RU56804U1 - TROACAR FOR REVISION AND SANITATION OF CANDID Pancreatic Neoplasms - Google Patents

Abstract

The utility model relates to medicine, in particular to abdominal surgery, and can be used in surgical interventions on cystic formations of the pancreas. The objective of the utility model is to improve the diagnosis and treatment of patients with post-necrotic pancreatic cysts. The problem is solved in that the device is a trocar with a stylet (diameter of the inner tube 10 mm) with internal gaskets made of fluoroplastic, ensuring tightness when passing through it a fibrogastroscope, and a movable outer sleeve having a flap-articulated device connected to the distal part with the inner tube of a trocar; as well as a movable outer ring of fluoroplastic for fixing the posterior wall of the stomach. The effectiveness of the design is to ensure tightness in the cavity of the cyst with the introduced trocar, which makes it possible to completely straighten it with air, as well as the fact that the trocar is adapted for use with a fibrogastroscope with end optics.

Description

The utility model relates to medicine, in particular to abdominal surgery, and can be used in surgical interventions on cystic formations of the pancreas. A device is known, which is a trocar suction cup (sleeve diameter 10 mm) with a stylet and a puncture aspiration-irrigation needle with a diameter of 5 mm with a two-way tap. Inspection of the inner wall of the fibrous capsule is carried out by a laparoscope with oblique optics. (Endovide surgery of hydatid cysts and residual cavities in liver echinococcosis. \ S.I. Emelyanov, M.A. Khamidov \\ Endoscopic surgery, 2000. - No. 1. - P. - 12-15). However, this device can only be used with gigantic cysts; structural rigidity makes it difficult to adequately examine the cystic cavity; there is no possibility of full-fledged rehabilitation with the removal of freely lying sequesters that support the inflammatory process and are a substrate of purulent complications;

A trocar is known which has an inflated balloon at the end for fixation and tightness in the stomach, as well as a limiter disk that fixes the front wall of the stomach to the abdominal wall. (Emelyanov S.I. Endovascular surgical drainage of the pseudocyst of the pancreas. \ S.I. Emelyanov, A.V. Protasov, V.A. Ponomarev, G.V. Khodos \\ Endoscopic surgery, 2001. - No. 2. - C . - 21-22) With the described method, the examination of the inner wall of the cyst is not carried out.

Both devices have disadvantages inherent in the method of laparoscopy associated with an increase in intra-abdominal pressure.

The objective of the utility model is to improve the diagnosis and treatment of patients with post-necrotic pancreatic cysts. The problem is solved in that the device is a trocar with a stylet - 1 (diameter of the inner tube 10 mm) with internal gaskets (not shown in the diagram) made of fluoroplastic, ensuring tightness when a fibrogastroscope is passed through it, and a movable outer sleeve - 2, having a petal-hinged device on the distal part - 4 connected to the inner tube of the trocar; as well as a movable outer ring of fluoroplastic for fixing the posterior wall of the stomach - 3.

The figure 1 schematically shows a trocar for revision of the cystic cavities of the pancreas.

In figure 2 - the same trocar in working condition.

In figure 1 and 2 are indicated: 1 - trocar tube, 2 - outer sleeve, 3 - movable outer ring, 4 - flap-joint device, 5 - stylet.

The device is used as follows:

Under ETN, the anterior gastrotomy is performed from the mini-access; during the audit of the posterior wall of the stomach, the localization of the cyst and the puncture area for the introduction of the trocar for the revision of cystic formations are determined. After the introduction of the trocar - 1 stylet - 5 is removed and, passing through the tube of the trocar a suction tube (not shown in the diagram), aspirate fluid from the cystic cavity, after which a fibrogastroduodenoscope with end optics is performed. By shifting the outer sleeve - 2 to the distal edge, straighten the petal-articulated device - 4, which allows you to fix the wall of the cyst from the inside; outside the back wall of the stomach is fixed with a movable ring of a trocar - 3.

After fixation, air is injected into the cyst cavity and, controlling the distal part of the fibrogastroduodenoscope, an examination of the inner wall of the cyst is performed.

Inspection of the inner wall of the cyst with the full expansion of its air also allows you to detect the presence of fistulous passage and freely lying sequestration. Detected sequesters are removed by an extractor in the form of a tripod drawn through the instrument channel of a fibrogastroduodenoscope.

The advantages of this design are: minimally invasive technology using mini-access, which allows you to visually control the manipulation and devoid of the disadvantages inherent in the laparoscopic technique; technical simplicity of the device;

expanding the spectrum of visibility due to the controlled bending of the distal part of the fibrogastroduodenoscope; the possibility of examining cysts with a diameter of ≥4 cm; complete expansion of the cyst walls with air introduced into the cavity, which makes it possible to detect the existing pancreatic fistula and freely lying sequesters; the presence of an instrumental channel in a fibrogastroscope, which allows manipulators to be carried out into the cyst cavity and mechanically remove sequestra detected during examination.

Claims (1)

A trocar for revision of the cystic formations of the pancreas, including a tube with a stylet and a movable outer ring, characterized in that it has a movable outer sleeve provided on the distal part with a flap-joint device connected to the tube.