RU2701770C1 - Method for formation of extracorporeal tightening surgical node in laparoscopic surgical interventions - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery, and can be used to form an extracorporeal tightening surgical assembly in laparoscopic surgical interventions. Driven end of monofilament thread is placed on top of fixed end, then bypassed by them fixed end behind and below and inserted into stitch ring, after which driven end is located from below fixed end, enveloping it from behind and from above and also introducing into the stitch ring, thus making two turns and alternating their directions, thereby forming differently directed ligature contours of the assembly, then, by suture of fixed end of thread, formed unit is lowered through laparoscopic port into abdominal cavity and tightened around ligated or sutured tissues, then to prevent loosening of formed ligature contours, additional intracorporeal assembly is applied.

EFFECT: method provides reliable ligation and connectivity of tissues, reduced time of manipulation.

1 cl, 3 dwg

Description

The invention relates to medical equipment, namely, to the technique of manual connection and ligation of tissues in laparoscopic surgery.

There is a known technique of atraumatic knotting used in endoscopic surgery, when the ligating thread is stretched counter-laterally until about 1-2 cm is left, after which the needle holder is rotated clockwise, winding the long end of the thread twice, and then capture the free end of the thread. The long end of the thread is pulled in the opposite direction to the needle holder, thereby forming the first double surgical unit; turn the needle holder in the opposite direction (counterclockwise), rewind the thread on it, grab the free end of the thread again with the needle holder and tighten the knot (Zoltan J. Operational technique and conditions for optimal wound healing, Budapest, 1983, p. 48). However, intracorporeal tying of a double surgical site with laparoscopy is difficult due to the limited mobility of the instruments within the abdominal cavity.

Closest to the proposed extracorporeal lingering surgical unit adapted to laparoscopy is the Roeder extracorporeal unit. For its formation, a ligature of 70-90 cm in length is needed, one end of it is lowered through the trocar with a clamp into the abdominal cavity, carried around the ligated tissue (or stitched) and removed again. As a result, outside, in the hands of the surgeon, there are two threads - the leading and the driven, between them to prevent gas leakage (the threads block the automatic valve), the assistant’s finger is placed on the sleeve rubber. One thread in the process of tying the knot is stationary, and the other is rotated around the first, while the knot is formed on top of the finger, the excess of the lower end is cut off and the knot is brought down into the abdominal cavity along the upper end. To do this, use either a disposable plastic or metal pusher. Then the loop is completely tightened and the end of the thread is cut (Endoscopic Surgery. Publishing House GEOTAR. Medical Series High Technologies in Medicine, Moscow, 1998. IV Fedorov, EI Sigal, VV Odintsov BC Editor-in-Chief Saveliev, p. 71.)

The disadvantage of this surgical node Roeder is the low reliability, allowing the possibility of its weakening. In addition, when applying it, additional tools and the help of an assistant are required, which does not help to reduce the time spent on laparoscopic manipulation.

The technical task is to develop a method of forming an extracorporeal protracted surgical site using a monofilament filament, characterized by ease of formation and not requiring additional devices and tools when it is applied, as well as providing reliable ligation and tissue connection.

The technical problem is achieved by the fact that in the method of forming an extracorporeal protracted surgical site during laparoscopic surgical interventions, which involves the use of a thread, one end of which is lowered into the abdominal cavity, carried around ligated tissues or sutured tissue to be sewn, after which the end of the thread is again removed outside, while one of its ends remains stationary during the formation of the knot, while the other, driven end, is rotated around the fixed, forming a knot, the driven end of the monofilament filament They place it on top of the fixed end, then circle the fixed end around it at the back and bottom and enter into the stitch ring, after which the driven end is placed at the bottom of the fixed end, circle it at the back and top and also enter the stitch ring, thus making two turns and, alternating their directions, thereby forming multidirectional ligature contours of the knot, then, by pulling the fixed end of the thread, the formed knot is lowered through the laparoscopic port into the abdominal cavity and the knot is tightened around the ligated or stitched tissues. To prevent the weakening of the formed ligature contours impose an additional intracorporal node.

