RU70111U1 - Aperture stapler - Google Patents

Abstract

The utility model relates to surgical instruments, in particular to instruments for suturing wounds of the diaphragm. The diaphragm stapler comprises a hollow tube (1) with a handle (3) from the proximal end and a needle (2) made hollow for passing suture material through it (13). The distal end of the needle (2) is made U-shaped with a bending diameter equal to the inner diameter of the tube (1), the needle (2) is located in the tube (1) with an offset to the inner wall and with the possibility of reciprocating movement with the exit from the distal end the tube (1) in the working position and with the bent end of the needle (2) entering the lumen of the tube (1) in the idle position, while the proximal end of the needle (2) is fixed in the handle (3), and the distal end is at the outlet of the tube ( one). The length of the exit of the needle (2) from the distal end of the tube (1) in the working position of the threader is equal to the length of the exit of the needle (2) from the proximal end of the tube (1) in the idle position of the threader. The needle (2) is made with the possibility of rotation around its axis in the working position. The proximal end of the needle (2) is connected with the needle control mechanism (4) for its reciprocating movement in the tube (1) and rotation around its axis. The needle (2) is spring-loaded between the needle control mechanism (4) and the handle (3). On the inner surface of the tube (1) and on the outer surface of the needle (2) there are protrusions (6), made with emphasis on each other when the needle (2) is in the working position. The proposed stapler allows you to effectively suture not only flat organs, but also organs with a concave contour, reduce the time of the operation due to the convenience of using this tool, reduce the number of postoperative complications and the number of hospital days, the tool is applicable in any surgical hospital. 5 n.p. f-ly, 3 ill.

Description

The utility model relates to surgical instruments, in particular to instruments for suturing wounds of the diaphragm.

One of the first methods is known, the end-to-end method of fine-enteric anastomosis using special cylinders (1826), as well as the method of applying an eventual anastomosis using metal rings (Egiev V.N. Magical world of staplers. 1995, p.13) - [one]. One of the popular instruments in surgery was the apparatus for applying gastric and intestinal anastomoses (NLCA), created in 1960 by Yu. Bobrov. and Gritsman Yu.Ya., which is fundamentally different from others - [1 - p. 51]. During its operation, the parts are located inside the stitched organs, which allows applying an inverted anastomosis. As a result, tissues are fixed between two branches of the apparatus, one of which contains brackets, and the second - thrust holes. After fixing the tissues, a wedge is activated, which forces the pushers on both sides to push out the brackets. In this case, the NLCA device simultaneously flashes the fabric with two brackets. A knife is mounted on the wedge, which cuts the tissue between two rows of brackets.

Known staplers of the GIA Premium series [2], characterized by two innovations: the presence of a mechanism of tissue thickness, which allows to obtain an ideal b-shape of brackets and the use of a larger number of titanium brackets. EndoGIA-30, EndoGIA-60 devices [3], have different device lengths of 30 mm and 60 mm, respectively, allowing 3 rows of stitch seams to be applied on each side, dissecting the fabric between the seams [1 - Appendix]. In addition, this device allows you to work with endoscopic operations, which made it possible by 1993 already in the United States 60% of all abdominal operations to be carried out endoscopically.

Currently, the percentage of chronic patients with

hiatal hernia and complications associated with this disease, such as bleeding, peptic stricture, malignant transformation of the esophagus. The appearance of endosurgical video complexes and the introduction in clinical practice in 1991 of V. Dalemagne laparoscopic fundoplication according to Nissen-Roseti - [4] allowed to significantly expand the indications for surgical treatment of hiatal hernia and their complications. Low-traumatic nature, efficiency, low cost of endosurgical operations; early rehabilitation of patients in the postoperative period makes laparoscopic surgery of the esophagus and diaphragm the method of choice. However, for safer quick manipulation of the diaphragm, special endoscopic staplers are required.

The closest device to the proposed one, taken as a prototype, is the stitching machine of the company "Auto Suture" (USA) "ENDO STITCH *". The apparatus consists of a tube and two branches in it, at the ends of which a straight needle with thread is inserted. Using levers located at the level of the handle, the ends of the jaws transfer the needle from one to another, which allows you to stitch the necessary tissue (Instructions for use of the device "ENDO STITCH". Firm "Auto Suture"). - [5].

