Surgical device with reusable handle
SUBSTANCE: group of inventions relates to medicine. A laparoscopic surgical device contains a detachable instrument. The instrument contains an external rod and an internal drive plunger, which can be connected to each other in a detachable or a non-detachable way. The handle of the device contains a two-button mechanism for the engagement and release of a detachable, tool-containing rod. The two-button mechanism is made with a possibility of engagement with matching holes of the external rod and the internal plunger, which extends through the external rod.
EFFECT: handle contains a convenient in operation locking device, which provides the reliable fixation and convenient detachment of the tool end unit.
20 cl, 5 dwg
AREA of TECHNOLOGY
The present invention relates, in General, to medical devices and, in particular, to a reusable handle that is configured with the possibility of manipulation of instrumental removable terminal node laparoscopic surgical device.
The LEVEL of TECHNOLOGY
As shown in Fig.1, a typical monopolar electrosurgical laparoscopic instrumentation device 100 contains, in General, five main components: the handle 102, the external terminal 104, continuing longitudinally from the handle, the drive rod 106, continuing through the external terminal, the electrode 108, which is in electrically conductive contact with a drive rod, and actuating the end effector 110 located at the distal end of the device. Pictured arm 102 is "ring grip", which has a fixed section 112 for the finger attached to the external terminal 104 and portion 114 that is driven by the thumb and fixed to the drive rod 106. The cast section 114 of the thumb into action by relative rotation of section 112 of the finger moves the drive rod 106 axially within the outer rod 104 and, thereby, actuates the end effector 110. Although in this area of technology offered many different options for each of the above-mentioned component�on components, there is a need for designs that provide efficiency in the manufacture and supply of surgeons and other users of ergonomic devices for enhanced security and ease of use. In particular, there is a need to arm design, which provides convenient work in a locking device, which provides reliable fastening and an excellent instrumental separation of leaf node.
Summary of the INVENTION
Embodiments of the present invention is arranged to satisfy the aforementioned needs in the art in ergonomic designs that give advantages in the manufacture and in operation. Preferred embodiments of the present invention can be designed so that they can be cleaned, sterilized and reused, or these options can be used disposable. The most preferred embodiments of the present invention contain the locking mechanism of the tool end portion that is biased to engage one-piece or split tool end Assembly, which can be released using a two-button component of the securing mechanism. Mentioned the locking mechanism ensures a reliable engagement BH�mob rod and the inner axis of actuation of the tool end portion, and arm, which can be repeatedly used. In some embodiments, applicable also reusable instrumental end caps. Although embodiments of the present invention presented in this application, refer to aspects of the handle for laparoscopic surgical devices, specialists in the art it should be clear that embodiments of the arm in accordance with the present invention can be used with many different configurations of rods and end effectors (e.g., needle holders, clamps, scissors, dissectors, seizures), and that such a use is possible within the scope of the present invention.
In accordance with one aspect, embodiments of the handle of the surgical device can include a housing tool end portion, which comprises an inner drive rod is located with the possibility of reciprocating movement along the longitudinal lumen of the outer rod, wherein the distal ends of the rod and the rod can be mounted permanently or can be fixed detachably.
BRIEF description of the DRAWINGS
Fig.1 - laparoscopic tool device in accordance with the prior art;
Fig.2 - the image of the first version of OS�span laparoscopic device in disassembled form;
Fig.2A is a longitudinal sectional view taken along the line 2A-2A in Fig.2, the fixation mechanism of the tool end portion of the first embodiment of the handle;
Fig.2B is a longitudinal sectional view of the proximal section of the core node housing the end portion of the tool taken along the line 2B-2B in Fig.2;
Fig.2C is a detail view of the proximal end area of the drive rod of the device shown in Fig.2;
Fig.3A-3B - sections, similar to the sectional view of Fig.2A, illustrating the method of Assembly; and
Fig.3C - image embodiment of the connection between the distal end of the driving rod and the rod body of the tool end portion;
Fig.4 is a detail view in perspective of Fig.3C;
Fig.5A-5C, respectively, side, top and cross-sectional embodiment of the inner core.
The appearance of a first embodiment of the laparoscopic surgical device 200 shown in Fig.2-2C. As shown in Fig.2, which shows the "three-element embodiment of the" unassembled, arm 210 includes an annular element 204 to the big toe (usually called "ring for the big toe") is fixed rotatably on the axis 208 of rotation to the annular element 206 for the index finger (usually called "the ring index for PAL�a"). In a preferred embodiment, the elements 204, 206 of the arm displaced from one another, for example, by a torsion spring or a plate spring. In a preferred embodiment, the annular elements 204, 206 thumb and index finger is made of a material based on resin, but, alternatively, can be fabricated from plastic or other materials known in the art, suitable for repeated autoclave sterilization. Implementation option is for single use can be made of materials known in the art, but not necessarily intended for repeated sterilization. The device 200 may be configured as a monopolar or bipolar instrument designed for cutting and coagulation/electracoustic that contains the contact 207 Bovie or other output electrode. At the distal end of the handle 210 may contain a head 212, made with the possibility of step-by-step or a smooth rotation around its longitudinal axis (different designs for both variants of rotation of the said head are widely known in the art).
