RU2805799C1 - Set of laparoscopic instruments for removing stones from common bile duct - Google Patents

Abstract

FIELD: medical equipment; surgical instruments.

SUBSTANCE: invention can be used to extract stones. A set of laparoscopic instruments for removing stones from the common bile duct contains a laparoscopic clamp with a working end for gripping, an instrument with a basket for removing stones and a bougie for expanding the terminal part of the common bile duct, each of which contains a rod, the end diameter of which is 4 mm, and limiters at the end of the rod, made in the form of washers located at a distance of 7 mm from each other. The laparoscopic clamp contains two jaws made with semicircular cutouts 3 mm deep, which form, when the jaws are closed, a hole with a diameter of 6 mm for gripping the end of the rod with the jaws between the washers of an instrument with a basket or bougie.

EFFECT: use of the invention allows to remove stones (concretions) from the common bile duct.

1 cl, 3 dwg

Description

The invention relates to medicine, namely to surgery and surgical instruments, and can be used to extract stones.

The problem of cholelithiasis remains relevant today. According to various authors, the incidence rate ranges from 8 to 20% among the adult population, and an increase in this pathology is noted. One of the most serious complications of cholelithiasis is choledocholithiasis - the presence of stones in the bile ducts, which occurs in 8-30%. In turn, choledocholithiasis leads to the development of such serious complications as obstructive jaundice, cholangitis, pancreatic necrosis, requiring emergency surgical interventions. Currently, there are two main approaches for the treatment of choledocholithiasis. Today, one of the treatment methods is laparoscopic choledocholithotomy, but difficulties arise when removing fixed, large stones larger than 10 mm, since laparoscopy eliminates the possibility of manual manipulation in this area. The use of Dormia endoscopic baskets in such cases is ineffective, since they are deformed. Therefore, an instrument specially designed for laparoscopic stone removal is required in cases where traditional instruments such as the Dormia endoscopic basket, Fogarty probe and others are ineffective.

The well-known “Instrument for removing stones from tubular organs” (Patent RU No. 2284771, IPC A61B 17/221 - 10.10.2006, Bulletin No. 28), consists of a tubular body, inside of which a conductor is located. The conductor has a handle on one end and a gripping basket on the other end. The conductor is made of a spring plate and is connected through an adapter to a basket of cables. The conductor has a radius rectangular bend. The basket has a spoon shape with a tip at the front. The cables are designed to be tensioned and form a bag.

The disadvantage of this instrument is that during laparoscopic access the handle is located outside the abdominal cavity and the guide with the basket can only perform reciprocating movements, while it has a fixed radius rectangular bend, which limits the ability to control the vector of movement of the basket (change the angle of movement of the basket in the distal sections of the common bile duct) depending on its diameter and the size of the stone. In addition, different sizes of gripping devices are required to remove stones of different sizes and diameters.

The “Device for removing stones from extrahepatic bile ducts” is known (Patent RU No. 2695750, IPC A61B 17/221 - 07/25/2019, Bulletin No. 21), containing a metal tube with a gripping working end, a mechanical handle with a spring mechanism. The gripping end contains a plate, the working end of which is made of shape memory metal. In the cavity of the plate there is a rod connected to the spring mechanism of the handle, which is equipped with a plug made with the possibility of reciprocating movement for extending and retracting the inner rod of the plate. When the inner rod is pushed in, the working end of the plate takes on a curved shape in the form of a hook.

The disadvantage of this device is the limited control of the vector of movement of the gripping basket in the lumen of the duct.

The objective of the claimed invention is to develop a set of laparoscopic instruments for removing stones (calculi) from the common bile duct (common bile duct), including fixed and large sizes.

The technical result of the claimed invention is to expand the capabilities of the kit, increase its versatility and efficiency of use, increase the degree of safety of using the kit and simplify its maintenance.

The technical result of the claimed invention is achieved due to the fact that the laparoscopic clamp has semicircular cutouts in the jaws 3 mm deep; when the jaws are closed, they form a 6 mm hole into which the 4 mm end of the tool for extracting stones with a basket or the 4 mm end of the bougie between two limiters on them in the form of washers, located at a distance of 7 mm. The presence of gaps between the jaws of the clamp and the captured instrument ensures a change in the angle of translational movement of the instrument, visually controlled directly inside the abdominal cavity. Also, the short length of the instrument and its rigid fixation along the axis of translational movement make it possible to control the force of influence of its working part on the surrounding tissues. The ability to freely change the direction of translational movement of the working end and control the impact force inside the duct prevent damage to its walls. The basket, consisting of spring-loaded cables with shape memory, can be folded in accordance with the gap between the stone and the wall of the duct, and then, after passing between them, straighten out and, when moving back, capture the stone. The same design and dimensions of the fixed end on instruments and bougies of different diameters allow the use of one clamp for their fixation. Three sizes of gripping baskets are available to suit different duct diameters and stone sizes, as well as a set of plastic bougies of different diameters from 2 to 5 mm, the sequential use of which allows you to remove stones and expand the outlet to the physiological norm, using one universal laparoscopic clamp.