The device operates as follows.

Before starting work, the edges of the metal bars are bred on the branches, a disposable ligature block is installed, the reliability of the installation of the block with the branches open is checked. Then, at the same time, the handle and crank lever are compressed to an audible sound to activate the levers, while the edges of the jaw are closed and the needle is captured from the ligature block. A box of disposable ligature block is removed. After laparoscopy, the instrument is inserted into the trocar in a position with closed branches. A manipulator is introduced through another trocar, with the aid of which a stitched fabric is supplied to the branches with a needle. With crankshaft

the needle moves from one branch to another, moving the levers up and down to the end, stitching the fabric to the required level. Remove the instrument from the abdominal cavity with the jaw closed.

This tool allows stitching of organs and tissues quite quickly. When using this tool, there is no need to introduce an additional tool for receiving the needle, as happens with a manual endoscopic suture. However, this tool is a fairly complex system in technical performance and, in the absence of good surgeon skills, is difficult to use. It is not possible to use this tool on organs having a concave surface, in particular a diaphragm. In practical use, the needle often gets stuck at the ends of the branches and does not allow the fabric to be stitched.

The technical result, the achievement of which the claimed tool is aimed, is to simplify the design and increase the efficiency of its use.

The technical result is achieved by the fact that in the diaphragm threader containing a hollow tube with a handle from the proximal end and the needle, it is new that the distal end of the needle, made hollow to pass suture material through it, is made U-shaped with a bending diameter equal to the inner the diameter of the tube, the needle is located in the tube with an offset to the inner wall and with the possibility of reciprocating movement with the exit from the distal end of the tube in the working position and with the entry of the curved end of the needle into the lumen logging in the inoperative position, the proximal end of the needle is fixed in the handle and a distal end - at the outlet from the tube.

The length of the exit of the needle from the distal end of the tube in the working position of the threader is equal to the length of the exit of the needle from the proximal end of the tube in the idle position of the threader.

The needle is made with the possibility of rotation around its axis in the working position.

The proximal end of the needle is connected to the needle control mechanism for its reciprocating movement in the tube and rotation around its axis.

The needle is spring-loaded between the needle control mechanism and the handle.

On the inner surface of the tube and on the outer surface of the needle there are protrusions made with emphasis on each other when the needle is in the working position.

The essence of the utility model is presented in figure 1, 2 a), b), 3 a), b), c), where:

Figure 1 - General view of the diaphragm stapler;

Figa, b - a hollow metal tube with a diameter of up to 10 mm and a hollow needle located inside the tube and U-shaped curved from the distal end:

2a is a view of the stapler in a non-working position;

2b is a view of the stapler in the working position;

Figure 3 - stages of suturing wounds of the diaphragm:

3a - the sequence of injections and punctures with a diaphragm stapler;

3b is a view of the seam applied;

3c is the final view of the sutured wound.

Here: 1 - tube; 2 - a needle; 3 - handle; 4 - needle control mechanism; 5 - spring; 6 - protrusions; 7 - aperture; 8 - wound of the diaphragm; 9 - place of the first injection and puncture of a needle with a ligature; 10 - place of the second injection and puncture of the needle with the ligature; 11 - place of the third injection and puncture of the needle with the ligature; 12 - place of the fourth injection and puncture of a needle with a ligature; 13 - suture material; 14 - node; 15 - the first edge of the wound; 16 - the second edge of the wound; 17 - boss; A - stops in the working position of the threader; B - fixation of the needle at the distal end of the tube of the stapler; In - emphasis in not working position of a thong.

The diaphragm stapler comprises a hollow tube 1 with a handle 3 from the proximal end and a needle 2, which is hollow to hold

through it suture material 13, the distal end is made U-shaped with a bending diameter equal to the inner diameter of the tube 1. The needle 2 is located in the tube 1 with an offset to its inner wall and with the possibility of reciprocating movement with the exit from the distal end of the tube 1 in the working position and with the entry of the curved end of the needle 2 into the lumen of the tube 1 in the idle position, while the proximal end of the needle is fixed in the handle 3 with the possibility of reciprocating movement through the hole in it, and the distal ntsom - at the outlet of the tube 1 through the hole in the boss 17, coaxial to the hole in the handle 3, with the possibility of reciprocating movement in it.

