Method for short-scar incision of gall bladder and extrahepatic bile ducts. RU patent 2513800.
 Method of treating venous hypertension syndrome of upper limb and brain accompanying brachiocephalic vein occlusion associated with arteriovenous fistula / 2513475Neck is incised. Two incisions are made: one is 5 cm long on the side of an occluded brachiocephalic vein in an infraclavicular fossa 1 cm below a clavicle parallel therewith with a cephalic vein separated through 4-5 cm. The second incision is 4 cm long and extends on the neck on the opposite side along a front edge of a sternocleidomastoid muscle. An anterior jugular vein is separated from a jugular notch in the cranial direction through 4 cm. The anterior jugular vein is clamped within the jugular notch, and a longitudinal venotomy being 3 cm long is started 4 cm above. That is followed by creating an anastomosis of the anterior jugular vein with a funnel-shaped prosthesis cuff made of spiral-reinforced polytetrafluoroethylene. The prosthesis is placed top to bottom towards a lower edge of the wound; the prosthesis is brought subcutaneously using a short tunnelling device, arch-wise into the subclavicular wound. A cephalic vein is clamped within a subclavicular vein inflow, and a longitudinal cephalic venotomy 2-3 cm long extends 4 cm in the distal direction, and an anastomosis of the prosthesis and cerebral vein is created. |
 Method for introducing first trocar in laparoscopy in patients suffering degree iii-iv obesity / 2513137Invention refers to medicine, particularly to surgery, and can be used in diagnostic laparoscopy and laparoscopic surgery of the abdominal cavity in the patients with degree III-IV obesity. In corpulent patients suffering degree III-IV obesity, an abdominal wall thickness exceeds standard lengths of a Veress needle and first introduced trocar. Using the standard instrument kit for laparoscopic operations in the patients suffering degree III-IV obesity, the substance of the method consists as follows: a semilunar transverse incision 2-3 cm long is performed at 1-1.5 cm above a navel. Thereafter, the navel is separated from subcutaneous fat along the whole circular length. A navel base is taken with a holder brought as close as possible to a surface of a white line of the aponeurosis. The navel skin is gripped from both sides using clamps and simultaneously pulled upwards in the holder at an angle of 30-60° in relation of the belly surface towards the pubis and to the sides using clamps. The wound is widened with one or two hooks to tract them to the head and to the sides. An incision 0.5 cm long is performed along the while line to introduce the Veress needle 10 cm long for the eye insufflation to be then removed, and the first trocar 10 cm long being introduced. |
 Repair plate for posttraumatic defects and deformities of eye grounds / 2512785Invention refers to medicine and may be used for the repair of posttraumatic defects and deformities of eye grounds. The plate is made of a bioinert spatially cross-linked polymer mould when heated to temperature min. 70°C and prepared by photopolymerisation of methacryl oligomers. The plate comprises a flat perforated working section and fasteners; the plate thickness increases from a front end to a distal one, or the plate is V-sectioned. |
| Method for surgical management of liquorrhea nasalis / 2512782 Defect of an olfactory fissure is repaired from an endoscopic intracranial minimally invasive approach to the olfactory fissure that is provided by incising along a skin fold in a projection of an inferomedial frontal lobe depending on the patient's characteristics. The mucosa is removed from a frontal sinus through a frontal sinus orifice of an anterior wall. A fragment of a posterior wall of the frontal sinus in a paramedian direction in a basal frontal sinus to form a duplication. A dura mater is stripped from the olfactory fissure, and an autogenous bone is laid into a bone bed of the olfactory fissure shaped thereafter. The autogenous bone is covered with an Indost plate and the dura mater duplication separated earlier; the repair region is sealed with Tissucol-KIT fibrin two-pack glue that is followed by the plastic repair of the posterior and anterior walls of the frontal sinus. |
 Laparoscopic hernioplasty technique / 2512761Invention refers to medicine, specifically to inguinal hernia surgery. A pneumoperitoneum procedure is followed by an abdominal inspection. The abdominal cavity is punctured with an injection needle from a left or right iliac region. A needle tip is used to pierce a peritoneum from an internal ring, and the preparation Deflux is injected in an amount sufficient for an obturation of the internal ring. |
 Method for serial surgical management of extended and/or multifocal laryngostenosis and/or tracheal stenosis / 2511661Invention refers to medicine, specifically to surgery. Forming a laryngotracheostoma is followed by tracheal endoprosthesis replacement with a T-tube, excising a stenotic portion of the thoracic trachea, forming an intratracheal anastomosis, performing anaplerosis in a front wall of the larynx and/or trachea after a lumen has been formed, and the intratracheal anastomosis has been healed. If the stenosis persists, the T-tube is removed, the cervical and thoracic trachea is approached; cutaneous-subcutaneous flaps are mobilised within the preserved trachea; that is followed by a sleeve resection of the stenotic portion of the trachea; a partial intratracheal anastomosis is formed along posterior and lateral walls of the trachea, while the mobilised cutaneous-subcutaneous flaps is fixed to a free anterior wall of the resected trachea thereby repairing the tracheostoma/laryngostoma; and the T-tube is placed into the tracheal lumen through the formed tracheostoma. |
