RU2841760C2 - Laparoscopic injection needle for introducing platelet autoplasma into ovaries - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to obstetrics and gynaecology and can be used for surgical interventions in endometriosis-associated infertility. Laparoscopic injection needle for introducing platelet autoplasma into ovaries has a cylindrical shape and consists of two parts. First part of the needle is tip 9 mm long and 2 mm in diameter, and the second part is a needle body with an outer diameter of 5 mm. Needle body is represented by a hollow tube with an internal diameter of 3 mm and length of 330 mm. On the proximal part of the needle body there is a Luer lock connection for using a disposable syringe with platelet autoplasma.

EFFECT: increased area of ovarian tissue irrigation with thrombocyte autoplasma, reduced risk of traumatisation of ovarian tissue and surrounding structures with possible development of haemorrhage.

1 cl, 2 dwg

Description

Laparoscopic injection needle for the introduction of platelet-rich autoplasma into the ovaries refers to medicine, namely obstetrics and gynecology, and is intended for performing surgical interventions in the treatment of endometriosis-associated infertility.

In obstetrics and gynecology, there are currently no laparoscopic puncture needles that are intended for intraovarian administration of platelet-rich autoplasma.

However, the state of the art includes a laparoscopic puncture needle manufactured by MPPO Endomedium (URL: https://endo.ru/product/laparoskopiya/igly-laparoskopicheskie/igla-punktsionnaya-laparoskopicheskaya), designed to introduce or extract fluid from the lumen of an organ or cavity during laparoscopic operations. The needle has a working part length of 280 mm and a diameter of 5 mm. The Endomedium laparoscopic puncture needle has a Luer lock connection.

The disadvantages of a laparoscopic puncture needle when performing an injection of platelet-rich autoplasma are:

1. The diameter of the puncture needle, since the injection causes excessive damage to the ovarian parenchyma, which reduces the ovarian reserve and creates the risk of bleeding;

2. The absence of a limiter for the inserted part of the needle creates a risk of damage to the ovary and underlying structures;

3. The absence of additional holes at the end of the needle to increase the area of irrigation of the ovarian tissue with platelet autoplasma.

The closest to the proposed invention is a laparoscopic biopsy needle manufactured by MNPO Endomedium (URL: https://endo.ru/product/laparoskopiya/igly-laparoskopicheskie/igla-biopsiynaya-laparoskopicheskaya/), designed to take biological material from parenchymatous organs during laparoscopic operations. The length of the working part of the biopsy needle is 325 mm and 5 mm in diameter. At the end of the needle is a biopsy tip 27 mm long and 2 mm in diameter.

The disadvantages of a laparoscopic biopsy needle when performing an injection of platelet-rich autoplasma are:

1. The length of the biopsy tip, since the average thickness of the ovary is ~15 mm for women of reproductive age, which creates the risk of puncturing the ovary through the entire thickness of the tissue;

2. The absence of additional holes at the end of the needle to increase the area of irrigation of the ovarian tissue with platelet autoplasma.

In developing the proposed method, the goal was to develop a safe and ergonomic laparoscopic injection needle for the introduction of platelet-rich autoplasma into the ovaries to stimulate ovarian function in patients with low ovarian reserve.

The technical result consists in increasing the area of irrigation of ovarian tissue with platelet autoplasma, reducing the risk of trauma to ovarian tissue and surrounding structures with the possible development of bleeding.

The technical result is achieved due to the fact that the laparoscopic injection needle for introducing platelet-rich autoplasma into the ovaries includes a tip 9 mm long and 2 mm in diameter with six holes 0.5 mm in diameter, located three holes on each semicircle, and a streamlined part passes into the body of the needle with an outer diameter of 5 mm, performing the function of a tip limiter, the body of the needle is represented by a hollow tube with an inner diameter of 3 mm and a length of 330 mm, on the proximal part of which a Luer lock connection is made for a plastic syringe with platelet-rich autoplasma.

