RU45614U1 - DEVICE FOR SEALING MINILAPAROTOMY Wounds WITH THE FOLLOWING CARRYING OUT OF THE INTRAOPERATIVE LAPAROSCOPY - Google Patents

Abstract

The utility model relates to medical equipment, namely to surgical instruments intended for laparoscopic interventions. In the device for sealing a minilaparotomic wound with subsequent intraoperative laparoscopy containing a trocar 1, an instrument channel 3 with a valve 4 preventing gas leakage, and a gas supply cock 5 in the abdominal cavity, at least two elastic cylinders 6 are hermetically sealed on the trocar tube 1 and 7 at a distance from each other and with the possibility of increasing their volumes. Tube 1 of the trocar is inserted through the surgical wound, previously formed by the laparotomic access according to Volkovich-Dyakonov, into the abdominal cavity with one lower balloon 6, leaving the second balloon 7 above the wound. In turn, sterile air or CO is supplied into the cavity of the cylinders 6 and 7, increasing their volumes. Increasing in volume, the cylinders touch each other, closing and fixing the wound tightly and reliably. Next, an insufflator is connected to the faucet 5 to supply gas to the abdominal cavity and a laparoscope is inserted for a detailed examination of the sloping places of the abdominal cavity. After completion of the necessary manipulations, the device is removed in the reverse order. The inventive utility model is simple in technical execution, allows to reduce the duration of the operation, to eliminate trauma to the peritoneum and intestines, and adequate tightness does not lead to subcutaneous emphysema, meets the criteria for atraumatic, improves immediate and long-term treatment results, which gives the right to accept it in a row with traditional tools, used in medicine, as well as in the prevention of purulent-inflammatory complications of surgical wounds in the postoperative period.

Description

The utility model relates to medical equipment, namely to surgical instruments intended for laparoscopic interventions.

There are a large number of trocars designed to provide access to the surgical field and create operational space. Troakar (I.V. Fedorov. Surgical Instruments. Functions and Purpose. AKP “Adelaide”, Kazan, 2001, p. 145, Fig. 15-15, 15-16) - [1], has a trocar tube, instrumental a channel with a valve and a gas supply tap To puncture the walls of the cavities, a stylet is inserted inside the trocar tube. The tip of the stylet can have a different shape, the atraumatic stylet is equipped with a protective cap for safe penetration through tissues - [1, p. 145, Fig. 15-17].

A trocar is known that contains an outer sleeve and a stylet with lateral cutting faces and a spring-loaded rod having a rounded working end, while the rod can be both in the recessed position and protrude beyond the stylet (ed. St. USSR No. 1568987, 1990) - [2]. After dissection of the anterior abdominal wall, the rounded working end of the spring-loaded stem extending beyond the stylet pushes the underlying intestinal loops and prevents injury to the intestinal wall. However, when conducting a trocar through the anterior abdominal wall, dissection of tissues and passing vessels occurs, which is a significant injury and requires stopping the bleeding by ligation of bleeding vessels.

Known trocar containing a sleeve placed in the sleeve stylet with a through central channel and a conical working end, and a needle for applying pneumoperitoneum with a sharp end and a spring-loaded

a mandrin having a blunt working end, placed in the stylet channel with the possibility of longitudinal movement (ed. St. USSR No. 1445713, 1988) - [3]. The tip of the needle pierce the anterior abdominal wall and insert the working end of the needle into the abdominal cavity, while the blunt working end of the mandrel extends beyond the needle and covers its sharp end, thereby preventing the possibility of damage to the organs of the abdominal cavity. Then, a trocar stylet with a sleeve is carried out on the needle, while the conical working end of the stylet does not cut adjacent tissues and vessels, but spreads them radially, thereby reducing the invasiveness of the intervention.

A device for installing a laparoscope sleeve according to the patent No. 2094017, A 61 B 17/02, A 61 B 17/34, publ. 10/27/1997 Bul. No. 30 - [4]. The device comprises a stylet with a surface under the sleeve, a conical working end and a through central channel with a needle installed for longitudinal movement of it for applying a pneumoperitoneum having an end narrowing with at least one hole connecting the needle cavity and the external environment.

Hasson’s trocar is known (I.V. Fedorov. Surgical instruments. Functions and purpose. AKP “Adelaide”, Kazan, 2001, p. 147, Fig. 15-23) - [5], which is a tool for blunt penetration into the abdominal cavity at the first stage of laparoscopic surgery.

