RU220511U1 - Retractor for hollow abdominal organs - Google Patents

Abstract

The utility model relates to medicine, namely to abdominal surgery, oncology, coloproctology, and can be used for resection of the small and large intestines, as well as suturing their stumps. The technical result is the creation of a device that makes it possible to simplify surgical interventions on hollow organs by reducing the number of instruments used through the use of two additional elastic sponges. The device consists of paired straight hard jaws (1) 65.0 mm long, a blind lock (2), two straight jaws (3) 120.0 mm long, a ratchet (4), two additional elastic jaws (5) 63.5 mm long mm, 2.0 mm thick, with an internal gap between rigid and elastic jaws of 3.0 mm; the distal end of the rigid jaws is connected to the elastic jaws at right angles. A combined clamp for hollow organs was used in 11 cases of resection of the small and large intestine for obstructive intestinal obstruction caused by malignant neoplasms of various parts of the intestine. The combined clamp for hollow organs made it possible to avoid the use of a second hard clamp due to the presence of an additional pair of elastic jaws, which simplify the process of suturing the stump and reduce the time of surgical intervention. 2 ill.

Description

The utility model relates to medicine, namely to abdominal surgery, and can be used for emergency surgical interventions on the gastrointestinal tract.

In emergency surgery, there is a need for quick and convenient access to the surgical site. Existing wound retractors (Sigala, Prutkova, Omni-Tract, etc.) are bulky and cannot provide effective creation of emergency surgical access in narrow, difficult-to-reach areas of the abdominal cavity and hollow organs.

The prototype of the instrument is the Self-retaining Jansen expander 17-722-10 100 mm, catalog of medical instruments “PTO MEDTEKHNIKA” [Electronic resource] // OOO PTO “MEDTEKHNIKA”, 2019. – URL: https://www.medtech.ru/catalog/ neurosurgical/section-1625/ (access date 02/10/2023)). The instrument has pointed jaws and jaws held by a lock with a screw release mechanism. The disadvantages of the prototype are the longitudinal arrangement of the screw mechanism for spreading the jaws, which makes it impossible to create handles that are convenient for fixation in the surgeon’s hand; traumatic nature of the existing pointed jaws.

The technical result is the creation of a device that allows, in emergency surgery, to quickly provide effective access to a difficult-to-reach pathological focus.

The technical result is achieved due to two jaws, bent in the distal and proximal parts at 90° and forming a superellipse when closed; the base of the outer branch, which is represented by a handle in the form of an ellipse - a large diameter of 25.0 mm, a small diameter of 22.0 mm; a mechanism for spreading the jaws, presented in the form of a round nut - outer diameter 6.0 mm, inner diameter 2.5 mm and a screw 15.0 mm long with a conical end and head, 7.0 mm in diameter and 7.0 mm long with a longitudinal knurling; an internal branch having at its base a platform 25.0 mm long and 15.0 mm wide with rounded corners and a 15° bend in the distal part; grooves on the lower surface of the inner jaw for the tapered end of the screw.

The utility model is illustrated by the figure (Fig. 1).

The figure shows a frontal view of the device.

The device consists of an outer (A) and inner (B) jaw, a blind lock (1), two jaws (2-3), bent in the distal and proximal parts at 90° and forming a superellipse when closed; the base of the outer jaw is represented by a handle (4) in the form of an ellipse with a large diameter of 25.0 mm, and a small diameter of 22.0 mm; the mechanism for spreading the jaws is presented in the form of a round nut (5) with an outer diameter of 6.0 mm, an inner diameter of 2.5 mm and a screw (6) 15.0 mm long with a conical end and a head with a diameter of 7.0 mm and a length of 7, 0 mm with longitudinal knurling; the inner branch has at its base a platform (7) 25.0 mm long and 15.0 mm wide with rounded corners and a 15° bend in the distal part; on the lower surface of the inner jaw there is a groove (8) for the cone-shaped end of the screw.

The device works as follows

When performing surgical interventions on hollow organs, if it is necessary to create access to the posterior, hard-to-reach wall, the anterior wall of the organ is dissected, followed by the application of an instrument and its extension to a position convenient for suturing the sponges with a continuous suture. After this, the edges of the wound, due to the mechanism of spreading the branches, are spread to the size of the surgical field necessary for performing the intervention. After performing a surgical intervention using a platform on the inner branch, the degree of opening of the instrument is reduced, which allows you to narrow the edges of the wound and safely remove the continuous suture. The defect of the hollow organ is sutured with a double-row suture behind the line of the applied continuous suture.

Clinical Application Examples

The retractor for the hollow abdominal organs was used in 17 clinical cases during surgical interventions on the abdominal organs in patients with complicated ulcers of the stomach and duodenum, Mallory-Weiss syndrome, varicose veins of the cardial part of the stomach, complicated by bleeding.

