RU95492U1 - LIVER RETRACTOR - Google Patents

Abstract

 A liver retractor containing a holder and a curved working end, characterized in that there are a number of coaxial holes on the retractor handle and perpendicular to the integral part of the working part, and the working end is bent three times in mutually perpendicular directions, and the retractor is equipped with a stand fixed to the operating table for it fixation and the possibility of rearrangement and change of angle.

Description

The proposed utility model relates to medical equipment, namely to surgical instruments, and can be used for liver abduction.

According to the data of domestic and foreign authors, when performing surgical interventions, retractors of various designs are used to create the most favorable conditions for access to the operated site and to perform manipulations in the surgical field - they use pushing and expanding tools (called retractors in English practice). Surgical retractors in medicine are designed to expand and hold laparotomy wounds in a fixed position, as well as to facilitate maintenance and reduce the composition of the assistants involved. To this day, the used surgical retractors are not without significant drawbacks, as different surgical instruments are used for various surgical procedures, and the instruments do not fully satisfy the needs of surgeons. All this emphasizes the relevance of the modernization of surgical retractors.

A device is known - a universal expander containing a handle and a sickle-curved working part. The working part is an all-metal blade of different lengths. The handle and the blade are interconnected by a hexagonal screw device with a fixing nut, which allows you to change the angle of inclination to the handle by 80-240 ° / Patent: 2002109120/14, 04/08/2002 Authors: Shestopalov SS, Mikhailova S.A. /

The device is used for abduction of the pelvic organs during operations on the rectum, both from the abdominal cavity and for mobilization of the rectum from the perineum, as well as in gynecological and urological pathology. According to the authors, a good overview of the vessels and ligaments is achieved during operations on the rectum, both from the abdominal cavity and from the perineum, including gynecological and urological pathologies.

This device has the following disadvantages:

1. Loss of visual control as the mirror moves deeper into the wound due to the closure of the field of view of the mirror plates tilted outward.

2. The inability to install the end of the mirror at the maximum lower point of the wound.

3. The device does not facilitate the work of the surgeon, in turn, leads to the introduction of additional tools.

The closest analogue is a surgical retractor device containing vertical racks with holders of removable mirror hooks installed with the possibility of interaction with the holders, retaining rings, the holders being made in the form of serrated strips, and the retaining rings are placed on the thickened ends of the racks with the possibility of interaction with the teeth and running stops, made in the form of an end collar and mounted on the rack of the sleeve, while the removable hooks-mirrors are connected to the toothed strips of the hole holes with a diameter of 8 mm / Patent: 5068579/14, 07/10/1992. Authors: Bekmachev V.I., Tarasov G.G. /

The retractor is used in operations for smooth dilution of the edges of the wound and stable retention during surgical interventions on organs and tissues of the abdominal cavity.

This device has the following disadvantages:

1. Frequent trauma to the walls of the wound channel with the end of the mirror.

2. Visual control only at the level of the surface of the abdominal cavity.

3. The inability to install the end of the mirror at the lowest possible point of the wound.

The objectives of this proposal are:

1. The release of the surgeon's hands during the displacement of the abdominal cavity and small pelvis.

2. Convenience of using the device and creating rational conditions for the surgeon.

3. Fixed holds the liver and uterus.

4. Quick dilution of the edges of the wound and stable retention of the designated organs and tissues in predetermined positions with a change in the angle of influence of the working end of the device.

5. Optimal surgical access to abdominal organs.

6. Planning for optimal surgical access and surgical wound length.

The tasks are achieved in that the device containing the holder and the curved working end has a number of coaxial holes on the retractor handle and perpendicular to the working part perpendicular to it, and the working end is bent three times in mutually perpendicular directions, and the retractor is equipped with a stand fixed to the operating table, for its fixation and the possibility of moving and changing the angle of inclination.

Technical result: the retractor allows to improve visual control due to the abduction of the liver cranially and to the right, which in turn reduces the incision of the laparotomy wound due to the design feature of the retracting working part of the retractor. The device was tested on 105 patients who were treated in the surgery department of the State Health Institution “Clinical Hospital for War Veterans named after Professor V.K. Krasovitov "Department of Health of the Krasnodar Territory, as well as in the Federal State Institution" Russian Center for Functional Surgical Gastroenterology of Roszdrav "and showed good results. All patients using this device managed to improve access and reduce the length of the surgical wound, which did not affect the course and time of the operation, and, in turn, reduced the time of the operation. In addition, a good visual opportunity was created for adequate control of operational manipulations. The hospital stay of patients was reduced by an average of 2-4 days.

For a better understanding, the device is schematically depicted in figure 1. “General view of the device”, where 1 is a curved working end, 2 is a retractor handle, 3 are coaxial holes, 4 is a vertical strut. Figure 2. “General view of the device when used,” where 1 is a curved working end, 2 is a retractor handle, 3 are coaxial holes, 4 is a vertical stand, 5 is an operating table, 6 are clamping screws, 7 are slats, 8 is a Segal expander.

The device is used as follows. At the beginning, operations on the operating table (5) on the left and right in the projection of the epigastrium establish vertical posts (4) fixed to the slats (7) with clamping screws (6) for the Seagal retractor (8) and additionally, a vertical stand (4) is also installed on the right for retractor of the proposed design. Upper median laparotomy is performed, and the wound aperture is corrected with the Segal retractor (8). Then a retractor of the proposed design is introduced into the upper abdominal cavity to lead the left lobe of the liver cranially and to the right without crossing the triangular ligament of the liver. The liver is tightened and stably fixed, without changing the location of the curved working end (1) on the uprights (4) with fastening elements to the operating table (5) located on both sides of the operating table (5). The presence on the handle of the retractor (2) and perpendicular to it at the same time the working part has a number of coaxial holes (3), which makes it possible to rearrange and change the angle of inclination of the retractor. The curved working end (1) of the retractor is bent three times in mutually perpendicular directions, fixes the liver lobe and excludes the movement of the left lobe of the liver with a change in the angle of inclination. All this gives good visual control when performing selective proximal vagotomy and duodenoplasty.

Example: Patient S., 52 years old. Suffers from duodenal ulcer (duodenal ulcer) for 12 years. Notes frequent seasonal exacerbations. An endoscopic examination revealed tubular stenosis of the duodenal bulb. Operation: upper median laparotomy, correction of the wound aperture with the Segal retractor, then a retractor of the proposed design is introduced into the upper abdominal cavity to discharge the left lobe of the liver cranially and to the right without crossing the triangular ligament of the liver. The liver is tightened and stably fixed, without changing the location of the hook on an additional vertical rack with fastening elements to the operating table located on the right side of the operating table. On the handle of the retractor and perpendicular to it at the same time the working part has a number of coaxial holes, which gives the retractor the ability to rearrange it and change the angle of inclination. The working end of the hook is bent three times in mutually perpendicular directions, it fixes the lobe of the liver and excludes the movement of the left lobe of the liver with a change in the angle of inclination. Performing selective proximal vagotomy and segmental duodenoplasty. Laparotomy wound closure. The patient was discharged in satisfactory condition 10 days after surgery for outpatient treatment.

Claims (1)

A liver retractor containing a holder and a curved working end, characterized in that there are a number of coaxial holes on the retractor handle and perpendicular to the integral part of the working part, and the working end is bent three times in mutually perpendicular directions, and the retractor is equipped with a stand fixed to the operating table for it fixation and the possibility of rearrangement and change of the angle of inclination.