RU2286723C1 - Tool kit for making operations from small cuts - Google Patents

Abstract

FIELD: surgical instruments.

SUBSTANCE: tool kit has wound expander's ring, light guide, pincers, scissors, rod instruments and removable light guide unit. Ring of wound expander is provided with slots where members for fixing retractors are mounted. Retractors are made in form of holders which are connected with variable size blades by means of clamp hinges. Clamp hinges are provided with openings for fixing ring of wound expander at fixing members and they are made for turn of blades about two mutually perpendicular axes. Removable light guide unit is provided with aid being it capable of mounting onto any hinge retractor. Hinge surgical instruments have branches which are curved around 30-50 mm radius and they have working part made in form of jaws and handle. Jaws are curved in the direction to plane of branches' displacement. Handles end up with rings and they are disposed at the same plane as ends of working parts. Handles of ligature needle, forks for tying ligatures, of electric-surgical hook and needle holder, are made cylindrical and they have working parts made of plastic metal. Pincers, one of which as to be bipolar electric surgical pincers, have bar-shaped curved working jaws. Operations can be made in small cuts at higher comfort under difficult anatomical conditions.

EFFECT: widened set of small access operations; improved safety of usage of instruments; reduced number of similar instruments; simplified maintenance.

2 cl, 4 dwg

Description

The invention relates to medicine and medical equipment, in particular to surgical instruments, and can be used in examination and surgical treatment in various fields of surgery using endosurgical operations from small incisions.

Minimally invasive small access surgery is one of the main ways of progress of modern surgery as a whole, including open surgery from small incisions (3-5 cm) using endosurgical instruments and surgical techniques. The small volume of the operating space excludes the possibility of manipulating laparoscopic instruments and, especially, traditional ones. In order for surgery to become possible, first of all, it is necessary to create sufficient operating space, provide an overview of all its departments, including those located outside the wound borders, and bright illumination deep in the wound, while the tools used should not cover the operation area. The visual control zone created in this way should be easily changed at the request of the surgeon. At the same time, there was always the task of ensuring safety when manipulating tools in a cramped operating space.

A known set of tools (issued for industrial design patent of the Russian Federation No. 39628, 1994), designed for open operations from small incisions and including a ring of a retractor (ring ring) with slots, in which fastening elements of retractors (hooks) are located, having a holder with slots for fixing on the fastening elements and the blade pivotally connected to it; optical fiber; clamps, tweezers, scissors with branches bent in the horizontal plane; ligature needle and fork for tying ligatures.

In this set, the ring of the conservator is made in the form of a rigid flat ring, and the blades of the retractors are connected by hinges having one axis of rotation. The swivel connection of the blade with the holder allows you to rotate the blade relative to the holder, fixedly mounted on the ring. Orientation of the hinge axis parallel to the horizontal plane of the ring allows using the blades of various lengths to form the cone of the operating space, changing its shape and size (without changing the size of the wound). The implementation of the hinge clamping provides the ability to fix the position of this space.

Surgical instruments (clamps, tweezers, scissors) consist of a jaw bent in the horizontal plane at an obtuse angle and a working part articulated with them, which allows the surgeon's hands to be removed from the operating area.

However, with all the advantages, this kit has a very narrow application - it is intended only for operations in the abdominal cavity and can be used for relatively simple operations, mainly for operations on the biliary tract, in cases where the operating area is in the center under the wound.

Closest to the claimed one is a set of tools for operating from small cuts, including a retractor ring with slots in which retractor fasteners are installed, a set of retractors made in the form of holders connected by clamping hinges with variable blades and provided with holes for fixing on the ring fasteners retractor; optical fiber, articulated surgical instruments (clamps, tweezers, scissors), which are jaws bent in the horizontal plane, having a pivotally connected working part in the form of jaws bent to the junction plane of movement, and handles ending in rings; needle holder; a set of core tools containing a rod with a working end connected to the handle (ligature needle, “fork” for tying ligatures, electrosurgical hook, blade holder) (see RF patent No. 45120, 1999, issued for industrial design - prototype).

