Device for endosurgery the suturing perforated gastroduodenal ulcers
The invention relates to the field of medicine and medical equipment and can be used in laparoscopic surgery for suturing a perforation of gastroduodenal ulcers. The device includes a housing with a handle, inside which is placed a rod, with the possibility of axial movement when pressed on removable thrust plate. The ability to return to its original position provides a spring. The working end of the rod is made in the form of a springy semicircular needle with an eye at one end, a fixed guiding groove of the working end of the housing. The bend radius of the needle is equal to the radius of the guide groove. The depth extension of the needle is determined by the limiter, fixed on the rod locking screw. The device has a label on the desktop end. The device is sealed, gasketed, from materials capable of withstanding sterilization processing. The result is a simple and reliable device for suturing perforated gastroduodenal ulcers endosurgical way. The device allows you to efficiently and quickly perform operations not only highly skilled surgeons, but young doctors, which bear the main burden for performing emergency and neotlojnyh technology and can be used in laparoscopic surgery for suturing a perforation of gastroduodenal ulcers.A known device for endosurgery the suturing perforating ulcer is a laparoscopic needle holder with a rounded atraumatic needle, which are separately inserted into the abdominal cavity through the trocars. Vcol needles produce, departing 0.5 to 1 cm from the edge of the hole, and Vical directly at the edge. Next make WCOL the opposite edge of the hole, and Vical also at the distance of 0.5-1 cm from the edge (L. C. Potashov in. A. Vasiliev, V. M. the problem and other Techniques of laparoscopic suturing perforating pyloroplasty ulcers. Bulletin of the surgery. I. I. Grekova, volume 158, 5, 1999, S. 62-64). The main difficulty of this manipulation is necessary, the correct performance semicircular needle on the selected path and requires a lot of practical skill of the surgeon. Each vCal and Vicol by repeated catching needle needle holder. These reasons make the process of suturing technically complex, laborious and lengthy, especially for "difficult" locations ulcers. These shortcomings are recognized by most authors (B. K. of Sourcelen, A., Krieger, K. E., Riebel. Laparoscopic surgery in the treatment of perforated gastroduodenal ulcers. Bulletin of the surgery. I. I. Grekova, volume 158, 3, 1999, ists of the anterior abdominal wall (Patent of the Russian Federation 2124315 C1, CL MKI 6 And 61 In 17/00, 17/04) containing a working part of the handle tube and mounted inside the tube the rod. The terminal has the possibility of axial movement and placed on the working end of the loop, her vengeance upon exit from the working end of the tube. The working part of the device is made in the form of a puncture needle with bevel cut at the end.However, the known device cannot be used for endosurgery suturing for perforating a hole in the wall of a hollow organ, as neither the design of the working part or nominated from the instrument loop does not allow flashing, at which the needle, followed by the thread, move along a given trajectory, describing a semicircle. To this end, the device is equipped with a guiding groove, and the needle is made of springy steel that allows it to be straight, while inside the unit, and as extensions take the form of a semi-circle with the specified radius. In addition, the device has a mechanism for limiting the maximum extension of the needle, and a sealing cuff for work in conditions of pneumoperitoneum.The objective of the invention is to provide a simple and reliable device for suturing perforating gastrodon the highly skilled surgeons, but young doctors, which bear the main burden for performing emergency operations. Difficulties during the operation related to the technique of suturing on the perforative hole, as a rule, are the most formidable (A. G. Krieger, K. E., Riebel. The risk of errors and complications in laparoscopic suturing perforated gastroduodenal ulcers. Endoscopic surgery, 3, 1999, S. 7-10).The essence of the invention lies in the fact that the device for endosurgery the suturing of the perforation ulcers, comprising a housing with a handle, inside which is placed a rod, with the possibility of axial movement when pressed on removable thrust plate returned to its original position by the spring, equipped with a working part, made in the form of springy semicircular needle with an eye at one end, a fixed guiding groove of the working end of the body, with bending radius of the needle is equal to the radius of the guide groove, and the needle has a possibility of extension to a depth determined by the limiter, fixed on the rod locking screw and located inside the housing, closed removable locking cap with cuff.The device is airtight, once the working end.The use of the invention allows to obtain the following technical result.The process of suturing on the perforative hole becomes universal, strictly predictable in accordance with the parameters of the device, to a small extent dependent on the practical skills of the surgeon that provides fewer complications, reduces the duration and cost of treatment.In Fig. 1 shows a device, General view, longitudinal section, Fig. 2 - the device is in working condition.The device consists of a housing 1, with the label 2 on the desktop end, provided with a handle 3, inside there is a channel 4 holds a movable rod 5, the working end is made in the form of a semi-circular spring needle 6 with the lug on the end 7. On the end part of the rod is provided with a thrust plate 8. The depth extension of the needle is determined by the stopper 9, which is fixed on the rod 5 locking screw 10, and the direction of extension sets the guide groove 11 located at the working end of the housing 1. The sealed enclosure is due to the locking of the cover 12, provided with a sealing cuff 13. Return movement of the moving rod 5 is carried by a spring 14. R-1 radiomarelli ulcers with the help of the device is as follows.Before surgery is performed sterilization processing device, after which the Assembly; to this end, the working end of the housing in the channel 4 forward end portion is inserted movable rod 5, with a semi-circular spring needle 6 is straightened, the rod is fixed limiter 9 using a locking screw 10. The casing is locked by the lid 12, is supplied to create the tightness of the cuff 13. On the protruding part of the rod 5 is mounted a return spring 14, and the thrust plate 8 is secured to the face end of the rod 5.In the eye 7 of the needle 6 is charged thread, about the middle of its length.The unit is ready for operation.The operation was performed under General anesthesia in the patient with a raised head end. After imposition of pneumoperitoneum and conduct of diagnostic laparoscopy in abdominal cavity is entered three manipulation of the trocar, one located above the perforating a hole through it into the abdominal cavity is entered the device, the working end of which is installed in the perforative hole against one of its edges so that the label 2 on the body 1 is situated above the longitudinal axis of the body. Clicking on uporno the inside to the outside in a predetermined direction in accordance with the radius of the needle at the required distance from the edge of the ulcer 0,7 see The free end of the held thread is fixed one of the manipulators. After you pressed on the bearing plate 8, the rod 5 is returned to its original position under the influence of spring 14. Is the rotation of the tool 180oand pressing on the bearing plate 8 is flashing the opposite edges of the ulcer also from the inside out. The free end of the thread is extracted from the needle 6, which returns to its original position inside the housing 1, and the tool is removed from the trocar for re-charging thread. Depending on the operating situation overlaps one or more seams.
Claims1. Device for endosurgery the suturing of the perforation ulcers comprising a housing with a handle, inside which is placed a rod, with the possibility of axial movement when pressed on removable thrust plate returned to its original position by a spring, characterized in that the working end of the rod is made in the form of a springy semicircular needle with an eye at one end, a fixed guiding groove of the working end of the body, with bending radius of the needle is equal to the radius of the guide groove, and the needle has a possibility of extension at depth of the bit locking cap with cuff.2. The device under item 1, characterized in that the pressurized, collapsible, made of materials capable of withstanding sterilization processing.3. The device under item 1, characterized in that the housing has a label on the desktop end.
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