The laparoscopic injection needle for the introduction of platelet-rich autoplasma into the ovaries has a cylindrical shape and consists of two parts (Fig. 1). The first part of the needle is a tip 9 mm long and 2 mm in diameter. The tip length is selected taking into account the average ovary diameter of ~ 15 mm, which reduces the risk of damaging the underlying structures. The tip has a 30-degree bevel. The tip has six holes 0.5 mm in diameter, three holes on each semicircle. These holes allow to increase the area of irrigation of the ovarian tissue. The tip with a diameter of 2 mm in a streamlined part passes into the second part - the body of the needle with an outer diameter of 5 mm, performing the function of a tip limiter. The body of the needle is a hollow tube with an inner diameter of 3 mm and a length of 330 mm, which is the standard length of laparoscopic instruments, and an outer diameter of 5, which allows it to be inserted into a 5 mm laparoscopic port. The proximal part of the needle body has a Luer lock connection for using a disposable syringe with platelet autoplasma. The needle is inserted into the ovarian tissue with a stylet. The stylet is a metal rod with three parts: a sharp tip 10 mm long and 1.5 mm in diameter, the main part 330 mm long and 3 mm in diameter, and the head of the stylet with a locking connection (Fig. 2).

The proposed laparoscopic injection needle for the introduction of platelet-rich autoplasma into the ovaries is used as follows.

Under aseptic conditions and general anesthesia, a Veress needle is inserted into the paraumbilical point and carboxyperitoneum is applied. A 10 mm optical trocar is inserted into the same point. Laparoports are inserted under optical control: a 5 mm trocar in the right iliac region and a 5 mm trocar in the left iliac region. The right and left ovaries are visualized. Three points for the injection of platelet-rich autoplasma are determined 5-7 mm from the main vessels in the medulla of each ovary. One of the ovaries is fixed with a manipulator and, using a laparoscopic injection needle for the injection of platelet-rich autoplasma, injections are made into three points, 1 ml each. Similar manipulations are repeated with the second ovary. Hemostasis is monitored. The total volume of platelet-rich autoplasma injected is 3 ml into each ovary.

The effectiveness of the proposed catheter for the introduction of platelet-rich autoplasma into the uterine cavity is confirmed by a clinical example.

Patient O., 37 years old, sought help with complaints of inability to become pregnant despite regular sexual activity for 3 years, nagging pain in the lower abdomen of varying intensity, radiating to the left lumbar region, and painful menstruation.

Final clinical diagnosis:

Main: External genital endometriosis stage II according to ASRM: endometrioid cyst of the left ovary, endometrioid infiltrate of the left uterosacral ligament, endometriosis of the pelvic peritoneum.

Associated diseases: Adenomyosis, diffuse form. Adhesions of the pelvic organs. Infertility II. Chronic gastritis, outside of exacerbation.

Medical history: menstruation since the age of 11, for 4 days, every 27-28 days, regular, moderate, painful. B - 1: R - 1. The patient has been planning a pregnancy for 3 years. A decrease in ovarian reserve is noted. AMH 0.99. The spouse has been examined, he is healthy. In 2020, she noted a nagging pain in the lumbar region, performed an MRI of the lumbosacral spine, according to which, according to her, a neoplasm of the left ovary was detected. She did not consult a gynecologist. She took NSAIDs on her own with a positive effect. She consulted a gynecologist in November 2023, an ultrasound of the pelvic organs was performed on November 22, 2023: endometrioid cyst of the left ovary. According to ultrasound of the pelvic organs from 06.12.2023: Echographic signs of diffuse adenomyosis. Cystic formation of the left ovary (endometrioid nature).

Surgical treatment is recommended.

Examined and prepared for outpatient surgery. 12/07/2023. Surgery: Laparoscopy. Salpingo-ovariolysis. Enucleation of left ovarian cyst. Excision of endometriosis foci. Intraovarian administration of platelet-rich autoplasma.

