RU2494692C2 - Surgical instrument for cross-clamping patient's kidney in resection - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine and can be applied for cross-clamping of kidney in resection. Surgical clamp contains curved in arch-like way working jaws with pivotally fixed working lugs, means for bringing together/apart working jaws, free ends of which go beyond working lugs, and fixer of position of working lugs; clamp is provided with means for regulating position of working lugs, means for bringing together/apart working jaws are made in form of two pivotally connected branches with ring-like handles and rack-type lock on one-side ends of branches, working jugs are made in form of installed with possibility of angular turn in transverse plane arch-like plates with technological holes for application of suture after performed compression; each means of regulation of working lug position is made in form of pin, installed with possibility of turn and fixation in working position in plane, perpendicular to plane of each working jaw, with fixer of each working jaw position being made in form of flat spring, free end of which is located in slot, made from rear side of each working lug and internal surfaces of working jaws are made with corrugation to prevent displacement of surgical clamp in the process of operation and improvement of its fixation in kidney.

EFFECT: clamp ensures convenience of application in zone of limited vision, makes it possible to reduce operation time.

4 dwg

Description

The invention relates to medical instruments and can be used in surgical operations to compress the internal tubular organs and hemostasis of the vessels of the parenchymal tissue, for example, when performing a resection of the kidney in a limited viewing area and in cramped conditions.

Modifications of surgical clamps are known which are used for hemostasis of parenchymal organs during open operations. The main problem that arises in the construction of such instruments is the provision of reliable pinching of the operated organ to prevent heavy bleeding and the creation of a surgical field convenient for the operating surgeon while ensuring minimal trauma to the operated organ.

The task of providing hemostasis is difficult to solve when conducting organ-preserving operations, when it is necessary to injure the operated organ as little as possible and maintain blood supply to this organ at least partially during the operation.

Known screw liver clamp, consisting of two removable upper and lower working branches and handles, providing their interaction, in which the branches are made curved along the length of respectively the convex and concave surface of the liver, have a groove-shaped cross section and longitudinal slots in the center, and the lower branch is rigid and corresponds the profile of the concave surface of the liver, the upper jaw is elastic, has a screw-threaded rod at the free end and a slider moving along the grooves of the handle, with the free end of the lower th jaws freely enters the groove of the handle, the distal ends pivotally connected Branche. In addition, a screw is fixed to the slider, the end of which enters the wing nut, the rotation of which clockwise moves the slider and causes the upper elastic jaw to straighten, resulting in the necessary compression of the liver tissue between the jaws. The existing longitudinal slots on the branches serve to stitch the liver after compression. For resection of the right lobe of the liver, jaws with ebbs directed to the right are used, and for resection of the left - to the left (see, for example, S. A. Borovkov. Liver operations, Moscow, publishing house “Medicine”, 1968, pp. 184-186 )

Given the significant fluctuations in liver size, three pairs of removable branches are designed for each lobe. In the working position, with closed branches, they form a loop thrown over the lobe of the liver to prevent it from slipping during the lowering of the instrument into the wound.

The practical use of this tool reveals a number of its shortcomings: with individual fluctuations in the anatomical size and features of the options for the operated liver, it is necessary in each case to individually select interchangeable branches, while the kit includes only three pairs of branches of different sizes, which may be insufficient in certain situations; due to the fact that the distal ends of the branches are pivotally connected, then in order to stabilize the lobes of the liver between them, in all cases additional preparation and operative allocation of the diaphragmatic surface of the organ is necessary, which complements the invasiveness of the operation and increases blood loss; the mechanism of rapprochement and fixation of the jaws in the working position with the compression of the organ is technically complicated, which increases the operation time and contributes to the early failure of the structure.

The closest known for its technical essence and the achieved result is a surgical clamp selected as a prototype for clamping the kidney during resection, containing arched curved working jaws with articulated working legs, means for information / breeding working jaws, the free ends of which extend beyond the working paws, and the clamp position of the working jaws (see, for example, the description of the patent of the Russian Federation for utility model No. 107471, class A61B 17/08, publ. 08.20.2011).

Vascular hemostasis is provided in two stages of compression on the organ: the first stage involves squeezing the resected portion of the liver between the upper and lower hard lips, while additional compression on the organ with an elastic internal plate is provided by turning the compression adjustment screw clockwise.

However, such a device does not exclude the possibility of damage to the kidney and does not provide the ability to rotate it to perform an operation in the restricted viewing area and in cramped conditions, which generally reduces the attractiveness of this surgical clamp.

The essence of the claimed invention is expressed in the aggregate of essential features sufficient to achieve the technical result provided by the invention, which is expressed in providing ease of use in the restricted viewing area and in cramped conditions, reducing the risk of postoperative complications, reducing the time of surgery and increasing the reliability of vascular homeostasis , tissues and internal organs during surgery with minimal cost due to the surgeon’s efforts, as well as improving the overall functional postoperative state of the patient.

The specified technical result is achieved by the fact that the surgical clamp for the clamped kidney during resection, containing arched curved working jaws with pivotally fastened working paws, means for information / dilution of working jaws, the free ends of which extend beyond the working paws, and the position lock of each working jaws, equipped with means for regulating the position of the working legs, and means for mixing / breeding of working jaws made in the form of two articulated jaws with ring-shaped handles and a chrome With a lock at one end of the jaw, the working legs are made in the form of arcuate plates mounted with the possibility of angular rotation in the transverse plane with technological holes for suturing after compression, each means of adjusting the position of the working foot is made in the form of a pin mounted for rotation fixation in a working position in a plane perpendicular to the plane of each working jaw.

