RU2638860C1 - Pusher for extracorporal application of endoscopic ligatures - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: pusher for in vitro application of endoscopic ligatures is designed as a metal cylindrical rod with a handle with a grooved surface at one end, and a working section with side grooves for thread fixation at the other end. The working part has the form of a "heart" with a wavy surface at the end with the following dimensions: length - up to 10 mm, width - up to 5 mm, thickness - up to 4.5 mm. On the front surface of the working area an arc-shaped recess is made in the entire thickness with the maximum depth to 1 mm in the center to contain the ligature assembly with formation of protrusions around the edges with an angle of 45 degrees dividing each across the center by a notch of up to 0.5 mm in depth, 1.5 mm in width, smoothly passing to the side groove.

EFFECT: application of the invention allows to ensure the elimination of the thread disintegration which facilitates its pushing and tightening.

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Description

The technical solution relates to medicine, namely to surgical instruments, and can be used to promote and tighten extracorporeal nodes in endoscopic operations.

Known pushers manufactured by Ethicon, made in the form of a plastic hollow tube, which are widely used when applying a ligature to protruding anatomical structures, for example, when ligating the base of the celoid process. The disadvantages of such pushers include the fact that when you tighten the knot, the thread slides around the ligated structure and grinds it. A pre-prepared loop cannot be brought under such structures as the non-intersected cystic duct, the mesentery of the vermiform appendix through the window formed in it at the dome of the cecum. To apply a ligature to such structures, you must first pass the thread through the specified window, extracorporeally form a Roeder loop from it, pass one of its ends through the thin channel of the plastic pusher, and only then tighten the loop, which takes too much time (see Dronov A.F. . and others. Laparoscopic appendectomy (literature review and own experience) // Endoscopic surgery. - 2000. - No. 3. - P. 16-20).

Known pushers of the company Lapomed and Sterna, made in the form of metal rods with a diameter of up to 5 mm and a length of 330 mm. There is a handle on one side of the shaft and a working part on the other. One model of the pusher along the axis of the working part is made with a longitudinal channel up to 10 mm long and up to 1 mm in diameter, located from the end to the side recess. Other models of pushers of these firms are made in the form of a metal cylindrical rod with lateral grooves on the working part, fixing the thread, or in the form of a metal rod with protrusions-traps for threads, made on the end of the working part (see Lapomed.com.ua/tolkateli-ligatur / tolkateli-uzla-endokorporain ...).

Known pusher for releasing extracorporeal nodes of the Roeder type, comprising an elongated shaft with a grooved handle at one end and a working part in the form of a truncated cone for interaction with the node at the other end. The working part is made with a cavity. A through window for the thread is made on the side surface, from which a groove for the thread is made along the pusher to its working end, made in the form of a slot extending in depth to the inner cavity of the working part (see patent 160124 U1, IPC A61B 17/04).

The disadvantages of the known technical solutions are:

- loosening of the threads when pushing the knot by pressure on it with the end part of the pusher, which makes it difficult to advance and tighten the knot, reducing its reliability;

- loose tightening of the knot (the knot opens) if the pressure of the pusher falls on one of the threads, and the second thread plays the role of an axis around which the first is tied. The axis thread located between the surgeon’s fingers and the knot is shorter than the one on which the pusher pressure is created. To tie the thread, the surgeon must hold both ends of the thread in tension. After tightening the first node and stopping the pressure of the pusher on the thread, the yarn-axis is pulled out until the length of both segments of the threads is completely equalized, while the threads roll in the knot and it dissolves;

- the pusher “sticks” into the tissue of the organ on which the ligature is applied, and can cause its damage with serious complications when the protrusions-traps for the thread located on the end of the pusher penetrate deeper into the fabric than the knot itself in the tightened state.

The closest technical solution to the claimed is a pusher company Lapomed, made in the form of a metal cylindrical rod with a diameter of up to 5 mm and a length of 330 mm. A handle with a grooved surface is made on one side of the rod, and on the other hand, a working part up to 10 mm long, on which lateral grooves are made for fixing the thread (see Lapomed.com.ua/tolkateli-ligatur/tolkateli-uzla-endokorporain ...).

A disadvantage of the known technical solution is the loosening of the threads of the node when pushing the node end part of the tool, pressing on the node itself. This makes it difficult to move and tighten the node, reducing its reliability.

The technical result of the claimed technical solution is the elimination of the loosening of the threads of the node, facilitating its pushing and tightening.

The technical result is achieved by the fact that in the pusher for extracorporeal application of endoscopic ligatures made in the form of a metal cylindrical rod containing a handle with a grooved surface at one end and a working part with side grooves for fixing the thread at the other end, the working part has the shape of a "heart" with a wavy surface at the end with the following dimensions: length - up to 10 mm, width - up to 5 mm, thickness - up to 4.5 mm, while on the end surface of the working part, an arcuate a container with a maximum depth in the center of up to 1 mm for placement of a ligature assembly in it with the formation of protrusions at the edges with an angle of 45 degrees with the separation of each protrusion in the center by a recess up to 0.5 mm deep, up to 1.5 mm wide, smoothly turning into the side groove .

