RU2141263C1 - Method and device for making anastomoses under laparoscopic control - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves bringing close parts of hollow organs to be anastomosed under laparoscopic observation. Hollow organs lumens are opened and suturing device is introduced through the so formed openings. The device has two coils of wire produced from material possessing shape memory properties. The coils are adjacent to one another along generatrix. Coil surfaces are enveloped with working part of thermoelement as arcs. The device being introduced, its cooling with thermoelement is stopped and the organ walls are connected by controlled pressing. Tissue compression being achieved, the device separates itself from the thermoelement that is to be removed from the abdominal cavity. Organ walls are connected with tissue dissected inside of the device and defect sutured in the anastomosis. EFFECT: excluded cases of suture material left in anastomosis; no coarse cicatrization; improved hemostatic and tightness properties of the junction. 2 cl, 6 dwg

Description

 The invention relates to medical equipment and can be used in endoscopic surgery for laparoscopic compression anastomosis between the hollow organs of the gastrointestinal tract.

There is a method of laparoscopic anastomosis by CEEA-28 apparatus, which provides mechanical circular intestinal anastomosis [Milsom IV, Lavery IC et.al.Use of laporoskopic technigues in colorectal surgery. Preliminary studi.Dis Colon Rectum, 37 (3): 215-18, 1994.]
The disadvantages of this method are: the introduction and abandonment of metal clips along the seam line, which do not exclude bleeding, insolvency and cause chronic inflammation around foreign bodies with severe scarring of the circular anastomosis; another drawback is the possibility of its implementation only on the rectum and sigmoid colon due to the need to introduce the main part of the structure through the anal canal. In addition, the implementation of this method includes the extraperitoneal stage of the operation with the removal of the mobilized intestine out through the minilaparotomic access, which increases the invasiveness and infection of the abdominal cavity.

 A known method of laparoscopic creation of anastomoses, selected as a prototype, which consists in the following.

 Endoscopically under video control, the anastomosed resected areas are brought together by endobebocom, and the corners of the mechanical suture are cut off by the endoscissors, which leads to the opening of the lumen of the anastomosed sections of the intestine. An Endo GIA-30 apparatus is inserted into the abdominal cavity. The apparatus jaws are opened and alternately inserted into the formed intestinal wounds to the last mark. After double flashing with the apparatus, an anastomosis is formed. A bowel and anastomosis defect is fixed with endobebcoci and stitched with the Endo GIA-30 apparatus [V.P. Sazhin, V.V. Didenko, A.S. Pigin. Endoscopic resection of the sigmoid colon. Ryazan, 1995.-S. 32-34).

 The known compression device for performing anastomoses, selected as a prototype device for creating anastomoses, contains two turns of wire from a material with a shape memory effect in contact along the generatrix [Makarov A.I., Borodin N.A., Ziganshin R.V. and others. A method of creating anastomoses. A.S. USSR N 1186199, publ. 23.10.85. -B.I. N 39.-C.22-23.].

 The disadvantages of the known method of laparoscopic execution of anastomoses - the prototype of the proposed method are the formation of anastomosis using a mechanical staple seam, which does not exclude bleeding from the seam ["Endosurgery today" (abstract. Journal) .- Kazan, 1995. -N 1. P.28.] . In addition, this type of suture does not exclude insolvency, severe scarring of the anastomosis; the latter explains the need to perform large sizes of anastomosis to maintain sufficient patency of the intestinal contents. These disadvantages are associated with unreliable hemostaticity, tightness of this type of suture, chronic inflammation around the suture material remaining in the body [N.N. Kanshin // Surgery. -1981. -N 7. -C.86-89.].

 A disadvantage of the known device for performing anastomoses, the prototype of the proposed device for creating anastomoses, is the quick, within 1 - 2 seconds, actuation of the device cooled with diluted turns in contact with the body, which is associated with the temperature of the form recovery. This factor makes it impossible to use it with the laporoscopic method of performing anastomoses.

 The objective of the invention is to develop a laparoscopic method for the formation of a compression anastomosis and a device for its implementation in order to prevent leaving suture material on most of the perimeter of the anastomosis and rough scarring of the anastomosis, to improve hemostaticity and tightness of the anastomosis.

 The problem is solved in that in the proposed method of laparoscopic anastomosis in the abdominal cavity under video surveillance, the anastomosed parts of the hollow organs are brought together, their lumen is opened, a stapling device is inserted through the openings and the organ walls are connected, followed by dissection of the tissues inside the device and suturing of the defect in the anastomosis. At the same time, a device with a thermomechanical memory is inserted into the gaps of the hollow organs, its cooling with the thermocouple is stopped and the walls of the organs are connected by their metered compression, and the thermocouple is removed from the abdominal cavity.

 The problem is solved in the same way that in the device for creating an anastomosis containing two turns of wire made of material with shape memory in contact with the generatrix, the surface of the turns of wire made of material with shape memory is arcuately covered by the working part of the thermocouple, with the possibility of self-separation from the turns in compression tissues.