In this set, the retractor clamping joints have one axis of rotation, the optical fiber is rigidly fixed to a hingeless retractor of a fixed size; the branches of the articulated surgical instruments are bent horizontally at a fixed obtuse angle, the spring needle holder and the electrosurgical hook, like the rest of the core tools, have rigid core parts of an unchanged shape; the ring of the expander is made unbendable.

However, this kit can also be used only for some relatively simple operations, when the operating area is in the center under the wound. Limitations are caused by design flaws in the toolbox:

- operating with this set of tools is possible only in cases where the operating area is located in the center under the wound, since single-hinged retractors that form the cone of the free operating space cannot move it away from the wound;

- bright lighting of the working space with a fixed-size light guide retractor, made without the possibility of changing its position, is possible only in a small local area under the light guide and is not sufficient for complex operations that require good lighting anywhere in the operating space;

- the implementation of the jaw of surgical instruments curved at a fixed obtuse angle limits the penetration of instruments into the wound, thereby reducing the safety of work in the wound. Therefore, to work at different depths of the wound, tools with different lengths of the working part are needed. This requires a set of several instruments of the same type of different sizes, which makes the set cumbersome and expensive, and their selection to the depth of the wound increases the time of the operation;

- the needle holder and the electrosurgical hook, having straight and rigid rod parts, can only work in conditions where the wound coincides with the operating area, in addition, fixing the needle in the needle holder with a spring is unreliable, which does not ensure the safety of the operation;

- the bendable ring of the retractor does not have the ability to adapt to various parts or sizes of the patient’s body.

The objective of the invention is to expand the range of operations performed from small access, increasing the degree of security of the use of the set.

The technical result is the ability to operate with a small incision in difficult anatomical conditions and in the operating space shifted away from the wound; improving the safety and efficiency of the use of tools, increasing the versatility of the kit, reducing the number of similar tools and simplifying maintenance, ease of operation.

This technical result is achieved in that in a set of tools for operating from small cuts, including a retractor ring with slots in which retractor fasteners are installed, a set of retractors made in the form of holders connected by clamping hinges with variable-sized vanes and provided with holes for fixing on fastening elements of the retractor ring; optical fiber; articulated surgical instruments (clamps, tweezers, scissors), which are jaws bent in the horizontal plane, having a pivotally connected working part in the form of jaws curved to the jaw plane of movement, and handles ending in rings; a needle holder and a set of rod tools containing a rod with a working end connected to a handle (ligature needle, “plug” for tying ligatures, electrosurgical hook, blade holder); according to the invention, the retractor clamping joints are arranged to rotate the blades around two mutually perpendicular horizontal axes, the jaws of the articulated surgical instruments (clamps, tweezers, scissors) are curved in the horizontal plane smoothly along a radius of 30-50 mm, while the jaw handles and the ends of the working parts these tools are located in the same plane; the handles of the core tools (ligature needle, plugs for tying ligatures, electrosurgical hook and blade holder) are made cylindrical, and their rod parts are made of ductile metal, the needle holder is made in the form of a jaw bent in a horizontal plane with a radius of 30-50 mm, having a pivotally connected working part in the form of sponges and handles ending in rings; wherein the kit further comprises a removable light guide block provided with means for installing it on any set retractor, for which a corresponding socket is made on each retractor, and two lamellar forceps, one of which is bipolar electrosurgical, with bayonet-shaped working jaws. The ring of the expander can be equipped with hinges for bending the plane of the ring in diameter and have an oval shape.

With this kit, the surgeon can create a sufficient operating space with a depth of 5 to 20 cm, provide an overview of all its departments, including the operating space that is shifted away from the wound, and bright lighting in the depth of the wound, while the tools used in the kit are universal and adapted to the created operating space and complex anatomical conditions:

- retractor clamping joints made with the possibility of rotation of the blades relative to two mutually perpendicular horizontal axes, allow the surgeon to create a considerable free space in the depth of the narrow wound, if necessary, shifted away from the wound (for example, when operating on the liver gate during surgery biliary tract), stably maintain it throughout the operation and quickly change in accordance with the surgical situation;

