UA140240U - METHOD OF INSTALLATION OF TROACARS FOR PERFORMANCE OF LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL ALUMINUM ALLOY PLASTIC - Google Patents

Abstract

A method of installing trocars to perform minilaparoscopic transabdominal preperitoneal alloplasty of inguinal hernia, which performs the placement of trocars on the anterior abdominal wall for the introduction of a laparoscope, power tools, working tools and polypropylene mesh Progrip. A 5 mm trocar is placed in the navel to insert a 5 mm laparoscope, and a 3 mm trocar for a 3 mm grasper is placed on the left edge of the rectus abdominis below the level of the navel by 1 cm or at the level of the navel.

Description

The useful model belongs to surgery, namely general surgery, and can be applied to minilaparoscopic transabdominal preperitoneal alloplasty of inguinal hernia.

Traditional surgical treatment of an inguinal hernia is performed by installing Z trocars on the anterior abdominal wall, after which dissection of the hernial sac is performed followed by plastic surgery of the inguinal canal with a mesh implant. Installation of standard-diameter trocars can lead to pronounced postoperative pain syndrome. In addition, after installing trocars of a standard diameter, there is a possible risk of developing trocar hernias in the postoperative period.

The closest to the claimed technical solution is a method of installing Z trocars on the anterior abdominal wall, which includes placing trocars on the anterior abdominal wall, namely: a trocar for the introduction of a laparoscope, a trocar for a working instrument and a trocar for an additional instrument before performing the dissection of the hernial sac and the inguinal alloplasty channel (1).

However, this development has the disadvantage that the installation of Z trocars of standard 5 mm and 10 mm sizes on the anterior abdominal wall leads to pronounced postoperative pain syndrome, the development of trocar hernias, longer wound healing and an unsatisfactory cosmetic effect are also possible.

The useful model is based on the task of improving the placement of trocars for minilaparoscopic transabdominal preperitoneal alloplasty of the inguinal canal by installing Z trocars that have a smaller diameter, which will reduce postoperative pain syndrome, prevent the development of trocar hernias, accelerate the healing of postoperative wounds, and improve the cosmetic effect of postoperative wounds.

The task is solved by the fact that, according to a useful model, instead of a 10 mm trocar for inserting a 10 mm laparoscope in the navel, a 5 mm trocar is installed for inserting a 5 mm laparoscope, instead of a 5 mm trocar for applying a 5 mm working tool along the left edge of the rectus muscle a 3 mm trocar for a 3 mm grasper is placed in the abdomen below the level of the navel by 1 cm or at the level of the navel.

The method is performed as follows:

Under endotracheal anesthesia, after treatment of the operative field according to the standard technique, a Veresh needle is used to perform a pneumoperitoneum in the navel, and the first 5-mm trocar for 5-mm optics is inserted into this same point. Then, under the control of 5 mm optics, a 3 mm trocar for the mini-grasper of the surgeon's left hand is inserted 1 cm below the level of the navel or at the level of the navel along the left edge of the rectus abdominis muscle. Next, a 5 mm trocar for power tools for the surgeon's right hand is inserted along the right edge of the rectus abdominis muscle at the level of the navel. After that, the abdominal cavity is revised, and the parietal peritoneum is dissected. The lower epigastric vessels are visualized. Step-by-step dissection of the hernia sac is performed until its complete removal from the inguinal canal.

At the next stage, the Ragpeiepe RgoStir mesh measuring 9x15 cm is twisted into a tube and, with the help of an endoscopic 3 mm grasper, it is introduced through a 5 mm trocar into the abdominal cavity and unfolded.

At the second stage, the mesh is deployed and placed with the closure of the straight and oblique space.

Next, hemostasis is checked, the opening of the parietal peritoneum is sutured with M-Ios 3-0 absorbable thread, trocars are removed, and subcutaneous cosmetic sutures are applied.

According to the stated method, 8 patients were operated on. All of them were discharged without complications with a recommendation for re-examination 1 month after the surgical treatment. On the second day, the patients did not need painkillers. All patients were discharged on the second day after surgery.

Thus, the proposed method, due to the original placement of mini-trocars, for performing transabdominal preperitoneal alloplasty of inguinal hernia with smaller diameters, allows to reduce postoperative pain syndrome, prevent the development of trocar hernias, shorten the duration of wound healing and significantly improve the cosmetic effect.

Sources of information: 1. Sazhyn A.V., Klymiashvili A.D., Kochiai Z. Technical features and direct results of laparoscopic transperitoneal and total extraperitoneal hernioplasty. Russian Medical Journal. 2016; 22(3): 125-129.

Claims (1)

USEFUL MODEL FORMULA The method of setting trocars for minilaparoscopic transabdominal preperitoneal alloplasty of inguinal hernia, in which placement of trocars is performed on the anterior abdominal wall of the abdomen for the introduction of a laparoscope, electric instruments, working instruments and polypropylene mesh Rgoahir, which is distinguished by the fact that a 5 mm trocar is installed in the navel for introduction of a 5 mm laparoscope, a 3 mm trocar for a 3 mm grasper is placed on the left edge of the rectus abdominis muscle 1 cm below the level of the navel or at the level of the navel.