The mechanical fixation of the implant when assisted surgery inguinal hernioplasty

 

The invention relates to laparoscopic surgery. Through micro incisions on the abdominal wall in places the projection of the implant from outside to inside the abdominal cavity impose furrier needle with thread. The thread is carried out through the thickness of the abdominal wall and the implant under the control of the laparoscope and leave it there, and bring the needle out. Through the same skin incision, but with a slight indent in the side of the first vcol, needle again similarly injected intraabdominally. Crochet needle capture loop introduced earlier thread and output. Produce a routine digital formation of knots on a thread that is when tightening plunge through the subcutaneous fat to the level of aponeurosis. As a result, the invention reduces the complexity and the complexity of forming andosov, reduce the time of surgical intervention and the cost of consumables. 1 C.p. f-crystals, 2 Il.

The invention relates to medicine, namely to laparoscopic surgery.

There are several options for fixation of mesh implants in the groin assisted surgery the hernioplasty. Most commonly used hardware overlay method bracket or spiral titanium retainers, Aya mechanical fixation of the suture material with the formation of intracorporeal knots (Endoscopic surgery. Fedorov, I. C., Segal E. I., Odintsov Century Century Series: high technology in medicine. M: GEOTAR Medicine, 1998 . 72-73).

The disadvantages are the counterpart: 1) the complexity of the manipulations on the formation andosov inside the abdominal cavity; 2) the long duration of the operation in connection with the complexity of technology strengthening of the implant; 3) the high cost of tools and material for fixing garnished.

An object of the invention is to reduce the complexity of manipulation, reduction of time required for the formation of the site, reducing the cost of fixing materials in laparoscopic inguinal hernioplasty.

The goal of the project is achieved by the fact that the primary fixation of the implant is performed using end-to-end furrier seams.

In Fig. 1 shows a diagram of the intra-abdominal location of the implant and the fixation of its furrier needle through percutaneous sutures.

1. The abdominal wall.

2. The laparoscope.

3. Furrier needle.

4. The implant.

5. Loop the thread.

In Fig.2 shows the stages of fixation of the implant in the projection of the hernial defect.

1. The introduction of the thread into the abdominal cavity.

2. The capture thread furrier hook needle.

3. Final appearance.

The proposed method of mechanical fixing bark micro incisions of the skin with a length of 1.5-2 mm. Through micro incisions from outside to inside the abdominal cavity impose furrier needle with thread. The thread is carried out through the thickness of the abdominal wall and the implant under the control of the laparoscope inside the abdominal cavity and leave it there. Then bring the needle out. Next, through the same skin incision, but with a slight indent in the side of the first vcol, needle again spend intraabdominal through the thickness of the anterior abdominal wall and the implant. Crochet needle capture loop introduced earlier thread and make it extraabdominal. Produce a routine digital formation of knots on a thread that is when tightening plunge through the subcutaneous fat to the level of aponeurosis. The free ends of the threads are cut below skin level, they are hiding in the subcutaneous fat. Formed knot securely locks the edge of the implant to the anterior abdominal wall. Similarly carry out the fixation of two free edges of the implant, excluding the inner bottom corner of the implant, which is projected onto the pubic bone and percutaneous fixation of which is difficult.

Reliable fixation is confirmed experimentally. On 10 unfixed cadavers after hernioplasty studied the mobility of the implant and investigated tear effort in Evoy. The minimum value of tear efforts in fixing points accounted for 61.6 N, maximum - 80,5 N, the mean - 74,000,67 (N=60). When comparing data obtained tear efforts with research data given in the work of C. I. Emelyanov et al. (2000), it was noted that the proposed method is superior in reliability fixation.

This invention allows to obtain the following technical result.

1. Greatly simplified technique of fixation of the implant.

2. Reduces the duration of the operation.

3. Reduces the need to use garnishable and expensive suture materials when performing laparoscopic inguinal hernioplasty.

The present invention is used in the clinical Department of General and Faculty surgery, Veliky Novgorod since 1998. 5 surgeries with fixation of the implant percutaneous sutures. Used needle for suturing trocar wounds (a utility model Certificate 22745, Bago S. Century).

Technical difficulties and discomfort were noted. The minimum operation time was 20 min, and the maximum is 43 minutes Average time operations - 36,71,56 minutes of Intra - and postoperative, ocrotiti supplies and time to surgical intervention in high efficiency and reliability of the method.