- the implementation of the jaw of surgical instruments (clamps, tweezers, scissors, a needle holder) curved smoothly in radius allows you to use one tool at different depths of a narrow surgical wound, which is especially necessary in case of displacement of the surgical field from the center of the wound, when different sections of the surgical field are located at different depths . This facilitates the work of the surgeon, increases the safety of the operation, and also reduces the number of instruments of the same type in the set. The location of the jaw handles and the ends of the working part of the instruments in the same plane allows the surgeon to confidently manipulate the ends of the working parts of the instruments outside the surgical wound, especially when the operating space is shifted away from the wound, and provides increased accuracy of manipulating an instrument of complex shape and safety of operation in low access conditions;

- the execution of the core parts of the core tools of ductile metal allows them to bend to give them the shape necessary for a specific anatomical situation and the depth of operation, which makes it possible to carry out complex manipulations with the tool and increases the safety of their use, and the cylindrical shape of the handles facilitates the work of the surgeon and allows you to finely manipulate instruments by rotation of the handles around its axis with the fingers of the surgeon;

- installation and reinstallation of a removable light guide block on any retractor provides good stable illumination of any part of the surgical field in low access conditions and the ability to change the position of the light spot during surgery without reinstalling the retractors, which reduces time, ensures the safety of the operation and creates the conditions for working with microsurgical instruments;

- complementing the set with two plate-shaped tweezers, the shape of which is adapted to the conditions of work in a narrow wound, allows more gentle handling of tissues and is necessary for fine manipulations on the vessels and bile ducts, without blocking the surgical field with the hands of the surgeon;

- the design of the needle holder allows you to work at any depth of the wound, the needle can be firmly gripped by the tips of the sponges and come closest to the stitched fabric, which also increases the safety of the operation;

- swivel of the parts of the ring of the retractor ensures its bending at any angle, which allows you to install the retractor in any anatomical region, taking into account the individual characteristics of the patient and the type of operation; The oval ring of the expander has two working diameters and replaces two rings of different diameters, which increases its versatility and reduces the number of rings in the set.

Figure 1 shows a set of tools for creating an operating space from a small section:

a) the ring of the conservator;

b) a set of retractors;

c) a removable light guide block;

D) retractor, remote view;

D) retractor, top view.

Figure 2 shows a set of universal articulated surgical instruments for operating from small incisions:

a) the clamp is curved with straight jaws;

b) the clamp is curved with graduated jaws;

c) clamp-dissector;

d) curved scissors;

e) curved toothed forceps;

e) needle holder.

Figure 3 shows a set of core tools:

a) a plug for tying ligatures;

b) the ligature needle,

c) electrosurgical suction hook,

d) the blade holder is bendable.

Figure 4 shows the plate-shaped tweezers: a) side view; b) top view.

The oval ring 1 of the expander (figa) has clamping hinges 2, slots 3 and the elements 4 located in them (which can be made in the form of pins) fastening the holders 5 of the retractors (fig.1b). Retractors (figb, 1G and 1D) are made in the form of holders 5, provided with holes 6 for fixing on the elements 4 of the ring 1 of the expander and connected to the blades 7 of the L-shaped clamping joint 8 with two rotation axes (made, for example, according to the patent RF No. 9137, 1999), while in the hinge body 8 a socket 9 is made for installing a removable light guide block therein.

The removable light guide block (Fig. 1c) consists of a light guide 10, which is mounted in a holder having a housing 11 in the form of a ring and is equipped with a fastener 12 of the light guide 10 (for example, a collet, a collar, a screw, etc.) and means for installing the light guide block in the corresponding socket 9 of the retractor, which can be performed, for example, in the form of a finger 13.

Universal surgical instruments for operating from small incisions (figa-e) are curved in the horizontal plane smoothly in a radius equal to 30-50 mm, branches 14 having articulated working part 15 in the form of sponges, and handles 16 ending in rings . The handles 16 and the ends of the working parts 15 of the tools shown in figa-e, are located in the same plane (made, for example, according to the patent of the Russian Federation No. 6321, 1998).

