RU2319468C1 - Device for fixing implant during endoscopic hernioplasy - Google Patents

Abstract

FIELD: surgery.

SUBSTANCE: device can be used for fixing mesh implant during endoscopic hernioplasty, in particular, during endoscopic hernioplasty related to button and post-operational ventral hernias. Device has case; needle comes from bottom side of case. Needle is provided with bevel at its end. Rod is placed inside needle for movement. One end of rod is attached to button. Other end of rod is capable of extending behind bevel of needle and it has slot at its side surface. Button is provided with shank. Shank comes out of top part of case. There is spring onto rod disposed between button and lower part of case. Device is additionally provided with second needle with rod. Second needle is disposed in parallel to first one at distance of 0,8 cm from it. Bevels of needle are made from lower side and directed sides being opposite to longitudinal axis of device. Slots at side surface of rods are made at distance of 0,5 cm from their ends and they are disposed at internal side. Device is provided with needle submersion restrictor made in form of two semi-round plates. Straight sides of plates are directed to bevels of needles. Bevels of needles are disposed at both sides of needles to move along them. Plates are provided with grooves at internal sides to move. Grooves correspond to diameter of needles. Round opening is disposed in center of plates at equal distances from needle. Opening is provided with thread at plate which is disposed at longer distance from head of screw. Screw is installed in openings of plates. Ligatures can be introduced and removed at ease. Corruption and slant in implant are excluded due to introduction of both needles simultaneously. Restriction of submersion of needles provides prophylactic measures against traumatization of abdominal organs.

EFFECT: reliability of connection of tissues and polypropylene mesh.

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Description

The invention relates to medicine, namely to surgery, and can be used to fix a mesh implant with endoscopic hernioplasty, in particular with endoscopic hernioplasty for umbilical and postoperative ventral hernias.

Known furrier needle for ligature. It consists of a handle and a rod with a tip, in which a hole is made that has a slot on the side (Catalog. Equipment for minimally invasive surgery. MEDFARMSERVICE. G. Kazan, p.21).

The needle is used as follows.

Having previously placed one end of the ligature in the slot of the needle, pierce the abdominal wall until the needle with the ligature enters the free abdominal cavity. Then the end of the ligature is removed with endoscopic instruments and fixed in the instrument. The needle is brought out. Repeatedly pierce the abdominal wall, stepping back a few millimeters from the first puncture, without ligature. Endoscopic instruments place the end of the ligature, located in the abdominal cavity, in the needle slot. Take the needle out. Thus, both ends of the ligature are located on the anterior abdominal wall at a distance of several millimeters from each other.

The disadvantages of this device are:

1. After the ligature is fed into the needle, when it is brought to the surface of the skin, the end of the ligature may slip out of the needle.

2. When performing a series of punctures, it is difficult to inject the needle strictly in one line and at the same given distance to create bridges of the same size.

A known method of hernioplasty, in which the ligature is carried out using a needle into the abdominal cavity. One end of the ligature is held by endo-clamp, filed through the trocar, and all manipulations are carried out under the control of a laparoscope. The end of the ligature, held by the end clamp, is fed into the loop and the loop with the ligature is removed onto the skin surface (“Hernioplasty Method.” Patent RU No. 2226992, M. Cl. A61B 17/00, BIMP No. 11, 04/20/2004).

The disadvantages of the analogue are as follows:

1. After the ligature is fed into the loop, when it is brought out onto the skin surface, the end of the ligature may slip out of the loop.

2. When performing a series of punctures, it is difficult to inject the needle strictly in one line and at the same given distance to create bridges of the same size.

The closest in technical essence to the claimed object, selected as a prototype, is a device consisting of a housing in which a button with a shank is placed. A needle with a bevel at the end departs from the bottom of the body. A rod is located in the needle that can move along the needle. On the rod at the end on the side surface there is a slot (EFA catalog. Technologies of the Future. 2003, p. 18).

The device is used as follows.

Under the control of a laparoscope, the anterior abdominal wall is punctured until a needle enters the free abdominal cavity. An implant with ligatures pre-fixed on it is inserted into the abdominal cavity through one of the laparoports. One end of the ligature is placed in a slot on the side surface of the rod, after pressing the button shank. The shank is released, the button rises due to the spring. Due to the return movement of the rod, the slot fixes the ligature at the bevel of the needle. The needle is brought out together with the ligature. Repeat the whole procedure, stepping a few millimeters from the first injection, and bring the second end of the ligature out. Ligature tighten.

The disadvantages of this design are as follows:

1. When performing a series of punctures, it is difficult to inject the needle strictly in one line and at the same specified distance to create bridges of the same size.