The instrumental case of the end portion containing an elongated tubular external terminal 240, continuing in the distal direction from the annular element 206 for the index finger. The drive rod 260 continues in diest�Lincoln direction from the annular element 204 thumb on longitudinal lumen of the rod 240 and contains instrumental 270 tip at its distal end. At the distal end of the device 200 of the end effector 264 is connected with the possibility of the actuator with the rod 240 and a drive rod 260. The connection of the drive rod with the external terminal 240 may be integral or may be separable (e.g., bayonet, threaded, snap fit, or other connection). The rod 240 may be made of metallic or polymeric materials and, in a preferred embodiment, contains electrically insulating coating when the device 200 is configured in the form of an electrosurgical instrument with a long section, which will, for the most part, rigid, semi-rigid, or will have very limited rigidity along its longitudinal axis. In a preferred embodiment, the rod 240 is made in a configuration for use with laparoscopic trocars methods for work or other abdominal laparoscopic, minimally invasive surgery (for example, standard options for implementation may have an outer diameter of from approximately 5 mm to approximately 10 mm). All components of preferred embodiments will be made with the possibility of providing conditions seal fluids, desirable for use during the procedure the patient is subjected to insufflation. Arm 210 may contain at least one snoring�howl mechanism, arranged to support the user in positioning and actuation of the device 200. Detailed description of the design of the handle, as well as examples of ratchet and other tools, fixing/manipulation that can be used within the scope of the present invention, contain descriptions and examples in published patent application U.S. No. 2007/0299469, the authors of carpenter and co-authors (Carpenter et al.), which is incorporated in this application by reference.
Fig.2A shows a local longitudinal sectional view of the handle 210, taken along line 2A-2A showing in the handle portion of the gear mechanism for releasably connecting rod 240 of the tool housing with a handle 210. The Central channel 211 continues through the head 212 and the upper portion of the annular element 206 for the index finger in the handle. Said channel 211 is configured to accommodate the proximal ends of the outer rod 240 and the inner drive rod 260 of the tool body. The annular element 204 thumb in the handle contains a hole 205 having a shape ballpoint boxes, which are arranged to grip the ball 262 at the proximal end of the drive rod 260.
The head 212 is essentially accommodates the parts of the gear shaft and gear rod gear mechanism (ball to�obca ring 205 204 thumb is not considered a part of the gear mechanism for the purposes of the present description, although ball box performs an important function when fixing/activating the inner core 260). The head contains two opposing push-buttons 216, 222. As shown in Fig.2A, the first button 216 is secured to the bidentate retaining element 218, which contains the teeth 219, which are preloaded up to the first button 216 in the channel 211, and is located opposite to the given element. The second button 222 is fixed to odnoselchanamy the locking element 224, which contains the tooth 225, which is preloaded down to the second button 222 in the channel 211, and is located opposite to the given element. As shown, the locking elements and their teeth (which collectively can be called "valves") is permanently fixed to the handle 210 and mechanically directly connected with the corresponding buttons. Actuation of the locking elements is explained below with reference to Fig.3A-3B. As shown, the biasing of each of the locking elements is provided by coil springs, however, also possible to use other gland means known in the art.
Fig.2B shows a longitudinal section of the handle 210 (taken along line 2B-2B in Fig.2) the proximal portion of the corpus node of the rod of the tool end portion 240. In this embodiment, the implementation, the inner portion 242 of the rod 240 is a metal, and Uch�drain 244 of the outer shell contains an insulating polymer. In the illustrated embodiment of the implementation, which is a variant of implementation with a large outer diameter, the outer shell 244 is separated from the interior section 242 of the rod 240, but, in some embodiments, "with a small outer diameter, the outer sheath 244 may be in direct contact with the inner section 242 of the rod and/or may be formed as the upper layer of the site. Near the proximal end of the rod is set protruding section 246, is arranged to fit into the cavity of conjugate shape of the head 212. The protruding section 246 contains the washing nozzle 247, which provides the message in a fluid environment with a longitudinal lumen 250, continuing along the length of the rod 240. The proximal end portion of the rod 240, which is arranged to fit into the channel 211 of the handle, comprises at least first and second openings are at least partially opposite one another. In a variant implementation, shown in Fig.2-3C, the first hole is implemented in the form of a pair of holes 249, made with the possibility of combining with the teeth 219 of the first locking element and receiving data of teeth. The second hole is implemented in the form of holes 255, which is located opposite to the first hole and is arranged in alignment with subco� 225 of the second fixing element and fit of this prong.
