RU2290108C1 - Knifeless trocar with hydraulic safety device - Google Patents

Abstract

FIELD: medical engineering.

SUBSTANCE: device has stiletto having surface mating trocar sleeve, conic operation end and through central canal. Longitudinally movable needle for applying pneumoperitoneum is mounted in the canal. The trocar sleeve has casing having through axial hole, tube connected to the casing and gate designed as bicuspid valve. The valve is mounted in the casing closing axial hole and additionally has transition bushing having instrumental axial canal. The bushing is mounted in the casing allowing detachment. The trocar is connectable to mechanical and pneumatic device via three-way cock for forcing liquid from syringe under pressure. Conic stiletto end ends in opening with dulled walls along its perimeter. Two plastic springy buttons with pushers are mounted in proximal trocar part. The internal casing surface is partially circumferentially abraded. Ring-shaped valve base is mounted on created ring-shaped projection. Two diametrically disposed recesses mating valve projections. Opening is available in casing wall connected to insufflation nipple. Cut notches are available in proximal part of casing wall diametrically along sleeve axis. The cut notches have passages at right angle. Cock is available on distal sleeve part diametrically with respect to the insufflation nipple. Bicuspid check valve having ring-shaped base and nozzle flattened near the exit is mounted on in the casing on the ring-shaped projection. It closes the axial opening. Transition bushing is detachably connected to the valve base. The transition bushing is shaped as flattened ring. Two needle columns are set in diametrically opposite positions on the ring perimeter. The bushing is arranged at right angle to the cylindrical part in proximal part. Notches are available on external bushing surface. Ring-shaped border for making detachable connection with plate and valve projections available thereon.

EFFECT: minimized tissue, blood vessel and nerve injuries risk; prevented injuries in abdominal organs and tissue.

5 cl, 4 dwg

Description

Currently, literature describes trocar damage to almost all abdominal organs and tissues. To prevent these complications, many different trocar designs have been proposed, including those with optical control and a TERNAMIAN trocar, but they are all traumatic and do not prevent damage to organs and tissues adjacent to the peritoneum at the site of entry into the abdominal cavity of the end of the cone of the trocar stylet.

The invention relates to medical equipment and is intended for carrying out endoscopes and instruments in the abdominal cavity during laparoscopic operations. A trocar is known that contains an outer sleeve and a stylet with lateral cutting faces and a spring-loaded stem, while the stem can be both in the recessed position and protrude beyond the cutting faces of the stylet (ed. St. USSR No. 1568987, 1990). Advancing a trocar of this design through the tissues of the anterior abdominal wall, the spring-loaded rounded working end of the stem is in a recessed state, and the cutting edges of the stylet along the entire path of movement of the stylet cut the tissues and the arteries, veins and nerves passing through them, because the stem is still in a recessed position, it is restrained by the tissues through which it moves. A stylet with cutting edges also enters the abdominal cavity without a “protective” stem, since it is still in a recessed position, tissues of the preperitoneal layer hold it, and only when the stem does not restrain the tissue, its rounded working end “shoots out”, protrudes beyond the cutting edges and protects the cutting edges of the stylet, but it’s too late, the cutting edges of the stylet entering the abdominal cavity damage organs and tissues of the abdominal cavity adjacent to the exit site of the double-edged stylet, this damage to organs and tissues is sometimes noticed the surgeon sutures the wound, but often does not notice the damage, since the place, area, area of the stylet entering the abdominal cavity is not indicated by anything or, at best, is indicated by the released blood or intestinal contents. The use of a trocar of this design and similar ones damages tissues, blood vessels, nerves of the anterior abdominal wall, does not prevent damage to the abdominal organs and does not mark the place, the exit zone in the abdominal cavity of the stylet with lateral cutting faces.

A trocar is known that contains a sleeve, a stylet placed in the sleeve with a through central channel and a conical working end, and a needle for applying pneumoperitoneum with a sharp end and a spring-loaded mandrel having a blunt working end, a needle with longitudinal displacement placed in the stylet channel (ed. USSR No. 1445713, 1988). The tip of the needle pierces the tissues of the anterior abdominal wall and the working end of the needle is inserted into the abdominal cavity, while the blunt working end of the mandrel should extend beyond the sharp needle and cover its sharp end, thereby preventing the possibility of damage to the abdominal organs, but practically never happens. since the blunted mandrin is retained by the tissues and enters the abdominal cavity only after the sharp needle enters the abdominal cavity and possibly injures the abdominal organs. Injury of the abdominal organs with a sharp needle is especially dangerous, since these small wounds from the sharp needle are difficult to detect, there is no way that would indicate, note which organs and tissues the sharp needle interacted with when entering the abdominal cavity. These punctures of the abdominal organs, if not noticed, can be the cause of the development of peritonitis in the postoperative period. The disadvantage of this trocar is damage to the tissues, blood vessels and nerves of the anterior abdominal wall with the tip of a needle for applying pneumoperitoneum when piercing the tissues of the anterior abdominal wall. Damage to organs and tissues of the abdominal cavity, as noted above, occurs due to the delay of the blunted mandrel by soft tissues and during the deformation of the mandrel, when the blunted working end of the mandrel stops moving freely longitudinally in the stylet channel and does not cover the needle tip.

