RU2529396C1 - Combined needle-clamp for ligature herniorhaphy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: needle-clamp for simultaneous application, grip and removal of the ligature in tissues comprises a hollow metal rod of the length of 13 cm and of the diameter of 1.9 mm. A distal end of the rod has a radius of curvature of 20 mm. The rod is rigidly attached to a handle. The rod comprises a movable branch of the length of 7 mm. When closed, the branch does not project above the rod surface. An end face of the handle comprises a spring-assisted button to control the branch by means of a rigid metal pole. When pressing the button, the branch opens at an angle of approximately 40 degrees. The handle comprises a connector.

EFFECT: using instrument in operations of video-assisted sub-peritoneal ligation of the hernia sac neck provides comfortable manipulations, non-invasiveness and reduced length of the operative intervention.

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Description

The invention relates to medicine, in particular to surgery, and can be used in the surgical treatment of children with hernias of the anterior abdominal wall using extraperitoneal ligature herniography. To do this, it is proposed to use a special tool in the form of a curved needle with a handle and a controlled movable jaw on the working part, with which you can grab and hold the ligature at the stages of passing through the fabric without the use of additional tools.

Surgery for inguinal hernias in frequency occupy the first place in planned surgery of children. Since 2005, a new type of surgical operation for inguinal hernias has been introduced into practice - the so-called SEAL (Subcutaneous EndoscopyAssisted Ligation), which consists in bandaging the neck of the hernial sac with surgical thread, carried out subperitoneally and circularly covering the neck. To conduct the ligature, several methods are used that require appropriate tools. So, S.K. Yeung suggests using a Deschamps-type needle with a blunted end and a hole through which the end of the ligature is threaded in a sagittal plane (1). The tool is safe enough for the tissues, but passing the thread through the hole is a difficult manipulation, which takes a lot of time and is possible only with a relatively rigid monofilament suture material. Karl Storz offers a similar tool - Yeung pediatric inguinal hemiotomy hook needle (catalog number 26167НН), which features a wider working part with a longitudinal recess along which the end of the thread slides, eventually falling into the hole. To further facilitate this stage, R.O. Ignatiev suggested using the additional “loop-lasso” method (2). Its essence lies in the formation of a loop from the auxiliary ligature threaded through the hole of the needle before insertion into the abdominal cavity. This loop serves to capture the end of the main ligature in the abdominal cavity. This technique significantly speeds up and simplifies manipulation. In addition, it becomes possible to use soft suture material that does not cause discomfort to the child in the postoperative period. These methods have a common serious drawback - they require the introduction of an additional tool (usually endo-clamp) into the abdominal cavity, which increases the invasiveness of the procedure and worsens the cosmetic result.

Yu.A. Kozlov et al. use the standard Tuohy 15G needle as a tool for ligature, moving the ligature through its lumen (3). To capture the end of the thread in the abdominal cavity, the “loop-lasso” technique is also used, which in some cases makes it possible to do without installing an additional trocar and using an endo-clamp. The disadvantage of this technology should be considered a high risk of injury to the sharp end of the needle of the vas deferens and blood vessels. D. Ozgediz et al. described several cases of iliac vein damage during manipulations with a Tuohy needle with the development of retroperitoneal hematomas (4).

The use of a standard surgical atraumatic needle during SEAL surgery, which is fixed on the outside with a standard needle holder, is guided through the tissues and expelled to the skin, cannot be considered the optimal way. At the same time, there is a risk of injury to the surrounding anatomical structures by the sharp end of the needle, and the features of the tool trajectory lead to excessively wide tissue capture, which does not exclude the gradual weakening of the seam or rough scarring. With this method, there remains the danger of capture in the suture of nearby nerve trunks with the development of postoperative pain.

Thus, the optimal tool for carrying out the ligature during such operations should have the following characteristics:

1. Atraumatic.

2. Convenience of manipulation.

3. The rapid release and capture of the ligature in the abdominal cavity without auxiliary tools.

4. The ability to fully sterilize.

The purpose of the development of the instrument was to improve the technology of ligature herniography in the treatment of children with hernias of the anterior abdominal wall.