Fig.2C shows a top view of the proximal section of the drive rod 260. At the proximal end of this site there is a ball 262 or other expanding construction made to grip the upper end of the annular element 204 thumb in the handle. The ball 262 may have an outer diameter larger than the diameter of the greater part of the length of the rod 260, and, in the most preferred embodiment, has an outer diameter larger than the diameter of the portion of the rod adjacent to the distal side to the ball. The inner rod 260 is arranged to location and shift in the lumen/lumen 250 of the rod. As shown, the proximal section of the length of the rod may have an outer diameter larger than the diameter of the greater part of the length of the rod 260 that will facilitate the flushing of the lumen 250 of the rod with the rod, not extracted from it, while ensuring the required proximal seal between them. Bringing in the rotational movement of the ring 204 of the thumb relative to the ring 206 to the index finger will reciprocatingly move the inner rod 260 in a longitudinal direction relative to the rod 240. At its distal end of the rod 260 contains the instrumental node 270, which is made with possibility of fixation to the external terminal 240. This pinning can be split as explained below with reference to Fig.3C, or may be integral to the terminal 240 and the rod 260 can be mounted/removed to/from the handle/and 210 in a single unit. The variants of implementation, in which the rod and the rod is permanently connected, can be configured to accommodate the distal node of the stem/rod/tool that is sent to waste after a single use, or is capable of cleaning and/or sterilization. In the technique known to a lot of different nodes 270 of tool bits for use with/actuating the inner piston rod, reciprocating movement, and the outer core which is relatively immobile. Tool tips can include clips, clamps, cutting shears or other Executive instrumental bits, known or developed in the future, however, their application does not exceed the limits of the present invention. The inner rod 260 may be formed as a single piece or of several parts and shall contain at least one plot (in addition to the proximal bulb 262), outer diameter greater than the outer diameter of the greater part of the length of the stock.
The proximal region of the rod 260 includes an elongated groove or hole 267 of the internal stem. Hole 267 of the internal rod is depicted, in General, rectangular with� rounded corners, but may have different internal geometry, including this opening can be implemented in the form of a pair of opposite grooves that do not pass all the way through to the stem (this geometry is not shown, but as is obvious to experts in the art, includes a longitudinal wall between the opposite surfaces of the hole 267). This hole is shaped with the ability to accommodate the ends of the teeth 219, 225 of the first and/or second locking elements. When the teeth 219, 225 will engage with a hole 267 of the internal rod, the prongs will allow longitudinal reciprocating movement of the rod, but, in General, will prevent the rotation of the rod 260 around its longitudinal axis. In essence, when the teeth 219, 225 comprises through holes 249, 255 external rod engaged in the hole 267 of the internal rod, they (the teeth) will be: (i) mainly to keep the external terminal 240 in the longitudinal and rotatable fixed position relative to the arm 210; and (ii) mainly to keep the inner rod 260 turning in a fixed position relative to the external terminal 240 and the arm 210, and to allow longitudinal reciprocating movement of the rod relative to the arm 210 and the external terminal 240 at the time of bringing in the rotational movement of the ring 204 thumb consider�till then ring 206 to the index finger. This construction and its operation is described below with reference to the method of Assembly of the device 200.
In most embodiments, the ring 204 thumb will be rotatable relative to the ring 206 to the index finger only in one plane. However, in the technique known design of the handle, in which you can use off-plane rotation. Preferred embodiments of the device 200 will contain the insulating material over the entire arm and other surfaces in the proximal region, which may conduct electrical current when the device is configured electrosurgical device and is connected to the electrosurgical power source. As shown in Fig.3B, as explained below, in embodiments, in which he used the site, this site is permanently fixed to the rod and will block external rod from rotating relative to the gear mechanism (regardless of whether is whether the gear mechanism in the installation head, as shown, or located on a stationary portion of the node 210 of the handle).
The method of Assembly of the device 200 shown in Fig.2-2C, described with reference to Fig.3A-3C. Fig.3A shows that the ring 204 thumb turn on the maximum upward angle from the ring 206 to the criminal code�optionally fingers. In this orientation, the hole in the top of a ballpoint box 205 is opened and aligned with the proximal longitudinal end of the channel 211 of the handle. The inner rod 260 is inserted through the lumen 250 of the rod and longitudinally directed into the channel 211 of the handle. The first and second button 216, 222 push inward towards the Central longitudinal axis of the gear mechanism in the mounting head 212. With this impact on the first button 216 teeth 219 bidentate retaining element 218 are pushed down from the channel 211 of the handle. Similarly, when the impact on the second button 222 prong 225 second dnsupdate fixing element 224 is pushed upwards out of the channel 211 of the handle.
