RU2795247C2 - Method for intraoperative visualization of the circulatory network of hollow organs in abdominal surgery and a diaphanoscope with a telescopic light-emitting probe for performing surgical operations on hollow organs in abdominal surgery - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: diaphanoscope consists of a body and a telescopic light-emitting probe, containing a main light-emitting olive and an auxiliary light-emitting olive, with the possibility of longitudinal movement, and during the operation, a telescopic light-emitting probe is inserted through the biological holes under visual control, visually determining the boundaries of the neoplasm with a lower intensity of luminescence compared to unchanged region; using transillumination, a telescopic light-emitting probe is placed above the neoplasm for further resection of the affected area; before resection, clipping of blood vessels, ligation of the organ at the intended level and excision of hollow organs under the control of transillumination are performed, exercising visual control from the side of the lumen of the hollow organ; then, the stump of the hollow organ is fixed at the distal end of the telescopic light-emitting probe and evagination is performed with the extension of the telescopic light-emitting probe, namely, the auxiliary light-emitting olive is extended beyond the area of the neoplasm, visually determining the boundaries of the neoplasm with a lower intensity of luminescence compared to the unchanged area; clipping and ligation of blood vessels and resection of the affected area of the hollow organ is performed under the control of transillumination of an auxiliary light-emitting olive; then the rest of the stump of the hollow organ is anastomosed with the unchanged tissues of the hollow organ.

EFFECT: use of this group of inventions will make it possible to visualize the circulatory network and the evagination of the operated organ.

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Description

SUBSTANCE: group of inventions relates to medicine, namely to surgery, and can be used during operations (manipulations) in abdominal surgery, namely for external intraoperative illumination of the intestine and esophagus over a large area.

The success of surgical intervention is largely determined by the recognition of lesions in the surgical field. The tasks of operational visualization are multifaceted and are not the same in complexity and content in different cases. They include the determination of the pathological focus, its nature, the extent of the lesion, concomitant changes, the identification of the source of bleeding, the determination of the viability of the wall of a hollow organ, the identification of anatomical and pathological formations. Much in the operating field remains invisible. A small layer on top of the underlying tissues or the location of formations in the inner layers of the organ wall is enough so that they cannot be seen, much is determined by palpation during the operation.

One of the visualization methods is the transillumination method, which is an assessment of shadow formation in transmitted light through the object under study. This method has found wide application in medicine for the detection of peripheral veins [1], the study of the inner membranes of the eye [2], and the study of dental hard tissues [3].

In open surgery, the transillumination method has long been known, which is used to study the structure of vessels that feed the hollow organs of the abdominal cavity, trachea, esophagus, etc. [4-6]. The device for illuminating the patient's internal tissues and organs includes an array of LEDs. The location of the LED array depends on the device configuration and the procedure for which the device is being used.

Numerous techniques with endoscopic and laparotomic approaches have been developed to remove the neoplasm. In abdominal surgery, the main way to remove stage 3-4 cancer is to extirpate the affected area within healthy tissues with an end-to-end anastomosis.

The scientific works of I.I. Grekov in the field of abdominal surgery. The methods of resection of the sigmoid colon developed by him (1910, 1924) were included in practical surgery as operations of "Greeks I" and "Greeks II" [7]. Of the simultaneous resections, one can point to the method of "Greeks I" with intestinal evagination. Technically, evagination is performed by introducing a forceps with a Murphy button fixed on it into the lumen of the rectum, around which a retractable segment of the affected intestine is fixed with a thick thread. However, this method lacks illumination for examination of organs and tissues in transmitted light.

Thus, the search for new methods of surgical intervention aimed at removing tumors of hollow organs is an urgent task of modern reconstructive surgery.

The prototype for the creation of this solution is the “Method for intraoperative visualization of a tubular structure” [8]. This method is recommended for visualization of ducts, ureters or blood vessels during operations. The method provides a reduction in the duration of the operation by reducing tissue trauma and damage to the hollow organ. Inside the tubular structure, a light guide with a rounded end is introduced by puncturing the wall or through natural paths. The organ is illuminated from the inside with monochromatic light with an intensity sufficient for external visualization through the surrounding soft tissues of the contours of the operated organ. The location of the operated organ is determined by the light.

However, the output of light at the end of the light guide does not provide uniform diametrical light radiation for visualizing the walls of a hollow organ over a large area, and the shape does not allow evagination of a hollow organ.

Achievable technical result is intraoperative visualization of the operated organ during evagination in abdominal surgery.

The method for implementing intraoperative visualization of the operated organ during evagination is carried out using a diaphanoscope created by us with a telescopic light-emitting probe. A telescopic light-emitting probe is inserted into the operated hollow organ.

