RU35213U1 - DUNA DEVICE FOR ENDOSCOPIC DISSECTION OF PERFORMANT VEINS - Google Patents

Description

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The proposed utility model relates to medicine and can be used for surgical treatment of all forms of chronic venous insufficiency of the lower extremities.

It is known that endoscopic transmission of perforating veins can be carried out using a standard set of tools designed for laparoscopic cholecystectomy. However, the effectiveness and safety of endosurgical intervention on the venous system depends on the use of special devices including those that ensure the creation of a working operating space under the fascia of the lower leg.

Known devices designed for dissection of perforating veins, made in the form of metal tubes of various lengths, equipped with an expansion sleeve at the end, or in the form of inflatable polyethylene sealed balloons, 20-25 cm long, inflated with compressed air or liquid, the so-called space-makers ( See Phlebology, edited by V.S. Savelyev, M., Medicine, 2001, p. 566-559).

The disadvantage of metal tubes is the low operational reliability due to constant contamination and fogging of the optical part of the endoscope due to condensation of gaseous coagulation products, burning of biological fluids on the optical part of the endoscope, as well as high trauma.

The disadvantage of space makers is the presence of postoperative complications in the form of subcutaneous emphysema on the hips, trunk and head, since after the space maker presses down

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ШЖ А 61 В 17/32

Dunaev’s device for endoscopic dissection of perforating muscle veins of the skin-fascial layer, it is removed, and in the formed

operating space injected carbon monoxide.

Closest to the claimed technical solution is a device for dissecting tissues, containing an elongated body with an internal cavity located along its longitudinal axis, in which a fastening unit of the cutting element is placed with limited longitudinal movement, while the body has the shape of a parallel or cylinder and is made detachable, consisting of fixed and mobile fragments (See, IPC A 61 B 17/32, RF patent and 2199282, publ. BI and 6 of 02.27.03, p.214) - the closest analogue.

The known device, like the claimed utility model, has an elongated body, in the internal cavity of which a surgical instrument is installed with the possibility of longitudinal movement. However, it is difficult in design due to the detachable execution of the case, requiring the fastening of its elements, as well as the attachment point of the surgical instrument.

In addition, the device has limited functionality due to its use only for resection of internal organs.

The technical result of the claimed utility model is to simplify the design, increase operational reliability, therapeutic effect and expand the scope of the device.

The essence of the technical solution lies in the fact that in the Dunaev device for endoscopic dissection of perforating veins containing an elongated body with an internal cavity along its longitudinal axis, in which a surgical instrument is placed with the possibility of longitudinal movement, the body is equipped with an elastic cuff and additionally contains three channels, one of which, with its output, is connected to the internal cavity of the elastic cuff, and the entrance is connected to a cannula equipped with

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spray can to control the flow of the working medium into the elastic cuff, while the other two channels are made respectively to accommodate the endoscope and feed the colloidal solution under the aponeurosis.

Achievement of the technical result - simplification of the design to expand the scope of the device is ensured by the multi-channel housing, and increased operational reliability is ensured by an elastic cuff, under the influence of which the muscles and aponeurosis are separated and a working space is created immediately before the endoscope with minimal trauma to the surrounding tissues, which in turn affects to increase the therapeutic effect. With this, there is no effect of fogging of the endoscope optics and deterioration of ETS kontrolya.Nadezhnost visual device is also improved by providing the balloon kankshi for supplying the working medium into the inner cavity of the elastic cuff.

Figure 1 presents a General view of the device.

Figure 2 is a device with a surgical instrument and an endoscope inserted into its body.

In Fig.Z is a front view of the device.

Dunaev’s device for endoscopic dissection; пер perorantn veins contains an elongated body I, made in the form of a tube with an oval cross-section, an elastic cuff 2, mounted directly at the input edge of the housing I, located along its longitudinal axis of the channel 3 for supplying a working medium to the elastic cuff 2 , channel 4 and internal cavity 5, respectively, for placement of the endoscope and surgical instrument, channel 6 for supplying a colloidal solution for extraction of goose: Channel 3 is connected with its output to the internal cavity of the cuff 2, and in odoms cannula 7 through the cartridge 8 to control the supply of hydraulic medium in the elastic cuff 2.

In Fig. 2, the device is shown with an endoscope 9 and a surgical instrument 10 installed in the channel 4 and in the internal cavity 5, respectively. The output of the channel 6 (see Fig. I) is connected to the cannula II for supplying a colloidal solution. Plastic cuff 2 (See .Fig. 1 and 2) is fixed on the housing I along the edges 12 with an adhesive joint, for example, with adhesive E5-b. Ka Figs. 1, 2 and 3, the elastic cuff 2 is presented in working condition with working L. see you.

