RU2242181C1 - Surgical mirror - Google Patents

Abstract

FIELD: medical equipment.

SUBSTANCE: surgical mirror has handle, plates retainer, transfer device, guiding part, and pivot hinge having spherical inner cavity for retaining of spherical member composed of two semi-spherical parts. Mirror has central and two additional plates with narrowed rounded upper part. Handle is equipped with channel having narrowing part and inner thread. Pin is engageable with narrowing part of channel for spreading apart said semi-spherical parts. Transfer device is adapted for spreading apart and bringing together of additional plates and is comprised of rectangular plates of different length, which are movably connected with one another by retainer arranged on guiding part, which is rigidly connected with central plate and through pivot hinge with handle.

EFFECT: complete and safe forcing of internal organs owing to automatically spread apart plates of surgical mirror, reduced traumatism and increased versatility.

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Description

The invention relates to medicine and, in particular, to medical equipment.

Surgical interventions on the organs of the thoracic and abdominal cavities, retroperitoneal space in most cases are associated with performing operations on organs that are anatomically limited in mobility and, as a whole, are not even partially removed directly into the surgical wound for performing various kinds of surgical procedures on them. In this regard, surgical manipulations on these organs are performed directly inside the chest and abdominal cavities, retroperitoneal space. To solve these problems, surgeons, along with various kinds of surgical hooks that only resize the surgical wound, use surgical mirrors that allow access to the operated organ or any area by pushing other organs located in these cavities in the immediate vicinity and tissues or parts of the organ itself.

There are mirrors for performing operations on the organs of the thoracic and abdominal cavities, retroperitoneal space which are rectangular metal plates of various lengths and widths, rigidly connected to the handle at an angle of 90 degrees (Operative Surgery and Topographic Anatomy. Edited by V.V. Kovanov. - M .: Medicine, 1985, p.131-132).

The disadvantage of these mirrors is the strictly fixed length and width of the plates, which requires replacing the mirrors during the operation with more or less wide, as well as more or less long ones, depending on the width and depth of the surgical wound, as well as the size of the organ pushed out by the mirror. In some cases, the width of their plates is still not enough, and then several mirrors are used simultaneously to push out the internal organs. Rigid fixation of the mirror plates to the handle at a strictly defined angle does not allow intraoperatively to change its value both when changing the direction of the thrust vector for the mirror handle, and in the presence of individual anatomical features of the patient, which in some cases even leads to damage to the extruded internal organs by the edges of the surgical mirror . Mounting the mirror at a fixed angle to the handle also often does not coincide with the most optimal vector of the assistant’s hand traction, which creates additional inconvenience to the surgeon’s work.

The closest analogue prototype is a surgical mirror proposed by I.S.Bely and R.Sh. Vakhtangishvili (I.S. Bely, R.Sh. Vakhtangishvili. Vagotomy for perforated ulcers. - Kiev: Health, 1984, p. 72- 73). The disadvantages of this mirror is that it is intended only for large surgical wounds, the length of which significantly exceeds the width of the mirror plates; the total width of the plates can increase no more than 1.5 times; the same length of the plate mounting levers in the absence of strict perpendicularity of the surface of the organ pushed away by the surgical mirror to the axis of its handle in the horizontal plane will lead to excessive pressure on it of one of the mirror plates, which can lead to injury; the impossibility of changing the angle of fixation of the handle to the plates in the horizontal plane; the distance of the hinge to change the angle of fixation of the handle to the mirror plates from the plates themselves, which prevents the full displacement of the organ beyond the edge of the operative wound; the inability to breed mirror plates wider than the length of the surgical wound, thereby limiting the possibility of its use only by extensive laparotomies; lack of intraoperative, safe automatic dilution and folding of the plates of the surgical mirror.

The task is to improve the design of the surgical mirror by creating a mirror with atraumatic, automatically extendable plates; the most complete and safe displacement of internal organs through the use of a universal surgical mirror.

The drawing shows:

Figure 1 - the handle of the mirror, Figure 2 - the hinge, Figure 3 - the Central plate with a guide part, Figure 4 - two additional plates, Figure 5 - plate in a diluted state.