2. Using the device, with one injection, only one ligature is displayed.

3. It does not make it possible to obtain an even, high-quality seam that holds polypropylene mesh well.

4. Does not guarantee implant fixation without distortions and corrugation.

The objective of the invention is to simplify and accelerate the removal of ligatures, ensuring the quality of the seam and reliable connection of tissues and polypropylene mesh, eliminating corrugation and distortion of the implant due to the introduction of two needles at the same time, prevention of trauma to the abdominal organs due to the needle immersion limiter.

The invention consists in the following.

The device for fixing the implant with endoscopic hernioplasty contains a housing, from which a needle with a bevel at the bottom departs from the lower part. A rod is placed in the needle with the possibility of movement, one end of which is attached to the button, and the other end can be extended beyond the bevel of the needle and has a slot on the side surface. The button has a shank extending from the top of the case. Between the button and the lower part of the housing is a spring worn on the shaft. The device is additionally equipped with a second needle with a rod parallel to the first one at a distance of 0.8 cm. The bevels of the needles are made from the outside and directed to the sides opposite from the longitudinal axis of the device. The slots on the side surface of the rods are made at a distance of 0.5 cm from their ends and are located on the inside. The device has a needle immersion limiter in the form of two semicircular plates directed straight to the bevels of the needles located on both sides of the needles, with the possibility of movement along them, for which the plates have grooves on the inside that correspond to the diameter of the needles. A circular hole is located in the middle of the plates at an equal distance from the needles. On one of the plates farthest from the screw head, the hole has a thread. A screw is inserted into the holes of the plates.

The novelty of the device.

The device is additionally equipped with a second needle with a rod parallel to the first one at a distance of 0.8 cm. This allows using the device to create bridges of the same size with one introduction of the device.

The bevels of the needles are made from the outside and directed to the sides opposite from the longitudinal axis of the device, which makes it impossible to get a fan-shaped divergence of the needles relative to each other when piercing the tissues.

The device has a needle immersion limiter in the form of two semicircular plates directed straight to the bevels of the needles located on both sides of the needles, with the possibility of movement along them, for which grooves are made in the plates corresponding to the diameter of the needles. A circular hole is located in the middle of the plates at an equal distance from the needles, and on one of the plates farthest from the screw head, the hole has a thread. A screw is inserted into the holes of the plates. The immersion limiter allows you to set the desired depth of penetration of the needles into the abdominal cavity during the first puncture, which prevents injury to the abdominal organs during subsequent punctures, and also eliminates the needles to diverge when piercing.

The slots on the lateral surface of the rods are made at a distance of 0.5 cm from the ends and are located on the inside, which makes it easy to simultaneously place both ends of the ligature in the slots with one tool.

The device allows to obtain a new technical result.

- Get a seam with the location of the ends of the ligatures strictly at a certain distance. Bridges of the same size are created. This avoids the corrugation and distortions of the mesh, which occurs with uneven distances between the ends of the ligatures and the eruption of tissues while reducing the distance between them.

- The device allows you to get a uniform seam, strictly parallel to the edge of the implant, which prevents its deformation and bending and prevents corrugation and distortion of the implant.

- Reduced time for ligatures and the entire operation, respectively.

- The device has a needle immersion limiter that allows you to select the desired depth of penetration of the needles into the abdominal cavity, which eliminates injury to the abdominal organs due to uncontrolled movement of the needles not only in depth, but also to the sides.

The device is presented in figures 1 and 2.

Figure 1 shows a device for fixing the implant in the context. Figure 2 shows a section along aa passing through the needle immersion stop.

The device for fixing the implant with endoscopic hernioplasty contains a housing 1, from which the needle 2, which has a bevel at the bottom, departs from the bottom. In the needle 2 is placed with the possibility of movement of the rod 3, one end of which is attached to the button 4, and the other end can be extended beyond the bevel of the needle 2 and has a slot 5 on the side surface. The button 4 has a shank 6 extending from the upper part of the housing 1. Between the button 4 and the lower part of the housing 1 is a spring 7, worn on the rod 3. The device is additionally equipped with a second needle 8 with a rod 9, parallel to the first at a distance of 0.8 cm. The bevels of the needles 2 and 8 are made from the outside and directed opposite to the longitudinal axis whiskers tripartite side. The slots 5 on the lateral surface of the rods 3 and 8 are made at a distance of 0.5 cm from their ends and are located on the inside. The device has a needle immersion limiter in the form of two semicircular plates 10 and 11, directed straight to the bevels of the needles located on both sides of the needles 2 and 8, with the possibility of movement along them, for which the plates 10 and 11 have grooves 12 on the inside and 13 corresponding to the diameter of the needles. Round holes 14 and 15 are located in the middle of the plates 10 and 11 at an equal distance from the needles 2 and 8, and on one of the plates farthest from the screw head 16, the hole 15 is threaded, a screw 16 is inserted into the holes of the plates.

