UA114151U - CAPACITY FOR PERFORMANCE OF GAS-FREE LAPAROSCOPIC CHOLECYSTECTOMY ON THE BIRCH OF AF. - Google Patents

Abstract

The tank for performing gas-free laparoscopic cholecystectomy includes a laparolifting element introduced into the abdominal cavity, and it is a container (1), which is made of a two-layer synthetic fabric in the form of a hemisphere in working order with the base (2) in the upper part of its composition interconnected openings of parallel particles (3), which are connected to the base with the possibility of their further understanding, and which have along the perimeter functional openings (4) intended for the introduction of trocars (7) with tools (10) and attached to one of them with a camcorder (8), in addition, to the base of the tank LED strip (9), to the base is also tightly attached PVC pipe (5) for inflating the compressor capacity, and at the bottom of it is fixed PVC pipe (6) for rehabilitation during the operation.

Description

The useful model belongs to the field of medicine, namely abdominal surgery, and can be used in the performance of gasless laparoscopic cholecystectomy itself and sanitation of the operating field.

A prerequisite for laparoscopic surgery is the creation of space in the abdominal cavity, necessary for intra-abdominal manipulations. This is most often achieved by applying a pneumoperitoneum with subsequent maintenance of intra-abdominal pressure at the level of 15-20 mm Hg. Art.

This invariably leads to various complications, namely: the introduction of carbon dioxide into the abdominal cavity, which consists in a decrease in pH and an increase in CO tension, vascular collapse and pronounced vasodilatation, which gives clinical symptoms of peritonitis. The introduction of nitrous oxide into the abdominal cavity leads to the appearance of pain in the right upper arm as a result of stretching of the diaphragm and irritation of the phrenic nerve (1).

At the same time, the appearance of clinical indicators in the form of shortness of breath, a decrease in blood pressure by 10-15 mm Hg is observed. Art., first tachycardia, and then bradycardia.

In addition, a decrease in the degree of blood oxygen saturation is noted. Intra-abdominal pressure that exceeds 20 mm Hg. art., capable of causing hemodynamic disturbances in the inferior vena cava system, and also contributes to the development of reflex oligo- and anuria (2).

The pathophysiological consequences of increased intra-abdominal pressure in pneumoperitoneum include the following changes: compression of the lungs when the diaphragm is raised with a decrease in the final capacity, an increase in the dead space and an exit into hypercapnia; heart failure; there is a change in the position of the heart, its transfer to a horizontal position; compression of the inferior vena cava with violation of venous blood flow in its basin causes venous stasis in the lower extremities, thrombosis with subsequent pulmonary embolism; violation of blood flow in the arteries of the abdominal cavity, which increases postoperative intestinal paresis against the background of decreased blood supply and ischemia; as a result of extraperitoneal gas insufflation, the development of subcutaneous emphysema, pneumoperitoneum, pneumomediastinum, pneumothorax, and pneumopericardium is possible.

All this limits the performance of laparoscopic operations in patients with chronic cardiopulmonary diseases, coagulopathy, in patients with chronic mesenteric ischemia, with chronic pathology of the venous system.

In connection with possible complications of pneumoperitoneum, alternative methods of creating the necessary working space in the abdominal cavity are being developed - mechanical lifting of the anterior abdominal wall (laparolifting) and devices for its implementation. The use of these devices allows to one degree or another to avoid hemodynamic, respiratory, and metabolic complications.

The closest to the declared technical solution is the laparolift model for performing laparoscopic cholecystectomy, which contains one or two rods and traction connected to the middle part of the rod and the bar (3). The rod is made in the form of at least three cylindrical links connected to each other with the possibility of turning at an acute angle to change the shape of the rod from straight to arc-shaped, which it takes under the influence of the weight of the front abdominal wall after installation.

The design of the intra-abdominal elevator ensures sufficient atraumaticity of laparolifting, however, the device does not allow to create the necessary working space in the abdominal cavity and to carry out optimal lifting of the anterior abdominal wall of more than one or two anatomical areas, when using it, it is impossible to ensure dosed regulation of the traction force of various links of the anterior abdominal wall. In addition, the design of the device is difficult to implement.

The basis of a useful model is the task of developing a device for performing laparoscopic cholecystectomy, which is made in the form of a container, which in working condition is similar to a hemisphere, and consists of connected parallel parts with the possibility of inflating them with a compressor to lift the anterior abdominal wall during the operation and push the internal organs (laparolifting), which will expand the possibilities of operative laparoscopic cholecystectomy by increasing the operating field, while eliminating the possibility of damage to internal organs, which reduces the possibility of adhesions in the postoperative period.