Patient J., 58 years old. He was treated in the surgical department of the Regional Clinical Hospital for Emergency Medicine from 04/22/2023 to 05/02/2023 with a clinical diagnosis of duodenal bulb ulcer, exacerbation, stage 2 intestinal bleeding. An emergency fibrogastroduadenoscopy was performed. An ulcer of the posterior wall of the duodenal bulb was discovered. Endohemostasis has been achieved. Recurrence of bleeding within the first 12 hours. According to emergency indications, the patient was operated on. An anterior duodenotomy was performed with the application of a “Redaliser for the hollow organs of the abdominal cavity” instrument. The edges of the duodenum were sutured with a continuous suture to the jaws of the instrument and separated until an operational access measuring 50.0 mm by 30.0 mm was created. An ulcerative defect with a diameter of 5.0 mm with ongoing bleeding was found on the posterior wall of the duodenal bulb (Forrest 1A). The ulcer of the posterior wall of the duodenal bulb was stitched with two interrupted sutures using 1/0 Lavsan thread. The bleeding stopped. After the final inspection of the duodenal bulb for additional sources of bleeding, the retractor was removed. The intestinal wall is sutured with a double-row suture and an expanding duadenoplasty is performed. The abdominal cavity is drained in the right hypochondrium with a tubular drainage. The laparotomy wound is sutured in layers. The duration of the intestinal surgery stage was 15 minutes. Aseptic dressing. The postoperative period was without complications. The drainage was removed on the 3rd day. 05/01/2023 during control fibrogastroduadenoscopy - grade 2 deformation of the duodenal bulb was revealed. without signs of erosive changes in the intestinal mucosa. A control ultrasound examination did not reveal any free fluid in the abdominal cavity. The patient was discharged on May 2, 2023 under outpatient supervision of a surgeon at his place of residence.

Patient K., 58 years old. He was treated in the surgical department of the Regional Clinical Hospital for Emergency Medicine from 04/05/2023 to 04/12/2023 with a clinical diagnosis of acute alcohol intoxication, complicated by acute gastric bleeding. After emergency fibrogastroduadenoscopy, a 3 cm long fissure in the cardia was discovered and a diagnosis was made: stage II Mallory-Weiss syndrome, with ongoing bleeding (F1 according to Forrest). Endoscopic electrocoagulation was performed. During the first day there was a recurrence of massive bleeding. According to emergency indications, surgery was performed. After a midline laparotomy, a high oblique gastrotomy was performed using the “Dilator for hollow abdominal organs” instrument. After inspection and sanitation of the cardiac part of the stomach, a crack in the mucous-submucosal layer was discovered with ongoing massive venous bleeding. The crack was stitched with 4 separate interrupted sutures using Vicryl thread. The bleeding has stopped. After final inspection for additional sources of bleeding, the retractor was removed. The gastrotomy wound is sutured with two rows of sutures. The duration of the gastric surgery stage was 15 minutes. The abdominal cavity is drained in the right hypochondrium with a tubular drainage. The laparotomy wound is sutured in layers. Aseptic dressing. The postoperative period proceeded without complications. The drainage was removed on the 2nd day. 04/11/2023 during control fibrogastroduadenoscopy - no bleeding or defects of the mucous layer were detected. A control ultrasound examination did not reveal any free fluid in the abdominal cavity. The patient was discharged on April 12, 2023 under outpatient supervision of a surgeon at his place of residence.

Patient P., 38 years old. He was treated in the surgical department of the Regional Clinical Hospital for Emergency Medicine from 04/08/2023 to 04/28/2023 with a diagnosis of liver cirrhosis, alcoholic, Child-Pugh class B, MELD 12. Portal hypertension, hepatic encephalopathy degree II, bleeding from varices veins of the cardial part of the stomach. Due to massive blood loss, the patient had a Blackmore tube installed, followed by hemostatic, replacement and antibiotic therapy. Due to the ineffectiveness of endohemostasis, according to emergency indications, the patient underwent a modified Tanner operation using a retractor for hollow abdominal organs in the first 24 hours. An upper midline laparotomy was performed. On the anterior wall of the stomach, closer to the cardia, a gastrotomy was performed from the fundus of the stomach to the lesser curvature. Access to the posterior wall of the stomach is provided by the “Dilator for hollow abdominal organs” instrument. After the initial inspection of the stomach and evacuation of its contents, a rupture of a varicose vein was discovered on the lesser curvature on the posterior wall of the cardia of the stomach. A varicose vein with a wall rupture and profuse bleeding was sutured with five separate interrupted sutures using long-term absorbable Vicryl threads. After additional revision, 3 more varicose veins were stitched. After the final revision, the retractor for hollow organs was removed. The gastrotomy wound is sutured with a double-row suture with a continuous suture line immersed. The duration of the gastric surgery was 20 minutes. The abdominal cavity is drained in the right hypochondrium. The laparotomy wound is sutured in layers. Aseptic dressing. The drain was removed on 04/12/2023. Control fibrogastroduodenoscopy was performed on April 26, 2023. The postoperative period was without complications. No recurrent bleeding was detected. The patient was discharged on April 28, 2023 for further observation by a gastroenterologist at his place of residence.

Thus, the wound retractor for hollow abdominal organs, due to its compactness and ergonomics, has made it possible to significantly reduce the time of emergency surgical interventions, while simultaneously increasing the convenience of their implementation in hard-to-reach parts of hollow organs. The mechanism for opening the jaws made it possible to dose-select the degree of impact on surrounding tissues, which significantly reduced their traumatic damage.

Claims (1)

A retractor for hollow abdominal organs, containing external and internal jaws, a blind lock and two jaws, characterized in that the jaws are curved in the distal and proximal parts at an angle of 90° and form a superellipse when closed; wherein the base of the outer jaw contains a handle in the form of an ellipse with a large diameter of 25.0 mm and a small diameter of 22.0 mm; the mechanism for spreading the jaws is made in the form of a round nut with an outer diameter of 6.0 mm, an inner diameter of 2.5 mm and a screw 15.0 mm long with a conical end and a head with a diameter of 7.0 mm, a length of 7.0 mm with longitudinal knurling; in this case, the inner branch has at its base a platform 25.0 mm long, 15.0 mm wide with rounded corners and a bend of the distal part at an angle of 15°; and on the lower surface of the inner jaw there is a groove for the cone-shaped end of the screw of the jaw opening mechanism.