The surgical mirror contains a handle 1 (Figure 1). Inside the handle 1 (Fig. 1), a through channel 2 (Fig. 1) is made along its axis, tapering uniformly at its proximal end 3 (Fig. 1). At the distal end 4 (FIG. 1) of the channel 2 (FIG. 1), an internal thread is made.

At one end of the handle 1 (Fig. 1), a neck 6 (Fig. 1) is attached to the neck 5 (Fig. 1), consisting of two hemispheres 7 (Fig. 1). The neck 5 (Figure 1) also consists of two halves 8 (Figure 1) and has a cylindrical shape.

In the channel 2 (Fig. 1) from the distal end 4 (Fig. 1), a pin 9 (Fig. 1) is inserted, which tapers uniformly in the form of a wedge at one end 10 (Fig. 1) and has a head 11 (Fig. 1) for screwing it into the handle 1 (Fig. 1) and the external thread 12 (Fig. 1) at its other end, which coincides in size with the internal thread of the distal end 4 (Fig. 1) of the channel 2 (Fig. 1) of the handle 1 (Fig. 1) .1).

The surgical mirror contains a hinge 13 (Figure 2), which has a through channel of a rectangular shape on the one side 14 (Figure 2), and a spherical shape of an internal cavity 15 (Figure 2) with round holes 16 (Figure 2) ) on the side surfaces and the end part 17 (Figure 2). The upper hole 18 (Figure 2), larger than the holes 16 and 17 (Figure 2), has on its outer edge a guide chamfer 19 (Figure 2). Between the upper hole 18 (Figure 2) and the hole in the end part of the hinge 17 (Figure 2) there is a slot 20 (Figure 2). In the lower part of the guide channel 14 (FIG. 2), a through channel 21 (FIG. 2) with a thread in its end portion 22 (FIG. 2) is made in the transverse direction. A latch 23 (FIG. 2) is inserted into this channel with a thread 24 (FIG. 2) at one end and a head 25 (FIG. 2) at the other.

To the guide portion 26 (FIG. 3) of the surgical mirror, a central plate 27 is attached (FIGS. 3, 5). On one side of the guide portion 26 (FIG. 3), a through guide channel 28 (FIG. 3) is made with a slot 29 (FIG. 3), and on the opposite side a T-shaped fixing plate 30 (FIG. 3) with side protrusions 31 is attached (Figure 3). On the outer surface 32 (FIG. 3) of the fixing plate 30 (FIG. 3), there are transverse locking grooves 33 (FIG. 3). In the upper part of the central plate 27 (Fig. 3), a hole 34 (Fig. 3) is made with an internal thread into which a screw 35 (Fig. 3) is screwed. The through guide channel 28 (Figure 3) with a slot 29 (Figure 3) moves the latch 36 (Figure 3), consisting of a rectangular plate 37 (Figure 3) with a pin attached to it with an external thread 38 (Figure 3) ) and screw 39 (Figure 3).

Two additional plates 40 (Fig. 4, 5), identical in size to the central plate 27 (Fig. 3), have a narrowed rounded upper part 41 (Fig. 4, 5) and a wide rectangular lower part 42 (Fig. 4, 5 ) The lower outer corner 43 (Fig.4, 5) of the plates 40 (Fig.4) has a significant rounding in order to prevent damage to internal organs when they are diluted to the sides. In the upper part 41 (Fig. 4, 5) of the plates 40 (Fig. 4, 5) there is an opening 44 (Fig. 4, 5) for fixing the plates 40 (Fig. 4) with a screw 35 (Fig. 3) to the central plate 27 (Figure 3). To the upper narrowed portion 41 (Figure 4) of the plates 40 (Figure 4) with rivets 45 (Figure 4), the transmission device 46 (Figure 4), consisting of narrow rectangular paired plates 47 (Figure 4) of various lengths also movably connected to each other. In the upper part of the transmission device 46 (Figure 4), the two upper pair plates 48 (Figure 4), interconnected by an overlay, have a common hole 49 (Figure 4), through which they are connected by a latch 36 (Figure 3).

