RU70623U1 - HEMOSTATIC LIQUID FOR LIVER RESECTION - Google Patents

Abstract

The utility model relates to medicine, namely to surgery, and is intended for resection of the liver in case of its wounds and pathological changes.

The purpose of the utility model is to develop a special hemostatic clamp that reliably provides compression of the intraorgan vessels of the liver at any level of its resection.

The proposed hemostatic pulp for liver resection consists of pivotally connected handles, at one end of which holes are made for fingers and a fixation unit with a jaw dilution regulator in the form of a cremallera lock, and at the other end there are two rigid working jaws.

The upper and lower rigid jaws are made of stainless steel that is stable in terms of deflection, and the elastic plate of the upper jaw is made of thinner flexible stainless steel.

The lower jaw is made rigid, in width it is two times wider than the upper (25 mm wide), has a flat surface and two longitudinal slots on both edges for flashing the liver after compression. At its end there is a groove in which, for better stabilization in the working position, it precision fits, the bent end of the upper rigid jaw is blunted.

The upper jaw consists of two parts: rigid-external and elastic-internal. The rigid outer part of the upper jaw is 10 mm wide and convex, it corresponds to the profile of the diaphragmatic surface of the liver, in its center there is a threaded hole for the compression adjusting screw, and the distal and proximal ends have longitudinal slots 1.5 cm long for holding fixing elements internal elastic plate. The distal longitudinal slot is characterized in that it begins with an oval extension for introducing a “cap” of the distal locking element of the inner elastic plate. The end of the rigid outer part of the upper jaw, to eliminate the risk of puncture of the diaphragm and the development of pneumothorax, is dulled and bent down; when the jaw is closed, it enters the groove at the end of the lower jaw.

The inner part of the upper jaw is a removable elastic movable plate, the width of which corresponds to the size of the lower rigid jaw (width 25 mm), it has two longitudinal slots on both sides for flashing the parenchyma of the compressed liver. At both ends of the inner elastic plate there are two locking elements for fixing to the upper rigid jaw: the first distal has a flat “hat” inserted into the oval groove of the distal longitudinal slot on the upper rigid jaw, and the second proximal is made in the form of a rod with a screw thread for fixing nut.

Hemostasis of intraorgan vessels of the liver when using the proposed instrument is provided in two stages of compression effects on the organ. The first stage involves the compression of the resected portion of the liver between the upper and lower rigid branches. The second stage consists of turning the compression adjustment screw clockwise, which provides additional compression on the organ of the elastic inner plate of the upper jaw. An exact comparison of the longitudinal slots on the lower rigid jaw and the elastic plate of the upper jaw allows flashing of the resected organ section through them.

Such a constructive solution allows taking into account age, local, as well as individual anatomical options and fluctuations in the size of the resected lobe of the liver to make a resection at any level of the organ.

Description

The utility model relates to medicine, namely to surgery, and is intended for resection of the liver in case of its wounds and pathological changes.

For hemostasis of the liver during its resections, Garre clamps (1912) were used (Ton That Thung “Surgery of the liver”, 1967, p. 61), gastric and intestinal clamps (Kocher, E.L. Berezov - cited from S.A. Borovkov “ Operations on the liver ", 1968, p.184), a semi-rigid screw liver clamp of Borovkov (S. A. Borovkov" Operations on the liver ", 1968, p.184 - 186), clamps for operations on the liver (USSR Author's Certificate No. 1627276, class A61B 17/12, 1961.), (USSR author's certificate No. 895418, class A61B 17/12, 1979), a method of liver resection and hepatic pulp (USSR author's certificate No. 1291128, class A61B 17/00, 17 / 12, 1986). However, they do not always satisfy practical surgeons, since in most cases they have a technically complex structure, which complicates the course of the operation, increases the time of its operation, the invasiveness, and also complicates the process of postoperative cleaning and sterilization of the instrument.

Prototype

As a prototype, we selected a semi-rigid screw liver clamp Borovkova (S. A. Borovkov "Operations on the liver", 1968, p. 184-186), consisting of two removable working branches and a handle that ensures their interaction. The branches are made curved along the length of the respectively convex and concave surfaces of the liver, have a grooved section and longitudinal slots in the center. The lower jaw is rigid and corresponds to the profile of the concave surface of the liver, and the upper elastic has a screw-threaded rod at the free end and a slider that moves along the grooves of the handle. The free end of the lower jaw freely fits into the groove of the handle. The distal ends of the branches are pivotally connected.

A screw is fixed to the slider, the end of which enters the wing nut. Rotating the latter clockwise moves the slider and causes the elastic jaw to straighten, resulting in the necessary compression of the liver tissue between

jaws. The existing longitudinal slots on the branches serve to stitch the liver after compression.