The advantage provided by the above set of features is the use of one endosurgical instrument for manipulation inside the bile duct with baskets and bougies of various sizes, changing them in the abdominal cavity.

Details, features, and advantages of the present invention follow from the following description of the implementation of the claimed technical solution using drawings that show:

Figure 1 - tool for removing stones with a basket,

Figure 2 - bougies for laparoscopic determination of patency and expansion of the terminal part of the common bile duct,

Figure 3 - laparoscopic clamp for fixing the basket and bougies for the common bile duct.

In the figures, the following positions are indicated by numbers: 1 - basket rod, 2 - wire basket, 3 - spring-loaded cables, 4 - washer, 5 - bougie rod, 6 - limiter, 7 - bougie, 8 - ratchet, 9 - jaws, 10 - semicircular cutouts.

Implementation of the invention.

A tool for removing stones with a basket (Fig. 1) consists of a rod 1 with a diameter of 4 mm, a length of 125 mm, made of metal that allows bending in the abdominal cavity, at one end of which there is a wire basket 2, consisting of at least 4 spring-loaded cables 3, folding when passing under a stone and then being captured. At the other end there is a limiter in the form of washers 4 for reliable fixation with a laparoscopic clamp (Fig. 3).

Bougie 7 (Figure 2) for laparoscopic determination of patency and expansion of the terminal part of the common bile duct consists of a rod 5 made of semi-flexible plastic, 120 mm long, with two limiters 6, adapted for capture by a laparoscopic clamp. The diameter of bougie 7 is 2, 3, 4, 5 mm for sequential expansion of the outlet section of the common bile duct to the required diameter.

The laparoscopic clamp (Fig. 3) for fixing the basket and bougies for the common bile duct is a modernized clamp with a switchable ratchet 8, length 315 mm, diameter 10 mm. The modernization consists of working jaws 9, the length of which is 22 mm, the diameter is 6 mm, having semicircular cutouts 10 with a depth of 3 mm, which, when closed, form a hole with a diameter of 6 mm for gripping the instruments from Fig. 1 and Fig. 2.

The set is used as follows: a laparoscopic clamp (Figure 3) is inserted into the abdominal cavity through a 10-mm trocar to fix baskets and bougies for the common bile duct. Through the second 10-mm trocar, a basket for the common bile duct is inserted (Figure 1). The jaws of the clamp 9 grasp the rod of the basket 1, in the transverse direction the end of the basket is between the locking washers 4, and is fixed in the cutouts 10. The working end of the basket 2 is inserted into the cut of the duct wall until an obstacle is felt, then changing the force and direction, the basket moves back and forth until the stone is captured, then the stone is removed. If the stone cannot be captured, a basket of larger or smaller diameter is inserted into the abdominal cavity, the basket in the abdominal cavity is changed, and the attempt is repeated. After removing the stones, the patency of the thermal section is checked by introducing a 3-mm bougie 7 into the common bile duct (Figure 2). The procedure is similar. With forward movement, the bougie, after some resistance from the sphincter, falls into the intestine. If the 3-mm bougie does not pass, then a 2-mm bougie is inserted through the trocar, a similar manipulation is performed, and then a 3-, 4-, 5-mm bougie is sequentially introduced to gradually widen the hole.

Using the inventive set, the surgeon can control the force and direction of the translational movement of the grasping basket in the lumen of the duct inside the abdominal cavity, which allows it to be passed between the stone and the wall of the duct, or a bougie into the lumen of the sphincter, without resting against the walls.

Claims (1)

A set of laparoscopic instruments for removing stones from the common bile duct, containing a laparoscopic clamp with a working end for gripping, characterized in that it additionally contains an instrument with a basket for removing stones and a bougie for expanding the terminal part of the common bile duct, each of which contains a rod whose end diameter is 4 mm, and limiters at the end of the rod, made in the form of washers located at a distance of 7 mm from each other, and the laparoscopic clamp contains two jaws made with semicircular cutouts 3 mm deep, which form, when the jaws are closed, a hole with a diameter of 6 mm for gripping the end of the rod between the jaws washers of a tool with a basket or bougie.