The objectives of the invention is the creation of a trocar, providing: the least injury to tissues, blood vessels and nerves when it moves through the tissues of the anterior abdominal wall; prevention of damage to organs and tissues of the abdominal cavity upon entry into the abdominal cavity of the tip of the cone of the trocar stylet; designation of tissues and organs in the area of introduction of the conical working end of the trocar into the abdominal cavity for a thorough examination through a laparoscope of possible damage.

Figure 1 shows an assembled trocar with a “light-sound indicator” and a “mechanical device for expelling fluid from a syringe under pressure" (mechluk). Figure 1a shows an assembled trocar with a "light-sound indicator" and a "pneumatic device for expelling fluid from a syringe under pressure" (pneumaluk). Figure 2 shows the stylet of a trocar. Figure 3 shows the sleeve of a trocar, the details of the sleeve are spaced along the axis.

The inventive device comprises a stylet 1 of FIG. 2 of a trocar having a surface under the sleeve of a trocar, a conical working end 2 of FIG. 2 and a through central channel 3 of FIG. 2, in the distal section, the stylet ends with a central hole 4 of FIG. 2 with blunt walls along it perimeter, the proximal end 5 of Figure 2 of stylet 1 of Figure 2 is connected to the cylinder 6 of Figure 2, with its bottom in the center of the cylinder and the through channel 3 of Figure 2 of the stylet is connected to the hollow fitting 7 of Figure 2, to the outer wall of the cylinder 6 of Figure .2 attach the handle 8 of Figure 2 detachably (or permanently), on the inside two cylinder guides 9 of FIG. 2 are diametrically installed on the bottom wall of the cylinder 6 of FIG. 2; the concept of a trocar sleeve includes a tube 15 of FIG. 3 and a housing 10 of FIG. 3 connected to each other in a housing 10 of FIG. 3 of a trocar sleeve with a through axial bore two plastic spring loaded with push rods in the form of pushbuttons 11 Figure 3, as a result, the pushers of the buttons when pressed on them provide sufficient opening of the closed valve flaps 19 of Figure 3, which prevents damage to the valve flaps during the introduction and removal of tools, removing stones and excised tissues from the abdominal th cavity. The inner surface of the housing 10 of FIG. 3 is partially seamed around the circumference from the proximal end, around the circumferential protrusion (not shown), the annular base of the valve 12 of FIG. 3 is installed, in the annular protrusion (not shown) for the correct installation of the valve 19 of FIG. .3 two diametrically located recesses (not shown) are selected, for serrated protrusions on the annular base of the valve 14 Fig. 3 in the wall of the housing 10 Fig. 3 of the trocar sleeve below the landing annular protrusion (not shown), insufflation pieces are installed p 16 of FIG. 3, in the proximal section of the housing 10 of FIG. 3, in its wall, cut-out grooves of the trocar sleeve diametrically arranged vertically along the axis of the slot 17 of FIG. 3, which at right angles turn into horizontal slot-grooves for the bayonet joint, consisting of the protrusions 21 of Figure 3 on the adapter sleeve and the slots-grooves. Guide slots 9 of FIG. 2 of cylinder 6 of FIG. 2 are included in the slots-grooves of FIG. 3, providing connection of the housing 10 of FIG. 3 of the sleeve of the trocar and cylinder 6 of FIG. 2, in the distal section of the housing of 10 of FIG. 3 of the sleeve of the trocar diametrically to the insufflation fitting 16 of Figure 3 set the trigger 18 of Figure 1 and Figure 3; the trigger together with the handle 8 of Figure 1 and Figure 2 provide a convenient rotational-translational advancement of the trocar at an angle to the surface of the skin; a double-leaf check valve 19 of Fig. 3 with an annular base 12 of Fig. 3 and a nozzle tapered to the outlet is installed in the housing 10 of Fig. 3 of the trocar sleeve on an annular protrusion (not shown) and block the axial hole; the adapter sleeve 20 of FIG. 3 with the tool axial channel is detachably connected to the annular base of the valve, it presses the annular base of the valve 12 of FIG. 3 against the annular protrusion inside the body of the trocar sleeve (not shown), in the distal section the sleeve looks like a flat ring, around the perimeter of the ring two pins are installed diametrically 21 of FIG. 3, in the proximal part, the sleeve passes at right angles to the cylindrical part, notches 22 of Figure 3 are made on its outer surface for ease of installation and removal of the sleeve, in the proximal barely cylindrical parts of the sleeve from the inside make an annular rim (not shown) for detachable connection with the plate 24 of Figure 3, with inserts placed on it, made under the instrumental channel of the adapter sleeve and having holes of various diameters. The minimum number of parts and the absence of threaded joints and gaskets provide ease of disassembly, washing, sterilization and assembly of the trocar.