To conduct a comparative analysis with the claimed utility model, the well-known disposable plastic trocar of the Ethikon Endosurgery company was used [1, p. 146, Fig. 15-18], which has a trocar tube, an instrument channel with a valve, which is a sealing unit, and a gas supply tap into the abdominal cavity. The trocar is designed to provide access to the surgical field and create surgical space through laparocentesis.

However, in the intraoperative period with laparotomic accesses of the Volkovich-Dyakonov type, surgeons need to revise other parts of the abdominal cavity, and due to the limited surgical field, this manipulation is difficult. Solving this problem, operators resort to intraoperative diagnostic laparoscopy, for which a trocar with subsequent laparoscope is inserted into the abdominal cavity through it, and to create a pneumoperitoneum, a purse string suture is placed on the peritoneum and tighten it around the trocar tube, achieving tightness. The disadvantage of this approach to achieving tightness for subsequent intraoperative laparoscopy is trauma in the loose peritoneum, when the suture begins to erupt, which leads to additional suturing (accordingly, increases the operation time). Due to repeated suturing, a lack of sufficient tightness is possible, and hence subcutaneous emphysema. There is also a risk of injury to the intestines by the tip of the needle when suturing.

The technical result, which is achieved by the claimed utility model, is to reduce tissue injury in intraoperative laparoscopy with high sealing minilaparotomic wounds.

The technical effect is achieved by the fact that in the device for sealing a minilaparotomic wound with subsequent intraoperative laparoscopy containing a trocar tube, an instrument channel with a valve preventing gas leakage, and a gas supply tap into the abdominal cavity, at least two elastic cylinders are hermetically sealed on the trocar tube, for example made of silicone material at a distance relative to each other and with the possibility of increasing their volumes. To increase its volume

Each cylinder has a tube for gas supply, for example, sterile air with a medical syringe.

The essence of the utility model is illustrated in figure 1. - Figure 2, where Figure 1 is a General view of the device, Figure 2 - The device is in working condition.

Here: 1 - trocar tube; 2 - holes for the passage of gas into the abdominal cavity; 3 - instrument channel with valve (sealing unit); 4 - valve node sealing; 5 - gas supply tap; 6, 7 - cylinders; 8, 9 - gas supply tubes in the cavity of the cylinders; 10 - operational wound.

A device for sealing a minilaparotomic wound (Figure 1) contains a trocar tube 1 with a through central channel and openings 2 at the end for the passage of gas, for example, sterile air or CO, into the abdominal cavity with a laparoscope installed in the trocar, an instrument channel (sealing unit) 3 s a gas leak prevention valve 4, and a gas supply cock 5 to the abdominal cavity. At least two flexible, soft cylinders 6 and 7, for example of silicone material, having tubes 8 and 9 for connecting the cavity of the cylinder to gas supply sources, for example, sterile air, are hermetically fixed at a distance from each other on the trocar tube 1.

The proposed device is used as follows. Tube 1 of the trocar is inserted through the surgical wound, previously formed by the laparotomic access according to Volkovich-Dyakonov, into the abdominal cavity with one lower balloon 6, leaving the second balloon 7 above the wound. In turn, sterile air or CO is supplied into the cavity of the cylinders 6 and 7, increasing their volumes. Increasing in volume, closing and fixing the wound tightly and reliably (Figure 2). Next, an insufflator is connected to the faucet 5 for gas supply through the through central channel of the trocar tube 1 and through the holes 2 at its end into the abdominal cavity and a laparoscope is inserted for a detailed examination of the sloping places of the abdominal cavity. After finishing

necessary manipulations remove the device in the reverse order.

Thus, the claimed utility model is simple in technical execution, allows to reduce the duration of the operation, to eliminate trauma to the peritoneum and intestines, and adequate tightness will not lead to subcutaneous emphysema, meets the criteria for atraumatic, improves immediate and long-term treatment results, which gives the right to accept it in a row with traditional instruments used in medicine, as well as during the prevention of purulent-inflammatory complications of surgical wounds in the postoperative period.

Claims (2)

1. Device for sealing a minilaparotomic wound with subsequent intraoperative laparoscopy, containing a trocar tube, an instrument channel and a gas supply cock in the abdominal cavity, characterized in that at least two elastic cylinders are hermetically sealed on the trocar tube at a distance from each other and with the possibility of increasing their volumes. 2. The device according to claim 1, characterized in that each cylinder is made of silicone material, and to increase its volume has a tube for connecting the cavity of the cylinder to a gas supply, for example, sterile air with a syringe.