RU96749U1 - SURGICAL MIRROR FOR ABDOMINAL DIGESTION - Google Patents

Abstract

 A surgical mirror for the abdominal esophagus containing a handle, characterized in that the working end of the mirror, made integral with the handle, is curved in the form of three mutually perpendicular flat equal surfaces, the last of which is directed outward, and the dimensions of the curved surfaces are 50 × 50 mm and their corners are zavulyany.

Description

The proposed utility model relates to medical equipment, namely to surgical instruments, and can be used to abdominal organs during interventions on the abdominal esophagus and duodenum (when suturing a perforated ulcer, segmental and bridge duodenoplasty, selective proximal vagotomy - at the stage of mobilization abdominal esophagus and cardiac part of the stomach).

According to domestic and foreign authors, during surgical interventions, in order to create the most favorable conditions for access to the operated area and performing manipulations in the surgical field, pushing and expanding tools are used (in English-speaking practice they are called retractors). Surgical mirrors in medicine are designed to expand cavity wounds and natural canals or to examine surfaces that are hidden from direct observation, and are straight or unidirectionally curved plates with polished surfaces or glass mirrors in a frame. To this day, the used surgical mirrors are not without significant drawbacks, since various surgical instruments are used in surgical procedures, and not all instruments are designed to conduct these types of operations and do not fully satisfy the needs of surgeons. All this underlines the relevance of modernizing surgical mirrors.

A device is known - a surgical retractor, containing vertical racks with holders of removable hooks-mirrors, installed with the possibility of interaction with the holders, retaining rings, and the holders are made in the form of serrated strips, and the retaining rings are placed on the thickened ends of the racks with the ability to interact with teeth and running stops made in the form of an end collar and mounted on the stand of the sleeve, while the removable hooks-mirrors are connected to the toothed strips with 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.

For the closest analogue, a device is adopted - 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 ° / Application: 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 objectives of this proposal are:

1) Creating conditions for a visual review of the lower point of the wound, thereby achieving a good view of the vessels and ligaments to facilitate manipulation in this field.

2) Favorable conditions for visual monitoring and manipulation, reducing trauma to the underlying tissues and eliminating the need to mobilize the left lobe of the liver by crossing its triangular ligament.

3) Providing normal visual control of the abdominal esophagus with a tool that does not require the introduction of additional mirrors.

The tasks are achieved in that the device containing the handle, the working end of the mirror which is made integral with the handle, is curved in the form of three mutually perpendicular flat equal surfaces, the last of them is directed outward, and the dimensions of the curved surfaces are 50 × 50 mm and their angles are worn. The device allows you to install the end of the mirror at the maximum lower point of the wound, while achieving a good visual overview of the vessels and ligaments, eliminating trauma to the underlying tissues and eliminating the need to mobilize the left lobe of the liver with the intersection of its triangular ligament, which in turn facilitates manipulation in this field without additional mobilization of the liver.

Technical result: the device allows to achieve the installation of the end of the mirror at the lowest possible point of the wound, improves visual visibility at the lower point, thereby achieving a good overview of the vessels and ligaments to facilitate manipulation in this field. The device was tested on 380 patients who were undergoing treatment in the surgical department of the 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. In all patients with this instrument, favorable conditions were achieved for visual control and manipulation, while there was no trauma to the underlying tissues, and there was no need to mobilize the left lobe of the liver by crossing its triangular ligament. In the observed patients, the postoperative period was favorable. The hospital stay of patients was reduced by an average of 2-4 days. After removal of skin sutures, patients were discharged on average on the 10th day for outpatient treatment.

For a better understanding, the device is schematically depicted in figure 1., where 1 is the handle, 2 is the working end of the mirror.

The device is used as follows. By performing the upper median laparotomy, the abdominal wall is opened in layers under intubation anesthesia, a thick probe is inserted into the patient’s stomach. Segmental duodenoplasty and selective proximal vagotomy are performed. At the stage of mobilization of the abdominal esophagus and cardiac part of the stomach, an instrument of our design was used. The device is inserted by the handle (1) into the abdominal cavity in the epigastrium and its lower part (2) pushes the liver cranially and to the right. The installation of the end of the mirror (2) at the maximum lower point of the wound is achieved due to the curved shape of three mutually perpendicular flat equal surfaces, the last of which is directed outward, which is adequate to the anatomical curvature, which gives a good visual overview of the vessels and ligaments. Thus, there is no trauma to the underlying tissues and there is no need to mobilize the left lobe of the liver with the intersection of its triangular ligament, in turn, manipulations in this field are facilitated without mobilization of nearby tissues. The laparotomic wound is sutured.

Example: M., 43 years old, diagnosis: duodenal ulcer, complicated by subcompensated stenosis. For 7 years, it was unsuccessfully treated conservatively. 2 years ago he urgently underwent suturing of a perforated duodenal ulcer. Operation: upper median laparotomy. A marked adhesion process was noted in the upper floor of the abdominal cavity. There is a narrowing of the duodenal bulb to 0.5 cm with the formation of two pseudo-diverticula. Performed segmental duodenoplasty, selective proximal vagotomy. At the stage of mobilization of the abdominal esophagus and cardia, the proposed tool was used. It was noted that favorable conditions are created for visual monitoring and performing manipulations, while there is no trauma to the underlying tissues and there is no need to mobilize the left lobe of the liver by crossing its triangular ligament. The postoperative period was favorable. After removal of skin sutures, the patient was discharged on the 10th day for outpatient treatment.

Claims (1)

A surgical mirror for the abdominal esophagus containing a handle, characterized in that the working end of the mirror, made integral with the handle, is curved in the form of three mutually perpendicular flat equal surfaces, the last of which is directed outward, and the dimensions of the curved surfaces are 50 × 50 mm and their corners are zavulyany.