The entire design of the surgical mirror is made of metal. The handle 1 (Fig. 1) has a through channel 2 (Fig. 1) inside its axis with the aim of introducing through its distal end 4 (Fig. 1) and free movement of the pin 9 (Fig. 1), and the internal thread at the distal end 4 (Fig. 1) of channel 2 (Fig. 1) and an external thread 11 (Fig. 1) of pin 9 (Fig. 1) serve for its fixation and further advancement with subsequent twisting of the head 12 (Fig. 1). In this case, the wedge-shaped initial part 10 (Fig. 1) of the pin 9 (Fig. 1) enters the uniformly tapering part of the through channel 2 (Fig. 1) and, expanding the hemisphere 7 (Fig. 1) of the ball 6 (Fig. 1) ), increases its size, thereby tightly pressing the hemisphere 7 (Figure 1) to the walls of the spherical shape of the internal cavity 15 (Figure 2) of the hinge 13 (Figure 2), which provides a rigid fixation of the handle 1 (Figure 1) .

The hinge 13 (Figure 2), in addition to the inner cavity 15 (Figure 2) of a spherical shape for fixing the ball 6 (Figure 1) of the handle 1 (Figure 1), has through holes on its lateral surfaces and the end part of the rounded shape. The upper hole 18 (Figure 2) is necessary for holding the ball 6 (Figure 1) directly into the internal cavity 15 (Figure 2), and the chamfer 19 (Figure 2) along the edge of this hole is made for its direction inside the cavity 15 (Figure .2), as well as the approach of the hemispheres 7 (Fig. 1) of the ball 6 (Fig. 1) in order to preliminary reduce the diameter of the ball 6 (Fig. 1) to the diameter of the hole 18 (Fig. 2).

Through the slot 20 (FIG. 2) between the upper hole 18 (FIG. 2) and the hole in the end part of the hinge 17 (FIG. 2), the neck 5 (FIG. 1) of the handle 1 (FIG. 1), which freely moves in the hole, is drawn 17 (Figure 2) of the end part of the hinge 13 (Figure 2), providing the handle 1 (Figure 1) mobility relative to the Central plate 27 (Figure 3)

Side holes 16 (Figure 2) of the hinge 13 (Figure 2) are made for a snug fit and fixation of the hemispheres 7 (Figure 1) of the ball 6 (Figure 1) in the cavity of the hinge 13 (Figure 2) when they are extended.

A through guide channel 15 (FIG. 2) is needed to move the T-shaped fixing plate 30 (FIG. 3) of the guide part 3 (FIG. 3) therein, the side protrusions 31 (FIG. 3) of which hold it in the hinge 13 (FIG. .2). The through channel 22 (FIG. 2) in its lower part in the guide channel 15 (FIG. 2) is presented in the form of a semicircular groove and when combined with similar transverse locking grooves 33 (FIG. 3), a T-shaped locking plate 30 (FIG. 3), forms a channel into which the latch 23 is inserted (FIG. 2). The thread 24 (FIG. 2) at its end and the thread in the end part of the through channel of the hinge 22 (FIG. 2), with the help of the head 25 (FIG. 2), allows to fix the latch, which prevents the movement of the guide part 3 (FIG. 3) relative to the hinge 13 (Figure 2) and sets the required length and, accordingly, the immersion depth of the surgical mirror.

The guide portion 26 (FIG. 3) of the surgical mirror is rigidly connected to the central plate 27 (FIG. 3), which allows the latter to bear the main load for the displacement of tissues.

A through guide channel 28 (FIG. 3) with a slot 29 (FIG. 3) is made to move a latch 36 (FIG. 3) therein, a rectangular plate 37 (FIG. 3) which holds it directly in the guide channel 28 (FIG. 3), and to the pin 37 attached to it (Figure 3) with an external thread 38 (Figure 3), a screw 39 (Figure 3) is attached to the transmission device 46 (Figure 4).