Diaphanoscope (Fig. 1) includes: telescopic light-emitting probe 1 and body 2.

Telescopic light-emitting probe (Fig. 2), consisting of a polyvinyl chloride (PVC) tube 3 with an outer diameter of 5-10 mm and a length of 500 to 1500 mm and a fluoroplastic tube 4, with an outer diameter of 2-3.5 mm and a length of 500 to 1500 mm; two connectors 5 for connection to the case 2; splitter 6 intended for dilution of the probe to different connectors of the body 2; the main light-emitting olive 7 with an outer diameter of 18 mm and a length of 13 mm, and an auxiliary light-emitting olive 8 with an outer diameter of 10 mm and a length of 11 mm, with an emission spectrum in the range from UV to IR inclusive; mounting wires coming from light-emitting olives 7, 8 through polyvinyl chloride (PVC) tube 3 and fluoroplastic tube 4 to connectors 5 of the telescopic probe.

The main light-emitting olive (Fig. 2a) includes a body of the main light-emitting olive 9, made of a material approved for use in medicine, with a fitting 10, in the form of a single piece and is hollow. The fitting 10 has herringbone notches for the best possible fixation. An optically transparent lens 11 is poured onto the body of the main light-emitting olive 9. LED crystals 12 are arranged in a circle on the first ring 13 with the help of conductive glue in the amount of 4 to 12 pcs. at an angle of 30 to 90 degrees from each other. The location of the LED crystals 12 in a circle allows you to get a uniform diametrical light emission directly in the area of the operated organ. The first ring 13 with LED crystals 12 and the second ring 14 are made of conductive material coated with silver to prevent corrosion, and are connected with gold wire 15 by spot welding to ensure permanent electrical contact. The mounting wire is led out through the hole 16 and soldered to the first ring 13 and the second ring 14 to provide electrical connection with the housing 2. The mounting wire is located in the insulating tube 17, designed to protect the wires during mechanical cleaning of the inner channel of the flexible tube. To prevent a short circuit on the body of the main light-emitting olive 9, when voltage is applied to the light-emitting crystals 12, a dielectric 18 is installed, since the body of the main light-emitting olive 9 during the operation has direct contact with the patient's organs. The dielectric 18 is designed to prevent a short circuit when voltage is applied. The cavity 19 of the body of the main light-emitting olive 9 to accommodate the auxiliary light-emitting olive.

Auxiliary light-emitting olive (Fig. 2b) includes a hollow body of the auxiliary light-emitting olive 20, made of a material approved for use in medicine. The LED crystals 21 are arranged in a circle on the first ring 22 by means of a conductive adhesive in an amount of 4 to 12 pcs. at an angle of 30 to 90 degrees from each other. The location of the LED crystals 21 in a circle, allows you to get a uniform diametrical light emission directly in the area of the operated organ. The first ring 22 with LED crystals 21 and the second ring 23 are made of conductive material coated with silver to prevent corrosion, and are connected with gold wire 24 by spot welding to ensure permanent electrical contact. To prevent a short circuit on the hollow body of the auxiliary light-emitting olive 20, when voltage is applied to the light-emitting crystals 21, a dielectric 25 is installed, since the hollow body of the auxiliary light-emitting olive 20 during the operation has direct contact with the patient's organs. Dielectric 25 is designed to prevent a short circuit when voltage is applied. Flexible cable 26 with a diameter of 1-1.5 mm, designed for additional structural rigidity, is glued to the hollow body of the auxiliary light-emitting olive 20 with epoxy glue 27. Flexible cable 26 is located in a fluoroplastic tube 28 since fluoroplastic does not cause immunological reactions, is biologically and physiologically harmless, and also for placement inside the tube of the mounting wire. The mounting wire is led out through the hole 29 and soldered to the first ring 22 and the second ring 23 to provide electrical connection with the body 2. An optically transparent lens 30 is cast on the hollow body 20 and part of the PTFE tube 28 from epoxy glue on a platinum catalyst.

Housing 2 (Fig. 3) is equipped with on/off buttons 31; a light indicator line showing the level of luminescence 32; buttons for adjusting the intensity of the glow 33; connectors 34 for connecting a telescopic light emitting probe; rechargeable battery; a telescopic light emitting probe control board; connector 35 for recharging the battery (battery). When the power button 31 is pressed and held for 5 seconds, one of the light indicator lines 32 lights up, indicating the battery charge level. The lighting of five LEDs on the indicator line means 100% battery charge, four LEDs - 80%, three LEDs - 60%, two LEDs - 40% and one LED - 20%.

