UA91606U - Technique for applying endovideo assisted aponeurotic-muscular-peritoneal suture on trocar wound - Google Patents

Abstract

A technique for applying endovideo assisted aponeurotic-muscular-peritoneal suture on the trocar wound comprises endovideosurgical suturing of the edges of the aponeurosis, the muscles and the parietal peritoneum. Following laparoscopy, trocar is removed without dilating the operation wound. The multifilament thread is inserted into the needle in such a mode that both ends of the thread are outside after puncture of the tissues with their middle part forming the loop outside the wound on the side of the puncture. The needle with the filament punctures the aponeurosis, the muscles and the parietal peritoneum under the endoscopic control. The loop of the filament is left in the abdominal cavity, the needle is removed, and then the aponeurosis, the muscles and the parietal peritoneum are punctured with the same needle on the other side of then wound under the endoscopic control. The longer end of the filament is inserted in the cannula of the needle. The end of the filament exits from the needle in the abdominal cavity passing through the loop. Then the loop is pulled and the end of the filament is passed outwards. Finally, the knots are tied up providing for suturing the edges of the aponeurosis, the muscles and the parietal peritoneum.

Description

The useful model belongs to the field of medicine, in particular to surgery, and can be used for the prevention of trocar hernias, postoperative adhesion obstruction and ligation of damaged epigastric vessels in laparoscopic surgical interventions in both children and adults.

At the current stage of the development of medicine, laparoscopy is increasingly included in the practice of surgeons.

Along with all the advantages of endoscopic methods over traditional surgical methods, they do not exclude a number of complications, among which the common complications from the trocar wound are such as the entry of strands of the omentum into the wound, bleeding from the muscles of the wound, the occurrence of trocar hernia and the development of adhesive postoperative intestinal obstruction in the area of the trocar wound.

Many methods of treatment of the above-described complications are known, but almost all of them require the expansion of the wound and its layer-by-layer suturing under visual control, which reduces the cosmetic effect and lengthens the operation time.

The method of suturing a trocar wound, proposed by S.V., is closest to the proposed useful model. Baido, which consists in passing a thread into the abdominal cavity with the help of a Kushner needle of the author's modification, then passing this needle through the second punctured hole, grasping the thread with it and bringing the thread out (S.V. Baido. Suturing a trocar wound with a skin needle.: pir/Llumly . gizteazegm.sot/aragozsoru/depegai. liti.

However, this method requires the use of a special Kushner needle of the author's modification and an 18 mm evacuator, which leads to the need to expand the trocar wound by 10 mm, which does not exclude the possibility of the above complications.

The basis of a useful model is the task of creating a new method of minimally invasive endovideo-assisted suturing of trocar wounds by applying a video-assisted aponeurotic-musculo-peritoneal suture to the trocar wound without its expansion, to ensure the possibility of preventing complications from the side of the trocar wound, such as bleeding, getting a strand of the omentum into the wound, occurrence of trocar hernia and development of postoperative adhesive intestinal obstruction.

The task is solved by the fact that according to the proposed method of applying an endovideo-assisted aponeurotic-muscular-peritoneal suture to a trocar wound, as

For example, a 10-millimeter trocar, which consists in endovideosurgical suturing of the edges of the aponeurosis, muscles and parietal peritoneum, according to a useful model, after the end of laparoscopic surgery in the abdominal cavity, a 10-mm trocar is removed from it without expanding the surgical wound, a polyfilament thread is inserted into the needle so that both ends of the thread are outside after piercing the fabrics, and their middle forms a loop. From the outer side of the wound, from the side of the puncture, puncture the aponeurosis, muscles and parietal peritoneum with a needle inserted into it under endoscopic control, leave a loop of the thread in the abdominal cavity, remove the needle and then puncture the aponeurosis, muscles and parietal peritoneum with the same needle with a thread on the other side of the wound under endoscopic control, while the longer end of the thread is inserted into the cannula of the needle so that the end of the thread exits the needle in the abdominal cavity and passes through the loop, followed by tightening the loop and bringing the end of the thread out and at the final stage the thread is tied with knots in such a way that the applied seam connects the edges of the aponeurosis, muscles and parietal peritoneum.

With such a set of known and proposed essential features, a new method of endovideosurgical suturing of the edges of the aponeurosis, muscles and parietal peritoneum after the end of the laparoscopic operation in the abdominal cavity with the removal of a 10 mm trocar without expanding the surgical wound was obtained, which prevents the occurrence of complications from the side of the trocar wound, such as bleeding, getting a strand of the omentum into the wound, the occurrence of a trocar hernia and the development of postoperative adhesive intestinal obstruction, that is, a technical solution sufficient to fulfill the task of a useful model was obtained.