The task consisted in the design, manufacture and practical application of a combined tool with the properties of a needle and a clamp, which allows for the capture and retention of the thread at all stages of its conduct in tissues without the use of additional tools.

To solve this problem, a combined tool was developed and manufactured (Figure 1), which is a hollow metal rod 13 cm long, with an external diameter of 1.9 mm and an internal diameter of 1.5 mm, made of medical stainless steel. A metal tip of circular cross section, coinciding in external diameter with a hollow rod, is rigidly attached to one of the ends of the rod by soldering. The tip has a curved shape, the bending radius is 20 mm (position 1). The tip tip is blunt. The transition point of the hollow rod into the tip is processed by grinding and polishing so that the transition zone is smoothed as much as possible. The opposite end of the hollow rod is rigidly attached to a metal handle of circular cross section with a diameter of 1 cm made of titanium alloy (position 2). The handle is collapsible, contains two parts with a threaded connection to each other. Inside the handle is hollow, the diameter of the internal channel is 6 mm. In the area where the straight part of the working rod passes into a curved tip, there is a movable jaw made of medical stainless steel with dimensions 1 × 1 × 7 mm (position 3), under which a longitudinal recess of similar dimensions is milled in the tip material. In the closed state, the branch is completely immersed in the recess, therefore, it does not protrude above the surface of the rod, which ensures unhindered progress of the instrument in the tissues. In the open state, the jaw forms an angle of about 40 degrees with the longitudinal axis of the tool (position 5). The jaw's mobility is ensured due to its articulated fastening of one of the ends on the transverse rigid axis, it is controlled by a metal wire of stainless steel with a diameter of 0.6 cm, passed inside the hollow shaft and the handle and reaching the opposite end of the handle. One end of the rod is movably connected to the jaw, the second is rigidly connected to the button (position 4) at the end of the handle that controls the position of the jaw. When the button is pressed, the movement is transmitted through the wire rod to the jaw, the jaw is opened, due to which it is possible to capture the thread. Inside the handle there is a metal spring, one end of which is fixed to the walls of the handle, and the other abuts against the button. When the button is pressed and the jaw is opened, the spring is compressed, when the button is released, the spring is opened, transferring force to the button, and thereby returns the jaw to the closed position, while holding the surgical thread. For high-quality sterilization of the instrument, all internal channels and parts are blown with compressed air through a Luer type connector soldered to the handle, which has direct communication with the internal channels (position 6), its location is not of fundamental importance. The view of the manufactured combined clamp-needle for hernioraphy is shown in the photograph (figure 2). The use of the instrument during the operation of ligature herniography in a child is represented by figure 3, figure 4.

Bibliography

1. Yeung C.K., Lee K.H. Inguinal Herniotomy: Laparoscopic - assisted Extraperitoneal Technique, in Klaas M.A. Bax (eds.) Endoscopic Surgery in Infants and Children, Berlin, 2008: 591-596.

2. RF patent for the invention No. 2452402 from 02.24.2011

3. Kozlov Yu.A. et al. Laparoscopic inguinal hernia is a modern method of treating inguinal hernias in young children. Russian Bulletin of Pediatric Surgery, Anesthesiology and Intensive Care, 2011, No. 4, p.20-27.

4. Ozgediz D., Roayaie K., Lee H. et al. Subcutaneous endoscopically assisted ligation (SEAL) of the internal ring for repair of inguinal hernias in children: report of a new technique and early results. // Surg Endosc. 2007 Aug; 21 (8): 1327-31

Claims (1)

A clamp-needle surgical instrument for simultaneously holding, gripping and retrieving a ligature in tissues in the form of a hollow metal rod 13 cm long with a diameter of 1.9 mm and a distal end having a bending radius of 20 mm, the rod being rigidly attached to a round cross-section handle with a diameter of 1 cm ; in the area where the straight part of the shaft becomes curved, there is a movable branch 7 mm long, which in the closed state does not protrude above the surface of the shaft, and in the open state forms an angle of about 40 degrees with the longitudinal axis of the tool; at the same time, a spring-loaded button is located at the end of the handle for controlling the jaws by means of a rigid metal rod: when the button is pressed, the jaw is opened, and when the jaw is released, it returns to the closed position; the handle contains a connector.

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