The indicated quantitative values of the structural elements of the telescopic light-emitting probe are optimal and it is obvious that depending on the anatomical features (for example, the patient's age, height, etc.), these dimensions can vary without changing the result achieved.

Implementation example:

When performing an operation in abdominal surgery, the main light-emitting olive is turned on, while the green light of the light indicator line on the body 2 lights up, which means a minimum of the glow of the main light-emitting olive. The telescopic light emitting probe is inserted into the rectum 36 of the patient through the anus 37 (FIG. 4). As necessary, the intensity of the glow of the main light-emitting olive 7 increases, while the LEDs on the light indicator line light up. The glow of all indicators on the light indicator line means the maximum light emission of the main light-emitting olive. Under visual control of light radiation through soft tissues, a telescopic light-emitting probe is advanced along the rectum 36 to the sigmoid colon 38, passing the area of the neoplasm 39. Directly in the neoplasm zone, the intensity of the luminescence is lower than in its unchanged part, which allows visualizing its borders.

Thus, the method developed by us is implemented as follows. The main light-emitting olive 7 provides visualization of the circulatory network of the operated organ, which allows for a qualitative assessment of the vessels, and in the presence of pathological formations, they can be detected.

The next step is the excision of the rectum 36 above the neoplasm 39 (Fig. 5) and during evagination, the stump of the rectum 36 is temporarily fixed with a silk thread 40 behind the body of the main light-emitting olive 7 to prevent slipping. Before excision of the rectum 36, clipping and ligation of blood vessels in transmitted light is performed.

Then produce traction telescopic light-emitting probe for evagination of the stump of the rectum 36 (Fig. 6). When carrying out evagination, the auxiliary light-emitting olive 8 is turned on, while the green light of the indicator light on the body 2 lights up, which means the minimum glow of the auxiliary light-emitting olive. As necessary, the intensity of the glow of the auxiliary light-emitting olive increases, while the LEDs on the light indicator line light up.

Then, the auxiliary light-emitting olive 8 is advanced beyond the area of the neoplasm 39 for further resection of the affected area (Fig. 7). Before resection of the rectum 36, blood vessels are clipped and ligated in transmitted light. The rest of the stump of the rectum 36 is anastomosed with the relegated sigmoid colon 38.

A diaphanoscope with a telescopic light-emitting probe allows you to quickly determine the location of blood vessels, conduct visual inspection in transmitted light over a large area, reduce the duration of operations and increase the proportion of organ-preserving operations.

Additional versions of the diaphanoscope with a telescopic light-emitting probe are possible:

- the body of the main light-emitting olive 9 and the hollow body of the auxiliary light-emitting olive 20 (Fig. 2) can be made of a non-metallic material approved for use in medicine, in which case the dielectric between the housings and current-conducting rings with light-emitting LEDs is not needed;

- it is possible to arrange the main and auxiliary light-emitting olives one behind the other (Fig. 8), which will ensure a decrease in the diameter of the olives;

- other ways of arranging the olives are possible to ensure the directivity of the light due to the reflectors 41, some possible options for the location of the olives are shown in figure 9;

- it is possible to change the form factor of the body of the main light-emitting olive 9 and the hollow body of the auxiliary light-emitting olive 20 (Fig. 2) due to structural changes, which allows to increase the number of LEDs and, as a result, to increase the glow area. One of the options for changing the form factor of the body of the main light emitting olive 9 and the hollow body of the auxiliary light emitting olive 20 is shown in figure 10;

- the splitter 6 of the telescopic light emitting probe (Fig. 2) can be rotated separately from the PVC tubes 3 by 360 degrees, which will provide "flexibility" for using the telescopic light emitting probe connected to the body 2 during surgical operations. The figure 11 shows one of the variants of the splitter. The rotation of the splitter is provided by rotating fittings;

- it is possible to use instead of flexible PVC 3 and fluoroplastic 4 tubes (Fig. 2) other types of flexible tubes approved for use in medicine, for example: silicone, rubber, etc., which allows you to select the necessary tubes according to physical and chemical properties and sizes;

- in case 2, it is possible to use various types of displays, including touch ones (OLED, LCD, TFT, LCD, etc.) to display information instead of a light indicator line 32 showing the level of luminescence (Fig. 3).

Information sources:

1. Zyatkov D.O., Glushkov G.S., Bogomolov E.N., Shashev D.V. Portable device for visualization of saphenous veins. Biotechnosphere. 2018; #1 (55): 15-18.

2. Kozlova I.V., Reshchikova B.C., Antonov A.A., Chichenkov O.N. Acute bilateral uveitis-like syndrome accompanied by transillumination of the iris (clinical case). GLAUCOMA. 2013; 3-1:59-64.

