UA65456A - Needle for sewing trocar wounds - Google Patents

Abstract

The needle for sewing the trocar wounds consists of the needle body, the ear, and the operating part. The needle body represents the hollow cylinder with the mandrin inside. The ear is located distally. The limiter with the thread fixation of the needle motion.

Description

The invention belongs to medicine, namely to endoscopic surgery and can be used for suturing trocar wounds.

A feature of laparoscopic surgery is minimal access when performing the same amount of surgery as in traditional surgery. The operation is performed in the abdominal cavity with special instruments introduced through trocars. Trocars are inserted through a 5-10 mm puncture of the anterior abdominal wall. When performing a laparoscopic cholecystectomy to remove the gallbladder from the abdominal cavity, one of the trocar punctures has to be expanded to 20-30 mm. If punctures of 5-10 mm do not need suturing, then a puncture extended to 2-3 cm must be sewn up. Factors that force the surgeon to carefully close the wound are bleeding from the anterior abdominal wall and the need to avoid postoperative hernia.

Suturing of such a wound is performed as follows |1|: hook the outer edges of the wound, expose the edges of the aponeurosis, take one edge with surgical tweezers, lift it up, catch it in the seam with a curved needle with a thread inserted into the ear. To ensure hemostasis, pre-peritoneal tissue should enter the suture.

After ensuring the stitching of the edges of the aponeurosis on one side, the opposite side of the aponeurosis is similarly stitched. The needle is removed from the wound and a thread is tied.

During laparoscopic operations, the described sequence can be performed only in patients with a thin abdominal wall, in which the length of the wound exceeds the depth. In overweight and obese patients of various degrees, with traditional suturing, when the depth of the wound exceeds the length by two or more times, there is excessive traumatization of the wound edges and technical difficulties for the surgeon.

Closest to the proposed method is the method of suturing narrow and deep wounds after laparoscopic operations using a straight needle with thread |2|Ї1. The aponeurosis of the pre-abdominal tissue, the parietal peritoneum are pierced with the awl and are inserted into the abdominal cavity. Then it is captured with a clamp-manipulator and removed from the abdominal cavity through the trocar of the manipulator. Similarly, the second side of the wound is sutured, and then the threads removed from the abdominal cavity are tied together. After that, the knot is introduced into the abdominal cavity, pulled through the stitched wall again from the abdominal cavity and then tied. The advantage of this technique is a fairly accurate stitching of the edges of the wound with preperitoneal tissue and peritoneum, complete hemostasis and tightness of the wound.

The disadvantage is that there is a danger of losing the needle in the abdominal cavity or damaging internal organs when it falls out of the clamp. In addition, pulling the tied knot through the layers of the abdominal wall increases the tension of the thread, which increases the possibility of its rupture.

The above-mentioned method of suturing narrow and deep wounds using a straight needle is the closest to the proposed one in terms of technical essence and the result that can be achieved, so it was chosen as a prototype.

The basis of the invention is the task of improving the design of the needle for suturing trocar wounds, which consists in making the working part in the cavity of a hollow cylinder in the form of a mandrel with a hook-eye and a limiter mounted on the body of the needle.

The problem is solved by the fact that, according to the invention, the body of the needle is a hollow cylinder, inside which the working part is located in the form of a mandrel, made according to the inner diameter of the body of the needle, and at the distal end of the mandrel, an eyelet is made in the form of a hook, and a limiter with threaded fixation of the course of the needle body.

In fig. the design scheme of the proposed needle for suturing trocar wounds is presented, where: 1 - needle; 2 - mandrel;

C - eyelet-hook; 4 - limiter.

The needle 1 is a hollow cylinder, which includes a mandrel 2, made according to the inner diameter of the needle and which at the distal end has a hook eye C for holding the thread, and a handle 5 is made at the proximal end of the mandrel for convenient holding of the needle. A limiter 4 with a threaded course is mounted on the needle 1, which allows you to avoid damage to internal organs in patients with different thicknesses of the anterior abdominal wall.

The proposed needle is used as follows. When suturing a trocar wound, all layers of the abdominal wall of one edge of the wound are pierced, the end of the thread is inserted into the abdominal cavity, which is pulled out from the needle under the control of the laparoscope. Then the opposite edge of the wound is similarly pierced with a needle without a thread, and in the abdominal cavity the end of the thread is again inserted into the ear and pulled out.

Compared to the prototype, the proposed needle allows to shorten the time of suturing a trocar wound, avoid damage to internal organs and prevent loss of the needle in the abdominal cavity during suturing.

Literature: 1. Operative surgery. / Ed. I. Lytman. - Budapest: Publishing House of the Academy of Sciences of Hungary, 1981. - P. 329-342. 2. Iuoappi5 K. SPpeigirara5, Kodeg U. Nai, Adat Madov5. Zitri jesppidie og Kesii5 Zpeai Siozige anyeg

And aragozsoris ZBygdegu Ovipud Bigaidpi Meeaiez, m/p Vemiem oi She TShegashte // And aragoeepdozsorisya; Admapsei Zygdisai

TesNpodcez. - 1999. - Ma. - R. 205-209.

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Fig.

Claims (1)

A needle for suturing trocar wounds, consisting of a needle body, an eye 1 of a working part, which is distinguished by the fact that the needle body is a hollow cylinder, inside which is located a working part in the form of a mandrel, made according to the inner diameter of the needle body, and at the distal end of the mandrel an eye in the form of a hook is made, and a limiter with threaded fixation of the movement of the needle body is mounted on the body of the needle.