RU2337640C1 - Gynecologic instrument for temporary occlusion of uterine arteries - Google Patents

Abstract

FIELD: medicine; gynecology.

SUBSTANCE: gynecologic instrument for temporary occlusion of uterine arteries contains a grasper and a removable directing clamp. The grasper is executed in the form of main jaw, which are connected by the first hinge and have the first rack gear, the first ring handles and the first working jaw members. The jaw members have the form of frameworks with detectors bent in opposite sides for determination of a place of localization of vessels on trailer intersections. The removable directing clamp is executed in the form of additional jaws connected by the second hinge. The additional jaws are bound to the first hinge with possibility of moving in a plane, perpendicular to the plane of moving of the main jaws. The additional jaws are supplied by the second ring handles, the second rack gear and the second working jaws in the form of the pointed hook and a cervical probe. Flexures of the frameworks are located at trailer intersections, executed with the direct sites focused along longitudinal axis of the frameworks, and interfaced to the extremities of intersections by the first additional radial flexures. The first additional radial flexures are supplied by notches on the surfaces turned to each other. Each trailer intersection is executed with the second additional radial flexure. The second additional radial flexure has bend deflection which exceeds thickness of the detector for determination of a place of localization of vessels on 0.5-1.5 mm.

EFFECT: improved contact of working parts of the gynecologic instrument with constricted tissues; exact determination of a place of an occlusion and improved results of treatment.

4 cl, 1 dwg

Description

The present invention relates to gynecology and can be used to treat uterine fibroids.

Among gynecological diseases, uterine fibroids is one of the most common pathologies. According to pathological studies, the incidence of this disease reaches 80%, which is explained by the possibility of an asymptomatic course of the disease, and clinically, uterine fibroids are detected in 30-35% of women over the age of 35 years.

Domestic and foreign studies have shown that uterine fibroids do not degenerate into a malignant tumor. This circumstance allows limiting the indications for hysterectomy and replacing it with organ-preserving operations (Vasilevskaya 1970; I.A. Yakovleva 1979; Shi, Xie et al. 1994; Vu, Yballe et al. 1995; Bonatz, Frahm et al. 1998; Valenti, Azzarello et al. 1998).

However, for carrying out such operations, as a rule, standard tools are used, which reduces their effectiveness.

Closer to the proposed invention is a gynecological instrument for temporary occlusion of the uterine arteries GAVilos, E.C. Vilos, W. Romano and B. Abu-Rafea (Vilos GA et.al. Temporary uterine artery occlusion for treatment ofmenorrhagia and uterine fibroids using an incisionless Doppler-guided transvainal clamp: Case report / Human Reproduction, 2006, Vol.21, No.1, pp269-271).

A disadvantage of the known instrument should be considered the shape of its working jaws, which does not take into account the anatomy of the uterus and reduces the accuracy of determining the location of occlusion of the uterine arteries.

The present invention is aimed at solving the problem of creating a specialized gynecological instrument, which allows to increase the effectiveness of temporary occlusion of the uterine arteries.

The technical result of the invention is improved contact of the working parts of the gynecological instrument with compressible tissues, accurate determination of the location of occlusion and improved treatment results.

The invention is expressed in the aggregate of essential features, in which the gynecological instrument contains forceps in the form of the main branches connected with the first hinge, having the first cremallera, the first annular handles, the first working jaws in the form of frames bent in opposite directions with sensors to determine the location of vessels on the end bridges , and a removable guide clip in the form of additional branches connected by a second hinge connected to the first hinge with the possibility of movement in the plane, perpendi the plain plane of movement of the main branches and equipped with second ring handles, a second cremallera and second working jaws in the form of a pointed hook and cervical probe, differs from the closest analogue in that the bends of the frames are located at the end bridges, made with straight sections located along the longitudinal axis of the frames, and mated with the ends of the bridges with the first additional radial bends, provided with notches on facing each other surfaces, with each end jumper made with a second th optional radiused bend having a deflection greater than the thickness of the sensor by 0.5-1.5 mm.

A gynecological instrument may contain sensors for determining the location of blood vessels, made in the form of measuring transducers using the Doppler effect.

Additional branches can be connected with the first hinge by a pin fixed on the first hinge and made for fixing in the holes located on the shank of the cervical probe, or can be connected with the first hinge of the tubular guide fixed on it and the shank of the cervical probe made to move in the tubular guide .

The essence of the gynecological instrument for temporary occlusion of the uterine arteries is illustrated in the drawing, which shows its General view.

A gynecological instrument for temporary occlusion of the uterine arteries contains forceps in the form of the main branches 2 and 3 connected by the first hinge 1. The main branches 2 and 3 have the first cremallera 4, the first ring handles 5 and 6, the first working jaws in the form of frames 7 and bent in opposite directions 8 with sensors 9 and 10 for determining the location of blood vessels on the end bridges 11 and 12. The gynecological instrument also contains a removable guide clip in the form of additional branches 14 and 15 connected by a second hinge 13. Additional branches 14 and 15 (n For example, by means of a pin 16) they are connected to the first hinge 1 with the possibility of moving in the plane perpendicular to the plane of movement of the main branches 2 and 3. Additional branches 14 and 15 are equipped with second ring handles 17 and 18, a second rack and pinion 19 and second working jaws in the form of a pointed the hook 20 and the cervical probe 21. The bends of the frames 7 and 8 are located at the end bridges 11 and 12 and are made with straight sections 22 and 23 located along the longitudinal axis of the frames 7 and 8, and are paired with the ends of the bridges 11 and 12 with the first additional radius zgibami 24 and 25. Additional radius bends 24 and 25 provided with notches 26 on the mutually facing surfaces. Each end jumper 11 or 12 is made with a second additional radius bend having a deflection arrow exceeding the thickness of the sensor 9 or sensor 10 by 0.5-1.5 mm.

