RU2843775C1 - Abdominal mirror - Google Patents

Abstract

FIELD: medical science.

SUBSTANCE: invention refers to medical equipment, namely to an abdominal mirror. Abdominal mirror comprises a handle and a fixation assembly for the removable wire wound templates. Handle is elongated and drop-shaped. Fixation assembly has rectangular shape 20.0 mm long, 10.0 mm wide, 8.0 mm high with a through hole in the centre of diameter of 5.0 mm having an internal metric thread for a butterfly screw with a rod of diameter of 5.0 mm. A front wall of the fixation assembly has groove 2.5 mm wide and 5.0 mm deep. In an end face of the fixation assembly there is a hole of diameter of 4.0 mm at a depth to a through hole in the centre of the fixation assembly; straight ends of the removable wire wound template are inserted into the groove of the fixation assembly and fixed with a butterfly screw.

EFFECT: use of the invention allows providing inspection of all parts of the abdominal cavity in emergency surgery at various sizes of a laparotomic wound and convenience for surgeons work.

1 cl, 3 dwg

Description

An abdominal mirror is related to medicine, namely to abdominal surgery, and can be used during surgical interventions on abdominal organs.

In abdominal surgery, various instruments are used for surgical interventions on abdominal organs: hooks, which provide access to individual organs, and mirrors, which provide access to most organs, but with the use of additional techniques and instruments.

Of great importance are instruments that provide the possibility of laparotomy with good revision of the abdominal cavity, are not bulky, and allow the use of additional instruments for operations on abdominal organs.

The prototype of the abdominal cavity mirror is a "retractor for hollow organs". Utility model patent No. 220511 dated 18.09.2023. This is a clamping device with a screw principle for spreading oval-shaped branches to which the wound edges are sutured. The disadvantage of the device is the limited size of the wound created.

The technical result is the creation of a simple device that allows for good inspection of all sections of the abdominal cavity in emergency surgery with different wound sizes and ease of operation for surgeons.

The technical result is achieved due to the presence in the device of an elongated teardrop-shaped handle, a fixation unit made of a rectangular shape, 20.0 mm long, 10.0 mm wide, 8.0 mm high with a through hole in the center with a diameter of 5.0 mm, having an internal metric thread for a wing screw with a rod with a diameter of 5.0 mm, on the front wall of the fixation unit there is a groove with a width of 2.5 mm, a depth of 5.0 mm, in the end of the fixation unit there is a hole with a diameter of 4.0 mm to a depth of the through hole in the center of the fixation unit, straight ends of a removable wire wound template are inserted into the groove of the fixation unit and secured with a wing screw.

THE INVENTION IS EXPLAINED BY FIGURES (Figs. 1-3).

Fig. 1. Isometric view of the device.

Fig. 2. View of the device from above.

Fig. 3. Side view of the device.

An abdominal mirror comprising a handle (1) characterised in that it comprises a fixation unit for removable wire wound templates (2), wherein the handle is made in an elongated teardrop shape, the fixation unit is made in a rectangular shape with a length of 20.0 mm, a width of 10.0 mm, a height of 8.0 mm with a through hole in the centre with a diameter of 5.0 mm (3) having an internal metric thread for a wing screw (4) with a rod with a diameter of 5.0 mm, on the front wall of the fixation unit there is a groove (5) with a width of 2.5 mm, a depth of 5.0 mm, in the end of the fixation unit there is a hole with a diameter of 4.0 mm to a depth of the through hole in the centre of the fixation unit, the straight ends of the removable wire wound template (6) are inserted into the groove of the fixation unit and secured with a wing screw.

THE DEVICE WORKS AS FOLLOWS

Depending on the type of operation and the size of the planned wound, the required size of the removable wire template is selected, installed in the fixation unit and fixed with a wing screw. After laparotomy, delimitation of the wound with sterile material, the wire template is sutured with a continuous suture to the peritoneum and a sterile napkin. Using the handle of the abdominal mirror, it can be set in the most optimal position for revision of the abdominal organs and for performing surgical intervention, creating the most favorable angle of surgical action.

EXAMPLES OF CLINICAL APPLICATION

The abdominal mirror device was used in 25 patients undergoing laparotomy for acute appendicitis and in 5 patients with gastric ulcer and duodenal ulcer complicated by bleeding and perforation.

Patient S., 46 years old. Hospitalized in the surgical department of the Kursk City Clinical Hospital of Emergency Medical Care on June 5, 2024 for emergency indications. Diagnosis: gastric ulcer, exacerbation, ulcer of the antral part of the anterior wall of the stomach, complicated by perforation. Local serous-fibrinous peritonitis. On June 5, 2024, laparotomy was performed, excision of the ulcer of the anterior wall of the stomach, sanitation, drainage of the abdominal cavity.