The hole 34 (Figure 3) with an internal thread in the upper part of the central plate 27 (Figure 3) and the holes 44 (Figure 4) of the additional plates 40 (Figure 4) are used for their fastening with a screw 35 (Figure 3) with a wide head directly to the Central plate 27 (Figure 3).

The narrowed rounded upper part 41 (Figs. 4, 5) of the additional plates 40 (Figs. 4, 5) allows, when diluted in small laparotomy wounds, to increase the width of the mirror in the abdominal cavity by 2 times (Fig. 5) due to their wide rectangular lower part 42 (Figs. 4, 5). Significant rounding of the lower outer corner 43 (Fig. 4, 5) of the plates 40 (Fig. 4, 5) prevents damage to internal organs.

The transmission device 46 (Figure 4) allows you to automatically expand and shift the additional plate 40 (Figure 4) when the latch 36 (Figure 3) moves up or down, while the lever system of the transmission device 46 (Figure 4) in the form of movably fastened between each other narrow rectangular plates of various lengths pushes the additional plates 40 (Figure 4) to a predetermined width even with a small amount of stroke of the latch 36 (Figure 3).

The design works as follows.

Before the operation, the ball 6 (Figure 1) of the handle 1 (Figure 1) is inserted into the hinge 13 (Figure 2) through its upper hole 18 (Figure 2). The neck 5 (Figure 1) of the handle 1 (Figure 1) is passed through the slot 20 (Figure 2) into the hole in the end part of the hinge 17 (Figure 2). Then, in the through channel 2 (Fig. 1) of the handle 1 (Fig. 1), a pin 9 (Fig. 1) is inserted from its distal end 4 (Fig. 1). Consistently screwing it into the handle 1 (Figure 1) for the head 11 (Figure 1), fix the handle 1 (Figure 1) in the hinge 13 (Figure 2).

The guide portion 26 (FIG. 3) of the surgical mirror with the central plate 27 (FIG. 3) is connected to the hinge 13 (FIG. 2) by inserting a T-shaped retaining plate 30 into its through guide channel 14 (FIG. 2) (FIG. 3) and its subsequent fixation in the hinge 13 (FIG. 2) by the latch 23 (FIG. 2) while aligning one of the transverse locking grooves 33 (FIG. 3) of the outer surface 32 (FIG. 3) of the fixing plate 30 (FIG. 3) with a semicircular groove of the through channel 21 (Figure 2) of the hinge 13 (Figure 2) with the establishment of the required length of the mirror for the operation.

Then, a pin with an external thread 38 (Figure 3) of the retainer 36 (Figure 3) is inserted into the common hole 49 (Figure 4) of the two upper pair plates 48 (Figure 4) of the transmission device 46 (Figure 4). A rectangular plate 37 (FIG. 3) of the retainer 36 (FIG. 3) is inserted into the through guide channel 28 (FIG. 3) of the guide portion 26 (FIG. 3), and two additional plates 40 (FIG. 4) are attached to the central plate 27 (Figure 3) screw 35 (Figure 3) through the hole 44 (Figure 4) and the hole 34 (Figure 3) with an internal thread in the upper part of the Central plate 27 (Figure 3).

After folding the additional plates 40 (Figure 4), the stroke of the latch 36 (Figure 3) at its upper location is limited by a screw 39 (Figure 3), screwing it onto a pin with an external thread 38 (Figure 3).

Directly during surgery, the surgeon can change the angle of fixation of the handle with respect to the plates in all planes. To do this, he moves the pin 9 (Figure 1), rotating it behind the head 11 (Figure 1), and, from the beginning, loosens the fixation of the ball 6 (Figure 1) of the handle 1 (Figure 1) in the hinge 13 (Figure 2) ), and then, after setting the required angle of fixation of the handle 1 (Fig. 1), it again rigidly fixes it.

Depending on the depth of the surgical wound, the surgeon also changes the length of the surgical mirror by combining one of the transverse locking grooves 33 (FIG. 3) of the outer surface 32 (FIG. 3) of the fixing plate 30 (FIG. 3) with the semicircular groove of the through channel 21 (FIG. 2) the hinge 13 (Figure 2) and introducing into the formed channel of the latch 23 (Figure 2).

