RU199682U1 - Extractor for the removal of kidney stones - Google Patents

Abstract

The proposed utility model relates to medical instruments used in urology for hydrodynamic evacuation of calculi from the renal cavity. The purpose of this device is to reduce the risk of injury to the kidney tissue during the operation to remove kidney stones by the method of percutaneous evacuation. The extractor for removing stones from the kidney cavity consists of a device body, a casing tube, a fluid inlet fitting mounted into the device body at an angle, a drainage pipe. for the withdrawal of removed calculi, mounted in the device body at an angle, bushings, washers, cap nuts located in the upper and lower parts of the housing. The flow of irrigation fluid captures renal calculi, which are removed by the flow through the outlet nozzle when the endoscope is moved until the distal end of the endoscope will be at the level of the outlet. In this case, the tube-casing remains stationary relative to the kidney wall. Dumping and storage of stone fragments in the chamber occurs through a flexible tube at the moment the distal end of the endoscope with a captured stone fragment passes by it without completely removing the endoscope and breaking the tightness of the system. Then the endoscope is again immersed in the kidney cavity to capture and remove the remaining fragments of the stone. The procedure is repeated until all stone fragments are completely removed from the kidney cavity.

Description

This utility model relates to medical instruments used in urology in the hydrodynamic evacuation of calculi from the renal cavity.

A device for removing fragments of crushed stone during nephroscopy is known, in which forceps or a special shape of a basket are used to capture, hold and then remove a fragment of a stone [1].

The disadvantages of using such a device include the need to alternately change working tools during the operation: an optical fiber or other device designed to crush a stone into fragments, supply laser radiation to the stone for its destruction, into forceps or a basket grip, which lengthens and complicates procedure.

Known device for irrigation of the cavity system of the kidneys and urinary bladder, in which the cavity of the kidney is washed after crushing stones and the removal of calculi in a special container [2].

The disadvantages of this device include:

- simultaneous use of mechanical and electrical devices, which makes the operation of the device quite difficult;

- special chemical solutions are used as an irrigation liquid;

- the device uses a differential pressure gauge that contains mercury vapors, which increases the risk of harm to the patient.

There is a known device made in the form of a casing tube, which is introduced into the kidney cavity before the operation [3]. Next, an endoscope is inserted into the casing tube, which is also immersed in the kidney cavity. A gap is created between the inner wall of the sheath and the endoscope due to the difference between the inner diameter of the sheath tube and the outer diameter of the endoscope. Through the instrumental channel of the endoscope, a liquid (saline) is supplied into the kidney cavity under a pressure of no more than 100 cm of water column. The outflow of fluid is carried out through the gap between the casing tube and the endoscope body. Before capturing a stone fragment, the distal ends of the tube - the casing and the endoscope - are set approximately at the same level relative to each other. Under visual control, the casing tube and the endoscope are brought together to the fragment to be removed. By the reverse flow of liquid due to the hydrodynamic effect, the stone fragment is captured and fixed in the gap zone. After that, the stone fragment captured in this way is taken out from the casing tube together with the complete removal of the endoscope.

The disadvantages of this device, providing the implementation of the above method include:

- the need to simultaneously bring the distal ends of the casing tube and the endoscope to the stone fragment in order to capture, hold and then remove the fragment, which increases the risk of kidney injury during such manipulations due to the constant movement of the casing tube relative to the kidney wall;

- unreliability of gripping and holding a stone fragment, since a stone fragment is captured only by a part of the gap. Therefore, for a confident capture and retention of a stone fragment by increasing the hydrodynamic effect, it is necessary to increase the fluid flow rate, which significantly increases the risk of an increase in pressure in the renal cavity with the possibility of injury to its tissues (pyelophoric and pyelovenous reflux);

- to remove a stone fragment, it is necessary to completely remove the endoscope with a tube with a casing from the kidney cavity, leading to a violation of the tightness of the system.

The objective of the proposed useful model is to reduce the risk of injury to the kidney tissue during the procedure for percutaneous evacuation of stone fragments beyond its limits, to simplify the procedure for the removal of renal calculi, and to reduce the time of the procedure.

An extractor for removing calculi from the kidney cavity, including a body, a tube-casing, a fluid inlet fitting mounted into the body of the device at an angle, bushings, washers, union nuts located in the upper and lower parts of the body, characterized in that the body of the device under a branch pipe is installed with a corner for the removal of the removed calculi.

The proposed device provides the ability to supply fluid to the gap between the casing tube and the endoscope, the outflow of fluid is carried out through the instrument channel of the endoscope, and the removal of renal calculi is carried out without depressurizing the device during the entire operation.

The casing tube, when used together with an endoscope inserted into it, circulates the irrigation fluid inside the kidney cavity to capture, hold and then remove stone fragments from the kidney cavity. Irrigation fluid is injected through the nipple into the kidney cavity. Irrigation fluid is removed through the instrument channel of the endoscope. Tightness is ensured by sealing sleeves, washers and union nuts in the upper and lower parts of the device body.

When the endoscope is moved along the casing tube until the distal end of the endoscope reaches the discharge port, renal calculi are removed with the flow of irrigation fluid through the discharge port outside the device. Then the endoscope is moved along the casing tube to its original position. The complete endoscope is withdrawn only after the end of the operation.

The irrigation fluid inlet and outlet are angled to the main axis of the casing tube to ensure uniform fluid flow.

The tube-casing during removal is stationary relative to the kidney, and the removal of the fragments is carried out without depressurizing the kidney cavity.

FIG. 1 shows an extractor for the removal of renal calculi, complete, where:

1 - extractor body;

2 - union nut;

3 - washer;

4, 5 - sealing sleeves; 6- tube-casing.

Removal of a stone fragment is carried out as follows: irrigation fluid (for example, saline) is introduced into the cavity of the extractor body and then through the gap between the inner surface of the casing tube and the outer surface of the endoscope body enters the kidney cavity (Fig. 1). The outflow of fluid from the kidney cavity is carried out through the instrument channel of the endoscope. The capture of a stone fragment occurs in the region of the distal end of the instrument channel of the endoscope due to the hydrodynamic effect. Removal of the captured stone fragment from the kidney cavity is carried out with the removal of the endoscope, which is moved along the tube - the casing. In this case, the casing tube remains stationary relative to the kidney wall. Dumping and storage of stone fragments in the chamber occurs through a flexible tube at the moment the distal end of the endoscope with a captured stone fragment passes by it without completely removing the endoscope and breaking the tightness of the system. Then the endoscope is again immersed in the kidney cavity to capture and remove the remaining stone fragments. The procedure is repeated until all stone fragments are completely removed from the kidney cavity.

The proposed device has the following advantages:

- the procedure for removing renal calculi is simplified;

- the time of the operation is reduced;

- provides a more effective capture of renal calculi;

- during the operation, the system is sealed due to the fact that during the operation the tube-casing does not move relative to the walls of the kidney, and the endoscope is removed from the device only at the end of the operation, which significantly reduces the risk of injury and minimizes the risks of increasing pressure inside the cavity above the allowable value.

Sources of information:

1. RF patent №2058115;

2. RF patent No. 2111016;

3. RF patent No. 2637820 - prototype.

Claims (1)

Extractor for the removal of renal calculi, including a body, a tube-casing, a connection for fluid inlet mounted into the body of the device at an angle, bushings, washers, union nuts located in the upper and lower parts of the body, characterized in that the body of the device is mounted at an angle outlet nozzle for removal of removed calculi.

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