Claims

1. The mechanical fixation of the implant when assisted surgery inguinal hernioplasty carried out with the help of sutures, characterized in that the fixation of the implant is performed using end-to-end furrier seams, and on the anterior abdominal wall in places of projection angles laid implant make micro incisions of the skin with a length of 1.5-2 mm, through which the needle thread, the thread is carried out through the abdominal wall and the implant is under the control of the laparoscope inside the abdominal cavity and left, bring the needle out through the same skin incision is indented in the direction from the first input again spend intraabdominal through the anterior abdominal wall and the implant, then crochet needle capture loop, make it extraabdominal and produce digital formation of knots on a thread that is when tightening plunge through nadkarni fatty tissue to the level of aponeurosis.

2. The method according to p. 1, characterized in that it is carried out by using a furrier needle.

 

Same patents:

The invention relates to medicine, namely to surgical treatment of injuries of the liver and spleen
The invention relates to medicine, particularly surgery, may be used for suturing wounds laparostomy
The invention relates to medicine, namely to surgery, and can be applied to optimize knitting surgical site

The invention relates to medical equipment, namely to devices for suturing, and can be used for sutures on the urethra at the stage of forming vesicourethral anastomosis when potadromous prostatectomy, radical prostatectomy or cystectomy or at the stage of ureteroureterostomy operation Koltsova

The invention relates to laparoscopic surgery

The invention relates to medicine, in particular for medical technology
The invention relates to medicine, namely to surgery, and may be applicable for knitting triple knot and trimming the excess ends of the hub ligatures
The invention relates to medicine, namely to surgery and can be applied to optimize knitting simple site

FIELD: medical engineering.

SUBSTANCE: device has elongated body having operation end engageable with ligature loop, lateral slit for ligature to exit and movable rod, mounted in the device body, having operation end for holding the ligature. The elongated body has special purpose design to match endosurgical port or trocar lumen. The rod is spring-loaded and has nonworking end projecting from the device body as handle. The rod operation end is hook arranged in front of the lateral slit for ligature to exit and making displacement at a distance minimum equal to distance from operation body end to end face of slit for ligature to exit, oriented towards the handle.

EFFECT: improved tissue and organ engagement conditions; simplified maintenance procedure; accelerated operation process.

3 cl, 2 dwg

FIELD: medical engineering.

SUBSTANCE: method involves mounting implant on supporting platform. The platform is turned and moved about and along its longitudinal axis to enable one to arrange needle in any given position on implant surface. The needle is controllable in a way that the first thread is brought through the implant wall from the first side of the wall. The first loop is formed from the first loop on the second implant wall. The thread is brought through the loop. The loop is tightened to produce a stitch. The stage the thread is passed through the loop is carried out by means of device movable back and forth along longitudinal implant axis. The device additionally has at least one driving mechanism for turning and moving transplant platform about and along its longitudinal axis to enable one to arrange needle in any given position on implant surface and additional driving mechanism for passing thread through the loop back and forth along longitudinal implant axis. Main device head piece is movable into any required position as a result of implant-carrying cylinder rotation or axial displacement on implant surface.

EFFECT: wide range of functional applications; enabled fitting of anatomical tubes of different diameters in several points arranged on an axis.

11 cl, 7 dwg

FIELD: medical engineering.

SUBSTANCE: device has handle having reel inside and casing having end for capturing needle. The handle has transverse reels and is connected to the hollow casing. Longitudinal bed bearing manipulation plate having lock and manipulation hook. The manipulation plate becomes a rod in its frontal part. Adaptation spring and eccentric pressed cone are put-on over the rod. The cone serves for fixing needle and reaches casing rest member. The rod comes in into opening of the rest member being convex ahead of it. Transverse concave groove is available near the rest member base for receiving curved surgical needle. The eccentric pressed cone base and the adaptation spring are covered with stabilizing buckle. Holes for passing thread ends are available above the buckle. Members for fixing ends of threads, coming from the reels placed in the handles, are arranged near the holes.

EFFECT: accelerated suturing process; retained suture material sterility; reduced thread consumption.

4 cl, 4 dwg

FIELD: medicine, abdominal surgery.

SUBSTANCE: one should perform marginal serous-muscular-submucous suturing for every wall of intestinal wound in oblique direction against cross-sectional intestinal axis being parallel to lateral branches of intraparietal intestinal vessels at an angle being opened towards mesenteric edge. Puncturing in and puncturing out of stitches at the serous membrane of every further suture should be performed being on the same line with puncturing in and puncturing out of stitches at the border of submucous and mucous layers of previous suture. Sutures should be tightened at forming the knots at serous membrane. The innovation suggested enables to decrease the frequency in developing failed sutures.

EFFECT: higher efficiency.

1 dwg

FIELD: general surgery methods and facilities.