If you hold in the side of the locking teeth 219, 225 channel 211 of the handle lets you move the inner rod 260 and the external terminal 240 in the proximal direction inside the channel, while the proximal balloon 262 of the rod will not enter ball box 205 and will not be captured last. As shown in Fig.3A, at least one of the teeth 219, 225 may be inclined, curved or rounded distal surface, the stem 260 and/or the rod 240 can more easily go to the battlements, to displace and pass them, even if the buttons 216, 222 are initially not fully pressed. Then the ring 204 thumb, release and guide/rotate down to the ring 206 to index PA�ICA, the ball 262 is fully captured in the ball box 205, which has a cross section in the shape of a keyhole to a wider proximal segment captured the ball 262, and a narrow distal section did not allow release of the ball in the distal direction when the ring 204 thumb turn down, as shown in Fig.3B. In a preferred embodiment, ball box 205 will not prevent neither the actuation elements of the arm or internal rotation of the rod 260 around its longitudinal axis. An elongated hole 267 of the internal rod can be seen in Fig.3A, the rod 260 and the external terminal 240 is shown rotated by approximately 90 degrees from the rotary position, which will allow the locking teeth 219, 225 to engage with the hole 267 of the internal rod through holes 249, 255 in the outer rod.
Fig.3B shows the node tool case containing the external terminal 240 and the inner rod 260 in condition, fully advanced in the proximal direction. The rod 240 and the rod 260 is rotated, and the buttons 216, 222 released so that: (i) the openings 249, 255 rod is aligned with the hole 267 of the internal stock; (ii) fixing the teeth 219, 225 continue in their respective pre-loaded position to engage with the hole 267 of the internal rod through holes 249, 255 exterior construction� rod; and (iii) the protruding section 246 is combined and is meshed with the installation head 212. As shown in configuration data/engaged position, the inner rod 260 will reciprocatingly move in the longitudinal direction relative to the external terminal 240 and the ring 206 to the index finger, which is longitudinally fixed together. In embodiments in which the mounting head 212 is rotatable, the head 212, the external terminal 240 and the inner rod 260 can rotate relative to the arm 210 around their shared longitudinal axis.
Fig.3C shows one of the connecting design for embodiments of the device 200, wherein the inner rod 260 is split with the external terminal 240, and not permanently attached to the distal side. The tool tip 270 is depicted in the form of a capture node, but may be in the form of cutting scissors, biopsy forceps, or any other numerous instrumental tips of the laparoscopic type. Proximal support surface 272 of the housing of the tool tip is, in General, cylindrical and contains a bayonet groove having a longitudinal section 274 of the groove and the radial section 275 of the groove. The inner rod 260 is axially movable relative to the support surface 22. Fig.3C also shows the distal end of the external terminal 240, which contains the distal hole 257, made with the possibility tight fit of the bearing surface 272 of the tip. The pin 258 meshing with the groove continues radially in the hole 257. Fig.4 shows a detail view in perspective of Fig.3C.
When the drive rod 260 is directed into the lumen 250 of the rod, the pin 258 meshing with the groove to hold to a distal end of the longitudinal section 274 of the bayonet grooves, then the tool tip can be rotated for engagement of the pin 258 with the end of the radial section 275 of the groove. In a preferred embodiment, the bayonet mechanism that contains a pin and groove are designed so that when the pin 258 is in full gear at the end of the grooves 275, the inner rod 260 comes at a pivotal position of alignment of its proximal holes with holes 267 249, 255 external terminal. It should be understood that in various embodiments can be applied one, two or more bayonet pins and grooves. In other embodiments, it is possible to apply a threaded connection, containing the Luer lock connection type that requires only a partial turn to lock (e.g., a quarter turn) or conventional connecting structures multiturn screw-in, snap-on, about�atna bayonet and/or another type, to perform a join between the distal ends of the rod 240 and the rod 260, without going beyond the scope of the present invention. Regardless of whether or not the rod and the rod is engaged with the handle, preferred is a variant in which the distal external connection terminal is arranged to engage with the distal areas of the inner rod and outer rod when the inner hole of the stem to combine the angle of rotation with at least one of the apertures of the outer rod.
Fig.5A-5C presents another embodiment of the inner actuation rod 560. The inner rod includes a proximal ball end region 562 and 563, which is directly adjacent to the distal side to the ball 562 and has an outside diameter less than the diameter of the next adjacent section of the rod 560, and which goes into the next area through the circumferential surface, oriented at angle of approximately 45 degrees relative to the Central longitudinal axis of the rod 560. Instead of holes 267, described above with reference to the embodiment of the inner rod 260, this variant implementation contains a narrowed portion 567 of stock, having, in General, a rectangular shape in cross section shown in Fig.5C (which is a section along line 5C-5C in Fig.5A).
Should�of divinity, that mentioned variant implementation of the stock can be used in combination with a handle, such as described above, the handle 210. In this application the teeth 219, 225 can enter into engagement with the surfaces 567a, 567b narrowed area 567 (with respect to the horizontal orientation shown in Fig.5A) or may be mutated so that these teeth contained, in General, a vertical longitudinal grooves (not shown), is arranged to engage with betrothed plot 567 stud/around this area (in a variant implementation, in which the flat portion is oriented relatively vertically, as shown in Fig.5B, the distal end of each of Fig.5A-5B, of course, may be performed differently for engagement of a tool tip/end effector, as is known in the technique).