Sensors 9 or 10 for determining the location of vessels are made in the form of measuring transducers using the Doppler effect.

In order to prevent ureteral clamping, the procedure for temporary occlusion of the uterine arteries is performed with a full bladder.

After anesthesia, achieved, for example, by epidural anesthesia, a removable guide clip is initially inserted through the vagina in the form of additional branches 14 and 15 connected by a second hinge 13, which are equipped with second ring handles 17 and 18. When a removable guide clip is inserted, the second cremallera 19 is opened, and the fingers surgeons are in the second annular handles 17 and 18. The working jaw of the removable guide clip, made in the form of a cervical probe 21, is inserted into the cervical canal. Then, additional branches 14 and 15 are brought together and connected by a second cremallera 19. When connecting additional branches 14 and 15, the working jaw of the clip, having the shape of a pointed hook 20, enters the uterine tissue and fixes the clip in the selected position.

Then, forceps are brought through the vagina to the cervix and placed in the projection area of the uterine arteries.

When summing up the forceps, the first cremallera 4 is open, the surgeon's fingers are in the first annular handles 5 and 6, and the main branches 2 and 3 are located in a plane perpendicular to the plane of the additional branches 14 and 15.

The location of the bends of the working jaws of the forceps at the end bridges 11 and 12 allows you to set the working jaws opposite the intended place of occlusion without touching the tissue with sensors 9 and 10, while the straight sections 22 and 23 located along the longitudinal axis of the frames 7 and 8 allow the forceps to be shifted in the longitudinal direction without significantly changing the distance between the sensors 9 and 10.

Then the jaws 2 and 3 are brought together and the first working jaws are applied in the form of frames 7 and 8 curved in opposite directions on the fabric. When reducing branches 2 and 3, frames 7 and 8, first of all, touch the fabrics with the first additional radius bends 24 and 25, which, having notches 26 on the surfaces facing each other, provide a relatively stable position of the fabrics to frames 7 and 8 even before starting work sensors 9 and 10. At this stage of the method, sensors 9 and 10 are removed from the tissues due to the second additional radius bends of the end bridges 11 and 12, and also because each additional radius bend has a deflection arrow exceeding the thickness of the sensor 9 or sensor 10 by 0.5-1.5 mm

The operation of sensors 9 and 10 to determine the location of blood vessels, which can be made in the form of measuring transducers using the Doppler effect, begins only with further reduction of branches 2 and 3 and with their interaction with the tissues prepared for contact. Since uterine tissues are pre-compressed and held by additional radius bends 24 and 25, the accuracy of determining the location of the uterine arteries is significantly increased. The stage of preliminary compression and retention provides the ability to stop blood flow by precise pressure on the artery itself, and not on adjacent tissues, and eliminates the partial resumption of blood flow during the procedure.

Upon receipt of signals about the exact position of the arteries, the branches 2 and 3 are reduced to a complete cessation of the signal and fixed in this position by the first cremallera 4. Then, using the pin 16, the forceps are connected to a removable guide clip and left for a predetermined period of time, for example, for 6 hours.

After removing the gynecological instrument, blood flow in the uterus is fully restored, but not detected in the myomatous nodes.

As a result of the above-described temporary occlusion of the uterine arteries, menstrual function normalizes for a shorter period of time, and the regression of myomatous nodes is on average 44% for 8 months of observation.

Claims (4)

1. A gynecological instrument for temporary occlusion of the uterine arteries, containing forceps in the form of primary jaws connected by a hinge, having a first cremallera, first annular handles, first working jaws in the form of frames with sensors curved in opposite directions to determine the location of vessels on the end bridges, and removable guide clip in the form of additional branches connected by a second hinge connected to the first hinge with the possibility of movement in a plane perpendicular to the plane of movement of the bases branches and equipped with second ring handles, a second cremallera and second working jaws in the form of a pointed hook and cervical probe, characterized in that the bends of the frames are located at the end bridges, are made with straight sections located along the longitudinal axis of the frames, and are paired with the ends of the bridges first additional radius bends provided with notches on facing each other surfaces, with each end jumper made with a second additional radius bend having an arrow iba exceeding the thickness of the sensor by 0.5-1.5 mm. 2. The gynecological instrument according to claim 1, characterized in that the sensors for determining the location of blood vessels are made in the form of measuring transducers using the Doppler effect. 3. The gynecological instrument according to claim 1, characterized in that the additional branches are connected to the first hinge by a pin mounted on the first hinge and made for fixing in the holes located on the shank of the cervical probe. 4. The gynecological instrument according to claim 1, characterized in that the additional branches are connected with the first hinge of the tubular guide mounted on the first hinge, and the shank of the cervical probe made to move in the tubular guide.