If necessary, a wide displacement of internal organs in the operated cavity, the surgeon by turning the screw 39 (Figure 3) loosens the latch 36 (Figure 3) and, moving the same screw 39 (Figure 3), shifts it down, while the transmission device 46 (Fig .4) automatically extends the additional plates 40 (Figure 4) on both sides of the central plate 27 (Figure 3), increasing the width of the mirror up to two times. Then the surgeon again by turning the screw 39 (Figure 3) secures the latch 36 (Figure 3) and additional plates 40 (Figure 4) in the desired position. In those cases when the length of the surgical wound is less than the width of the additional plates 40 (Fig. 4), which are sideways apart (Fig. 4), they are automatically folded to remove the surgical mirror from the internal cavity by subsequent movement of the latch 36 (Fig. 3) with a screw 39 (Fig. 3) to the initial extreme upper position.

Benefits:

- allows you to intraoperatively change its value both along the length and width of the plates, without removing the mirror from the operated cavity or retroperitoneal space;

- does not injure the forced out internal organs since allows you to adjust the angle of fixation of the plates with respect to the handle in all planes and has a significant rounding of their edges;

- allows to increase the width of the plates by 2 times;

- allows you to perform a wide displacement of internal organs and tissues, regardless of the length of the surgical wound itself;

- allows to reduce surgical trauma due to the widespread displacement of organs and tissues inside the chest or abdominal cavities, in the retroperitoneal space, even with relatively small surgical access;

- allows you to fix the mirror at a convenient angle for the surgeon to work with the handle;

- facilitates the work of the surgeon, as the thrust vector of his hand coincides with the direction of fixation of the handle;

- reduces the time of the operation, because there is no need to change mirrors of different sizes during the operation;

- allows you to reduce the number of assistants and medical instruments.

Example.

The mirror handle 1 (Fig. 1) is made 19 cm long, its neck 5 (Fig. 1) is 1 cm in diameter and 15 cm long. The diameter of the ball 6 (Fig. 1) of the mirror handle 1 (Fig. 1), consisting of two hemispheres 7 (Figure 1), in the normal state is 2 cm. Pin 9 (Figure 1), evenly tapering in the form of a wedge at its end 10 (Figure 1), is made with a diameter of 0.4 cm

The diameter of the upper hole 18 (Figure 2) of the hinge 13 (Figure 2), as well as the diameter of the ball 6 (Figure 1) of the mirror handle 1 (Figure 1), is 2 cm. The hole in the end of the hinge 17 (Figure 2) ) is made with a diameter of 1.8 cm, and a slot 20 (Figure 2) between these holes is 1.2 cm wide.

A T-shaped fixing plate 30 (FIG. 3) with lateral protrusions 31 (FIG. 3) of the guide portion 26 (FIG. 3) of the surgical mirror is 4.5 cm long.

The central and additional plates are made with a total length of 16.5 cm. The length of the upper narrowed part is 8.2 cm and the lower, wide part of the plates is 8.3 cm. The width of the plates in the upper narrowed part is 4.8 cm and in the lower wide part plates - 10 cm. The radius of curvature of the lower outer corner 43 (Figure 4) of the additional plates 40 (Figure 4) is 6.4 cm.

Claims (2)

1. A surgical mirror containing a handle and plates, characterized in that it further comprises a latch, a transmission device, a guide part and a hinge having a spherical internal cavity for fixing a ball of two hemispheres attached to the handle by a neck of two halves, wherein the mirror consists of the Central and two additional plates, which have a narrowed rounded upper part, the handle has a channel with a tapering part and with a uniform narrowing in the form of a wedge at the end, with the possibility of interaction With a tapering part of the channel and the separation of the hemispheres, the transmission device is designed to push and slide additional plates and consists of rectangular plates of different lengths, movably connected to each other and with a latch located on the guide part, rigidly connected to the central plate, and the guide part is connected through hinge with handle. 2. The mirror according to claim 1, characterized in that it is made with the possibility of changing the length depending on the depth of the surgical wound.

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