Specialists in the art it should be clear that to control the relative position/preload above-described ratchet elements exist known means, which are suitable for use within the scope of the present invention, and that embodiments of the present invention is applicable to different materials. Specialists in the art should also be understood that in embodiments of the handle in accordance with the present invention the annular element for a�on finger and/or ring element for the index finger, in fact, not required to have a closed ring structure, but may contain a support structure in the form of an open ring or other shape for thumb and other fingers of the user, respectively. It is assumed that detailed above should be considered illustrative and not restrictive.
Specialists in the art should be understood that within the scope of the present invention can be implemented variants of implementation, are not represented explicitly in this application, including the signs described in this application for different variants of implementation, can be combined with each other and/or with currently known or future technologies, without going beyond the scope of the claims following claims. It is therefore assumed that detailed above should be considered illustrative and not limiting. And you must understand that the nature and scope of the present invention are defined by the following claims all equivalent. In addition, the above advantages are not necessarily the only advantages of the invention, and should not expect that all of the described advantages will be achieved in each embodiment of the invention.
1. A surgical instrument, comprising:
the first element of the handle;
the second element of the handle, a swivel connected to the first arm element, made with the possibility of relative rotation of the first element of the handle;
the case containing:
a tubular outer rod detachably connected with the first element of the handle;
the inner rod passing through the longitudinal lumen of the outer shaft and detachably connected with the second element of the handle in a manner that allows reciprocating longitudinal movement relative to the outer rod; and
the gear mechanism that is arranged to provide a releasable connection between the handle and the housing containing:
at least the first hole of the external terminal and the second hole of the outer rod, which at least partially opposite to each other and arranged through the proximal region of the outer rod;
the first locking element permanently connected with the possibility of actuation, with the first arm element and preloaded in releasable engagement with at least the first hole of the external terminal;
the second locking element is permanently connected with the possibility of actuation, with the first element of the handle at least partially opposite to the first fixing element and preloaded in �izjemno engagement with, at least a second external terminal hole;
the tool is designed so that rotation of one of the first and second arm elements relative to the other longitudinally moves the inner rod relative to the outer rod.
2. A surgical instrument according to claim 1, wherein the inner rod further comprises a proximal opening of the inner rod, which is capable of combining with at least one of the external holes of the rod and fit at least one of the first and second locking elements, whilst ensuring the possibility of longitudinal movement of the inner rod relative to the outer rod when the arm is powered by the rotation of one of the arm elements relative to another element of the handle.
3. A surgical instrument according to claim 1 or 2, wherein the handle further comprises a mounting head, made with the possibility of rotation of the body around its longitudinal axis, and, wherein, when the tool is assembled, the installation head is essentially accommodates a gear mechanism.
4. A surgical instrument according to claim 1 or 2, wherein the first and second retainer elements have a working relationship with the first and second buttons, respectively, wherein actuation of each of the buttons configured with the ability� counter the biasing of the locking element, corresponding to the button, and move the element out of engagement with the corresponding hole of the external terminal.
5. A surgical instrument according to claim 1 or 2, further comprising instrumental end nozzle on a distal portion of the outer rod and inner rod.
6. A surgical instrument according to claim 5, in which the nozzle on the outer rod is removable.
7. A surgical instrument according to claim 1 or 2, further comprising a first button that is directly mechanically connected with the first fixing element and configured so that actuation of the first button counteracts the biasing of the first locking element and move the element out of engagement with the first hole of the external terminal.
8. A surgical instrument according to claim 7, further comprising a second button that is directly mechanically connected with the second fixing element and configured so that actuation of the second button counteracts the biasing of the second fixing element and moves it out of engagement with the second hole of the external terminal.
9. A surgical instrument according to claim 1 or 2, wherein the proximal end of the inner rod has an outer diameter larger than the diameter of the greater part of the length of the internal stem.
10. A surgical instrument according to claim 1 or 2, in which the second� element arm includes a hole, made with the possibility of capture and fixation of a proximal end of the inner rod.
11. A surgical instrument according to claim 1 or 2, in which
the inner rod further comprises a proximal opening of the inner rod, which is capable of combining with the specified at least one of the external holes of the rod and fit at least one of the first and second locking elements, whilst ensuring the possibility of longitudinal movement of the inner rod relative to the outer rod when the arm is powered by the rotation of one of the arm elements relative to another element of the handle; and
the inner rod further comprises a distal connection to an external terminal, is arranged to grip the inner rod with an external terminal, when the inner hole of the rod during rotation combined with at least one of the apertures of the outer rod.
