RU68312U1 - DEVICE FOR LIQUID EDUCATION PUNCTION - Google Patents

Abstract

A device for puncture of fluid formations under the control of a laparoscope refers to abdominal surgery and is intended for puncture of fluid formations (abscesses, cysts). The device consists of a needle, the proximal end of which has lateral openings overlapping by the spring-loaded end valve in the compressed position, the distal end of the needle has a constriction, the needle is inserted into the suction tube so that its lateral openings are located inside the suction tube, the distal segment of which is pinched. Using the device of the proposed design improves the efficiency and safety of using the laparoscopic method during laparoscopic opening and drainage of the abscess of the abdominal cavity. In this case, the probability of infection of the free abdominal cavity is completely eliminated and the invasiveness of the intervention is reduced. The proposed device is simple in execution, easily sterilized due to collapsible design

Description

The proposed device for puncture of fluid formations under the control of a laparoscope relates to abdominal surgery and is intended for puncture of fluid formations (abscesses, cysts).

In the surgical treatment of abdominal abscesses, two surgical options are used: opening an abscess with laparotomy; minimally invasive techniques (drainage of an abscess under the control of ultrasound or computed tomography and laparoscopic opening and drainage of the abscess).

When using laparotomy (1), an incision is made over the abscess. After opening the shells of the abscess, the contents of the cavity are removed by suction.

However, when performing this manipulation, there is a great danger of opening the lumen of the hollow organ and the formation of an intestinal fistula. After dissection of the peritoneum, care should be taken to carefully isolate the surgical wound in order to avoid purulent contents entering the free abdominal cavity.

When laparoscopic opening the abscess cavity, two additional 5 mm trocars are used to separate the adhesive process and the abscess shells. After opening the shells of the abscess, the liquid contents are removed by suction introduced through one of the trocars. (2)

However, surgical treatment of abdominal abscesses using laparotomy is a traumatic surgery. Sometimes quite complicated, depending on the location of the abscess in the abdominal cavity. At the same time, there is a risk of infection of the free abdominal cavity with the development of severe complications. The "dull" separation of the adhesive process poses a risk of the contents of the abscess entering the free abdominal cavity.

It is known to drain cavities under ultrasound control. For this purpose, the “stylet-catheter” technique is used (3). The device consists of a needle with a mandrin. The needle is inserted into the drain. After the puncture of the formation, the needle is drained into the abscess cavity.

With this method, the use of special needles is necessary. In addition, the ultrasonic method is possible only when using small-diameter needles, which does not always allow to effectively remove the liquid contents from the abscess cavity.

The problem solved by the proposed device is to increase the efficiency and safety of using the laparoscopic method for laparoscopic opening and drainage of the abscess of the abdominal cavity.

To solve this technical problem, a device for puncture of fluid formations under the control of a laparoscope, consisting of

from a needle, the proximal end of which has lateral openings overlapping by a spring-loaded end valve, and the distal end of the needle has a narrowing; the needle is inserted into the suction tube in such a way that its side holes are located inside the suction tube, the distal segment of which is pinched.

In common with the prototype is the presence of a needle.

Distinctive features are the following: the proximal end of the needle has lateral openings overlapping by the end spring loaded valve in the compressed position, the distal end of the needle has a narrowing; the needle is inserted into the suction tube in such a way that its side holes are located inside the suction tube, the distal segment of which is pinched.

The presence of a spring-loaded valve allows you to create maximum vacuum to more efficiently remove the contents of the purulent formation through the suction tube. The narrowing of the distal end of the needle provides greater safety of the puncture process due to a more complete fit of the needle to the abscess sheath, because when performing a puncture, the needle is inserted into the cavity to the wide part, which prevents the liquid contents of the formation from entering the abdominal cavity.

Side holes in the needle are used to evacuate the contents of the cavity through the suction tube. Pinching the distal section of the suction tube is dictated by the need to create a seal of the entire device.

Description of the device. The device consists of a long needle (1), the distal end (2) of which has a narrowing. The opposite end of the needle is equipped with a valve (3). The diameter of the valve (3) corresponds to the inner diameter of the needle (1), which ensures a snug fit to the inner walls of the needle (1) to ensure tightness. Between the needle (1) and the valve (3), a spring (4) is located, which provides free movement of the valve (3). Two holes (5) are made in the needle (1) at such a distance that, with a compressed spring (4), the holes (5) overlap with the valve (3). The needle (1) is inserted into the suction tube (6) in such a way that a joint seal is created. The holes (5) of the needle (1) are located inside the suction tube (6). The distal section (7) of the tube (6) is clamped by a clamp or ligature.

The device operates as follows. A needle (1) is inserted into the abdominal cavity through an additional trocar. The formation wall (abscess) is pierced with a needle (1). In this case, the valve (3) of the needle (1) blocks the holes (5) in it, and the maximum vacuum is created in the suction tube (6). After piercing the wall, the needle (1) is inserted into the cavity to the wide part, which prevents the liquid contents of the formation from entering the abdominal cavity. Valve (3) is released. The high vacuum created in the suction tube (6) contributes to the rapid evacuation of the contents of the formation through the suction tube, which is an additional factor in the prevention of infection of the abdominal cavity.

Clinical observation 1. Patient T., 47 years old, was operated on for a blunt abdominal injury with a rupture of the small intestine. Postoperative period

complicated by the formation of a subhepatic abscess. On day 9, laparoscopy was performed. Partial separation of the adhesive process in the subhepatic space was made. Produced puncture education of the proposed device. Received 150 ml. pus that is removed by suction. As much as possible pus is removed from the cavity. Remediation of the cavity. The puncture opening is expanded. Additional sanitation of the cavity with subsequent placement in the cavity of two drains brought to the skin. Recovery. Discharged from the hospital 10 days after the intervention.

Clinical observation 2. Patient M., 71 years old, was operated on for gallstone disease, acute phlegmonous cholecystitis. The postoperative period was complicated by the formation of a subhepatic abscess. On the 7th day, laparoscopy was performed. Partial separation of the adhesive process in the subhepatic space was made. Produced puncture education of the proposed device. Received about 80 ml. pus removed by suction. After the expansion of the puncture opening and additional debridement, two drains for irrigation and aspiration drainage are installed in the abscess cavity. Recovery. No additional interventions were required. Discharged from the hospital 12 days after the second intervention after removal of the drains.

When using the inventive device, the probability of infection of the free abdominal cavity is completely eliminated and the invasiveness of the intervention is reduced. The proposed device is simple in execution, easily sterilized due to the collapsible design. The area of use of the laparoscopic method in the treatment of various diseases, especially postoperative abdominal abscesses, is increasing. The operation is simplified due to the preliminary puncture of the formation and the removal of its contents.

Source

1. Zhebrovsky V.V. Early and late postoperative complications in abdominal surgery. - Simferopol: Publishing center of KSMU, 2000. - 688 p. ISBN 966-7348-22-9 p. 165-210.

2. Fedorov A.V., Sazhin A.V., Stegniy K.V. Technical aspects of laparoscopic surgery for postoperative abdominal abscesses // VII All-Russian Congress on Endoscopic Surgery. - M., 2004 - S.172-173.

3. Ivshin V.G. Percutaneous diagnostic and therapeutic interventions in patients with obstructive jaundice. Abstract dis. doctor of medical sciences M - 2001.

Claims (1)

A device for puncture of fluid formations, consisting of a needle, characterized in that the proximal end of the needle has lateral openings overlapping by a spring-loaded end valve in a compressed position, the distal end of the needle has a constriction, the needle is inserted into the suction tube so that its side holes are located inside the tube suction, the distal segment of which is pinched.