When resecting the right lobe of the liver, jaws with ebbs directed to the right are used, and for resection of the left, to the left.

Given the significant fluctuations in liver size, three pairs of removable branches are designed for each lobe. In the working position, with closed branches, they form a loop thrown over the lobe of the liver to prevent it from slipping during the lowering of the instrument into the wound.

The practical use of this tool reveals a number of its shortcomings: with individual fluctuations in the anatomical size and features of the options for the operated liver, it is necessary in each case to individually select interchangeable branches, while the kit includes only three pairs of branches of different sizes, which may be insufficient in certain situations; due to the fact that the distal ends of the branches are pivotally connected, in order to stabilize the lobes of the liver between them, in all cases, additional preparation and operative isolation of the diaphragmatic surface of the organ is necessary, which complements the invasiveness of the operation and increases blood loss; the mechanism of rapprochement and fixation of the jaws in the working position with the compression of the organ is technically complicated, which increases the time of the operation and contributes to the early failure of the structure.

The purpose of the proposed utility model is to develop a special hemostatic clamp that reliably provides compression of the intraorgan vessels of the liver at any level of its resection.

Utility Model Description

Scheme of pulp parts.

1. Pulp;

2. Upper rigid jaw;

3. Elastic plate of the upper jaw;

4. Lower rigid jaw;

5. Compression adjustment screw;

6. Threaded hole for adjusting screw;

7. "Hat" distal fixing element of the elastic plate of the upper jaw;

8. Locking nut of the proximal retainer of the elastic plate;

8a. Screw thread for proximal retainer of elastic plate;

9. A distal longitudinal slot on the upper rigid jaw with an oval extension for the “cap” of the distal retainer of the elastic plate;

10. The proximal longitudinal slot for the rod with a screw thread of the proximal retainer of the elastic plate;

11. Longitudinal slots along the edges of the elastic plate for flashing the liver;

12. Longitudinal cuts along the edges of the rigid lower jaw for flashing the liver after its compression;

13. The stabilization groove at the end of the lower rigid jaw;

14. The blunt end of the upper rigid jaw is bluntly precision inserted into the stabilization groove at the end of the lower rigid jaw.

The proposed hemostatic pulp for liver resection (Fig. 1, pos. A) consists of pivotally connected handles, at one end of which holes are made for fingers and a fixation unit with a jaw dilution regulator in the form of a cremallera lock, and at the other end there are two rigid working jaws.

The upper and lower rigid jaws are made of stainless steel that is stable in terms of deflection, and the elastic plate of the upper jaw is made of thinner flexible stainless steel.

The lower jaw (Figure 1, pos. D) is made rigid, in width it is twice as wide as the upper (width 25 mm), has a flat surface and two longitudinal slots on both edges for flashing the liver after compression. At its end there is a groove in which, for better stabilization in the working position, it accurately enters, the bent end of the upper rigid jaw is blunted (Figure 1, pos. D).

The upper jaw (Figure 1, pos. A) consists of two parts: rigid-external (Fig. I, pos. B) and elastic-internal (Fig. 1, pos. B). The rigid outer part of the upper jaw (Fig. I, pos. B) is made 10 mm wide and convex, it corresponds to the profile of the diaphragmatic surface of the liver, in its center there is a hole with a threaded thread for the compression screw, and at the distal and proximal ends there are longitudinal slots 1.5 cm long for holding the fixing elements of the inner elastic plate. The distal longitudinal slot is characterized in that it begins with an oval extension for introducing a “cap” of the distal locking element of the inner elastic plate. The end of the rigid outer part of the upper jaw, to eliminate the risk of puncture of the diaphragm and the development of pneumothorax, is dulled and bent down; when the jaw is closed, it enters the groove at the end of the lower jaw.

The inner part of the upper jaw (Fig. I, pos. B) is a removable elastic movable plate, the width of which corresponds to the size of the lower rigid jaw (width 25 mm), it has two longitudinal slots on both sides for flashing the parenchyma of the compressed liver. At both ends of the inner elastic plate there are two locking elements for fixing to the upper rigid jaw: the first distal has a flat “hat” inserted into the oval groove of the distal longitudinal slot on the upper rigid jaw, and the second proximal is made in the form of a rod with a screw thread for fixing nut.

Hemostasis of intraorgan vessels of the liver when using the proposed instrument is provided in two stages of compression effects on the organ. The first stage involves compression of the resected liver between the upper and lower rigid

jaws. The second stage consists of turning the compression adjustment screw clockwise, which provides additional compression on the organ of the elastic inner plate of the upper jaw. An exact comparison of the longitudinal slots on the lower rigid jaw and the elastic plate of the upper jaw allows flashing of the resected organ section through them.

Such a constructive solution allows taking into account age, local, as well as individual anatomical options and fluctuations in the size of the resected lobe of the liver to make a resection at any level of the organ.