12. Handle for a laparoscopic surgical instrument, wherein the handle contains:
the first element of the handle;
the second element of the handle, a swivel connected to the first arm element, made with the possibility of relative rotation of the first element of the arm in one plane; and
the gear mechanism adapted to provide releasable connection with a computer�tion between the first arm element and the housing of the rod, wherein the gear mechanism includes:
channel to accommodate the housing, configured to accommodate longitudinal proximal end of the housing of the rod;
the first locking element permanently connected with the possibility of actuation, with the first arm element and preloaded to continue, at least partially, into the channel to accommodate the housing;
the second locking element is permanently connected with the possibility of actuation, with the first element of the handle at least partially opposite to the first fixing element and preloaded to continue, at least partially, into the channel to accommodate the housing;
thus the second element of the handle contains a hole made with the possibility of capture and fixation of a proximal end of the drive rod.
13. Handle according to claim 12, in which the first element arm comprises a mounting head, made with the possibility of rotation about the element around the longitudinal axis of the channel to accommodate the housing.
14. Handle according to claim 13, in which the gear mechanism is contained in the installation head.
15. Handle according to claim 12, further comprising an internal drive rod detachably connected at the proximal end of the rod to the second arm element.
16. Handle according to claim 15, in which the distal end of the drive storestarget surgical tool tip.
17. Handle according to claim 16, further comprising an external terminal, detachably connected at the proximal end of the rod to the first arm element.
18. Handle according to claim 17, in which the distal end of the outer rod detachably connected to a tool tip.
19. Handle according to claim 17, in which the distal end of the outer rod is permanently connected to the tool tip.
20. A surgical instrument, comprising:
housing, continuing distally from the handle and containing:
a tubular outer rod detachably connected with the handle;
domestic stock, continued on longitudinal lumen of the outer rod and detachably connected to the handle in a manner that allows reciprocating longitudinal movement relative to the outer rod; and
the gear mechanism that is arranged to provide a releasable connection between the handle and the housing containing:
at least the first hole of the external terminal and the second hole of the outer rod, which at least partially opposite to each other and arranged through the proximal region of the outer rod;
the first locking element permanently connected with the possibility of actuation of a handle and preloaded in releasable engagement with the specified, at �'ere, the first hole of the external terminal; and
the second locking element is permanently connected with the possibility of actuation of the handle at least partially opposite to the first fixing element and preloaded in releasable engagement with the specified at least the second hole of the external terminal.
SUBSTANCE: left total nephrectomy is performed. A kidney is approached by forming an oval window into a mesocolon of a descending colon. The window area is limited by: v. mesenterica inf, arcus Riolani, a. colicae sin and a tail of pancreas. A ligament of Treitz, a peritoneum and mesocolon tissues are incised. A free oval area of the mesocolon and peritoneum are left on the kidney. The kidney is evacuated through the mesocolon window. The mesocolon is left open. A strand of a greater omentum is placed into a retroperitoneal cavity formed after the kidney has been removed. In specific case, the kidney is mobilised together with an adrenal gland.
EFFECT: method enables optimising the surgical procedure by eliminating the stage of intestinal mobilisation, leads to the fastest postoperative intestinal functional recovery.
3 cl, 2 ex
SUBSTANCE: peritoneum and mesocolon tissues of a descending colon are incised above an involved region and above a vascular renal pedicle to perform a left partial nephrectomy. Through the local mesocolon incision above the vessels, a renal artery is filopressed and compressed for thermal ischemia. A new growth is incised and evacuated through the mesocolon incision made above the involved region of the kidney.
EFFECT: method provides the ergonomic approach through a minimum thickness of the mesocolon tissues, minimises the risk of intestinal and splenic injuries and development of complications, ensures the fast postoperative intestinal functional recovery.
2 cl, 2 ex
SUBSTANCE: planned skin incision is first configured on an anteriolateral neck surface by projection zoning of a clavisternomastoid and a neck median line to be marked with colour graphic lines. A first line extends along a medial border of the clavisternomastoid. A second line extends from a suprasternal notch to the middle of a hyoid shaft. Both of the lines are then combined by drawing a perpendicular third line from a lower border of the middle of a hyoid shaft to the medial border of the clavisternomastoid, thereby forming a projection triangle. Cutaneofascial layers, platysma and subcutaneous fat are incised along the first and third lines to cut out a musculocutaneous flap, which is brought outwards. Underlying soft tissues are dissected to an anterior surface of cervical spinal bodies by splitting subcutaneous fat between a neurovascular bundle and a pharynx, detaching an intracervical fascia, splitting perioesophageal subcutaneous fat and displacing midline organs of the neck in the medial direction, and the neurovascular bundle - in the lateral direction.
EFFECT: method enables reducing a risk of treatment-induced traumatic injuries of the midline organs of the neck, an upper laryngeal nerve, upper and lower thyroid arteries, as well as a parenchyma and an excretory duct of a submandibular salivary gland with optimising topographo-anatomical relations of the incision wound structures, thus providing a surgical angle approaching 90 degrees.
SUBSTANCE: muscle of the neophallus is mobilised. A corset is formed intra-operatively according to the diameter and length of a mobilised muscle from a mesh with non-absorbable polypropylene 0.5-0.6 mm thick monofilaments, with the porosity of 85-90%, with run-proof edges in case of resection. The muscle is circularly wrapped up with the formed corset.
