UA142164U - METHOD OF INSTALLATION OF TROACARS FOR PERFORMANCE OF LAPAROSCOPIC ALOPLASTY OF THE GASTROINTESTINAL HOLE OF THE DIAPHRAGM AND FOUNDATION OF NISSEN - Google Patents

Abstract

A method of installing trocars to perform minilaparoscopic alloplasty of the esophageal orifice of the diaphragm and fundoplication according to Nissen, which performs the introduction of trocars on the anterior abdominal wall to accommodate the laparoscope, power tools, work tools, hepatic retractor and additional tools. For introduction of 10 mm of a laparoscope on 1,5-2,0 cm above a navel on the left parasternal line establish 5 mm trocar for 5 mm of a laparoscope, for introduction of the working tool under a xiphoid process establish 3 mm trocar, for introduction of the additional tool on an anterior axillary line on 2 cm below the costal arch set 3 mm trocar, to install the hepatic retractor in the right hypochondrium 2 cm below the costal arch along the midclavicular line make a 5 mm incision for Nathanson retractor along the parasternal line under the left costal arch.

Description

The useful model belongs to surgery, namely general surgery, and can be applied for minilaparoscopic hiatal hernia alloplasty and fundoplication for

Nissen.

Traditional surgical treatment of esophageal hiatal hernia is performed by placing 5 trocars on the anterior abdominal wall, followed by crurorrhaphy and fundoplication. Installation of standard-diameter trocars can lead to pronounced postoperative pain syndrome. In addition, after the installation of 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 5 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, a liver retractor, an electric instrument and an additional instrument for tissue traction before performance crurorrhaphy and fundoplication (1).

However, this development is technically impractical, because the installation of 5 trocars of standard 5 mm and 10 mm sizes on the anterior abdominal wall leads to a pronounced postoperative pain syndrome, as well as the development of trocar hernias, longer wound healing and an unsatisfactory cosmetic effect.

The useful model is based on the task of improving the placement of trocars for minilaparoscopic alloplasty of the esophageal hiatal hernia and Nissen fundoplication by placing 4 trocars that have a smaller diameter.

The method of installing trocars for performing minilaparoscopic alloplasty of the esophageal opening of the diaphragm and fundoplication according to Nissen, in which trocars are inserted on the anterior abdominal wall for placement of the laparoscope, electric instruments, working instruments, liver retractor and additional instruments.

To introduce a 10-mm laparoscope 1.5-2.0 cm above the navel along the left parasternal line, a 5-mm trocar is installed for a 5-mm laparoscope, to introduce a working instrument under the xiphoid process, a 3-mm trocar is installed, to introduce an additional instrument along the anterior axillary line at 2 cm below the costal arch, a C mm trocar is installed to install a liver retractor in the right hypochondrium 2 cm below the costal arch along

From the midclavicular line, a 5-mm incision for the Nathanson retractor is made along the parasternal line under the left costal arch.

The method is performed as follows:

Under endotracheal anesthesia after treatment of the operative field according to the standard technique, a Veresh needle along the left midclavicular line under the costal arch (at the point

Palmer) perform pneumoperitoneum. After applying the pneumoperitoneum, the first 5-mm trocar for the main working tools of the surgeon's right hand is inserted into this same point.

Next, under the control of the 5-mm optic inserted through it, along the left parasternal line in the middle of the distance between the navel and the costal arch, immediately to the left of the round ligament, a second 5-mm trocar is introduced for a 5-mm full-format 30" optic. Then, on midway between the first trocar and the xiphoid process, a third 5 mm Nathanson retractor is inserted to lift the left lobe of the liver.IM and M 3 mm minigrasper trocars are inserted into the xiphoid region for the surgeon's left hand and along the left anterior axillary line for the assistant.

The first stage is the mobilization of the abdominal part of the esophagus, the bottom of the stomach and the edges of the esophageal opening of the diaphragm according to the standard method. After dissection of the legs of the diaphragm, plastic surgery of the esophageal opening is performed, posterior crurorrhaphy is performed.

The second stage involves fundoplication according to Nissen. In the lower part of the cuff, an anchor seam is applied with stitching of the muscle wall of the esophagus to prevent the cuff from slipping.

At the last stage, hemostasis is checked, trocars are removed and subcutaneous cosmetic sutures are applied.

According to the stated method, 12 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 minitrocars for the alloplasty of the esophageal hiatal hernia and fundoplication, with smaller diameters and instead of a 10 mm trocar for the installation of a hepatic retractor, a 5 mm incision in the left hypochondrium, allows to reduce the postoperative pain syndrome. prevent the development of trocar hernias, reduce the duration of wound healing and improve the cosmetic effect.

Sources of information: 1. Technical aspect of laparoscopic plastic hernia of the esophageal opening of diaphragms!: review of the literature and proprietary opiate / E.A. Kalinina, A.N. Pryakhin // Herald

YuURrSU Series "Education, healthcare, physical culture". - 2014. - T. 14, Mo. 3. - P.

Claims (1)

54-60. UTILITY MODEL FORMULA Method of installing trocars for minilaparoscopic esophageal hiatal alloplasty and Nissen fundoplication, in which trocars are inserted into the anterior abdominal wall to accommodate a laparoscope, power tools, working tools, a liver retractor, and an additional tool, which is distinguished by the fact that for the introduction 10 mm laparoscope 1.5-2.0 cm above the navel along the left parasternal line, a 5 mm trocar is installed for a 5 mm laparoscope, a 3 mm trocar is installed for the introduction of a working instrument under the xiphoid process, and an additional instrument is installed 2 cm below the anteroaxillary line 3 mm trocar is installed in the costal arch, to install the hepatic retractor in the right subcostal area 2 cm below the costal arch along the midclavicular line, a 5 mm incision is made for Nathanson's retractor along the parasternal line under the left costal arch.