RU2499566C1 - Surgical instrument for lifting aponeurosis in suturing of post-laparoscopic trocar wounds - Google Patents

Abstract

FIELD: field: medicine.

SUBSTANCE: invention relates to medical equipment and can be applied for suturing post laparoscopic trocar wounds of patients with obesity, to prevent herniation. Surgical instrument contains two crossing, pivotally connected to each other branches with rack, working parts and handles in form of rings. Ends of working parts are made rounded at right angle with projections on ends for holding tissue from slide. Working ends in closed condition close down parallel to each other in one plane with handle rings and when separated move with open parts apart.

EFFECT: surgical instrument makes it possible to lift aponeurosis in suturing post-laparoscopic trocar wounds under visual control, which increases reliability of suturing post-laparoscopic trocar wounds in patients with obesity and prevents formation of post-operative trocar hernia.

3 dwg

Description

The invention relates to medical equipment and can be used for suturing post-laparoscopic trocar wounds in patients with obesity.

For suturing post-laparoscopic trocar wounds using:

Lowsley retractor with manual closing.

Technically, the Lowsley retractor (Circon ACMI, Stanford, CT, USA) is a needle conductor and a curved needle directly into which suture is charged. When closed, the Lowsley retractor is fed into the abdominal cavity through a 12 mm port. Then, to a maximum of 180 °, the blades of the Lowsley retractor open. After that, the port is removed and only the retractor remains in the wound. Then the retractor is pulled up, thus flashing the peritoneum and fascia on both sides simultaneously. After removing both ends of the thread, the usual manual suture is applied to the wound surface (V. A. Gorsky, E. R. Ovanesyan, M. A. Agapov. Methods of suturing a trocar wound as a method for preventing the formation of hernias after laparoscopic cholecystectomy. Annals of Surgery No. 6. Moscow 2008 p. 48-54).

Disadvantages: the surgeon cannot visually control the capture of the aponeurosis due to the fact that the retractor captures the anterior abdominal wall through all layers. Due to the fact that in patients with obesity subcutaneous fatty tissue is pronounced, tissue interposition between the leaves of the aponeurosis is not excluded, which can lead to the formation of trocar hernias.

Clasps of the Mikulich type are also used to suture post-laparoscopic trocar wounds.

The clamp consists of a long curved working part with teeth on the end, a handle with rings and a lock in the form of a cremallera (http://bone-surgery.ru/view/zazhimy_mikulicha/).

The technique of suturing includes three stages:

The first clamp (performed by an assistant) is inserted into the abdominal cavity, its lips are placed subperitoneally in the open position and the abdominal wall is lifted up. The second clamp (performed by the operator) spreads the subcutaneous tissue. The fascia is sutured with a needle so that the tip extends between the apart lips of the first clamp, the needle and the needle holder are captured with the second clamp, similarly they are acted on the other side (Fedorov I.V., Valiullin I.N., Agliullin A.F., Prevention of trocar complications in laparoscopy . \ Textbook for Doctors. Kazan, 2009, p. 39).

Disadvantages: this method of suturing a postoperative trocar wound is the most common and often used. However, the use of this method is difficult in patients with morbid obesity. Given that the skin incision reaches a maximum of 1.5 cm, it is technically difficult for the surgeon to suture the aponeurosis due to the depth of the wound (sometimes subcutaneous fatty tissue can reach more than 5 cm), sometimes it is necessary to suture it blindly. Accordingly, the surgeon is not sure about tissue matching and the reliability of closure of the postoperative trocar wound, which can lead to the formation of post-laparoscopic trocar hernias.

The aim of the present invention is to increase the reliability of suturing post-laparoscopic trocar wounds in patients with obesity by controlling the capture of aponeurosis by the needle and eliminating tissue interposition between the leaves of the aponeurosis, as well as preventing the formation of trocar hernias.

Thus, the technical result achieved by this invention is to prevent the formation of trocar hernias.

The essence of the invention lies in the fact that the proposed surgical tool for raising the aponeurosis when suturing post-laparoscopic trocar wounds, containing two intersecting, articulated jaws with a cremolera, working parts and handles in the form of rings, and the ends of the working parts are rounded at right angles with protrusions at the ends to keep the fabric from slipping, while the working ends in the closed state are closed parallel to each other in the same plane with the handle rings, and when divorced NII diverge open part to the side.

Figure 1 shows the tool in the closed state. Figure 2 presents the tool in the open state. Figure 3 - at the time of raising the aponeurosis.

A surgical instrument is designed to raise the aponeurosis when suturing post-laparoscopic trocar wounds. The tool contains two intersecting branches 1 pivotally connected to each other with a handle in the form of rings 2 for fingers at one end and working parts at the other end. The working part 3 of the jaw 1 has a bent at right angles with protrusions 4 at the ends to keep the fabric from slipping. The rounding of the working part 3 with the protrusions 4 in the closed state are closed parallel to each other in the same plane with the rings 2 of the handle. The tool is equipped with a clamp in the form of a cremolera 5.

When suturing post-laparoscopic trocar wounds, the instrument is inserted vertically into the abdominal cavity when closed (Fig. 1). The rounding of the working part 3 is thus closed parallel to each other and does not injure the surrounding tissue. Then, under the control of the laparoscope, the tool is opened using the rings 2 of the handle (Fig. 2), while the jaws with curves 3 diverge in opposite directions, forming a guide for raising the aponeurosis 6. The protrusions 4 on the curves of the working part 3 exclude tissue slipping from the tool (Fig. 3). The surgeon’s assistant removes the skin and subcutaneous fatty tissue with a Farabef hook 7. The next step is to capture the aponeurosis 6 with a needle under visual control, then the instrument is closed using the rings of the 2 handles. The diluted roundings of the working part 3 are closed parallel to each other. The tool is removed from the wound without injuring the surrounding tissue.

This tool has been tested in the surgical department of KBSMP Smolensk. The tool was used in 40 obese patients with a body mass index (BMI) of more than 30 kg / m ² . Patients are represented by age categories from 35 to 75 years. The postoperative period was uneventful. Patients were discharged 5-6 days after surgery. Skin sutures were removed on day 7 on an outpatient basis. In the period up to 1 year, not a single case of the formation of a trocar hernia was detected. Monitoring of patients continues.

The proposed tool is designed to raise the aponeurosis when suturing trocar wounds. Its application provides the following advantages:

increasing the reliability of suturing post-laparoscopic trocar wounds in patients with obesity, since it is possible to visually control the capture of the aponeurosis by the needle, which excludes tissue interposition between the leaves of the aponeurosis;

prevention of the formation of postoperative trocar hernias.

The tool should be used as a preventive measure to prevent hernia formation, especially in patients with obesity.

Claims (1)

A surgical tool for raising the aponeurosis when suturing post-laparoscopic trocar wounds, containing two intersecting, articulated jaws with a rack, working parts and handles in the form of rings, the ends of the working parts being rounded at right angles with protrusions at the ends to keep the tissue from slipping, while the working ends in the closed state are closed parallel to each other in the same plane with the handle rings, and when breeding, they diverge with the open part to the sides.

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