Option 1. The operation of the trocar using a "mechanical device for expelling fluid under pressure from a syringe" and a "light and sound indicator".

The surgeon performs an incision in the skin of the anterior abdominal wall measuring 10-15 mm and covers it with a ball. The operating nurse prepares the trocar for work: inserts the stylet 1 of Figure 2 of the trocar into the sleeve 10 of Figure 3 of the trocar, connect the fitting 7 of Figure 1 to the socket 26 of Figure 1 through the three-way valve 25 of Figure 1, the connection of the light-sound indicator 27a of Figure 1 connect with socket 27 of Fig. 1. 50 ml of a 0.25% solution of, for example, novocaine are drawn into a syringe and a non-toxic dye, for example methylene blue, is added. The movable bar 8 of FIG. 1 is maximally lifted upward, the latch 7 of FIG. 1 is passed through the hole 6 of FIG. 1 and in this position is secured with a fuse 5 of FIG. 1. A syringe filled with a novocaine solution with a dye is inserted into a “mechanical device for expelling fluid from the syringe under pressure”. In the socket 28 of Figure 1 of the three-way valve 25 of Figure 1, the nozzle of the syringe 16 is screwed in Figure 1, the valve for transferring the liquid from the syringe into the stylet channel is closed. A three-way valve 25 of FIG. 1 connects the channel of the light-sound indicator 27a of FIG. 1 and the channel 3 of FIG. 2 of the stylet 1 of FIG. 2 of the trocar, the fuse 5 of FIG. 1 is moved away. The trocar is ready to go.

Option 2. The operation of the trocar using a "pneumatic device for expelling pressurized fluid from the syringe" and "light and sound indicator".

The surgeon performs an incision in the skin of the anterior abdominal wall measuring 10-15 mm and covers it with a ball. The operating nurse prepares the trocar for work: insert the stylet 1 of Figure 2 of the trocar into the sleeve 10 of Figure 3 of the trocar, connect the trocar fitting to the socket 14 of Figure 1a with a three-way valve, connect the light and sound indicator 15a of Figure 1a to the socket 15 of Figure 1a. 50 ml of a solution, for example, a 0.25% novocaine solution are added to the syringe 1 of FIG. 1a, a non-toxic dye, such as methylene blue, is added to the solution, the pusher is cut off with a piston 2 of FIG. 3 FIG. 1a, the syringe 1 Fg. 1a with the liquid is installed in the cylinder 4 of FIG. cylinder holder 5 Fig. 1a insert a cylinder 8 of Fig. 1a with compressed gas CO ₂ and screw cap 10 Fig. 1a the syringe barrel 1 of Fig. 1a is connected to the socket 13 of Fig. 1 a of a three-way valve and the valve of the socket 14 of Fig. 1a is closed, the valve of the socket 13 and 15 of Fig. 1a is opened. Rotate the handle 11 and the pusher 12 1a 1a 1a is pushed onto the cylinder 8 by a needle with a channel 7 1a, the needle pierces the stopper 9 lead 1a and the gas pressure of CO ₂ into a closed cavity and presses the piston 16 FIG. 1a, this pressure is recorded by a pressure gauge 6 of FIG. 1a. The trocar is ready to go.