 Method for surgical correction of mammary glands in ptosis / 2511522Skin of the mammary glands are pre-marked. 10-15 Radiating circumferential lines 11.0-12.0 cm long are marked about a circular line surrounding an areola. The mammary gland is corrected using Silhouette Soft absorbable surgical sutures with fixing members in the form of elastic microcones and needles at the ends. A needle 18 G is formed in the centre of each line in the skin. A suture needle is introduced into the hypodermis layer, brought it to the circular line around the areola. Another suture needle is brought in the opposite direction to the end of the line. The sutures are brought out onto the skin and cut out from the suture. The sutures are tensed as tight as possible, and the in-between skin is collected to reach a distance between the points of suture output up to 6.0-8.0 cm. |
 Method of treating midthoracic esophageal diseases / 2511474Invention relates to surgery and may be applied for treating midthoracic esophageal diseases. Inferior and middle one-thirds of the oesophagus are resected with a one-piece gastroplasty. The gastric transplant is mobilised with preserving unconditionally a collateral region of the left gastro-omental, splenic and short gastric vessels that is ensured by transection of splenic arteries and veins with preserving their bifurcated joints, while the spleen is removed by transection of the vessels of the splenic hilum immediately in the pulp. |
 Method of endovideosurgical hemistrumectomy / 2511461Invention refers to medicine, namely to endocrine surgery, and may be used for the surgical management of the patients suffering a pathology localised in one lobe of a thyroid gland. The operation is performed from an endoscopic, axillary retroauricular approach. An endovideosurgical hemistrumectomy is performed by mobilising upper and lower poles of the lobe of the thyroid gland to be removed. A lateral surface of the thyroid gland, a parathyroid gland and a recurrent laryngeal nerve are visualised. The parathyroid gland and the recurrent laryngeal nerve is separated from the thyroid gland posteriorly and laterally. An isthmus of the thyroid gland is separated and transected. |
| Method for laparoscopic drainage of residual abscess cavity in localised and combined appendicular peritonitis in children / 2511458 Invention relates to medicine, namely surgical management. What is involved is an optical controlled drainage with a double-lumen drain tube through an anterior abdominal wall puncture. The drain tube is placed into an abscess cavity using two endoscopic forceps. The drain tube is attached to a vacuum suction. At the completion of the surgical intervention, the drain tube position is adjusted while eliminating a pneumoperitoneum with underlying abdominal pressure reduction. An excessive length in the abdomen is eliminated by tightening an outer end of the drain tube. After the endoscopic instruments have been removed, the drain tube is fixed to the skin with a separate interrupted suture. The postoperative follow-up requires abdominal ultrasonography. The drain tube is removed if observing no free fluid and residual pus pockets in a projection of the drain tube. |
 Method for treating the cases of destructive pancreaticonecrosis aggravated with retroperitoneal space infection / 2243725Method 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. |
 Method for carrying out plastic repair of the esophagus / 2243726Method 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. |
 Method for preventing cicatricial commissure process development in epidural space after having removed intervertebral disk hernia at the lumbar level / 2243727Method 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. |
 Device (protector) for preventing, stopping and controlling hemorrhages in performing laparotomic operations / 2243728Device 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. |
| Method for treating the cases of male enuresis / 2243729 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. |
 Method for treating duodenum stump / 2243730Method involves evaginating duodenum stump with polypotomy loop into organ wall followed by electric surgical excision. |
| Method for carrying out biliary tracts reconstruction / 2243731 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. |
| Method for capsular pancreatic decompression / 2243732 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. |
 Method for correcting combined deformations of external nose due to oral-vestibular operative access / 2243733The 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. |
 Method for correcting rotating penile deformation / 2243734The 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. |
FIELD: medicine.
