RU2317028C1 - Lamellar controlled clamp for endoscopic removal of gravels from bile duct - Google Patents

Abstract

FIELD: surgical instruments.

SUBSTANCE: clamp can be used for endoscopic treatment of choledocholetiasis. Controlled lamellar clamp for endoscopic removal of graves from bile duct has aid for gripping gravel, which aid is connected with pusher. Pusher is placed in catheter. Catheter is installed in endoscope. Aid for gripping gravel is made in form of resilient plate. Plate has edge for separating gravel from walls of duct; it is made for passage between gravel and wall of duct and it has one end connected with pusher. There is lug at other end of plate for attaching two thrusts. Thrusts are made for bending plate and for combined clamping of gravel after thrusts are conducted by plate between gravel and walls of duct.

EFFECT: improved efficiency of endoscopic treatment; reduced number of abdominal operations.

2 cl, 3 dwg

Description

Gallstone disease (cholelithiasis) is a socio-economic problem due to the increasing incidence of this nosology and an increase in the number of elderly and senile patients with severe comorbidity. Stones in the bile ducts are found in 15-25% of patients with cholelithiasis.

Existing tools and methods for endoscopic removal of stones from the bile ducts have long and fairly effectively been used in specialized centers. The frequency of successful endoscopic sanation of the common bile duct reaches 65-90%.

However, in some cases (large calculus, fixed calculus), it is not possible to put the instrument behind a stone, which forces one to abandon minimally invasive treatment and perform surgical operations.

An analogue of the present invention are devices presented in the 2004 Axiom catalog of the Russian Corporation of Manufacturers of Endoscopic Equipment, where on page 47 instruments for flexible endoscopes are presented. (Annex 1)

1. The oval loop is provided for attaching it to the pusher located in the catheter installed in the endoscope. In the device with an oval loop, a handle is provided at the end opposite the worker for moving the pusher together with the oval loop in the catheter and leading it out of the catheter in the area behind the stone. The handle for moving the catheter in the endoscope and removing its working end along the duct behind the stone is provided.

A device with an oval loop has disadvantages:

- it is necessary to push the catheter along the bile duct behind the stone. If the stone is more than 1 cm, it can be difficult.

- the loop does not provide reliable capture of the stone and its removal from the duct.

2. The spiral grip basket is provided in the device with its fastening to the pusher on the working side, placed in the catheter installed in the endoscope.

A device with this solution can be used in the form of the closest analogue. When working with such a device, the endoscope is brought to the large duodenal papilla, the catheter with the grip-basket located at its working end is removed from the endoscope and inserted into the duct between the duct wall and the stone by means of a handle fixed to the catheter at the end opposite to the worker. The pusher displays the gripping basket behind the stone and reveals the elastic properties of the cables. The pusher is moved by means of a handle fixed to it at the end opposite to the worker. With the movement of the catheter and pusher during the capture of the stone by the grab-basket, the stone is removed from the duct.

Such a device has disadvantages:

- it is necessary to push the catheter along the bile duct behind the stone. With a stone over 1 cm, this is difficult.

- the elastic properties of the capture basket do not always ensure reliable capture of the stone and its removal from the duct.

Tasks:

- providing a passage through the channel for capturing stone for a stone fixed in the channel;

- ensuring the forced disclosure of means of capturing stone;

- providing the ability to separate the stone from the duct wall;

- ensuring reliable control of the means of capturing the stone;

- ensuring the reliability of stone extraction from the duct;

- ensuring the convenience of work when removing the stone.

The essence of the invention is that the controlled plate grip is made with a stone grip means in the form of an elastic plate passing between the stone and the duct wall by means of a pusher connected to it at one end and having an eyelet on the other end for fastening two rods, through which the plate , passing behind the stone, bending, covers the stone and conducts traction between the stone and the walls of the duct, together capturing the stone to remove it.

A control body is provided on the opposite working side on the catheter passing through the endoscope on a catheter, on which the plates with rings for the fingers of the hand are connected in grooves, connected to the pusher and the rods, and a holder with a handle is attached to the outer diameter to move the catheter.