The conical working end of the trocar stylet is inserted into the previously made wound of the anterior abdominal wall and immersed in tissue, open the nest tap 26 of Fig. 1 of the three-way valve 25 of Fig. 1 and by this action connect the syringe cavity and the through channel of the trocar stylet, the fluid from the syringe under pressure begins enter through the opening of the end of the cone of the trocar into the tissue, while the surgeon performs a rotary-translational movement with the trocar using the handle 8 of Figure 2 and the trigger 18 of Figure 1 and Figure 3. The fluid coming under pressure from the syringe infiltrates the tissues through the stylet channel from the opening of the trocar cone, discharges, reduces its density, the trocar stylet cone radially spreads the tissues and facilitates the passage of the trocar stylet through the soft tissues without damaging the vessels and nerves. When reaching the peritoneum of the trocar stylet, they reach the peritoneum, perforate the peritoneum and a stream of liquid under pressure from the opening of the end of the trocar stylet cone, repel organs and tissues adjacent to the place where the end of the trocar stylet cone enters the abdominal cavity and simultaneously stain all organs and tissues in this zone, which allows the surgeon to carefully examine this stained area, exclude or identify the wound when introducing a laparoscope into the abdominal cavity. The fluid flowing under pressure from the syringe through the stylet channel simultaneously exerts pressure on the membrane of the light-sound indicator. The moment of entry into the abdominal cavity of the end of the cone of the trocar stylet is accompanied by a light and sound signal, because the pressure on the membrane of the light-sound indicator when communicating with the abdominal cavity decreases due to negative pressure in the abdominal cavity. It is important to note that in the presence of an adhesion process between the peritoneum, organs and tissues of the abdominal cavity, the end of the trocar stylet cone entering the adhesion area does not damage them, since a stream of liquid under pressure infiltrates the fusion zone and separates them without damaging organs and tissues adjacent to the peritoneum.

Using the proposed trocar:

- leading the movement of the trocar, fluid infiltration of the tissues of the anterior abdominal wall from the opening of the end of the trocar facilitates the movement of the trocar through the infiltrated tissue;

- does not damage the vessels and nerves of the tissues of the anterior abdominal wall, since the stream of fluid pushes them away from the end of the trocar cone, the vessels and nerves are more dense tissues in comparison with the surrounding tissue, which loses its density more infiltrated by the fluid;

- does not damage organs and tissues of the abdominal cavity, as a stream of liquid coming out under pressure from the opening of the end of the cone of the trocar stiletto repels them from the end of the cone of the trocar;

- colors the area of organs and tissues adjacent to the entry into the abdominal cavity of the end of the cone of the trocar stylet;

- signals with the light and sound of the indicator the instant of entry into the abdominal cavity of the end of the cone of the trocar stylet;

- during the adhesion process of the peritoneum with organs and tissues of the abdominal cavity, when the end of the stylet cone enters, it does not damage them, because a stream of liquid under pressure separates adhesions, separating the peritoneum from organs and tissues of the abdominal cavity;

- novocaine solution provides anesthesia of the entire path of the trocar through the tissues and peritoneum, reducing the invasiveness of the operation;

- the design of the trocar is designed to produce a reusable model of metal and a disposable model of plastic.

Claims (5)

1. A trocar containing a stylet with a surface under the sleeve of the trocar with a conical working end and a through central channel with a needle installed for longitudinal movement of a pneumoperitoneum, a sleeve containing a body with a through axial hole, a tube connected to the body and a shutter in the form a bicuspid valve installed in the housing and blocking the axial hole, further comprising a transition sleeve with an instrumental axial channel, detachably mounted in the housing, characterized that is made with the possibility of connecting through a three-way valve with a socket of a mechanical or pneumatic device for expelling fluid from a syringe under pressure, while the conical end of the stylet ends with a hole with blunt walls around its perimeter, the proximal end of the stylet is connected to the bottom of the cylinder in its center, and the through channel of the stylet is connected to the hollow fitting, a handle is detachably or permanently attached to the outer wall of the cylinder, two guide posts are diametrically installed on the inner wall of the cylinder , two plastic buttons, springy with pushers, are diametrically installed in the case of the sleeve of the trocar, the inner surface of the case is partially sharpened around the circumference, an annular base of the valve is installed on the formed annular protrusion, two diametrically located indentations for protrusions on the valve are selected in the housing wall, made hole and connected to the insufflation fitting, in the proximal section in the wall of the body, diametrically, along the axis of the trocar sleeve are made slot-grooves that have a transition odes at right angles, a trigger is installed on the distal section of the sleeve body to the diametrically insufflation fitting, a two-leaf check valve with an annular base and a nozzle tapered to the outlet is mounted on the annular protrusion and closes the axial hole, the adapter sleeve is detachably connected to the valve base, in the distal section the sleeve has the form of a flat ring, two columns — a pin — are diametrically installed around the ring perimeter; in the proximal section, the sleeve passes at right angles into a cylindrical the main part, notches are made on its outer surface, in the proximal part from the inside there is an annular rim for detachable connection with the plate with protrusions placed on it - valves. 2. The trocar according to claim 1, characterized in that it is made to repel from the end of the cone of organs and tissues of the abdominal cavity with a stream of liquid that exits under pressure from the opening of the cone. 3. The trocar according to claim 1, characterized in that it is made for coloring the area of organs and tissues adjacent to the end of the cone. 4. The trocar according to claim 1, characterized in that it is made for the anesthesia of tissues along the entire path of the anterior abdominal wall. 5. The trocar according to claim 1, characterized in that it is made for separation of tissues by a stream of liquid during adhesions of the peritoneum.

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