EFFECT: provision of the sufficient rigidity of the neophallus and elimination of its deformation due to the application of the corset, formed from the mesh with non-absorbable polypropylene monofilaments.
SUBSTANCE: invention relates to medical equipment, namely to sealing device for reparation of heart defect and vessel diseases in the process of performing surgical operations for treating such diseases as patent foramen ovale (PFO) or heart stunt, vascular system diseases, etc. Sealing device contain stretchable frame ad sealing element. Frame contains multitude of wires, each of which passes from proximal end to distal end of frame. First and second segments from multitude of wires form wound proximal loop and distal loop respectively. Multitude of wires form proximal disc and distal disc when sealing devise is extended. Proximal disc and distal disc are located between proximal and distal loops. Each wire from multitude of wires forms respective petal of proximal disc and respective petal of distal disc. Respective petals form zones of overlapping and unsupported sections. Sealing element, at least, partially encapsulates extending wire frame.
EFFECT: invention has improved compatibility with heart anatomy, it is easier to extend, reposition and return into initial condition in the place of opening.
25 cl, 16 dwg
SUBSTANCE: invention refers to medicine, namely surgery, and can be used for treating aseptic pancreonecrosis. Intra-organic pulseless pancreatic segments are localised and removed. To cover the pancreas, a greater omentum is incised into two portions - 1/3 from the left and 2/3 from the right up to a base of the greater omentum. Segments with pulse oscillation amplitude not less than 3.0 mm in the left 1/3 of the greater omentum and not less than 2.0 mm in the right 2/3 of the greater omentum are localised. The left portion in the distal segment is anchored with U-sutures to peripancreatic subcutaneous fat, whereas the right portion in the distal segment is anchored to a right hepatic lobe.
EFFECT: method enables arresting the disease progression and preventing infected pancreatic necrosis, improving pancreatic tissue blood supply by detecting the intra-organic pulse, removing all necrotic portions of the pancreas and using the greater omentum to cover the pancreas.
3 dwg, 2 ex
SUBSTANCE: distal pancreas resection is performed. That involves transecting a parenchyma to the right from a superior mesenteric vein. That is followed by a resection of an anterior surface of the pseudocysts of the head of pancreas. A Roux pancreatocystojejunoanastomosis with isolated enteric loop is created.
EFFECT: reduced intraoperative injuries and risk of postoperative complications, lower extent of the operation, preserved portion of the pancreatic parenchyma and physiological passage of food and bile in the gastrointestinal tract by the distal pancreas resection and created pancreatocystojejunoanastomosis with the cyst walls and the anterior surface of the head of pancreas.
SUBSTANCE: invention refers to systems for applying a filling material onto a working surface and can be used for applying a multicomponent compound, such as a surgical filling material for a tissue mass. A mixture feed device comprises a Luer mandrel sub-assembly, a cannula and a nozzle atomiser sub-assembly. The Luer mandrel sub-assembly is formed to contact at least two containers and forms the first and second fluid pipes of the mandrel for facilitating the flow of the first and second components. The cannula comprises the first and second cavities carrying the fluid. Each cavity is fluid connected to one of the first or second fluid pipes of the mandrel. The nozzle atomiser sub-assembly is arranged at the end of the cannula and involves at least a part of a nozzle insert placed into a nozzle cap. The nozzle cap has an end wall with an outlet therein. The nozzle insert and nozzle cap form at least three feed channels and are configured to limit at least three fluid passages in three respective feed channels. Each of the three feed channels is fluid connected to the fluid passage.
EFFECT: more effective mixing of the components, prevented cross-contamination of the components and facilitated fluid feed.
12 cl, 25 dwg
SUBSTANCE: invention refers to traumatology and orthopaedics and is applicable for joint drainage in revision endoprosthesis replacement. A drain tube is inserted into a wound with implanting a bone cement spacer containing an antibiotic. Within the first 24-48 postoperative hours, the fluid content is actively gradually evacuated from the postoperative wound every hour for 10-15 minutes.
EFFECT: method enables increasing the antibacterial effect.
SUBSTANCE: invention refers to medicine, namely to otorhinolaryngology, and can be used in myringoplasty, for repairing partially lost anatomic structures, such as tympanic membrane. The surgery is performed with local or general anaesthesia. A tympanic membrane defect is closed with a thinned prepared alloplant in the form of an allogeneic cartilage plate. Before implanting, the alloplant is fragmented up to 0.2-0.3 mm thick and 0.8-0.9 cm in diameter that is followed by placing the plate into a bottle with a fixing fluid. The final stage of the operation involves placing the alloplant on the edges of the tympanic membrane defect. The cartilage plate is supposed to be more by 1.0-1.5 mm in size with the plate edges to be ovelapped with the acoustic meatus skin. The acoustic meatus is packed.