 Comparative analysis with the prototype shows that a significant distinguishing feature in the form of using a compression device determines a new property of the population, providing new technical results: in the form of the absence of suture material on the greater part of the perimeter of the anastomosis, after rejection of the compression device, eliminating gross scarring of the anastomosis, as well as form of increasing tightness and hemostaticity.

 Declare two objects of the invention - the device and method are interconnected by a single inventive concept.

 In FIG. 1 shows the stage of laporoscopic approximation of anastomosed parts of the organ and the opening of their gaps. In FIG. Figure 2 shows the dissection of the adjacent inner walls of the resected ends of the intestine and the introduction of a diluted compression device into the lumens of the anastomosed parts of the hollow organ. In FIG. 3 shows the beginning of the dissection stage by endoscissors with usuras (recesses) of the septum from the tissues inside the compression device. In FIG. 4 shows a completed view of a laporoscopic anastomosis with an stitched defect of anastomosis. Figure 5 shows the position of the introduced device with shape memory in the lumens of the anastomotic parts of the intestine, relative to the walls of the organ before the form restoration and tissue compression, a general sectional side view. In FIG. Figure 6 shows the stage of the form restoration of the device and tissue compression with self-separation from the turns of the thermocouple, a general sectional side view.

 The proposed method of laparoscopic anastomosis is implemented as follows.

 (According to Fig. 1). After endoscopic mobilization and resection of the intestine 1, the anastomosed areas are brought closer to each other by endobecoccus 2, and the corners of the mechanical suture 3 are cut off by the endoscissors. The length of the cut-off part on each side should not exceed 1 cm, while the lumen of the anastomosed sections of the intestine 1 is opened.

 (According to FIG. 2). Introduce into both lumens of the intestine 1 the corresponding branches of the endoscissors and perform an incision 4 by dissection along the axis of the intestine 1 of the inner adjacent walls of the organ. Without stopping the fixation of anastomosed portions of the intestine 1, a compression device with shape memory 5 is introduced into the abdominal cavity in the continuous cooling mode to a temperature below the temperature of the shape restoration of the shape memory material. As a compression device 5, a device is used, consisting of two turns of nickel-titanium wire 6 in contact along a generatrix, the turns of which are cooled by the working part of the thermocouple 7.

 Correct installation in the organ gives reason to stop the cooling of the structure, which leads to heating of the device with thermomechanical memory 5 with the subsequent compression of the stitched tissues and the formation of a compression anastomosis. Remove the thermocouple 7 of the device 5 from the abdominal cavity through a trocar (not shown in Fig.).

 (According to Fig. 3). With endo scissors 8 with usuras (recesses) 9 made on them, a partition is made of clamped tissues of the intestine 1.

 (According to FIG. 4). The anastomosis is completed by suturing with a mechanical stitch seam 3 defects in the anastomosis by flashing with the GIA-30 endo device.

 The device for creating an anastomosis (Fig. 2 - 6) contains two turns 6 of nickel-titanium wire of the ТН-10 grade and the working part of the thermocouple 7, consisting of semiconductors providing the presence of hot 10 and cold 11 zones of thermocouple 7. Electrical wires 12 are connected thermocouple 7 made of semiconductors with an electric power source (the latter is not shown in FIG.).

The device operates as follows. An undiluted device 5, fixed by end-clamping 13, is introduced into the abdominal cavity through a trocar under aseptic conditions. Due to the functioning of the thermoelement 7 operating on the Peltier thermoelectric effect, two turns 6 of nickel-titanium wire of the ТН-10 grade are continuously cooled below its shape-recovery temperature, which is the interval is from +10 to +35 ^o C. In the abdominal cavity, the turns 6 of the device 5 are diluted and each turn 6 is introduced into the corresponding section of the anastomosed intestine 1 (Fig. 5). After endoscopic verification of the correct installation of device 5, the polarity at the terminals of the power supply is changed, which leads to a change in temperature zones on the thermocouple and heating of the device with thermomechanical memory. And this, in turn, leads to the form restoration and prolonged compression of the tissues of the anastomosis with the formation of a compression anastomosis. Moreover, due to the convergence of the coils 6 and the arc-shaped fixation of the thermocouple 7, the tissues are ejected and the thermocouple 7 is self-separated from the coils 6 of the shape memory device (according to FIG. 6).

Claims (2)

 1. A method of laporoscopic anastomosis, in which anastomosed parts of the hollow organs are brought together under video-laparoscopic observation, the lumen is opened, a stapler is inserted through the openings and the organs are connected to the walls, followed by dissection of the tissue in the anastomosis, characterized in that the lumens hollow organs, a device with a thermomechanical memory is inserted, its cooling with a thermocouple is stopped, and the walls of the organs are connected by their metered compression ia, and the thermocouple is removed from the abdominal cavity.  2. A device for creating an anastomosis, containing two turns of wire from a material with shape memory in contact with the generatrix, characterized in that the surface of the turns of wire from a material with shape memory is arcuately covered by the working part of the thermocouple with the possibility of self-separation from the turns with compression of tissues.

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