SUBSTANCE: material for various genesis, localization, and configuration defect grafting is made from thin (up to 100 mcm in diameter) titanium nickelid wire weaved into porous-permeable structure according to knitted-fabric and textile technology or by felting. Thanks to plasticity of titanium nickelid and quasiplasticity of woven structure, effective plasticity of material is many times superior to that in nonwoven porous sheet materials and meets requirements of congruent disposition of materials in organs and tissues to be operated.

EFFECT: increased plasticity of grafting material.

7 dwg

FIELD: medicine, surgery.

SUBSTANCE: one should apply a P-shaped suture, then it is necessary to form a V-shaped suture: one of the free ends of a ligature should be applied under the one that forms the top of letter P, then this ligature should be tightened and thrown over the wound as a Latin letter V. Then free ends of ligature should be tightened into the knot. The method enables to improve hemostasis and increase reliability of sutures.

EFFECT: higher efficiency.

3 dwg, 1 ex

FIELD: medicine; traumatic surgery; orthopedics; neuron-surgery.

SUBSTANCE: device can also be used in rehabilitation surgery for curing nerve pipes. Extension has drive mechanism and traction unit, both disposed inside cylindrical case onto vertical axis. Case and cap have cylindrical shape. Drive mechanism is made in form of spring-loaded unit which has crown-shaped ring with beveled teeth and double-teeth pusher with single-sided beveled teeth connected by compression-torsion spring. Drive mechanism is installed of form of horizontal protrusions inside guides onto internal surface of case to provide movement of rest pins along circle onto horizontal arms of which pins it is placed. Under pressure applied to cap of case, reciprocal motion of cap transforms to interrupted rotational motion of coil in cheek of which coil the rest pins are fixed. Coil has flexible link fastened onto hub. Free end of flexible link is drawn outside through the hole in wall of case. Coil and hub compose traction unit being rigidly connected with axis of the extension. Lugs provided with holes are made in bottom of case.

EFFECT: reduced traumatism of surgical operation; better results of cure.

4 dwg

FIELD: medicine; medical engineering.

SUBSTANCE: method involves implanting a ribbon into the body on each side of the urethra between the vaginal wall and abdominal wall. The ribbon is drawn above the pubic bone. The ribbon is introduced on both sides of the urethra to make a loop around the urethra. It is arranged on each side of the urethra between the vaginal wall and abdominal wall and stretched by pulling its ends brought outside of the abdominal wall. The ribbon is introduced pulling it inside through two holes produced in soft tissues with needle-shaped member using tubular envelope prefitted on the needle-shaped member. The tubular envelope is left in the hole when pulling the needle-shaped member from the hole in the direction reversed with respect to PIERCE direction. Ribbon is pulled into the hole in the introduced tubular envelope drawing the corresponding end. Then the tubular envelope is removed from the body in the direction of ribbon end. Surgical instrument has implantable ribbon and rod having handle on the first end with curved needle-shaped member on the second end and through hole on the free end with an ear which sizes are enough for passing from the internal surface of the vagina wall above the posterior back side of the pubic bone to the external surface of the abdominal wall. The instrument additionally has removable tubular envelope which dimensions allow the ribbon under implantation, moving through the hole. The removable tubular envelope is fittable over curved needle-shaped member as far as possible from the rod side to the prominent free end of the curved needle-shaped member projecting from the tubular envelope.

EFFECT: enhanced effectiveness of treatment; reduced instrument production costs; simplified design.

23 cl, 8 dwg

FIELD: medicine, surgery.

SUBSTANCE: one should apply a single-row uninterrupted suture upon skin and subcutaneous fiber, fix ligature in subcutaneous fiber in one of the wound's corners, apply a subcutaneous-intracutaneous suture up to the wound's opposite corner, form a knot in subcutaneous fiber with the help of terminal ligature of aponeurosis suture. The method enables to prevent purulent complications and provide the development of valuable cicatrix.

EFFECT: higher efficiency of suturing in post-operational wound.

1 dwg, 2 ex

FIELD: medicine, surgery.

SUBSTANCE: one should dissect epidermis up to derma along pre-set lines, perform deepidermization of the stripe of 55 mm width from the side of removed skin section, dissect derma as it is along stripe's edge and then - fatty fiber, apply subcutaneous buried interrupted sutures onto deepidermized stripe of derma by the following technique: perform puncture in into deepidermized skin stripe of one of the edges of skin wound from the side of subcutaneous fiber followed by puncture out at the distance of 1 mm against the edge of dissected epidermis. At another edge of skin wound one should make puncture in with a needle into deepidermized skin stripe at the distance of 1 mm against the edge of dissected epidermis and puncture out from the side of subcutaneous fiber. Then one should apply removable intracutaneous suture. The innovation enables to increase quality of derma healing.

EFFECT: decreased risk for skin deformation.

2 dwg, 1 ex

Up!