The device operates as follows.

Needles 2 and 8 of the device pierce the anterior abdominal wall until the needles enter the free abdominal cavity, under the control of a laparoscope. Under visual control, the depth of injection of the needles is selected and, by loosening the screw 16, the immersion stop is moved to the skin level. Turning the screw 16, tighten the plate 11 and thereby press the plates 11 and 10 to the needles 2 and 8 located in the grooves 12 and 13, and to the head of the screw 16. After tightening the screw 16, the movement of the immersion limiter along the needles 2 and 8 is impossible, this is achieved fixed depth with subsequent injections of needles 2 and 8 into the abdominal cavity. In addition, the immersion stop prevents the ends of the needles 2 and 8 from diverging to the sides and keeps them in a strictly parallel state. An implant with ligatures pre-fixed on it is inserted into the abdominal cavity through one of the laparoports. Pressing the button 6, the buttons 4 compress the springs 7 and bring the rods 3 and 9 to the working position. The slot 5 on the lateral surface of the rod 3 and 9 is released. The ends of the ligature are placed in the slot 5 and the shank 6 of the button 4 is released. The springs 7 are opened and the side slot 5, approaching the bevel of the needle, reliably fixes the ligature. The device is brought out together with the ends of the ligatures. By tying the ends of the ligatures on the skin, the implant segment is fixed. The number of punctures corresponds to the number of ligatures attached to the implant.

A high-quality even seam is obtained, since the needles are guided when they are injected sharply parallel to one another.

The time for suturing is reduced by 2 times, since for one puncture two ends of the ligature are brought to the surface, the device is immersed at a predetermined depth verified during the first immersion, which also reduces the operation time.

A reliable connection of tissues and mesh is achieved without corrugating and skewing of the implant.

Using the proposed device performed 12 operations.

Example 1. Patient K., 48 years old, was hospitalized in the department of elective surgery on 08.28.05 with a diagnosis of postoperative ventral hernia. A history of appendectomy. The size of the hernial defect is 8.0–4.0 cm. The operation option was selected: laparoscopic hernioplasty with the Ethikon polypropylene mesh according to the in lay technique. The mesh dimensions are 12.0 × 7.0 cm.

Needles 2 and 8 of the device pierced the anterior abdominal wall until the needles hit the free abdominal cavity, under the control of a laparoscope. Under visual control, the individual needle injection depth was selected and, having loosened screw 16, the immersion limiter was shifted to the skin level. Turning the screw 16, we tightened the plate 11 and thereby pressed the plates 11 and 10 to the needles 2 and 8 located in the grooves 12 and 13, and to the head of the screw 16. After tightening the screw 16, the movement of the immersion limiter along the needles 2 and 8 is impossible, this is achieved fixed individual depth with subsequent injections of needles 2 and 8 into the abdominal cavity.

An implant with ligatures pre-fixed on it is inserted into the abdominal cavity through one of the laparoports. Pressing on the shank 6, the buttons 4 compress the springs 7 and bring the rods 3 and 9 to the working position. The slot 5 on the lateral surface of the rod 3 and 9 is released and leaves the needles.

During the operation, a device was used to fix the mesh implant with a slot on the rod at a distance of 0.3 cm from the pointed end of the rods with a distance between the needles of 0.8 cm. When working and bringing the device out together with the ends of the ligatures in two of the three cases, the thread slips out from the slot, since the needle is not pressed against the bevel, which requires an additional introduction of the device into the abdominal cavity in order to remove the thread on the anterior abdominal wall, this complicated the operation and lengthened its course.

Example 2. Patient M., 34 years old, was hospitalized in the emergency surgery department 03/12/05, with a diagnosis of postoperative ventral hernia. A history of adnexectomy on the right. The size of the hernial defect is 7.0 × 4.0 cm. The operation option was selected: laparoscopic hernioplasty with a polypropylene mesh from Etikon firm according to the in lay technique. The mesh dimensions are 11.0 × 7.0 cm.

Needles 2 and 8 of the device pierced the anterior abdominal wall until the needles hit the free abdominal cavity, under the control of a laparoscope. Under visual control, the depth of injection of the needles was selected and, by loosening the screw 16, the immersion stop was moved to the skin level. Turning the screw 16, we tightened the plate 11 and thereby pressed the plates 11 and 10 to the needles 2 and 8 located in the grooves 12 and 13, and to the head of the screw 16. After tightening the screw 16, the movement of the immersion limiter along the needles 2 and 8 is impossible, this is achieved fixed depth with subsequent injections of needles 2 and 8 into the abdominal cavity.