3. Granko S.A., Danilova D.V., Beloded L.V. Diagnosis of initial carious lesions of hard tissues of teeth. Modern dentistry. 2017; #4: 59-62.

4. Yi-Shan Liu, Hung-Chi Chen, Kuo-Piao Chung, Tzong-Shiun Li. Transillumination Instrument Facilitates Faster and More Accurate Dissection of Right Colon Segment for Oesophageal Reconstruction. ASIAN JOURNAL OF SURGERY. 2010; Vol 33(2): 94-96.

5. Botsula O.H., Dambaev G.Ts., Soloviev M.M., Popov A.M. A method for intraoperative assessment of blood supply to the small intestine in acute mesenteric ischemia. Bulletin of new medical technologies. 2012; T. XIX, No. 4: 78-79.

6. Abdelkader Boukerrouche. 15-year Personal Experience of Esophageal Reconstruction by Left Colic Artery-dependent Colic Graft for Caustic Stricture: Surgical Technique and Postoperative Results. Journal of GHR. 2016, No. 5(1), 1931-1937.

7. Morgoshiya T.Sh. The contribution of the legendary surgeon Ivan Ivanovich Grekov to clinical surgery (to the 150th anniversary of his birth) // Annals of Surgery. 2017. Vol. 22, No. 6.

8. Patent RU No. 2160046 dated 12/10/2000. A method for intraoperative visualization of a tubular structure. Authors: Tarasov A.N.; Tarasov D.A.

Claims (4)

1. A method for intraoperative imaging in abdominal surgery, including visualization of the circulatory network of hollow organs, characterized in that a diaphanoscope is used to visualize the circulatory network and evagination of the operated organ, consisting of a body and a telescopic light-emitting probe containing a main light-emitting olive and an auxiliary light-emitting olive, with the possibility longitudinal movement, and during the operation, a telescopic light-emitting probe is inserted through the biological holes under visual control, visually determining the boundaries of the neoplasm with a lower luminescence intensity compared to the unchanged area; using transillumination, a telescopic light-emitting probe is placed above the neoplasm for further resection of the affected area; before resection, clipping of blood vessels, ligation of the organ at the intended level and excision of hollow organs under the control of transillumination are performed, exercising visual control from the side of the lumen of the hollow organ; then, the stump of the hollow organ is fixed at the distal end of the telescopic light-emitting probe and evagination is performed with the extension of the telescopic light-emitting probe, namely, the auxiliary light-emitting olive is extended beyond the area of the neoplasm, visually determining the boundaries of the neoplasm with a lower intensity of luminescence compared to the unchanged area; clipping and ligation of blood vessels and resection of the affected area of the hollow organ is performed under the control of transillumination of an auxiliary light-emitting olive; then the rest of the stump of the hollow organ is anastomosed with the unchanged tissues of the hollow organ. 2. Diaphanoscope, including a housing that is a power source, and a telescopic light-emitting probe, consisting of a PVC tube with an outer diameter of 5-10 mm and a length of 500 to 1500 mm and a fluoroplastic tube with an outer diameter of 2-3.5 mm and a length of 500 to 1500 mm; two connectors for connection to the case; a splitter designed to dilute the probe to different housing connectors; the main light-emitting olive with an outer diameter of 7-20 mm and a length of 10-15 mm and an auxiliary light-emitting olive with an outer diameter of 4-15 mm and a length of 5-11 mm with an emission spectrum in the range from UV to IR inclusive; installation wires coming from light-emitting olives through a PVC tube and a fluoroplastic tube to the connectors of the telescopic probe. 3. The main light emitting olive according to claim 2, characterized in that it contains a body of the main light emitting olive with a fitting in the form of a single piece, an optically transparent lens, the first ring on which the LED crystals are located in a circle at an angle of 30 to 90 degrees from each other in the amount of 4 to 12 pcs., the second ring, the first ring and the second ring are connected by wire to provide permanent electrical contact, the mounting wire is led out through the hole and soldered to the first ring and the second ring to provide electrical connection with the housing. 4. Auxiliary light-emitting olive according to claim 2, characterized in that it contains a hollow body of the auxiliary light-emitting olive, an optically transparent lens, the first ring, on which LED crystals are arranged in a circle at an angle of 30 to 90 degrees from each other in an amount of 4 to 12 pcs., the second ring, with the first ring and the second ring connected by a wire to provide an integral electrical contact, a flexible cable, a mounting wire that is led out through the hole and soldered to the first ring and the second ring to provide an electrical connection to the body.

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