Rod tools (figa-d) contain a rod 17 with a working end 18 connected to a cylindrical handle 19. The rods 17 are made of ductile metal subjected to heat treatment and allowing them to bend repeatedly during the operation in accordance with the specific anatomical situation.

Plate tweezers 20 and bipolar electrosurgical tweezers 21 (figa-b) have bayonet-curved working jaws 22.

The kit is used as follows (for example, during abdominal surgery). Before the operation starts, the blades 7 are installed perpendicular to the holders 5 and their position is fixed by the clamping hinge 8. After the cut, the oval ring 1 of the retractor is placed on the skin around the wound, bending it if necessary using hinges 2 and fixing the desired position. Manually push the abdominal organs to the sides, freeing the surgical field. In this case, retractors are selected whose blade length 7 corresponds to the depth of the wound at the retractor installation site. Retractors are installed in pairs against each other (4-6 retractors depending on the anatomical location of the wound). The hinges 8 of the retractors are unclenched, the blades 7 are installed in the wound position, turning them with the help of hinges 8 around two mutually perpendicular horizontal axes, forming the necessary operating space, after which the hinges 8 are finally clamped, fixing the positions of the blades 7. The holders 5 are installed in the slot 3 rings 1, combining the holes 6 of the holders 5 with the fastening elements 4.

To illuminate the desired location of the surgical field on one of the already installed retractors, a light guide block is installed by inserting a finger 13 of the light guide holder 10 into the socket of the retractor.

Then, in turn, in a standard manner, tools are used (FIGS. 2-4) for separating, connecting and stitching fabrics, tying ligatures, adapted to work in the created operating space at various depths. To change the lighting conditions, reinstall the light guide block to another retractor without changing the position of the retractors.

Thus, the design features included in the claimed set of tools make them universal with the possibility of use in various anatomical situations. The set of instruments of the set, adapted to the conditions of work in a narrow wound and complex anatomical situations, to lighting conditions and to each other, as well as to the surgeon allows for more complex, accurate, safe operations in various anatomical areas in a small incision, including in the surgical space displaced from the wound.

The inventive tool kit was successfully used to perform a wide range of surgical operations from a small incision, carried out in difficult anatomical conditions and in the surgical space shifted away from the wound:

- on the gallbladder and bile ducts, including the common, right and left hepatic ducts, reconstructive operations for cicatricial strictures, for damage to the bile ducts;

- on the liver, stomach, pancreas, kidneys, ureters, pelvic organs;

- with appendicitis, pancreatic necrosis in the lateral zones of the retroperitoneal fiber of all 4 quadrants, etc.

Claims (2)

1. A set of tools for operating from small cuts, including a retractor ring with slots, in which retractors with fasteners are installed, made in the form of holders connected by clamping hinges to variable-sized blades and provided with holes for fixing on the retractor ring fasteners; optical fiber; articulated surgical clamps, tweezers, scissors, which are curved branches, having a pivotally connected working part in the form of jaws curved to the plane of movement of the branches, and handles ending in rings; needle holder; rod tools containing a rod with a working end connected to the handle and made in the form of a ligature needle, a plug for tying ligatures, an electrosurgical hook, a blade holder, characterized in that it further comprises a removable optical fiber holder equipped with installation means in an appropriate socket on each retractor and two lamellar forceps, one of which is bipolar electrosurgical, with bayonet-shaped working jaws, and the clamping hinges of the retractors are made to rotate l sheath around two mutually perpendicular horizontal axes, branches of articulated surgical clamps, tweezers, scissors are curved along a radius equal to 30-50 mm, while the handle branches and the ends of the working parts of surgical clamps, tweezers, scissors are located in one plane; the handles of the ligature needle, the plugs for tying the ligatures, the electrosurgical hook and the blade holder are cylindrical, and their rod parts are made of ductile metal, the needle holder is made in the form of a jaw curved along the radius of 30-50 mm, having a jointed articulated part in the form of jaws and handles ending in rings. 2. The kit according to claim 1, characterized in that the ring of the expander is provided with hinges for bending the plane of the ring in diameter and has an oval shape.

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