The device works as follows: the endoscope 9 is inserted into the channel 4 of the building I and then the device is inserted into the incision under; 1 side of the lower leg of the patient. Using a standard syringe with a volume of 20-30 ml (not shown) through cannula 7, balloon 8 and channel 3 a working line, liquid or gas is injected into the inner cavity 13 of the elastic cuff 2, under the influence of which the elastic cuff is inflated, creating a three-dimensional shape with a maximum diameter of 3.5-4 cm. The inflation of the elastic cuff 2 is carried out until the necessary visualization is provided on the monitor, under the control of which under the action of elastic cuff 2 there is a careful separation of muscles and aponeurosis. At the same time, at the time of elastic cuff 2 inflating, the tibial aponeurosis is pulled into the zone of elastic cuff 2, increasing the working space in front of the endoscope 9. Then, surgical instrument 10 is inserted into the internal cavity 5 and dissection of the perforating vein located in the created workspace within the visual control is carried out. After dissection, the elastic cuff 2 is deflated until the cartridge 8 completely drops, the device is brought to the next perforating vein and the cycle is repeated. Upon completion of the dissection of the perforating veins, the elastic cuff 2 is deflated before the device is removed from the aponeurosis, and through the channel 6 under the fascia

a sterile colloidal solution, for example, gelatinol, half-glucose, etc., is injected into the golep to prevent the formation of commissural commissures by splines and aponeurosis, through cannula II. Channel 6 is also reserve if it is necessary to use standard gas insufflation for aponeurosis.

EXAMPLE. Patient PC., 63, was admitted with a diagnosis of recurrent varicose disease of the left lower limb, stage 3, with complications: lipdermatosclerosis of the lower leg, secondary lymphostasis, tropical ulcer of the lower third of the left lower leg.

After preoperative preparation of the ulcer surface of the lower leg on 05/30/03, endoscopic dissection of perforating veins was performed using epidural anesthesia using a prototype of the inventive device and a standard set for laparoscopic operands. Endoscopic dissection of perforating veins took 30 microns of conventional 50 kt average. At the same time, there was a complete absence of fogging of the fiber optics and good visualization of the subaponeurotic space. Gas insufflation was not applied. The incisions were reduced to 1.5 cm. The wounds were healed by primary intention. The wounds were removed on the 9th day. Postoperative hospital stay was II days. Ulcers and other trophic disorders were epithelialized on the day the sutures were removed. Patient K was discharged for outpatient treatment by the surgeon of the polyclinic in satisfactory condition. The patient was examined after I month. Thin scars, trophic disturbances regress, no leg edema. Cosmetic and clinical results of surgical treatment were found to be good.

The proposed device performed the dissection of perforating veins of another 2 patients suffering from diseases of shichngh limbs of various stages L. They vygotsapy from the hospital for 10-12 days after surgery in good condition with good

cosmetic effect without postoperative complications. After dissection, one of them was injected with a colloidal polyglucne solution.

Dunaev’s device for endoscopic dissection of perforating veins, simply by design, can be disposable when its body is made, for example, of silicone or polyvinyl chloride, and the elastic cuff is made of latex rubber or polyethylene, and used with a standard set of laparoscopic equipment, which is available practically in every medical institution.

Compared with known devices, it allows you to:

- insert the body into the section with a compressed elastic cuff without injuring the wound;

-to ensure the creation of a working space and dissection without the endoscope being taken out of the device’s body, which eliminates fogging of optics and deterioration in the quality of visual control, and also provides protection of optics from electrical damage when using monopolar coagulation;

-create a larger, compared with known devices, the workspace immediately in front of the endoscope due to the elasticity of the aponeurosis;

-improve visual control by placing the tube of the endoscope in the channel of the device and ensuring rigidity;

-exclude the use of carbon dioxide to form a working space for aponeurosis or, which increases the healing effect and eliminates postoperative complications;

-povns / .тъ therapeutic es & ect due to the introduction of a colloidal solution and prevention of the development of adhesions under the shin aponeurosis.

used in surgery, vascular surgery, phlebology in the surgical treatment of chronic venous insufficiency caused by post-thrombotic diseases, as well as angio dysplasia in the stage of trophic disorders.

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Dunaev’s device for endoscopic dissect persOrant veins, containing a strangulated corpus case with an internal cavity located along the longitudinal axis of the longitudinal axis, which is positioned with the possibility of longitudinal movement of the surgical instrument, which is flexible in that the case is equipped with a mannette and additionally contains three channels, one of which has in about: k-, the output is connected to the internal ii cavity elastically, and the input or is connected to the cannula :: equipped with a canister to control the flow of the working medium: into the elastic cuff, with two other channels are made, respectively, to place an endoscope and supply a colloidal solution under the aponeurosis.

Claims (1)

A device for endoscopic dissection of perforating veins, containing an elongated body with an internal cavity along its longitudinal axis, in which a surgical instrument is placed with the possibility of longitudinal movement, characterized in that the body is equipped with an elastic cuff and further comprises three channels, one of which is connected by its output with an internal cavity of the elastic cuff, and the inlet is connected to a cannula equipped with a canister to control the flow of the working medium into the elastic cuff, while two their channel is made respectively to place an endoscope and supply a colloidal solution under the aponeurosis.