The execution of the working part in the form of a "heart" with a wave-like surface at the end with the following dimensions: length - up to 10 mm, width - up to 5 mm, thickness - up to 4.5 mm with the execution on the end surface of the working part to the entire thickness of the arcuate recess with the maximum with a depth of up to 1 mm in the center for placement of a ligature unit in it with the formation of protrusions at the edges with an angle of 45 degrees with the separation of each protrusion in the center by a notch with a depth of up to 0.5 mm, a width of up to 1.5 mm, smoothly passing into the lateral groove, knot threads on the surface ok at a distance of 0.5 mm from the end in the center of the side protrusions, while the node is located in the center of the end part at a distance of up to 0.5 mm from the end in the recess, which creates a space for the node, free from tool pressure, and when pushing the node, the pressure is on both ends of the thread, well fixed in the side grooves of the working part of the tool. The knot does not feel pressure and its threads do not get loose, which facilitates the promotion and tightening of the knot with good quality ligature and reducing the time for surgery.

In FIG. 1 a) - general view of the pusher; b) is a view along arrow A in FIG. one;

In FIG. 2 a) - the working part of the pusher, increased; b) is a view along arrow A in FIG. 2 a; c) is a view along arrow B in FIG. 2a;

In FIG. 3 shows schematically the location of the threads and the knot on the pusher when applying a ligature.

The pusher for extracorporeal application of endoscopic ligatures is made in the form of a cylindrical rod 1 of metal. The length of the pusher, for example, 240 mm or 290 mm, depending on the type of operation. On one side of the rod 1, a handle 2 is made in the form of a corrugated cylinder with a diameter and length of, for example, 9 mm and 40 mm, respectively. On the other side of the cylindrical rod 1 is located the working part of the pusher with dimensions: length - up to 10 mm, width - up to 5 mm, thickness - up to 4.5 mm, in shape resembling a "heart", the wavy surface of which is located at the end of the pusher, and the top smoothly passes into the cylindrical rod 1 of the pusher. An arcuate recess 3 is made on the end surface over the entire thickness of the working part, with a maximum depth in the center of up to 1 mm for placement of a ligature unit in it. The recess 3 gradually disappears to the side edges of the end surface, forming protrusions 4 with an angle of 45 degrees. On the lateral surfaces of the working part of the pusher are located along one longitudinal groove 5 for fixing the thread with dimensions, for example, up to 1.5 mm wide, up to 10 mm long and up to 1 mm deep. The longitudinal grooves 5 smoothly disappear to the rod 1 of the pusher. Each protrusion 4 in the center is divided by a recess 6 with a depth of up to 0.5 mm, a width of up to 1.5 mm, smoothly passing into the side groove 5.

A pusher for extracorporeal application of endoscopic ligatures is used as follows.

With an endoscopic clamp, the thread, folded in half in the form of a loop, is passed through the port into the abdominal cavity and is thrown onto the protruding anatomical formation, for example, the celiac process, while the two ends of the thread remain outside. Then, extracorporeally (outside), we knit a knot from these threads. This knot is pushed into the abdominal cavity by the pusher. For this, the threads are placed on the surface of the recesses 6 and in the side grooves 5 of the pusher, while the node is placed in the center of the end surface in the recess 3 at a distance of up to 0.5 mm from the end face (Fig. 3). Holding the threads with one hand, with the other hand we move the pusher, while the pressure is applied not to the knot, but to the thread through the surface of the recesses 6 of the pusher. The node is pushed into the abdominal cavity and tightened on a ligated anatomical formation. We take out the pusher, again knit the knot from the outside, push it into the abdominal cavity in the same way and tighten it to fix the knot. We carry out these manipulations several times to firmly fix the knot and impose a high-quality ligature.

To apply a ligature to the disjointed cystic duct or mesentery of the appendix, one end of the thread is brought under the formation and brought out. Both ends of the thread in the hands are tied into a knot, advanced and tightened with a pusher in the same way.

A pusher for extracorporeal application of endoscopic ligatures, which provides ligature application without loosening the threads of the knot, which facilitates pushing and tightening of the knot, accelerating the process and improving the quality of ligature application, will be used in medicine.

Claims (1)

Pusher for extracorporeal application of endoscopic ligatures, made in the form of a metal cylindrical rod containing a handle with a grooved surface at one end and a working part with side grooves for fixing the thread at the other end, characterized in that the working part has the shape of a "heart" with a wavy surface at the end with the following dimensions: length - up to 10 mm, width - up to 5 mm, thickness - up to 4.5 mm, while on the end surface of the working part, an arcuate notch with a maximum depth of with a bin in the center of up to 1 mm for placement of a ligature unit in it with the formation of protrusions at the edges with an angle of 45 degrees with each dividing each in the center by a notch with a depth of up to 0.5 mm, a width of up to 1.5 mm, smoothly turning into a side groove.

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