EFFECT: method provides the reliable fixation of the alloplant, preventing its postoperative dislocation and retraction, audiological characteristics of the alloplant as close to the characteristics of the normal tympanic membrane as possible, the absence of implant rejection and pronounced immune response, proteolytic enzyme stability, necessary rigidity of the cartilage plate, reduced length of the intervention, the absence of a cosmetic auricle defect.
SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.
EFFECT: enhanced effectiveness of treatment in healing pyo-inflammation foci.
5 cl, 1 dwg
SUBSTANCE: method involves carrying out left-side laparophrenotomy. Esophagus and stomach stump extirpation is carried out. Large intestine is conducted in the posterior mediastinum. Distal end-to-end anastomosis of transplant and the duodenum is created using atraumatic sutures.
EFFECT: enhanced effectiveness of plastic repair in the cases of resected stomach cancer.
SUBSTANCE: method involves carrying out hernia removal in intralaminar way. Posterior longitudinal ligament defect is covered with Tacho-Comb plate after having done disk cavity curettage. Subcutaneous fat fragment on feeding pedicle is brought to dorsal surface of radix and dural sac.
EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications.
FIELD: medical engineering.
SUBSTANCE: device has thread knitted into fabric. Fabric for tamponing wound and removing it by pulling the thread is connected to internal film surface with collagen gel. The film overlaps fabric area and has opening equal to two-lumen draining tube canal connected to external film surface and having one canal longer than the other one. Distal end of the shorter canal is connected to opening in the film and distal end of the longer one is brought outside of its boundary. Proximal ends are connectable to vacuum receiver. Fabric thread is brought to the shorter canal from the internal wall and fixed on the external shorter canal wall.
EFFECT: reliability in stopping hemorrhages and retaining patient mobility.
SUBSTANCE: method involves applying sling urethropexy. Pneumoextraperitoneum is created by means of trocar introduced under the pubis. Then, longitudinal perineotomy and paraurethral tissue dissection is carried out to the right and to the left towards the descending branches of pubic bones to pelvic fascia. The urethra is moved to its left. TVT needle is introduced under descending branch of pubic bone to the right of the urethra. The pelvic fascia is perforated in away that needle tip enters retropubic space laterally with respect to the prostate and in front of the urinary bladder. The needle is brought along the posterior pubic bone surface and exits via abdominal wall outside pulling one end of polypropylene ribbon. The like manipulations are accomplished at the left side to form a loop around the urethra tightly adjacent to bulbocavernous muscles. Final ribbon fixation is carried out after having eliminated the pneumoextraperitoneum and having removed the trocar.
EFFECT: simplified operation; avoided intra- and postoperative complications and recidivation.
SUBSTANCE: method involves evaginating duodenum stump with polypotomy loop into organ wall followed by electric surgical excision.
EFFECT: stable hemostasis; provided aseptic conditions in sealing the stump.
3 dwg 1 tbl
SUBSTANCE: method involves carrying out rein performing pancreaticoduodenal resection. Cholecystoenteroanastomosis is built. Anastomosis application takes place between the right hepatic duct and gallbladder neck near its flexure.
EFFECT: prevented biliary hypertension.
FIELD: medicine, surgery.
SUBSTANCE: one should perform incisions of parietal peritoneum by leaving 2 cm against inferior and superior edges of patient's pancreas being of 1.5 cm length to apply them in checkered order for the purpose to prevent vascular lesion.
EFFECT: higher efficiency of decompression.
FIELD: medicine, surgery.
SUBSTANCE: the method is applied for the purpose to correct combined deformations of external nose due to oral-vestibular operative access. The method deals with dissecting mucosal membrane and periosteum in oral vestibule followed by separating soft tissues of the upper lip. Then one should perform internal incision along the edge of alar cartilages to connect two incisions together. Then comes final tissue separation at subsequent correction of the shape, size of external nose structures and its septum. The method enables to achieve wide access to all the structures of external nose and provide optimal cosmetic result.
EFFECT: higher efficiency of correction.
FIELD: medicine, urology.
SUBSTANCE: the present innovation deals with affecting the sclera and applying deformation-correcting sutures at the background of medicinal erection. Along lateral surfaces of cavernous bodies symmetrically from both sides one should make incisions of scleral surface layer. Then comes manual derotation, moreover, at the side of derotation incision's lower edge should be shifted downwards and backwards, its upper edge - upwards and to the front, and at contralateral side the lower edge is shifted downwards and to the front, and the upper edge - upwards and backwards. After manual penile derotation one should apply sutures onto the edges of dissected scleral layer in incision area by shifting needle's puncture out towards the side being opposite to shift direction of the lower edge against incision's perpendicular axis. The quantity of incisions should be calculated by the following formula: Q = N/n, where Q - the desired quantity of incisions, N - the angle of total initial rotation, n - the angle of derotation achieved after applying sutures onto the first pair of incisions. The method enables to decrease the risk for development of either new or residual penile deformation in postoperational period.
EFFECT: higher efficiency of correction.
3 dwg, 1 ex