The device will provide:

- the passage of the plate with rods along the duct for a stone in the duct;

- forced bending of the elastic plate by means of elastic rods and a pusher covering the stone, ensuring reliable grip of the stone from three sides and its removal from the duct by moving the stone with the catheter along the duct;

- the ability to separate the stone from the walls of the duct with the edge of the plate when the plate is shifted to the side by the action of one of the rods and a pusher;

- the convenience of controlling the device by the presence of control rods for bending the plate fixed to the ear of the plate, attaching the plate to the push rod, as well as the presence of rings for the fingers to control the pusher rods and the handle for catheter control;

- increasing the efficiency of endoscopic treatment of choledocholitnase by reducing the number of abdominal operations.

The design of the device for endoscopic removal of stone from the bile duct is shown in Figure 1 - General view of the device when entering the plate along the duct for a fixed stone; figure 2 - General view of the device when bending the plate 3 by means of rods 10 and 15.

A fixed stone 2 is located in the bile duct 1. The plate 3 with the eye 4 is advanced along the duct 1 with a pusher 5 connected to it, placed in a catheter 6 installed in the endoscope 7 and passing through an opening 8 of the body 9 connected by a screw 20 with a spider 24 with a ring 21 , passing through the groove 25 of the housing 9. In the eyelet 4 of the plate 3, rods 10 and 15 are fixed. The left rod 10, passing through the catheter 6, the hole 8 in the housing 9, is connected by a screw 12 to the spider 11 with the ring 13 passing through the groove 22 in the housing 9. The right thrust 15 passes through the catheter 6, the hole 8 of the housing 9, soy inena screw 14 polzushkoy 16 with the ring 18 extending through a slot 23 in the casing 9. The casing 9 the cage 17 is fitted with a handle 19 to bias the catheter 6.

The operation of the device is performed in the following sequence.

The plate 3, attached to the push rod 5 with rods 10 and 15 fixed to its ear 4, is inserted through the opening 8 of the housing 9 into the catheter 6. The catheter 6 is inserted into the endoscope 7. The endoscope 7 is brought by the working end to the bile duct 1. The handle 19, sitting on ferrule 17, the catheter 6 with the working end is removed from the endoscope 7 and is carried out in the duct 1 to the stone 2 at the place of its abutment to the wall of the duct 1. Ring 21 with the crawler 24 passing through the groove 25 in the housing 9, fixed by a screw 20 to the pusher 5, is pushed plate 3 with rods 10 and 15 fixed in the ear 4 between cam I eat 2 and the duct wall 1 and is held behind the stone 2. By means of a ring 13 with a spider 11 passing through a groove 22 in the housing 9, fixed with a screw 12 with a rod 10 connected to the eye 4 of the plate 3, and also through the ring 18 with the spider 16, passing through a groove 23 in the housing 9, fixed by a screw 14 with a rod 15 connected to the eye 4 of the plate 3, the plate 4 is bent, which together with the rods 10 and 15 captures the stone to remove it from the duct. Under the action of one of the rings 12 or 18, the plate 3 bends with an offset to one side and with its edge will allow to separate the stone from the duct wall.

Claims (2)

1. Lamellar grip controlled for endoscopic removal of stones from the bile duct, containing means for capturing stone connected to a pusher located in a catheter mounted in the endoscope, characterized in that the means for capturing stone is made in the form of an elastic plate, which has an edge for separating stone from the walls of the duct, made for the passage between the stone and the wall of the duct and connected at one end with a pusher, while the plate has an ear at the other end for attaching two rods made for bending the plates and a joint plate stone capture after linkage plate between the stone and the duct walls. 2. The grip according to claim 1, characterized in that on the catheter on the opposite working side there is a control body, on which the grooves with rings for the fingers of the hand are placed in the grooves, wherein the grips are connected to the pusher and rods, and a casing is fixed to the outer diameter of the body handle to move the catheter.

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