An implant with ligatures pre-fixed on it is inserted into the abdominal cavity through one of the laparoports. Pressing on the shank 6, the buttons 4 compress the springs 7 and bring the rods 3 and 9 to the working position. The slot 5 on the lateral surface of the rod 3 and 9 is released and leaves the needles.

When performing the operation, a device was used to fix the mesh implant with a slot located on the rod at a distance of 0.5 cm from the pointed end with a distance between the needles of 0.5 cm. During operation, the grip of the thread is normal, there is no slipping from the slot. However, when the thread was tightened on the anterior abdominal wall in two cases during the operation through the laparoscope, mesh penetration by the ligature was recorded. Another device was used with a spacing of 0.8 cm between the needles. No teething was noted. The postoperative period was uneventful, the patient was discharged on the 5th day for outpatient treatment.

Example 3. Patient F., 52 years old, was hospitalized in the emergency surgery department 02.02.06, with a diagnosis of postoperative ventral hernia. A history of uterine amputation. The size of the hernial defect is 9.0 × 6.0 cm. The operation option was selected: laparoscopic hernioplasty with Etikon polypropylene mesh according to the in lay technique. The mesh dimensions are 15.0 × 10.0 cm.

Needles 2 and 8 of the device pierced the anterior abdominal wall until the needles hit the free abdominal cavity, under the control of a laparoscope. Under visual control, the depth of injection of the needles was selected and, by loosening the screw 16, the immersion stop was moved to the skin level. Turning the screw 16, we tightened the plate 11 and thereby pressed the plates 11 and 10 to the needles 2 and 8 located in the grooves 12 and 13, and to the head of the screw 16. After tightening the screw 16, the movement of the immersion limiter along the needles 2 and 8 is impossible, this is achieved individual fixed depth with subsequent injections of needles 2 and 8 into the abdominal cavity.

An implant with ligatures pre-fixed on it is inserted into the abdominal cavity through one of the laparoports. Pressing on the shank 6, the buttons 4 compress the springs 7 and bring the rods 3 and 9 to the working position. The slot 5 on the lateral surface of the rod 3 and 9 is released and leaves the needles.

The ends of the ligature are placed in the slot 5 and the shank 6 of the button 4 is released. The springs 7 are opened and the side slot 5, approaching the bevel of the needle, reliably fixes the ligature.

When performing the operation, a device was used to fix the mesh implant with the slot located on the rod at a distance of 0.5 cm from the pointed end with a distance between the needles of 1.0 cm. During operation, the grip of the thread is normal, there is no slipping from the slot. However, when the thread was tightened on the anterior abdominal wall during surgery, the mesh was fixed through a laparoscope. No teething marked. During the operation, additional extraperitonization of the mesh by the strands of the greater omentum was required in order to prevent contact of the mesh assemblies with loops of the small intestine in order to prevent the formation of intestinal fistulas. The postoperative period was uneventful, however, there was a prolonged pain syndrome, which lengthened the patient's hospital stay up to 12 days.

The proposed device allows you to get a high-quality smooth seam, since the needles are guided when injected expensively parallel to one another.

The time for suturing is reduced by 2 times, since for one puncture two ends of the ligature are brought to the surface, the device is immersed at a predetermined depth verified during the first immersion, which also reduces the operation time.

A reliable connection of tissues and mesh is achieved without corrugating and skewing of the implant.

Using the proposed device performed 12 operations.

Claims (1)

A device for implant fixation in endoscopic hernioplasty, comprising a body from which a needle with a bevel at the bottom departs, a rod is placed in the needle with the ability to move, one end of which is attached to the button, and the other end can be extended beyond the bevel of the needle and has on the side the surface is slotted, the button has a shank extending from the upper part of the housing, between the button and the lower part of the housing there is a spring worn on a shaft, characterized in that the device is additionally equipped with a second needle with with a rod parallel to the first one at a distance of 0.8 cm, the bevels of the needles are made from the outside and directed to the sides opposite from the longitudinal axis of the device, the slots on the side surface of the rods are made at a distance of 0.5 cm from their ends and are located on the inside, the device has a needle immersion limiter in the form of two semicircular plates directed straight to the bevels of the needles located on both sides of the needles, with the possibility of movement along them, for which the plates have grooves on the inside, respectively stvuyuschie diameter needles, the middle plate is equidistant from the needle disposed circular hole, and on one of the plates, farthest from the screw head has a threaded hole, into the holes of plates inserted screw.

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