep wounds and subsequent monitoring of its work, as with this arrangement, the handles of the device are located on the side of the wound.

The implementation of a removable curved needle in the form of an atraumatic needle, as well as its placement in the guide channel with a pointed working end reduces the morbidity of the device. The reduction in trauma is due to the fact that the maximum use of the channel length eliminates the deformation of the needle during the flashing process. It was found that when the end of the needle is removed from the exit from the guide channel by more than 0.3 mm, the probability of its deformation increases sharply, because the area of the needle support on the channel wall decreases.

The implementation of the device with a needle protruding above the surface of the jaw allows you to accurately determine the location of the injection, using the protruding end as a guide. It was found that an excess of the protrusion by a value greater than 0.6 mm leads to the trauma of the device, because the likelihood of tissue damage increases, including with visual inspection of the end of the needle.

The invention is illustrated by drawings, where Fig. 1 shows a general view of a device for suturing tissues in narrow and deep wounds, Fig. 2 shows an enlarged image of the working jaws of this device with a disconnected needle, and Fig. 3 shows working jaws with a needle installed for sewing and figure 4 presents an enlarged image of the working jaws in the process of flashing.

A device for suturing tissues in narrow and deep wounds contains elongated branches 1 and 2 with a movable handle 3 and a fixed handle 4. Handles 3 and 4 have rings 5 and 6 for fingers. Along the longitudinal axis of the elongated branches 1 and 2, there are straight working jaws 7 and 8. The working jaw 7 is movable, and the working jaw 8 is made as part of the elongated jaw 1 and cannot be moved. A removable curved needle 9 is installed on the movable jaw 7. The needle 9 can move in the guide channel 10 on the fixed jaw 8. The handles 3 and 4 are oriented at an angle to the elongated jaws 1 and 2 and are located in the plane of movement of the working jaws 7 and 8. The movable working jaw 7 is connected to the elongated jaw 2 from the side of the handles 3 and 4. The removable curved needle 9 is made atraumatic, placed in the guide channel 10 and has a pointed working end, which is located in the guide channel at a distance of not more than 0.3 mm from the channel exit or R The labeled working jaws protrude no more than 0.6 mm above the surface of the stationary working jaw.

A device for suturing tissues in narrow and deep wounds can be equipped with a means for fixing (not shown) a removable curved needle 9 located on a fixed working jaw 8 at the guide channel 10. The needle 9 can be fixed in the installation recess 11.

In the process of preparing the device for operation, the removable curved atraumatic needle 9 is placed in the movable working sponge 7. For this, the movable working sponge 7 is withdrawn from the fixed working sponge 8 to the maximum possible distance, the removable curved atraumatic needle 9 is inserted into the guide channel 10 with its pointed end and fixed in the installation recess 11 end with a thread 12.

The device is brought to the injection site of the needle 9 so that the outlet of the guide channel 10 is oriented to this place. In the case when the needle protrudes above the surface of the stationary working jaw 8, its pointed end is used as a guide, which simplifies flashing. Since with the separated working jaws 7 and 8, the end of the needle 9 protrudes no more than 0.6 mm above the surface of the stationary working jaw 8, tissue injury is practically excluded.

The proposed device was performed 5 surgical interventions. All cases ended successfully. No complications were noted.

Patient V., card number 4161-C, was admitted to the thoracic department of SKKOD on May 21, 2001. During the examination, the diagnosis was established: central cancer of the right main bronchus, Article IIIA (T3N2M0), class gr. II. On June 7, 2001, an extended combined pneumonectomy was performed on the right with circular resection of the tracheal bifurcation. On June 24, 2001, a clinic of covered insolvency of sutures of a tracheobronchial anastomosis appeared in the form of hemoptysis. Conservative treatment of complications was performed. On June 28, 2001, in connection with the progression of the insolvency clinic, an urgent surgical intervention was performed: retoracotomy on the right, plastic surgery of the defect in the anastomosis with a muscle flap “on the leg”. To fix the muscle flap to the edges of the bronchopleural fistula (trachea and left main bronchus), the instrument of the proposed design was used. In the postoperative period, empyema of the residual pleural cavity and rehabilitation of the tracheobronchial tree were treated. On the 6th day, the tightness of the tracheobronchial anastomosis was ascertained. The patient's condition improved during treatment. The patient was discharged on August 13, 2001 with complete tightness of the residual pleural cavity, confirmed by clinical, radiological and endoscopic methods. After 6 months, the intrapleural staircase thoracoplasty was performed to eliminate the residual empyema cavity. The patient was examined after 3 years, data for bronchopleural fistula and residual pleural cavity is not determined. The patient is active, returned to his previous hobbies (fishing, hunting).