The problem is solved by the fact that, according to a useful model, the container is made of two-layer synthetic fabric in the form of a hemisphere in working condition, with a base in its upper 60 part and consists of parallel parts connected by holes to each other, which are attached to the base with the possibility following their expansion, and which have along the perimeter functional holes intended for the introduction of trocars with a video camera attached to each of them, in addition, an LED strip is attached to the base of the container, a PVC tube is also tightly attached to the base for inflating the container with a compressor, and in the lower part of it is fixed

PVC tube for sanitation during surgery.

In fig. 1, 2 shows a top view (Fig. 1) and a side view (Fig. 2), where: 1 - capacity; 2 - base of the container;

C is a share of the capacity; 4 - opening of the container for trocar insertion; 5 - PVC pipe for inflating the container; 6 - PVC tube for suction of biomaterial residues; 7 - trocar; 8 - video camera; 9 - LED strip; 10 - tools for performing laparoscopic cholecystectomy.

The task is solved by the fact that, according to a useful model, a container for manufacturing from synthetic two-layer fabric in the form of a hemisphere with a base in its upper part, parallel particles connected by holes are attached to the base with the possibility of their subsequent inflation, the base has four functional holes intended for the introduction of trocars into the abdominal cavity through them, a video camera is attached to each of them, in addition, an LED strip is tightly fitted to the base of the container around the perimeter, a polyvinyl chloride (PVC) tube is tightly fixed to the base of the container, which serves to inflate the container with a compressor, and in the lower part, along the perimeter of the container, a PVC pipe is fixed for sanitation of the operating field.

The stated technical solution is implemented as follows. The operation of laparoscopic cholecystectomy includes the following stages: After preparing the patient, two trocars 7 with embedded video cameras 8 are inserted through typical points of the epigastric and mesogastric areas of the abdominal cavity. According to the standard method, a supraumbilical incision is made and inserted tightly

From the collapsed container 1 under the control of tools 10 introduced through trocars: the container is pulled into the projection of the gall bladder, inflated through the PVC tube with the help of a compressor and the indicated two trocars with tools are introduced into the container. Next, through the incision in the supraumbilical area, a third trocar with an instrument is introduced into the container. Fix the base of 2 containers to the peritoneum at 3-4 points with laparoscopic clips.

In addition, the capacity is inflated with a pressure of 3-4 atm until the appearance of the laparolifting effect, namely, the increase of the operating field to the required size. The gallbladder is removed by applying clips to the gallbladder artery and bile duct by the evisceration method without injuring the liver tissue. Biological tissues isolated during the operation are collected in containers and suctioned with the help of PVC tube 6 (sanitation), thereby preventing infection of the abdominal cavity. In addition, locating the laparoscopic instruments inside the trocars, which are placed in the container, also prevents possible infection of the abdominal organs.

After the operation to remove the gallbladder, the clips securing the base to the peritoneum are removed, the compressor is turned off, all (3) trocars are removed from the container, and the trocar inserted through the supraumbilical incision is removed from the abdominal cavity. Then the container is rolled up with tools and removed through an incision in the supraumbilical area. Then the trocars are removed. The operation is completed according to the standard method.

Compared to the prototype, the proposed capacity for performing gasless laparoscopic cholecystectomy due to the original design allows to avoid the possibility of postoperative adhesion formation, trauma when creating a laparolifting for laparoscopic intervention, to achieve controllability of the shape and volume of the operating space, to improve the quality of diagnostics due to the use of video cameras and LED tapes, improve working conditions and reduce the fatigue of the surgeon, improve the quality of the results of surgical intervention, expand the range of operative interventions in laparoscopy, reduce patient suffering during diagnosis and treatment.

Sources of information: 1. Fedorov I.V., Sigal E.I., Odintsov V.V. Endoscopic surgery. - M.. GOZTAR, 1998. -

P.109-139. 2. Potashov L.V. et al. Vestn. surgery - 1999. - Mo 2. - p.22-26. 60 3. Pat. RF 2123810, Ab1B 17/02, publ. 27.12.98. - Bull. Mo 36.

Claims (1)

UTILITY MODEL FORMULA A gasless laparoscopic cholecystectomy container comprising a laparolifting element inserted into the abdominal cavity, characterized in that it is a container (1) made of a two-layer synthetic fabric in the form of a hemisphere in the working state with a base (2) in its upper part and consists of parallel parts (3) connected to each other through holes, which are attached to the base with the possibility of their subsequent disassembly, and which have functional holes (4) along the perimeter, designed for the introduction of trocars (7) with instruments ( 10) and a video camera (8) attached to each of them, in addition, an LED strip (9) is attached to the base of the container, a PVC pipe (5) is also tightly attached to the base for inflating the container with a compressor, and in its lower part, a PVC tube (6) for sanitation during the operation. "OM, ххх ЧОЙ хм Х. И КК В КК ж ve h. nn 5 Ki SCHO shchi ke B. "Fig. 2