SUBSTANCE: skin and subcutaneous fat are incised longitudinally in a right hypochondrium 2-3 cm lower from an edge of a costal arch of the length up to 5 cm. An anterior leaf of an aponeurosis of an abdominal rectus muscle is incised longitudinally in compliance with the length of the skin incision. In an upper corner, the incision is extended to the right at an angle of 45 degrees, of the length up to 3 cm. In a lower corner of the wound, the incision of the leaf of the aponeurosis is similarly deflected to the left. Muscle fibres of the abdominal rectus muscle are bluntly layered, and a posterior leaf of the aoneurosis is exposed. The latter is gripped together with the peritoneum and dissected longitudinally up to 5 cm. The incision of the posterior leaf of the aponeurosis is formed similarly to the incision of the anterior leaf.
EFFECT: expansion of surgical manipulations on the gall bladder, hepatoduodenal elements, reduced intraoperative injuries and risk of developing postoperative hernias and other postoperative complications.
1 ex, 1 dwg
The invention relates to medicine, namely to abdominal surgery, and can be used in operations for cholelithiasis.
The known method of surgical access to the gall bladder and the common bile duct, which carry out layer-by-layer dissection of tissue of the anterior abdominal wall, the access is formed by successive dissection of the skin in parallel costal arch at the distance of 2-3 cm below its edges, starting 2-3 cm lies lateral middle line, 4-5 cm in length, front sheet of the vagina right rectus respectively the length and direction of the skin incision, longitudinal bundle of fibers right rectus and dissection of the rear sheet vagina right rectus and peritoneal respectively the incision of the skin (see RF patent №2309682, publ. 10.11.2007).
The obstacles to achieve listed below is a technical result, when using a known way, is the limited availability of cervix of the gall and the common bile duct, as the muscle fibers have longitudinal direction, to stratify them in the transverse direction is difficult, leading to injuries fibers right rectus and poor wound healing.
The closest technical solution in relation to the proposed combination of essential features is the way through a mini-approach at Prudkov M.I. (see Prudkov M.I. "Minilaparotomy and open laparoscopy in the treatment of patients with gallstone disease." Abstract of Dr. med. of Sciences. Moscow, 1993. S-16). This access is done in the following way: over the place projection hepatoduodenal ligament on the anterior abdominal wall is vertical transrectal incision in the abdominal wall with a length of up to 5 see Cut through the skin, subcutaneous tissue, front sheet aponeurosis. Muscle fibers right rectus stupidly rasslaivath along fibres and expose the rear sheet aponeurosis direct muscles. The last together with the peritoneum capture and dissect also in the vertical direction.
The obstacles to achieve the specified below technical result when using a known way, taken as a prototype, is the limited availability of cervix of the gall and the common bile duct.
The objective of the invention is a method through a mini-approach to the gall bladder and extrahepatic bile ducts providing technical result consists in expanding the volume of surgical manipulations on the gall bladder, the elements liver-duodenal sheaf, reducing trauma surgery, the risk of postoperative hernia and other postoperative complications.
This technical result is achieved that way through a mini-approach to the gall bladder and extrahepatic bile ducts includes the incision of the skin, subcutaneous tissue dissection of the anterior leaflet of the aponeurosis of the rectus abdominis muscle, blunt dissection of muscle fibres right rectus and exposure rear sheet aponeurosis direct muscles, which then with the peritoneum captured and dissected.
The peculiarity is that perform a skin incision in the right hypochondrium below the edge of a costal arch is 2-3 cm, lateral middle line 2-3 cm in length, up to 5 cm, at upper-right corner of the wound the cut of the anterior leaflet of the aponeurosis rejects the right at an angle of 45 degrees up to 3 cm, and in the bottom corner of the wound the cut of the anterior leaflet of the aponeurosis rejects the left at an angle of 45 degrees, up to 3 cm, similarly to form a section of the rear sheet aponeurosis direct muscles.
Essence the invention is illustrated by drawings, where 1 - costal arch; 2 - incision of the skin, subcutaneous tissue, front and rear leaf of the aponeurosis direct muscles; 3 - in upper right corner of the wound the cut aponeurosis denied the right at an angle of 45 degrees; 4 - in the bottom corner of the wound the cut aponeurosis rejected the left at an angle 45 degrees.
The method is as follows.