Procedure: Under aseptic conditions and combined endotracheal anesthesia, a 1 cm skin incision was made in the supraumbilical area, laparolifting was performed with 2 pins, laparocentesis was performed with a Veress needle, which was confirmed by a drip test, syringe test, and hardware test, CO2 insufflation was performed with automatically maintained intra-abdominal pressure of 12 mm Hg, a trocar was inserted for a 10 mm camera, 30 g optics. Trocars for instruments were inserted under optical control. During overview laparoscopy: subdiaphragmatic space, liver, gallbladder, stomach, greater omentum, appendix, small and large intestines are without visible changes. The peritoneum is smooth and shiny. The body of the uterus is of normal size, "spherical" in shape, the serous cover is shiny, smooth, "marbled" in color. The right appendages are in planar adhesions with each other: the ovary is 35x20 mm in size, of normal structure; the fallopian tube is of normal structure and color, the fimbrial section is free. The left appendages are in planar adhesions with each other: the ovary is 45x35 mm in size, contains a liquid formation with a dense smooth capsule of a whitish color, filled with "chocolate" contents, 25 mm in diameter, soldered to the ovarian fossa; the fallopian tube is of normal structure and color, the fimbrial section is free. Multiple foci of endometriosis with deep infiltration of the underlying tissues, up to 7 mm in size, are determined on the pelvic peritoneum of the retrouterine space. The peritoneum of the vesicouterine fold is without visible changes.

Completed: Using coagulation in ForceTriad mode, the above-described adhesions were separated, and the normal anatomical arrangement of organs was restored. A Clermont-Ferrand uterine manipulator was inserted into the uterine cavity. Enucleation of the left ovarian cyst was performed using blunt and sharp methods with scissors in cold mode, hemostasis was achieved using point bipolar coagulation. Using coagulation in ForceTriad mode, excision of pelvic peritoneum endometriosis foci was performed. The removed tissues were removed from the abdominal cavity in a plastic container and sent for histological examination. Using a laparoscopic injection needle for introducing platelet-rich autoplasma into the ovaries, 2 ml of autoplasma were injected alternately into the right and left ovaries through 3-4 punctures in each ovary. Hemostasis control - dry. Abdominal cavity lavage. The uterus with appendages is covered with the anti-adhesion barrier "Mesogel". Desufflation. Instruments and trocars are removed from the abdominal cavity. Trocar wounds are sutured layer by layer. Individual intradermal sutures are applied to the skin. Aseptic stickers. The postoperative period is uneventful. Treatment: infusion, antibacterial, symptomatic therapy. Clexane, compression hosiery, intraoperative variable pneumocompression of the veins of the lower extremities with the Kendall system were used to prevent thrombosis. In a satisfactory condition, the patient is discharged under the supervision of a gynecologist at the clinic with recommendations.

The proposed laparoscopic injection needle for the introduction of platelet-rich autoplasma into the ovaries has a number of distinctive features:

1. allows for uniform injections into the ovarian medulla, increasing the volume and area of impact of autoplasma on the ovarian reserve;

2. reduces the risk of damage to major vessels and internal organs by limiting the length of the inserted part;

3. The diameter of the tip reduces damage to ovarian tissue and the risk of bleeding.

Brief description of the drawings

Fig. 1 Laparoscopic injection needle for the introduction of platelet-rich autoplasma.

Fig. 2 Stylet of laparoscopic injection needle for introduction of platelet-rich autoplasma.

Claims (1)

A laparoscopic injection needle for introducing platelet-rich autoplasma into the ovaries, comprising a needle body, a stylet and a tip that has a length of 9 mm, a diameter of 2 mm, a 30-degree bevel and three holes of 0.5 mm on each semicircle, wherein the tip with a streamlined part passes into the needle body, made in the form of a hollow tube 330 mm long, having an internal diameter of 3 mm and an external diameter of 5 mm for insertion into a laparoscopic port, wherein on the proximal part of the needle body there is a Lucr lock connection for a disposable syringe, and the stylet is made in the form of a metal rod with a main part of 330 mm and a diameter of 1.5 mm and a length of 10 mm and with a head of 3 mm in diameter, made with a fixing connection.

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