Patient M., 54 years old, card No. 11324-C, was admitted to the thoracic department of SKKOD on 3.10.2003 with complaints of coughing with sparse mucous sputum. The diagnosis was made: central cancer of the left lung, Article IIIA (T3N2M0), complicated by hemoptysis. October 12, 2003 operation was performed: extended combined pneumonectomy on the left. On the 7th day after the operation, a clinic of insolvency of the stump of the left main bronchus developed. 10.20.03 performed retoracotomy, secondary bronchomyoplasty. When fixing the muscle flap to the walls of the bronchus, the proposed tool was used. The further postoperative period was uneventful, systematic sanitation of the residual pleural cavity with antiseptic solutions was carried out. On the 13th day after retoracotomy, the clinic of the bronchopleural fistula was not determined, the development of empyema of the residual pleural cavity was prevented. 11/26/03 the patient was discharged in satisfactory condition under the supervision of a regional oncologist. Examined after 2 months - there are no signs of recanalization of bronchopleural fistula.

Thus, when flashing the fabric with the proposed device, this fabric is located on one side of the fixed working jaw 8, and not between its working jaws 7 and 8, as this usually happens, for example, when using the known devices described above.

During the flashing process, the surgeon's fingers, which are located in rings 5 and 6, bring the handles 3 and 4 together and move the jaws 1 and 2.

The jaws 1 and 2, in turn, provide the reduction of the working jaws 7 and 8 and, accordingly, the movement of the removable curved atraumatic needle 9 with the thread 12 in the guide channel 10.

The guide channel 10 does not allow the needle 9 to deviate from the injection site or to deform when the stitching forces increase. The presence of the needle 9 in the guide channel 10 at a distance of not more than 0.3 mm from the exit from the channel 10 allows you to use almost the entire length of the needle 9 and enter the device into the wound with a minimum distance between the working parts 7 and 8.

When reducing the working parts 7 and 8, the removable curved atraumatic needle 9 moves in a plane parallel to the plane of movement of the handles 3 and 4, in the direction from the surface of the working part 8, piercing, for example, the wall of the bronchus or bronchopleural fistula. In an operational wound, this will mean flashing "from the depth of the wound out." In addition, such a movement does not require the surgeon to perform large-amplitude movements during flashing, which is extremely difficult in conditions of deep and narrow wounds.

Claims (3)

1. A device for suturing tissues in narrow and deep wounds, containing elongated jaws with movable and fixed handles having finger rings, and with movable and fixed working jaws having a removable curved needle fixed to the movable sponge and mounted to move in the guide channel on a fixed jaw, characterized in that the working jaws are straight and located along the longitudinal axis of the elongated branches, and the handles are oriented at an angle to the elongated branches and are located in the plane of the the working jaws, while the movable working jaw is connected to the elongated jaw on the side of the handles, and the removable curved needle is made atraumatic, placed in the guide channel and has a pointed working end, which is located in the guide channel at a distance of not more than 0.3 mm from the exit the channel or with diluted working jaws protrudes above the surface of the stationary working jaw by no more than 0.6 mm. 2. The device according to claim 1, characterized in that it has means for fixing a removable curved needle located on a fixed working jaw near the guide channel. 3. The device according to claim 1, characterized in that the removable curved atraumatic needle is fixed in the installation recess.

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