In the right hypochondrium cut through the skin, subcutaneous tissue (pos.2) below the edge of a costal arch 1 2-3 cm, lateral middle line 2-3 cm in length and 5 cm and the anterior leaflet of the aponeurosis of the rectus abdominis muscle (pos.2). In the upper corner of the wound the cut of the anterior leaflet of the aponeurosis rejects the right (3), at an angle of 45 degrees, up to 3 cm, and then in the bottom corner of the wound the cut of the anterior leaflet of the aponeurosis rejects the left (pos.4) at an angle of 45 degrees, up to 3, see Muscle fibers right rectus stupidly rasslaivath along fibres and expose the rear sheet aponeurosis direct muscles. Rear sheet aponeurosis direct muscles together with the peritoneum capture and dissect (pos.2), then in the upper right corner of the wound the cut back of sheet aponeurosis rejects the right (3), at an angle of 45 degrees up to 3, see Then in the bottom right corner of the wound the cut back of sheet aponeurosis rejects the left (pos.4) at an angle of 45 degrees, up to 3 see All this provides adequate availability of cervix of the gallbladder and extrahepatic bile ducts.
Clinical example.
The patient K., 74 years old, was admitted to the 6th Department of surgery of the MUSES UGKBSIEP, Ulyanovsk 12.06.2012 was diagnosed with Gallstones. Acute destructive cholecystitis.
When entering the patient's state of medium gravity. Integuments usual color. In pulmonary respiration vesicular. A/D 150/90 mm Hg muffled heart sounds, rhythmic. Stomach : no swelling, mild, painful to palpation in the right hypochondrium, where is palpated increased, intense, painful gallbladder.
When ultrasound gallbladder increased 11 x 3.5 cm, the walls were thickened up to 7 mm, in the lumen of the three large stone. Pathology of the liver, the pancreas is not revealed. Diameter choledochus 7 mm Held preoperative preparation. 12.06.2012, the patient urgently operated.
Is made the incision of the skin, subcutaneous tissue below the edge of a costal arch 2 cm, lateral middle line 2 cm, a length of 4 cm and cut front sheet aponeurosis direct muscle stomach and then in the upper right corner of the wound the cut of the anterior leaflet of the aponeurosis denied the right at an angle of 45 degrees, with a length of 2.5 cm, then in the bottom right corner of the wound the cut of the anterior leaflet of the aponeurosis rejected the left at an angle of 45 degrees, length 2,5 see Muscle fibers right rectus he was stratified along fibres and exposed rear sheet aponeurosis direct muscles. Rear sheet aponeurosis together with the peritoneum captured and dissected accordingly to the length of the incision of the skin, then in the upper right corner of the wound the cut back of sheet aponeurosis rejected right at an angle of 45 degrees, length 2,5 cm, and in the bottom corner of the wound - section rear sheet aponeurosis rejected the left at an angle of 45 degrees, length 2,5 see Made cholecystectomy from the cervix. When the control ultrasound from 17.06.2012 in subhepatic space and in the projection of the gallbladder bed no free liquid. The postoperative period without features. Sutures are removed on day 7. Healing by primary intention. Histology: acute phlegmonously cholecystitis.
Discharged in satisfactory condition on the 8-th day after operation. Surveyed in six months. Had no complaints, diet is trying to pursue, the result of the operation is assessed as good.
Thus, the proposed method allows to ensure an adequate volume of surgical manipulations on the gall bladder, the elements liver-duodenal sheaf, reduces the trauma surgery, the risk of postoperative hernia and other postoperative complications and improves the processes of healing of postoperative wounds.
Way through a mini-approach to the gall bladder and extrahepatic bile ducts, including the incision of the skin, subcutaneous tissue dissection of the anterior leaflet of the aponeurosis of the rectus abdominis muscle, blunt dissection of muscle fibres right rectus and exposure rear sheet aponeurosis direct muscles, which then with the peritoneum capture and dissect notable the skin incision is carried out in the right hypochondrium below the edge of a costal arch is 2-3 cm, lateral middle line 2-3 cm in length, up to 5 cm in the upper right corner of the wound the cut of the anterior leaflet of the aponeurosis rejects the right at an angle of 45 degrees up to 3 cm, and in the bottom corner of the wound the cut front sheet aponeurosis rejects the left at an angle of 45 degrees, up to 3 cm, then similarly to form a section of the rear sheet aponeurosis direct muscles.