RU2560779C1 - Method for blood sampling for reinfusion from laparoscopic approach - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: flexible tube, a free end of which is delivered to blood pockets, is inserted through a manipulation trocar into the abdominal cavity. That generates a pressure difference and makes the blood flow spontaneously into an additive container.

EFFECT: effective blood sampling for reinfusion from a laparoscopic approach by passive aspiration that causes preventing blood cell damage, and simplifies the blood sampling procedure.

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Description

The present invention relates to medicine, namely to abdominal surgery, and can be used in patients with abdominal trauma.

An urgent problem in abdominal surgery for traumatic injuries and injuries of the abdominal organs are measures to return the lost blood to the bloodstream. At the present stage of surgery, when up to 70% of operations in emergency abdominal diseases of the abdominal organs are performed from minimally invasive approaches, reinfusion methods have not been developed for these interventions. The lack of blood sampling methods for reinfusion during laparoscopy in order to replenish the volume of circulating blood significantly limits the use of laparoscopic access in conditions associated with acute intraperitoneal blood loss.

Often, on diagnostic laparoscopy, to establish the localization of damage and the nature of intra-abdominal bleeding, it is necessary to evacuate blood that is quite suitable for reinfusion. Our experience shows that often with abdominal injuries, bleeding at the time of laparoscopy has already stopped or it is of a low degree of intensity, and the severity of the condition is determined by the volume of spilled blood. In this regard, it seems possible to take this blood for reinfusion, perform hemostasis manipulations and further eliminate the effects of damage.

State of the art

There is a method of intraoperative hardware reinfusion of autologous blood, which consists in collecting blood from the surgical wound by gravity into a sterile package containing an anticoagulant attached with a sterile adhesive film to the lower edge of the surgical wound below the intended surgical incision, this autologous blood is processed in the apparatus and return to the bloodstream of the patient, and also collect blood by extracting red blood cells from surgical wipes soaked in blood; while the latter is placed in a sterile container containing an anticoagulant and a 0.9% sodium chloride solution, where they are kept for 20-30 minutes, after which the wipes are removed, and the red blood cells eliminated from the wipes and weighed in a preservation solution are processed in the apparatus and also returned into the bloodstream of the patient [patent RU 2232031, 2004].

A known method of blood sampling from the abdominal cavity with laparotomic access using a scoop [Reinfusion of blood with combined trauma [Electronic resource]. Access Mode: http://meduniver.com/Medical/Xirurgia/258.html MedUniver http://meduniver.com/Medikal/Xirurgia/258.html. Date of appeal: 02/07/2014].

The closest analogue of the invention is a method of blood sampling for reinfusion during laparoscopy by using a cannula for blood aspiration [Divakova TS et al. New technologies in the treatment and rehabilitation of patients with ectopic pregnancy using laparoscopic surgery (Instructions for use). Approved on June 26, 2006. S. 27-29 [Electronic resource]. Access mode: http: //med.bymethods/pdfy002-0106.pdf.]. However, this technique involves the collection of blood from laparoscopic access by active aspiration, which can lead to damage to blood cells.

The technical result of the invention is the prevention of damage to blood cells, simplification and reduction of the duration of the method, increasing the convenience for the surgeon.

The proposed method is as follows: during laparoscopy, a sterile flexible (polyvinyl chloride, silicone, etc.) tube with a diameter of 4 mm from 35 to 100 cm in length is inserted through the 5 mm trocar into the abdominal cavity (you can use a tube from the system for intravenous infusion), depending from the patient’s constitution, using the laparoscopic clamp inserted into the abdominal cavity through another manipulation trocar, direct the free end of the tube to the places of blood accumulation (lateral channels, small pelvis) using a paroscopic clamp installed from another 5 mm trocar access (figure). Due to the presence of pneumoperitoneum (12-20 mmHg, usually 14 mmHg), blood freely flows without the use of active aspiration by gravity due to the pressure difference into a container with a preservative, for example, Glugicir (Dextrose + Sodium Citrate). The average calculated blood flow rate is 150 ml per minute. Further, this blood through the Cell Saver apparatus returns to the bloodstream of the patient.

The advantages of the method of blood sampling for reinfusion from laparoscopic access:

1. Preservation of mini-invasiveness;

2. The minimum time for laparoscopic access (installation of trocars) and the start of reinfusion compared with laparotomy;

3. The time of laparoscopic blood sampling for reinfusion is from 2 to 10 minutes with a volume of 200 ml to 1500 ml;

4. The absence of negative effects of vacuum on blood cells;

5. Lack of reduction of pneumoperitoneum and, as a consequence, deterioration in the visualization of abdominal organs;

6. Blood sampling for reinfusion with laparoscopy greatly facilitates the further rehabilitation of the abdominal cavity.

Laparoscopic blood sampling for reinfusion was used for closed injuries of the spleen, liver, mesentery of the small and large intestine, tears of the ligamentous apparatus of parenchymal organs, in only 27 cases. The volume of blood taken ranged from 200 ml to 2000 ml, an average of 940 ml. The average manipulation time was 6.5 minutes. With a blood loss of over 2000 ml or continued intensive intra-abdominal bleeding, blood was not taken for reinfusion, but a wide laparotomy and measures to stop the bleeding were performed, since delaying the laparoscopic stage can lead to an increase in the volume of blood loss. We found this situation in 2 (7.4%) patients.

The invention is illustrated by the following clinical example. Patient G., 59 years old, was admitted to the hospital 06/26/2013 3 hours after receiving an intentional injury (received a blow to the abdomen with an unknown person). On admission, the patient’s condition of moderate severity, clear consciousness, heart rate of 96 beats per minute, blood pressure 100/60 mm Hg The patient underwent an ultrasound examination of the abdomen, in which free fluid was revealed in the abdominal cavity. Further, a patient under intubation anesthesia underwent emergency diagnostic laparoscopy, in which blood was revealed in the right lateral canal, in the subhepatic space, in the right subphrenic space and in the small pelvis with 1/3 immersion of the loops of the small intestine. Then, through a 5 mm manipulation trocar, a sterile tube with a diameter of 4 mm and a length of 60 cm was introduced into the abdominal cavity from the intravenous infusion system, the free end of which was sequentially directed to the above-described places of blood accumulation using a laparoscopic clamp installed from another 5 mm trocar access. Due to the presence of pneumoperitoneum (14 mmHg), blood of 1400 ml volume was freely evacuated without gravity by gravity into a container with Glugicir, after which it was returned to the bloodstream with the Cell Saver. The source of bleeding was a superficial rupture of 6 segments of the liver along the diaphragmatic surface of 40 × 5 mm, with bleeding of low intensity at the time of surgery. Hemostasis is achieved by electrocoagulation of the rupture area. The operation was completed by draining the small pelvis and the right lateral canal with 2-lumen polyvinyl chloride drainages through separate incisions on the anterior abdominal wall. Sutures from the wound were removed to the patient on the 7th day after the operation. On day 12, the patient was discharged with recovery in satisfactory condition.

Claims (1)

The method of blood sampling for reinfusion during laparoscopy, characterized in that a flexible tube is inserted through the manipulation trocar into the abdominal cavity, the free end of which is sent to the places of blood accumulation, after which the blood flows by gravity into the container with a preservative.

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