The drawings explain the essence of the proposed method.

In Fig. 1 shows the initial stage of applying a seam by inserting a polyfilament thread into the needle. In Fig. 2 - puncture of the muscles and parietal peritoneum from the right side of the wound. In fig. C - the next puncture of the muscles and parietal peritoneum from the left side of the wound. In Fig. 4 - a view of the final stage of the seam application method with the end of the thread being pulled out and tying the knot.

The essence of the proposed method is as follows.

After the end of the laparoscopic operation in the abdominal cavity, a 10 mm trocar is removed from the latter. Take a needle 1, into which a polyfilament thread 2 is inserted so that both ends of the thread (2) are outside after piercing the tissues, and their middle forms a loop 4, as shown in Fig. 1. From the outside of the wound, for example from the right side of the wound, puncture 5 of the aponeurosis 6, muscles 7 and parietal peritoneum 8 under endoscopic control with a needle (1) with a thread (2) inserted into it (Fig. 2). The thread loop (4) is left in the abdominal cavity, and the needle (1) is removed. Then on the other hand, in this case, from the left side of the wound, a puncture 9 (Fig. 2) of the aponeurosis (6), muscles (7) and parietal peritoneum (8) is performed with the same needle (1) with a thread (2) ) under endoscopic control, while the longer end (3) of the thread (2) is inserted into the cannula of the needle (1) hook so that the end (3) of the thread (2) exits the needle (1) in the abdominal cavity and passes through the loop (4) . Next, the loop (4) is tightened and the end (3) of the thread (2) is brought out, as shown in Fig. 3. The thread (2) is tied with 10 knots, as an example with ordinary knots. In this way, the applied suture (11) connects the edges of the aponeurosis (b), muscles (7) and parietal peritoneum (8), providing a proper cosmetic effect (Fig. 4).

The proposed method of applying an endovideo-assisted aponeurotic-muscular-peritoneal suture (11) to a trocar wound, as an example of a 10-millimeter one, performed in 45 children in which one 10-mm trocar was used to remove biomaterial, including 33 children who were operated on about destructive forms of acute appendicitis with peritonitis and in 12 girls with large cysts of uterine appendages.

According to the results of the operations, the large omentum did not enter the wound, there was no bleeding, in the postoperative period the wound healed by primary tension, and trocar hernia did not occur.

Example I. Patient D., 9 years old, was admitted to the surgical department urgently due to acute appendicitis. The child was operated laparoscopically. A 10 mm trocar was used to remove the appendix. An aponeurotic-muscular-peritoneal suture 11 is placed on the wound in the proposed way. On the 5th day, the child was discharged home in satisfactory condition. There were no complications from the postoperative wound in the early and late postoperative period.

Example II. Patient Sh... 10 years old, was admitted to the surgical department as an emergency due to acute appendicitis. P/o diagnosis - acute gangrenous-perforating appendicitis.

Diffuse purulent peritonitis. An urgent laparoscopic appendectomy was performed using one 10 mm trocar. After evacuation of the appendix, an aponeurotic-muscular-peritoneal suture was placed on the wound in the proposed way. On the 7th day after

After the operation, the child was discharged home in satisfactory condition. There were no complications from the postoperative wound in the early and late postoperative period.

Thus, the proposed method of applying a video-assisted aponeurotic-muscular-peritoneal suture to a trocar wound allows to prevent such complications from the side of the trocar wound as bleeding, getting a strand of the omentum into the wound, the occurrence of a trocar hernia, and the development of postoperative adhesive intestinal obstruction.

Claims (1)

USEFUL MODEL FORMULA The method of applying an endovideo-assisted aponeurotic-muscular-peritoneal suture to a trocar wound, which consists in endovideosurgical suturing of the edges of the aponeurosis, muscles and parietal peritoneum, which is distinguished by the fact that after the end of the laparoscopic operation in the abdominal cavity, 10 mm is removed from it trocar without expansion of the operative wound, a polyfilament thread is inserted into the needle so that both ends of the thread are outside after tissue puncture, and their middle forms a loop, from the outside of the wound, on the side of the puncture, puncture the aponeurosis, muscles and parietal peritoneum with a needle with a thread inserted into it under endoscopic control, leave a loop of the thread in the abdominal cavity, remove the needle and then puncture the aponeurosis, muscles and parietal peritoneum with the same needle with a thread on the other side of the wound under endoscopic control, at the same time, the longer end of the thread is introduced into the cannula of the needle so that the end of the thread exits the needle in the abdominal cavity and passes through the loop, followed by tightening the loop and bringing the end of the thread out, and at the final stage, the thread is tied with knots, thus, so that the applied suture connects the edges of the aponeurosis, muscles and parietal peritoneum.