In addition, the position lock of each working jaw is made in the form of a flat spring, the free end of which is placed in a groove made on the back of each working foot, and the inner surfaces of the working jaws are grooved to prevent the surgical clamp from moving during the operation and improve its fixation on the kidney.

The claimed combination of essential features is in direct causal relation to the achieved result.

The proposed device meets the conditions of patentability "inventive step" and "industrial applicability", since it can be implemented by existing technical means and meets the criterion of "inventive step", since it does not explicitly follow from the prior art, while the latter does not reveal any transformations characterized by significant features distinctive from the prototype, to achieve the specified technical result.

Thus, the proposed technical solution meets the established conditions of patentability of the invention.

The other known technical solutions for a similar purpose with similar significant features by the applicant was not found.

Figure 1 presents the proposed surgical clamp, General view; figure 2 is the same side view; figure 3 is a section A-A in figure 1, figure 4 is a section B-B in figure 2.

The surgical clamp for the clamped kidney during resection contains arched curved working jaws 1 with pivotally fastened working paws 2, means for reducing / diluting working jaws 1, the free ends of which extend beyond the working paws 2, and the position lock of each working jaw.

The surgical clamp is equipped with means for adjusting the position of the working legs.

Means for information / breeding of the working jaws 1 are made in the form of two pivotally connected branches 3 with ring-shaped handles 4 and a lock 5 at one end of the branch 3.

The working legs 2 are made in the form of arched plates with the possibility of angular rotation in the transverse plane with technological holes (not marked) for suturing after compression. The execution of technological holes on the working jaws 2 symmetrically relative to each other makes it possible to make a suture with a straight surgical needle in the restricted viewing area and in cramped conditions, minimizing the risk of kidney cutting through, since with this method of suturing, there is no need to tighten the seam much. The seam is evenly tightened over the entire plane of the kidney while loosening the clamp. Also, with this method of suturing, brackets can be used to fix the thread, which in turn reduces the time of suturing and, ultimately, reduces the time of the performed surgical operation.

Each means of regulating the position of the working foot 2 is made in the form of a pin 6 mounted for rotation and fixing in the working position in a plane perpendicular to the plane of each working jaw 1. The pin 6 of the fastening of each working foot 2 in its center is pivotally connected to the working jaws 1. The pin 6 fastening passes through the position lock of each working jaw and is installed with the possibility of discrete rotation in it. Radial working jaws 1 are curved towards each other in the longitudinal plane of the surgical clamp. The inner surfaces of the working jaws are made with corrugation to prevent displacement of the surgical clamp during the operation and improve its fixation on the kidney.

The position lock of each working jaw 1 is made in the form of an elastic flat spring 7, fixed by a fastening unit 8, which is fixed from falling out by the fixing fingers 9. The free end of the elastic flat spring 7 is placed in a groove (not marked) made from the back of each working foot 2, which allows you to evenly distribute the degree of pressure on the operated organ without damaging its tissue.

The work of the proposed surgical clamp is as follows.

By pressing on the ring handles 4, the jaw 3 releases the cremaleric lock 5, then the jaws are parted. The working jaws open. The working jaws 1 are set relative to the working legs 2 in the most convenient position to create hemostasis of the organ being operated on. The clamp in this state is inserted into the wound and brought to the operated organ. The branches 3 are closed until hemostasis is created and their position is fixed with a lock 5. In this case, the kidney parenchyma is compressed due to the spring properties of the elastic flat spring 7 with the cessation of blood flow through the organ vessels of the kidney at the site of the proposed resection, but the remaining part of the kidney is not excluded from the blood circulation. The branches are removed by turning to the required position after unlocking the cremeler lock, which is then fixed, creating the most convenient surgical field for the surgeon and assistant to work and conduct operations in the restricted viewing area and in cramped conditions. They perform a kidney resection and suture closure of the organ wound after resection under conditions of maximum expansion of the space for the hands of the surgeon and assistants. Stitching is performed through round holes with a straight surgical needle. After flashing and ligation of blood vessels in the thickness of the kidney parenchyma, the degree of compression of the kidney with clamp jaws is somewhat reduced. After additional ligation of the vessels established by bleeding from them, the branches are removed from the kidney by turning them back after opening the cremallera lock and removed from the wound.

Thus, the proposed device provides ease of use in a limited viewing area and in cramped conditions, reduces the risk of postoperative complications, reduces the time of the performed surgical operation and increases the reliability of homeostasis of blood vessels, tissues and internal organs during the surgical operation with minimal costly effort of the surgeon, and also improves the overall functional postoperative condition of the patient.

Claims (1)

A surgical clamp for clamping the kidney during resection, containing arched curved working jaws with pivotally attached working paws, means for reducing / diluting working jaws, the free ends of which extend beyond the working paws, and a clamp for positioning the working jaws, characterized in that it is equipped with adjustment means the position of the working legs, and the means for mixing / breeding the working jaws are made in the form of two pivotally connected branches with ring-shaped handles and a lock with a lock at one end of the branch, ra the side legs are made in the form of arcuate plates mounted with the possibility of angular rotation in the transverse plane with technological holes for suturing after compression, each means of adjusting the position of the working foot is made in the form of a pin mounted to rotate and fix in the working position in the plane, perpendicular to the plane of each working jaw, while the position lock of each working jaw is made in the form of a flat spring, the free end of which is placed a groove, taken from the rear side of each working foot, while the inner surfaces of the working jaws are made with corrugations to prevent displacement of the clip during surgical operations and improving its fixation on the kidney.

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