The length of the exit of the needle 2 from the distal end of the tube 1 in the working position of the extender is equal to the length of the exit of the needle 2 from the proximal end of the tube 1 in the idle position of the extender.

The needle 2 is made with the possibility of rotation around its axis in the working position.

The proximal end of the needle 2 is connected with the control mechanism of the needle 4 for its reciprocating movement in the tube 1 and rotation around its axis.

The needle 2 is spring-loaded 5 between the needle control mechanism 4 and the handle 3.

On the inner surface of the tube 1 and on the outer surface of the needle 2 there are protrusions 6, made with emphasis on each other when the needle 2 is in the working position.

The diaphragm stapler operates as follows.

A laparoscopy is performed, for which a laparoscope is inserted, the abdominal cavity is examined, and after a defect is detected in the diaphragm 7, the instrument is inserted into the abdominal cavity through a 10 mm trocar. Previously, a monofilament thread 13 is passed through the cannula 2. The working part (distal end) of the suturing device is inserted between the edges of the wound 8 of the diaphragm 7,

then, by pressing the needle control mechanism 4, the needle 2 is withdrawn from the hollow tube 1 and brought over the edge of the wound 15. By moving the handle 3, the needle 2 with the thread 13 with the first injection-puncture 9 sews the edge of the wound 15 from top to bottom, departing from the edge of the wound by 5 mm. The protruding end of the ligature 13 from the needle 2 is pulled into the abdominal cavity to the length necessary for suturing the wound 8, using a manipulator, also installed through the trocar. Next, the needle 2 with the ligature 13 remaining in the hollow needle 2, lead to the edge of the wound 16, where they spend the second injection 10 also from top to bottom and 5 mm from the edge of the wound. Through the loop formed from the ligature 13, located in the abdominal cavity, spend the free end of the ligature from the first injection 9, and the thread 13 is pulled. The third injection-puncture 11 is conducted on the side of the first injection-puncture 9 similarly to the second 10 (Fig. 3a). Similar manipulations in the form of injections, punctures and thread pulling are performed until the wound is completely closed 8. After the last injection, the ligature is pulled from the needle 2 by 10-15 cm into the abdominal cavity and cut off. The needle 2 is punctured from the tissues and, using the mechanism for controlling the needle 4, it is returned to the cavity of the tube 1 (Fig. 2a), and then the instrument is removed from the abdominal cavity (Fig. 3b). The final step is tying the remaining ends of the ligature 13 into the node 14 using the manipulators (Figv).

Thus, the proposed utility model makes it possible to effectively suture not only flat organs, but also organs with a concave contour, reduce the operation time due to the convenience of using this tool, reduce the number of postoperative complications and the number of hospital days, the tool is safe to use and is applicable in any surgical hospital.

Claims (6)

1. A diaphragm stapler comprising a hollow tube with a handle from the proximal end and a needle, characterized in that the distal end of the needle, made hollow to pass suture through it, is made U-shaped with a bending diameter equal to the inner diameter of the tube, the needle is located in the tube with an offset to the inner wall and with the possibility of reciprocating movement with the exit from the distal end of the tube in the working position and with the entry of the curved end of the needle into the lumen of the tube in the idle position, while the prox -formal end of the needle is fixed in the handle and a distal end - at the outlet from the tube. 2. The diaphragm stapler according to claim 1, characterized in that the length of the needle exit from the distal end of the tube in the working position of the stapler is equal to the length of the needle exit from the proximal end of the tube in the inoperative position of the stapler. 3. The diaphragm stapler according to claim 1, characterized in that the needle is rotatable around its axis in the working position. 4. The diaphragm stapler according to claims 1, 3, characterized in that the proximal end of the needle is connected to the needle control mechanism for its reciprocating movement in the tube and rotation around its axis. 5. The diaphragm stapler according to claim 4, characterized in that the needle is spring-loaded between the needle control mechanism and the handle. 6. The diaphragm stapler according to claim 3, characterized in that on the inner surface of the tube and on the outer surface of the needle there are protrusions made with abutment against each other when the needle is in the working position.