A midline laparotomy was performed under ETN. Hemostasis of the edges of the anterior abdominal wall. The wound was delimited with sterile material, the wire template of the abdominal mirror was sutured with a continuous suture to the peritoneum and a sterile napkin. An optimal view of the antrum of the stomach for revision of the abdominal organs is created by the handle of the abdominal mirror. There is turbid fluid and fibrinous deposits in the subhepatic space and along the right lateral canal. After removal of the exudate with an electric suction, an ulcerative infiltrate up to 20.0 mm in diameter was found on the anterior wall of the antrum of the stomach, with a perforation hole with a diameter of 3.0 mm in the center. Taking into account the absence of an ulcerative anamnesis, a decision was made to excise the ulcer using a closed method in the transverse direction of the longitudinal axis of the stomach. A suturing row of sutures is applied with a continuous suture with an atraumatic needle and PGA thread. The second row of seromuscular sutures is applied with lavsan. The abdominal cavity was sanitized with a furacilin solution. In total, the time of applying an abdominal mirror to the anterior abdominal wall and removing a continuous suture led to a reduction in this stage of the operation by half. The abdominal cavity is drained with tubular drains in the right hypochondrium and iliac region on the right. On 06/09/2024, the drainage was removed from the right iliac region, on 06/11/2024, the drainage was removed from the right hypochondrium. On 06/15/2024, the sutures were removed from the laparotomy wound, healing by primary intention. On 06/17/2024, fibrogastroscopy was performed, no ulcerative defects were found in the antral part of the stomach. On 06/19/2024, the patient was discharged under the supervision of a gastroenterologist at the place of residence. Recommendations were given.

Patient N., 36 years old. Was treated in hospital at the Kursk City Clinical Hospital of Emergency Medical Care from 15.06.2024 to 22.06.2024. Diagnosis: acute gangrenous-perforated appendicitis. Disseminated purulent peritonitis. On 15.06.2024, a laparotomy, appendectomy, sanitation of abdominal organs, drainage of the small pelvis and the right lateral canal with tubular drains were performed.

Under ETN, after triple treatment of the surgical field with antiseptics, a lower midline laparotomy was performed. The wound was delimited with sterile material, the wire template of the abdominal mirror was sutured with a continuous suture to the peritoneum and a sterile napkin. An optimal view of the organs of the right iliac cavity is created by the handle of the abdominal mirror. 250.0 ml of purulent exudate is determined in the small pelvis and right lateral canal. The exudate is removed with an electric suction machine, the vermiform appendix up to 6.0 mm long is sharply thickened, tense, gangrenously changed with a perforation in the middle part. A typical appendectomy is performed. The mesentery of the vermiform appendix is sutured and ligated in portions. The stump of the appendix is immersed in Z-shaped and purse-string sutures. The abdominal cavity is sanitized with a furacilin solution. Drainage of the small pelvis and the right lateral canal with tubular drains. The stage of installation and removal of the abdominal mirror was reduced by half compared to the application of interrupted sutures. Layered sutures on the aponeurosis, subcutaneous fat and skin. Iodine on the skin, aseptic dressings on the wounds. On 06/18/2024, drains were removed from the right iliac region and right hypochondrium. Sutures were removed on 06/22/2024, healing by primary intention. Discharged on 06/22/2024 under the supervision of a surgeon at the place of residence. Recommendations were given.

Patient M., 44 years old. Hospitalized in the Kursk Regional City Clinical Hospital of Emergency Medical Care on June 8, 2024. Diagnosis: Mallory-Weiss syndrome complicated by grade 3 bleeding. On June 8, 2024, the following operations were performed: laparotomy, gastrotomy, suturing of the subcardial fissure, drainage of the abdominal cavity.

An upper midline laparotomy was performed under intubation anesthesia. The wound was delimited with sterile material, the wire template of the abdominal mirror was sutured with a continuous suture to the peritoneum and a sterile napkin. An optimal view of the epigastric organs was created by the handle of the abdominal mirror. The stomach was tamponed with blood. Fragmentary blood was detected in the loops of the small intestine. An anterior-upper gastrotomy was performed. A large number of blood clots were removed. During revision of the subcardia, a 20.0 mm by 5.0 mm crack in the mucous membrane of the posterior wall under fibrin with a bleeding venous vessel was detected. Hemostasis was achieved by suturing the crack with three interrupted fluorest sutures. Hemostasis is consistent. There are no other sources of bleeding. The gastrotomy opening was sutured with a continuous catgut suture. Peritonization of the stitched suture with interrupted serous-muscular sutures using PGA threads. The abdominal cavity was washed with a furacilin solution and drained with a tubular drainage in the right hypochondrium. The stage of installation and removal of the abdominal mirror was reduced by half compared to the application of interrupted sutures. The peritoneum was sutured with a continuous catgut suture, the aponeurosis was sutured with interrupted nylon sutures, interrupted nylon sutures on the subcutaneous tissue, nylon sutures on the skin. Aseptic dressings on the wounds of the abdominal wall. The drainage from the abdominal cavity was removed on 11/06/2024. The sutures were removed on 17/06/2024, healing by primary intention. In a satisfactory condition, he was discharged under the supervision of a gastroenterologist on 18/06/2024.

Thus, the absence of branches in the instrument, additional hooks on the device, the creation of a more advantageous angle of surgical action, led to greater convenience in using the device for revision of abdominal organs and performing emergency surgical interventions, a reduction in the time of installation and removal of the device, and a reduction in the duration of surgical interventions.

Claims (1)

An abdominal mirror comprising a handle, characterized in that it comprises a fixation unit for removable wire wound templates, wherein the handle is made in an elongated teardrop shape, the fixation unit is made in a rectangular shape with a length of 20.0 mm, a width of 10.0 mm, a height of 8.0 mm with a through hole in the center with a diameter of 5.0 mm, having an internal metric thread for a wing screw with a rod with a diameter of 5.0 mm, on the front wall of the fixation unit there is a groove with a width of 2.5 mm, a depth of 5.0 mm, in the end of the fixation unit there is a hole with a diameter of 4.0 mm to a depth of the through hole in the center of the fixation unit, straight ends of the removable wire wound template are inserted into the groove of the fixation unit and secured with a wing screw.