An example of the practical use of the instrument: a (experimentally) purebred dog weighing 30 kg.

A laparotomy was made by a combination of the upper mid-median with a left-side hypochondrium bend and the largest left lateral lobe of the liver was distinguished with the semi-oval contours. The selected organ lobe along the line of the proposed resection was surrounded by a strip of prolene mesh. After that, the pulp branches of the pulp were brought to the liver, so that its lower branch lay under the visceral surface, and the upper on the diaphragmatic.

Then the pulp arms were brought together and cremallerally fixed until the lobe was completely stabilized. Given the anatomical features of the size of the organ and to enhance the hemostatic effect by turning the adjusting screw on a rigid upper jaw, precision additional compression of the resected lobe with an elastic plate of the upper jaw was performed. Then, through the longitudinal slots of the jaw, through the nested strips of the prolene mesh, the liver parenchyma was stitched with a vikril thread. After carefully inserting the organ, a resected lobe was cut off with a scalpel along the edge of the branch. No bleeding was observed. The large intrahepatic vessels in the center of the stump were seized with the tip of a clamp and bandaged for the reliability of hemostasis.

For the purpose of peritonization of the stump of the liver, a free omentum flap was brought to it, and it was hemmed with a continuous twisted seam.

The wound was sutured in layers, after having previously installed a polypropylene drainage tube in the abdominal cavity through additional contraperture in the wall.

Using hemostatic pulp, 12 liver resections were performed in 12 outbred dogs. According to the results of the postoperative period, contrast radiography of blood vessels and bile ducts, morphological studies of macro- and micropreparations, complications in the form of blood and bile ducts, as well as purulent-inflammatory processes in the area of surgical intervention on the liver were not observed.

Features distinctive from the prototype.

1. The prototype consists of one handle and two removable working branches, and the proposed hemostatic pulp is made of articulated arms, at one end of which holes for fingers are made, and at the other end there are two rigid integral working branches with a handle.

2. The approach of the jaws in the prototype is carried out by rotating the wing nut and screw, rigidly fastened with a slide, the movement of which along the grooves of the handle causes the elastic branches to straighten with the necessary pressure of the liver, in the proposed hemostatic pulp, the liver is compressed by first converging the upper and lower hard workers the jaw on the organ, due to the pressure of the thumb and forefinger on the handles, with fixation in the lock and then turning the adjusting screw on the rigid upper jaw , until complete hemostasis, the organ is precision compressed by an elastic plate.

3. In the prototype, for the resection of the right or left lobe of the liver, it is necessary to replace the jaws, since on the upper and lower working jaws there is only one longitudinal slot for flashing the organ, which pass on the side of the right or left low tide, in a hemostatic pulp on both edges of the hard and the elastic upper working jaw there are two longitudinal slots for flashing the liver after compression, which allows one tool to resect both the right and left lobe of the organ.

The positive effect of using the utility model:

A positive effect of using the proposed tool is to ensure reliable hemo- and cholestasis by controlled compression of the resected area of the liver, the technical simplicity and reliability of the design, as well as reducing the time it takes to complete the operation.

The proposed hemostatic pulp can find practical application in surgical departments when performing liver resections.

Claims (1)

Hemostatic pulp for liver resection, which is a device with jaws made curved along the length of the respectively convex and concave surface of the liver, having a groove-shaped cross section and longitudinal slots, characterized in that the pulp has two rigid jaws made of stainless steel, the lower jaw is made rigid the width is two times wider than the upper (25 mm wide), has a flat surface and two longitudinal slots on both edges for flashing the liver after compression, there is a groove at its end, in which For better stabilization in the working position, the blunt end of the upper rigid jaw is precisely included in the blunt end, the upper jaw consists of two parts: the rigid-external and elastic-internal, while the rigid external part of the upper jaw is 10 mm wide and convex, corresponding to the profile of the diaphragmatic surface of the liver , in the center there is a threaded hole for the compression adjustment screw, and at the distal and proximal ends there are longitudinal slots 1.5 cm long for holding the locking elements in of the morning elastic plate, the distal longitudinal slot begins with an oval extension for the introduction of the “cap” of the distal fixing element of the internal elastic plate, and the end of the rigid outer part of the upper jaw is dulled and bent down; when the jaw is closed, it enters the groove at the end of the lower jaw, the inner part the upper jaw is a removable elastic movable plate, the width of which corresponds to the size of the lower rigid jaw (width 25 mm), has two longitudinal slots on both sides for flashing the compressed parenchyma liver, at both ends of the inner elastic plate there are two fixing elements for fixing to the upper rigid jaw: the first distal has a flat “hat” inserted into the oval groove of the distal longitudinal slot on the upper rigid jaw, and the second proximal is made in the form of a rod with a screw thread for fixing nut.