The technical result consists in the fact that the absence of the need to use additional tools, the assistance of an assistant in the formation of this node speeds up the execution and increases the safety of laparoscopic surgery, reduces its complexity and cost.

In FIG. 1 is a diagram of the formation of two multidirectional contours of an extracorporeal protracted surgical site; in FIG. 2 is a diagram illustrating the reduction of an extracorporeal protracted surgical site into the abdominal cavity; in FIG. 3 is a diagram of a knot tightening around ligated or stitched fabrics.

The method is as follows.

A ligature is needed - a thread from a surgical suture material monofilament. The end 1 of the suture (Fig. 1) is lowered through the laparoscopic port into the abdominal cavity, carried around the ligated tissue, or the connected tissues are stitched, and then removed to the outside. In the initial position in the hands of the surgeon are two ends of the thread 1 and 2. End 1 during the formation of the extracorporeal surgical unit remains stationary, and the other end 2, driven, rotates around the fixed end 1, forming a node. The turns are formed as follows. The driven end 2 is placed on top of the fixed end 1, then the end 2 is encircled by the end 1 from the back and bottom and introduced into the stitch ring. Then, the driven end 2 is placed at the bottom of the fixed end 1, circled it at the rear and at the top, and also inserted into the stitch ring. Thus, two turns are made, alternating their directions, thereby forming multidirectional contours of the node. Subsequently, by pulling the fixed end 1 of the thread, the formed extracorporeal tightening knot is lowered through the laparoscopic port 3 (Fig. 2) into the abdominal cavity and a reliable tightening of the knot around the ligated or stitched tissues is achieved (Fig. 3). To prevent the weakening of the formed ligature contours impose an additional intracorporal node (not shown in the figure).

The proposed method for the formation of extracorporeal protracted surgical site during laparoscopic surgical interventions has the following advantages over the above analogues. Due to the fact that one end of the monofilament yarn during the formation and lowering of the node remains stationary and in constant tension, the possibility of weakening the node in the process of its formation is excluded. The use of monofilament yarn provides ease of sliding of the knot during its lowering and tightening, which prevents the possible risk of trauma and rupture of ligated tissues by eliminating the voltage surge on the fabric when tightening the knot with its fixed end. The prolonged fixation of closed multidirectional ligature circuits creates sufficient rigidity and elasticity over the entire area of the node and prevents the weakening of the node, ensuring its reliability. The absence of the need to use additional tools, the assistance of an assistant in the formation of this node speeds up the execution and increases the safety of laparoscopic surgery, reduces its complexity and cost. The proposed extracorporeal lingering surgical unit was used during 30 laparoscopic procedures for hiatal hernia, 12 laparoscopic procedures for inguinal hernias, 4 laparoscopic procedures on the common bile duct, 2 salpingectomies and proved to be simple and reliable. Not a single case of weakening and untying the knot was recorded.

Example: Patient K.P., 56 years old, 02/14/2017. Laparoscopic hernioplasty was performed for a hiatal hernia. Curararaphy was performed using the proposed extracorporeal site. 02.21.2017, the patient was discharged for outpatient observation in satisfactory condition.

Claims (1)

A method of forming an extracorporeal protracted surgical site during laparoscopic surgical interventions, which involves the use of a thread, one end of which is lowered into the abdominal cavity, carried around ligated tissues or sutured tissue to be sewn, after which the end of the thread is again pulled out, while one of its ends remains in the formation of the node fixed, and the other, driven end, rotate around the fixed, forming a node, characterized in that the driven end of the monofilament yarn is placed on top of of the moving end, then they circle the fixed end at the back and bottom and enter into the stitch ring, after which the driven end is placed at the bottom of the fixed end, circle it at the back and top and also enter the stitch ring, thus making two turns and alternating their directions, thereby forming multidirectional ligature contours of the knot, then by pulling the fixed end of the thread, the formed knot is lowered through the laparoscopic port into the abdominal cavity and the knot is tightened around the ligated or stitched tissues, then to prevent attenuation circuits formed ligature impose additional intracorporeal knot.

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